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    Sexed

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    Virtual Mentor

    Ethics Journal of the American Medical Association


    October 2005, Volume 7, Number 10

    Medicine and Society


    Sex Education in the Public Schools
    by Robynn Barth

    Today’s kids are inundated with sex. There is nudity on the Internet, sex in the movies,
    and intimations of sex in popular music. All schools and teachers face the problem of
    how to help these kids grow into sexually healthy adults by encouraging safe behaviors
    without stepping on the toes of their parents. Two types of sex education programs
    have evolved in response to this challenge—abstinence-only sex education and
    abstinence-plus (sometimes called “comprehensive") sex education.

    How the Curricula Differ


    The 2 types of curricula share the same strong message: the only sure means of avoiding
    teenage pregnancy or sexually transmitted diseases (STDs) is abstinence. Where they differ is
    whether or not they include discussion of contraception. Joe McIlhaney, Jr, MD, of
    the Medical Institute for Sexual Health, is a prominent spokesman for abstinence-only
    programs. He explains that the only information these programs provide about
    contraception is its failure rates [1]. In the mind of an adolescent, critics say, this
    equates to saying about contraceptive devices, “they don’t work, therefore don’t use
    them.” In most schools, though, abstinence-only education means " we definitely won’t
    talk about contraception."

    A Boom in Abstinence-only Programs


    In 1996, President Bill Clinton signed into law the “welfare reform act," which
    appropriated $50 million in funds for school-based sex education programs that
    focused exclusively on abstinence as a means to prevent pregnancy and STD
    transmission. Since then, there has been an influx of published curricula as federal
    funding for abstinence-only education has shot up: $80 million in 2001, and $167
    million in 2005. President Bush’s proposed 2006 budget appropriates $206 million for
    these programs [2]. This is exciting news for most districts; it equates to free teaching
    materials. Yet any school choosing the “abstinence-plus” format will not receive any
    of this federal money.

    Problems with Current Studies of Abstinence-only


    After the initial funding boom many states instituted a variety of abstinence-only
    programs, prompting myriad studies to assess the effectiveness of the curricula.
    Advocates for Youth compiled evaluations from several states after the first 5-year
    funding cycle came to a close. Their conclusion was that the programs implemented
    showed “little evidence of sustained (long-term) impact on attitudes” toward sex [3].
    They also asserted that the evaluations showed “some negative impacts on youth’s
    willingness to use contraception, including condoms.” The curricula evaluated in the

    Virtual Mentor, October 2005


    701
    Advocates for Youth study, as well as other abstinence-only material, face a huge
    limitation: none has been around long enough to show evidence of success in delaying
    sexual initiation among youth.

    A second problem in determining which format is more successful is that the 2 types
    of curricula are not being compared to each other in any studies. Dr McIlhaney’s
    studies publicize success with the abstinence-based programs, but typically the
    abstinence-only curricula are being compared to simple abstinence lectures [1]. Studies
    have found that 1 year later, students who experienced the curricula have a
    significantly better understanding of the importance of abstinence than students who
    received the lecture. That should go without saying.

    States are saying “No” to abstinence-only curricula.


    Douglas Kirby, PhD, an authority on abstinence-plus sex education, has reviewed
    research on a wide range of curricula. He identifies 10 common characteristics of
    effective sex education programs [4]. My home state of Washington has chosen to
    base its Guidelines for Sexual Health Information and Disease Prevention on these distinctive
    attributes. Washington is one of many states that encourages its schools to adopt a
    more comprehensive approach to sex education and, in so doing, to forgo the federal
    funding available for implementing abstinence-only curricula. This particular subject
    area is the only one that is state-mandated; the law states that all schools shall provide
    “the minimum requisites for good health including the beneficial effect of physical
    exercise and methods to prevent exposure to and transmission of sexually transmitted
    diseases” [5]. The state further identifies guidelines for human immunodeficiency virus
    (HIV) education in The Acquired Immunodeficiency Syndrome (AIDS) Omnibus Act.
    This law requires that all students, beginning no later than the fifth grade, must receive
    education on the dangers of AIDS, its transmission, and its prevention [6]. The state
    provides HIV education curricula for grade levels 5-12 and requires that school
    districts either use it or develop their own and get it approved for medical accuracy by
    the state Department of Health Office on HIV/AIDS [7].

    How a District Decides What to Teach


    The number of different-but-really-the-same curricula available is overwhelming.
    Many districts decide to reuse a previously adopted health textbook (which may be
    from 2002 or may be from 1993, depending on appropriation of funds). There are also
    supplemental materials available from acne and feminine product companies; they
    provide fun, puberty-related materials with their corporate name plastered on them (a
    form of free advertisement). Some parents are uncomfortable having their children
    learn about sex in school, so most districts offer parents a way to “opt out” on behalf
    of their child. One district I worked in allowed a parent group to choose abstinence-
    only curricula and find community members to deliver it to students during the school
    day. Other districts leave it up to the individual schools to decide what to teach.
    In my district, there is a small high school with a high pregnancy rate. The health
    teacher told me that, when he was hired, the principal gave him the health textbook
    and told him to teach whatever he wanted to—except for the parts about the
    reproductive system. That administrator’s discomfort with the subject has contributed
    to life-changing events for many families in our community.

    www.virtualmentor.org
    702
    Tips for Physicians
    Physicians can greatly assist in teaching sex education by helping parents out of their
    denial. I believe that at each yearly physical exam during the adolescent years the
    physician should hand the parent a brochure about sex: how to talk about it, the rates
    of sexual behaviors based on age, and possible warning signs of sexual activity. Simply
    having such materials on a stand in the lobby does not help. No child wants to be seen
    with a parent who picks up that brochure, and not all parents realize they need to have
    that conversation with their child. If the physician sends a message to the parent with
    the kid present, no one can hide the elephant in the room.

    What I Have Seen as a Teacher


    Some of the abstinence-only studies show promising findings when, one year later,
    middle school students still have positive attitudes about remaining abstinent [8]. What
    they don’t have are the responses from these same kids when they are juniors in high
    school. As the pressures to be sexually active increase, attitudes change. I have had
    discussions with quite a few middle school kids who believe they are safe because they
    are “virgins.” What they fail to understand, and what must be taught to them and their
    parents as early as the 8th grade is that you don’t have to have sexual intercourse to be
    infected by an STD. Every time I teach about STDs to a new group of 8th graders, I
    see looks of fear upon the faces of some of the girls. These looks give them away.
    Today’s kids are having sex. We cannot control the sexual pressures they face, but we
    can shape their response to those pressures. We can do so by providing them with
    factual information about the transmission, progression, and prevention of sexually
    transmitted diseases. Their bodies are being run by that drill sergeant of a pituitary
    gland, and the hormones are completely in charge. If we don't fit in a few facts about
    the risks of following the sexual desire portion of these hormones, then we are doing a
    great disservice to these children and to our society.

    References
    1. McIlhaney J. Interview for background research on the PBS special The Education of
    Shelby Knox. Available at:
    http://www.pbs.org/pov/pov2005/shelbyknox/special_interviews_3.html. Accessed
    July 10, 2005.
    2. McDermon D. Research from the PBS special The Education of Shelby Knox. Facts &
    Stats. Available at:
    http://www.pbs.org/pov/pov2005/shelbyknox/special_overview.html. Accessed July
    10, 2005.
    3. Hauser D. Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact.
    Washington, DC: Advocates for Youth; 2004. Available at:
    http://www.advocatesforyouth.org/publications/stateevaluations/index.htm.
    Accessed July 10, 2005.
    4. Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy.
    Available at: http://www.teenpregnancy.org/resources/data/report_summaries/
    emerging_answers/default.asp. Accessed July 10, 2005.
    5. Wash Rev Code. Sec 28A.230.020. Available at:
    http://www.leg.wa.gov/RCW/index.cfm?section=28A.230.020&fuseaction=section.

    Virtual Mentor, October 2005


    703
    Accessed August 14, 2005.
    6. Wash Rev Code. AIDS Omnibus Act. Sec 28A.230.070. Available at:
    http://www.leg.wa.gov/RCW/index.cfm?section=28A.230.070&fuseaction=section.
    Accessed August 14, 2005.
    7. Washington Office of Superintendent of Public Instruction (OSPI). Sex Education
    Expectations. Available at:
    http://www.k12.wa.us/curriculumInstruct/healthfitness/prevention.aspx. Accessed
    July 10, 2005.
    8. Pfleiderer J. Abstinence Education Programs Increased Youth’s Support for Abstinence; Effects
    on Expectations to Remain Abstinent Less Clear. Study conducted by Mathematica Policy
    Research, Inc. June 14, 2005. Available at: http://www.mathematica-
    mpr.com/Press%20Releases/abstinence.asp. Accessed August 14, 2005.

    Robynn Barth is a middle-school health teacher in a small Washington state school district.

    The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views
    and policies of the AMA.

    Copyright 2005 American Medical Association. All rights reserved.

    www.virtualmentor.org
    704

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