In the United States schools have played an increasingly important role in educating adolescents about and preparing them for the responsibilities that come with sexual maturation, whereas instruction about human sexuality and the inculcation of sexual values formerly were delegated principally to families and churches. Historically, deciding whether and what schools should teach about human sexuality has been a difficult and contentious debate. Unlike most curricular decisions, choices about sexual education attract the interest of political, social, and religious factions. Control of the content of sexual education is regarded as a political battle over who defines larger American social values. Therefore, curricular choices are not necessarily dictated by sound pedagogy, the health needs of students, or the recommendations of health educators but instead reflect a broader social agenda on the part of policymakers.
The larger role in sex education granted to schools coincided with societal changes in the status of teens that occurred at the turn of the twentieth century. The "social invention" of adolescence as its own developmental stage of life is a recent phenomenon in industrialized societies, including the United States. According to the historian Jeffrey Moran, the recognition of adolescence as a unique stage of life "rested on three important material changes" that occurred as the nineteenth century ended: (1) increased age segregation in the educational system, allowing adolescents to develop a stronger age-group identity; (2) an earlier age for the onset of puberty; and (3) the delay of marriage and the prolonging of education and training into the young adult years (Moran 2000, p. 15). Those factors set the stage for modern youth to experience a period when they identify closely with their own age cohort, are sexually capable, and are not recognized as adult members of society with full sexual rights. A substantial proportion of those years are spent in school, making teenage sexuality an issue that American schools cannot ignore.
TEEN SEXUAL PRACTICES AND THE NEED FOR EDUCATION
The case for providing sexual education in the schools is compelling in light of the sexual practices of minors and the resulting social, health, and economic consequences. Many American teens are sexually active, especially if one recognizes that sexual activity includes a wide range of activities beyond vaginal intercourse. Minors often engage in noncoital sexual behavior such as oral and anal sex instead of or in addition to intercourse, sometimes as a way to postpone intercourse or because those activities are regarded as less risky and more socially acceptable (Mosher and associates 2005). About 64 percent of males and females between ages fifteen and nineteen have engaged in sexual contact, including vaginal intercourse or oral or anal sex (Mosher and associates 2005). For many decades the age of first sexual intercourse had grown younger; however, the age of first sexual intercourse among teens later showed some upward trends. Nevertheless, about half of seventeen-year-olds had had sexual intercourse in the early years of the twenty-first century (Mosher and associates 2005). According the United States Census, the average age of marriage increased over the last century; females are generally sexually active for eight and males for ten years before marriage (Alan Guttmacher Institute 2002).
Some youth are engaging in particularly risky sexual behaviors. According to the Centers for Disease Control and Prevention (CDC), 7 percent of minors under the age of thirteen have had sexual intercourse and 14 percent of students have had four or more partners (Mosher and associates 2005). Only 63 percent of sexually active high school students used a condom at last intercourse (Klein 2005).
The health and socioeconomic consequences of risky sexual activity during adolescence can be severe. Approximately four in ten women will become pregnant at least once before the age of twenty years, one in four sexually active teens contract sexually transmitted diseases (STDs) each year, and half of new HIV infections occur in individuals under age twenty-five (Klein 2005).
The health and socioeconomic burdens of pregnancy and STDs are borne disproportionately by young women. Early pregnancy carries increased health risks for young women and often negatively affects their education, earning power, and social status. Although the teen pregnancy rate in the United States declined in the early years of the twenty-first century, American teens continue to have the highest rate of pregnancy in the industrialized world. The health burden associated with STDs is generally greater for females as well. Females contract STDs more easily than do males because of anatomical differences between the sexes. STDs in females often go unrecognized longer because STDs may be asymptomatic in internal female organs. Therefore, females often have greater long-term chronic consequences of STDs.
The health and socioeconomic burdens of teen pregnancy and STDs are passed on to children. The infants of mothers with STDs and HIV may be infected, and the problem is compounded because pregnant teens often do not receive sufficient prenatal care. Teen pregnancy also is associated with premature birth, low birth weight, and higher infant and maternal mortality. Children born of adolescent mothers also bear social and economic burdens, including developmental delays, school and learning problems, increased risks of substance abuse and depression, and a higher likelihood of becoming teenage parents (Klein 2005).
APPROACHES TO SEXUAL EDUCATION
Because many teens are sexually active and because unprotected sex can have serious consequences, addressing teenage sexuality is an important societal responsibility. Many factors, including family structure, values and attitudes toward sex, religiosity, socioeconomic status, ethnicity, peer influences, and school performance, influence adolescent sexual activity. Therefore, many different community initiatives and strategies are needed to make meaningful strides in reducing teen pregnancy and STD rates. Sexual education programs can help minors make better-informed choices about sexuality but are only a small part of a meaningful public health campaign to improve teens' sexual health and reduce their risks of pregnancy and STDs.
Curricular approaches to sexual education generally fall into two categories: comprehensive sex education and abstinence-only sex education. "However, in practice, curricula-based programs don't really divide neatly into these two groups; they actually exist along a continuum" (Kirby 2001, p. 7). Some researchers also identify a middle ground approach in "abstinence-plus" sexual education, which emphasizes the values espoused in abstinence-only sexual education curricula but also presents preventive health information in comprehensive sexual education curricula.
Comprehensive sex education treats human sexuality broadly and inclusively. A comprehensive curriculum attempts to prepare students to manage their sexuality by providing a broad range of accurate health information and promoting core values of mutual respect and self-responsibility. Although comprehensive curricula typically encourage adolescents to remain abstinent, they also provide students with information about methods to avoid pregnancy and disease if they become sexually active. Comprehensive sexual education tries to impart the value of respect and provide skill building to enable students to resist negative peer pressure (SIECUS 2006).
In general abstinence-only curricula are designed to encourage individuals to abstain from sexual activity until marriage and attempt to give students skills and reasons to avoid sexual activity. Even though some teenagers may be sexually active when they take these courses or become so before they marry, the curricula teach that abstinence is the only acceptable and healthy choice for people outside a heterosexual marriage. These curricula concentrate on teaching minors ways to resist the temptation and peer pressure to engage in sexual acts. One of the most controversial aspects of abstinence-only courses is that they do not teach students how to avoid STDs or pregnancy except by remaining abstinent. Therefore, those courses do not provide instruction that could reduce the risks to sexually active youth.
School curricula are determined largely at the local level. Therefore, there is considerable diversity in the policies and curricular approaches to sexual education across the nation. It is estimated that about two-thirds of school districts in the United States have a districtwide or statewide policy about sexual education, whereas about one-third leave the decisions about whether and what to teach to the individual schools or the teachers. Among the districts with a policy mandating sexual education, approximately one-third require that abstinence be taught as the only option outside of marriage and either forbid instruction about condoms and contraception or teach only about the failure rates of those preventive measures (Landry, Kaeser, and Richards 1999).
The prominence of "abstinence-only-until-marriage" sexual education is unique to the United States; most other Western countries endorse comprehensive sexual education. European countries also have lower teen pregnancy and STD rates. "Countries with low levels of adolescent pregnancy, childbearing and STDs … generally exhibit 'societal acceptance of sexual activity among young people' and provide 'comprehensive and balanced information about sexuality and clear expectations about commitment and prevention of childbearing and STDs'" (Friedman 2005, p. 769).
CRITICISMS OF FEDERAL POLICY
Federal resources for sex education are directed exclusively at abstinence-only-until-marriage sex education. The federal government provides grants for abstinence-only programs to states and directly to community groups and schools. The direct grants frequently are provided to religious and community groups that regard sex outside heterosexual marriage as immoral or sinful (Beh and Diamond 2006).
One justification offered for teaching abstinence-only but not other preventive strategies is the concern that providing adolescents with specific preventive information may dilute the abstinence message and give them the impression that their instructors are giving them permission to have sex. Another argument is that teens already learn about sex from other sources but do not learn about abstinence (Pardue, Rector, and Martin 2004). However, according to critics, these are unfounded premises. No studies have shown that providing adolescents with accurate health information increases the likelihood that they will become sexually active. Also, there is evidence that teens are an underserved population in regard to health education and preventive services (Klein 2005).
Many health and education professional organizations, including the American Medical Association, the American Academy of Pediatrics, and the National Education Association, do not approve of the federal policy in place in the first years of the twenty-first century (Beh and Diamond 2006). The American Academy of Pediatrics Committee on Adolescence has observed that comprehensive education that encourages abstinence but also provides accurate information about other preventive strategies sexually active teens should practice is preferable to abstinence-only education (Klein 2005). There is concern that the federal government has endorsed abstinence programs even though there is no evidence that they produce positive results and some evidence that they produce negative results. Most studies have shown that these curricula have little or no impact on reducing teen sexual activity or sexual risk-taking behavior (Kirby 2001).
There are many other criticisms of abstinence-only sexual education. One problem is that the instruction does not define abstinence precisely, and so minors may engage in risky behaviors other than intercourse, believing that they are remaining abstinent and not taking precautions. In addition, since abstinence-only curricula do not teach or endorse any preventive measures other than abstinence, those programs fail to provide useful instruction to teens who are or soon will become sexually active. Typically, if an abstinence-only course discusses condoms or contraception, it is in the context of the failure rates of those prevention methods.
Researchers who have examined abstinence-only curricula have noted that some do not provide accurate information about the failure rates of condoms and contraception. They sometimes combine user and method failure rates. The fallacy of combining user failure and method failure is obvious: User failure is the result of the user's inconsistent or improper use of the contraceptive or condom, and that rate can be improved through better instruction, not less. When failure rates are combined and emphasized, adolescents who engage in sexually activity are not prepared or do not have appropriate confidence in preventive practices that can reduce their risk of contracting HIV or STD infection or getting pregnant (Beh and Diamond 2006). Studies conducted by the public health researchers Peter Bearman and Hannah Brückner in 2005 found that some teens who took "virginity pledges" to demonstrate their commitment to abstinence until marriage did delay having sexual intercourse for a short period but were less likely to use contraceptives at their sexual debut, had STD rates consistent with those of other teens, and were less aware of their STD status and less likely to be tested.
Two relatively comprehensive reviews of some of these curricula revealed troublesome issues. In 2004 the U.S. House of Representatives Committee on Government Reform Minority Staff prepared an evaluation of thirteen of the most popular federally funded abstinence-only education programs (Minority Staff Investigations Division 2004). In addition, the state of Ohio, a large recipient of federal funds for abstinence-only education, commissioned an evaluation of Ohio programs in 2005 (Frank 2005). Both evaluations observed that the curricula often tended to be overtly religious, perpetuated negative gender stereotypes, ignored the health needs of lesbian, gay, bisexual, and transsexual youth, and instilled unhealthy fear about human sexuality.
Legal commentators have criticized abstinence-only sexual education on several grounds. Some argue that by ignoring sexual minority youth these curricula are discriminatory and may violate state antidiscrimination laws or constitutional equal protection rights (McGrath 2004). Some scholars argue that the federal government violates the First Amendment by funding programs with overtly religious messages (Simson and Sussman 2000). Others assert that teenagers have constitutionally protected privacy rights related to sexuality and procreation that are impinged on by curricula that impair their ability to make informed decisions about their sexual health (Beh and Diamond 2006).
Alan Guttmacher Institute. 2002. "Facts in Brief: Sexual and Reproductive Health: Women and Men." Available from http://www.guttmacher.org/pubs/fb_10-02.
Beh, Hazel Glenn, and Milton Diamond. 2006. "The Failure of Abstinence-Only Education: Minors Have a Right to Honest Talk about Sex." Columbia Journal of Gender & Law 15: 12-62.
Brückner, Hannah, and Peter Bearman. 2005. "After the Promise: The STD Consequences of Adolescent Virginity Pledges." Journal of Adolescent Health 36: 271-278.
Frank, Scott. 2005. "Report on Abstinence-Only-Until Marriage Programs in Ohio." Cleveland, OH: Case Western University. Available from http://www.plannedparenthood.org/pp2/clvld/files/clvld/Frank_Report.
Friedman, Jane. 2005. "Teen Sex: Do Abstinence-Only Programs Discourage Teen Sex?" Congressional Quarterly Researcher 15(32): 761-784. Available from http://www.guttmacher.org/media/clips/2005/09/16/9_16_05_Teen_Sex.pdf.
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Landry, David; Lisa Kaeser; and Cory Richards. 1999. "Abstinence Promotion and the Provision of Information about Contraception in Public School District Sexuality Policies." Family Planning Perspectives 31: 280-286.
McGrath, James. 2004. "Abstinence-Only Education: Ineffective, Unpopular, and Unconstitutional." University of San Francisco Law Review 38: 665-700.
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Moran, Jeffrey. 2000. Teaching Sex: The Shaping of Adolescence in the 20th Century. Cambridge, MA. Harvard University Press.
Mosher, William; Anjani Chandra; Jo Jones; and the Centers for Disease Control. 2005. "Sexual Behavior and Selected Health Measures: Men and Women 15-44 Years of Age, United States, 2002." Available from http://www.cdc.gov/nchs/products/pubs/pubd/ad/361-370/ad362.htm.
Pardue, Melissa; Robert Rector; and Shannan Martin. 2004. "Government Spends $12 on Safe Sex and Contraceptives for Every $1 Spent on Abstinence." Heritage Foundation. Available from http://www.heritage.org/Research/Family/bg1718.
SIECUS (Sexuality Information and Education Council of the United States). 2006. "Guidelines for Comprehensive Sexuality Education." Available from http://www.siecus.org/pubs/guidelines/guidelines.
Simson, Gary, and Erika Sussman. 2000. "Keeping the Sex in Sex Education: The First Amendment's Religion Clauses and the Sex Education Debate." Southern California Review of Law & Women's Studies 9: 265-297.
Hazel Glenn Beh