Sexuality Education

At the turn of the twenty-first century the rate of sexual intercourse among U.S. teenagers has declined; teen contraception rates, particularly condom use, have increased; and, as a result, teen birthrates declined during most of the 1990s.

Support for sexuality education also seems to be at an all-time high. A poll jointly conducted in 1999 by the Sexuality Information and Education Council of the United States (SIECUS) and Advocates for Youth showed that 93 percent of adults supported teaching sexuality education in high school and 84 percent supported teaching sexuality education in middle school/junior high school. And although most Americans believe abstinence should be a topic in sexuality education, the poll indicates that they reject abstinence-only-until-marriage education that denies young people information about contraception and condoms. The poll and subsequent focus groups demonstrate that many American parents do not see a conflict between providing information about abstinence and providing information about contraception in sexuality education programs. For these parents, it is not a matter of either/or–they want both.

The Basics of Sexuality Education

Human sexuality encompasses the sexual knowledge, beliefs, attitudes, values, and behaviors of individuals. Its various dimensions include the anatomy, physiology, and biochemistry of the sexual response system; identity, orientation, roles, and personality; and thoughts, feelings, and relationships. The expression of sexuality is influenced by ethical, spiritual, cultural, and moral concerns.

Sexuality education is a lifelong process that begins at birth. Parents, family, peers, partners, schools, religion, and the media influence the messages people receive about sexuality at all stages of life. These messages can be conflicting, incomplete, and inaccurate. SIECUS, along with many other national organizations, believes that all people have the right to comprehensive sexuality education that addresses the biological, sociocultural, psychological, and spiritual dimensions of sexuality from the cognitive domain (information); the affective domain (feelings, values, and attitudes); and the behavioral domain (communication, decision-making, and other relevant personal skills).

Comprehensive school-based sexuality education that is appropriate to students' age, developmental level, and cultural background should be an important part of the education program at every grade. A comprehensive sexuality education program will respect the diversity of values and beliefs represented in the community and will complement and augment the sexuality education children receive from their families, religious and community groups, and health care professionals.

SIECUS's Guidelines for Comprehensive Sexuality Education: Kindergarten–Twelfth Grade provide an organizational framework for the knowledge of human sexuality and family living within four development levels. The Guidelines are organized into six key concepts that represent the most general knowledge and encompass the components of the broad definition of sexuality. These six key concepts are human development, relationships, personal skills, sexual behavior, sexual health, and society and culture. Each key concept has associated life behaviors, topics, subconcepts, and age-appropriate developmental messages.

The primary goal of sexuality education is the promotion of sexual health. In 1975 the World Health Organization defined sexual health as "the integration of the physical, emotional, intellectual, and social aspects of sexual being in ways that are positively enriching, and that enhance personality, communication, and love…. Every person has aright to receive sexual information and to consider accepting sexual relationships for pleasure as well as for procreation."

There is public and professional consensus about what is sexually unhealthy for teenagers. Professionals, politicians, and parents across the political spectrum share a deep concern about unplanned adolescent pregnancy; out-of-wedlock childbearing; sexually transmitted diseases, including HIV/AIDS; sexual abuse; date rape; and the potential negative emotional consequences of premature sexual behaviors.

There is, however, little public, professional, or political consensus about what is sexually healthy for teenagers. The public debate about adolescent sexuality has often focused on which sexual behaviors are appropriate for adolescents and has ignored the complex dimensions of sexuality.

Becoming a sexually healthy adult is a key developmental task of adolescence. Achieving sexual health requires the integration of psychological, physical, societal, cultural, educational, economic, and spiritual factors. Sexual health encompasses sexual development and reproductive health, and such characteristics as the ability to develop and maintain meaningful interpersonal relationships; appreciate one's own body; interact with both genders in respectful and appropriate ways; and express affection, love, and intimacy in ways consistent with one's own values.

Adults can encourage adolescent sexual health by providing accurate information and education about sexuality, fostering responsible decision-making skills, offering young people support and guidance to explore and affirm their own values, and modeling healthy sexual attitudes and behaviors. Society can enhance adolescent sexual health by providing access to: comprehensive sexuality education; affordable, sensitive, and confidential reproductive health care services; and education and employment opportunities.

Most scholars and activists argue that adolescents should be encouraged to delay sexual behaviors until they are ready physically, cognitively, and emotionally for mature sexual relationships and their consequences. This support should include education about intimacy; sexual limit setting; resisting social, media, peer, and partner pressure; the benefits of abstinence from intercourse; and the prevention of pregnancy and sexually transmitted diseases.

Ongoing Challenges

In spite of recent declines, the birthrates among African-American and Hispanic young women aged fifteen to nineteen are still significantly higher than the overall birthrate in this age group. The rates of intercourse, pregnancy, and sexually transmitted diseases (STDs) are still much higher in the United States than in other industrialized countries.

Adults, whether they agree with young people's actions or not, cannot ignore the fact that millions of America's teenagers are engaging in a range of sexual behaviors. From a public-health perspective, some of these behaviors are less risky in terms of pregnancy or sexually transmitted disease transmission, whereas others carry greater risks. Because of these realities, all young people in the United States need the information, skills, and access to services to make and carry out informed, responsible decisions about their sexuality–both at the present time in their lives and in the future.

Americans hold both confused and contradictory attitudes about sexuality. While being generally relaxed enough to participate in sexual behaviors, Americans are not accepting enough of these behaviors to avoid guilt or shame. And Americans often have no commitment to pregnancy and disease prevention. This cultural confusion about sexuality is especially profound considering that adults must deal not only with their own sexuality-related issues but also with adolescent sexuality and sexual behaviors.

In American society, many adults do not model sexual health for young people. In fact, teenagers often behave more responsibly than adults. For example, 75 percent of unintended pregnancies in the United States occur to adult women. Never-married teens use birth control more consistently than never-married young adults in their twenties, and adolescents are much more likely to use condoms than older couples. Nearly all sexually transmitted HIV infection among both female and male teens and 60 percent of all teen births are the result of sexual intercourse with adult males.

Discussions about adolescent sexuality and sexuality education often revolve around adults' perceptions of how "things should be" rather than a realistic understanding or appreciation of the dynamics of adolescents' lives. Adolescence is the time when young people develop the knowledge, attitudes, and skills that become the foundation for their healthy adulthood. Recognizing that nearly all Americans eventually become sexually active, an effective sexuality education program would ensure that young people have the information and skills they need to make responsible decisions about their sexuality–whether they make those decisions as adolescents or adults.

Supporting Parents in Their Roles as Sexuality Educators

Parents and families play a major role in ensuring adolescent sexual health. Parents are the primary sexuality educators of their children. They educate both by what they say (and do not say) as well as by how they behave. Research indicates that young people who are able to talk to their parents about sexuality often behave more responsibly.

With open communication, young people are more likely to turn to their parents for help and support. Some parents have difficulty communicating with their children about sexuality, particularly because many of their parents also had difficulty with this issue. In order to overcome this difficulty, the education community can provide parents with information about sexuality and show them how to provide this education and information to their children. Educational programs may also provide parents with the help and encouragement they need to express their values about sexuality to their children and to provide accurate, honest, and developmentally appropriate sexuality information.

Parents and other trusted adult family members play an important role in encouraging and supporting adolescent sexual health. Parents and adults can assure that young people have access to accurate information and education about sexuality issues through direct communication and by providing books, pamphlets, and videos. Parents and other adults need to foster responsible sexual decision-making skills and need to model healthy sexual attitudes and responsible behaviors in their own lives.

Training Teachers

Comprehensive sexuality education is an important component of formal schooling. Yet often teachers do not have the skills, knowledge, or inclination to teach such courses. Few have received training in sexuality education, and even fewer have received certification as sexuality educators. A 1995 SIECUS study revealed that the nation's elementary and secondary school teachers are not adequately prepared at the pre-service level to provide sexuality education, including the teaching of HIV prevention, to their students. Because sexuality issues touch on so many developmental issues relating to children and youth, SIECUS has, since 1965, urged that all pre-kindergarten through twelfth grade pre-service teachers receive at least one course in human sexuality.

Research shows that one of the characteristics that effective sexuality education programs share is that they are taught by teachers and leaders who believe in the program and are trained to deliver it. Trained teachers can complement the education provided by families as well as that provided by religious and community groups. Yet studies reveal that teachers do not feel adequately trained to teach sexuality education. Teachers report concern about their ability to teach personal skills, about their knowledge of HIV/AIDS, and about their knowledge of STDs. Most of those teaching sexuality education report receiving their training in short workshops or seminars.

Training for teachers on how to teach sexuality education is critical to the success of programs and to the health of American children. Teachers responsible for sexuality education must receive specialized training in human sexuality that includes basic information on sexuality topics and a special focus on the philosophy and methodology of teaching sexuality education. Teachers should, ideally, receive this training as pre-service teachers in academic courses or programs in schools of higher education that provide them with time-intensive and rich training. This training can be complemented by extensive in-service courses, continuing education classes, or intensive seminars.

Few states have either training or certification requirements for teachers who deliver sexuality or HIV-prevention lessons. Although the vast majority of states require or recommend teaching about sexuality or HIV/AIDS, a 1995 study found that only twelve states, the District of Columbia, and Puerto Rico required any licensure for teachers of sexuality education and only twelve states and the District of Columbia required licensure for teachers of HIV-prevention education. Only six states and Puerto Rico required teacher training for sexuality educators, and nine states, the District of Columbia, and Puerto Rico required training for teachers of HIV-prevention education. States should develop requirements that integrate expertise in the methodology and pedagogy of sexuality education into existing health education licensure requirements. Current licensing and accreditation bodies should also integrate these criteria into their requirements for health educators.

Building Support Networks for Sexuality Education

A wide range of organizations support comprehensive sexuality education–including those representing health care professionals, businesses, the media, and faith communities–and are willing to advocate on its behalf. On the national level, the National Coalition to Support Sexuality Education includes more than 130 national organizations that support comprehensive sexuality education such as the American Association of School Administrators, the American Medical Association, the National School Boards Association, the National Association of School Psychologists, the National Education Association Health Information Network, the Religious Institute for Sexual Morality, Justice, and Healing, and the United States Conference of Mayors. Many of these organizations have affiliates at the state and community levels.

Education professionals can also become actively involved in supporting sexuality education programs in their communities. Professionals have an important role to play as outspoken advocates by writing letters to editors, voting in school board elections, writing supportive letters to teachers and administrators, and serving on community advisory committees. This involvement will help assure that young people have access to effective programs.

Reaching People outside of School

While an important component of efforts toward ensuring a sexually healthy society focuses on sexuality education in schools, these efforts need to be broadened beyond schools. Out-of-school adolescents are more likely to report having had sexual intercourse and to having had four or more sexual partners.

One of the challenges for the education and health community is to develop innovative, accessible approaches that meet the sexual health needs of adolescents who are not in school. Community based organizations, youth-serving agencies, health agencies, families, and faith communities often have contact with young people who may not be engaged in school, and these entities can be important sources of sexuality information and programming. Agencies need to be encouraged and supported in their efforts to work together to establish and strengthen partnerships for ensuring the sexual health of all young people, particularly those at most risk.

In addition, the Internet and other technologies are making sexuality information more accessible for many young people, both inside school and out. Many Internet sites provide age-appropriate, unbiased sexuality information for teens.

Conclusion

The debate continues in the United States over the focus and content of sexuality education programs. The prevailing political climate makes it difficult for people to publicly advocate for much beyond abstinence for young people. In spite of this there is much parental and scientific support for a more comprehensive approach to sexuality education. The challenge for the education community is to ensure that school policies and programming provide all young people with the information, services, and support they need to grow up to become sexually healthy adults.