Only 13 states require that HIV and sexual education be medically accurate.
Here, as early as age 4, school children are taught about their bodies and respect. By 8 years old, they learn about gender stereotypes and self-image. And by 11, they are introduced to the concepts of sexual orientation and the importance of safe sex and contraception.
Here, the teen pregnancy rate is 14 pregnancies for every 1,000 girls ages 15 to 19 and 4 births per 1,000 girls.
Here is the Netherlands — a world away from the United States, where the pregnancy rate is 57 for every 1,000 girls ages 15 to 19, and the birth rate 24 per 1,000 teen girls. While the CDC reports this as a record low, it notes that the teen pregnancy rate in the U.S. remains “substantially” higher than than in any other industrialized country.
The consequences are significant. The CDC reports that teen childbirth and pregnancy costs taxpayers at least $9.4 billion due to increased health and foster care. Only 50 percent of teen mothers receive a high school diploma by age 22, compared to 90 percent of those who did not have children during their teen years. The children of teen mothers are more likely to be incarcerated, unemployed and find themselves pregnant as teenagers.
Also, chlamydia, syphilis, and gonorrhea are on the rise for the first time since 2006. And Americans between the ages of 15 and 24 accounted for almost two-thirds of new chlamydia and gonorrhea cases.
Jonathan Zimmerman, a New York University professor and the author of “Too Hot To Handle: A Global History of Sex Ed,” is not ready to ascribe the Netherlands’ low teen pregnancy and birth rates to better sex education in their schools. He does point out that their purpose in teaching about sex is different than America’s.
“Historically,” he said, “in the United States, the sex education goal has been to prevent negative outcomes, that is STDs and pregnancy,” while in many parts of Europe, the goal is to promote positive outcomes by helping “to develop a positive sexual life.”
In addition, in the U.S. there are two competing methods vying for top billing in the classroom. One, known as comprehensive sex education, focuses on sexual risk reduction (SRR), and generally gives equal time to the benefits of contraception and safe sex as it does to the value of abstaining from sexual activity.
An abstinence-emphasized curriculum focuses on sexual risk avoidance (SRA), which discourages any sort of activity between two people that may be seen as a “gateway” to sexual activities.
“The truth for America is that we have two political sides with differing opinions who may never agree,” Zimmerman said. “Sex is intimately tied to our most basic assumptions about ourselves, and fundamentally [people] differ on it.”
Sex ed often not required — or even true
Those core differences can be seen in the vastly divergent ways that American schools teach sex education. In a country where implementing common standards for English and math sparked a revolt, it’s probably no surprise that there is no uniform sex ed curriculum.
And though there has yet to be a direct correlation between sex education and pregnancy rates, a 2014 report by the Guttmacher Institute examining the causes behind the record low teen pregnancy and birth rates notes that comprehensive sex education can do two powerful things — delay sexual activity and influence teens’ behavior when they do become sexually active.
The divide over the best way to educate America’s youth on sex is clearly visible in Washington, D.C. In early 2015, Congress increased funding for states that taught abstinence-emphasized curriculum by $25 million. But in early 2016, President Obama released his proposed budget for 2017 which cut $10 million in funding per year for abstinence-only education,
Given the ongoing disagreement over approach, the depth and accuracy of the sex education received by many American teenagers in the classroom (and maybe only there if their parents are uncomfortable with the topic) can depend largely on where they live.
Only 22 states and the District of Columbia require that sexual education be taught in schools, while 33 states mandate HIV education curriculums. Yet only 13 states require that HIV and sexual education be medically accurate.
A 2004 investigation “The Content of Federally Funded Abstinence-Only Education Programs” by U.S. Rep. Henry A. Waxman found that one curriculum identified tears and sweat as ways HIV is transmitted, information debunked long ago. Another stated that mental health issues and other personal problems — such as poverty, substance abuse, depression and suicide — can be avoided by remaining abstinent, while another suggested that these same problems were the direct result of sexual activity. None of these claims have any basis in science, according to the CDC.
One of the 37 states that doesn’t specify medical accuracy is Mississippi.
The teen birth rate there is 42.6 per 1,000 girls — roughly double the national rate. Further, contraception education and information on sexually transmitted illnesses may only be taught with direct permission from the state Board of Education.
Contrast that with New Jersey, where the teen birth rate is 14.8 per 1,000 girls: sex education and HIV education are mandated and must be medically accurate.
Across the country, California’s new sex education laws are going a few steps further. Beginning January 1, 2016, all school districts are required to not only teach comprehensive sex education including HIV/AIDS education, but also educate students on a number of other topics. These topics include instruction on gender identity, sexual orientation, decision-making and negotiation to overcome peer pressure, and in some cases, sexual harassment.
Nearby Utah takes a different approach. Sex education and HIV education are mandated, and must be medically accurate. That is, as long as the education promotes abstinence until marriage and stays away from any information on contraception, including a component that stipulates educators legally cannot answer “students’ spontaneous questions,” if the question conflicts with any parts of the law. In Utah the teen birth rate is 20.6 per 1,000 girls.
Sex ed in the Bible Belt
Perhaps nowhere are the rules more intricate than in Tennessee, where sex education and teen pregnancy are actually wed when it comes to the law: Sex education is only required to be taught in counties where the teen pregnancy rate is higher than 19.5 per 1,000 female students age 15-17.
And it only need be taught for one year (it used to be four but that requirement was recently lessened).
As of September 2015, there are 37 counties in Tennessee with a high enough teen pregnancy rate that sex education must be taught. But how enforced is the law?
Take Ripley and Halls high schools in Lauderdale County in western Tennessee, where the teen pregnancy rate is 25.6 per 1,000 female students. Only Halls could confirm that it has the required sex education requirement, known as Family Life Curriculum. At Halls High School, the content is taught through Right Choices, an outside group that comes into high schools around Tennessee to teach the Family Life Curriculum.
“None,” Shelley Smith, the guidance counselor at Halls High School in Halls, Tenn., said when asked how many students enrolled there were pregnant. Perhaps realizing how quickly that could change, she added half-jokingly, “Well now you’ve jinxed me. I’ll probably get a pregnant teen in my office next week.”
At nearby Ripley High School, school nurse Kristen Deaton sighed when asked about their teen pregnancy rate. She estimated there were five or six pregnant students this year — that she knew of. There is no curriculum in place for sex education at her school to her knowledge. There had been many discussions, she said, about the need for it at Ripley, but nothing has materialized.
The 74 called in March to confirm these numbers prior to publication. Smith confirmed there were still no pregnancies at Halls High School. “It’s odd,” she said, “Last year we had two or three and next year we could have a bunch. It varies.” An updated number from Deaton was not available at the time of publication.
No official sex education curriculum has been brought before the school board for approval, despite adults having discussed the need “many times,” according to Michelle Brazier, the director of coordinated school health/nurses for the Lauderdale County Department of Education.
Kim Hampton, a former nurse and executive director of Right Choices, spoke to The 74 about its work in western Tennessee. Of Ripley, she said, “We used to be there, but then their pregnancy rate went down and the state scoring levels were so low academically, so they needed more classroom time.”
She estimated they hadn’t taught a Family Life Curriculum at Ripley since 2012, but “they need to let us come back in there,” she said, “it’s mandated.”
The state Education Department did not respond to a request for comment regarding enforcement of implementing the Family Life Curriculum in schools where the pregnancy rate was higher than 19.5 pregnancies per 1,000 female students.
Tennessee is among the 27 states that requires abstinence be stressed as the only viable option for teens.
Like many other states dedicated to sexual risk avoidance education, the state forbids instructors from discussing or sharing any information that may “promote, implicitly or explicitly, any gateway sexual activity or health message that may encourage students to experiment.” The limitations on what can be talked about reflect the attitudes of the area.
“You have to remember,” Hampton said, “this is a majority Bible Belt conservative area. We believe in sexual risk avoidance.” And when it comes to covering contraception? “We can’t show how to use a condom” added the Right Choices coordinator, “and as a mother and as a nurse I think it would be inappropriate to do so. As a mother, I would be very upset if someone showed my teens how to use that.”
Regional mores in teaching teens about sex dominate the decision-making, says Zimmerman.
“Politically we need to be realistic about how in depth and explicit sex education can be in schools because of all the constraints,” the NYU professor said. “We need to be limited in what we expect our public schools to do, because they are locally controlled and take into account constituency and message.”
Abstinence and the “Mean Girls” approach
Those regional sentiments are not likely to be changed by a Columbia University study cited in the 2004 Waxman Report showing that comprehensive sex education that covers both the benefits of abstinence and effective use of contraception helps to delay sex among teens and increase the use of condoms and other forms of protection.
It also found that students who went through abstinence-only curriculums are less likely to use protection when they do engage in sexual activity, increasing their risk of sexually transmitted diseases.
Lauderdale County is not unique in Tennessee. In McMinn County, in the southeastern part of the state, the teen pregnancy rate is 31.9 per 1,000 girls. Family Life curriculum is taught there, as mandated.
The 74 spoke with Kaylee Huskey, who graduated from Central High School in McMinn County in 2007.
“There were no resources,” she recalls. “Sex really wasn’t discussed at all, and if it was, it was like you see in “Mean Girls” where you have a coach saying ‘If you have sex, you will get pregnant and die.’”
Huskey is now a nurse who did a rotation in women’s health through the Tennessee state health department. She recalls encountering “situations with a teen pregnant or with STDs who didn’t have any access to education or safety and had no idea what the symptoms they were complaining about meant, or where to go or who to talk to.”
So parents are as much to blame as educators when it comes to the lack of sexual education in Tennessee, she said, with many refusing to fill in the gaps that the schools leave in a child’s knowledge.
“A lot of parents didn’t want kids taking part in sex education. They didn’t want their child introduced to the possibility of sex,” she said. “But that’s unrealistic.”