Comprehensive sex education

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 curriculums.[22] Educators have also accused CSE as 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.[23] "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."[23]

The LGBT population experiences health disparities associated with stigma, discrimination, negative connotations as well as stereotypes.[24] This population is subject to systemic barriers to adequate healthcare services ultimately impacting their wellbeing and welfare negatively.[24] The care that they are provided with often is from clinicians who are not trained well in addressing the concerns of this population.[25] This lack of training from the provider hinders the experience and ultimately influences the quality of care and adequate delivery of healthcare.[25] Due to discrimination and lack of cultural sensitivity that perpetuate prejudice, this population experiences limited health-seeking behaviors.[24] Thus, making preventative services unattainable, furthermore, increasing and prolonging illnesses and ailments. Research shows higher risk of contracting HIV and other STDs; the number is increased when assessing the intersecting population of gay men of color.[24] Lesbian and bisexual females are less likely to obtain routine care like: breast and cervical cancer screenings.[24] 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.[25] As a result stigma, discrimination, victimization, and sexual abuse LGBT youth is more likely to be involved in high-risk sexual behaviors at an earlier age.[25]

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.[26] 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.[26] Sexual health involves not only preventing disease, but also a respectful approach to sexual relationships, sexuality, and accepting an individual's gender iedntity and sexual orientation.[26]

The term "comprehensive" is also often misleading because some comprehensive programs do not show the holistic picture of human sexuality.[27] 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. 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." [28] Inclusion of LGBT identities and health topics is necessary for LGBT students to feel safe and seen in their sex ed classrooms.[29] When sex education fails to include LGBT identities and experiences, LGBT youth can be vulnerable to risky sexual behaviors and encourage 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.[30] 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 LGBT community has less access to health services and faces more comprehensive health challenges compared to the general population. As a result of 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 sexual and gender identity, sexually transmitted infections (STIs), healthy social relationships, and depression. They do this though workshops, arts‐based projects, and one‐on‐one meetings. The CHEW project is set exclusively to the LGBT community in order to establish a safe environment in which LGBT youth can gain resources for sex education.[31]

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."[32] 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.[33] 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 be have accurate information to all identities as well as establish a safe classroom for LGBT students.[34]

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).[35] Additionally, several states have passed legislation that bans teachers from discussing gay and transgender issues, such as sexual health and HIV/AIDS awareness.[33] Furthermore, three states require that teachers only portray LGBT people in a negative light (Alabama, South Carolina, and Texas).[35]

"Before the late 1800s, delivering sex education in the United States and Canada was primarily seen as a parent’s responsibility.[33] 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.[27]

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 (AGEP), 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.[3]

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.[36] They are as follows:

A. Has as its exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity;

B. Teaches abstinence from sexual activity outside marriage as the expected standard for all school-age children;

C. Teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems;

D. Teaches that a mutually faithful, monogamous relationship in the context of marriage is the expected standard of sexual activity;

E. Teaches that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects;

F. Teaches that bearing children out of wedlock is likely to have harmful consequences for the child, the child's parents, and society;

G. Teaches young people how to reject sexual advances and how alcohol and drug use increase vulnerability to sexual advances; and

H. Teaches the importance of attaining self-sufficiency before engaging in sexual activity;[36]

In addition to abiding by these 8 conditions, AGEP compliant programs cannot discuss contraception, STIs, or methods for protecting against STIs, except when describing failure rates.[3]

More recently legislation has pushed for funding that goes beyond abstinence only education.[36] In 2010, President Obama introduced the Teen Pregnancy Prevention Program (TPP), which provides a total of $114.5 million annually to sex education programs that are "medically accurate and age-appropriate."[3][36] TPP falls under a subsection of United States Department of Health and Human Services ("HHS") which is overseen by the Office of Adolescent Health. Funding for TPP is dispersed if "they emulate specific evidence-based programs promulgated under TPP."[3]

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 that all materials are 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 if marital status. Furthermore, it is now required to have discussions about all FDA-approved contraceptive methods in preventing pregnancy, including the morning after pill.[3]

In conclusion now requires that all sex education programs promulgated in the state should[3]

• normalize sexuality as part of human development;
• ensure people receive integrated, comprehensive, accurate, and unbiased sexual health and HIV prevention and instruction; and
• provide pupils with the knowledge and skills to have healthy, positive, and safe relationships.

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, termiology also differs. Abortion, homosexuality, abstinence have connotations and definitions that vary state. 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" connotates 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.[22]

According to the Sexuality Information and Education Council of the United States (SIECUS), the guidelines for comprehensive sexuality education are as follows:[36]

• appropriate to the age, developmental level, and cultural background of students;
• respects the diversity of values and beliefs represented in the community;
• complements and augments the sexuality education children receive from their families, religious and community groups, and healthcare professionals;
• teaches not only about abstinence, but also contraception, including emergency contraception and reproductive choice;
• teaches about lesbian, gay, bisexual, transgender (LGBT) issues and questions issues;
• teaches anatomy, development, puberty, and relationships;
• teaches all of the other issues one would expect to be covered in a traditional sexuality education class; and
• should be science-based and medically accurate

Just as teaching methods and curricula vary by state, excusal from sex education also varies by state. States may have with an opt out or opt in produce. 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.[3]