American Sex Education

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When only 13 states in the nation require sex education to be medically accurate, a lot is left up to interpretation in teenage health literacy. Research published by the Journal of Adolescent HealthExternal link:open_in_new shows that when sex education is comprehensive, students feel more informed, make safer choices and have healthier outcomes — resulting in fewer unplanned pregnancies and more protection against sexually transmitted diseases and infections.
“Sex education is about life skills,” said Elizabeth Nash, interim associate director of state issues at the Guttmacher Institute.External link:open_in_new “There are so many aspects you take with you for the rest of your life, but you only get it once or twice in school.”
Of course, many young students pick up sexual health information from sources other than school: parents, peers, medical professionals, social media and pop culture. However, public school is the best opportunity for adolescents to access formal information. So what happens when that information isn’t regulated by the state? Teachers are left to interpret vague legislative guidelines, meaning information might not be accurate or unbiased.
State-by-State Sex Education Policies
The chart below compares the legislative policies of all 50 states, including how they mandate specific aspects of sex education like contraception, abstinence and sexual orientation.
While only roughly half of states in the U.S. require sex education, even fewer states have legislation requiring medical accuracy, inclusive language, and information about contraception. Go to a tabular version of Sex Ed Legislation in the United States.
What Does Comprehensive Sex Ed Look Like?
Even when sex education is required, state policies still vary widely regarding the inclusion of critical information. In short, comprehensive sex ed programs include “developmentally and culturally responsive, science-based and medically accurate information on a broad set of topics related to sexuality, including human development, relationships, personal skills, sexual health and society and culture,” according to the Sexuality Information and Education Council of the United States (PDF, 7.1MB).External link:open_in_new
USC Suzanne Dworak-Peck School of Social Work Department of Nursing professor Dr. Theresa Granger says that comprehensive sex ed goes beyond the biophysical aspects. 
“It’s about focusing on the emotional, psychosocial and economic impacts of what happens when youth and adolescents engage in sexual intercourse and other sexual practices,” she said.
Granger said that in order to be comprehensive, sex education programs have to consider the whole student. But many states leave issues like sexual orientation and contraception unaddressed, and some even prohibit public schools from addressing them.
“It’s hard to get legislators behind comprehensive sex ed,” said Nash, who explained that campaigning on controversial and sensitive topics can make lawmakers uncomfortable.
It can take years for policies to change, even in the most progressive states. California is known for pioneering reforms, but it wasn’t until 2016 that California passed a law to mandate comprehensive sex education in public schools.External link:open_in_new Before the new law went into effect last January, California left sex education as an optional component of health curricula for students in grades 7 through 12.
The legislation is part of a nationwide trend — albeit a slow and deliberate one — to transform disjointed sex education laws into comprehensive requirements that lead to better health outcomes for adolescents in public schools, says Nash, who has tracked sex education policies for over a decade.
Other states have a more volatile history with regulating sex education. In 2010, Wisconsin’s governor and legislature passed a law mandating comprehensive sex ed. Two years later, it was replaced with Wisconsin’s current abstinence-focused policy.External link:open_in_new
In recent years, states have begun to mandate sex ed to include information about learning life skills for family communication, avoiding coercion and making healthy decisions. According to Nash, including these skills is part of progressive trends across the country, where states have begun to require discussions of sexual consent, harassment and sexual orientation. Overall, most trends are slow to change.
“Most states will tweak the policies they already have to be more inclusive or double down on conservative regulations,” Nash said.
The Health Outcomes of Comprehensive Sex Education
The result of sex education policies becomes more clear when considering that in 2016, the United States had higher rates of teen pregnancy and sexually transmitted disease than most other industrialized countries,External link:open_in_new according to research published by the Guttmacher Institute in the National Library of Medicine. What feels like progress at the state level can be seen as mere catch-up to the policies of other developed nations that require teachers to discuss sex ed as early as kindergarten.External link:open_in_new
Granger said school programs need to work on adapting to current health issues and trends that affect the scope of sexual health literacy.
“There are rewards and consequences to our behavior at every age across the lifespan,” she said. “We can’t always assume that an adolescent will wait to become an adult before making adult decisions.”
Though the teen birth rate varies across states, studies show that teens have a lower risk of pregnancy when they have access to comprehensive sex ed and contraception. Go to a tabular version of Teen Birth Rates in the United States.
Even though the United States falls behind other industrialized nations in preventing teen births, its teen pregnancy rates hit an all-time low in 2016, a decade-long trend that has been attributed by many studies to increased education about contraception in public schools.
A report on comprehensive sex-ed published in the Journal of Adolescent Health in 2008External link:open_in_new concluded that when sex education included information about contraception, teens had a lower risk of pregnancy than adolescents who received abstinence-only or no sex education. The findings could alleviate a common fear of parents and teachers who worry that students are more likely to increase their sexual activity after receiving comprehensive sex education.
The more students can access accurate information from a trusted provider, the more prepared they can be when making decisions about their bodies and relationships. Granger said that in her clinical experience, teens will make a decision to engage in sexual activity whether or not they feel adequately informed, leaving health professionals with an opportunity to promote sexual health literacy.
“Teens will often reach out for education after they have made their decision,” Granger said. “When they reach out, it’s important for this education to be accurate and comprehensive, not biased or based on judgment.”
Sexually Transmitted Diseases and Infections
People ages 15 to 19 report more cases of STDs than any other age group, according to the CDC. Go to a tabular version of STDs Reported by Teens in the United States.
According to the CDC, teens who identify with LGBTQ communities can be at higher risk of contracting STDs,External link:open_in_new but safeguarding against transmissions becomes difficult when states prohibit teachers from discussing sexual orientation in class.
Some states expect that sexual orientation will get discussed at home, but the reality is that many students feel they lack the relationships to comfortably ask parents, teachers or peers about health information related to orientation.
“Teens who are healthy and in supportive relationships involving friends and family will often make much different decisions than those who aren’t,” said Granger, who has conducted research on the impact of relationships on adolescent development. “Stable, present and meaningful relationships with parents and other family members are all protective factors from a variety of interrelated risky behaviors.”
“In some states, teachers are allowed to answer questions from students, even if it focuses on a forbidden topic like STDs or sexual orientation,” Nash said. Though this loophole is disappearing in some states like Tennessee, it allows students to stay engaged in discussions that would otherwise exclude them because of focus on heterosexual relationships.
“More students are becoming open about their sexual identities and preferences, and schools have to address that,” Nash said. But discrepancies persist across communities over the responsibility of providing meaningful sex education.   
Having ‘The Talk’ About Safe Sex With Teens
One of the main challenges of mandating comprehensive sex education is considering everyone involved in the process: students, their classmates, parents, teachers and legislators. Teachers feel pressure from parents to deliver just the right amount of information, but students tune out when educators fail to address their individual questions.External link:open_in_new
So whose responsibility is it to make sure young people have the information they need to make healthy choices? In areas where sex ed isn’t required, states can assume that parents will educate their children at home, but some studies show that adolescents are increasingly more likely to seek information from social media and online communities,External link:open_in_new which can be more inclusive of gender and sexual minorities but not consistently reliable for medical accuracy.
Granger said assigning responsibility for “The Talk” is part of the problem that leaves teens uninformed.
One of the weaknesses in our current system is that we’re trying to assign primary responsibility, and it is too tall of an order for any single entity to try to tackle,” she said. When there’s a disconnect between the information students get at school and what they can find on the internet, mixed messaging makes it harder for teens to rely on the people they trust. When there’s a disconnect between the information students get at school and what they can find on the Internet, mixed messaging makes it harder for teens to rely on the people they trust.
That’s where medical professionals can step in, according to Granger. She currently practices inWashington, one of few states that allows minors to seek testing and treatment for STDs, as well as contraception, without consent from a parent or guardian, as indicated in a document on providing health care to minors in Washington state (PDF, 92KB).External link:open_in_new
“I do, however, tell patients’ parents about the minor’s consent to treatment law, and the fact that it was designed to help youth seek treatment for communicable disease,” Granger said. Though the conversations can be difficult, she said acknowledging the awkwardness can alleviate the tension around discussions of sexual health for parents and their children.
“Every practitioner handles this differently,” she said. “However, I always try to talk to the parents separately, the child separately, and then the parents and the child together.”
Encouraging openness and compassion helps parents and teens keep communication flowing with honesty, says Granger, and it is something all family nurse practitioners can do with their patients.
Sometimes the best place to start can be asking pediatric patients to talk about what they already know. Granger recommends asking, “What does having sex mean to you?” as a jumping-off point to deeper conversations.
“People developing these curricula, myself included, need to think about the common goal to help youth maintain a positive sense of self-esteem, work toward healthy life goals and make responsible decisions with their bodies,” Granger said. “We all need to do our part. We need to educate teens whenever and wherever they are.”
The following section contains tabular data from the graphics in this post.
Legislation for sex education falls under the jurisdiction of states’ rights, creating disparities in what public school students learn in classrooms across the country. The chart below indicates which states require critical components of comprehensive sex education and whether they mandate sex education at all.
States Where Sex Education Is Mandated
California
Delaware
District of Columbia
Georgia
Hawaii
Iowa
Kentucky
Maine
Maryland
Minnesota
Mississippi
Montana
Nevada
New Jersey
New Mexico
North Carolina
North Dakota
Ohio
Oregon
Rhode Island
South Carolina
Tennessee: Sex education is required if the pregnancy rate for women ages 15-17 is at least 19.5 or higher.
Utah: State also prohibits teachers from responding to students’ spontaneous questions in ways that conflict with the law’s requirements.
Vermont
West Virginia
States Where Sex Education Must Be Medically Accurate When Taught
California
Colorado
Hawaii
Illinois
Iowa
Maine
Michigan: Sex education “shall not be medically inaccurate.”
New Jersey
North Carolina
States Where Sex Education Must Cover Contraception
Alabama
California
Colorado
Delaware
District of Columbia
Hawaii
Illinois
Maine
Maryland
Mississippi: Localities may include topics such as contraception or STIs only with permission from the State Department of Education.
New Jersey
New Mexico
North Carolina
Oregon
Rhode Island
South Carolina
Vermont
Virginia
Washington
West Virginia
States Where Sex Education Must Cover Abstinence
North Dakota
Vermont
Virginia
West Virginia
States Where Sex Education Must Stress Abstinence
Alabama
Arizona
Arkansas
Delaware
Florida
Georgia
Illinois: Sex education is not mandatory, but health education is required and includes medically accurate information on abstinence.
Indiana
Louisiana
Maine
Massachusetts
Mississippi
Missouri
New Jersey
North Carolina
Ohio
Oklahoma
Oregon
Rhode Island
South Carolina
Tennessee
Texas
Utah
Washington
Wisconsin
States Where Sex Education Must Be Inclusive of Sexual Orientation
States Where Sex Education Must Be Negative Toward Sexual Orientation
Alabama
Arizona: If HIV education is taught in Arizona, it cannot “promote” a “homosexual lifestyle” or portray homosexuality in a positive manner.
Oklahoma: Mandated HIV education in Oklahoma teaches that, among other behaviors, “homosexual activity” is considered to be “responsible for contact with the AIDS virus.”
South Carolina
Texas
Alaska
Kansas
Nebraska
South Dakota
Wyoming
Source: Guttmacher Institute, 2017. https://www.guttmacher.org/state-policy/explore/sex-and-hiv-education
Teen Birth Rates in the United States arrow_upwardReturn to graphic
Though the teen pregnancy rate has hit a historic low in the United States, the nation still holds one of the highest rates in the developed world. This chart shows states’ disparate birth rates for women ages 15 to 19 in 2015, according to the CDC.
Births per 1,000 women ages 15 to 19 estimated in each state
Alabama 30.1
Alaska 29.3
Arizona 26.3
Arkansas 38
California: 19
Colorado: 19.9
Connecticut: 10.1
Delaware: 18.1
District of Columbia: 25.6
Florida: 20.8
Georgia: 25.6
Hawaii: 20.6
Idaho: 22.5
Illinois: 21.1
Indiana: 26
Iowa: 18.6
Kansas: 25.5
Kentucky: 32.4
Louisiana: 34.1
Maine: 15.4
Maryland2: 17
Massachusetts: 9.4
Michigan: 19.4
Minnesota: 13.7
Mississippi: 34.8
Missouri: 25
Montana: 25.3
Nebraska: 22
Nevada: 27.6
New Hampshire: 10.9
New Jersey: 12.1
New Mexico: 34.6
New York: 14.6
North Carolina: 23.6
North Dakota: 22.2
Ohio: 23.2
Oklahoma: 34.8
Oregon: 19
Pennsylvania: 17.7
Rhode Island: 14.3
South Carolina: 26.2
South Dakota: 26.4
Tennessee: 30.5
Texas: 34.6
Utah: 17.6
Vermont: 11.6
Virginia: 17.1
Washington: 17.6
West Virginia: 31.9
Wisconsin: 16.2
Wyoming: 29.2
Source: Centers for Disease Control and Prevention, 2015 https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_01.pdf
STDs Reported by Teens in the United States arrow_upwardReturn to graphic
People ages 15 to 24 only make up 25% of the American population, but they account for 50% of all new STDs reported in 2013, which raises concerns from medical professionals about the scope of sex education.
People can report having more than one STD within a year; this data reflects the rate of cases per 1,000 people in the 15–24 age group estimated in a state.
Alabama: 40.388
Alaska: 36.139
Arizona: 25.274
Arkansas: 34.465
California: 20.683
Colorado: 21.065
Connecticut: 20.662
Delaware: 34.614
District of Columbia: 42
Florida: 25.963
Georgia: 31.347
Hawaii: 22.959
Idaho:17.112
Illinois: 31.336
Indiana: 26.039
Iowa: 19.793
Kansas: 21.67
Kentucky: 24.424
Louisiana: 40.515
Maine: 14.916
Maryland: 27.75
Massachusetts: 17.29
Michigan:28.32
Minnesota: 20.877
Missouri: 28.951
Montana: 20.241
Nebraska: 21.84
Nevada: 23.897
New Hampshire: 12.944
New Jersey: 19.689
New Mexico: 29.765
New York: 25.651
North Carolina: 31.963
North Dakota: 20.577
Ohio: 30.583
Oklahoma: 29.578
Oregon: 19.3
Pennsylvania: 26.032
Rhode Island: 20.014
South Carolina: 34.17
South Dakota: 26.481
Tennessee: 30.013
Texas: 28.406
Utah: 11.157
Vermont: 15.603
Virginia: 23.954
Washington: 18.619
West Virginia: 18.32
Wisconsin: 24.407
Wyoming: 18.596
Data Source: National Electronic Telecommunications System for Surveillance, Centers for Disease Control and Prevention, 2013.
https://www.cdc.gov/nchhstp/newsroom/2014/std-surveillance-report.html

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There is broad public support for sex ed, but many young people are still not receiving the sex education they need.
Sex Education is widely supported by the vast majority of people in the United States. In Planned Parenthood’s most recent poll on sex education, 93 percent of parents supported having sex education taught in middle school, and 96 percent of parents supported having sex education taught in high school. The vast majority of parents support sex education in middle school and high school that covers a wide range of topics, including STDs, puberty, healthy relationships, contraception, and sexual orientation. Other national, state and local polls on sex education have shown similarly high levels of support.
Sex education is supported by numerous prestigious health and medical organizations including the American Medical Association, the American Academy of Pediatrics, and the Society for Adolescent Health and Medicine. Over 150 organizations are members of the National Coalition to Support Comprehensive Sexuality Education.
Sex Education programming varies widely across the United States. Currently, 24 states and the District of Columbia mandate sex education and 34 states mandate HIV education. Although almost every state has some guidance on how and when sex education should be taught, decisions are often left
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