Sex Education in the U.S. 1
A Call for Improvement in U.S. Sexuality Education for Adolescents
CHHS 302 Section 2
Professor Natasha Oehlman
December 16, 2013
Sex Education in the U.S. 2
Abstinence-only sexuality education has been ineffective in reducing teen pregnancy
and sexually transmitted infections (STI) in the U.S., which has the highest
adolescent STI and pregnancy rates of most other developed nations.
It is clear that contraceptive use is a greater indicator for teen pregnancy rates than
sexual activity itself. The average age at which people first engage in sexual behavior
is the same in the U.S. as all other countries of the world, yet American teen
pregnancy is a prevailing issue. The United States approaches extramarital sexuality
from a well-intended moral standpoint: Its history describessexuality as a moral
issue and labelscontraception information "obscene."
In contrast with the moral approach of the U.S., the Netherlands, a developed
country with low teen pregnancy and STI rates, addresses teen sexual health and
safety by integrating sexual health topics into many other school subjects, as well as
answering theirstudents’ questions with truthful information.
Comprehensive sexuality education, or health instruction that includes pregnancy
prevention methods beyond abstinence, became increasingly common in the U.S.
between the 1970s—with the rise of STIs and AIDS—and1995, when the Adolescent
Family Life Act (AFL) was instated. The AFL, now called the Pregnancy Assistance
Fund under the Patient Protection and Affordable Care Act, provides support to
pregnant teens, but it also providesgrants to organizations that strictly adhere to an
While no studies show abstinence-only education to be effective, the American
Psychological Association, the majority of parents, teachers and students all express
a desire for more comprehensive sexuality education in schools. This report
advocates that the Pregnancy Assistance Fund be amended and used to create
incentive for teaching comprehensive sexuality education in schools.
Sex Education in the U.S. 3
Table of Contents
Overview of Sexuality Education in the U.S...............................................................4
The Root Causes of Poor Sexual Health Among Teens...........................................4
U.S. Approaches to Sex and Relationship Education................................................. ......5
The rise of comprehensive sexuality education..........................................................................7
Outcomes of Current Sexuality Education Policy............................................... .....8
How to Improve Teen Sexual Health through Policy..............................................9
Foreign Approaches to Sex and Relationship Education...............................................9
Improving Adolescent Sexual Health Through Policy...................................................10
A Final Summary and Call to Action............................................................................11
Sex Education in the U.S. 4
Overview of Sexuality Education in the U.S.
Education is paramount because it provides the foundation for individual and
community growth. However, one might be educated yet not have the necessary
knowledge or wisdom for preventing STI transmission and early, unintended
pregnancy. It is imperative to open political discussion regarding why the teen
pregnancy rates are so much higher in the United States than in many other
In the UnitedStates,a simple Internet search would reveal that age-appropriate
sexuality education is a constant, controversial issue debated thoroughly among
politicians, social scientists, psychologists, medical doctors, educators, sexual health
professionals, religious leaders, and parents.
There is no greater stakeholder, however, than the adolescent population, although
they are the least heard voices in public discussion on sexuality education.
Additionally, statistical research shows that the U.S. falls drastically behind many
other industrialized nations in teen pregnancy and STI transmission rates (World
The limits set in place for acceptable curricula in youth sexuality education
exemplify U.S. cultural attitudes toward sexuality, and show a need not only for
advocating new limits, but also for seeking out alternative ways to teach the next
generations to develop healthier relationships and sexual habits.
Inadequate sexuality education leads to substandard sexual health among teens,
butby taking queues from other nations, re-appropriating funds,and creating
incentives for comprehensive sexuality education, we can provide healthier
outcomes for our nation’s youth.
The Root Causes of Poor Sexual Health among Teens
One may ask what it means to be sexually healthy or unhealthy. An obvious reaction
to this question would be whether or not a person has a sexually transmitted
infection (STI/STD). In the case of teenagers, many would agree that pregnancy and
child rearing in U.S. culture could also be damaging to their emotional, mental, and
According to Steinberg (2005), “When faced with an immediate personal decision,
adolescents will rely less on intellectual capabilities and more on feelings.
Nevertheless, when reasoning about a hypothetical, moral dilemma, the adolescent
will rely more on logical information” (as cited in Casey, Jones & Hare, 2008,
conclusions, para. 6). In other words, teens can make rational decisions, but they are
still developing the aptitude for making optimal choices in the heat of a moment.
Still, Steinberg also showed that the emotional significance of a decision and its
environmental context are very influential to an adolescent (as cited in Casey et al.
Sex Education in the U.S. 5
2008), so there is hope if teens are taught to make at least some of their decisions in
advance and through building positive habits.
Bringing a baby into the world during this stage of life could only add to the stress of
developing into a well-adjusted adult. In the words of Wellings, Collumbien,
Slaymaker, Singh, Hodges, Patel, and Bajos (2006), "The ability of individuals or
couples to pursue a fulfilling and safe sex life is central to achievement of sexual
health” (p. 1706).Teen pregnancy and STI transmission are common indicators of
unsafe sexual activity, and based on these indicators, the sexual health of U.S.
teenagers is in jeopardy.
The critical issue is that the U.S. falls behind many other countries, especially
Western European and Scandinavian countries, in unintended teen pregnancy rates
as well as in STI screening and transmission (Darroch, Singh, and Frost, 2001).
According to the National Surveillance Data published by the CDC in 2008, “The
largest number of reported cases of both chlamydia and gonorrhea . . . was among
girls between 15 and 19 years of age” (p.1). Also, data from the World Bank (2009)
shows the U.S. to have a higher birth rate among teens age 15-19 than many other
developed countries, including Australia, Belgium, Canada, China, Denmark, Finland,
France, Germany, Greece, Hong Kong, Hungary, Iceland, Ireland, Israel, Italy, Japan,
North and South Korea, the Netherlands, New Zealand, Norway, Poland, Portugal,
Romania, Russia, Saudi Arabia, Singapore, Spain, Sweden, Switzerland, and the U.K.
Based on this concern, the high STI transmission and unintended pregnancy rates
among teens in the U.S. warrant examination of current sexuality education policies.
There is no doubt culture takes an important role in determining how sexual
wellness and relationship education is approached in any given country.
Regardless of who has attempted to address the reproductive health problems of
adolescents, all agree on the critical issues presented by the statistics. The point of
disagreement is primarily how to best resolve the issues. Some countries, such as
the Netherlands and France, look at teen sexuality realistically by acknowledging
not only that many teens are sexually active, but also that there is little variation in
age at first intercourse across the nations (Weaver et al., 2005). Weaver et al.
(2005) also suggested, “A deeply entrenched and ongoing tension exists between
those who accept or tolerate sex between young people and those who do not.” This
passage continues to say that while some people think the cause of poor sexual
health is primarily sexual activity itself among youth, others claim the cause is a lack
of education and guidance in making healthy sexual choices.
There are also those who believe that the root of the problem is pre-marital sex.
This belief takes a moral approach to the problem, posing that the correct response
is to encourage young people to abstain from sex until marriage (Weaver et al.,
2005). While abstinence is a well-intended approach, the conclusion from one study
published in 2001 indicated, “Data on contraceptive use are more important than
Sex Education in the U.S. 6
the data on sexual activity in explaining variation in levels of adolescent pregnancy
and childbearing among the five developed countries; however, the higher level of
multiple sexual partnership among American teenagers may help explain their
higher STD rates” (Darroch, Singh, and Frost, 2001, abstract). Although the origin of
these particular behaviors and attitudes toward multiple partnerships is unknown,
an examination of the origin of current U.S. sexuality education policies may prove
helpful in understanding the root causes of unhealthy sexual practices among teens.
U.S. Approaches to Sex and Relationship Education
Abstinence-only education.Although U.S. culture is an amalgamation of various
traditions and religious beliefs, the most influential value system stems from the
New England settlers, especially Puritans, Edwardsian Calvinists, and Revivalists. An
article in the journal William and Mary Quarterly cited two historians, Henry F. May
and Perry Miller, who described the religious history of America (Cohen, 1997).
Cohen explained the spread of Puritan concepts of sin and redemption to the South
and West from New England. He wrote, “By the Revolution, the New England mind
had become America’s (p. 696).” Among the New England settlers’ values was that
of abstinence from sex until marriage.
Pre-marital sex and extra-marital sex have been taboos consistent in many cultures
throughout the world, but the central beliefs of the New England Puritans were
based on the following Bible passage (Romans 13:12-14): “The night is far spent, the
day is at hand; not in carousing and drunkenness, not in debauchery and lust, not in
strife and jealousy. But put ye on the Lord Jesus Christ, and make no provision for
the flesh, to fulfill the lusts thereof (as cited in Campbell, 2010).” Essentially, all
sexual activity was considered shameful and sinful.
This Puritan worldview became so ingrained in American society that written
information regarding contraception was considered obscene material under the
Comstock Laws in the late 1800s (Comstock Act, 2012). Contraception was not
legalized for use by all citizens of the United States until 1976, when the Supreme
Court declared it unconstitutional to deny sales of contraceptives to people under
the age of 16 (“History and Successes,” 2012).
Abstinence was and continues to be considered the most moral and widely accepted
form of birth control in the United States.As stated by Santelli, Ott, Lyon, Rogers,
Summers, and Schleifer (2006), “There is broad support for abstinence as a
necessary and appropriate part of sexuality education. Controversy arises when
abstinence is provided to adolescents as a sole choice and where health information
on other choices is restricted or misrepresented.” Furthermore, they pointed out
the heavy influence of politicians in promoting abstinence-only education,
acknowledging that since 1996, the federal government has been funding
community-based programs that teach only abstinence and restrict other
information; grants are directly sent to the organizations running the programs,
thus bypassing the course of state approval (Santelli, et al. 2006).
Sex Education in the U.S. 7
Figure 1provides a basic depiction of the prevalence of sexuality education
programs that strongly support abstinence in the U.S., by region(see Appendix for
more detail). Despite the dominance of abstinence-stressed education, several
studies have shown the majority of parents, students, and teachers want a more
comprehensive version of sexuality
education to be taught in schools
The rise of comprehensive
widespread promotion of
comprehensive sexuality education
is not a recent occurrence in the
United States. According to the
Guttmacher Institute (2012),
Americans in the 1970s supported
sex education in schools due to the
alarming rise in teen pregnancies
and the influx of HIV/AIDS.
Currently, the majority of parents,
educators, and health professionals
all support comprehensive
sexuality education, while an
aggressive public minority and
many politicians push abstinenceonly education with the belief that
sex among adolescents is a moral
issue rather than a health issue
(Berne &Huberman, 1999; Santelli,
et al. 2006).
In the article written by Santelli, et
al. (2006), the authors discussed the sexual behaviors of youth as a health issue
according to proponents of comprehensive sexuality education. Because for these
proponents sexuality is a health issue, they do not believe it is ethical to withhold
information regarding personal health maintenance; to do so would cause harm.
Causing harm to others directly violates the common medical principle of nonmaleficence. Further, more studies have been done that validatecomprehensive
sexuality education as opposed to abstinence-only education. The opposing core
beliefs of sexuality as a health issue and sexuality as a moral issue polarize the
discussions regarding sex education without either position offering compromise
(Berne &Huberman, 1999).
Sex Education in the U.S. 8
Such controversy inhibits progression toward creating policies that would cause the
rates of U.S. teen pregnancy and STI transmission to decline to levels more
consistent with those of other developed countries, which take much different
approaches to ensuring the sexual health of their youth.
Outcomes of Current Sexuality Education Policy
There are two key determinants of inadequate sexuality education in the United
States: Pregnancy (along with childbirth and abortion), and STI transmission.
Figure 2 shows the U.S. has a significantly higher teen birth rate than several other
industrialized countries. Many young women who become pregnant outside of
marriage are ostracized from the conservative families in which they were raised,
leaving them without financial and familial support (Saewyc, 2003). These young
people are left with less access to proper health care and in turn, their babies may
*Compiled by Associated Press 2010
The debates regarding sexuality education have not only been based on health
indicators, but also based on the moral state of U.S. society. Many studies and
evaluations have been done on the different types of sexuality education programs
in the U.S. to determine their efficacy in delaying age of first intercourse and
reducing teen pregnancy.
Unlike many other developed countries, the United States has no federal
requirement for sexuality education, so it is left to each state to decide their own
Sex Education in the U.S. 9
policies regarding sexuality education. For example, Maine has completely refused
to accept any federal funding for abstinence-only programs. Although many
individual organizations have welcomed the federal incentive to teach abstinenceonly sexuality education, there is an overwhelming lack of evidence showing the
efficacy of such programs (Santelli, et al., 2006).
The other determinant of inadequate sexuality education is that the U.S. has seen a
rise in STI transmission. Conversely, the countries that take a more pragmatic and
sex-positive approach to sexuality education—acceptingadolescents as sexual
beings—demonstratemore widespread and correct use of contraceptive devices,
thus reducing the rate of unintended teen pregnancy and STI transmission (Byrne
&Huberman, 1999). Many young people who have chlamydia, gonorrhea, and HIV
are unaware of their infection due to lack of symptoms, and if left undetected and
untreated, chlamydia and gonorrhea can lead to pelvic inflammatory disease,
infertility, ectopic pregnancy, and in the case of HIV, death (CDC, 2008).
It would be valuable to the health of U.S. teens if the U.S. federal and state
governments consider and incorporate some of the examples other industrialized
countries have provided.
How to Improve Teen Sexual Health
Foreign Approaches to Sex and Relationship Education
While the United States has the highest teen pregnancy rate of all other developed
countries, Switzerland and Netherlands have the lowest and second lowest,
respectively (World Bank, 2009). The Netherlands has a method for sex education
that is different from many other countries. The Dutch treat sexuality as a matterof-fact, natural part of humanity. Weaver, et al. (2005) discussed the sex education
policies of the Netherlands as well as those of France and Australia. Since 1993,
schools in the Netherlands have been required to include sexuality education in
their curriculum, although no specific curriculum is enforced. Teachers are free to
incorporate the necessary topics into their other courses as they choose (p. 174).
The Dutch highly value education and believe it is important that students direct
class discussions through asking questions; the goal is more to talk about sexual
health rather than simply teach it, and all the teachers receive training in sexual
health (Byrne &Huberman, 1999).
The French, on the other hand, do mandate a national curriculum for sexuality
education for youth aged 13, believing that by this age, the information provided on
this topic is necessary for maintaining personal and public health, and parents are
not permitted to remove their teenagers from the sexuality education program
(Byrne &Huberman, 1999, p. 175).
In Australia, sexuality education has been a part of school policies in all the states
since the 1970s, although reforming how it was taught became apparent with the
Sex Education in the U.S. 10
influx of AIDS in the 1980s. Since then, Australia has developed national policy
guidelines for promoting adolescent sexual health through comprehensive sexuality
education (p. 176).
The United States can stand to learn from these other industrialized nations and
reform sexuality education.
Improving Adolescent Sexual Health through Policy
As stated in Weaver, Smith, and Kippax (2005), “Sex education policies are generally
considered ‘public policy.’” Thus, it is the politicians who have the most influence on
policies, and are provided with research and support from social media and a
variety of professional sources.
In 1981, Congress instated the Adolescent Family Life program (AFL) (Dailard,
2001, p. 9), which was a well-intended step toward caring for adolescent
reproductive health. This program helped fund organizations providing assistance
to pregnant adolescents in order to help them carry out healthy pregnancies and
births, and funding increased for AFL in 1996 with the new welfare reform (Dailard,
2001, p.9). The purpose of AFL is to prevent abortions by ameliorating some of the
negative consequences of having children at such a young age (Department of
Health and Human Services, 2012). These negative consequences may include
financial stress, lack of medical care and lack of familial support; the AFL provides
services to relieve some of these stresses and to ensure a healthier birth. The AFL,
now called the Pregnancy Assistance Fund under the Patient Protection and
Affordable Care Act of 2010, continues to provide assistance to pregnant teens in
order to minimize abortion rates and continues to focus sexuality education efforts
on the value of abstinence. A new policy is needed to ensure the sexual health and
safety of non-pregnant adolescents as well.
The most valuable step toward improving teen sexual health in the U.S. would be for
Congress to create a policy that acknowledges and addresses the reality of teen
sexual behavior. The reality is the following:
Teens have sex despite abstinence-only education
o Alabama and Mississippi have the highest teen pregnancy
rates, respectively, both of which stress abstinence in their
state sex education policies (Guttmacher Institute, 2012; Office
of Adolescent Health, 2013).
Teens have greater numbers of reported STI cases.
The Internet is a valuable resource for spreading health information among
teens (Web Watch: Update teen knowledge with Internet resources, 2005).
A policy is needed that would support programs that promote the delay of first
intercourse as well as provide the knowledge necessary for adolescents to make
healthier and wiser choices in their relationships and sexual behaviors. This is not
to say that abstinence and morals are useless when taught in schools, but that these
Sex Education in the U.S. 11
values should be taught as supplemental to the truth about sexual health and sexual
diversity, knowing that the United States is home to citizens from hundreds of
different cultural backgrounds, each with their own values and the innate human
desire to ensure the health of one’s offspring. As such, parents should be allowed to
opt out of a school-based sexuality education program, provided they agree to
review the school’s literature for any helpful information and they agree to discuss
sexuality-related topics of their choosing with their children.
An effective sex education policy should:
Encourage parent-child discussions on sexual health,
Stress a necessity for including rhetorically relevant sexual health topics,
Expand the website of the Office of Adolescent Health (a division of the
Department of Health and Human Services) to include sections aimed
specifically at educating schools, parents and/or teens on currentsexual
And provide a requirement that all state sexuality education policies be
regularly evaluated based on the efficacy of programs developed under these
Federal funds originally allocated to grants for abstinence-only education should be
re-appropriated for the most successful comprehensive sexuality education
programs in each state. This re-appropriation of funding would be more cost
efficient than the current policy, since using the grants as incentive to be more
successful in reducing teen pregnancies and STI transmission would create
competition among the programs within each state, and the number of programs
eligible to receive federal funding would be much fewer.
A Final Summary and Call to Action
It is clear there are stout core morals and values diffused into United States culture
since the time of early colonization. These mores do not have to conflict with an
agenda for creating a sexually healthier society. While there are many psychological
benefits for beginning one’s sexual experiences within a loving and committed
relationship, our government cannot ignore the negative health results caused by
withholding information vital for its young people to have the ability to make
conscientious and responsible choices within the context of sexual behavior.
Congress members, please create a policy that:
Addresses STI prevention and contraception, and recognizes that teens do
engage in sexual behaviors,
Provides information to parents about sexual health and sexual health
communication within the family.
Sex Education in the U.S. 12
Teaches youth how to have healthy relationships and make wise personal
decisions, and includes an emphasis on positive self-esteem.
This research is applicable to parents and their children, health educators, and
policy makers. Policies affect everyone within their jurisdiction, so it is the
responsibility of the legislators to keep the majority of their constituents’ best
interests in mind, while encouraging the constituent minority to pass cultural
wisdom regarding sexuality to their children. Regulations regarding education affect
a whole society and its future. Therefore, all policy makers and those impacted by
their decisions should care about research that could benefit the overall health of
society. Politicians and the communities they represent need to diligently work
together to create laws aimed at increasing the sexual health of their posterity, and
above all, to do no harm.
Sex Education in the U.S. 13
Berne, L., &Huberman, D. (1999). European approaches to adolescent sexual
behavior & responsibility: Executive summary & call to action. Washington,
DC: Advocates for Youth. Retrieved from
Boonstra, H.D. (2010). New Pregnancy Assistance Fund under health care reform:
An analysis. Guttmacher Policy Review 13(4), 11-14. Retrieved from
Casey, B.J., Jones, R.M. & Hare, T.A. (2008).The adolescent brain.Annals of the New
York Academy of Sciences, 1124, 111-126. Retrieved from
CDC (2008).Sexually transmitted diseases in the United States. Retrieved from
Campbell, D.M. (2010). Puritanism in New-England. Literary Movements.
Department of English, Washington State University. Retrieved from
Cohen, C. (1997). The post-Puritan paradigm of early American religious
history.The William and Mary Quarterly, 54(4), 695-722. Retrieved from
Comstock Act. (2012). In Encyclopedia Britannica. Retrieved from
Dailard, C. (2001). Sex education: Politicians, parents, teachers and teens. The
Guttmacher Report on Public Policy, 4(1), 9-12. Retrieved from
Darroch, J.E., Singh, S., & Frost, J.J. (2001). Differences in teenage pregnancy rates
among five developed countries: The roles of sexual activity and
contraceptive use. Family Planning Perspectives, 33(6), 244-250+281.
Department of Health and Human Services (2012). Justification of estimates for
appropriations committees – Fiscal year 2012, pages 123-124. Retrieved
Guttmacher Institute. (2012). Sex and HIV education.State Policies in
“History and Successes.” (2012). Planned Parenthood Federation of America, Inc.
Retrieved from http://www.plannedparenthood.org/about-us/who-weare/history-and-successes.htm#era
Kost, K., &Henshaw, S. (2013). U.S. Teenage Pregnancies, Births and Abortions,
2008: State Trends by Age, Race and Ethnicity. Retrieved from
Sex Education in the U.S. 14
Office of Adolescent Health (2013).National and State Facts.Department of Health
and Human Services. Available from
Saewyc, E.M. (2003). Influential life contexts and environments for out-of-home
pregnant adolescents.Journal of Holistic Nursing, 21(4), 343-367. Retrieved
Santelli, J., Ott, M.A., Lyon, M., Rogers, J., Summers, D., &Schleifer, R. (2006).
Abstinence and abstinence-only education: A review of U.S. policies and
programs. Journal of Adolescent Health 38(1), 72-81. Retrieved from
Weaver, H., Smith, G.,&Kippax, S. (2005). School-based sex education policies and
indicators of sexual health among young people: A comparison of the
Netherlands, France, Australia and the United States. Sex Education. 5(2),
Web Watch: Update teen knowledge with Internet resources. (2005, August 1).
Contraceptive Technology Update. Retrieved from
Wellings, K., Collumbien, M., Slaymaker, E., Singh, S., Hodges, Z., Patel, D., &Bajos, N.
(2006). Sexual behaviour in context: A global perspective. The Lancet,
368(9548), 1706-1728. Retrieved from
World Bank (2009).Adolescent fertility rate (Births per 1,000 women ages 15-19).
Sex Education in the U.S. 15
The following table is a breakdown of all U.S. states’ policy requirements for
sexuality education, taken from the Guttmacher Institute’s (2012), State Policies in
Brief, found at http://www.guttmacher.org/statecenter/spibs/spib_SE.pdf.
Content Requirements for Sex* and HIV Education
When Provided, Sex Education Must
Include Information on:
Include Life Skills for:
of Sex Only
Sex Education in the U.S. 16
*Sex education typically includes discussion of STIs
** Localities may omit state-required topics, but may not include material that “contradicts the required components.” Information on contraception may
only be provided with prior approval from the Department of Education.
State also prohibits teachers from responding to students’ spontaneous questions in ways that conflict with the law’s requirements.