U.S. school based programs fall into one of the two broad categories: abstinence only and comprehensive. Abstinence only programs aim to defer sexual activity entirely until older or married. Strict abstinence only programs aim to teach only abstinence from sex as the best way to avoid unwanted pregnancy, HIV, and STDs. While practicing abstinence is 100% effective in controlling negative outcomes, abstinence only education is not effective. Toups and Holmes (2002) reviewed a number of abstinence based program evaluations and found evidence of lower sexual activity and pregnancy rates in program participants. However, other research has been contradictory. One cohort study of so-called virginity pledgers found that the pledgers delayed sexual intercourse for an average of 18 months. However, they were less likely to use contraception when they began having intercourse, and six years later had similar rates of STDs to their peers (Santelli et al., 2006). In other words, the positive results were not long lasting and the pledgers were more compromised in their use of contraceptives. In 1993, The World Health Organization reported that comprehensive programs that covered abstinence, contraception, and STD prevention were more effective in reducing risky behavior in young people (Starkman N & Rajani N, 2002).
Many state guidelines and individual curriculums fall somewhere in between these broad categories. In general, all of the programs aim to reduce sexually risk behaviors among teens, therefore reducing such outcomes as HIV and STD transmission, teen pregnancies, and abortion.
For Americans, the broad majority (90%) of high school parents believe that it is important for their children to receive sexual education in school. Majority of them also want teens to learn about delaying sex (95%) and how to make sexual choices based on individual values (91%) (Santelli et al., 2006). While no parent wants to see their child burdened with a disease, unplanned pregnancy, or coercion into sexual activity, many parents also do not want their children taught in a way that contradicts their family values, whether their values are liberal or conservative, Christian, or secular. Since not every state mandates a certain type or any programming, some parents and students may want the education and find that their school district doesn’t offer it or doesn’t offer the type they would like. This represents a lack of distributive justice in what is available for students. In these cases, programming might need to shift to respect these values while still accommodating those who disagree and the most vulnerable students. In Sarasota County, FL, a school board had engaged Planned Parenthood speakers to teach on certain topics for sexual education in their schools. Some parents and board members began to voice complaints after hearing of the Planned Parenthood involvement due to the organization’s association with abortion. Eventually the school board was forced to create a compromise (Planned Parenthood of Florida, 2014). In Poudre, CO, an advisory board worked to bring together a curriculum that was “relevant for 10th graders while conforming to community norms.” Their goal was to meet the needs of all students including those were gay, Christian, sexually active, and abstinent (Vail, 2005). These examples show how community members can help influence or even develop curriculums that meet their needs and reflect community values.
Alternatives in the Community
Concerning informed consent options for parents, as of 2011 all but five states have an opt-out policy, and those five have opt-in programming (Stanger-Hall & Hall, 2011). All states then theoretically give parents full autonomy over their child’s education, so that no child will have to undergo education that clashes with parental values. States such as Idaho view sexual education as being inseparable from the local home and church environments, and allow local school boards to choose a program with the goal of supplementing the values of local families, churches, and culture (NASBE, n.d.). Although this policy leaves the possibility of inadequate education, it also shows admirable respect for the community (Ataguba & Mooney, 2011). An alternative might be to supplement education through programs offered elsewhere through community based programs. A successful chlamydia reduction program for youth in Florida partnered with other entities such as the local health department, community centers, churches, and a Boys and Girls Club. The program also included curriculum to teach parents how to become their children’s “primary sexuality educators” (National Center for HIV/AIDS Prevention, 2012). Chlamydia rates for the affected county went from 2nd in the state (2008) to 40th (2012).
Discrimination in Sexual Education Policies
The trend concerning higher teen pregnancy rates in abstinence-only states reveals some discrimination against minority teens. The states with abstinence only education tend to have higher numbers of black teens (Stanger-Hall & Hall, 2011). Young black and Hispanic women disproportionately account for 75% of HIV infections among women (Collins et al., 2002), another reason to reexamine the effectiveness of interventions in these states. Some states, including Arizona and Alabama, require that sex education emphasize only an ideal of heterosexual behavior and specify that homosexual behaviors cannot be promoted or taught as acceptable (NASBE, n.d.). Given that homosexual/bisexual/transgender people are especially at risk for HIV (Collins et al., 2002), the danger is real that these programs will deny education to the adolescents most likely to be at risk. These curriculums may also stigmatize LGBT youth depending on what is taught about homosexuality. Under Alabama state law sex education must teach that “homosexuality is not a lifestyle acceptable to the general public and that homosexual conduct is a criminal offense under the laws of the state” (NASBE, n.d.).
The United States lags behind other developed nations on measures of teen pregnancies and STDs. Although sex education policies are complex, answers can be found. Comprehensive programs appear to be more effective in achieving public health goals, but parents need to have opportunity to maintain some autonomy over the children’s education (Ataguba & Mooney, 2011). Because states are free to set their own requirements, sexual education is not equally available to all students. Some populations such as the LGBT population may have even less access. To ethically choose a curriculum, one must acknowledge the contributors, and consider effectiveness, local values, and culture.