Comprehensive Sexuality Education Adalah
Abstinence Education Grant Program (AEGP)
Historically, funding for abstinence education has always been favored over CSE. In 1996, during Bill Clinton's presidency, legislation was passed to promote abstinence in education programs. Under Title V Section 510 of the Social Security Act, the Abstinence Education Grant Program (AEGP), was passed. AEGP has always been renewed before its expiration date, and each time funds gradually increase from fifty million dollars per year to seventy-five and as high as $6.75 million per state grant in 2015. The way the funds are disbursed are based on the proportion of low-income children in each state. So far, thirty-six states have been given AEGP funds.[5]
Part of Section 510(b) of Title V of the Social Security Act, contains the "A-H guidelines", which are the eight criteria that programs must abide by order to be eligible to receive federal funding.[42] They are as follows:
In addition to abiding by these 8 conditions, AEGP compliant programs cannot discuss contraception, STIs, or methods for protecting against STIs, except when describing failure rates.[5]
Sexual content in the media
Since 1997, the amount of sexual content on TV has nearly doubled in the United States.[43] Additionally, a study done in 2008 showed that nearly 40% of popular music lyrics contained sexual references which were often sexually degrading. These lyrics were also often accompanied with mentions of other risk behaviors, such as substance use and violence.[43]
Teens (ages 13–15) in the United States, use entertainment media as their top source for education in regards to sexuality and sexual health. Additionally, a study found that 15–19-year-olds in the U.S use media far more than parents or schools to obtain information about birth control.[43] Some studies have found that, "very few teen television shows mention any of the responsibilities or risks (e.g., using contraception, pregnancy, STIs) associated with sex and almost none of the shows with sexual content include precaution, prevention, or negative outcomes as the primary theme."[43] Television shows 16 and Pregnant and its spin-off, Teen Mom, which first aired on MTV in 2009 received major disapproval from some parents as they thought the shows glamorized teen pregnancy and motherhood. However, 16 and Pregnant actually led to a 4.3 percent reduction in teen pregnancy, mostly as a result of increased contraceptive use.[5] In contrast, other data shows that exposure to high levels of sexual content on the television causes adolescents to have twice the risk of becoming pregnant in the following three years, compared to those who were exposed to low levels.[43]
The film Mean Girls, directed by Mark Waters shed light on the state sex education in some parts of the United States. In the film the health instructor states, "At your age, you're going to have a lot of urges. You're going to want to take off your clothes and touch each other. But if you do touch each other, you will get chlamydia and die." This line is meant to be satirical, but it illustrates common flaws within sex education in the U.S. It depicts simplistic descriptions of sexual activity and implementation of fear without any legitimate basis.[5]
Comprehensive sex education is the main topic in the documentary The Education of Shelby Knox (2005) about Lubbock, Texas, which has one of the highest teen pregnancy and STD rates in the nation; the "solution" to which is a strict abstinence-only sex education curriculum in the public schools and a conservative preacher who urges kids to pledge abstinence until marriage.
In 2013, How to Lose Your Virginity was released, a documentary that questioned the effectiveness of the abstinence-only sex education movement and observed how sexuality continues to define a young woman's morality and self-worth.[44][45] The meaning and necessity of virginity as a social construct is also examined through narration and interviews with notable sexuality experts, such as former Surgeon General Joycelyn Elders, "Scarleteen"[46] creator and editor Heather Corinna, historian Hanne Blank, author Jessica Valenti, and comprehensive sex education advocate Shelby Knox.
Not only have films portrayed sex education, but so has social media. Platforms such as YouTube, Facebook, and others are used as a tool to uplift the narratives of marginalized communities such as persons of color and LGBT persons in hopes to "strengthen sexual health equity for all."[36]
As a result of the mass amount of sex content in media, media literacy education (MLE) has emerged. It was created to address the influence of unhealthy media messages on risky health decisions, such as intention to use substances, body image issues, and eating disorders.[43] A study analyzed the effectiveness of a teacher-led MLE program, called Media Aware Sexual Health (MASH), which provides students with accurate health information and teaches them how to apply that information to critical analysis of media messages. This comprehensive sex education resulted in increased intentions to talk to a parent, partner and medical professional prior to sexual activity, and intentions for condom use.[43]
Due to knowledge gaps in most sex education curricula for teens, free online resources like Sex, Etc., Scarleteen.com, and teensource.org[47] have been created to promote comprehensive, inclusive, and shame-free sex education for teenagers.
This article incorporates text from a free content work. Licensed under CC-BY-SA IGO 3.0 (license statement/permission). Text taken from Emerging evidence, lessons and practice in comprehensive sexuality education: A global review 2015, 14, 15, 25, 29, UNESCO, UNESCO. UNESCO.
What does comprehensive sexuality education do?
CSE imparts knowledge and skills that are critical to ensuring that children, adolescents, and young adults are equipped to make informed decisions about their bodies, their health, and their relationships. Its benefits are myriad: CSE can delay sexual initiation; increase the use of birth control, including condoms; and reduce sexual risk behaviors, sexually transmitted infections, and rates of unintended pregnancy. It also helps people recognize intimate partner violence, including among adolescents, and enables people to conceptualize sexuality, recognize and foster healthy relationships, understand consent, and make informed decisions about their health. A systematic literature review of three decades of research on school-based CSE programs showed that CSE led to “an appreciation of sexual diversity, dating and intimate partner violence prevention, development of healthy relationships, prevention of child sex abuse, improved social/emotional learning, and increased media literacy.”
CSE should be medically accurate, based in evidence, and appropriate for the age of the intended audience. ACOG guidance recommends that curricula include …
CSE also provides much-needed and timely education about sexuality, bodily autonomy, and personal boundaries in the digital age, safeguarding against the rise of behaviors such as sexting, which is associated with higher likelihood of reporting high-risk sexual behaviors, and online dating, which has been associated with dating violence among adolescents.
What can policy makers and elected officials do?
UNFPA works to empower young people to shape the lives they want. This means mitigating adolescents’ risk of developing harmful behaviours, while promoting positive, protective actions and attitudes. Comprehensive sexuality education is a key component of UNFPA’s global strategy for adolescents and youth.
UNFPA works with governments and partners to develop and implement comprehensive sexuality education programmes, in and out of school, that meet international technical standards. In 2019, UNFPA launched a global programme for out-of-school comprehensive sexuality education, specifically targeting frequently left-behind young people. Among many other initiatives, in Moldova, UNFPA is working with the government and partners to deliver comprehensive sexuality education to refugees from Ukraine, with sessions on life skills and resilience building, as well as mental health counseling and sexual and reproductive health referrals and information. UNFPA Malawi has a specific emphasis on delivering comprehensive sexuality education to young people living with HIV, by identifying and training facilitators from the same community. UNFPA Palestine has developed a digital educational platform for sexual education; the application has been made accessible to young people with hearing impairment and also has been adapted to audio for those with visual disabilities.
In addition, many countries have been expanding the breadth of their in-school curricula in response to the UN International Technical Guidance on Sexuality Education. In Lao People’s Democratic Republic, the guidance was used to develop lesson plans and learning objectives after an analysis revealed a lack of content on gender, rights, sexual behavior and equitable social norms in the existing life skills curricula. In South Africa, the guidance was used to create lesson plans and training for teachers to empower them to address important sensitive topics that might otherwise be left out. Other examples can be found in the Global Status Report on Comprehensive Sexuality Education.
In advocating for policies on, and investments in, comprehensive sexuality education, in and out of schools, UNFPA and partners recognized that traditional sexuality education does not meet the needs of all young people, such as populations outside of school. To address this, UNFPA and partners (UNESCO, WHO, UNICEF, UNAIDS) launched the International Technical and Programmatic Guidance on Out-of-School Comprehensive Sexuality Education in 2020. It provides evidence-based, human rights-centred guidelines and recommendations for reaching the most vulnerable young people. Out-of-school programmes often include community-based training and education, and may focus on groups such as young people with disabilities, young indigenous people, LGBTQIA+ youth, young people living with HIV or young people living in humanitarian settings.
UNFPA also co-convenes the Global Partnership Forum on Comprehensive Sexuality Education together with UNESCO, with the aim to advance research, promote good practices, enhance collaboration and overcome challenges. Members include UN agencies, funding agencies, international civil-society organizations working in the area of sexual and reproductive health and rights, youth-led organizations, research or academic institutions, and education-related and other professional networks.
UNFPA is building the evidence on comprehensive sexuality education. It is among others collaborating with the World Health Organization in conducting research on UNFPA’s comprehensive sexuality education programming, in partnership with local research institutions. In May 2023, a special edition of the journal Sexual and Reproductive Health Matters, titled “Learning beyond the classroom: comprehensive sexuality education for outside-of-school settings,” shared implementation research from Colombia, Ethiopia, Ghana and Malawi.
Updated on 3 July 2024
Comprehensive sexuality education (CSE) is a curriculum-based process of teaching and learning about the cognitive, emotional, physical, and social aspects of sexuality. It aims to equip children and young people with knowledge, skills, attitudes, and values that will empower them to: realize their health, well-being, and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and understand and ensure the protection of their rights throughout their lives.
[Source: UNESCO. 2017. International technical guidance on sexuality education, pp.16-17.]
Depending on the country or region, CSE may go by other names. It may be referred to as ‘life skills’, ‘family life’, or ‘HIV’ education. It is sometimes called ‘holistic sexuality education’. It is important to confirm with ministries what they use to describe CSE, particularly as context-based terms can inform the most effective approach to take when partnering with and supporting these ministries.
The comprehensive aspect of CSE refers to the breadth, depth, and consistency of topics, as opposed to one-off lessons or interventions. CSE addresses sexual and reproductive health issues, including, but not limited to:
CSE also addresses the psychological, social, and emotional issues relating to these topics, including those that may be challenging in some social and cultural contexts. It supports learners’ empowerment by improving their analytical, communication, and other life skills for health and well-being in relation to:
CSE builds on and promotes universal human rights for all, including children and young people. It emphasizes all persons’ rights to health, education, information equality, and non-discrimination. It raises awareness among young people that they have their own rights, and that they must acknowledge and respect the rights of others, and advocate for those whose rights are violated.
Integrating a gender perspective throughout CSE curricula is integral to effective CSE programmes. CSE analyses how gender norms can influence inequality, and how inequality can affect the overall health and well-being of children and young people, as well as the efforts to prevent issues such as HIV, STIs, early and unintended pregnancies, and gender-based violence. CSE contributes to gender equality by building awareness of the centrality and diversity of gender identities and expressions in people’s lives; examining gender norms shaped by cultural, social and biological differences and similarities; and by encouraging the creation of respectful and equitable relationships based on empathy and understanding.
CSE must be delivered in the context of the range of values, beliefs, and experiences that exist even within a single culture. It enables learners to examine, understand, and challenge the ways in which cultural structures, norms, and behaviours affect their choices and relationships within a variety of settings.
CSE impacts whole cultures and communities, not simply individual learners. It can contribute to the development of a fair and compassionate society by empowering individuals and communities, promoting critical thinking skills, and strengthening young people’s sense of citizenship. It empowers young people to take responsibility for their own decisions and behaviours, and how they may affect others. It builds the skills and attitudes that enable young people to treat others with respect, acceptance, tolerance, and empathy, regardless of their ethnicity, race, social, economic, or immigration status, religion, disability, sexual orientation, gender identity or expression, or sex characteristics.
CSE teaches young people to reflect on the information around them in order to make informed decisions, communicate and negotiate effectively, and develop assertiveness rather than passivity or aggression. These skills foster the creation of respectful and healthy relationships with family members, peers, friends, and romantic or sexual partners.
[Source: UNESCO. 2017. International technical guidance on sexuality education, pp 16-17.]
‘Sexuality’ is defined as ‘a core dimension of being human which includes: the understanding of, and relationship to, the human body; emotional attachment and love; sex; gender; gender identity; sexual orientation; sexual intimacy; pleasure and reproduction. Sexuality is complex and includes biological, social, psychological, spiritual, religious, political, legal, historic, ethical and cultural dimensions that evolve over a lifespan’.
[Source: UNESCO. 2017. International technical guidance on sexuality education, p.17.]
The word ‘sexuality’ has different meanings in different languages and in different cultural contexts. Taking into account a number of variables and the diversity of meanings in different languages, the following aspects of sexuality need to be considered in the context of CSE:
[Source: UNESCO. 2017. International technical guidance on sexuality education, p. 17.]
When viewed holistically and positively:
Comprehensive sexuality education is curriculum-based teaching about cognitive, emotional, physical and social aspects related to sexuality and aims to provide children and young people with the knowledge, skills, attitudes and values that will enable them to protect their own health, welfare and dignity and develop positive relationships. It also provides them with awareness of how their own choices affect themselves and others and how they can safeguard their own rights. Sexuality education can be included as an interdisciplinary topic, as an individual subject or a dedicated subject. Comprehensive sexuality education is therefore a central part of support to education, since a good education needs to prepare children and young people for the future.
The work with comprehensive sexuality education in schools consists of including this in various topics in the curriculum and syllabus and developing programmes to train teachers to deliver evidence-based and quality-assured sexuality education in the classroom. It is also important to work with comprehensive sexuality education in an evidence-based manner. This involves supporting different types of studies and research projects and obtaining adequate, quality-assured data to meet the opposing and coordinated resistance against the right to learn about your own body, sexuality, rights and how to relate to other children and young people. SDG 4 states that pupils and students must be able to acquire the skills to promote human rights, equality and contribute to sustainable development. This includes comprehensive sexuality education.
The term “sexuality education” can be difficult to translate in many contexts and may lead to confusion and resistance due to lack of clarity. Terms such as “life skills education”, “family education”, etc. are therefore often used at national level, also to reflect national priorities and the realities of learners. A more flexible use of the term may be beneficial though this also entails a risk of the concept and discipline being diluted.
The truth about comprehensive sexuality education, based on global evidence, is that it increases the age of sexual debut and decreases risky sexual behavior. However, the arguments against comprehensive sexuality education are largely based on the unfounded belief that it will encourage sexual activity among young people. There is also the conviction that parents should be responsible for educating their children about the topics covered in comprehensive sexuality education and resistance to LGBTQ+ (lesbian, gay, bisexual, transgender and queer), gender equality and sexual and reproductive rights being covered in sexuality education. Some opposition groups spread misinformation and claim that comprehensive sexuality education teaches children to be sexually active, but evidence shows that, it helps young people protect themselves from unsafe situations, treat girls and boys with respect and dignity, decreases the frequency of sexual intercourse as well as the number of sexual partners. Together with safe abortion and gender identity, sexuality education is a very sensitive topic in international negotiations and references to the term CSE (comprehensive sexuality education) can be problematic. However, teaching children about their health, their bodies, and how to recognise abuse, helps keep them happy, healthy, and safe from harm.
The development of sexuality education programmes has had a positive impact in many countries (UNESCO 2023). It is important to ensure that sexuality education programmes are transparent and that what schools are trying to achieve through such teaching and the content taught in schools is well understood. This is necessary to ensure support from the local community and to include decision-makers such as politicians and religious leaders. Sexuality education can have a positive impact on the reduction of teen pregnancy, thereby reducing dropouts from school which can be viewed as an effective approach by the national education authorities in improving girls’ education.
The main channels for Norwegian support to comprehensive sexuality education are UNESCO and UNFPA. UNESCO primarily works on comprehensive sexuality education in schools, while UNFPA does so outside of schools. Norad also supports comprehensive sexuality education through core funding for several multilateral organisations and funds, such as the Global Partnership for Education, UNAIDS, Global Financing Facility and the Robert Carr Fund, among others. Norway also supports comprehensive sexuality education through civil society partners such as Save the Children, Plan, Norwegian Church Aid, Sex og Politikk and SAIH.
Most of our funding goes to countries in sub-Saharan Africa. We do not earmark funding for countries, but we support our partners’ strategies. Nevertheless, some funding is provided via embassies, such as funding to UNESCO in Malawi.
For further information, please contact the Section for Education and Research
Comprehensive sexuality education (CSE) plays a central role in the preparation of young people for a safe, productive, fulfilling life in a world where HIV and AIDS, sexually transmitted infections (STIs), unintended pregnancies, gender-based violence (GBV) and gender inequality still pose serious risks to their well-being.
However, despite clear and compelling evidence for the benefits of high-quality, curriculum-based CSE, few children and young people receive preparation for their lives that empowers them to take control and make informed decisions about their sexuality and relationships freely and responsibly.
Countries are increasingly acknowledging the importance of equipping young people with the knowledge and skills to make responsible choices in their lives, particularly in a context where they have greater exposure to sexually explicit material through the Internet and other media.
Changes in government can put support for CSE at risk due to politicians’ varying stances on the topic. Advocates may consider vouching for the creation of a “permanent” CSE team within the relevant ministry. While a fixed team cannot be entirely immune to political shifts, its initial existence can at least strengthen CSE efforts’ sustainability and reinforce continuity between different CSE initiatives.
CSE programming is not reaching many adolescents and youth, even in regions with supportive policies. In addition to uneven access among very young adolescents (VYAs), young people who occupy marginalized groups also have challenges accessing CSE. Specific subgroups—like married adolescents—need to be explicitly included in outreach strategies.
Check out this High Impact Practice Brief on effective community group engagement!
Digital media and especially mobile phones have taken off as novel means of building connections. Online platforms can provide personalized experiences to users whose needs aren’t adequately addressed by other, generalized programs. There are risks and problems that come with using digital communications: Vulnerable groups may not have reliable access to the required technology, and there are privacy and confidentiality considerations associated with online platforms. Still, there is promising evidence that digital CSE is not only effective in disseminating information, but also that it leads to concrete, significant positive behavior changes. Program planners should weigh the advantages, disadvantages, and uncertainties of integrating technology early on in the development process.
Over 40% of UNESCO’s surveyed countries reported that the topics of gender, pregnancy, relationships, and violence are not officially incorporated into CSE curricula. UNESCO has a suggested list of key concepts to cover at varying stages of life, and Knowledge SUCCESS has a toolkit introducing adaptable teaching materials.
Practical tips to prepare curricula that are inclusive and informed by evidence:
Countries have increasingly acknowledged the importance of equipping young people with the knowledge, skills and attitudes to develop and sustain positive, healthy relationships and protect themselves from unsafe situations. While 85% of countries have policies that are supportive of sexuality education, significant gaps remain between policy and curricula, as per the global status report on CSE. The same report identifies that more than 4 in 5 countries cover relevant sexuality education content and topics in their national curriculum, though more progress is needed because a number of key topics are missing or taught too late.
UNESCO believes that with CSE, young people learn to treat each other with respect and dignity from an early age and gain skills for better decision making, communications, and critical analysis. They learn they can talk to an adult they trust when they are confused about their bodies, relationships and values. They learn to think about what is right and safe for them and how to avoid coercion, sexually transmitted infections including HIV, and early and unintended pregnancy, and where to go for help. They learn to identify what violence against children and women looks like, including sexual violence, and to understand injustice based on gender. They learn to uphold universal values of equality, love and kindness.
In the International Technical Guidance on Sexuality Education, UNESCO and UN partners recommend pathways to promote health and well-being, respect for human rights and gender equality, and empower children and young people to lead healthy, safe and productive lives through quality CSE. The guidance is intended to support countries in their policies and decisions to invest in sexuality education for all learners based on the needs and realities of their peoples and culture. An online toolkit was developed by UNESCO to facilitate the design and implementation of CSE programmes at national level, as well as at local and school level. A tool for the review and assessment of national sexuality education programmes is also available. Governments, development partners or civil society organizations will find this useful. Guidance for delivering CSE in out-of-school settings is also available.
Through its flagship programme, Our rights, Our lives, Our future (O3), UNESCO reached 34 million learners in 35 countries across sub-Saharan Africa with life skills and sexuality education by the end of its first phase mid-2023,and an additional 35 million young people in and out of school through media platforms and advocacy mobilizing communities, teachers, religious leaders, parents and civil society. O3 Plus is also reaching and supporting learners in higher education institutions.
To strengthen coordination among the UN community, development partners and civil society, UNESCO co-convenes the Global partnership forum on CSE together with UNFPA, providing a structured platform for collaboration, exchange of information and good practices, research, youth advocacy and leadership, and evidence-based policies and programmes.
Good quality CSE delivery demands up to date research and evidence to inform policy and implementation. UNESCO regularly conducts reviews of national policies and programmes and has documented the existing policy environment on CSE in several countries. Examples of good practice on the need to ensure inclusive sexuality education for learners with disabilities in Asia and East and Southern Africa, and for learners of diverse sexual orientation, gender identity and expression are also available.
Sex education instruction method
Comprehensive sex education (CSE) is an instructional approach aimed at providing individuals, particularly young people, with accurate, holistic information about sexuality, relationships, and reproductive health. Unlike abstinence-only education, CSE includes a broad curriculum that covers topics such as safe sex practices, contraception, sexually transmitted infections (STIs), sexual orientation, gender identity, and relationship skills. This approach seeks to empower individuals to make informed, responsible decisions regarding their sexual health and to promote respect and equality in sexual relationships.[1][2][3]
CSE is widely supported by health organizations for its effectiveness in improving public health outcomes. Research shows that comprehensive sex education contributes to reduced rates of unintended pregnancies and STIs, delayed initiation of sexual activity, and increased use of contraceptives among sexually active youth. Furthermore, CSE addresses the diverse needs of young people, including LGBTQ+ youth and individuals from various cultural backgrounds, fostering inclusivity and helping reduce health disparities across communities.[4]
In the United States, the implementation of CSE varies significantly across states due to decentralized education policies. Some states mandate CSE or HIV education, while others continue to prioritize abstinence-based programs. The debate around CSE often involves ideological and political conflicts, with advocates emphasizing its health benefits and critics raising concerns about age-appropriateness and cultural values. Internationally, CSE is recognized by agencies like UNESCO and the World Health Organization as a critical component of human rights and adolescent development, with recommended integration into school curricula for its role in enhancing both individual well-being and public health.
As of 2019, sex education in the United States is mandated at the state level, with individual states, districts, and school boards responsible for determining the implementation of federal policy and funds for sex education. Currently, 24 out of the 50 U.S. states and the District of Columbia mandate general sex education, while 34 states mandate HIV education. Notably, in states where sex education is mandated, there is no federal policy requiring the instruction of comprehensive sex education.
During the George W. Bush administration, conservative Republicans in Congress strongly supported abstinence-only-until-marriage sex education. Conversely, under the Barack Obama administration, there was opposition to abstinence-only education, with suggestions to eliminate it. With advent of President Trump's administration, the federal agenda reverted back to supporting an abstinence-based approach.
According to the 2014 School Health Places and Practices Study conducted by he Centers for Disease Control and Prevention, high school courses, on average, dedicate 6.2 hours of class time to human sexuality, with a notable emphasis on abstinence. However, the same study found that 4 hours or less are typically allocated to topics such as HIV, other sexually transmitted infections and pregnancy prevention.
Studies have found that comprehensive sexuality education is more effective than receiving no instruction and/or those who receive abstinence-only instruction.[5] Acknowledging that people may engage in premarital sex rather than ignoring it (which abstinence-only is often criticized for) allows educators to give the students the necessary information to safely navigate their future sexual lives.[6] Additionally, young people that do not identify as heterosexual or their gender identity assigned at birth, have increased sexual risk behaviors and adverse health outcomes compared to their heterosexual and cisgender peers.[7][8][9] Sex educators argue comprehensive sex education, which includes specific attention to minority groups, is essential for improving this health disparity and ensuring the livelihoods of all people, including LGBTQ+ youth, racial minorities, or students with disabilities.
CSE advocates argue that promoting abstinence without accompanying information regarding safe sex practices disregards reality, and is ultimately putting the student at risk.[10] For example, programs funded under AEGP are reviewed for compliance with the 8 standards (listed below in "Abstinence Education Grant Program (AEGP) Requirements), but are not screened for medical accuracy. Therefore, critics believe that students under these educational programs are put at a disadvantage because it prevents them from making informed choices about their sexual health. Additionally, under these AEGP programs, health educators have referred to those that engage in sex, especially females, as "dirty" and "used". They have also used phrases such as "stay like a new toothbrush, wrapped up and unused" and "chewed-up gum" to teach abstinence. Under a CSE model, language would be more sensitive.
There is clear evidence that CSE has a positive impact on sexual and reproductive health (SRH), notably in contributing to reducing STIs, HIV and unintended pregnancy.[11] Sexuality education does not hasten sexual activity but has a positive impact on safer sexual behaviours and can delay sexual debut.[12] A 2014 review of school-based sexuality education programmes has demonstrated increased HIV knowledge, increased self-efficacy related to condom use and refusing sex, increased contraception and condom use, a reduced number of sexual partners and later initiation of first sexual intercourse.[13] A Cochrane review of 41 randomized controlled trials in Europe, the United States, Nigeria and Mexico also confirmed that CSE prevents unintended adolescent pregnancies.[14] CSE is very beneficial in regards to teen pregnancy because studies show that, teen pregnancy and childbearing have a significant negative impact on high school success and completion, as well as future job prospects.[5] A study in Kenya, involving more than 6,000 students who had received sexuality education led to delayed sexual initiation, and increased condom use among those who were sexually active once these students reached secondary school compared to more than 6,000 students who did not receive sexuality education.[15][16] CSE also reduces the frequency of sex and the number of partners which in turn also reduces the rates of sexually transmitted infections.[5]
UNAIDS and the African Union have recognized CSE's impact on increasing condom use, voluntary HIV testing and reducing pregnancy among adolescent girls and have included comprehensive, age-appropriate sexuality education as one of the key recommendations to fast track the HIV response and end the AIDS epidemic among young women and girls in Africa.[17][16]
As the field of sexuality education develops, there is increasing focus on addressing gender, power relations and human rights in order to improve the impact on SRH outcomes. Integrating content on gender and rights makes sexuality education even more effective.[18] A review of 22 curriculum-based sexuality education programmes found that 80 per cent of programmes that addressed gender or power relations were associated with a significant decrease in pregnancy, childbearing or STIs. These programmes were five times as effective as those programmes that did not address gender or power.[19] CSE empowers young people to reflect critically on their environment and behaviours, and promotes gender equality and equitable social norms, which are important contributing factors for improving health outcomes, including HIV infection rates. The impact of CSE also increases when delivered together with efforts to expand access to a full range of high- quality, youth-friendly services and commodities, particularly in relation to contraceptive choice.[20][16]
A global review of evidence in the education sector also found that teaching sexuality education builds confidence,[21] a necessary skill for delaying the age that young people first engage in sexual intercourse, and for using contraception, including condoms. CSE has a demonstrated impact on improving knowledge, self-esteem, changing attitudes, gender and social norms, and building self-efficacy.[16]
How are some legislators restricting CSE?
Despite the myriad benefits that CSE provides for people of all ages, lawmakers have been mounting increasingly frequent attacks meant to limit or outright ban various aspects of CSE. Florida’s notorious “Don’t Say Gay” bill, HB 1557, shone a spotlight on anti-CSE legislation when it prohibited “classroom discussion about sexual orientation or gender identity in certain grade levels or in a specified manner.” In May 2023, Florida legislators expanded on the Don’t Say Gay bill when they passed HB 1069, which prevents education on menstruation and other sex education topics in elementary school, including answering questions from students who have begun menstruating but have not yet entered middle school. This same bill requires educators to teach that “reproductive roles are binary, stable, and unchangeable” and students should abstain from sexual activity outside of heterosexual marriage. In April 2023, Florida’s education board also voted to ban education on gender identity and sexual orientation for grades four through 12 in all public schools, expanding on a 2022 ban that prohibited education on gender identity and sexual orientation from kindergarten through third grade.
Florida isn’t alone in its restrictive, regressive policies: Ohio HB 8, referred to the state senate in 2023, would permit parents to remove their children from CSE courses without the child’s input or consent. This bill also requires school employees to notify parents if their child requests to identify as a gender that does not align with the student’s biological sex, effectively mandating that school officials out students to families without the students’ consent—regardless of the danger being outed may pose to the student. And in some states, elected officials have advanced policies that would require students to watch biased and inaccurate content intended to support a particular ideological viewpoint and direct students’ future decisions about reproductive health care.
Policies that ban CSE or co-opt it to spread a particular ideology or demonize entire groups of people leave young people without the unbiased, scientifically accurate information necessary to understand and make informed choices about their bodies, gender, sexuality, and involvement in sexual activity and healthy relationships. Without CSE, children and young people may struggle to establish the framework for evaluating and understanding accurate information, science-based foundations of anatomy of reproductive and sexual health, and healthy social and emotional relationships. In an era in which misinformation proliferates about everything from how menstrual cycles work to how to avoid pregnancy to simple bodily anatomy and functions, providing children and young people with accurate, science-based information about their bodies and relationships with others is critical.
California Comprehensive Sexual Health and HIV/AIDS Prevention Education Act
In January 2016, the California Healthy Youth Act amended the California Comprehensive Sexual Health and HIV/AIDS Prevention Education Act to include minority groups and expand health education. Before, it authorized schools to provide comprehensive sex education and required all materials to be made accessible to students with a variety of needs; it also focused solely on marital relationships. It now mandates that schools provide comprehensive sex education and states that "materials cannot be biased and must be appropriate for students of all races, genders, sexual orientations, and ethnic and cultural backgrounds, as well as those with disabilities and English language learners." Additionally, education must now include "instruction about forming healthy and respectful committed relationships," regardless of marital status. Furthermore, it is now required to have discussions about all FDA-approved contraceptive methods in preventing pregnancy, including the morning-after pill.[5]
In conclusion now requires that all sex education programs promulgated in the state should:[5]
Some critics state that young people's access to CSE is grounded in internationally recognized human rights, which require governments to guarantee the overall protection of health, well-being and dignity, as per the Universal Declaration on Human Rights, and specifically to guarantee the provision of unbiased, scientifically accurate sexuality education.[16]
These rights are protected by internationally ratified treaties, and lack of access to sexual and reproductive health (SRH) education remains a barrier to complying with the obligations to ensure the rights to life, health, non-discrimination and information, a view that has been supported by the Statements of the Committee on the Rights of the Child, the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) Committee, and the Committee on Economic, Social and Cultural Rights.[16]
The commitment of individual states to realizing these rights has been reaffirmed by the international community, in particular the Commission on Population and Development (CPD), which – in its resolutions 2009/12 and 2012/13 – called on governments to provide young people with comprehensive education on human sexuality, SRH and gender equality.[16]
Other analysis show that comprehensive sex education is not an international right nor a human right because it not clearly stated in either a treaty or custom. By international law, states are required to provide access to information and education about reproductive health, but this does not require a sex education curriculum. It may take different forms such as mandating that local school districts create a system for providing information to students, or mandating that health clinics and practitioners dispense information to patients.[30]
As CSE gains momentum and interest at international, regional and national levels, governments are increasingly putting in place measures to scale-up their delivery of some form of life skills-based sexuality education, as well as seeking guidance on best practice, particularly regarding placement within the school curriculum. Sexuality education may be delivered as a stand-alone subject or integrated across relevant subjects within the school curricula. These options have direct implications for implementation, including teacher training, the ease of evaluating and revising curricula, the likelihood of curricula being delivered, and the methods through which it is delivered.[16]
Within countries, choices about implementing integrated or stand-alone sexuality education are typically linked to national policies and overall organization of the curricula. The evidence base on the effectiveness of stand-alone vs. integrated sexuality education programming is still limited. However, there are discernible differences for policy-makers to consider when deciding the position of CSE within the curriculum.[16]
As a stand-alone subject, sexuality education is set apart from the rest of the curriculum, whether on its own or within a broader stand-alone health and life skills curriculum. This makes it more vulnerable to potentially being sacrificed due to time and budget constraints, since school curricula are typically overcrowded.[16]
However, a stand-alone curriculum also presents opportunities for specialized teacher training pathways, and the use of non-formal teaching methodologies that aim to build learners' critical thinking skills. The pedagogical approaches promoted through sexuality education – such as learner-centred methodologies, development of skills and values, group learning and peer engagement – are increasingly being recognized as transformative approaches that impact on learning and education more widely. As a standalone subject, it is also significantly easier to monitor, which is crucial in terms of evaluating the effectiveness of programming, and revising curricula where it is not delivering the desired learning outcomes.[16]
When sexuality education is integrated or infused, it is mainstreamed across a number of subject areas, such as biology, social studies, home economics or religious studies. While this model may reduce pressure on an overcrowded curriculum, it is difficult to monitor or evaluate, and may limit teaching methodologies to traditional approaches.[16]
Apart from the different teaching methods, terminology also differs. Abortion, homosexuality and abstinence have connotations and definitions that vary by state and by nationality. For example, the word "abstinence" may refer to disengaging from all forms of sexual activities until marriage or may refer to only disengaging from sexual intercourse. Furthermore, the degree of sexual activity that "abstinence" connotes is often unclear, because sexual behavior that is not sexual intercourse may or may not be included in its definition. As a result, students are left confused about what activities are risky and teachers do not know what they can and cannot teach.
The term "comprehensive", is also falls on spectrum, therefore can be considered an umbrella term. CSE means something radical for some institutions while it can mean something moderate and even conservative for others.[25]
According to the Sexuality Information and Education Council of the United States (SIECUS), the guidelines for comprehensive sexuality education are as follows:[42]
The Healthy Youth Act Massachusetts
An Act Relative to Healthy Youth, or the Healthy Youth Act, is a bill (HD.3454/SD.2178) that would require any public school in Massachusetts with a sex education curriculum to be fully comprehensive. This would include materials that are age-appropriate, medically-accurate, LGBTQ-inclusive, and consent-focused. Content would address how to build healthy relationships and how to prevent pregnancy and STIs when a person does have sex. The Healthy Youth Act was initially filed in January 2011 and has been revised multiple times since. This bill is a framework that does not mandate a particular curriculum, but does require that schools where sex education is already being taught fit this framework. Parents will be given 30 days-notice to review the material and opt-out.
In 2021, the Healthy Youth Act was cosponsored by Senator Sal N. DiDomenico and Representatives Christina A. Minicucci, Vanna Howard, and Jack Patrick Lewis of the 192nd General Court of the Commonwealth of Massachusetts. Bill SD.2178 has been advocated for over 10 years and has successfully passed the Massachusetts Senate, however it has yet to be passed by the Massachusetts House of Representatives[needs update].
Reactions to the Healthy Youth Act have been mixed, but it has gained increased support over the years. Some of its most dedicated supporters include Fenway Health, the Healthy Youth Coalition, The Massachusetts Healthy Youth Consortium, and Getting to Zero. The Planned Parenthood League of Massachusetts states that "comprehensive sex education is about more than just sex – it helps creates a culture of consent, recognizes and prioritizes LGBTQ youth health needs, and gives young people the tools to build healthy relationships... We can combat sexual assault at its roots by teaching young people how to build healthy, respectful relationships". In 2018, a poll of Massachusetts residents showed that 92% of people agree that students should receive comprehensive sex education in high school. In a testimony in support of the bill, supporters claim that "sex education is a perfect opportunity for youth to develop skills like communication, healthy relationships, decision-making, planning, and critical thinking. Such life skills can contribute to their positive development throughout adolescence and into adulthood".
The Massachusetts Family Institute (MFI), a conservative organization that promotes traditional Judeo-Christian values and the bill's main opponent, highlights the article "Pornographic 'Comprehensive Sexuality Education' in Massachusetts Public Schools" on the front page of their website. This article refutes Planned Parenthood's claims, stating that "it’s no wonder that Planned Parenthood is pushing it in our schools. Planned Parenthood administrators know that if they sexualize young people, they will create new customers who seek out their abortion services, sexually transmitted infection treatments, and transgender hormone therapies". Instead, MFI argues that the Healthy Youth Act would inappropriately expose underaged youth to "pornographic" content that would encourage youth to engage in sexual behaviors, concluding that "state education officials and local school administrators ought to reject Comprehensive Sexuality Education as the poisoner of children that it is".
Sexual Risk Avoidance (SRA) curricula has been promoted in direct opposition to the Healthy Youth Act. Advanced by Ascend, this curricula promotes an abstinence-only approach to sex education. Within SRA education programs "Ascend works with SRA educators, community organizations and more as they educate youth using a primary prevention health model".
Benefits of Pleasure-Inclusive Material
Though a focus on behavior change (i.e., increased condom use and delayed onset of sexual debut) is an important benefit and measure of outcomes associated with sex education, a pivot to exploring the mental health and well-being implications associated with shifting the narrative from a purely biological and procreative approach to a pleasure-inclusive and sex positive approach showcases a host of beneficial outcomes.[22] Two avenues hold particular interest when implementing a pleasure-based curricula: Benefits of CSE[23] and Benefits of Sexual Expression.[24]
Such avenues have been recognised by official organising bodies such as the World Association of Sexual Health (WAS). Indeed, their Sexual Pleasure Declaration outlines that the pursuit of pleasurable and safe sexual experiences, free from discrimination and coercion, is integral to sexual health and overall well-being. Recognising sexual pleasure as a fundamental aspect of human rights - which also holds its own declaration on Sexual Rights - its diverse expressions should be incorporated into global education, health promotion, research, and advocacy efforts, fostering comprehensive, immediate, and sustainable actions for individual well-being and contributing to global health and sustainable development.
Another notable organisation paving the way of pleasure-inclusive sex education curricula is The Pleasure Project. Which recently published a systematic review uncovering the distinct value added by embedding a pleasure-based lens within sexual health interventions.[22] The Pleasure Project also underscores seven guiding principles: Be Positive, Rights First, Think Universal, Be Flexible, Talk Sexy, Embrace Learning, and Love Yourself.
While CSE implementation is on the rise in the United States, it remains difficult for state officials to regulate what is and is not taught in the classroom. This is due in large part to the undefinability of CSE; CSE has the potential to comprise such a wide range of sexual information, and over-all focus varies widely between curricula.[25] Educators have also accused CSE of fundamentally operating as a form of "abstinence-plus", due to the reality that CSE often involves minimal body-related information and excessive promotions of abstinence.[26] "So-called Comprehensive Sex Ed" says Sharon Lamb, a professor at the University of Massachusetts Boston, "has been made less comprehensive as curricula are revised to meet current federal, state, and local requirements."[26]
The LGBT population experiences multiple health disparities which may be impacted by stigma, discrimination, and lack of provider cultural sensitivity.[27] This population is subject to systemic barriers to adequate healthcare services ultimately impacting their wellbeing and welfare negatively.[27] They often receive care from clinicians without specialty training in addressing the concerns of this population; which may hinder communication and trust, and ultimately influence the quality and adequate delivery of healthcare.[28] Discrimination and lack of cultural sensitivity may also contribute to the limited health-seeking behaviors experienced by this population.[27] This lack of health-seeking behavior both limits preventative services, and increases and prolongs illness and ailments. Research shows a higher risk of contracting HIV and other STDs; particularly in gay men of color.[27] Lesbian and bisexual females are less likely to obtain routine care like breast and cervical cancer screenings.[27] Gay men are at an increased risk of prostate, testicular, anal, and colon cancers, while lesbian and bisexual women have an increased risk of ovarian, breast, and endometrial cancers.[28] As a result of stigma, discrimination, victimization, and sexual abuse, LGBT youth are more likely to be involved in high-risk sexual behaviors at an earlier age.[28]
While comprehensive sex education exists in schooling, many programs do not address the needs of the LGBT community. This population faces different health disparities ultimately driven by discrimination, shortfalls of peers, the lack of parental support, community services, and school-based sex education.[29] The implementation of LGBT comprehensive sex education utilized as an intervention seeks to combat these health disparities, by informing the population of the importance of developing sexual health.[29] Sexual health involves not only preventing disease, but also a respectful approach to sexual relationships, sexuality, and accepting an individual's gender identity and sexual orientation.[29]
The term "comprehensive" is also often misleading because some comprehensive programs do not show the holistic picture of human sexuality.[30] LGBT advocates have long been critical of the ways in which comprehensive sex education generally promotes marriage as the end goal for students. LGBT advocates want to express other forms of relationships other than marriage. They advocate that students should have sex education that encompasses the different forms and should be allowed to exercise those forms in which they are most comfortable with. Even when curriculums claim to be inclusive of LGBT experiences, they often promote heteronormative lifestyles as "normal."[31] Inclusion of LGBT identities and health topics is necessary for LGBT students to feel safe and seen in their sex ed classrooms.[32] When sex education fails to include LGBT identities and experiences, LGBT youth can be vulnerable to risky sexual behaviors and experience negative sexual health outcomes. Due to the lack of LGBT sex education provided in schools, LGBT youth will look to peers and the internet, which can lead to misinformation.[33] When these students do not have access to or an interest in marriage they are practically erased from the CSE narrative.
In Canada, a federal report showed that the LGBT community has less access to health services and faces more comprehensive health challenges compared to the general population. As a result of the lack of support for the LGBT population, the Comprehensive Health Education Workers (CHEW) Project emerged in October 2014. Their goal is to educate the LGBT community about topics such as sexual and gender identity, sexually transmitted infections (STIs), healthy social relationships, and depression. They do this through workshops, arts‐based projects, and one‐on‐one meetings. The CHEW project is set exclusively for the LGBT community in order to establish a safe environment in which LGBT youth can gain resources for sex education.[34]
A cross-sectional study done in New York City analyzed the sexual behaviors of high school girls. Studies found that, "high school girls who identified as LGBT were more likely to report substance use such as: alcohol, marijuana, cocaine, heroin, meth, ecstasy and prescription drugs. They also had higher rates of contemplating and/or attempting suicide."[35] Another study found that "the LGBT youth accesses health information online five times more than the heterosexual population, and these rates are even higher for LGBT youth that identify as a person of color which stems from the fact that they lack health resources".[36] Rights, Respect, Responsibility includes an inclusive LGBT curriculum for grades K-12. By having a curriculum, such as the Right, Respect, Responsibility suggests, students will have accurate information about all identities as well as establishing a safe classroom for LGBT students.[37]
As of May 2018, only 12 states require discussion of sexual orientation and of these, only 9 states require that discussion of sexual orientation be inclusive (California, Colorado, Delaware, Iowa, New Jersey, New Mexico, Oregon, Rhode Island, and Washington).[38] Additionally, several states have passed legislation that bans teachers from discussing gay and transgender issues, such as sexual health and HIV/AIDS awareness.[36] As of 2022, five states require that heterosexuality be emphasized over homosexuality.[38]
Before the late 1800s, delivering sex education in the United States and Canada was primarily seen as a parent's responsibility.[36] Today, programs under the Sexuality Information and Education Council of the United States (SIECUS) begin comprehensive sex education in pre-kindergarten, drawing criticism related to the age at which it is appropriate to address sexual matters with children.[30]
Federal Funding for Sexual Education
Although there is no federal mandate that requires states to teach sexual education, there is federal funding available to assist with sexual education programs.[42]
Sexual education exemption
Just as teaching methods and curricula vary by state, excusal from sex education also varies by state. States may have an opt-out or opt-in policy. In some states, students can opt out of receiving sexual education without specifying a particular reason. In other states, students can only opt out for religious or moral reasons. In an opt-in provision, parents must actively agree to allow their children to receive sex education prior to the start of the sexual education.[5]
