Inconsistent state laws undermine sexual education across the United States

While the majority of states require public school students to take at least one sexual education course, a patchwork of state-level provisions that mandate inaccurate, outdated, or politically motivated curricula may inhibit students from receiving essential information for their sexual health and well-being. 

Despite overwhelming evidence of the health benefits of school-based sexual education, no federal law requires schools in the United States to teach this subject. As a result, the decision to provide sexual education to students falls to states or local school districts, leaving a patchwork of inconsistent, inequitable, and often inaccurate instruction that could leave students ill-equipped to make informed decisions about their sexual health, relationships, and well-being.

A new study that aimed to better understand and assess current sexual education laws in the US found that while 42 states require public school students to take a sexual education course that covers at least one topic within this subject between kindergarten and high school, only 19 states mandate that this instruction be medically accurate-and 5 of those states only require medical accuracy for specific topics.

Led by a Boston University School of Public Health researcher, the study found that 34 states that mandate this education require instruction on abstinence, a method that has consistently proven to be ineffective or harmful to adolescent sexual health, but continues to be embraced and funded by the federal government. Thirty-four states also allow parents to opt their children out of receiving any sexual education instruction, while five states require parents to opt in for their children to receive this instruction. The findings were published in the American Journal of Public Health.

Adolescents are at a disproportionate risk of experiencing sexual health conditions, including sexually transmitted diseases and HIV/AIDS, as well as unwanted pregnancies, and unhealthy relationships. Many states have amended their sexual education laws over the five years, and researchers hope this new insight will spur additional policy changes that expand adolescents' access to comprehensive, inclusive, and age-appropriate education and improve their sexual health and well-being.

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. 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." 

Dr. Kimberly Nelson, study lead and corresponding author, associate professor of community health sciences at BUSPH

For the study, Dr. Nelson and colleagues from BUSPH, Cornell Law School, and Florida International University identified and analyzed state statutes, administrative regulations, and state court decisions that mandated sexual education in public schools in every US state and Washington, D.C., and also examined sexual education content requirements and parental notice and consent policies. 

These state mandates varied by region, with all Northeast states requiring school-based sexual education for at least one topic, followed by 88 percent of states in the South, 83 percent of states in the Midwest, and 62 percent of states in the West.

In addition to abstinence, 34 states mandate school instruction about HIV, while 32 states require education about STIs, and 31 states mandate instruction on child abuse prevention. While less common, 27 states require instruction about healthy relationships, 24 states require education about sexual assault, and 21 states require instruction about dating violence or intimate partner violence.

Only 20 states require instruction about contraception, and even fewer mandate instruction about sexual orientation (12 states), condoms (11 states), and consent to sex (9 states). Two of the 12 states (Oklahoma and Texas) that mandated instruction about sexual orientation also required the use of stigmatizing or otherwise negative messaging, such as the idea that same-sex activity is "primarily responsible" for AIDS exposure.

The researchers note that more studies are needed to understand the extent to which parental opt-in and opt-out policies, as well as parents' rights to review or receive advance notice of sexual education curricula, limit the effect of state sexual education mandates. But they acknowledge that these policies likely serve as political compromises that may be difficult to reverse. 

"Because policy decisions about sexual education curricula happen at the state-level, state-level sociopolitical forces exert substantial influence on sexual education," Dr. Nelson says. These forces also help explain why sexual education in school still embraces abstinence-only instruction, versus more comprehensive approaches, she 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."

The senior author of the study is Dr. Kristen Underhill, associate dean for faculty research and professor of law at Cornell Law School.