States Inch Towards Comprehensive Sex Ed

Kay Steiger

Across the country, in states red and blue, legislatures are taking steps toward mandating comprehensive, medically-accurate sexuality education for students.

In states across the
country this spring, the mounting evidence condemning abstinence-only programming
that reveal it is ineffective
and half
of states rejecting federal funding for it
— is having an effect on legislatures. Some states
are introducing bills that would compel schools to teach comprehensive sex
education, and many are stipulating that curricula be "medically
accurate." While some of the states are the usual blue state suspects, including
Hawaii, New York, Minnesota, and Oregon, others are more surprising: the Indiana,
Texas, North Carolina, Florida, and Utah legislatures have all introduced bills
that are taking a big step toward teaching comprehensive, medically accurate
sex education in schools. About 19 states total have introduced such

The momentum has been building for a long time. Measures to require more
comprehensive sexuality education began appearing 15 years ago. Teen pregnancy
rates are once
again on the rise
after dropping
during the 1990s. The Centers for Disease Control reports that one in four teenage girls has a sexually
transmitted infection. Even Bristol Palin, daughter of the conservative darling
Alaska Gov. Sarah Palin, said that abstinence wasn’t a "realistic" expectation. States are beginning to realize that abstinence-only programs
aren’t working for students. Such proposed legislation comes on the heels of changes to California’s sex education
and adoption of a
comprehensive sex education program in the District of Columbia
, both of which passed last year.

"It seems that right now is a really good time for states to try to make
sure that students are getting the most they can out of sex education,"
said Elizabeth Nash, public policy associate at Guttmacher Institute. The
reason it’s a good time, besides the increased number of social progressives in
state legislatures, is that, of those state legislatures that meet every year, odd
years are those when state legislature focus on non-budget-related bills
(legislatures tend to work on two-year state budgets during even-numbered
years).  Several states are trying to use
that window of opportunity to  create a
comprehensive sex ed strategy in schools.

Nash noted that Utah is an interesting example. Technically, Utah already has a
definition of sex education on the books — but that definition is damaging.
The law currently
that sex education
that is taught in Utah schools "…shall stress…the importance of
abstinence from all sexual activity before marriage and fidelity after marriage
as methods for preventing certain communicable diseases." It even goes
farther, forbidding the "advocacy or encouragement of the use of contraceptive
methods or device." The bill proposed in Utah would require the state to not only
teach sex ed in a comprehensive way, including contraception as means of
preventing the spread of infection and preventing pregnancy, but also be
"medically accurate." The term, which is defined in about half of the
states that uses it in laws, usually has language along the lines of
"verified or supported by research conducted in compliance with scientific
methods and published in peer-reviewed journals, where appropriate, and
recognized as accurate and objective by professional organizations and agencies
with expertise in the relevant field, including the federal Centers for Disease
Control and Prevention and the American College of Obstetricians and
Gynecologists." Unfortunately, the clause of the Utah legislation that
would have pushed public schools to provide comprehensive and medically
accurate information to students in the state was struck last Friday, essentially
killing the bill. The measure would have overturned Utah’s current damaging

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North Carolina’s proposed
, called the
"Healthy Youth Act" is a slightly compromised step forward. While the
legislation would require the state to teach comprehensive sex education
classes, it would also allow parents to "opt out" by signing a form.
The students whose parents have opted out of the comprehensive sex ed class can
be placed in an abstinence-only class. This may be while the legislation in
North Carolina is gaining traction in a more socially conservative state.
Still, "I think it’s going to have a real fight on its hands," Nash

Advocates for Youth, a pro-sex ed youth organization, held a lobby
in North Carolina
earlier this month that more than 200 teens attended. "There are
definitely a lot of young people on the ground who are talking to principals,
who are talking to school boards, who are talking to their governors, to their
state legislators, to their federal representatives about sex education,"
said Meghan Rapp, state strategies program manager at Advocates for Youth.
"There’s a shift going on in that people are waking up after almost a

Rapp noted that one Pittsburgh teenager, Madeline Chandler, began working as an
activist to start conversations with her principal and school board to push for
comprehensive sex education. In a blog
, Chandler wrote,
"I was treated with wonderful respect. Nobody yelled at me or called me
inappropriate names. Many adults and teachers even walked up to me, thanking me
for being at the meeting. … A few days later, I was on Facebook when my dad
sent me a link. The board had passed the new policy. Students will now be
learning from a comprehensive sex education curriculum." Thanks to the
work of young activists like Chandler, teens can get the education that most
benefits them.

Even if a state were to pass legislation that would require medically accurate
comprehensive sex education, the policy takes time to implement. "A lot of
times it is working with the state board or the state entity that supervises
education, usually the department of education or the superintendent of
education, or like in California’s case, the school board association. But then
it’s also working school board by school board, which is really challenging and
is actually one of the big challenges we’re facing right now, is
implementation," Rapp said.

Of the states that have introduced legislation, the ones that look most
promising to actually pass it are Oregon and Hawaii. Oregon already has
comprehensive sex ed requirements, but this law would just codify them. Hawaii
has already passed the bill through the state senate and under consideration by
House committees, Nash says.

Even if legislation is only introduced and won’t pass in red states like Utah,
it’s important that states are beginning to beginning to open up the discussion
about what kind of sex education is best for the students. Unless Congress
passes the REAL Act, states are left to decide to choose a path of abstinence-only
programming or to do the best they can to distribute accurate information about
the best ways to prevent pregnancy and the spread of HIV and other infections "Even
though a lot of young people, especially high school students can’t vote, they
have a really powerful voice and they’re the ones that are actually being
affected by this," Rapp said.

News Sexual Health

State with Nation’s Highest Chlamydia Rate Enacts New Restrictions on Sex Ed

Nicole Knight Shine

By requiring sexual education instructors to be certified teachers, the Alaska legislature is targeting Planned Parenthood, which is the largest nonprofit provider of such educational services in the state.

Alaska is imposing a new hurdle on comprehensive sexual health education with a law restricting schools to only hiring certificated school teachers to teach or supervise sex ed classes.

The broad and controversial education bill, HB 156, became law Thursday night without the signature of Gov. Bill Walker, a former Republican who switched his party affiliation to Independent in 2014. HB 156 requires school boards to vet and approve sex ed materials and instructors, making sex ed the “most scrutinized subject in the state,” according to reproductive health advocates.

Republicans hold large majorities in both chambers of Alaska’s legislature.

Championing the restrictions was state Sen. Mike Dunleavy (R-Wasilla), who called sexuality a “new concept” during a Senate Education Committee meeting in April. Dunleavy added the restrictions to HB 156 after the failure of an earlier measure that barred abortion providers—meaning Planned Parenthood—from teaching sex ed.

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Dunleavy has long targeted Planned Parenthood, the state’s largest nonprofit provider of sexual health education, calling its instruction “indoctrination.”

Meanwhile, advocates argue that evidence-based health education is sorely needed in a state that reported 787.5 cases of chlamydia per 100,000 people in 2014—the nation’s highest rate, according to the Centers for Disease Control and Prevention’s Surveillance Survey for that year.

Alaska’s teen pregnancy rate is higher than the national average.

The governor in a statement described his decision as a “very close call.”

“Given that this bill will have a broad and wide-ranging effect on education statewide, I have decided to allow HB 156 to become law without my signature,” Walker said.

Teachers, parents, and advocates had urged Walker to veto HB 156. Alaska’s 2016 Teacher of the Year, Amy Jo Meiners, took to Twitter following Walker’s announcement, writing, as reported by Juneau Empire, “This will cause such a burden on teachers [and] our partners in health education, including parents [and] health [professionals].”

An Anchorage parent and grandparent described her opposition to the bill in an op-ed, writing, “There is no doubt that HB 156 is designed to make it harder to access real sexual health education …. Although our state faces its largest budget crisis in history, certain members of the Legislature spent a lot of time worrying that teenagers are receiving information about their own bodies.”

Jessica Cler, Alaska public affairs manager with Planned Parenthood Votes Northwest and Hawaii, called Walker’s decision a “crushing blow for comprehensive and medically accurate sexual health education” in a statement.

She added that Walker’s “lack of action today has put the education of thousands of teens in Alaska at risk. This is designed to do one thing: Block students from accessing the sex education they need on safe sex and healthy relationships.”

The law follows the 2016 Legislative Round-up released this week by advocacy group Sexuality Information and Education Council of the United States. The report found that 63 percent of bills this year sought to improve sex ed, but more than a quarter undermined student rights or the quality of instruction by various means, including “promoting misinformation and an anti-abortion agenda.”

Commentary Sexual Health

Parents, Educators Can Support Pediatricians in Providing Comprehensive Sexuality Education

Nicole Cushman

While medical systems will need to evolve to address the challenges preventing pediatricians from sharing medically accurate and age-appropriate information about sexuality with their patients, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Last week, the American Academy of Pediatrics (AAP) released a clinical report outlining guidance for pediatricians on providing sexuality education to the children and adolescents in their care. As one of the most influential medical associations in the country, AAP brings, with this report, added weight to longstanding calls for comprehensive sex education.

The report offers guidance for clinicians on incorporating conversations about sexual and reproductive health into routine medical visits and summarizes the research supporting comprehensive sexuality education. It acknowledges the crucial role pediatricians play in supporting their patients’ healthy development, making them key stakeholders in the promotion of young people’s sexual health. Ultimately, the report could bolster efforts by parents and educators to increase access to comprehensive sexuality education and better equip young people to grow into sexually healthy adults.

But, while the guidance provides persuasive, evidence-backed encouragement for pediatricians to speak with parents and children and normalize sexual development, the report does not acknowledge some of the practical challenges to implementing such recommendations—for pediatricians as well as parents and school staff. Articulating these real-world challenges (and strategies for overcoming them) is essential to ensuring the report does not wind up yet another publication collecting proverbial dust on bookshelves.

The AAP report does lay the groundwork for pediatricians to initiate conversations including medically accurate and age-appropriate information about sexuality, and there is plenty in the guidelines to be enthusiastic about. Specifically, the report acknowledges something sexuality educators have long known—that a simple anatomy lesson is not sufficient. According to the AAP, sexuality education should address interpersonal relationships, body image, sexual orientation, gender identity, and reproductive rights as part of a comprehensive conversation about sexual health.

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The report further acknowledges that young people with disabilities, chronic health conditions, and other special needs also need age- and developmentally appropriate sex education, and it suggests resources for providing care to LGBTQ young people. Importantly, the AAP rejects abstinence-only approaches as ineffective and endorses comprehensive sexuality education.

It is clear that such guidance is sorely needed. Previous studies have shown that pediatricians have not been successful at having conversations with their patients about sexuality. One study found that one in three adolescents did not receive any information about sexuality from their pediatrician during health maintenance visits, and those conversations that did occur lasted less than 40 seconds, on average. Another analysis showed that, among sexually experienced adolescents, only a quarter of girls and one-fifth of boys had received information from a health-care provider about sexually transmitted infections or HIV in the last year. 

There are a number of factors at play preventing pediatricians from having these conversations. Beyond parental pushback and anti-choice resistance to comprehensive sex education, which Martha Kempner has covered in depth for Rewire, doctor visits are often limited in time and are not usually scheduled to allow for the kind of discussion needed to build a doctor-patient relationship that would be conducive to providing sexuality education. Doctors also may not get needed in-depth training to initiate and sustain these important, ongoing conversations with patients and their families.

The report notes that children and adolescents prefer a pediatrician who is nonjudgmental and comfortable discussing sexuality, answering questions and addressing concerns, but these interpersonal skills must be developed and honed through clinical training and practice. In order to fully implement the AAP’s recommendations, medical school curricula and residency training programs would need to devote time to building new doctors’ comfort with issues surrounding sexuality, interpersonal skills for navigating tough conversations, and knowledge and skills necessary for providing LGBTQ-friendly care.

As AAP explains in the report, sex education should come from many sources—schools, communities, medical offices, and homes. It lays out what can be a powerful partnership between parents, doctors, and educators in providing the age-appropriate and truly comprehensive sexuality education that young people need and deserve. While medical systems will need to evolve to address the challenges outlined above, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Parents and Caregivers: 

  • When selecting a pediatrician for your child, ask potential doctors about their approach to sexuality education. Make sure your doctor knows that you want your child to receive comprehensive, medically accurate information about a range of issues pertaining to sexuality and sexual health.
  • Talk with your child at home about sex and sexuality. Before a doctor’s visit, help your child prepare by encouraging them to think about any questions they may have for the doctor about their body, sexual feelings, or personal safety. After the visit, check in with your child to make sure their questions were answered.
  • Find out how your child’s school approaches sexuality education. Make sure school administrators, teachers, and school board members know that you support age-appropriate, comprehensive sex education that will complement the information provided by you and your child’s pediatrician.

School Staff and Educators: 

  • Maintain a referral list of pediatricians for parents to consult. When screening doctors for inclusion on the list, ask them how they approach sexuality education with patients and their families.
  • Involve supportive pediatricians in sex education curriculum review committees. Medical professionals can provide important perspective on what constitutes medically accurate, age- and developmentally-appropriate content when selecting or adapting curriculum materials for sex education classes.
  • Adopt sex-education policies and curricula that are comprehensive and inclusive of all young people, regardless of sexual orientation or gender identity. Ensure that teachers receive the training and support they need to provide high-quality sex education to their students.

The AAP clinical report provides an important step toward ensuring that young people receive sexuality education that supports their healthy sexual development. If adopted widely by pediatricians—in partnership with parents and schools—the report’s recommendations could contribute to a sea change in providing young people with the care and support they need.