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Creating a Sexually Healthy NationThroughout the month of September, we will be posting a series of essays on sexual health topics in recognition of World Sexual Health Day. This essay on the sex education comes from Debra Hauser, MPH, President of Advocates for Youth and current vice chair of ASHA’s board of directors. It is featured in Creating a Sexually Healthy Nation, a volume of essays published in honor of ASHA’s 100th anniversary.

Every hour of every day in the United States 85 youth become pregnant, 425 contract an STI, and two contract HIV. Every hour of every day. Yet, 30 years of public health research demonstrates that comprehensive sex education can provide young people with the essential information and skills they need to reduce their risk for unplanned pregnancy and STIs, including HIV. When done well, comprehensive sex education can also help young people traverse puberty, understand the difference between healthy and unhealthy relationships, develop a positive body image, communicate effectively, make informed decisions, and navigate the health care system. In short, quality sex education can go beyond the promotion of abstinence or even the prevention of unplanned pregnancy and disease to provide a lifelong foundation for sexual health.

Comprehensive sexuality education, when done well, can also help shift the culture of fear, shame, and denial which permeates our society and create instead a culture in which sexuality is accepted as normal, natural, and healthy; one in which young people are valued and celebrated for who they are no matter their sexual orientation, gender identity, or gender expression; where sexual development is recognized as an important task of adolescence and education about sexuality is valued over the promotion of ignorance.

One would imagine then, that in the wake of the evidence, policy and practice in support of comprehensive sex education would follow suit. Unfortunately, the United States is home to a conspiracy of silence, shame, and fear that surrounds adolescent sexual health. All too often, politics and ideology trump science, not to mention basic common sense. Since the 1990s, social conservatives have promoted an abstinence-only or “just-say-no” approach to sex education. Deeply rooted in social conservatism, abstinence-only-until-marriage programs are a strategic initiative designed to undermine gains in both the women’s rights and gay rights movements. These programs are anti-gay, anti-woman, anti-sex, anticontraception, and pro-heterosexual marriage. In other words, social conservatives were able to convince the U.S. government to spend more than 1.5 billion dollars since 1998 to undermine public confidence in condoms and contraception, promote homophobia, stigmatize sexuality and sexual development, and inculcate youth with notions of traditional gender stereotypes.

Though we are by no means where we want to be, there has been a great deal of progress in recent years, especially in dismantling abstinence-only programs. By 2010, sex education advocates had helped to eliminate two-thirds of federal abstinence-only funding and to shape two new federal funding streams for evidencebased sex education—the Presidents’ Teen Pregnancy Prevention Initiative at $75 million and the Personal Responsibility Education Program at $110 million. By 2012, 14 states and Washington, D.C. had rejected what was left of federal abstinence-only funding, while most states happily accepted the new funding sources. In addition, over the past few years Colorado, Illinois, Mississippi, North Carolina, Washington, and Wisconsin were among the states that passed new sex education laws. In 2013 alone, Alabama, Nevada, and South Carolina also introduced sex education bills (that did not pass but will most likely be reintroduced); the Broward County School District in Florida introduced a new sex education policy that will be voted on in 2014; Chicago Public Schools passed a comprehensive sex education policy which mandates sex education at every grade level; the Tulsa School Board (Oklahoma) voted to implement comprehensive sex education to select schools, with plans to expand across the district; and the National Sexuality Education Standards were widely used to fuel sex education advocacy and implementation efforts across the country.

In addition, sex education implementation took a huge leap forward with the launch of the WISE initiative (Working to Institutionalize Sex Education). WISE’s goal is to pilot, field test, map, and scale up a strategy for sex education implementation and institutionalization in school districts with positive or neutral policy climates. Currently operating in ten states, WISE is reaching hundreds of thousands of young people each year with new or improved sex education.

Fueled by the success of WISE and the National Sexuality Education Standards, in 2013 the CDC’s Division of Adolescent and School Health began funding 19 state education agencies and 17 large municipal school districts to implement what it calls exemplary sexual health education or ESHE.

All of this is contributing to some success: the teen pregnancy rates have dropped 52 percent since 1991—driven down primarily by young people using condoms and contraception more consistently than ever before. But change has not come easily, nor has it been consistent. We still face rising rates of STIs, including HIV infections, among young people. Improvements in sex education are unevenly spread, and there are pockets in most states, and particularly in the South, where abstinence-only education continues to prevail.

To truly become a sexually healthy nation, we will need to continue to confront the cultural myths that undermine rights, pragmatism, and basic common sense when it comes to sex education in America.

We should start with the myth that education is a threat rather than a solution—the belief that educating young people about sex causes them to have sex continues to prevail. Research has debunked this falsehood for decades but opponents of comprehensive sex education cannot seem to let go of their “umbrellas cause rain” argument.

The second myth is that just say no until marriage constitutes a viable national sex education policy in a country where 95 percent of people have sex prior to marriage and 70 percent of young people have sex by the age of 19. Throughout the industrialized world, the average age of sexual initiation is 17. Trying to stop this behavior in its tracks by censoring information about condoms and birth control is not just naïve and ineffective, it’s dangerous and irresponsible. Denial will never be a successful strategy when it comes to sex education in America.

We must also refute the idea that young people are incapable of regulating their sexual behavior in a responsible fashion. This “teens run amok” stereotype fuels the perception that young people are problems in the making rather than partners in prevention. Yet despite the characterization, U.S. teens are often more responsible than their adult counterparts (condom use being one example). The bottom line: respect youth and give them the information, education, support, and guidance that they need, and they will act responsibly.

Finally, we must address our conflicted cultural norms around sexuality itself. In America, we use sex to sell everything from laptops to lipstick; we parade advertisements for Viagra and Cialis across TV screens in prime time; and we promote sex-drenched sitcoms during what was once the “family hour.” Yet, advertising for condoms during the same time slots is deemed “too controversial” despite the fact that condoms are the most effective disease prevention tool available for those who are sexually active.

On the one hand, young people are being told that sex is dirty, filthy, and disgusting while on the other they are being asked to save it for someone they love. Sex is used for entertainment and commerce but rarely spoken of openly and honestly in our homes, schools, and faith communities. We obsess about what makes us sexually attractive but spend little time educating one another about what makes us successful as partners in a relationship.

Culture will continue to dictate the ceiling for progress on sexual health in America. The sex education our youth get will be decided by how tightly our culture holds on to the fear, shame, and denial promoted by social conservatives and their “just say no” approach. We need to break through this ceiling and provide young people with comprehensive sex education. Only then will we become a society where sexuality is viewed as a normal, natural, positive part of life; where young people are valued as assets rather than liabilities; where public policy is shaped by science and evidence; and responsibilities are properly balanced with rights in a way that empowers young people to become sexually healthy adults.

I don’t think it is overstated to say that we have begun to reframe the debate; but how far we go will be determined by our willingness to educate our children—honestly and openly. Only then will we become a sexually healthy nation.

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