Comprehensive Sex Health Education is about social change, not health
A review of the CSHE literature reveals that its goal has nothing to do with reducing abortions or STDs. It's all about changing beliefs about sex.
Background
Every public school in Washington state is required by law to provide comprehensive sexual health education (CSHE) to each student. In RCW 28A.300.475, the state legislature finds “that young people should have the knowledge and skills necessary to build healthy relationships, and to protect themselves from unintended pregnancy and sexually transmitted diseases, including HIV infection.”
But does CSHE actually achieve these goals: to build healthy relationships, protect them from unintended pregnancies and keep them free from STDs?
The following is my search for an answer to this question.
Three Decades of Research: The Case for Comprehensive Sex Education
In an article titled, “Three Decades of Research: The Case for Comprehensive Sex Education,” the authors claim to have completed an extensive survey of over thirty years of research surrounding the efficacy of CSHE. The article, however, completely ignores CSHE’s impact on abortions and STDs.
While the authors’ original search revealed over 40,000 articles to potentially review, the authors eliminated the vast majority of those articles. They ended up with only 80 articles, purposefully ignoring any research into the impacts CSE has on pregnancy and STDs.
Given the breadth and sheer number of studies, and in the interest of drawing conclusions about the broader impact of CSE, the researchers decided to exclude studies focused only on pregnancy and disease prevention programs.
With their focus on a “broader impact” the authors concluded that the benefits of CSHE include:
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. Substantial evidence supports sex education beginning in elementary school, that is scaffolded and of longer duration, as well as LGBTQ inclusive education across the school curriculum and a social justice approach to healthy sexuality.
Most of the studies they chose to review were done between 2001-2018. Only 6 studies were from the 90s. Thus, they did not really cover 30 years of research.
The authors’ conclusion seems typical of research on CSHE. That is, the benefits of CSHE are not measured in terms of reduced numbers of pregnancies or fewer STDs. Rather, it’s measured by less tangible factors, such as enhanced appreciation of sexual diversity, reduced homophobia and homophobic bullying, expanded understanding of gender norms, improved recognition of gender equity, rights and social justice, etc. (see pages 16-21).
It’s worth noting that the authors think that not only should there be children’s literature that challenges heteronormity but that teachers should actively push such literature.
Qualitative studies of efforts to expand understanding of gender and gender norms, all at the elementary school level (third to fifth grades), suggest that making children's literature that challenges gender stereotypes available and accessible to students may not be enough. Using that literature to engage students in discussions, relating gender-based bullying and harassment to harassment and oppression of other marginalized populations, and using a critical literacy approach [97] engaged students in different ways of thinking about and expressing the messages from these books and other media. p.16
More comprehensive sex education reduced teen births: Quasi-experimental evidence
This study claims to evaluate CSE. But in fact, it evaluates Personal Responsibility Education Programs (PREP) and Teen Pregnancy Prevention Programs (TPPP).
Because our causal identification strategy relies on county-level variation in the timing and receipt of federal funding, we focus attention on TPPP.
“The TPPP was created with bipartisan support in 2010 to fund both evidence-based programs and innovative approaches to reducing pregnancy among adolescents and supporting their sexual health. Grant recipients have implemented and evaluated a wide range of interventions, including youth development, child and parent communication, abstinence-based programs, HIV prevention programs and sex education.” Gutmacher Institute. Note that TPPP is implemented to reduce pregnancies. CSHE is not.
Given that CSHE is not an abstinence-based program and that abstinence-education is routinely disparaged in pro-CSHE literature, this study clearly equivocates on the definition of CSHE. Is it possible that the reduction in teen pregnancies is attributable to the abstinence-only programs? It seems likely that TPPP has a greater emphasis on teen pregnancy and STDs than does CSHE.
Whatever the case, the authors claim that federal funding for CSHE lowered the rate of “teen births” by 3%. Seems specious to me.
A Meta-Analysis of the Effects of Comprehensive Sexuality Education Programs on Children and Adolescents
This study looked at 34 articles. None of those articles specifically evaluated CSHE’s impact on abortion or STD rates. Instead, they evaluated the impact based on other core components of CSE:
Miedema et al. identified the core components of CSE as follows [15]: (A) Rights, participation, and agency of young people: CSE aims to develop knowledge, attitudes, and life skills to protect the sexual and reproductive health and rights of adolescents. (B) Issues and practices related to sexual and reproductive health: CSE should address a wide range of issues and practices related to sexual and reproductive health. (C) Gender equality and power relations: this component emphasizes the impact of gender equality and women’s decision-making power. (D) Positive sexuality and respectful relationships: this component highlights the cultivation of healthy perceptions and attitudes toward sexual relationships among adolescents [15,16,17].
Indeed, the impact of CSHE on STIs and abortion is of far less concern than its impact on kids’ attitudes.
The outcome variables in CSE were predominantly related to knowledge. This seems appropriate as the goal of CSE is to effect changes in knowledge and attitudes, providing a deeper understanding of one’s sexuality [13]. Specifically, the enhancement of sexual knowledge impacts individual behavior and helps one better understand their rights and responsibilities when making sexual decisions [71,72]. It is known that the changes in knowledge brought about through CSE have a direct positive effect on the responsibility for children and adolescents’ sexual behavior [13], thus making it one of the most crucial effects of education. In the current context, where ambiguous information related to sex is easily accessible [73,74], comprehensive sexuality education, which equips children and adolescents with the knowledge and skills for responsible decision making, not just the mere dissemination of sexual knowledge, can be considered essential for effective health promotion [42,75,76
International technical guidance on sexuality education: an evidence-informed approach
This resource by UNESCO claims that CSHE helps to prevent STDs and abortions. However, sifting through the evidence for this claim is no easy task. Studies are occasionally cited, but I do not have the time to read through them. So I do not have a rebuttal. Here are some pertinent clips from the book:
Note The Healthy Youth Survey in Washington state that I discuss below may offer some corroborating evidence that students are waiting longer to have sex and are using more contraception. However, whether this change is attributable to CSHE or to the proliferation of pornography (due to an enhanced preference for pornographic over partnered sexual excitement, the devaluation of intimate sexual communication, decreased partnered sex due to masturbatory displacementt) is unknown and possibly unknowable. We need to realize that the use of pornography and the increased teaching of CSHE are parallel. We need a study that can separate the two and accurately identify the causes of the changes mentioned in the slide above.
The “International Technical Guidance continues:
Throughout the literature, there is a constant refrain that “abstinence only education is not only ineffective but also harmful.” But I just don’t see the evidence.
Healthy Youth Survey
“The Healthy Youth Survey (HYS) is a biennial, cross-sectional survey of 6th–12th graders that measures adolescent health and wellbeing in Washington state administered since 2002.”
Here are the questions HYS asks our children. If you have kids in public schools, please know that you can opt your child out of this survey.
Here is some pertinent info related to sex from the HYS:
In 2010, 47.4% of Washington 12th graders said they had never had sex. In 2023, 60.8% said they had never had sex.
If this is accurate, that means over the past 13 years, around 13% more 12th graders have delayed their first experience with sexual intercourse. Can this be attributed to CSHE? Or is it due to a preference for pornographic over partnered sexual excitement, the devaluation of intimate sexual communication, decreased partnered sex due to masturbatory displacement?
Over the same 13 years, it also appears that more birth control was used. However, the wording of the survey question related to birth control changed. In 2010, the survey asked only about condoms.
Table 1. 2010 results of HYS
Table 2. 2023 results of HYS
While it appears that partnered sexual activity has decreased over the years, the HYS also found that 6.8% of our kids have tried to kill themselves. With known causal links between porn and depression, it is surprising the HYS did not ask any questions about porn use. The number of students who have cell phones and internet access has exploded, and the age of kids’ first being exposed to porn has decreased. “Experts estimate that in the U.S. and UK, the average age at which boys begin to access Internet pornography is now 11” (Should we teach…) Some say that porn has hijacked our sexuality. I would add CSHE.
CSHE and porn have changed the world’s attitude about sex.
Other research
Other interesting discoveries I came across while researching for this article:
Abstinence-Only-Until-Marriage: An Updated Review of U.S. Policies and Programs and Their Impact
Many articles explicitly state that abstinence-only education is not only ineffective but harmful. The reasoning goes, “Kids are going to have sex anyway and we must show them how!” And many studies go on to claim that the problem is not sexual intercourse but society’s attitude towards it. If society would just lighten up, we’d have no psychological or emotional symptoms from it (i.e. guilt?). Here’s what the above study claims:
“Recent large studies of representative adolescent populations suggest early sexual intercourse is not associated with physical or emotional symptoms, except to the extent that cultural norms and social sanctions create disparities for girls compared to boys with respect to early sexual behavior [26]. Rigid cultural norms and social sanctions likely account for this gender disparity; these gender stereotypes undermine adolescents' sexual health.”
Again, the true purpose of CSE is to change social norms. Societal norms are the problem. The norms must be changed, not the people. If we follow this logic, there will soon be absolutely NO basis for saying any act constitutes sexual perversion.
2. One way we could get a glimpse into whether CSHE is really helping to reduce abortion rates and STDs is to just look at STD and abortion rates in Washington over time. Here’s what I found.
Some apparently good news is that induced abortions have decreased from 127,181 in 2001-2004 to 85,542 in 2018-2022. That is, we have seen a more than 8% decrease in abortions over the last 20 years.
Great news, right? Well…the following questions need to be answered before I celebrate.
Did reporting requirements change over this time?
Has the definition of “Induced abortions” changed over time?
Is the abortion pill considered an induced abortion and has the rate of consumption increased over this time?
"Planned Parenthood’s annual report earlier this year claimed that it had managed to commit a record 392,715 abortions in 2023 as well as 123,855 telehealth appointments…and it is widely believed that mail distribution of abortion pills across state lines is responsible for a significant number of abortions beyond what can be officially documented.” Lifesite News
Another possible explanation for the fewer abortions is that, according to an article in Mashable, Women are becoming more celibate. Being “boy sober” is all the rage. That doesn’t seem to be the the trend among men. Instead, there seems to be a trend to have sex with other men. This may explain why the abortion rate can go down but STDs go up.
Over the past 20 years in Washington State, the number of Chlamydia cases went from 79,344 to 154,434. Syphilis went from 431 cases to 3,624 cases. And HIV infections also increased. New cases went from 398 in 2018 to 421 in 2024.
Stay tuned for an upcoming article that looks into the curricula used in CSHE in our public schools and the organizations behind the push for social change.