Sexuality Education

There is little debate that the words sex and sexuality produce immediate attention. Researchers and teachers in this area have also come to employ the terms family life education, human growth and development, and human sexuality to describe instruction in human reproduction and sexuality (Roth 1993). The Sex Information and Education Council of the United States (SIECUS) recommends the term sexuality education (1992). This term refers to a comprehensive curriculum of instruction addressing not only sexual anatomy and physiology but also reproduction, contraception, sexually disseminated infections (SDIs), and related topics. Sexuality education is viewed by SIECUS as "a lifelong process of acquiring information and forming attitudes, beliefs, and values about identity, relationships, and intimacy." These programs commonly address issues of personality, value formation, decision-making, peer and social pressures, affection, intimacy, body image, gender roles, communication strategies, and various sexual behaviors (Haffner and de Mauro 1991).

There continues to be wide variation in results from various sexuality education interventions in the United States as well as in other countries (Dryfoos 1985; Ekstrand, Siegel, and Krasnovsky 1994). Some have had positive results on actual sexual behavior while others have failed to attain favorable outcomes (Kirby, Short, and Collins 1994). Because a clear means for designing or implementing preventive sexuality education programs has not emerged, researchers and teachers need to remain current on which approaches work best for which students under which circumstances.

Sexuality Education and Development Stages

For clarity, the developmental stages are classified into four very broad categories: younger children (five to seven), intermediate children (eight to ten), older children (eleven to twelve), and teenagers. Education regarding sexuality in children one to four years of age is not examined, since little data exists on sexuality during these ages (Borneman 1983). It is important to note, however, that these children do receive "education" in the form of modeling from their caregivers.

Younger children (five to seven). Children five to seven years of age do not see the distinction between causes and their effects. The process of thinking is centered around themselves, and they have difficulty seeing the perspectives of others (Piaget 1930; Werner 1948). From a sexual standpoint, young children at this stage generally have a clear sense of the basic anatomical distinctions between the sexes. There is typically modesty regarding public exposure of their bodies. Not surprisingly, parents and other adults exert a strong influence regarding issues such as nudity in the home (Masters, Johnson, and Kolodny 1992). At the same time, children have a natural curiosity about their bodies. Since the child considers the parent to be the main guide for appropriate behavior, it is critical that parents not overreact to catching the child in various sexual exploration games such as playing "doctor" or "house" with peers.

By the time the child enters first grade, the frequency of exploration games decreases, and exchange of sex information emerges in the form of sexual jokes, riddles, and rhymes (Borneman 1983). Children become fascinated with the new array of words that have sexual or forbidden connotations. Researchers have studied this phenomenon in children and have suggested that when information on sexuality is not clearly provided by adults (e.g. parents and teachers), sexual jokes become the primary source of such knowledge (Money 1980). Sexuality education at this level requires an emphasis on the importance of knowing and being comfortable with one's sexual self while simultaneously avoiding negative modeling. A sound educational foundation at this level can foster greater social and sexual maturity at later stages.

Intermediate children (eight to ten). During this period, thinking is characterized by the ability to differentiate between self and others, between internal and external bodily events, and by an ability to comprehend cause-and-effect relationships. Sexuality education at this age can illustrate causality and thus more complex information. At this stage, children become intrigued with reproductive mechanisms. The idea of hormones as crystal-like structures flowing through one's blood is not abstract or unbelievable at this stage. Sexuality programs during this period have a twofold purpose: (1) provision of relevant, as well as scientifically correct, knowledge and language usage; and (2) instruction that facilitates the child's ability to understand causation and thus help them act to prevent future problems.

The goal of preventive sexuality education at this stage is important in view of AIDS/HIV in the United States and in other countries, such as those in southern and central Africa. Various medical and scientific authorities agree that the most promising method for controlling this crisis is early preventive and developmentally appropriate sexuality education (Greenberg, Bruess, and Hafner 2000).

Older children (eleven to twelve). During this time children integrate internal and external phenomena into one system. Their level of cognitive sophistication is also more intricate. They can easily see how one factor (lack of knowledge) may interact or combine with another factor (lack of self-esteem) to produce risky sexual acts and teenage pregnancies. Such interactive relationships are crucial in sexuality education designed to foster self-protective thinking among students. In contrast to prior stages, however, the biological side of development now begins to play a major role. There is a strong sense of one's external appearance and how it may be perceived as significant by others. Most children experience puberty at this age. Sex hormones begin to increase in activity and stimulate bone growth. This "growth spurt" typically occurs two years earlier for females than males (on average, age twelve versus fourteen).

Sexuality education is of crucial importance during this time. For girls, there is a need to know about breast development (phelarche), appearance of pubic and axillary hair (pubarche, thelarche), and the onset of menstrual cycles (menarche). There is also a need to know about vaginal secretion changes that may occur (transudation) and, most importantly, that these body changes are part of normal sexual development. In boys, there is a need for information on genital growth and ejaculation. Although males do not have a direct counterpart to menarche in females, the first nocturnal ejaculation of a young boy can cause the same psychological concern. Boys, like girls, also need to know about the onset of pubic and facial hair and how it is a biologically normal process. A condition known as gynecomastia or breast enlargement occurs in many young males whose hormonal systems are still trying to find their balance. Boys need clear and compassionate information that assures them this condition is not life threatening or cancerous and that it typically disappears within a year or two without any harmful effects.

Physical changes are also part of sexual differentiation at this period of development. Young girls tend to be overly concerned with the shape, texture, and general aesthetic of their bodies as estrogen causes fat to accumulate under the skin to produce the classic female figure. Boys, conversely, are more fixated on height and muscle mass comparisons as testosterone production begins to influence muscles that eventually produce the male physique.

Teenagers. By the time young people reach fourteen or fifteen years of age, their biological development is established. Most pubertal changes have occurred, and most of their physical attributes are set. Still, the teen years are considered by most authorities in development to be the most stressful. Personal appearance and social popularity grow to be overwhelming forces in teens' daily life. Teenagers naturally make sexual behavior a part of attaining peer affirmation. A teen may be asked, dared, or even belittled into proving solidarity with the peer group by performing sexual acts (Lewis and Lewis 1984; Duryea 1994). Research studies have shown that teenagers consistently submit to these pressures even without any inducement from peers (Duryea 1991; Saarni 1989).

Sexuality education for teens must present material perceived as relevant to them, in a factual manner that avoids the appearance of preaching or admonishment. Teenagers at this level possess a strong sense of autonomy. They easily detect in adults, especially their teachers, hidden strategies designed to alter their behavior or thinking. Course material and exercises examining reproduction, contraception, and communication are among the more meaningful at this stage, but prevention of sexual assault and information on sexual varieties also generate interest among teenagers. At this age students require contemporary information and skills to form a thorough knowledge base from which to make complex and pressure-filled health-related decisions. Some research evidence suggests, however, that while sexuality programs do provide this information and these skills, they are not consistently decreasing risky sexual behavior (Frost and Forrest 1995; Kipke, Futterman, and Hein 1990).

Contexts and Types of Sexuality Education

Over the past twenty years sexuality education in the United States has experienced four distinct generations of school-based programs. In the first generation the focus was on providing students with knowledge of basic sexual anatomy and the risks and consequences of pregnancy. The context for such approaches was that information was the main objective and that students would apply it as needed. This approach was consistently criticized for not showing any linkage between increasing knowledge and reducing risky sexual behavior. The second generation of programs emphasized values, communication skills, and decision making in one's personal life. This approach was based on the assumption that such areas, if enhanced using sexuality education, would inevitably produce healthier young people. Many of these efforts were also criticized for not addressing a wider range of sexuality concepts (e.g. contraception options). Although students demonstrated enhanced communication and decision-making skills, there did not appear to be any relationship with decreased sexual risk especially with regard to actual sexual behavior. The third generation currently promotes "abstinence only" and in its most strict form omits examination of various contraceptive options. Its context is conservative and often grounded in religion. It proposes that offering students too many options about contraception—and thus "safer sex"—actually encourages risky sexual actions. Their critics argue that such a philosophy ignores the reality of adolescent sexuality: a large number of youth will engage in sex and that they need to do it safely (with effective and consistent contraception). The latest generation is referred to as comprehensive sexuality education which emphasizes abstinence as the best choice but also trains students in refusal skills, assertiveness, communication strategies, and related areas. These programs revolve around acknowledging and addressing all of the major factors seen by adolescents as both real and important. This approach incorporates information about contraceptive options and even where teens can get access to contraceptives in their schools and community. Unsurprisingly, their opponents are abstinence-only advocates who suggest that including how to purchase contraceptives in a school curriculum is not only immoral and irresponsible but illegal, since students—by law—should not be having sexual relations. Conversely, in most European countries, Australia, and Canada, there is no such debate. Instead, many countries prefer to treat contraceptive access as a normal part of adolescent social development.

Since the mid-1980s, one trend in preventive sexuality education in the United States has been peer-based programs. These curricula are jointly designed and taught by well-respected, older-age peers in collaboration with the teacher. The rationale for using peers to help conduct these programs is student desire for ownership of this instruction. Peer leaders also tend to increase the credibility by which such instruction is viewed by students. Increased credibility is linked to greater student interest and ultimately to more meaningful learning. Such curricula are helpful to teachers responsible for teaching this class but who are uncomfortable with the content. Popular students recruited to help teach these programs often lessen this uneasiness and facilitate topical discussion. Results of such peer-based strategies, particularly if followed up with "booster" programs, have been variable but generally seen as favorable (Grunseit 1997).

Peers can enhance sexuality education programs, but parents and legal guardians remain the major sexuality teachers of their children. Research published by the Henry J. Kaiser Family Foundation (1999) estimated that 59 percent of youth ten to twelve years of age reported that they personally learned the "most" about sexuality from their parents. Seventy percent of parents of youth thirteen to fifteen years of age reported that they had spoken with their children regarding relationship issues and becoming sexually active. With or without parental support most communities in the United States have institutionalized sexuality education within school-based curricula. This allows teachers an opportunity to integrate parents into the curriculum content on a regular basis. The question to parents and teachers is no longer if sexuality education should be taught but how such material should be taught. Unfortunately, a number of studies indicate that relatively few parents systematically and comprehensively educate their children in sexuality (Cross 1991; Kallen, Stephenson, and Doughty 1983). Research suggests that open communication between parents and children helps develop enhanced self-confidence, caring relationships, and the skills needed to make healthy sexuality decisions later in life (Centers for Disease Control and Prevention 2000). Experts also suggest that young people who talk with their parents about sexuality are more likely to postpone first sexual activity and to use protection if and when they do become sexually active (Pike 2000; Darroch 2000). Canada, Britain, and the United States each emphasize the inclusion of parents in the schools sexuality education curriculum. They also emphasize delay of first intercourse as a major curricular theme. Such a theme is not emphasized in various European nations such as the Netherlands, Denmark, and France. Some research suggests specific areas that should be addressed in sexuality discussions within the family. These include delivering comprehensive messages, parental communication skill and sensitivity in discussing sexuality, and the timing of communication. Comprehensive messages foster discussion on a range of topics such as decision making, menstruation, reproduction, physical and sexual development, the age when one should assess whether or not to become sexually active, birth control methods, choosing partners, masturbation, and STD/HIV prevention strategies (Whitaker et al. 1998). Parental communication ability and sensitivity to difficult topics are consistently emphasized in successful school-based programs.

A recent study conducted by the Epidemiological Branch of Center for Disease Control's (CDC) Division of HIV/AIDS Prevention examined how selected individual, familial, peer, and environmental factors influence HIV risk and risk-reduction behaviors among adolescents age fourteen to seventeen. Interview data were collected from adolescent-mother pairs recruited from various public high schools and locations. The study focused on the role of mother-child communication regarding sex. The investigators examined how the content, process, and timing of this communication related to the child's later sexual risk behaviors. They found that adolescents who talked with their mothers before their first sexual encounter were three times more likely to use a condom than adolescents who did not talk with their mothers. Such a finding is critical because condom use at first intercourse strongly predicts future use. In fact, adolescents who used condoms at first intercourse were twenty times more likely to use condoms regularly in subsequent acts.

The World Health Organization's Expert Committee on Comprehensive School Health Education and Promotion released a report with recommendations that could enable schools to promote healthy lifestyles. Some of the key recommendations emphasize implementation of community and family involvement. Such involvement could serve as reinforcement for young people to adopt healthy sexual behavior throughout their adolescence and well into marriage.

Unlike their European counterparts, however, relatively few U.S. fathers play an active role in providing their children with age-appropriate sex information. Fathers who fail to participate in such education run the risk of allowing their children to interpret what they view in the media as accurate depictions of sexuality. This neglect can and often does produce negative consequences. Even when there exists a progressive, comprehensive, and developmentally sound school curriculum, parental involvement at home is needed to reinforce and support the skills, information, and viewpoints being explored at school. How to consistently foster this parental reinforcement is a dilemma for sexuality programs in U.S. schools. With the possible exception of Poland and Ireland, both Catholic countries, this dilemma does not pervade European countries. Since sexuality education is viewed the same way as any other education area such as mathematics or history, parental support and inclusion is not the major barrier it is in the United States.

There is a growing movement to implement sexuality education within various medical settings (Mansfield, Conroy, Emans, and Woods 1993). Such education is implemented in physicians' offices or hospitals during patient visits. Normally, a nurse conducts the education although health educators, or even a physician, can be employed. Mansfield and associates (1993) studied the effects of one such physician-delivered HIV education program for high-risk adolescents. After thorough counseling and preventive education in the medical office, sexual behaviors of these adolescents were not significantly changed. Other research teams (Rickert, Gottlieb, and Jay 1990) have had similar difficulty altering sexual behavior of female adolescents in clinic-based interventions. Many health maintenance organizations (HMOs) routinely employ health educators to implement sexuality programs for youth. These interventions employ interactive videos, reading material, and counseling to motivate youth to make responsible choices in sexuality areas. The effectiveness of these education efforts is clear. While knowledge and skill levels are favorably enhanced, the degree to which they prevent later risky sexual actions is not known.

Since the mid-1980s, various religious organizations have instituted their own sexuality or family life education programs. Whereas schools and medical settings tend to emphasize personal responsibility in sexual behavior, religious programs are more likely to emphasize abstinence, a choice included in most major sexuality programs. The curricula offered in more conservative and/or religious areas usually have prohibitions against specific topics and language.

Despite the wide range of contexts, settings, and types of sexuality education in the United States, programs are implemented with the goal of providing relevant knowledge and training so that such education is internalized by students and that they will, therefore, act to avert potential sexual problems (Zabin and Hayward 1993). One specific area which received attention in the 1990s is preventive sexuality education in diverse student populations. The higher epidemiologic rates of teenage pregnancy, HIV, and SDIs in minority students continue to receive significant study and support.

Approaches and Controversies in Other Countries

Similar to young people in the United States, youth around the world are curious about sexual information and experiment with sexual behaviors. Not surprisingly authorities in other countries responsible for sexuality education have different ways of approaching such education. Unlike the United States, most western European countries and Canada have neither racial heterogeneity nor the poverty the United States has (MacFarlane 1997). Program implementation under such constraints is much more difficult for U.S. educators. In many European nations, such as Sweden, France, and the Netherlands, governments—and thus social policy in this area—tend to be more liberal and better financially supported than in the United States. The conservative religious lobby in these countries is not nearly as evident, vocal, or powerful as in the United States. The focus in these nations is on reducing unprotected intercourse rather than trying to completely eliminate sexual behavior among the young (Greenberg, Bruess, and Hafner 2000). Due to the absence of an organized or persuasive opposition many European countries have little difficulty routinely offering students sequential sexuality education throughout their adolescent years—not just during a select few years. The philosophy underlying many curricula is that sexuality education should be considered as important to a young person's education as science, literature, language, or mathematics. In sharp contrast to the United States, most European countries, as well as Canada and Australia, offer access to contraceptives both in school clinics and in the community. In the Netherlands, for example, the various family planning organizations throughout the country develop curricula and advertise the availability of contraceptives. Essentially, the European approach is two-pronged: ongoing education in a variety of crucial areas (anatomy, sexual health, reproduction, contraception) and easy access to contraceptive clinics and contraceptives. Comparable to the United States, however, is the almost universal problem, even in Sweden, concerning the lack of teacher training in sexuality content.

In Francophone Africa, a girl's access to higher education is often halted by early pregnancy and consequently by early family responsibilities. Thus, the government has recognized the need for reproductive health education among this group. Although the government has tried to implement programs in sexuality courses, the students receive information only in their biology classes. One group, the Ministry of Youth and Sports, has implemented the Youth Promotion Program that conducts counseling life education. In other parts of Africa, such as Cameroon, the law states that, "Sex education for girls—especially information on contraceptive methods, STDs, and AIDS—receive special emphasis." Unfortunately, the reality is that education concerning young girls' sexuality remains taboo, except in the Muslim community, which teaches only from the religious perspective (Center for Reproductive Law and Policies 1999).

Over the past several years, the Catholic Church in Poland has played a major role in the teaching of young people in the schools. The availability of information related to sexuality has been restricted to sexual relations after one is married. Due to the lack of sexual information, and a religious prohibition against practicing birth control, many women use natural family planning methods, which increase their chances of an unwanted pregnancy (Nowicka 1996). Wanda Nowicka states: "Although the exact figures do not exist, it is estimated that there are from 180,000 to 300,000 unwanted pregnancies per year and, the sex education program under preparation by the ministry of Education, encompasses Catholic teaching on sexuality and a patriarchal model of the family in which a woman's main role is that of mother and wife, and that the only contraception that is recommended as acceptable is natural family planning."

Religious convictions also play a crucial role in the delivery of sexuality education in the Dominican Republic. As Article XII of the Concordato guarantees, the cardinal not only has the right to question state policy regarding sex education of students, but also can dictate this policy and even decide who teaches such courses (Women's Health Journal, 2000). As it is currently formulated, the public schools "have to conform to the Catholic morals and doctrine" (p. 2).

Although many countries strive to increase young people's access to sexuality information, Chile has recently regressed in this area due to pressure from several conservative groups. Currently in Chile, there are over 40,000 adolescent pregnancies every year, which comprise 20 percent of all pregnancies in the country. Moreover, AIDS continues to escalate at a rate that requires urgent solutions. Despite such trends the Chilean government has changed their curriculum to a more conservative program that focuses on how to "avoid shortcomings in the formation of values." It replaced the previous curriculum which emphasized a program for "dialogue on feelings and sexuality" (Gonzalez 1996).

There are considerable differences between countries and how they view and implement sexuality education for youth. Some nations have strong and vocal religious forces that dictate morality, and thus policy, and ultimately educational instruction. Others view sexuality education as just one of many life skills that young people require education in and thus permit greater freedom in accessing information and contraceptives. Regardless of the country, culture, or language, however, the impact of the family and marriage is crucial to the sexuality education of all young people.

The Family and Marriage

The family and the institution of marriage have changed dramatically throughout the world in the past few decades due to social, economic, technological, and medical influences. The traditional "nuclear" family of western nations where neither parent had ever been divorced, there were two to four children, and they lived in a different geographic region than their relatives, is a thing of the past (Greenberg, Bruess, and Hafner 2000). One out of every three children in the United States now resides with a stepparent. People getting married now face a 33 percent probability that the marriage will end in divorce. Gay marriages are the subject of federal litigation in various states, and court cases emerge regularly concerning which parent owns embryos, sperm, and egg donations. A child in today's society could theoretically count five "parents": legal mother and father, sperm and egg donors and the surrogate mother who carries and delivers the child. Children in Africa routinely see their families deteriorate as siblings, relatives, and parents die from AIDS. Amidst this complex and threatening landscape children must somehow be educated on the foundations of healthy human sexuality.

Schools cannot and should not be held solely responsible for this part of their education. U.S. schools, for instance, have eliminated much of their traditional sexuality education curricula (safe sex, condom use, birth control methods) and have replaced it with programs that pledge abstinence only (Hazelwood 1993). Federal funding guidelines, stemming from the 1996 Welfare Reform Act, prohibit many programs from providing students with information about contraception and contraceptive access (Sheer 2001). The debate over the place of moral and behavioral norms in sexuality education, and particularly how they influence family and marriage continues to be contentious.

In Europe, with the exception of Britain, this debate does not generate much controversy. Most European countries acknowledge that portraying sexual relations among young people as shameful makes contraceptive use also shameful. The result can only be that students will not be protected from unwanted pregnancy, HIV, and STDs. Such outcomes most certainly harm marriages as well as the family (Furedi 2001). Britain conversely does have a conservative and vocal representation and has many of the same family and morality debates as the United States. In India, with its population crisis, the State Institute of Education stipulated that children need "scientific knowledge of the process of growing up, drug addiction, bad effects of population explosion, family life and quality of life" (Indian Express 1999). While family integrity and the sanctity of marriage is a top priority, the population problem has caused Indian authorities to relax religious restrictions in order to control the birth rate and its harmful effects on the quality of life.

The specific effects of sexuality education on the institution of marriage are not fully documented. There is evidence that young, newly married couples that are able to plan their families (skill in contraception) experience greater success in avoiding divorce and economic hardship (Fielding and Williams 1990). Because couples who are skillful in negotiating the emotional stresses of early marriage will have a greater chance of remaining married, previous exposure to effective sexuality curricula or programs that help prepare youth for these challenges may foster a more successful marriage. Around the world, societies which support respectful, caring, and thus stable marriages also tend to produce these same types of families. Such families subsequently foster in their children these same traits. Ultimately, young people with these traits increase the quality of life for all members of the society.

See also:Abstinence; Acquired Immunodeficiency Syndrome (AIDS); Adolescent Parenthood; Assisted Reproductive Technologies; Birth Control: Contraceptive Methods; Birth Control: Sociocultural and Historical Aspects; Circumcision; Family Life Education; Family Planning; Menarche; Religion; Sexual Communication: Parent-Child Relationships; Sexuality; Sexuality in Adolescence; Sexuality in Childhood; Sexually Transmitted Diseases; Sexual Orientation

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elias j. duryea

kari l. kuka

denise e. herrera

SEXUALITY EDUCATION

At the turn of the twenty-first century the rate of sexual intercourse among U.S. teenagers has declined; teen contraception rates, particularly condom use, have increased; and, as a result, teen birthrates declined during most of the 1990s.

Support for sexuality education also seems to be at an all-time high. A poll jointly conducted in 1999 by the Sexuality Information and Education Council of the United States (SIECUS) and Advocates for Youth showed that 93 percent of adults supported teaching sexuality education in high school and 84 percent supported teaching sexuality education in middle school/junior high school. And although most Americans believe abstinence should be a topic in sexuality education, the poll indicates that they reject abstinence-only-until-marriage education that denies young people information about contraception and condoms. The poll and subsequent focus groups demonstrate that many American parents do not see a conflict between providing information about abstinence and providing information about contraception in sexuality education programs. For these parents, it is not a matter of either/or–they want both.

The Basics of Sexuality Education

Human sexuality encompasses the sexual knowledge, beliefs, attitudes, values, and behaviors of individuals. Its various dimensions include the anatomy, physiology, and biochemistry of the sexual response system; identity, orientation, roles, and personality; and thoughts, feelings, and relationships. The expression of sexuality is influenced by ethical, spiritual, cultural, and moral concerns.

Sexuality education is a lifelong process that begins at birth. Parents, family, peers, partners, schools, religion, and the media influence the messages people receive about sexuality at all stages of life. These messages can be conflicting, incomplete, and inaccurate. SIECUS, along with many other national organizations, believes that all people have the right to comprehensive sexuality education that addresses the biological, sociocultural, psychological, and spiritual dimensions of sexuality from the cognitive domain (information); the affective domain (feelings, values, and attitudes); and the behavioral domain (communication, decision-making, and other relevant personal skills).

Comprehensive school-based sexuality education that is appropriate to students' age, developmental level, and cultural background should be an important part of the education program at every grade. A comprehensive sexuality education program will respect the diversity of values and beliefs represented in the community and will complement and augment the sexuality education children receive from their families, religious and community groups, and health care professionals.

SIECUS's Guidelines for Comprehensive Sexuality Education: Kindergarten–Twelfth Grade provide an organizational framework for the knowledge of human sexuality and family living within four development levels. The Guidelines are organized into six key concepts that represent the most general knowledge and encompass the components of the broad definition of sexuality. These six key concepts are human development, relationships, personal skills, sexual behavior, sexual health, and society and culture. Each key concept has associated life behaviors, topics, subconcepts, and age-appropriate developmental messages.

The primary goal of sexuality education is the promotion of sexual health. In 1975 the World Health Organization defined sexual health as "the integration of the physical, emotional, intellectual, and social aspects of sexual being in ways that are positively enriching, and that enhance personality, communication, and love…. Every person has aright to receive sexual information and to consider accepting sexual relationships for pleasure as well as for procreation."

There is public and professional consensus about what is sexually unhealthy for teenagers. Professionals, politicians, and parents across the political spectrum share a deep concern about unplanned adolescent pregnancy; out-of-wedlock childbearing; sexually transmitted diseases, including HIV/AIDS; sexual abuse; date rape; and the potential negative emotional consequences of premature sexual behaviors.

There is, however, little public, professional, or political consensus about what is sexually healthy for teenagers. The public debate about adolescent sexuality has often focused on which sexual behaviors are appropriate for adolescents and has ignored the complex dimensions of sexuality.

Becoming a sexually healthy adult is a key developmental task of adolescence. Achieving sexual health requires the integration of psychological, physical, societal, cultural, educational, economic, and spiritual factors. Sexual health encompasses sexual development and reproductive health, and such characteristics as the ability to develop and maintain meaningful interpersonal relationships; appreciate one's own body; interact with both genders in respectful and appropriate ways; and express affection, love, and intimacy in ways consistent with one's own values.

Adults can encourage adolescent sexual health by providing accurate information and education about sexuality, fostering responsible decision-making skills, offering young people support and guidance to explore and affirm their own values, and modeling healthy sexual attitudes and behaviors. Society can enhance adolescent sexual health by providing access to: comprehensive sexuality education; affordable, sensitive, and confidential reproductive health care services; and education and employment opportunities.

Most scholars and activists argue that adolescents should be encouraged to delay sexual behaviors until they are ready physically, cognitively, and emotionally for mature sexual relationships and their consequences. This support should include education about intimacy; sexual limit setting; resisting social, media, peer, and partner pressure; the benefits of abstinence from intercourse; and the prevention of pregnancy and sexually transmitted diseases.

Ongoing Challenges

In spite of recent declines, the birthrates among African-American and Hispanic young women aged fifteen to nineteen are still significantly higher than the overall birthrate in this age group. The rates of intercourse, pregnancy, and sexually transmitted diseases (STDs) are still much higher in the United States than in other industrialized countries.

Adults, whether they agree with young people's actions or not, cannot ignore the fact that millions of America's teenagers are engaging in a range of sexual behaviors. From a public-health perspective, some of these behaviors are less risky in terms of pregnancy or sexually transmitted disease transmission, whereas others carry greater risks. Because of these realities, all young people in the United States need the information, skills, and access to services to make and carry out informed, responsible decisions about their sexuality–both at the present time in their lives and in the future.

Americans hold both confused and contradictory attitudes about sexuality. While being generally relaxed enough to participate in sexual behaviors, Americans are not accepting enough of these behaviors to avoid guilt or shame. And Americans often have no commitment to pregnancy and disease prevention. This cultural confusion about sexuality is especially profound considering that adults must deal not only with their own sexuality-related issues but also with adolescent sexuality and sexual behaviors.

In American society, many adults do not model sexual health for young people. In fact, teenagers often behave more responsibly than adults. For example, 75 percent of unintended pregnancies in the United States occur to adult women. Never-married teens use birth control more consistently than never-married young adults in their twenties, and adolescents are much more likely to use condoms than older couples. Nearly all sexually transmitted HIV infection among both female and male teens and 60 percent of all teen births are the result of sexual intercourse with adult males.

Discussions about adolescent sexuality and sexuality education often revolve around adults' perceptions of how "things should be" rather than a realistic understanding or appreciation of the dynamics of adolescents' lives. Adolescence is the time when young people develop the knowledge, attitudes, and skills that become the foundation for their healthy adulthood. Recognizing that nearly all Americans eventually become sexually active, an effective sexuality education program would ensure that young people have the information and skills they need to make responsible decisions about their sexuality–whether they make those decisions as adolescents or adults.

Supporting Parents in Their Roles as Sexuality Educators

Parents and families play a major role in ensuring adolescent sexual health. Parents are the primary sexuality educators of their children. They educate both by what they say (and do not say) as well as by how they behave. Research indicates that young people who are able to talk to their parents about sexuality often behave more responsibly.

With open communication, young people are more likely to turn to their parents for help and support. Some parents have difficulty communicating with their children about sexuality, particularly because many of their parents also had difficulty with this issue. In order to overcome this difficulty, the education community can provide parents with information about sexuality and show them how to provide this education and information to their children. Educational programs may also provide parents with the help and encouragement they need to express their values about sexuality to their children and to provide accurate, honest, and developmentally appropriate sexuality information.

Parents and other trusted adult family members play an important role in encouraging and supporting adolescent sexual health. Parents and adults can assure that young people have access to accurate information and education about sexuality issues through direct communication and by providing books, pamphlets, and videos. Parents and other adults need to foster responsible sexual decision-making skills and need to model healthy sexual attitudes and responsible behaviors in their own lives.

Training Teachers

Comprehensive sexuality education is an important component of formal schooling. Yet often teachers do not have the skills, knowledge, or inclination to teach such courses. Few have received training in sexuality education, and even fewer have received certification as sexuality educators. A 1995 SIECUS study revealed that the nation's elementary and secondary school teachers are not adequately prepared at the pre-service level to provide sexuality education, including the teaching of HIV prevention, to their students. Because sexuality issues touch on so many developmental issues relating to children and youth, SIECUS has, since 1965, urged that all pre-kindergarten through twelfth grade pre-service teachers receive at least one course in human sexuality.

Research shows that one of the characteristics that effective sexuality education programs share is that they are taught by teachers and leaders who believe in the program and are trained to deliver it. Trained teachers can complement the education provided by families as well as that provided by religious and community groups. Yet studies reveal that teachers do not feel adequately trained to teach sexuality education. Teachers report concern about their ability to teach personal skills, about their knowledge of HIV/AIDS, and about their knowledge of STDs. Most of those teaching sexuality education report receiving their training in short workshops or seminars.

Training for teachers on how to teach sexuality education is critical to the success of programs and to the health of American children. Teachers responsible for sexuality education must receive specialized training in human sexuality that includes basic information on sexuality topics and a special focus on the philosophy and methodology of teaching sexuality education. Teachers should, ideally, receive this training as pre-service teachers in academic courses or programs in schools of higher education that provide them with time-intensive and rich training. This training can be complemented by extensive in-service courses, continuing education classes, or intensive seminars.

Few states have either training or certification requirements for teachers who deliver sexuality or HIV-prevention lessons. Although the vast majority of states require or recommend teaching about sexuality or HIV/AIDS, a 1995 study found that only twelve states, the District of Columbia, and Puerto Rico required any licensure for teachers of sexuality education and only twelve states and the District of Columbia required licensure for teachers of HIV-prevention education. Only six states and Puerto Rico required teacher training for sexuality educators, and nine states, the District of Columbia, and Puerto Rico required training for teachers of HIV-prevention education. States should develop requirements that integrate expertise in the methodology and pedagogy of sexuality education into existing health education licensure requirements. Current licensing and accreditation bodies should also integrate these criteria into their requirements for health educators.

Building Support Networks for Sexuality Education

A wide range of organizations support comprehensive sexuality education–including those representing health care professionals, businesses, the media, and faith communities–and are willing to advocate on its behalf. On the national level, the National Coalition to Support Sexuality Education includes more than 130 national organizations that support comprehensive sexuality education such as the American Association of School Administrators, the American Medical Association, the National School Boards Association, the National Association of School Psychologists, the National Education Association Health Information Network, the Religious Institute for Sexual Morality, Justice, and Healing, and the United States Conference of Mayors. Many of these organizations have affiliates at the state and community levels.

Education professionals can also become actively involved in supporting sexuality education programs in their communities. Professionals have an important role to play as outspoken advocates by writing letters to editors, voting in school board elections, writing supportive letters to teachers and administrators, and serving on community advisory committees. This involvement will help assure that young people have access to effective programs.

Reaching People outside of School

While an important component of efforts toward ensuring a sexually healthy society focuses on sexuality education in schools, these efforts need to be broadened beyond schools. Out-of-school adolescents are more likely to report having had sexual intercourse and to having had four or more sexual partners.

One of the challenges for the education and health community is to develop innovative, accessible approaches that meet the sexual health needs of adolescents who are not in school. Community based organizations, youth-serving agencies, health agencies, families, and faith communities often have contact with young people who may not be engaged in school, and these entities can be important sources of sexuality information and programming. Agencies need to be encouraged and supported in their efforts to work together to establish and strengthen partnerships for ensuring the sexual health of all young people, particularly those at most risk.

In addition, the Internet and other technologies are making sexuality information more accessible for many young people, both inside school and out. Many Internet sites provide age-appropriate, unbiased sexuality information for teens.

Conclusion

The debate continues in the United States over the focus and content of sexuality education programs. The prevailing political climate makes it difficult for people to publicly advocate for much beyond abstinence for young people. In spite of this there is much parental and scientific support for a more comprehensive approach to sexuality education. The challenge for the education community is to ensure that school policies and programming provide all young people with the information, services, and support they need to grow up to become sexually healthy adults.

See also: Health Education, School; Risk Behaviors, subentries on HIV/AIDS and Its Impact on Adolescents, Sexual Activity among Teens and Teen Pregnancy Trends, Sexually Transmitted Diseases, Teen Pregnancy.

bibliography

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Alan Guttmacher Institute. 1990. Preventing Pregnancy, Protecting Health. New York: Alan Guttmacher Institute.

Ballard, Daniel; White, D.; and Glascoff, M. 1990. "AIDS/HIV Education for Pre-service Elementary School Teachers." Journal of School Health 60:262–265.

Brown, Sarah S., and Eisenberg, Leon, eds. 1995. The Best Intentions. Washington, DC: National Academy Press.

Centers for Disease Control and Prevention. 1992. "Health Risk Behaviors among Adolescents Who Do and Do Not Attend School–United States, 1992." Morbidity and Mortality Weekly Report 43 (8):129–132.

Council of Economic Advisers. 2000. Teens and Their Parents in the Twenty-First Century: An Examination of Trends in Teen Behavior and the Role of Parental Involvement. Washington, DC: Council of Economic Advisers.

Forest, Jacqueline Darroch, and Silverman, Jane. 1989. "What Public School Teachers Teach about Preventing Pregnancy, AIDS, and Sexually Transmitted Diseases." Family Planning Perspectives 21 (2):65–72.

Haffner, Debra W., and Wagoner, James. 1999. "Vast Majority of Americans Support Sexuality Education." SIECUS Report 27 (6):22–23.

Institute of Medicine. Committee on Prevention and Control of Sexually Transmitted Diseases. 1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academy Press.

Kann, Laura; Kinchen, Steven A.; Williams, Barbara I.; Ross, James G.; Lowry, Richard; Grunbaum, Jo Anne; Blumson, Pamela S.; Collins, Janet L.; Kolbe, Lloyd J.; and State and Local YRBSS Coordinators. 2000. "Youth Risk Behavior Surveillance–United States, 1999." Morbidity and Mortality Weekly Report Surveillance Summaries 49 (SS-5):1–94.

Kirby, Douglas. 2001. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy.

Levenson-Gingiss, P., and Hamilton, R. 1989. "Teacher Perspectives after Implementing a Human Sexuality Education Program." Journal of School Health 59:427–431.

Males, Mike A. 1996. The Scapegoat Generation. Monroe, ME: Common Courage Press.

National Commission on Adolescent Sexual Health. 1995. Facing Facts: Sexual Health for America's Adolescents. New York: Sexuality Information and Education Council of the United States.

Rodriguez, Monica; Young, Rebecca; Renfro, Stacie; Asencio, Marysol; and Haffner, Debra W. 1995/1996. "Teaching Our Teachers to Teach: A SIECUS Study on Training and Preparation for HIV/AIDS Prevention and Sexuality Education." SIECUS Report 25 (2):15–23.

Sexuality Information and Education Council of the United States. 1995. SIECUS Position Statements on Sexuality Issues. New York: Sexuality Information and Education Council of the United States.

Sexuality Information and Education Council of the United States. 1995. SIECUS Review of State Education Agency HIV/AIDS Prevention and Sexuality Education Programs. New York: Sexuality Information and Education Council of the United States.

Sexuality Information and Education Council of the United States. 1996. Guidelines for Comprehensive Sexuality Education: Kindergarten–Twelfth Grade. New York: Sexuality Information and Education Council of the United States.

Temporary Assistance to Needy Families Act of 1996. U.S. Public Law 104-193. U.S. Code.

Ventura, Stephanie J.; Mathews, T. J.; and Curtin, Sally C. 1999. "Declines in Teenage Birthrates, 1991–1998: Update of National and State Trends." National Vital Statistics Reports 47 (26):1–9.

Whitaker, Daniel J.; Miller, Kim S.; May, David C.; and Levin, Martin L. 1999. "Teenage Partners' Communication about Sexual Risk and Condom Use: The Importance of Parent-Teenager Discussions." Family Planning Perspectives 31 (3):117–121.

Monica Rodriguez

Sex Education

The idea that schools and the state have a responsibility to teach young people about sex is a peculiarly modern one. The rise of sex education to a regular place in the school curriculum in the United States and Western Europe is not, however, simply a story of modern enlightenment breaking through a heritage of repression and ignorance. Rather, the movements for sex education can be understood from several related angles: as part of larger struggles in the modern era over who determines the sexual morality of the coming generation; as part of the persistent tendency to view adolescence–especially adolescent sexuality–as uniquely dangerous; and as part of the broader historical tendency for more and more realms of personal life to come under rational control. Sex education has always been shaped by its historical context.

It is worth noting that formal sex education has never held a monopoly on sexual information. Much to the distress of sex educators, young people do not simply memorize their school lessons and apply them perfectly. They have always cobbled together their own understanding of their (and others') bodies out of their personal experiences and an accidental agglomeration of "official" sex education, parental teaching, playground mythology, popular culture, and even pornography.

Early History

Prior to the twentieth century, sex education was even more haphazard. Most Americans and Europeans lived in the countryside, where chance observation of animal behavior provided young people with at least a measure of information about reproductive sexuality. Beyond that, education was mixed. Given the expectation that girls would remain chaste until their wedding night, sex education for them did not seem pressing until the eve of matrimony, when their mothers were supposed to sit them down and explain sex and reproduction; contrary expectations for boys often meant that a young man's male relatives or co-workers would take him to a brothel to initiate him into the mysteries of sex.

In the 1830s, however, various health reformers and ministers in the United States and in England began to publish a flood of pamphlets and books to inform and fortify the young man who left home for school or a job. These works were typically great stews of theological, nutritional, and philosophical information, but all aimed to help readers control their sexual urges until they could be safely expressed in marriage. More particularly, these early sex educators tended to be obsessed with the dangers of masturbation. For example, the health reformer Sylvester Graham's 1834 Lecture to Young Men and the Reverend John Todd's 1845 The Young Man. Hints Addressed to the Young Men of the United States followed works by the English physician William Acton in warning that the "solitary vice" (i.e., masturbation) could and probably would lead to a physical and mental breakdown–even death. The literature seldom addressed women, as society generally considered them to be at all times under the protection of their parents and then their husbands, while young men were more mobile. In France, the sex education literature that began appearing in the 1880s, was usually addressed to bourgeois mothers, and focused chiefly on their duty to instruct their daughters on the dual need to be chaste until marriage but prepared for sexual contact after matrimony. Despite these small steps toward education, later reformers complained that a "conspiracy of silence" about sexual matters existed into the early years of the twentieth century.

Origins of a Movement

The formal movement for sex education commenced in the early twentieth century. Oddly, early reformers seldom said anything about needing to compensate for the loss of barnyard knowledge when families grew up in the city rather than on a farm. In other societies undergoing rapid urbanization, such as China at the dawn of the twenty-first century, newspapers regularly reported on young city couples who wanted children for years but never picked up the essential information on animal breeding that would have suggested how to become pregnant. American reformers, like their counterparts in England at roughly the same time, were more focused on the related dangers of medical and moral decline. First, physicians were growing alarmed about the impact of syphilis and gonorrhea–the "venereal diseases"–among all classes of citizens, and among women as well as men. Investigators had come to recognize that these sexually transmitted diseases (STDs) annually caused thousands of cases of pelvic inflammation, sterility, infant blindness, and even insanity. Second, physicians and their allies associated this "epidemic" with what many Americans considered the immorality of life in the city. Native-born Americans in particular believed that a moral crisis loomed in cities such as Chicago and New York as immigrants and migrants from the countryside crowded together in dismal tenements and children grew up without the "ennobling influence" of life on the farm. Equally alarming, in an era in which prostitution was a fairly open secret in the red light districts of most urban areas, doctors became convinced that the majority of STDs were transmitted through men visiting prostitutes. This meshing together of moral and medical concepts was to remain characteristic of American and, to a lesser extent, European sex education.

Sex education became a significant part of the response to these twin anxieties. Founded in 1914 by the New York physician Prince Morrow and the religious crusader Anna Garlin Spencer, the American Social Hygiene Association (ASHA) quickly took the lead in recommending reforms to accomplish the twin goals of medical and moral improvement. After leading police crackdowns on prostitution and presenting a series of sex education lectures to adults, ASHA and related societies proposed a program in "sex instruction" for high-school-age youth. ASHA's leaders hoped they could reach young people with proper "scientific" facts about sex before they were "corrupted" by harmful misinformation, such as the widely held belief that young men suffered from a "medical necessity" to have sex. If citizens only knew the medical dangers of sexual immorality, reformers believed, then they would rationally decide not to experiment with prostitution or promiscuity.

Although the English movement for sex education grew out of similar anxieties, and was led by a similar combination of medical and moral authorities, the French movement differed in certain essential respects. France officially tolerated and regulated prostitution, for example, so it never became a focus of educators' efforts. Instead, French sex educators were more concerned about preparing young middle-class women for the sexual aspects of marriage and reproduction. They generally ignored working-class females, believing they were already immoral by nature. French authorities occasionally supported sex education for men to combat the scourges of STDs, but after the carnage of World War I, French educators also linked sex education to the need for French families to bear more children to repopulate the state.

Moving into the Schools

Sex educators in the United States sometimes experimented with working through parents, churches, and public lectures, but they quickly turned to the public schools. In the early twentieth century, public school attendance was exploding as compulsory education laws and the changing structure of the economy pressured more students into the classroom and kept them there longer. At the same time, observers were becoming more conscious of youth as a period of life separate from adulthood, with its own particular needs and dangers, and this new conception of the adolescent was widely popularized by the publication of G. Stanley Hall' sessential Adolescence in 1904. Trapped between the sexual awakening of puberty and the "legitimate" sexual outlet of marriage, adolescents seemed particularly to need careful guidance, and the public schools could step in to give it to them where parents seemed to be failing. Not coincidentally, moving their mission to the classroom promised to give sex educators a captive audience.

Reflecting their own uneasiness with sexuality, the early sex educators constructed a program whose central mission was to quash curiosity about sex. Initially, the sex education program consisted of an outside physician delivering a short series of lectures outlining the fundamentals of the reproductive system, the destructive power of syphilis and gonorrhea, and the moral and medical dangers caused by sex before or outside of marriage. Boys and girls sat in separate classrooms, and their lessons reflected a strong sense of difference between the sexes. Besides hearing the medical warnings about sexually transmitted diseases, boys learned that they had a moral responsibility to their mothers and future wives to remain chaste. Girls were instructed much more deliberately in raw fear–especially in the high likelihood of contracting syphilis from a male. So vivid were the warnings that some instructors in the first decades of the twentieth century actually worried that their female students might never marry. Because they sought to ennoble sexuality by making it synonymous with reproduction, early sex educators seldom dwelled on the threat of teen pregnancy.

Despite the educators' moralistic tone, sex education met immediate opposition. When Chicago became the first major city to implement sex education for high schools in 1913, the Catholic Church in particular led a powerful attack on the program and helped secure the resignation of its sponsor, Ella Flagg Young, the famous superintendent of schools.

The Chicago controversy, as it was called, laid out the themes that were to characterize the politics of sex education in the United States over the next century. Both supporters and opponents agreed that youthful sexuality was a problem. But where supporters felt that "scientific" knowledge about sexuality (or at least reproduction) would lead young people down the path to moral behavior, opponents argued that any suggestion of sexuality, no matter how well intended, would corrupt students' minds.

The federal government first became involved in sex education during World War I, when the Chamberlain-Kahn Act of 1918 first earmarked money to educate soldiers about syphilis and gonorrhea. Over half a million young men had their first experience with sex instruction in the war. ASHA later took many of the materials its consultants had developed for the military, such as the film Fit to Fight, and adapted them for public school use by editing out the segments on prophylaxis. Until the 1950s, the federal government remained involved in sex education, mainly through the U.S. Public Health Service, emphasizing the medical and moral dangers of sexually transmitted diseases.

More than Hygiene

In the Jazz Age of the 1920s, sex education made progress into the curriculum both in the United States and in France. American sex education typically took place in high school biology classes, but leaders in the movement also faced for the first time a clear divergence between adult sexual ideals and society's expectations for youth. Up to the early twentieth century, when sexual fulfillment was not considered a public or respectable ideal even for married adults, it was easy for educators to condemn sex in their lessons. But in the 1920s, as more Americans came to believe that sexual fulfillment was a crucial part of marriage, educators faced the dilemma of recognizing that sex was a positive force in marriage while at the same time needing to condemn its expression among the unmarried. Sex educators responded partly by reemphasizing the health dangers of sex outside of marriage, but also by incorporating the new ideals. Greatly concerned over the sexual freedom of the "new youth" in the 1920s and 1930s, sex educators appealed to psychology and sociology for evidence that sexual experimentation before marriage endangered a youth's chances for a fulfilling wedded life.

After the discovery of penicillin's uses in World War II lessened the danger of syphilis, ASHA and its allies focused more directly on the social aspects of sexuality and married life. Known by a variety of names, the new "family life education" represented an expansion of the educators' mission. Instead of teaching mostly about sexual prohibitions, family life educators attempted to instruct students in the positive satisfactions to be gained from a properly ordered family life. Lessons on child rearing, money management, wedding planning, dating, and a wide variety of other daily tasks were intended to bring a new generation of American youth into conformity with white, middle-class norms.

In response particularly to the "sexual revolution" of the 1960s and 1970s, in which rates of premarital sexual activity, pregnancy, and sexually transmitted diseases climbed steeply, sex educators developed what they called "sexuality education," to distinguish their approach from the overt moralizing and narrow heterosexual focus of its predecessors. The leaders in sexuality education, such as the Sexuality Information Education Council of the United States (SIECUS, founded in 1964), believed that teaching about sexuality in a value-neutral manner would allow students to reach their own conclusions about sexual behavior and sexual morality. Sexuality education was intended to include information on birth control methods, teenage pregnancy, masturbation, gender relations, and, eventually, homosexuality. Although value-neutral sexuality education generally avoided the overt moralizing of its predecessors, it nevertheless stacked the deck in favor of traditional morality–abstinence until heterosexual marriage.

Despite its generally traditional message, sexuality education quickly aroused a firestorm of opposition. Beginning in 1968, conservative groups and previously apolitical religious activists mobilized to attack what one pamphlet called "raw sex" in the schoolhouse. Opponents were offended not only by sexuality education's greater explicitness, but by its refusal to drill students in "proper" sexual morality. Sexuality education seemed to represent a wide variety of liberal attitudes that were beginning to appear in American society, and the struggles over sexuality education helped motivate a new generation of religious conservatives to enter American politics in the 1970s. It was at this point that the American experience began to diverge from the European approach, which had aroused occasional Catholic disapproval but never faced a highly political campaign of opposition.

HIV/AIDS Crisis

In the United States, the debate between opponents and supporters continued to follow the same lines until the pandemic of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) began in the 1980s. As the magnitude and deadliness of this sexually transmitted illness became known (and as the public became aware that heterosexuals as well as homosexuals were at risk), sex educators found their position bolstered. By the mid-1990s almost every western European nation sponsored fairly explicit educational programs in "safe sex"; in the United States, every state had passed mandates for AIDS education, sometimes combined with sexuality education, sometimes as a stand-alone program. AIDS provided crucial justification for the more liberal sexuality educators' inclusion of information on contraception, homosexuality, and premarital sex. At universities and many high schools, students also started "peereducation" groups to offer students a sex education message that was even less hierarchical and judgmental (and sometimes much more explicit). Despite a renewed conservative attack on these programs, sexuality education's place seemed to have become secure.

As conservative opponents in the United States came to recognize that some form of sex education was going to be almost inevitable, they launched their own movement to replace sexuality education with "abstinence education." Religious conservatives, in particular, helped add provisions for abstinence education to the 1996 Welfare Reform Act, and the federal government for the first time began to direct tens of millions of dollars to abstinence education programs, most of which were tied to religious groups rather than the more traditional public health organizations. Unlike sexuality education's value neutrality, abstinence education was directly moralistic and explicitly supported traditional gender and sexual relations. Abstinence education also harked back to the early years of sex education in its strong emphasis on the dangers of sexual activity. Many curricula intentionally omitted or distorted information about protective measures such as condoms or birth-control pills. Again, this contrasted with the European experience, in which sexuality education was firmly under the control of secular medical authorities and faced little religious or political challenge.

International Context

Outside of Western Europe and the United States, sex education remained largely informal until concerns over a population explosion and the AIDS crisis prompted international organizations such as the United Nations to become involved in educating residents in Africa and South Asia particularly about contraception and prophylaxis. Although the religious opposition there has been muted, educators have often met with resistance from governments unwilling to admit that their populations were experiencing problems with AIDS, and from male traditionalists reluctant to allow women greater control over their own sexuality. Political battles in the United States, too, have affected the shape of sex education in the less-developed regions of the world, as American conservatives at the dawn of the twenty-first century attempted to use U.S. funding to shift the content of international sex education programs away from contraception and towards abstinence and a more moralistic approach to sexual relations.

Conclusion

The response to the AIDS crisis once again underlined the general tendency to justify sex education as disaster prevention in response to diseases or other "epidemics," such as teenage pregnancy. Throughout the history of sex education, adults in the West have generally treated adolescent sexuality as existing in a different world from its grown-up version, blaming hormones or the youth culture for recurring crises in adolescent sexual behavior. But youthful sexual behavior has almost always been closely tied to adult patterns of behavior: rising rates of extramarital intercourse among adolescents, for example, only followed the same phenomenon among adults; the same held true for the "epidemic" of pregnancy outside of marriage in the 1970s, as pregnant teenage females followed their adult counterparts in having more children outside of wedlock.

Although it has undoubtedly dispelled much ignorance and anxiety among students, sex education in the United States, at least, has generally failed to deliver on its promise to change adolescent sexual behavior. Sexual behavior is a complex phenomenon, and hours in the classroom have seldom managed to counteract the influence of class, race, family, region, and popular culture. Nevertheless, the history of sex education reveals a great deal about modern conceptions of sexuality, adolescence, and authority.

See also: AIDS; Hygiene; Venereal Disease.

bibliography

Bigelow, Maurice A. 1916. Sex-Education: A Series of Lectures Concerning Sex in Its Relation to Human Life. New York: Macmillan.

Chen, Constance M. 1996. "The Sex Side of Life": Mary Ware Dennett's Pioneering Battle for Birth Control and Sex Education. New York: Free Press.

Hall, G. Stanley. 1904. Adolescence: Its Psychology and its Relations to Physiology, Anthropology, Sociology, Sex, Crime, Religion, and Education. New York: D. Appleton.

Irvine, Janice. 2002. Talk About Sex: The Battles Over Sex Education in the United States. Berkeley: University of California Press.

Moran, Jeffrey P. 2000. Teaching Sex: The Shaping of Adolescence in the Twentieth Century. Cambridge, MA: Harvard University Press.

Smith, Ken. 1999. Mental Hygiene: Classroom Films 1945–1970. New York: Blast Books.

Stewart, Mary Lynn. 1997. "'Science is Always Chaste': Sex Education and Sexual Initiation in France, 1880s–1930s." Journal of Contemporary History 32: 381–395.

Jeffrey P. Moran

SEX EDUCATION

SEX EDUCATION. The movement for sex education, also at times known as sexuality education, began in the United States in the late nineteenth and early twentieth centuries. Dr. Prince Morrow developed the impetus for some of the first formal sex education curricula with an emphasis on the prevention of venereal disease, a focus that had its roots in the scientific social-hygiene and purity movements of the Progressive Era. In 1905, he established the American Society of Sanitary and Moral Prophylaxis, focusing on private agencies outside of schools, working with youth on sexually transmitted disease prevention. For the most part, Morrow's approach to sex education sought to discourage sexual activity and to emphasize the dangers of sex while also providing instruction about human anatomy and physiology. During this same time, Margaret Sanger began her pioneering work dispensing birth control information to young women in New York City.

In 1914, the National Educational Association began to endorse sex education, usually referred to as sex hygiene, in the schools. The NEA resolution stated that public school sex hygiene classes should be conducted by "persons qualified by scientific training and teaching experience in order to assure a safe moral point of view." By the second and third decades of the twentieth century, sex education in the public schools had become more institutionalized and had begun to shift from the earlier dis-ease prevention model to a focus on helping young people relate sex to love, marriage, and family life. There was a strong proscriptive bent to most of these programs—"worthwhile" sexual experiences were only those that led to mature love and marriage. Sex educators in this era generally viewed bodily pleasure unto itself as morally dangerous.

In the 1940s, sex education continued to be taught primarily as part of social-hygiene classes and often existed in classes called "homemaking," "character building," or "moral or spiritual values." These classes were frequently sex segregated, although sex education specialists debated this issue. The post–World War II era witnessed a major social movement in support of a more explicit, normative, and nonjudgmental approach to sexuality education. The development of the Sex Information and Education Council of the United States in the early 1960s, followed by the American Association of Sex Educators and a number of other organizations, transformed the teaching of sex education in the schools. The pioneering work in the fields of human sexuality by Alfred Kinsey and William H. Masters and Virginia E. Johnson also had an enormous influence in promoting sex education. These organizations and individuals sought to develop programs that encouraged healthy sexuality to enhance individual growth and fulfillment. In addition, the women's movement challenged and transformed many previous assumptions about the teaching of female sexuality.

Nevertheless, sex education programs continued to be subject to considerable controversy. Some religious organizations voiced strenuous objections to teaching young people about issues such as contraception, abortion, or masturbation, or to framing homosexuality as an acceptable lifestyle in sex education classes. Throughout the 1980s and 1990s, local school boards waged protracted and divisive battles over the content of sex education curricula. In addition, political conservatives in the United States sought, at times successfully, to restrict the content of sex education programs and to limit explicit discussions of birth control in favor of an emphasis on abstinence. These controversies over the content of sex education curricula took on a more fevered pitch with the advent of the AIDS virus.

BIBLIOGRAPHY

Hottois, James, and Neal A. Milner. The Sex Education Controversy. Lexington, Mass.: Lexington Books, 1975.

Scales, Peter. "Historical Review of Sex Education Efforts and Barriers." In Facilitating Community Support for Sex Education, Centers for Disease Control Final Report. Bethesda, Md.: 1981.

Strong, Bryan. "Ideas of the Early Sex Education Movement in America, 1890–1920." History of Education Quarterly 12 (1972): 129–161.

John S.Berman

See alsoBirth Control ; Birth Control Movement ; Kinsey Report .

Sex Education. Before the twentieth century, sex education took the form primarily of personal observation and informal talks, but a handful of books such as Aristotle's Masterpiece (first published in English around 1684) and the Reverend John Todd's moralistic Student's Manual (1837) also conveyed rudimentary information about sexual functions. In the 1880s and 1890s, the Woman's Christian Temperance Union called for students to take a vague pledge of premarital sexual abstinence as part of its White Cross Movement for personal purity. Countless religious writers and moralists issued veiled but dire warnings against prostitution, masturbation, and all forms of sexual activity outside the bonds of matrimony.

The modern movement to place sex education in the public schools grew out of a broader Progressive Era crusade against prostitution and venereal diseases that came to be known as the social‐hygiene movement. Social Diseases and Marriage (1904) by Dr. Prince A. Morrow (1846–1913), a New York dermatologist, became the central document for the American Social Hygiene Association, a union of public‐health physicians, educators, and antiprostitution activists funded by John D. Rockefeller Jr. From its founding in 1914 to its decline and withdrawal from the field in the early 1960s, this organization led the fight for sex education. Prompted as much by fears of moral breakdown as by medical concern, Morrow and others insisted that almost all venereal diseases were transmitted through prostitution and that the social‐hygiene movement must therefore attack both problems simultaneously. Despite what they perceived as a “conspiracy of silence” surrounding sexual matters, social hygienists argued that sex education was essential to dispel the ignorance about sex, disease, and immorality that made prostitution and other misbehavior possible. After experimenting with public lectures to adult audiences, sex educators by 1914 turned decisively toward the public schools to teach young people a mixture of medical and moral lessons about anatomy; proper thoughts; and Protestant, middle‐class morality.

Sex education in universities and public schools expanded significantly during World War I with funding from the Chamberlain‐Kahn Act (1918), so that by 1920 at least 25 percent of public high schools offered some form of sex education through biology and social‐studies classes, poster exhibits, or lectures by physicians. Despite attempts by sex educators to ally with the progressive‐education and mental‐hygiene movements, sex education drew most of its funding and energy from public‐health officials in individual cities and states. Although most sex educators took a generally sober and conservative approach, opponents in the late 1960s publicly attacked the allegedly radical programs favored by the U.S. Sex Information Education Council and its leader Mary Steichen Calderone. Sex education was subsequently marked by public acrimony, even as the AIDS crisis and concerns over teenage pregnancy prompted more schools to institute some form of instruction.

Central questions dating from the earliest days of the sex‐education movement persisted nearly a century later: Is sex education's mission primarily moral or medical? Is sex education the school's or the parents’ responsibility? Does knowledge of sexual facts lead young people to experiment sexually? Conversely, is sexual information by itself sufficient to alter sexual behavior at all?
See also Acquired Immunodeficiency Syndrome; Prostitution and Antiprostitution; Sexual Morality and Sex Reform.

Bibliography

James T. Sears, ed., Sexuality and the Curriculum: The Politics and Practices of Sexuality Education, 1992.
Jeffrey P. Moran , Teaching Sex: The Shaping of Adolescence in the Twentieth Century, 2000.

Jeffrey P. Moran