Archive for month: October, 2023
By: Samantha Hollinshead, J.D. Candidate, Sandra Day O’Connor College of Law, Arizona State University, and
Jennifer L. Piatt, J.D., Co-Director, Center for Public Health Law and Policy, Sandra Day O’Connor College of Law, Arizona State University
Sexual education has historically focused on disease and pregnancy prevention. In 2009, the United Nations (UN) moved towards a more holistic approach, defining “comprehensive sexual education” (CSE) as (1) “scientifically accurate,” (2) “incremental,” (3) “age-and developmentally appropriate,” (4) “curriculum based,” (5) “comprehensive,”[i] (6) “based on a human rights approach,” (7) “based on gender equality,” (8) “culturally relevant and context appropriate,” (9) “transformative,”[ii] and (10) focused towards development of life skills needed to “support healthy choices.”
Extensive research has indicated that CSE is generally effective in producing positive public health outcomes such as reducing teen pregnancy and HIV rates. CSE is most effective when educators provide accurate information on a range of topics, empowering students to take ownership of their physical and emotional development. Deliberately excluding critical aspects of sexual education, including menstruation, gender identity, and sexual orientation, reduces its overall efficacy, contributes to misinformation, and leads to greater risk-taking, precipitating broader public health implications.
CSE has not been uniformly adopted in the U.S. despite the U.S. having the highest rates of teen pregnancy among industrialized countries, per various studies conducted over the past several decades.[iii] Current law and policy approaches to sexual education in the U.S. resemble a checkerboard of state requirements that do not reflect the UN’s CSE guidance. As described below, the health of American populations may benefit extensively from domestic implementation of CSE programs as compared to other nations. Yet, profound political, social, and legal complications toward this realization exist across multiple U.S. jurisdictions on three key CSE determinants: (1) age limitations; (2) abstinence-only education; and (3) LGBTQ+ inclusivity.
Age and Informational Limitations
Even though providing broad and accurate information makes CSE more effective, some U.S. states are continuing to pass legislation or operate programs that directly limit access to sexual education. Florida’s House Bill 1069, signed by Governor Ron DeSantis in May 2023, expressly restricts health education, including discussions on puberty, to students in 6th – 12th grades. The average age individuals assigned female at birth start their periods is just over 12 years, but some start as early as 8 years. By limiting the age at which health education is taught, individuals assigned female at birth may lack vital information until after they have already begun menstruating. Poor period hygiene can result in the spreading of diseases (e.g., bacterial vaginosis, urinary tract infections, hepatitis B) and long-term reproductive issues, including complications during birth and infertility.
Comparatively, in the Netherlands, CSE starts as young as 4 years of age. Students receive education about their physical development, ways to prevent adverse health outcomes, body image, and healthy relationships, among other topics. Consequently, Dutch teen pregnancy and HIV infection rates in 2021 were among the lowest in the world among industrialized countries, due partly to incorporating CSE principles into the curriculum at a young age.
Approaches to Combat Misinformation
Abstinence-only sexual education has been proven ineffective in diminishing risky behaviors and contributes to misinformation rooted in stigma and fear-based tactics. Still, according to the Guttmacher Institute, educators in 29 U.S. states, including Arizona, are required to stress the importance of abstinence in sexual education. In 2011, Zambia introduced components of CSE to address the spread of misinformation extending from students receiving inaccurate and outdated guidance online or from family members. Consequently, Zambian health authorities measured a roughly 7% decrease in unintended pregnancies from 2010 and 2019 and a 50% drop in new HIV infections between 2011 and 2021. Zambia’s program, though, lacks inclusivity of LGBTQ+ individuals, so still does not fully meet the UN’s definition of CSE.
LGBTQ+ Inclusivity
Currently, only eleven U.S. states require sexual education curricula to address sexual orientation inclusively. In fact, Florida, Kentucky, and Louisiana, among other states, have legislatively banned discussions on gender identity or sexual orientation in schools. While some states have not outright banned inclusive sex education, states such as North Carolina require educators to emphasize monogamous heterosexual marriages. Limiting LGBTQ+ students’ access to relevant sexual education further entrenches social stigma and discrimination lending to significant health related repercussions, including sexual violence and unintended pregnancies. Importantly, some states have recently moved in more inclusive directions. In 2019, Arizona eliminated an educational requirement to “promote honor and respect for monogamous heterosexual marriage.”
Estonia was the first post-Soviet Union country to introduce comprehensive sexual education in schools and currently implements a highly regarded CSE program. Estonia’s CSE curriculum, introduced in 1996, was updated in 2011 to include LGBTQ+ individuals. Estonia has experienced a marked improvement in sexual health indicators since its adoption of CSE, with abortions falling by 37%, sexually-transmitted infections by 55%, and HIV-specific infections by a whopping 89% from 2001 to 2009.
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International comparisons illustrate the significant public health benefits of CSE among school-age children. Timely, adaptive, accurate, and meaningful sexual education reinforces their physical and mental well-being and helps ensure students can make informed and responsible decisions. While there are myriad legal and political reasons why CSE is not adopted more broadly across the U.S., its uniform implementation could provide similar benefits for American school students burdened with the negative public health consequences of inadequate sexual education.
The legal information and assistance provided in this document do not constitute legal advice or legal representation. Views expressed in this piece are those of the authors alone.
[i] UNESCO, International Technical Guidance on Sexuality Education (2018), https://unesdoc.unesco.org/ark:/48223/pf0000260770 (finding an educational program comprehensive if it addresses a wide range of sexual and reproductive issues including anatomy, physiology, reproduction, puberty, contraception, menstruation, childbirth, and STIs).
[ii] Id. (defining educational programs as transformative if they encourage development of critical thinking skills and healthy attitudes towards sexual and reproductive health in an effort to foster compassionate citizens).
[iii]Gilda Sedgh et al., Adolescent Pregnancy, Birth, and Abortion Rates Across Countries: Levels and Recent Trends, 56 J. Adolescent Health 223 (2015), https://www.sciencedirect.com/science/article/pii/S1054139X14003875?via%3Dihub;Susheela Singh and Jacqueline E. Darroch, Adolescent Pregnancy and Childbearing: Levels and Trends in Developed Countries, 32 Fam. Plan. Persp. 14 (2000), https://www-jstor-org.ezproxy1.lib.asu.edu/stable/2648144?origin=crossref.