There’s overwhelming evidence that school-based sexual education provides tangible, lasting health benefits for children. There’s no federal law that requires schools in the US to teach this subject, but most US states still mandate some sex ed. That sounds pretty promising but here’s the thing: few require accuracy and abstinence still dominates.
“While many students in the US are required to get some form of sexual education, our study shows that substantially fewer students are likely to be getting the comprehensive sexual education that public health and medical associations recommend,” says study lead and corresponding author Kimberly Nelson, associate professor of community health sciences.
In the end, the American education system has become a patchwork of inconsistent policies where the quality and accuracy of education depends less on science and more on politics.
Sex Ed Is a Health Topic, But It’s Been Politicized
For decades, the US Congress has politicized sexual education, even though the evidence is increasingly clear. Multiple reviews and studies show that abstinence-only programs don’t delay sex or reduce teen pregnancy/STIs. They don’t seem to be better than doing nothing. It’s such a bad approach that one study went as far as saying that abstinence-only programs “threaten fundamental human rights to health, information, and life.”
The “abstinence” approach means telling students not to have sex until marriage. Oftentimes, it omits or minimizes practical instruction on contraception and condoms, and frames sex outside marriage negatively. The American Academy of Pediatrics recommends against the use of abstinence-only sex education. They note that the approach is ineffective.
Yet, abstinence is the most common sex-ed topic in K-12 education, present in 34 states. The stats get even more shocking: only 19 states require the material to be medically accurate. Plus, five of these 19 limit the accuracy to specific topics.
“Only 58 percent of students reside in a jurisdiction that requires sexual education to be medically accurate, and many jurisdictions have content mandates that extend only to a few topics. This means that many US students are living in jurisdictions where they are unlikely to receive the accurate and comprehensive information that we know will help them make informed, healthy choices about their sexual behaviors and relationships.”
This is all the more discouraging because comprehensive sex ed, especially when done in an accurate way, is linked to lower teen pregnancy and fewer risky behaviors. Yet it’s not evidence that’s backing most states’ policies.
What The Researchers Found
For the study, Nelson and colleagues from several research institutions identified and analyzed state statutes, administrative regulations, and state court decisions that mandated sexual education. They looked at public schools in every US state and Washington, DC, analyzing sexual education content requirements and parental notice and consent policies.
They found a great deal of variation. For instance, 34 states require school instruction about HIV, while 32 require education about STIs. Just 27 states require education on healthy relationships, and just 24 on sexual assault. A mere 20 states require instruction about contraception. Even fewer mandate instruction about sexual orientation (12 states), condoms (11 states), and consent to sex (9 states).
The result is a patchwork of classrooms. Some kids learn how to protect themselves accurately while many others hear little more than “just don’t do it.” And of course, the effects are showing: the U.S. still records millions of new STI cases every year, with teens and young adults hit hardest. Congenital syphilis (babies born with the disease) has surged to record highs.
Meanwhile, opt-out rules, parental consent laws, and outright bans on LGBTQ+ content act as escape hatches for lawmakers. They appease vocal advocacy groups while keeping science on the sidelines. This endangers children by presenting them misleading or incomplete information.
“Because policy decisions about sexual education curricula happen at the state-level, state-level sociopolitical forces exert substantial influence on sexual education,” Nelson says. “In states where sociopolitical forces and vocal advocacy groups push an abstinence-focused approach, that approach is likely to be seen as politically advantageous and be adopted.”
For decades, Congress has shoveled millions into abstinence-first programs, now rebranded with the friendlier-sounding label “sexual risk avoidance.” Federal money still props up this approach, even though it fails at its own stated goal. The Trump administration doubled down, slashing grants for comprehensive programs and proposing more cash for abstinence-only education. This will likely end up being a generational problem for US children.
Sex ed should be about keeping kids healthy. Instead, it’s treated as a culture-war football, leaving students to pay the price.
The study was published in AJPH.
