Sex Education: Needs,
Programs and Policies
The Guttmacher Institute
© July 2005
The Need to Help Young People
Make Healthy Decisions
33.2
28.5
26.7
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30
35
30.9
25
26.0
20
25.1
WOMEN
15
17.4
10
12.6
AGE
14.0
MEN
16.9
Young people are at high risk of
unintended pregnancy and STDs for
many years
Sex Education
Many teenagers experience
pregnancy and STDs
More than 800,000 women younger than 20 become
pregnant each year
80% of these pregnancies are unintended
Nine million teenagers and young adults acquire an
STD each year
Two young people every hour become infected with
HIV
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The teenage pregnancy rate is
going down
Pregnancies per 1,000 women aged 15-19
120
100
80
60
40
20
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
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Both abstinence and contraceptive
use are responsible for the decline in
teenage pregnancy
53% of the decline was due to more
teens choosing to delay sexual activity
47% of the decline was due to more
effective contraceptive use
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The proportion of high school students
who have had sex has declined
% of students
100
80
60
40
20
0
Male
Female
1991
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The proportion of sexually active high
school students who use condoms
has risen
% of students
100
80
60
40
20
0
Female
Male
1991
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Sex Education
U.S. teenagers have higher rates of
pregnancy, birth and abortion than teenagers
in most other developed countries
Pregnancy rate
Russian Federation
United States
Bulgaria
England and Wales
Canada
Sweden
France
Japan
0
20
40
Birth
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60
80
100
120
Abortion
Sex Education
Why Do U.S. Teenagers Fare
Worse Than Teenagers in Other
Developed Countries?
Levels of teenage sexual activity across
developed countries are similar…
% of women aged 20-24 who had sex in their teenage years
United States
Great Britain
Canada
Sweden
France
0
20
40
60
By age 15
By age 18
By age 20
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80
100
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…but U.S. teenagers have higher
rates of unintended pregnancy and
STDs because they
Are less likely to use contraceptives
Have shorter relationships
Have more sexual partners
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What accounts for lower teenage
pregnancy and STD rates in other
countries?
Clear and unambiguous prevention
messages
Expectation that childbearing will be
delayed until adulthood
Societal supports for young people
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What accounts for lower teenage
pregnancy and STD rates in other
countries?
Greater access to contraceptive and
reproductive health services
Comprehensive sex education
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Sex Education in U.S. Public
Schools
Most school district policies promote
abstinence
14%
35%
Abstinence as only
option
Abstinence as
preferred option/
contraceptives
effective
Abstinence as one
option in broader
sex education
51%
Districts with a sex education policy
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School district sex education policies vary
widely by region
% of districts with a policy
100
80
60
40
20
0
Northeast
South
Midwest
West
Abstinence as one option in broader sex education
Abstinence as preferred option/contraceptives effective
Abstinence as only option
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There is a large gap between what
teachers believe should be covered in sex
education and what they actually teach
% of sex education teachers
100
80
60
40
20
0
HIV
STDs
Abstinence
Opinion
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Birth
control
Facts on
abortion
Condom
use
Sexual
orientation
Instruction
Sex Education
Many sex education teachers do not
teach about contraception
One in four sex education teachers are
prohibited from teaching about
contraception
Four in 10 either do not teach about
contraceptive methods (including condoms)
or teach that they are ineffective
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Teachers who teach the effectiveness of
contraception are more likely to cover
key prevention topics
% of sex education teachers
100
80
60
40
20
0
Condoms for
STD/HIV
prevention
How to resist
peer pressure
Teach contraception is effective
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Correct and
consistent
method use
Sources of
STD/HIV help
Teach contraception is ineffective
Sex Education
Public Opinion
Americans overwhelmingly favor
broader sex education
93% of parents reported their child has
benefited from sex education
94% of parents say that sex education
should cover contraception
Only 15% of Americans want abstinenceonly education taught in the classroom
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Many teenage males do not receive
sex education before first sex
% who have sex before receiving sex education
100
80
60
40
20
0
How to put How to say
on a
no to sex
condom
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STDs
Birth
control
AIDS
prevention
Any
Sex Education
Students say they need more sex
education in school than they
currently receive
% who want more information
100
80
60
40
20
0
What to do
if sexually
assaulted
STDs
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HIV/AIDS
How to talk
with a
partner
about birth
control and
STDs
Birth
control
How to
handle
pressure to
have sex
Sex Education
Support for comprehensive
sex education
American Medical Association
American Academy of Pediatrics
American Nurses Association
American College of Obstetricians and
Gynecologists
American Psychological Association
American Public Health Association
National Institutes of Health
Institute of Medicine
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Sex Education
The Big Disconnect
Teachers, parents, students and health
organizations want young people to receive
comprehensive sex education.
Conservative groups and politicians are
promoting education in U.S. schools that
emphasizes abstinence and denies young
people accurate information about
contraception.
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U.S. Government Support for
Abstinence Education
The Federal Definition of
Abstinence Education
“Abstinence education…has as its
exclusive purpose, teaching the social,
psychological, and health gains to be
realized by abstaining from sexual activity”
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Total Federal Funding for
Abstinence Education—FY 2005
Welfare:
AFLA:
CBAE:
Total:
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$50 million
$13 million
$104 million
$167 million
Sex Education
Funding for abstinence-only sex
education has increased substantially
Funding $ in millions
180
160
140
120
100
80
60
40
20
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
Fiscal year
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Federally funded abstinence
education programs mislead youth
Contraceptive effectiveness
Risks of abortion
STD incidence and transmission
Scientific facts
Medical evidence
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The Grand Total
Federal and matching state funding for
abstinence education that fails to include
accurate and complete information about
contraception has topped $1 billion since
1996.
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Effectiveness of
Sex Education
What do evaluations say about the
effectiveness of sex education?
No evidence shows that abstinence
without contraceptive education
effectively protects teenagers
Contraceptive education does not
encourage sexual activity
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What do evaluations say about the
effectiveness of sex education?
Considerable evidence that certain
programs that include abstinence and
contraceptive education help
teenagers
delay sexual activity
increase contraceptive use
reduce number of partners
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The Potential for Harm
Virginity pledges help some teens to
delay sexual activity, BUT
Most pledgers break their pledge, AND
Pledge-breakers are:
Less likely to use condoms or seek STD
care
More likely to engage in alternative
sexual behavior
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The Potential for Harm
HIV prevention messages that
promote only abstinence and not
condoms may result in more
unprotected sex than do safer-sex
messages.
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In Conclusion…
A “risk reduction” approach to teenage
sexual activity remains vital
Sex among young people is common in the
United States and worldwide
Undermining confidence in contraception
threatens young people’s lives and health
Providing teens with medically accurate
information reduces their risk of STDs and
unwanted pregnancies
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Summary
Many U.S. teenagers experience unintended
pregnancy and STDs
Teenagers in other developed countries fare
better
Abstinence education that omits accurate
information about contraceptives is prevalent
across the country
Many sex education teachers believe they are
not meeting students’ needs
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Summary
Current federal policy ignores public
opinion and research on “what works”
Only a balanced and comprehensive
approach will help teenagers to
become sexually healthy adults
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Major Sources
National Surveys
Youth Risk Behavior Survey–Centers for
Disease Control and Prevention
National Survey of Family Growth–
National Center for Health Statistics
Surveys of school superintendents and
sex education teachers–Guttmacher
Institute
Survey of students and public opinion–
Henry J. Kaiser Foundation
National Survey of Adolescent Males–
Urban Institute
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Major Sources
Other Sources
Teenage pregnancy statistics–
Guttmacher Institute
International birth and abortion
statistics from various sources
Evaluation research–National Campaign
to Prevent Teen Pregnancy
Federal law and policy
Statements on sex education from
national organizations
Policy analysis–Guttmacher Institute
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This presentation was developed with
support from the Program on
Reproductive Health and Rights of
the Open Society Institute.
For more information, visit
www.guttmacher.org
References
Slide 3: The Alan Guttmacher Institute (AGI), In Their Own Right: Addressing the Sexual and
Reproductive Health Needs of American Men, New York: AGI, 2002, p. 8; and Dailard C,
Marriage is no immunity from problems with planning pregnancies, The Guttmacher
Report on Public Policy, 2003, 6(2):10-13.
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women aged 20-24, New York: AGI, May 2003,
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SK, Unintended pregnancy in the United States, Family Planning Perspectives, 1988,
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women aged 20-24, New York: AGI, May 2003,
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Progress Be Made? Occasional Report, New York: AGI, 2001, No. 3.
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pregnancy: trends and lessons learned, The Guttmacher Report on Public Policy, 2002,
5(1):7-10.
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References
Slide 14: AGI, Teenage Sexual and Reproductive Behavior in Developed Countries: Can More
Progress Be Made? Occasional Report, New York: AGI, 2001, No. 3; and Boonstra H, Teen
pregnancy: trends and lessons learned, The Guttmacher Report on Public Policy, 2002,
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policies on sexuality, STD education, The Guttmacher Report on Public Policy, 2001,
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information about contraception in public school district sexuality education policies,
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information about contraception in public school district sexuality education policies,
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secondary schools, Perspectives on Sexual and Reproductive Health, 2003, forthcoming.
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CA: KFF, 2000.
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education, 1988-1995, Family Planning Perspectives, 2000, 32(5):220-226.
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References
Slide 25: Boonstra H, Legislators craft alternative vision of sex education to counter
abstinence-only drive, The Guttmacher Report on Public Policy, 2002, 5(2):1-3.
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Report on Public Policy, 2001, 4(1):9-12; and Boonstra H, Legislators craft alternative
vision of sex education to counter abstinence-only drive, The Guttmacher Report on
Public Policy, 2002, 5(2):1-3.
Slide 28: P.L. 104-193, Aug. 22, 1996.
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equal funding, The Guttmacher Report on Public Policy, 2002, 5(1):1-3.
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DC: AGI, 2003.
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Pregnancy, Washington, DC: The National Campaign to Prevent Teen Pregnancy, 2001;
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Pregnancy, Washington, DC: The National Campaign to Prevent Teen Pregnancy, 2001;
and Satcher D, The Surgeon General’s Call to Action to Promote Sexual Health and
Responsible Sexual Behavior, Rockville, MD: Office of the Surgeon General, 2001.
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intercourse, American Journal of Sociology, 2001, 106(4):859-912; Jemmott JB,
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and teen family planning: the misguided drive for equal funding, The Guttmacher Report
on Public Policy, 2002, 5(1):1-3.
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STD prevention efforts, The Guttmacher Report on Public Policy, 2003, 6(1):1-2 & 14.
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