Three Decades of Research: The Case for Comprehensive Sex Education


  • 1 Department of Public Health, Montclair State University, Montclair, New Jersey. Electronic address: [email protected].
  • 2 Department of Public Health, Montclair State University, Montclair, New Jersey.
  • PMID: 33059958
  • DOI: 10.1016/j.jadohealth.2020.07.036

Purpose: School-based sex education plays a vital role in the sexual health and well-being of young people. Little is known, however, about the effectiveness of efforts beyond pregnancy and sexually transmitted disease prevention. The authors conducted a systematic literature review of three decades of research on school-based programs to find evidence for the effectiveness of comprehensive sex education.

Methods: Researchers searched the ERIC, PsycINFO, and MEDLINE. The research team identified papers meeting the systematic literature review criteria. Of 8,058 relevant articles, 218 met specific review criteria. More than 80% focused solely on pregnancy and disease prevention and were excluded, leaving 39. In the next phase, researchers expanded criteria to studies outside the U.S. to identify evidence reflecting the full range of topic areas. Eighty articles constituted the final review.

Results: Outcomes 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.

Conclusions: Review of the literature of the past three decades provides strong support for comprehensive sex education across a range of topics and grade levels. Results provide evidence for the effectiveness of approaches that address a broad definition of sexual health and take positive, affirming, inclusive approaches to human sexuality. Findings strengthen justification for the widespread adoption of the National Sex Education Standards.

Keywords: CSE; K-12; National Sex Education Standards; National Sexuality Education Standards; Sex education; Sexuality education; Systematic Literature Review; comprehensive sex education.

Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review
  • Sex Education*
  • Sexual Behavior
  • Sexually Transmitted Diseases*
  • Reference Manager
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Review article, a systematic review of the provision of sexuality education to student teachers in initial teacher education.

sex education in schools review

  • 1 School of Languages, Law and Social Sciences, Technological University of Dublin, Dublin, Ireland
  • 2 School of Human Development, Institute of Education, Dublin City University, Dublin, Ireland
  • 3 Department of Psychology, Faculty of Science & Engineering, Maynooth University, Kildare, Ireland

Teachers, and their professional learning and development, have been identified as playing an integral role in enabling children and young people’s right to comprehensive sexuality education (CSE). The provision of sexuality education (SE) during initial teacher education (ITE) is upheld internationally, as playing a crucial role in relation to the implementation and quality of school-based SE. This systematic review reports on empirical studies published in English from 1990 to 2019. In accordance with the PRISMA guidelines, five databases were searched: ERIC, Education Research Complete, PsycINFO, Web of Science and MEDLINE. From a possible 1,153 titles and abstracts identified, 15 papers were selected for review. Findings are reported in relation to the WHO Regional Office for Europe and BZgA (2017) Training Matters: Framework of core competencies for sexuality educators . Results revealed that research on SE during ITE is limited and minimal research has focused on student teachers’ attitudes on SE. Findings indicate that SE provision received is varied and not reflective of comprehensive SE. Recommendations highlight the need for robust research to inform quality teacher professional development practices to support teachers to develop the knowledge, attitudes and skills necessary to teach comprehensive SE.


Sexuality education.

Our understanding of sexuality education is ever evolving, and differences exist in the terminology, definitions and criteria employed across various international documentation relating to SE (cf. Iyer and Aggleton, 2015 ; European Expert Group on Sexuality Education, 2016 ). While the term comprehensive sexuality education (CSE) has, in the last decade or so, come to be widely employed ( WHO Regional Office for Europe and BZgA, 2017 ; United Nations Educational Scientific and Cultural Organisation [UNESCO], 2018 ), given its more recent common usage, for the purpose of this paper, sexuality education (SE) is the broader term employed.

An international qualitative review of studies which report on the views of students and experts/professionals working in the field of SE ( Pound et al., 2017 ) provides recommendations for effective SE provision. According to that review, effective SE provision should include: The adoption of a “sex positive,” culturally sensitive approach; education that reflects sexual and relationship diversity and challenges inequality and gender stereotyping; content on topics including consent, sexting, cyberbullying, online safety, sexual exploitation, and sexual coercion; a “whole-school” approach and provide content on life skills; non-judgmental content on contraception, safer sex, pregnancy and abortion; discussion on relationships and emotions; consideration of potentially risky sexual practices and not over-emphasize risk at the expense of positive and pleasurable aspects of sex; and the production of a curriculum in collaboration with young people. Similarly, Goldfarb and Lieberman’s (2021) systematic review provides support for the adoption of comprehensive SE that is positive, affirming, inclusive, begins early in life, is scaffolded and takes place over an extended period of time.

Teachers as Sexuality Educators

While there are a variety of sources from which students access information for SE, and diversity in respect of students expressed preferences with regards to SE sources ( Turnbull et al., 2010 ; Donaldson et al., 2013 ; Pound et al., 2016 ), the formal education system remains a significant site for universal, comprehensive, age-appropriate, effective SE. Teachers are particularly well-positioned to provide comprehensive SE and create a climate of trust and respect within the school ( World Health Organisation [WHO]/Regional Office for Europe & Federal Centre for Health Education BZgA, 2010 , 2017 ; Bourke et al., 2022 ). Qualities of the teacher and classroom environment are associated with increased knowledge of health education, including SE, for students. Murray et al. (2019) found that the teacher being certified to teach health education, having a dedicated classroom, and having attended professional development training were associated with greater student knowledge of this subject. Inadequate training, embarrassment and an inability to discuss SE topics in a non-judgmental way have been cited as explanations provided by students as to why they would not consider teachers suitable or desirable to teach SE ( Pound et al., 2017 ).

Walker et al. (2021) in their systematic review of qualitative research on teachers’ perspectives on sexuality and reproductive health (SRH) education in primary and secondary schools, reported that adequate training (pre-service and in-service) was a facilitator that positively impacted on teachers’ confidence to provide school-based SRH education. These findings highlight the importance of quality teacher professional development, commencing with initial teacher education (ITE), for the provision of comprehensive SE. Consequently, ITE has increasingly been proposed as key in addressing the global, societal challenge of ensuring the provision of high-quality SE.

Initial Teacher Education

Teacher education provides substantial affordances to respond to the opportunities and challenges presented in the area of SE ( WHO Regional Office for Europe and BZgA, 2017 ). Furthermore, a research-informed understanding of teacher education is emphasized to better support teacher educators in their work with student teachers ( Swennen and White, 2020 ).

Quality ITE provides a strong foundation for teachers’ delivery of comprehensive SE and the creation of safe and supportive school climates. Research has found that teacher professional development in SE is a significant factor associated with the subsequent implementation of school-based SE ( Ketting and Ivanova, 2018 ). A recent Ecuadorian study reported that student teachers held a relatively high level of confidence in terms of their perceived ability to implement SE and to address specific CSE topics. Furthermore, favourable attitudes toward CSE, strong self-efficacy beliefs to implement CSE, and increased confidence in the ability to implement CSE were significantly associated with positive intentions to teach CSE in the future. Insufficient mastery of CSE topics, however, may temper student teachers’ intentions to teach CSE ( Castillo Nuñez et al., 2019 ). Internationally, research suggests there is inconsistency in the provision of SE in ITE and that access to professional development in SE in ITE, and after qualification, needs substantial development ( United Nations Educational Scientific and Cultural Organisation [UNESCO] , 2009 , 2018 ; Ketting et al., 2018 ; O’Brien et al., 2020 ).

Research is thus warranted to explore aspects at the institutional, programmatic and student-teacher level at ITE to address issues regarding the provision, and barriers to SE provision during ITE. Contemporaneous to the current review, O’Brien et al. (2020) undertook a systematic review of teacher training organizations and their preparation of student teachers to teach CSE. They found that teacher training organizations are often strongly guided by national policies and their school curricula, as opposed to international guidelines. They also found that teachers are often inadequately prepared to teach CSE and that CSE provision during ITE is associated with greater self-efficacy and intent to teach CSE in schools. The importance of ITE with regards to the provision of SE cannot be underestimated. Teachers are in an optimal position to provide age-appropriate, comprehensive and developmentally relevant SE to all children and young people.

The current systematic review will assess the provision of SE to student teachers in ITE and how this relates to the relevant knowledge, attitudes and skills required of sexuality educators as proposed by the international guidelines produced by the WHO Regional Office for Europe and BZgA (2017) . The WHO Regional Office for Europe and BZgA (2017) Training Matters: Framework of core competencies for sexuality educators adopts a holistic definition of core competencies, espousing an understanding of teacher competencies as “…overarching complex action systems” and as multi-dimensional, made up of three components: attitudes, skills and knowledge ( WHO Regional Office for Europe and BZgA, 2017 , p. 20). This framework outlines a set of general competencies, together with more specific attitudes, skills and knowledge competencies for sexuality educators. Attitudes, which may be explicit or implicit, are understood as a factor pertaining to the influencing and guiding of personal behaviour. Skills are understood in terms of the abilities educators can acquire which enables them to provide high-quality education. While knowledge is understood as professional knowledge (pedagogical knowledge, content knowledge and pedagogical subject knowledge) in all relevant areas required to deliver high-quality education. Overall, the framework endorses a holistic and multi-dimensional approach which focuses on sexuality educators and the inter-related competencies, in relation to the knowledge, attitudes, and skills that they should have, or need to develop to become effective teachers of SE.

Aims and Objectives

The current study aimed to systematically review existing empirical evidence on the provision of SE for student teachers in the context of ITE.

The objectives were:

• To review the existing peer-reviewed, published literature on SE provision during ITE.

• To synthesize the research on SE provision at ITE institutional/programmatic level.

• To synthesize the research on individual level student teachers’ knowledge, attitudes, and skills in relation to SE during ITE.

Materials and Methods

The systematic review was completed in accordance with PRISMA guidelines ( Liberati et al., 2009 ). A descriptive summary and categorization of the data is reported ( Khangura et al., 2012 ).

Eligibility Criteria

Articles were included in the review subject to adherence to specific inclusion criteria. An overview of inclusion criteria is outlined in Table 1 .

Table 1. Screening and selection tool.

Information Sources

A three-reviewer process was employed. Searches were conducted in August 2019 on five databases selected for their ability to provide a focused search within the disciplines of education (ERIC and Education Research Complete), psychology (PsycINFO), and multi-disciplinary research in the disciplines of health/public health (Web of Science and MEDLINE).

Screening and Study Selection

Reviewers’ selected keywords from two domains, namely ITE and SE as outlined in Table 2 , for the searches. Search terms for each domain were combined using the Boolean search function “AND.”

Table 2. Overview of Systematic Review search terms.

Where possible, limits were applied to include articles from peer reviewed journals as outlined in Table 3 .

Table 3. Overview of database searches and limits applied.

In accordance with Boland et al. (2017) , a pilot screening of a sample of titles and abstracts were completed by two reviewers to assess the inclusion and exclusion criteria. All titles and abstracts were then screened using Abstrackr software ( Abstrackr, 2010 , accessed 2019; Wallace et al., 2010 ). A selection of abstracts were then cross checked by two reviewers. The final selection involved a three reviewer process. Duplicates and references which did not meet the eligibility criteria were removed at this stage. Full text papers of the remaining articles were obtained, where possible. All three reviewers blindly screened the texts of the remaining articles. Consensus was reached that 15 articles met the criteria for this review. Two experts in the field of SE reviewed the list of 15 articles to ensure there were no outstanding papers for consideration within the parameters of the review. No additional papers were identified.

Data Collection Process

A data extraction template was devised in accordance with Boland et al.’s (2017) recommendations. Information was collected on each study regarding: participant characteristics (data on participant gender, age, programme and institution of study, ethnicity, socio-economic status and religion were extracted, where provided); whether the studies examined programmatic input and if so the duration/extent of input; theoretical and conceptualization of SE within the programme; topics covered; whether this was a compulsory or elective programme; and whether the study addressed the WHO-BZgA competencies of knowledge, attitudes and skills of student teachers during ITE ( WHO Regional Office for Europe and BZgA, 2017 ). One lead author was contacted for the purpose of data collection and provided further information regarding their study.

Synthesis of Results

A qualitative synthesis was conducted; the purpose of which was to provide an overview of the evidence identified regarding research on the provision of SE in the ITE context. The findings of the reviewed studies were synthesized following consideration of the key learnings and recommendations from the studies and consideration of the WHO Regional Office for Europe and BZgA (2017) competencies of knowledge, attitudes, and skills necessary for the provision of SE at ITE. The WHO Regional Office for Europe and BZgA (2017) framework was selected to support the categorization and analysis of findings as it was developed by global experts in the field and is thus, an international standard for SE. While there are limitations to the use of this framework, it offered the ability to categorize and analyze findings through a multi- dimensional lens of knowledge, attitudes, and skills.

Quality Appraisal

The Mixed Methods Appraisal Tool (MMAT) ( Pluye et al., 2009 ; Hong et al., 2018 ) was used to appraise the quality of papers by two reviewers. This tool has been found to be reliable for the appraisal of qualitative, quantitative and mixed methods studies ( Pace et al., 2012 ; Taylor and Hignett, 2014 ) and has been successfully used in previous systematic reviews (e.g., McNicholl et al., 2019 ). For each paper, the appropriate study design was selected (i.e., 1. Qualitative, 2. Quantitative randomized controlled trials, 3. Quantitative non-randomized, 4. Quantitative descriptive, and 5. Mixed methods). Next, the paper was assessed using the checklist associated with the study design (see Appendix A for overview of checklist). For example, if the study was categorized as 4. Quantitative descriptive, the study was assessed against the five criteria (4.1–4.5) associated with this study design. An example of a question on the checklist includes “Are the measurements appropriate?” criteria were reported as “met,” “not met,” “cannot tell if criteria were met” or “criteria not applicable.” The results of the quality appraisal are presented in Table 4 . The same numbering as the methodological quality criteria of Hong et al.’s (2018) study was used.

Table 4. MMAT quality appraisal.*

Study Selection

Fifteen articles reporting on thirteen empirical studies were included in the review (see Figure 1 ). Harrison and Ollis (2015) and Ollis (2016) articles are derived from the same dataset, as are Sinkinson and Hughes (2008) and Sinkinson (2009) articles. Given, however, that these articles refer to unique aspects of the particular studies, they have been described and discussed as separate studies in this review. An overview of the process of screening and study selection is outlined in Figure 1 .

Figure 1. Flow diagram of systematic review process.

Study Characteristics

Six qualitative, five quantitative, and four mixed methods studies were reviewed. Where information was available, the research studies were identified as having been conducted predominantly in Australia, New Zealand, and South Africa. The studies were published between 1996 and 2016. Data was most frequently collected from one source; student teachers ( n = 10) and teacher educators/course providers ( n = 3). One study collected data from both student teachers and teacher educators/course providers ( Johnson, 2014 ). The samples size of studies varied from three to 478 participants but were generally small (eight of the studies had fewer than 90 participants: Vavrus, 2009 ; Carman et al., 2011 ; Goldman and Coleman, 2013 ; Johnson, 2014 ; Harrison and Ollis, 2015 ; Brown, 2016 ; MacEntee, 2016 ; Ollis, 2016 ).

Seven studies assessed SE educational inputs at ITE, and three conducted content analysis of content covered on SE educational input at ITE. As the studies were predominantly descriptive and explorative in design, specific outcome variables were often neither defined nor addressed. Educational input studies were classified as examples of research which assessed a particular course, module, or lecture on SE at ITE. With regards to theoretical approaches that may have informed the educational input studies reviewed, three did not report a specific theoretical approach ( Sinkinson, 2009 ; Gursimsek, 2010 ; MacEntee, 2016 ), and the remaining four reported that a critical approach was adopted ( Vavrus, 2009 ; Harrison and Ollis, 2015 ; Brown, 2016 ; Ollis, 2016 ). An overview of study characteristics are presented in Table 5 .

Table 5. Overview of characteristics of reviewed studies.

Quality Appraisal Results

An overview of the results of the MMAT are presented in Table 4 . All the papers in the review were empirical studies and therefore could be appraised using the MMAT. Predominantly the studies reviewed employed the use of qualitative methods, and of the mixed methods studies there was often an emphasis on the qualitative data. Generally, the quality of the mixed methods studies was varied with only a minority of these studies providing a rationale for the use of mixed methods and reporting on divergences between the qualitative and quantitative findings.

The rigour and quality of the qualitative research was also varied. An explicit statement of the epistemological stance adopted and detail of the analytical process were reported in a minority of studies. With regards to educational input studies, data was often collected only after the educational input was completed and thus behavioral change as a result of engagement in the educational input could not be ascertained (e.g., Harrison and Ollis, 2015 ; MacEntee, 2016 ; Ollis, 2016 ). Only one study employed a quasi-experimental design ( Gursimsek, 2010 ), and in this case a purposive sample of student teachers who did not complete the SE course was selected as the control group. Within the remaining 14 studies there were no control groups, randomization, or concealment.

Findings are reported in relation to (a) institutional/programme level and (b) individual student teacher level aligned with the World Health Organisation ( WHO Regional Office for Europe and BZgA, 2017 ) Training Matters: Framework of Core Competencies for Sexuality Educators . An awareness of the interaction of these aspects of student teachers’ development was informative in terms of structuring the findings.

The research studies reviewed predominantly focused on examining a particular educational input on SE during ITE ( Sinkinson, 2009 ; Vavrus, 2009 ; Gursimsek, 2010 ; Harrison and Ollis, 2015 ; Brown, 2016 ; MacEntee, 2016 ; Ollis, 2016 ) or investigating the SE content covered during ITE ( Rodriguez et al., 1997 ; McKay and Barrett, 1999 ; Carman et al., 2011 ). Fewer of the reviewed studies focused on student teachers’ skills to teach SE (e.g., Sinkinson, 2009 ; Vavrus, 2009 ; Harrison and Ollis, 2015 ; Goldman and Grimbeek, 2016 ; MacEntee, 2016 ) or student teachers’ attitudes regarding SE (e.g., Sinkinson and Hughes, 2008 ; Sinkinson, 2009 ; Vavrus, 2009 ; Gursimsek, 2010 ; Johnson, 2014 ; Brown, 2016 ). The findings of the studies were synthesized and categorized in relation to institutional/programmatic level or individual student teacher level. Findings which reflected responses and perceptions of student teachers were categorized as individual student teacher level. Institutional/Programme level related to studies assessing particular modules or comparing course content across programmes, and institutional level studies were categorized as studies where data was collected from multiple institutions. Individual student teacher level findings were reported in relation to the knowledge, attitudes, and skills competency areas required of sexuality educators. These competency domains, however, are not discrete entities or mutually exclusive. In taking a systemic approach, it is, therefore, acknowledged that they are dynamically interconnected, and influence and interact.

Institutional/Programme Level Findings

At a programmatic level, studies revealed variance in the type of SE provision (core/mandatory and elective), student teachers receive during ITE. May and Kundert (1996) found that coursework on SE was reported as part of a mandatory course by 66% of respondents and as part of an elective course by 14% of respondents. While McKay and Barrett (1999) reported that only 15% of the health education programmes in their study offered mandatory SE training with 26% of programmes offering an elective component. With regards to the provision of skill development and training for SE that student teachers received during ITE, Rodriguez et al. (1997) found that of a potential 169 undergraduate programmes, the majority (i.e., 72%) offered some training to student teachers in health education: A minority offered teaching methods courses in SE (i.e., 12%) and HIV/AIDS prevention education (i.e., 4%). Two of the reviewed studies also investigated programme time allocated to SE and found that time spent on SE varied from 3.6 hours ( May and Kundert, 1996 ) to between 9.6 and 36.2 hours ( McKay and Barrett, 1999 ). While at an institutional level, Carman et al. (2011) found that eight of 45 teacher training institutions did not offer any training in SE and of those that did, 62% offered mandatory, and 38% elective inputs.

Findings indicate the paucity of SE topics covered across ITE programme curricula. Rodriguez et al. (1997) reported that 90% of the courses they reviewed listed a maximum of three SE topic areas. The top three SE topics reported in terms of coverage were human development, relationships, and society and culture. Somewhat consistently, McKay and Barrett (1999) found that the topics least emphasized on courses were masturbation, sexual orientation, human sexual response, and methods of sexually transmitted disease prevention. Johnson (2014) sought to examine coverage of, what they defined as, “lesbian, gay, bisexual, transsexual and intersexual (LGBTI)” (p. 1249) issues on ITE courses and reported that of the three ITE institutions examined, none specifically reference LGBTI issues. Finally, one study reported that the provision of SE was found to be contingent on the interest and expertise of the university teacher educators ( Carman et al., 2011 ). Collectively, these findings bring to light the variance in mandatory and/or elective SE provision during ITE, as well as the diverse content covered and the role of teacher educators on its provision.

Individual Student Teacher Level Findings

Factors associated with student teachers’ attitudes regarding sexuality education topics.

Gender, geographical location, religious beliefs, and family background were identified as factors associated with student teachers’ attitudes regarding SE ( Sinkinson and Hughes, 2008 ; Gursimsek, 2010 ; Johnson, 2014 ). Attending a SE course may have positive implications for student teachers’ attitudes as Gursimsek (2010) found that students who had not attended the SE course reported more conservative and prejudiced views toward sexuality than those who had attended the SE course. Given that this was an elective course, however, it is important to consider self-selection bias regarding those who may have opted to take the course.

Student teachers in Johnson’s (2014) study reported that, through engagement in educational inputs which discussed sexuality issues in an open and inclusive way, greater awareness of student teachers’ own and others’ biases was developed. So, too, was knowledge to better understand sexuality issues. Student teachers did, however, acknowledge difficulty integrating these new learnings with their family backgrounds, and belief systems. MacEntee’s (2016) study also brought to light tensions between student teachers’ intentions to teach, and their own attitudes to SE topics and norms within schools. Since the educational input, however, none had used the participatory visual methods when teaching about HIV and AIDS during their teaching practice. Student teachers’ responses indicated that external factors made it difficult to independently continue to integrate participatory visual methods and HIV and AIDS topics into their teaching practice experiences in schools. The findings from Johnson (2014) , and MacEntee (2016) studies indicate that student teachers’ intentions and the realities of teaching subjects and using pedagogical approaches in schools do not always align.

Critical Consciousness

The WHO Regional Office for Europe and BZgA (2017) Training Matters: Framework outlines the objectives of SE, including “open-mindedness and respect for others” (p.26). Although SE courses during ITE may be student teachers’ first exposure to issues of sexual and gender equality, for example, critiques of hetero-normativity ( Vavrus, 2009 ) and introductions to critical feminist discourses ( Harrison and Ollis, 2015 ), findings from several of the studies ( Sinkinson, 2009 ; Vavrus, 2009 ; Harrison and Ollis, 2015 ), indicated that the SE programmes offered during ITE may be insufficient in developing student teachers’ critical consciousness—the ability to recognize and analyze wider social and cultural systems of inequality and the commitment to take action to address such inequalities.

Vavrus (2009) found student teachers expressed varying degrees of critical consciousness as a result of completing a multi-cultural curriculum and assignment. While Harrison and Ollis’s (2015) examination of micro-teaching lessons indicated that completion of an educational input on SE from a feminist, post-structuralist perspective did not suffice in increasing student teachers’ understanding of gender/power relations but rather brought to light the challenges of employing such a perspective. Similarly, Sinkinson (2009) reported a noticeable lack of development of criticality regarding socio-cultural perspectives of SE from the completion of an introductory health education course (2004, first year) to the completion of a specialist health education course (2006, third year). Finally, albeit difficult to generalize given the study’s small sample size, Brown (2016) reported that experiential pedagogical approaches, through inclusion of a guest speaker living with HIV, and employment of a critical, creative arts-based pedagogical strategy offered a critical lens through which student teachers moved from a position of stigmatization toward one of understanding and compassion.

Factors Associated With Student Teachers’ Skills Regarding Sexuality Education Topics

With regards to student teachers’ skills, or potential skill development during ITE, several aspects of ITE were identified as significant in relation to the acquisition of the required skills to teach SE. These included the pedagogical approaches adopted during ITE; the learning environment; opportunities for practical teaching experience, and critical self- reflection.

Pedagogical Approaches and Practical Teaching Experiences

Seven of the studies reviewed examined aspects of pedagogical approaches to teaching SE ( Rodriguez et al., 1997 ; Sinkinson and Hughes, 2008 ; Sinkinson, 2009 ; Carman et al., 2011 ; Goldman and Coleman, 2013 ; Johnson, 2014 ; Goldman and Grimbeek, 2016 ). Goldman and Coleman (2013) reported that their small sample of six student teachers indicated that they learned very little regarding knowledge and pedagogical approaches specific to SE during ITE. Sinkinson (2009) , however, found that student teachers identified co- constructivist pedagogical approaches as being important when teaching SE. Student teacher participants in MacEntee’s (2016) study indicated that the use of participatory visual methods was a novel and thought-provoking way to learn about HIV and AIDS.

Several of the studies indicated the need for opportunities for student teachers to teach and develop the skills to teach SE. Harrison and Ollis (2015) article was the sole study to report on the evaluation of the potential pedagogical skills student teachers had acquired following the completion of SE input. Their examination of micro-teaching lessons indicated the value in examining student teachers teaching of SE. Through this experience, they identified that the educational input had been insufficient in providing student teachers with the opportunity to reflect on a critical approach to gender and sexuality, and to develop the pedagogical skills to teach SE from a critical perspective.

Vavrus (2009) suggested that, given the level of fear acknowledged by student teachers around teaching SE, interventions and programmes should provide structured opportunities for student teachers to construct lesson plans that critically address gender identity and sexuality in developmentally appropriate ways. Vavrus (2009) further suggests that instruction on conducting discussions related to gender identity and sexuality, and strategies to respond to homophobic and sexist discourse should also be provided. Participants in Brown’s (2016) study similarly reported that they would have liked to have had more opportunities to familiarize themselves with facilitating visual participatory methods when teaching about SE topics such as HIV and AIDS.

Learning Environment

MacEntee’s (2016) study provides provisional support for the use of workshops in learning about HIV and AIDS. Student teachers ( Goldman and Grimbeek, 2016 ) and course providers ( Johnson, 2014 ), indicated preferences for the use of tutorial groups, small group face-to-face discussion, and case studies when teaching about SE. In both studies, these approaches were associated with creating less threatening, and more comfortable environments for student teachers to engage with topics on a personal level. Across studies, student teachers remarked that respect and acceptance of other people’s views and opinions were critical to ensure that the environment in which SE provision takes place is safe. These views are aligned with two of the overarching skills outlined by the WHO Regional Office for Europe and BZgA (2017) ; the “ability to use interactive teaching and learning approaches” and the “ability to create and maintain a safe, inclusive and enabling environment” (p. 28). In relation to assessment of SE at ITE, Goldman and Grimbeek (2016) found that student teachers had a preference for group-based assessments, independent research, and self-assessment.

Consistent with the WHO Regional Office for Europe and BZgA (2017) Training Matters: Framework of Core Competencies for Sexuality Educators , sexuality educators should “be able to use a wide range of interactive and participatory student-centered approaches” (p. 28). These findings indicate that the creation of interactive and participatory learning environments is conducive to SE at ITE level. The opportunity to engage in these types of learning environments and student teachers’ positive perceptions of these learning environments may have consequences for the classroom environment which student teachers subsequently create.

Critical Self-Reflection

The ability of sexuality educators to reflect on beliefs and values is a vital skill, according to WHO Regional Office for Europe and BZgA (2017) . The reviewed studies consistently cited the importance of self-reflection in SE provision during ITE. Vavrus (2009) found that self-reflection was critical to the development of a more understanding, and empathetic, approach to teaching. Harrison and Ollis (2015) emphasized the need to support teachers in the development of reflective practices. Ollis (2016) concluded that the opportunity for self-reflection would impact on student teachers’ intention to include pedagogies of pleasure in their practice. Johnson’s (2014) study indicated that engagement in reflection regarding the self and others, helped students to develop a better understanding of their own beliefs and assumptions. The findings from Johnson’s study, however, also show that increased opportunity for self-reflection, and exposure to critical interpretations of content, do not necessarily transfer to teaching behaviours. Gursimsek (2010) recommended the inclusion of critical self-reflection components on future SE courses as it was suggested that components would assist student teachers in clarifying their own social and sexual values, life experiences, and learning histories. This clarification then assists, and supports, maturation in terms of attitudes, beliefs, knowledge as they relate to sexuality. Collectively, these findings indicate that teaching in ITE needs to provide safe spaces for self-reflection on the part of student teachers—and honest engagement with others.

Factors Associated With Student Teachers’ Knowledge Regarding Sexuality Education Topics

Two of the reviewed studies explored the topics student teachers perceived as important for school students to learn about, and the topics they themselves would like to study during ITE. Sinkinson and Hughes (2008) found that, of the aspects of health education student teachers prioritized for school students, the most important were mental health (62%); aspects of sexuality (61.2%); and drugs and alcohol (46.8%). Mental health included “personal development, relationships, emotional health and essential skill development such as decision making” (p. 1079). Student teachers’ responses indicate that they saw personal and interpersonal topics as important aspects of health education. Goldman and Grimbeek (2016) reported that, during ITE on SE, student teachers would most prefer to have social, psychological, and developmental factors associated with student/learner puberty and sexuality addressed. Older student teachers—those in the 22–48 year-old age range—were significantly more likely than their younger student teachers to strongly rate preferences for knowledge about wider socio-cultural contextual factors.

Student Teachers’ Confidence and Comfort to Teach Sexuality Education

Four of the studies reviewed reported student teachers’ comfort and confidence in teaching SE ( Sinkinson, 2009 ; Vavrus, 2009 ; Johnson, 2014 ; Ollis, 2016 ). Student teachers in Sinkinson’s (2009) study suggested that increases in knowledge and learning about SE topics increased comfort levels and intention to teach SE. Student teachers suggested that the opportunity to listen, learn, and discuss topics in an open environment reduced their embarrassment in discussing SE issues. These opportunities increased their comfort for answering pupils’ questions, and using language that they had previously considered taboo ( Sinkinson, 2009 ). Vavrus (2009) reported that having completed the educational input on SE, all student teachers felt they would create an open and safe space for students. Some student teachers reported confidence in their ability to create content, and think of topics to cover, relating to sexuality and gender identity. Responses also indicated challenges for student teachers regarding empathy; fears on how to respond to issues of sexuality and gender identity; lack of experience; feeling unprepared; and fear of reprisal for working outside traditional norms. Cognitive dissonance between the knowledge student teachers acquired about sexuality issues during ITE, and their personal and familial belief system in Johnson’s (2014) study was associated with discomfort for student teachers. Thus, findings from Vavrus’s (2009) and Johnson’s (2014) studies indicate that, although ITE had provided student teachers with knowledge on SE topics, wider socio-cultural/systemic factors may influence student teachers’ confidence or comfort to integrate or apply this knowledge outside of the ITE context.

A lack of student teacher knowledge about SE topics, especially with regards to “non- normative” areas, such as HIV/AIDS, was reported by Brown (2016) as associated with “othering” and discomfort regarding teaching SE content. Ollis (2016) reported the discomfort student teachers’ experience with topics on sexual pleasure and observed that engagement in teaching a 20-minute lesson on a positive sexual development theme—such as pleasure—resulted in increased confidence and skill to discuss sexual pleasure, orgasm, and ethical sex. The topic of student teachers’ comfort and confidence provides a prime example of the interaction of all three competency areas; knowledge, attitudes, and skills in relation to SE. Furthermore, the findings highlight that a more systemic consideration of these competency areas and teachers’ comfort and confidence to teach SE beyond the ITE context to the lived experience of school contexts, is warranted.

Overview of Findings

This systematic review sought to investigate the empirical literature on SE provision with student teachers during ITE. Fifteen articles, reporting on thirteen studies, from predominantly Western, English-speaking contexts met the criteria for review. The findings reveal the varied nature of the provision of SE during ITE for student teachers ( Rodriguez et al., 1997 ; McKay and Barrett, 1999 ; Carman et al., 2011 ). This is consistent with the findings of O’Brien et al.’s (2020) systematic review which similarly found variability in the provision of SE for student teachers. The current reviewed studies document an examination of SE provision at institutional/programme level, and individual student teacher level. The latter studies, in the main, reflected student teachers’ experiences regarding a particular educational input on SE, and to a lesser extent related to an examination of student teachers’ general knowledge, attitudes, or skills regarding SE.

Along with the acknowledged need to provide educational input on SE in ITE, the findings reflect that SE is perceived of as more than a stand-alone curriculum subject. Recommendations from the reviewed studies in respect of educational input provide some support for a more embedded and intersectional approach to SE provision during ITE. Similarly, O’Brien et al.’s (2020) systematic review emphasized the need for greater collaboration, integration and consistency in provision of SE at ITE. ITE in SE is typically seen within the realm of student teachers who are going to qualify as health educators, however, there is a strong argument to make that all pre-service teachers require a fundamental understanding of SE. With regards to the current review, for example, Vavrus (2009) concluded that there is a need for teacher education programmes that extend curricular attention to gender identity formation and sexuality, beyond specific SE modules, as it was suggested that this will help student teachers better understand socio-cultural factors that influence their teacher identities. Harrison and Ollis (2015) acknowledged that—as student teachers may not have engaged with critical approaches to material previously and may not have been provided with adequate time to consider these interpretations of gender and power—programmes over an extended period of time and engagement with these topics across the curriculum may facilitate increased engagement and reflection on this content. The findings provide some support that more time invested in educational input programmes may be beneficial. Courses covered over a semester ( Sinkinson, 2009 ; Gursimsek, 2010 ), for example, may be more beneficial than those covered over much shorter periods ( Harrison and Ollis, 2015 ; Ollis, 2016 ).

The WHO Regional Office for Europe and BZgA (2017) states that an important pre-requisite to teaching SE is the ability and willingness of teachers to reflect on their own attitudes toward sexuality, and social norms of sexuality. Sexual Attitudes Reassessment or values clarification has been an integral part of sexology education and training since the 1990s ( Sitron and Dyson, 2009 ). Indeed, many accreditation bodies set a minimum number of hours in this process-orientated exploration as a requirement for sexology or sexuality education work ( Areskoug-Josefsson and Lindroth, 2022 ). This involves a highly personal internal exploration that is directed toward helping participants to clarify their personal values and provides opportunities for participants to explore their attitudes, values, feelings and beliefs about sexuality and how these impact on their professional interactions ( Sitron and Dyson, 2009 ). This type of input would be valuable in the ITE space. The current findings indicate that educational inputs which facilitate self-reflection and the development of critical consciousness may be particularly beneficial and necessary in supporting student teachers to teach SE. Having the space and time to engage with one’s own belief systems, and experiences, can provide student teachers with insights regarding factors that shape identity and human interaction, which are fundamental to comprehensive SE. This is an important task for teachers and previously has been identified as a gap within existing teacher education programmes ( Kincheloe, 2005 , as cited in Vavrus, 2009 ).

With regards to pedagogical approaches for teaching SE during ITE, the findings indicate that the use of tutorial groups, small group face-to-face discussions, case studies, participatory visual methods, and the inclusion of guest speakers sharing their lived experiences may create less threatening, and more comfortable, environments for student teachers to engage with SE topics on a personal level ( Johnson, 2014 ; Brown, 2016 ; Goldman and Grimbeek, 2016 ; MacEntee, 2016 ). These findings are somewhat consistent with existing evidence that supports experiential and participatory learning techniques for SE (e.g., United Nations Educational Scientific and Cultural Organisation [UNESCO], 2018 ; Begley et al., 2022 ). A lack of practical teaching experience was acknowledged by student teachers as a barrier to teaching SE topics (e.g., Vavrus, 2009 ; MacEntee, 2016 ). Given the reported ( Ollis, 2016 ), and potential ( Vavrus, 2009 ) benefits from engaging in the practice of teaching SE the inclusion of skills-based and practical teaching experience of SE or its proxy as a minimum, within the ITE context may be warranted.

There were some notable absences from the literature reviewed. Although there are examples of research in this review which refer to positive SE topics such as pleasure, sexual orientation, and gender identity, the studies in the main do not reflect an examination of topics fundamental to a CSE curriculum. Studies did not consider or examine the impact of the Internet and social media in relation to SE. Apart from May and Kundert’s (1996) study, the research did not reflect consideration of the provision of SE for students with diverse learning abilities and needs. Some studies considered correlational factors pertaining to student teachers’ attitudes regarding SE. These included gender, geographical location of upbringing ( Gursimsek, 2010 ), and student teachers’ previous school experiences of SE ( Sinkinson and Hughes, 2008 ; Vavrus, 2009 ). Overall, in the studies reviewed there was a dearth of research on student teachers’ attitudes about SE, and the inter-dependence of factors that may influence student teachers’ attitudes.

Given that this field of research is in its relative infancy, the findings which may be inferred from the educational input studies ( Sinkinson, 2009 ; Vavrus, 2009 ; Gursimsek, 2010 ; Harrison and Ollis, 2015 ; Brown, 2016 ; MacEntee, 2016 ; Ollis, 2016 ), are tentative. These studies are generally informative regarding a particular topic or educational input but tend not to shed light on student teachers’ experiences. Furthermore, the findings from Carman et al.’s (2011) and Johnson’s (2014) studies, highlight the role of teacher educators in relation to SE provision being taught during ITE. Teacher educators provide vital support and facilitate new understandings and guidance in the context of SE and teacher professional development. Consistent with O’Brien et al. (2020) , this review highlights the need to promote greater shared learning and evidence-based resources among teacher educators and ITE institutions.


This systematic review should be considered in light of its limitations. There is inherent risk of bias across studies given that only peer reviewed articles written in English were reported on. Consequently, a wealth of potential research may have been precluded from review and the findings of the studies will pertain to and potentially reflect the experiences of those in the global north and/or a Westernized view. The exclusion of grey literature such as dissertations and theoretical papers is indicative of publication bias. The very process of selecting inclusion and exclusion criteria is subjective and may facilitate the exclusion of minority voices, or creative methodologies for conducting and or presenting research. Through the exclusion of position papers or articles that do not make reference to empirical data, important voices to this conversation may have been limited/excluded.

Findings were discussed in relation to the competencies outlined by the WHO Regional Office for Europe and BZgA (2017) . Although an international standard for SE, there are limitations to these guidelines. Our understanding of the provision of SE is continuously developing. In 2019, the Sex Information and Education Council of Canada (SIECCAN) updated their guidelines to include an emphasis on changing demographics in relation to sexual health, the need for sexual health educators to demonstrate awareness of the impact of colonialism on the sexual health and well-being of indigenous people, to recognize the impact of technology on sexual health education, to meet the needs of young people of all identities and sexual orientations, and the need to address the topic of consent within sex education. These aspects of SE are not reflected in the WHO Regional Office for Europe and BZgA (2017) guidelines, nor are they reflected in the studies reviewed. This is indicative of the dynamic and complex nature of the field of SE and specifically in ITE.

Given the design of the studies we cannot conclude that ITE experiences translate to teachers’ SE teaching practice. Some studies provided examples of the barriers student teachers can face in the translation of ITE experiences to classroom experiences (e.g., MacEntee, 2016 ). However, other than MacEntee (2016) , examples of research with both student teachers and in-service teachers were not identified nor were longitudinal studies examining the progression from ITE to classroom experiences. Notably, upon screening the abstracts, the literature tended to assess SE received by medical and health care professionals, and there were far less examples regarding research with teachers in general and as may be garnered from this systematic review, a very limited amount of research conducted with student teachers in ITE. As ITE programmes do not routinely publish their course content, there is also a chance that such professional learning and development is being provided but not being reported. Furthermore, given that research on SE within an ITE context is a relatively novel field, diverse methodological approaches have been adopted and there appears to be limited reporting of the theoretical basis informing on this work which has implications for cross-study synthesis of findings. The studies included in this systematic review, predominantly employed qualitative designs and consequently were more idiosyncratic in their selected methodological approach.


Drawing on the findings from the systematic review the overarching recommendation is for more quality research on teacher professional development in the context of SE during ITE. Aspects which require further research attention are outlined below.

Along with the provision of educational input on SE at ITE, an embedded and intersectional approach to SE at ITE programme-level requires further exploration. If student teachers are to meet their future school students’ SE needs, a foundational element of teacher preparation must involve actively addressing issues that are linked to teacher confidence and comfort for delivering SE. The reviewed studies broadly indicate that opportunities for critical self-reflection, practice-oriented and small-group, dialogical, inclusive and participatory pedagogical approaches may be beneficial to adopt with regards to the provision of SE during ITE, however, further robust research is required to support this.

Larger scale, multi-dimensional, integrative studies employing rigorous methodologies to assess inter alia student teachers’ knowledge, attitudes, and skills, regarding sexuality during ITE including student teachers’ knowledge, comfort, confidence and preparedness to teach sexuality are warranted. Furthermore, research which is inclusive of both student teachers’ and teacher educators’ voices, is needed.

Adoption of a systemic approach examining individual-level and contextual factors relating to SE provision during ITE is needed to develop theoretically derived, research-informed, and evidence-based SE programmes at ITE. In order to improve the provision of SE at ITE an evaluation of provision must be in place for best practice to be achieved.

ITE provision needs to adopt a holistic approach when supporting teacher development. As documented by the WHO Regional Office for Europe and BZgA (2017) guidelines, this involves supporting the development and acquisition of relevant knowledge, attitudes and skills pertaining to SE. Although ITE in SE often focuses on student teachers who will qualify as health educators, it can be argued that all pre-service teachers require a fundamental understanding of SE. Furthermore, the SE provided during ITE should be nuanced to support LGBTI students, students with special educational needs and/or from diverse racial and cultural backgrounds ( Whitten and Sethna, 2014 ; Ellis and Bentham, 2021 ; Michielsen and Brockschmidt, 2021 ). A series of indicators to assess the relevant factors pertaining to SE provision and how these indicators relate to the knowledge, attitudes, and skills required for sexuality educators would be helpful. Monitoring and evaluation of structural indicators such as the designated SE components of course programmes, whether courses are elective or core, whether practice elements are provided etc. would provide a baseline from which system change and improvements could be measured. This systematic review has provided tentative suggestions as to what may work to ensure best practice of SE during ITE. Further research is required to evaluate the outcomes associated with their implementation.

Author Contributions

AC, CM, CC, and AB were responsible for the development and design of the study and final decisions regarding the reviewed articles. AC and CM completed the initial pilot searches. AC completed the final searches and wrote the first draft of the manuscript. AC, CM, and CC reviewed the articles. AC and AB developed the data extraction template. All authors contributed to manuscript revision, read, and approved the submitted version.

This work was supported by the Irish Research Council IRC Coalesce Research Award (Strand 1E—HSE—Sexual Health and Crisis Pregnancy Programme) for the research study TEACH-RSE Teacher Professional Development and Relationships and Sexuality Education: Realizing Optimal Sexual Health and Wellbeing Across the Lifespan (Grant No. IRC COALESCE 2019/147).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords : systematic review, sexuality education, student teacher, initial teacher education, comprehensive sexuality education, sex education

Citation: Costello A, Maunsell C, Cullen C and Bourke A (2022) A Systematic Review of the Provision of Sexuality Education to Student Teachers in Initial Teacher Education. Front. Educ. 7:787966. doi: 10.3389/feduc.2022.787966

Received: 01 October 2021; Accepted: 08 February 2022; Published: 07 April 2022.

Reviewed by:

Copyright © 2022 Costello, Maunsell, Cullen and Bourke. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Aisling Costello, [email protected]

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Article Contents

Introduction, purpose of the study, literature search and selection criteria, coding of the studies for exploration of moderators, decisions related to the computation of effect sizes.

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The effectiveness of school-based sex education programs in the promotion of abstinent behavior: a meta-analysis

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Mónica Silva, The effectiveness of school-based sex education programs in the promotion of abstinent behavior: a meta-analysis, Health Education Research , Volume 17, Issue 4, August 2002, Pages 471–481,

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This review presents the findings from controlled school-based sex education interventions published in the last 15 years in the US. The effects of the interventions in promoting abstinent behavior reported in 12 controlled studies were included in the meta-analysis. The results of the analysis indicated a very small overall effect of the interventions in abstinent behavior. Moderator analysis could only be pursued partially because of limited information in primary research studies. Parental participation in the program, age of the participants, virgin-status of the sample, grade level, percentage of females, scope of the implementation and year of publication of the study were associated with variations in effect sizes for abstinent behavior in univariate tests. However, only parental participation and percentage of females were significant in the weighted least-squares regression analysis. The richness of a meta-analytic approach appears limited by the quality of the primary research. Unfortunately, most of the research does not employ designs to provide conclusive evidence of program effects. Suggestions to address this limitation are provided.

Sexually active teenagers are a matter of serious concern. In the past decades many school-based programs have been designed for the sole purpose of delaying the initiation of sexual activity. There seems to be a growing consensus that schools can play an important role in providing youth with a knowledge base which may allow them to make informed decisions and help them shape a healthy lifestyle ( St Leger, 1999 ). The school is the only institution in regular contact with a sizable proportion of the teenage population ( Zabin and Hirsch, 1988 ), with virtually all youth attending it before they initiate sexual risk-taking behavior ( Kirby and Coyle, 1997 ).

Programs that promote abstinence have become particularly popular with school systems in the US ( Gilbert and Sawyer, 1994 ) and even with the federal government ( Sexual abstinence program has a $250 million price tag, 1997 ). These are referred to in the literature as abstinence-only or value-based programs ( Repucci and Herman, 1991 ). Other programs—designated in the literature as safer-sex, comprehensive, secular or abstinence-plus programs—additionally espouse the goal of increasing usage of effective contraception. Although abstinence-only and safer-sex programs differ in their underlying values and assumptions regarding the aims of sex education, both types of programs strive to foster decision-making and problem-solving skills in the belief that through adequate instruction adolescents will be better equipped to act responsibly in the heat of the moment ( Repucci and Herman, 1991 ). Nowadays most safer-sex programs encourage abstinence as a healthy lifestyle and many abstinence only programs have evolved into `abstinence-oriented' curricula that also include some information on contraception. For most programs currently implemented in the US, a delay in the initiation of sexual activity constitutes a positive and desirable outcome, since the likelihood of responsible sexual behavior increases with age ( Howard and Mitchell, 1993 ).

Even though abstinence is a valued outcome of school-based sex education programs, the effectiveness of such interventions in promoting abstinent behavior is still far from settled. Most of the articles published on the effectiveness of sex education programs follow the literary format of traditional narrative reviews ( Quinn, 1986 ; Kirby, 1989 , 1992 ; Visser and van Bilsen, 1994 ; Jacobs and Wolf, 1995 ; Kirby and Coyle, 1997 ). Two exceptions are the quantitative overviews by Frost and Forrest ( Frost and Forrest, 1995 ) and Franklin et al . ( Franklin et al ., 1997 ).

In the first review ( Frost and Forrest, 1995 ), the authors selected only five rigorously evaluated sex education programs and estimated their impact on delaying sexual initiation. They used non-standardized measures of effect sizes, calculated descriptive statistics to represent the overall effect of these programs and concluded that those selected programs delayed the initiation of sexual activity. In the second review, Franklin et al . conducted a meta-analysis of the published research of community-based and school-based adolescent pregnancy prevention programs and contrary to the conclusions forwarded by Frost and Forrest, these authors reported a non-significant effect of the programs on sexual activity ( Franklin et al ., 1997 ).

The discrepancy between these two quantitative reviews may result from the decision by Franklin et al . to include weak designs, which do not allow for reasonable causal inferences. However, given that recent evidence indicates that weaker designs yield higher estimates of intervention effects ( Guyatt et al ., 2000 ), the inclusion of weak designs should have translated into higher effects for the Franklin et al . review and not smaller. Given the discrepant results forwarded in these two recent quantitative reviews, there is a need to clarify the extent of the impact of school-based sex education in abstinent behavior and explore the specific features of the interventions that are associated to variability in effect sizes.

The present study consisted of a meta-analytic review of the research literature on the effectiveness of school-based sex education programs in the promotion of abstinent behavior implemented in the past 15 years in the US in the wake of the AIDS epidemic. The goals were to: (1) synthesize the effects of controlled school-based sex education interventions on abstinent behavior, (2) examine the variability in effects among studies and (3) explain the variability in effects between studies in terms of selected moderator variables.

The first step was to locate as many studies conducted in the US as possible that dealt with the evaluation of sex education programs and which measured abstinent behavior subsequent to an intervention.

The primary sources for locating studies were four reference database systems: ERIC, PsychLIT, MEDLINE and the Social Science Citation Index. Branching from the bibliographies and reference lists in articles located through the original search provided another source for locating studies.

The process for the selection of studies was guided by four criteria, some of which have been employed by other authors as a way to orient and confine the search to the relevant literature ( Kirby et al ., 1994 ). The criteria to define eligibility of studies were the following.

Interventions had to be geared to normal adolescent populations attending public or private schools in the US and report on some measure of abstinent behavior: delay in the onset of intercourse, reduction in the frequency of intercourse or reduction in the number of sexual partners. Studies that reported on interventions designed for cognitively handicapped, delinquent, school dropouts, emotionally disturbed or institutionalized adolescents were excluded from the present review since they address a different population with different needs and characteristics. Community interventions which recruited participants from clinical or out-of-school populations were also eliminated for the same reasons.

Studies had to be either experimental or quasi-experimental in nature, excluding three designs that do not permit strong tests of causal hypothesis: the one group post-test-only design, the post-test-only design with non-equivalent groups and the one group pre-test–post-test design ( Cook and Campbell, 1979 ). The presence of an independent and comparable `no intervention' control group—in demographic variables and measures of sexual activity in the baseline—was required for a study to be included in this review.

Studies had to be published between January 1985 and July 2000. A time period restriction was imposed because of cultural changes that occur in society—such as the AIDS epidemic—which might significantly impact the adolescent cohort and alter patterns of behavior and consequently the effects of sex education interventions.

Five pairs of publications were detected which may have used the same database (or two databases which were likely to contain non-independent cases) ( Levy et al ., 1995 / Weeks et al ., 1995 ; Barth et al ., 1992 / Kirby et al ., 1991 /Christoper and Roosa, 1990/ Roosa and Christopher, 1990 and Jorgensen, 1991 / Jorgensen et al ., 1993 ). Only one effect size from each pair of articles was included to avoid the possibility of data dependence.

The exploration of study characteristics or features that may be related to variations in the magnitude of effect sizes across studies is referred to as moderator analysis. A moderator variable is one that informs about the circumstances under which the magnitude of effect sizes vary ( Miller and Pollock, 1994 ). The information retrieved from the articles for its potential inclusion as moderators in the data analysis was categorized in two domains: demographic characteristics of the participants in the sex education interventions and characteristics of the program.

Demographic characteristics included the following variables: the percentages of females, the percentage of whites, the virginity status of participants, mean (or median) age and a categorization of the predominant socioeconomic status of participating subjects (low or middle class) as reported by the authors of the primary study.

In terms of the characteristics of the programs, the features coded were: the type of program (whether the intervention was comprehensive/safer-sex or abstinence-oriented), the type of monitor who delivered the intervention (teacher/adult monitor or peer), the length of the program in hours, the scope of the implementation (large-scale versus small-scale trial), the time elapsed between the intervention and the post-intervention outcome measure (expressed as number of days), and whether parental participation (beyond consent) was a component of the intervention.

The type of sex education intervention was defined as abstinence-oriented if the explicit aim was to encourage abstinence as the primary method of protection against sexually transmitted diseases and pregnancy, either totally excluding units on contraceptive methods or, if including contraception, portraying it as a less effective method than abstinence. An intervention was defined as comprehensive or safer-sex if it included a strong component on the benefits of use of contraceptives as a legitimate alternative method to abstinence for avoiding pregnancy and sexually transmitted diseases.

A study was considered to be a large-scale trial if the intervention group consisted of more than 500 students.

Finally, year of publication was also analyzed to assess whether changes in the effectiveness of programs across time had occurred.

The decision to record information on all the above-mentioned variables for their potential role as moderators of effect sizes was based in part on theoretical considerations and in part on the empirical evidence of the relevance of such variables in explaining the effectiveness of educational interventions. A limitation to the coding of these and of other potentially relevant and interesting moderator variables was the scantiness of information provided by the authors of primary research. Not all studies described the features of interest for this meta-analysis. For parental participation, no missing values were present because a decision was made to code all interventions which did not specifically report that parents had participated—either through parent–youth sessions or homework assignments—as non-participation. However, for the rest of the variables, no similar assumptions seemed appropriate, and therefore if no pertinent data were reported for a given variable, it was coded as missing (see Table I ).

Once the pool of studies which met the inclusion criteria was located, studies were examined in an attempt to retrieve the size of the effect associated with each intervention. Since most of the studies did not report any effect size, it had to be estimated based on the significance level and inferential statistics with formulae provided by Rosenthal ( Rosenthal, 1991 ) and Holmes ( Holmes; 1984 ). When provided, the exact value for the test statistic or the exact probability was used in the calculation of the effect size.

Alternative methods to deal with non-independent effect sizes were not employed since these are more complex and require estimates of the covariance structure among the correlated effect sizes. According to Matt and Cook such estimates may be difficult—if not impossible—to obtain due to missing information in primary studies ( Matt and Cook, 1994 ).

Analyses of the effect sizes were conducted utilizing the D-STAT software ( Johnson, 1989 ). The sample sizes used for the overall effect size analysis corresponded to the actual number used to estimate the effects of interest, which was often less than the total sample of the study. Occasionally the actual sample sizes were not provided by the authors of primary research, but could be estimated from the degrees of freedom reported for the statistical tests.

The effect sizes were calculated from means and pooled standard deviations, t -tests, χ 2 , significance levels or from proportions, depending on the nature of the information reported by the authors of primary research. As recommended by Rosenthal, if results were reported simply as being `non-significant' a conservative estimate of the effect size was included, assuming P = 0.50, which corresponds to an effect size of zero ( Rosenthal, 1991 ). The overall measure of effect size reported was the corrected d statistic ( Hedges and Olkin, 1985 ). These authors recommend this measure since it does not overestimate the population effect size, especially in the case when sample sizes are small.

The homogeneity of effect sizes was examined to determine whether the studies shared a common effect size. Testing for homogeneity required the calculation of a homogeneity statistic, Q . If all studies share the same population effect size, Q follows an asymptotic χ 2 distribution with k – 1 degrees of freedom, where k is the number of effect sizes. For the purposes of this review the probability level chosen for significance testing was 0.10, due to the fact that the relatively small number of effect sizes available for the analysis limits the power to detect actual departures from homogeneity. Rejection of the hypothesis of homogeneity signals that the group of effect sizes is more variable than one would expect based on sampling variation and that one or more moderator variables may be present ( Hall et al ., 1994 ).

To examine the relationship between the study characteristics included as potential moderators and the magnitude of effect sizes, both categorical and continuous univariate tests were run. Categorical tests assess differences in effect sizes between subgroups established by dividing studies into classes based on study characteristics. Hedges and Olkin presented an extension of the Q statistic to test for homogeneity of effect sizes between classes ( Q B ) and within classes ( Q W ) ( Hedges and Olkin, 1985 ). The relationship between the effect sizes and continuous predictors was assessed using a procedure described by Rosenthal and Rubin which tests for linearity between effect sizes and predictors ( Rosenthal and Rubin, 1982 ).

Q E provides the test for model specification, when the number of studies is larger than the number of predictors. Under those conditions, Q E follows an approximate χ 2 distribution with k – p – 1 degrees of freedom, where k is the number of effect sizes and p is the number of regressors ( Hedges and Olkin, 1985 ).

The search for school-based sex education interventions resulted in 12 research studies that complied with the criteria to be included in the review and for which effect sizes could be estimated.

The overall effect size ( d +) estimated from these studies was 0.05 and the 95% confidence interval about the mean included a lower bound of 0.01 to a high bound of 0.09, indicating a very minimal overall effect size. Table II presents the effect size of each study ( d i ) along with its 95% confidence interval and the overall estimate of the effect size. Homogeneity testing indicated the presence of variability among effect sizes ( Q (11) = 35.56; P = 0.000).

An assessment of interaction effects among significant moderators could not be explored since it would have required partitioning of the studies according to a first variable and testing of the second within the partitioned categories. The limited number of effect sizes precluded such analysis.

Parental participation appeared to moderate the effects of sex education on abstinence as indicated by the significant Q test between groups ( Q B(1) = 5.06; P = 0.025), as shown in Table III . Although small in magnitude ( d = 0.24), the point estimate for the mean weighted effect size associated with programs with parental participation appears substantially larger than the mean associated with those where parents did not participate ( d = 0.04). The confidence interval for parent participation does not include zero, thus indicating a small but positive effect. Controlling for parental participation appears to translate into homogeneous classes of effect sizes for programs that include parents, but not for those where parents did not participate ( Q W(9) = 28.94; P = 0.001) meaning that the effect sizes were not homogeneous within this class.

Virginity status of the sample was also a significant predictor of the variability among effect sizes ( Q B(1) = 3.47 ; P = 0.06). The average effect size calculated for virgins-only was larger than the one calculated for virgins and non-virgins ( d = 0.09 and d = 0.01, respectively). Controlling for virginity status translated into homogeneous classes for virgins and non-virgins although not for the virgins-only class ( Q W(5) = 27.09; P = 0.000).

The scope of the implementation also appeared to moderate the effects of the interventions on abstinent behavior. The average effect size calculated for small-scale intervention was significantly higher than that for large-scale interventions ( d = 0.26 and d = 0.01, respectively). The effects corresponding to the large-scale category were homogeneous but this was not the case for the small-scale class, where heterogeneity was detected ( Q W(4) = 14.71; P = 0.01)

For all three significant categorical predictors, deletion of one outlier ( Howard and McCabe, 1990 ) resulted in homogeneity among the effect sizes within classes.

Univariate tests of continuous predictors showed significant results in the case of percentage of females in the sample ( z = 2.11; P = 0.04), age of participants ( z = –1.67; P = 0.09), grade ( z = –1.80; P = 0.07) and year of publication ( z = –2.76; P = 0.006).

All significant predictors in the univariate analysis—with the exception of grade which had a very high correlation with age ( r = 0.97; P = 0.000)—were entered into a weighted least-squares regression analysis. In general, the remaining set of predictors had a moderate degree of intercorrelation, although none of the coefficients were statistically significant.

In the weighted least-squares regression analysis, only parental participation and the percentage of females in the study were significant. The two-predictor model explained 28% of the variance in effect sizes. The test of model specification yielded a significant Q E statistic suggesting that the two-predictor model cannot be regarded as correctly specified (see Table IV ).

This review synthesized the findings from controlled sex education interventions reporting on abstinent behavior. The overall mean effect size for abstinent behavior was very small, close to zero. No significant effect was associated to the type of intervention: whether the program was abstinence-oriented or comprehensive—the source of a major controversy in sex education—was not found to be associated to abstinent behavior. Only two moderators—parental participation and percentage of females—appeared to be significant in both univariate tests and the multivariable model.

Although parental participation in interventions appeared to be associated with higher effect sizes in abstinent behavior, the link should be explored further since it is based on a very small number of studies. To date, too few studies have reported success in involving parents in sex education programs. Furthermore, the primary articles reported very limited information about the characteristics of the parents who took part in the programs. Parents who were willing to participate might differ in important demographic or lifestyle characteristics from those who did not participate. For instance, it is possible that the studies that reported success in achieving parental involvement may have been dealing with a larger percentage of intact families or with parents that espoused conservative sexual values. Therefore, at this point it is not possible to affirm that parental participation per se exerts a direct influence in the outcomes of sex education programs, although clearly this is a variable that merits further study.

Interventions appeared to be more effective when geared to groups composed of younger students, predominantly females and those who had not yet initiated sexual activity. The association between gender and effect sizes—which appeared significant both in the univariate and multivariable analyses—should be explored to understand why females seem to be more receptive to the abstinence messages of sex education interventions.

Smaller-scale interventions appeared to be more effective than large-scale programs. The larger effects associated to small-scale trials seems worth exploring. It may be the case that in large-scale studies it becomes harder to control for confounding variables that may have an adverse impact on the outcomes. For example, large-scale studies often require external agencies or contractors to deliver the program and the quality of the delivery of the contents may turn out to be less than optimal ( Cagampang et al ., 1997 ).

Interestingly there was a significant change in effect sizes across time, with effect sizes appearing to wane across the years. It is not likely that this represents a decline in the quality of sex education interventions. A possible explanation for this trend may be the expansion of mandatory sex education in the US which makes it increasingly difficult to find comparison groups that are relatively unexposed to sex education. Another possible line of explanation refers to changes in cultural mores regarding sexuality that may have occurred in the past decades—characterized by an increasing acceptance of premarital sexual intercourse, a proliferation of sexualized messages from the media and increasing opportunities for sexual contact in adolescence—which may be eroding the attainment of the goal of abstinence sought by educational interventions.

In terms of the design and implementation of sex education interventions, it is worth noting that the length of the programs was unrelated to the magnitude in effect sizes for the range of 4.5–30 h represented in these studies. Program length—which has been singled out as a potential explanation for the absence of significant behavioral effects in a large-scale evaluation of a sex education program ( Kirby et al ., 1997a )—does not appear to be consistently associated with abstinent behavior. The impact of lengthening currently existing programs should be evaluated in future studies.

As it has been stated, the exploration of moderator variables could be performed only partially due to lack of information on the primary research literature. This has been a problem too for other reviewers in the field ( Franklin et al ., 1997 ). The authors of primary research did not appear to control for nor report on the potentially confounding influence of numerous variables that have been indicated in the literature as influencing sexual decision making or being associated with the initiation of sexual activity in adolescence such as academic performance, career orientation, religious affiliation, romantic involvement, number of friends who are currently having sex, peer norms about sexual activity and drinking habits, among others ( Herold and Goodwin, 1981 ; Christopher and Cate, 1984 ; Billy and Udry, 1985 ; Roche, 1986 ; Coker et al ., 1994 ; Kinsman et al ., 1998 ; Holder et al ., 2000 ; Thomas et al ., 2000 ). Even though randomization should take care of differences in these and other potentially confounding variables, given that studies can rarely assign students to conditions and instead assign classrooms or schools to conditions, it is advisable that more information on baseline characteristics of the sample be utilized to establish and substantiate the equivalence between the intervention and control groups in relevant demographic and lifestyle characteristics.

In terms of the communication of research findings, the richness of a meta-analytic approach will always be limited by the quality of the primary research. Unfortunately, most of the research in the area of sex education do not employ experimental or quasi-experimental designs and thus fall short of providing conclusive evidence of program effects. The limitations in the quality of research in sex education have been highlighted by several authors in the past two decades ( Kirby and Baxter, 1981 ; Card and Reagan, 1989 ; Kirby, 1989 ; Peersman et al ., 1996 ). Due to these deficits in the quality of research—which resulted in a reduced number of studies that met the criteria for inclusion and the limitations that ensued for conducting a thorough analysis of moderators—the findings of the present synthesis have to be considered merely tentative. Substantial variability in effect sizes remained unexplained by the present synthesis, indicating the need to include more information on a variety of potential moderating conditions that might affect the outcomes of sex education interventions.

Finally, although it is rarely the case that a meta-analysis will constitute an endpoint or final step in the investigation of a research topic, by indicating the weaknesses as well as the strengths of the existing research a meta-analysis can be a helpful aid for channeling future primary research in a direction that might improve the quality of empirical evidence and expand the theoretical understanding in a given field ( Eagly and Wood, 1994 ). Research in sex education could be greatly improved if more efforts were directed to test interventions utilizing randomized controlled trials, measuring intervening variables and by a more careful and detailed reporting of the results. Unless efforts are made to improve on the quality of the research that is being conducted, decisions about future interventions will continue to be based on a common sense and intuitive approach as to `what might work' rather than on solid empirical evidence.

References marked with an asterisk indicate studies included in the meta-analysis.

Description of moderator variables

Effect sizes of studies

Tests of categorical moderators for abstinence

Weighted least-squares regression and test of model specification

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  • least-squares analysis
  • sex education

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The State of Sex Education in the United States

Kelli stidham hall.

Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia

Jessica McDermott Sales

Kelli a. komro, john santelli.

Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, New York

For more than four decades, sex education has been a critically important but contentious public health and policy issue in the United States [ 1 – 5 ]. Rising concern about nonmarital adolescent pregnancy beginning in the 1960s and the pandemic of HIV/AIDS after 1981 shaped the need for and acceptance of formal instruction for adolescents on life-saving topics such as contraception, condoms, and sexually transmitted infections. With widespread implementation of school and community-based programs in the late 1980s and early 1990s, adolescents’ receipt of sex education improved greatly between 1988 and 1995 [ 6 ]. In the late 1990s, as part of the “welfare reform,” abstinence only until marriage (AOUM) sex education was adopted by the U.S. government as a singular approach to adolescent sexual and reproductive health [ 7 , 8 ]. AOUM was funded within a variety of domestic and foreign aid programs, with 49 of 50 states accepting federal funds to promote AOUM in the classroom [ 7 , 8 ]. Since then, rigorous research has documented both the lack of efficacy of AOUM in delaying sexual initiation, reducing sexual risk behaviors, or improving reproductive health outcomes and the effectiveness of comprehensive sex education in increasing condom and contraceptive use and decreasing pregnancy rates [ 7 – 12 ]. Today, despite great advancements in the science, implementation of a truly modern, equitable, evidence-based model of comprehensive sex education remains precluded by sociocultural, political, and systems barriers operating in profound ways across multiple levels of adolescents’ environments [ 4 , 7 , 8 , 12 – 14 ].

At the federal level, the U.S. congress has continued to substantially fund AOUM, and in FY 2016, funding was increased to $85 million per year [ 3 ]. This budget was approved despite President Obama’s attempts to end the program after 10 years of opposition and concern from medical and public health professionals, sexuality educators, and the human rights community that AOUM withholds information about condoms and contraception, promotes religious ideologies and gender stereotypes, and stigmatizes adolescents with nonheteronormative sexual identities [ 7 – 9 , 11 – 13 ]. Other federal funding priorities have moved positively toward more medically accurate and evidence-based programs, including teen pregnancy prevention programs [ 1 , 3 , 12 ]. These programs, although an improvement from AOUM, are not without their challenges though, as they currently operate within a relatively narrow, restrictive scope of “evidence” [ 12 ].

At the state level, individual states, districts, and school boards determine implementation of federal policies and funds. Limited in-class time and resources leave schools to prioritize sex education in competition with academic subjects and other important health topics such as substance use, bullying, and suicide [ 4 , 13 , 14 ]. Without cohesive or consistent implementation processes, a highly diverse “patchwork” of sex education laws and practices exists [ 4 ]. A recent report by the Guttmacher Institute noted that although 37 states require abstinence information be provided (25 that it be stressed), only 33 and 18 require HIV and contraceptive information, respectively [ 1 ]. Regarding content, quality, and inclusivity, 13 states mandate instruction be medically accurate, 26 that it be age appropriate, eight that it not be race/ethnicity or gender bias, eight that it be inclusive of sexual orientation, and two that it not promote religion [ 1 ]. The Centers for Disease Control and Prevention’s 2014 School Health Policies and Practices Study found that high school courses require, on average, 6.2 total hours of instruction on human sexuality, with 4 hours or less on HIV, other sexually transmitted infections (STIs), and pregnancy prevention [ 15 ]. Moreover, 69% of high schools notify parents/guardians before students receive such instruction; 87% allow parents/guardians to exclude their children from it [ 15 ]. Without coordinated plans for implementation, credible guidelines, standards, or curricula, appropriate resources, supportive environments, teacher training, and accountability, it is no wonder that state practices are so disparate [ 4 ].

At the societal level, deeply rooted cultural and religious norms around adolescent sexuality have shaped federal and state policies and practices, driving restrictions on comprehensive sexual and reproductive health information, and service delivery in schools and elsewhere [ 12 , 13 ]. Continued public and political debates on the morality of sex outside marriage perpetuate barriers at multiple levels—by misguiding state funding decisions, molding parents’ (mis)understanding of programs, facilitating adolescents’ uptake of biased and inaccurate information in the classroom, and/or preventing their participation in sex education altogether [ 4 , 7 , 8 , 12 – 14 ].

Trends in Adolescents’ Receipt of Sex Education

In this month’s Journal of Adolescent Health , Lindberg et al. [ 16 ] provide further insight into the current state of sex education and the implications of federal and state policies for adolescents in the United States. Using population data from the National Survey of Family Growth, they find reductions in U.S. adolescents’ receipt of formal sex education from schools and other community institutions between 2006–2010 and 2011–2013. These declines continue previous trends from 1995–2002 to 2006–2008, which included increases in receipt of abstinence information and decreases in receipt of birth control information [ 17 – 19 ]. Moreover, the study highlights several additional new concerns. First, important inequities have emerged, the most significant of which are greater declines among girls than boys, rural-urban disparities, declines concentrated among white girls, and low rates among poor adolescents. Second, critical gaps exist in the types of information (practical types on “where to get birth control” and “how to use condoms” were lowest) and the mistiming of information (most adolescents received instruction after sexual debut) received. Finally, although receipt of sex education from parents appears to be stable, rates are low, such that parental-provided information cannot be adequately compensating for gaps in formal instruction.

Paradoxically, the declines in formal sex education from 2006 to 2013 have coincided with sizeable declines in adolescent birth rates and improved rates of contraceptive method use in the United States from 2007 to 2014 [ 20 , 21 ]. These coincident trends suggest that adolescents are receiving information about birth control and condoms elsewhere. Although the National Survey of Family Growth does not provide data on Internet use, Lindberg et al. [ 16 ] suggest that it is likely an important new venue for sex education. Others have commented on the myriad of online sexual and reproductive resources available to adolescents and their increasing use of sites such as,, and Scarleteen. [ 2 , 14 , 22 – 24 ].

The Future of Sex Education

Given the insufficient state of sex education in the United States in 2016, existing gaps are opportunities for more ambitious, forward-thinking strategies that cross-cut levels to translate an expanded evidence base into best practices and policies. Clearly, digital and social media are already playing critical roles at the societal level and can serve as platforms for disseminating innovative, scientifically and medically sound models of sex education to diverse groups of adolescents, including sexual minority adolescents [ 14 , 22 – 24 ]. Research, program, and policy efforts are urgently needed to identify effective ways to harness media within classroom, clinic, family household, and community contexts to reach the range of key stakeholders [ 13 , 14 , 22 – 24 ]. As adolescents turn increasingly to the Internet for their sex education, perhaps school-based settings can better serve other unmet needs, such as for comprehensive sexual and reproductive health care, including the full range of contraceptive methods and STI testing and treatment services. [ 15 , 25 ].

At the policy level, President Obama’s budget for FY 2017 reflects a strong commitment to supporting youths’ access to age-appropriate, medically accurate sexual health information, with proposed elimination of AOUM and increased investments in more comprehensive programs [ 3 ]. Whether these priorities will survive an election year and new administration is uncertain. It will also be important to monitor the impact of other health policies, particularly regarding contraception and abortion, which have direct and indirect implications for minors’ rights and access to sexual and reproductive health information and care [ 26 ].

At the state and local program level, models of sex education that are grounded in a broader interdisciplinary body of evidence are warranted [ 4 , 11 – 14 , 27 – 29 ]. The most exciting studies have found programs with rights-based content, positive, youth-centered messages, and use of interactive, participatory learning and skill building are effective in empowering adolescents with the knowledge and tools required for healthy sexual decision-making and behaviors [ 4 , 11 – 14 , 27 – 29 ]. Modern implementation strategies must use complementary modes of communication and delivery, including peers, digital and social media, and gaming, to fully engage young people [ 14 , 22 , 23 , 27 ].

Ultimately, expanded, integrated, multilevel approaches that reach beyond the classroom and capitalize on cutting-edge, youth-friendly technologies are warranted to shift cultural paradigms of sexual health, advance the state of sex education, and improve sexual and reproductive health outcomes for adolescents in the United States.


Funding Sources

K.S.H. is supported by the National Institute of Child Health and Human Development #1K01HD080722-01A1.

Contributor Information

Kelli Stidham Hall, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.

Jessica McDermott Sales, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.

Kelli A. Komro, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.

John Santelli, Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, New York.

UN publishes new report on Comprehensive Sexuality Education

sex education in schools review

Despite good progress in some countries, too many are failing to ensure children and young people have the knowledge and skills they need for good health and well-being, according to findings from a new UN report on comprehensive sexuality education (CSE).

Too often, teachers are not prepared, students are not learning the range of topics they need to learn and misinformation undermines the development of CSE. Today, millions of children and young people still receive little information on how to manage the transition to adulthood.

The findings from the report, released by UNESCO, UNAIDS, UNFPA, UNICEF, UN Women and the WHO, are being released in the lead up to the  Generation Equality Forum ,  at which UNESCO will announce a set of concrete commitments on girls' education.

Assistant Director-General for Education at UNESCO, Stefania Giannini, said the findings released from  The journey towards comprehensive sexuality education: Global Status Report , reveal the progress countries are making towards providing good quality school based CSE to all learners but also highlight the fact that that much more needs to be done.

In Tunisia, a national law to combat violence against women mandates education for health and sexuality; in Sweden, sexuality education is expected to promote gender equality and the equal dignity of all; and in Chile, a range of teaching and learning materials on sexuality education is being developed to support teachers. In Pakistan, strong efforts are being made to build community support for CSE and ensure programmes are responsive to local context, while in South Africa, teachers are supported with lesson plans developed from the revised  UN Technical Guidance on Sexuality Education.

  • Read the key findings from the Report here

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What Works In Schools : Sexual Health Education

CDC’s  What Works In Schools  Program improves the health and well-being of middle and high school students by:

  • Improving health education,
  • Connecting young people to the health services they need, and
  • Making school environments safer and more supportive.

What is sexual health education?

Quality provides students with the knowledge and skills to help them be healthy and avoid human immunodeficiency virus (HIV), sexually transmitted infections (STI) and unintended pregnancy.

A quality sexual health education curriculum includes medically accurate, developmentally appropriate, and culturally relevant content and skills that target key behavioral outcomes and promote healthy sexual development. 1

The curriculum is age-appropriate and planned across grade levels to provide information about health risk behaviors and experiences.

Beautiful African American female teenage college student in classroom

Sexual health education should be consistent with scientific research and best practices; reflect the diversity of student experiences and identities; and align with school, family, and community priorities.

Quality sexual health education programs share many characteristics. 2-4 These programs:

  • Are taught by well-qualified and highly-trained teachers and school staff
  • Use strategies that are relevant and engaging for all students
  • Address the health needs of all students, including the students identifying as lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ)
  • Connect students to sexual health and other health services at school or in the community
  • Engage parents, families, and community partners in school programs
  • Foster positive relationships between adolescents and important adults.

How can schools deliver sexual health education?

A school health education program that includes a quality sexual health education curriculum targets the development of functional knowledge and skills needed to promote healthy behaviors and avoid risks. It is important that sexual health education explicitly incorporate and reinforce skill development.

Giving students time to practice, assess, and reflect on skills taught in the curriculum helps move them toward independence, critical thinking, and problem solving to avoid STIs, HIV, and unintended pregnancy. 5

Quality sexual health education programs teach students how to: 1

  • Analyze family, peer, and media influences that impact health
  • Access valid and reliable health information, products, and services (e.g., STI/HIV testing)
  • Communicate with family, peers, and teachers about issues that affect health
  • Make informed and thoughtful decisions about their health
  • Take responsibility for themselves and others to improve their health.

What are the benefits of delivering sexual health education to students?

Promoting and implementing well-designed sexual health education positively impacts student health in a variety of ways. Students who participate in these programs are more likely to: 6-11

  • Delay initiation of sexual intercourse
  • Have fewer sex partners
  • Have fewer experiences of unprotected sex
  • Increase their use of protection, specifically condoms
  • Improve their academic performance.

In addition to providing knowledge and skills to address sexual behavior , quality sexual health education can be tailored to include information on high-risk substance use * , suicide prevention, and how to keep students from committing or being victims of violence—behaviors and experiences that place youth at risk for poor physical and mental health and poor academic outcomes.

*High-risk substance use is any use by adolescents of substances with a high risk of adverse outcomes (i.e., injury, criminal justice involvement, school dropout, loss of life). This includes misuse of prescription drugs, use of illicit drugs (i.e., cocaine, heroin, methamphetamines, inhalants, hallucinogens, or ecstasy), and use of injection drugs (i.e., drugs that have a high risk of infection of blood-borne diseases such as HIV and hepatitis).

What does delivering sexual health education look like in action?

To successfully put quality sexual health education into practice, schools need supportive policies, appropriate content, trained staff, and engaged parents and communities.

Schools can put these four elements in place to support sex ed.

  • Implement policies that foster supportive environments for sexual health education.
  • Use health content that is medically accurate, developmentally appropriate, culturally inclusive, and grounded in science.
  • Equip staff with the knowledge and skills needed to deliver sexual health education.
  • Engage parents and community partners.

Include enough time during professional development and training for teachers to practice and reflect on what they learned (essential knowledge and skills) to support their sexual health education instruction.

By law, if your school district or school is receiving federal HIV prevention funding, you will need an HIV Materials Review Panel (HIV MRP) to review all HIV-related educational and informational materials.

This review panel can include members from your School Health Advisory Councils, as shared expertise can strengthen material review and decision making.

For More Information

Learn more about delivering quality sexual health education in the Program Guidance .

Check out CDC’s tools and resources below to develop, select, or revise SHE curricula.

  • Health Education Curriculum Analysis Tool (HECAT), Module 6: Sexual Health [PDF – 70 pages] . This module within CDC’s HECAT includes the knowledge, skills, and health behavior outcomes specifically aligned to sexual health education. School and community leaders can use this module to develop, select, or revise SHE curricula and instruction.
  • Developing a Scope and Sequence for Sexual Health Education [PDF – 17 pages] .This resource provides an 11-step process to help schools outline the key sexual health topics and concepts (scope), and the logical progression of essential health knowledge, skills, and behaviors to be addressed at each grade level (sequence) from pre-kindergarten through the 12th grade. A developmental scope and sequence is essential to developing, selecting, or revising SHE curricula.
  • Centers for Disease Control and Prevention. Health Education Curriculum Analysis Tool, 2021 , Atlanta: CDC; 2021.
  • Goldfarb, E. S., & Lieberman, L. D. (2021). Three decades of research: The case for comprehensive sex education. Journal of Adolescent Health, 68(1), 13-27.
  • Centers for Disease Control and Prevention (2016). Characteristics of an Effective Health Education Curriculum .
  • Pampati, S., Johns, M. M., Szucs, L. E., Bishop, M. D., Mallory, A. B., Barrios, L. C., & Russell, S. T. (2021). Sexual and gender minority youth and sexual health education: A systematic mapping review of the literature.  Journal of Adolescent Health ,  68 (6), 1040-1052.
  • Szucs, L. E., Demissie, Z., Steiner, R. J., Brener, N. D., Lindberg, L., Young, E., & Rasberry, C. N. (2023). Trends in the teaching of sexual and reproductive health topics and skills in required courses in secondary schools, in 38 US states between 2008 and 2018.  Health Education Research ,  38 (1), 84-94.
  • Coyle, K., Anderson, P., Laris, B. A., Barrett, M., Unti, T., & Baumler, E. (2021). A group randomized trial evaluating high school FLASH, a comprehensive sexual health curriculum.  Journal of Adolescent Health ,  68 (4), 686-695.
  • Marseille, E., Mirzazadeh, A., Biggs, M. A., Miller, A. P., Horvath, H., Lightfoot, M.,& Kahn, J. G. (2018). Effectiveness of school-based teen pregnancy prevention programs in the USA: A systematic review and meta-analysis. Prevention Science, 19(4), 468-489.
  • Denford, S., Abraham, C., Campbell, R., & Busse, H. (2017). A comprehensive review of reviews of school-based interventions to improve sexual-health. Health psychology review, 11(1), 33-52.
  • Chin HB, Sipe TA, Elder R. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: Two systematic reviews for the guide to community preventive services. Am J Prev Med 2012;42(3):272–94.
  • Mavedzenge SN, Luecke E, Ross DA. Effective approaches for programming to reduce adolescent vulnerability to HIV infection, HIV risk, and HIV-related morbidity and mortality: A systematic review of systematic reviews. J Acquir Immune Defic Syndr 2014;66:S154–69.

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Michael Castleman M.A.

What Good Is School-Based Sex Education?

It fails to reduce teen pregnancies and stis. another approach succeeds..

Posted May 14, 2020 | Reviewed by Jessica Schrader

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During the 1970s, I worked in family planning and spoke to dozens of high school classes about all the contraceptive methods and how condoms prevent transmission of most sexually transmitted infections (STIs). Afterward, I produced a box of condoms. The kids grabbed them. I believed I’d made a difference. Actually, I accomplished little, if anything.

Forced to Reconsider

Fast-forward 45 years and many studies show that school-based sex education simply does not work. Comparing pre- and post-tests, teens often register greater knowledge about contraceptives and STIs, but school sex ed has near-zero impact on their behavior—no delay of first intercourse, no fewer pregnancies or STIs.

You may recall occasional headlines touting pregnancy -reduction success for a few school sex ed initiatives. They’re outliers. Even the most “comprehensive” sex education curricula show no significant impact on teen behavior. And when promising pilot programs have been rolled out to more teens, replication efforts have failed.

Meanwhile, substantial research shows that adolescents’ most effective sex educators are their parents. As a parent myself, I found this hard to believe. When I mentioned sexual responsibility to my two teens, they fled. Actually, they were sponges.

The research has been consistent for decades. When parents discuss their sexual values, whatever they may be, teens feel acknowledged as sexual beings and feel less need to prove it with sexual recklessness. They’re more likely to delay first intercourse and to use condoms.

What Crisis?

If there ever was a “teen pregnancy crisis,” it has abated:

  • From 1991 through 2018, births to teens dropped 70 percent.
  • In 1991, 54 percent of teens 15 to 19 reported having intercourse. Today, it’s 41 percent, down 13 percent
  • In 1991, 46 percent of sexually active teens said they’d used condoms during their previous intercourse. Today, it’s 59 percent, up 13 percent.
  • Since 1991, the teen gonorrhea rate has dropped 69 percent.

Both conservatives and liberals have rushed to claim credit for these successes. Both are mistaken.

Failure of Abstinence-Only Sex Education

Since the 1990s, Congress has allocated $1 billion to abstinence-only school sex education, which exhorts teens to refrain from intercourse until they marry. Social conservatives claim it’s succeeded—proven by the statistics just mentioned. Hardly.

  • Abstinence-only programs began in 1998. Teen pregnancies began falling in 1992, six years earlier.
  • Researchers at McMaster University in Hamilton, Ontario, analyzed 26 studies of school-based pregnancy-prevention efforts. With abstinence-only, pregnancies often increased.
  • University of Georgia researchers analyzed teen pregnancy trends in all 50 states. As states increased emphasis on abstinence-only, their teen pregnancy rates rose. “Abstinence-only sex education is ineffective in preventing teen pregnancy and actually contributes to it.”

Failure of “Comprehensive” Sex Education

Comprehensive sex education, what I taught, is comprehensive only in that it discusses all the contraceptives and encourages condoms to prevent STIs. It’s utterly silent on erotic pleasure.

Liberals claim comprehensive sex education explains why teen pregnancies and STIs have plummeted. Actually:

  • The just-mentioned McMaster analysis included many comprehensive programs. They had no significant impact—no delay of first intercourse, no increased use of contraceptives, no fewer pregnancies and STIs.
  • British researchers analyzed eight studies of comprehensive school sex education programs involving 55,157 teens. Before-and-after surveys showed no reductions in pregnancies or STIs.
  • In 2016, the American Journal of Public Health published a supplement containing evaluations of 15 school sex education programs, involving 60,000 teens at 250 sites in 200 cities, including roll-outs of promising pilot programs. Three-quarters of the studies (74 percent) showed that comprehensive sex education has no impact on teens’ sexual behavior. And in the few programs that altered teen behavior, success rates were modest and not cost-effective.

sex education in schools review

Success! Parents Speaking Up

The real reason teen pregnancies and STIs have fallen is—surprise!—AIDS. The disease was identified in 1981 and by 1990 had become a significant threat to heterosexuals. Parents feared for their children’s lives and many who’d never uttered a peep about sex and condoms spoke up. These discussions had a major impact. Teen pregnancies peaked in 1991 and have declined 70 percent since.

In recent years, AIDS has faded from the headlines, and some parents have stopped talking. Consequently, the teen pregnancy rate has inched up a bit, but it’s still more than two-thirds below its 1991 peak.

Robust research confirms the effectiveness of parental sex education.

  • University of Oklahoma scientists surveyed 1,083 teens (half girls, half boys). When parents discussed sex and contraception, “Teens were much less likely to have intercourse, and if youth were sexually active, they were significantly more likely to use contraception.”
  • University of Minnesota researchers interviewed 2,006 teen virgins. One year later, 16 percent of the girls and 11 percent of the boys reported intercourse. Among those who remained virgins, the best predictor was frequent discussion of sex and birth control with their mothers.
  • Columbia University investigators surveyed 130 sexually active teen girls. “Our most striking finding—parent-teen sexuality communication is a strong predictor of regular contraceptive use.”
  • CDC researchers interviewed 372 teens. Those who talked with their mothers about sex were three times more likely to use condoms. Those who used them their first time were 20 times more likely to become regular users.
  • Finally, researchers at North Carolina State University analyzed 52 studies of home sex education involving 25,000 teens over thirty-two years (1982-2014). More than three-quarters of studies (79 percent) showed that when parents spoke up, teens significantly delayed first intercourse, and when they went all the way, were very likely to use condoms. “Parent-adolescent communication increases adolescents’ use of contraceptives regardless of how parents deliver their messages.”

A note on that last statement (“regardless of how parents deliver their messages”): To discuss sex, parents need not be sex experts. They just have to try—and keep trying.

Classes for Parents

School sex education costs a fortune and doesn’t work. We could instead invest that money in the only approach that’s effective. Let’s fund evening classes and home visits for parents to help them crystalize their sexual values and discuss them with their children.

Conservatives have long argued that, because it involves values, sex education belongs in the home. They’re right—not just because parents control the message, but because home sex education is the only approach that works:

  • Penn State researchers surveyed teens and their mothers. Then the mothers took classes devoted to sexual communication. Afterwards, both mothers and children said sex was easier to discuss.
  • Scientists at Emory University in Atlanta recruited 582 mothers, most single African-Americans, into a program that encouraged family sex discussions. Two years later, those mothers “showed substantial increases in comfort talking about sex, and surveys of their children showed significantly increased use of condoms.”

What I Told My Teens

When my son and daughter were teens, I told them it was entirely their decision when they became sexual. I said I hoped they’d wait until at least sixteen, but the decision was theirs. I emphasized four values:

  • Consent . No shaming , pressure, or coercion. If you ever feel uncomfortably pressured, do whatever it takes to extricate yourself, then feel free to call me 24/7.
  • Condoms . I offered to supply as many as they wanted—and didn’t care if they gave some to friends.
  • Lubrication . Vaginal lubrication reduces the risk of condom breakage and increases comfort during intercourse. Some perfectly normal teen girls don’t self-lubricate well. I offered to supply as much lube as my kids wanted.
  • Pleasure . Great sex is all about pleasure. Who can feel pleasure with lovers who ignore contraception and STIs? The most enjoyable sex is safe sex.

I told my teens, “Practice safe sex because it leads to better, more pleasurable lovemaking.” That might sound radical. But I believe that message would further reduce teen pregnancies and STIs. It would also help teens grow up to be something they all hope to become—skilled lovers.

Abe, Y. et al. “Culturally Responsive Adolescent Pregnancy and Sexually Transmitted Infection Prevention Program for Middle School Students in Hawaii,” American Journal of Public Health (2016) 106:S110.

Barbee, A.P. et al. “Impact of Two Adolescent Pregnancy Prevention Interventions on Risky Sexual Behavior: A Three-Arm Cluster Randomized Control Trial,” American Journal of Public Health (2016) 106:S85.

Bearman “After the Promise: The STD Consequences of Adolescent Virginity Pledges,” Journal of Adolescent Health (2005) 36:271.

Bull, S. et al. “Text Messaging, Teen Outreach Program, and Sexual Health Behavior: A Cluster Randomized Trial,” American Journal of Public Health (2016) 106:S117.

Bruckner, H. and P. Bearman “After the Promise: The STD Consequences of Adolescent Virginity Pledges,” Journal of Adolescent Health (2005) 36:271.

Calise, T.V. et al. “’Healthy Futures’ Program and Adolescent Sexual Behaviors in 3 Massachusetts Cities: A Randomized Controlled Trial,” American Journal of Public Health (2016) 106:S103.

DiCenso, A et al. “Interventions to Reduce Unintended Pregnancies Among Adolescents: Systematic Review of Randomized Controlled Trials,” BMJ [ formerly British Medical Journal] (2002) 324(7351):1426.

Fortenberry, D.J. “The Limits of Abstinence-Only in Preventing Sexually Transmitted Infections,” Journal of Adolescent Health (2005) 36:269.

Francis, K. et al. “Scalability of an Evidence-Based Adolescent Pregnancy Prevention Program: New Evidence from 5 Cluster-Randomized Evaluations of the Teen Outreach Program,” American Journal of Public Health (2016) 106:S32.

Gelfond, J. et al. “Preventing Pregnancy in High School Students: Observations From a 3-Year Longitudinal, Quasi-Experimental Study,” American Journal of Public Health (2016) 106:S97.

Goesling, B. et al. “Impacts of an Enhances Family Health and Sexuality Module of the Health Teacher Middle-School Curriculum: A Cluster Randomized Trial,” American Journal of Public Health (2016) 106:S125.

Jenner, E. et al. “Impact of an Intervention Designed to Reduce Sexual Health Risk Behaviors of African-American Adolescents: Results of a Randomized Controlled Trial,” American Journal of Public Health (2016) 106:S78.

Kelsey, M. et al. “Replicating “Reducing the Risk:” 12-onth Impacts of a Cluster Randomized Trial,” American Journal of Public Health (2016) 106:S45.

Kelsey, M. et al. “Replicating the Safer Sex Intervention: 9-Month Impact Findings of a Randomized Controlled Trial,” American Journal of Public Health (2016) 106:S53.

Kelsey, M. et al. “Replicating ‘Cuidate!:’ 6-Month Impact Findings of a Randomized Controlled Trial,” American Journal of Public Health (2016) 106:S70.

LaChance, R.B. “A Clustered Randomized Controlled Trial of the Positive Prevention PLUS Adolescent Pregnancy Prevention Program,” American Journal of Public Health (2016) 106:S91.

Lindau. S.T. et al. “What Schools Teach Our Patients about Sex: Content, Quality, and Influences on Sex Education,” Obstetrics and Gynecology (2008) 111:256.

Mason-Jones, A.J. et al. “School-Based Interventions for Preventing HIV, sexually Transmitted Infections, and Pregnancy in Adolescents,” Cochrane Database Systematic Reviews (106) 11:CD006417.

Phipps, M.G. “Consequences of Inadequate Sex Education in the United States,” Obstetrics and Gynecology (2008) 111:254.

Potter, S.C. et al. “’It’s Your Game…Keep It Real’ in South Carolina: A Group Randomization Trial Evaluating the Replication of an Evidence-Based Adolescent Pregnancy and Sexually Transmitted Infection Prevention Program,” American Journal of Public Health (2016) 106:S60.

Robinson, W.T. et al. “Randomized Trial of the Teen Outreach Program in Louisiana and Rochester, New York,” American Journal of Public Health (2016) 106:S39.

Rosenbaum, J.E. “Patient Teenagers? A Comparison of the Sexual Behavior of Virginity Pledgers and Matched Non-Pledgers,” Pediatrics (2009) 123:e110. Doi: 10.1542/peds.2008-0407.

Stanger-Hall, K.F. and D.W. Hall. “Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S.,” PlosOne . (2011) .

Michael Castleman M.A.

Michael Castleman, M.A. , is a San Francisco-based journalist. He has written about sexuality for 36 years.

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New RSHE guidance: What it means for sex education lessons in schools

RSHE guidance

R elationships, Sex and Health Education (RSHE) is a subject taught at both primary and secondary school.  

In 2020, Relationships and Sex Education was made compulsory for all secondary school pupils in England and Health Education compulsory for all pupils in state-funded schools.  

Last year, the Prime Minister and Education Secretary brought forward the first review of the curriculum following reports of pupils being taught inappropriate content in RSHE in some schools.  

The review was informed by the advice of an independent panel of experts. The results of the review and updated guidance for consultation has now been published.   

We are now asking for views from parents, schools and others before the guidance is finalised. You can find the consultation here .   

What is new in the updated curriculum?  

Following the panel’s advice, w e’re introducing age limits, to ensure children aren’t being taught about sensitive and complex subjects before they are ready to fully understand them.    

We are also making clear that the concept of gender identity – the sense a person may have of their own gender, whether male, female or a number of other categories   – is highly contested and should not be taught. This is in line with the cautious approach taken in our gu idance on gender questioning children.  

Along with other factors, teaching this theory in the classroom could prompt some children to start to question their gender when they may not have done so otherwise, and is a complex theory for children to understand.   

The facts about biological sex and gender reassignment will still be taught.  

The guidance for schools also contains a new section on transparency with parents, making it absolutely clear that parents have a legal right to know what their children are being taught in RSHE and can request to see teaching materials.   

In addition, we’re seeking views on adding several new subjects to the curriculum, and more detail on others. These include:   

  • Suicide prevention  
  • Sexual harassment and sexual violence  
  • L oneliness  
  • The prevalence of 'deepfakes’  
  • Healthy behaviours during pregnancy, as well as miscarriage  
  • Illegal online behaviours including drug and knife supply  
  • The dangers of vaping   
  • Menstrual and gynaecological health including endometriosis, polycystic ovary syndrome (PCOS) and heavy menstrual bleeding.  

What are the age limits?   

In primary school, we’ve set out that subjects such as the risks about online gaming, social media and scams should not be taught before year 3.   

Puberty shouldn’t be taught before year 4, whilst sex education shouldn’t be taught before year 5, in line with what pupils learn about conception and birth as part of the national curriculum for science.  

In secondary school, issues regarding sexual harassment shouldn’t be taught before year 7, direct references to suicide before year 8 and any explicit discussion of sexual activity before year 9.  

Do schools have to follow the guidance?  

Following the consultation, the guidance will be statutory, which means schools must follow it unless there are exceptional circumstances.   

There is some flexibility w ithin the age ratings, as schools will sometimes need to respond to questions from pupils about age-restricted content, if they come up earlier within their school community.   

In these circumstances, schools are instructed to make sure that teaching is limited to the essential facts without going into unnecessary details, and parents should be informed.  

When will schools start teaching this?  

School s will be able to use the guidance as soon as we publish the final version later this year.   

However, schools will need time to make changes to their curriculum, so we will allow an implementation period before the guidance comes into force.     

What can parents do with these resources once they have been shared?

This guidance has openness with parents at its heart. Parents are not able to veto curriculum content, but they should be able to see what their children are being taught, which gives them the opportunity to raise issues or concerns through the school’s own processes, if they want to.

Parents can also share copyrighted materials they have received from their school more widely under certain circumstances.

If they are not able to understand materials without assistance, parents can share the materials with translators to help them understand the content, on the basis that the material is not shared further.

Copyrighted material can also be shared under the law for so-called ‘fair dealing’ - for the purposes of quotation, criticism or review, which could include sharing for the purpose of making a complaint about the material.

This could consist of sharing with friends, families, faith leaders, lawyers, school organisations, governing bodies and trustees, local authorities, Ofsted and the media.  In each case, the sharing of the material must be proportionate and accompanied by an acknowledgment of the author and its ownership.

Under the same principle, parents can also share relevant extracts of materials with the general public, but except in cases where the material is very small, it is unlikely that it would be lawful to share the entirety of the material.

These principles would apply to any material which is being made available for teaching in schools, even if that material was provided subject to confidentiality restrictions.

Do all children have to learn RSHE?  

Parents still have the right to withdraw their child from sex education, but not from the essential content covered in relationships educatio n.  

You may also be interested in:

  • Education Secretary's letter to parents: You have the right to see RSHE lesson material
  • Sex education: What is RSHE and can parents access curriculum materials?
  • What do children and young people learn in relationship, sex and health education

Tags: age ratings , Gender , Relationships and Sex Education , RSHE , sex ed , Sex education

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Summary State Policies on Sex Education in Schools

Why is sexual education taught in schools.

A 2017 Centers for Disease Control and Prevention (CDC)  survey  indicates that nearly 40 percent of all high school students report they have had sex, and 9.7 percent of high school students have had sex with four or more partners during their lifetime. Among students who had sex in the three months prior to the survey, 54 percent reported condom use and 30 percent reported using birth control pills, an intrauterine device (IUD), implant, shot or ring during their last sexual encounter.

The birth rate for women aged 15-19 years was  18.8 per 1,000 women  in 2017, a drop of 7 percent from 2016. According to CDC, reasons for the decline are not entirely clear, but evidence points to a higher number of teens abstaining from sexual activity and an increased use of birth control in teens who are sexually active. Though the teen birth rate has declined to its lowest levels since data collection began, the United States still has the highest teen birth rate in the industrialized world.

Certain social and economic costs can result from teen pregnancy. Teenage mothers are less likely to finish high school and are more likely than their peers to live in poverty, depend on public assistance, and be in poor health. Their children are more likely to suffer health and cognitive disadvantages, come in contact with the child welfare and correctional systems, live in poverty, drop out of high school and become teen parents themselves. These costs add up, according to The National Campaign to Prevent Teen and Unplanned Pregnancy, which estimates that teen childbearing costs taxpayers at least $9.4 billion annually. Between 1991 and 2015, the teen birth rate dropped 64%, resulting in approximately  $4.4 billion  in public savings in one year alone.

Sexually transmitted infections (STIs) disproportionately affect adolescents due to a variety of behavioral, biological and cultural reasons. Young people ages 15 to 24 represent  25 percent  of the sexually active population, but acquire half of all new STIs, or about 10 million new cases a year. Though many cases of STIs continue to go  undiagnosed and unreported , one in four sexually-active adolescent females is reported to have an STI.

Human papillomavirus  is the most common STI and some estimates find that up to 35 percent of teens ages 14 to 19 have HPV. The rate of reported cases of chlamydia, gonorrhea, and primary and secondary syphilis increased among those aged 15-24 years old between 2017-2018. Rates of reported chlamydia cases are consistently highest among women aged 15-24 years, and rates of reported gonorrhea cases are consistently highest among men aged 15-24 years. A CDC analysis reveals the annual number of new STIs is roughly equal among young women and young men. However, women are more likely to experience long-term health complications from untreated STIs and adolescent females may have increased susceptibility to infection due to biological reasons.

The estimated direct medical costs for treating people with STIs are nearly $16 billion annually, with costs associated with HIV infection accounting for more than 81% of the total cost. In 2017, approximately  21 percent  of new HIV diagnoses were among young people ages 13 to 24 years.

Sex Education and States

All states are somehow involved in sex education for public schoolchildren.

As of October 1, 2020:

  • Thirty states and the District of Columbia require public schools teach sex education, 28 of which mandate both sex education and HIV education.
  • Thirty-nine states and the District of Columbia require students receive instruction about HIV.
  • Twenty-two states require that if provided, sex and/or HIV education must be medically, factually or technically accurate. State definitions of “medically accurate" vary, from requiring that the department of health review curriculum for accuracy, to mandating that curriculum be based on information from “published authorities upon which medical professionals rely.” (See table on medically accuracy laws.)

Many states define parents’ rights concerning sexual education:

  • Twenty-five states and the District of Columbia require school districts to notify parents that sexual or HIV education will be provided.
  • Five states require parental consent before a child can receive instruction.
  • Thirty-six states and the District of Columbia allow parents to opt-out on behalf of their children.

*Medical accuracy is not specifically outlined in state statue, rather it is required by the New Jersey Department of Education, Comprehensive Health and Physical Education Student Learning Standards.

** Medical accuracy requirement is pursuant to rule R277-474 of the Utah Administrative Code.

***Medical accuracy is not outlined in state statute, rather it is included in the Virginia Department of Education Standards of Learning Document for Family Life Resources.

Source: NCSL, 2019; Guttmacher Institute, 2019; Powered by StateNet

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Sex education ‘is under attack’ by a wave of proposed legislation, advocate warns

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What constitutes sexual education and the grade in which it’s taught varies greatly in America, and 2024 is shaping up to set a record for legislative proposals mostly aimed at restricting the subject in schools. Sara Flowers, vice president of education at Planned Parenthood Federation of America, joins Ali Rogin to discuss the increasingly complicated nature of sex education.

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Notice: Transcripts are machine and human generated and lightly edited for accuracy. They may contain errors.

What constitutes sex education and the grade in which it's taught varies greatly in America, and this year is shaping up to set a record for legislative proposals that are mostly aimed at restricting the teaching of the subject in schools. Ali Rogin has more on the increasingly complicated nature of sex education.

The Centers for Disease Control defines quality sexual education as medically accurate developmentally appropriate culturally relevant content that promotes healthy development but only three states require comprehensive education to be taught in all schools. 17 states provide abstinence only sex education.

And so far this year at least 135 bills pertaining to sexual education have been introduced, or are in place nationally, a majority of which would place restrictions on sexual education in public schools. That's according to an analysis by the nonprofit organization, Sexuality Information and Education Council of the United States. Sara Flowers is Vice President of Education at Planned Parenthood Federation of America, a nonprofit organization that provides reproductive and sexual health care and sexual education in the United States and globally.

Dr. Flowers, thank you so much for being here. First of all, when we think about comprehensive sex education, what does that look like?

Sara C. Flowers, Planned Parenthood Federation of America: Comprehensive sex education means teaching a wide variety of topics in grades K through 12, including topics like consent, understanding what boundaries are and how to decide where your personal boundaries are self-esteem, anti-bullying, healthy relationships, how to stay safe online.

And of course, the things that most people usually think of when they think of sex education, which is like puberty, contraception, and STI prevention. There's also a wealth of research that shows that kids who get this sort of comprehensive sex education and start in elementary school build on those skills through middle and high school are more likely to foster healthy relationships, have better social emotional skills, respect sexual and gender diversity, and prevent unintended pregnancy and STI transmission when they do become sexually active. That's education works like building blocks.

So it's incredibly important to start these conversations at home and in school, and to have them early. And often. What I mean by building blocks is this. When we teach math, we start with the basics. Kids learn to count zero, one, two, three. Eventually, we move into addition and subtraction. We don't start with calculus. So for topic like consent, if you're a small child, you understand that you don't want someone to take your truck without asking.

An elementary school consent covers topics like how to ask before taking a snack from someone else's lunchbox, or how to respect another person's decision not to want to be hugged. In middle school, learning about consent includes talking about peer pressure, learning assertive communication skills, thinking about your own boundaries, and learning to respect the boundaries of others.

In high school, we talk about consent during sex, we talk about thinking about what we ourselves would like getting clear on our own wants and dislikes and being a good listener making space for a partner to communicate their wants and needs, and being able to say no, and also to respect someone else's. Now, it also talks about how to continually check in to make sure that everyone feels safe as the relationship evolves.

There's a wide variety of sexual education curricula that really varies based on the state. And as I mentioned, 17 of them are abstinence only. But what is behind the varied nature of sexual education state by state? And what is the effect of having such different regimens available, depending on where you live?

Sara C. Flowers:

It's really important for parents to understand that in the U.S., there is no law or national program that dictates if sex education is going to be taught in schools and how sex education was going to be taught in schools. We have a patchwork of sex education laws and policies across the country.

So instead, decisions about sex education are left up to states and school districts. This means that the quality of sex education including the curriculum who is teaching and whether or not it's medically accurate, as well as whether or not you receive it at all, all of that depends on where you live, and who makes decisions about sex education in your area or school or school districts.

There is a effort happening on the federal level in Congress to pass a bill that would establish grants for comprehensive sexual education. Is that what you see as a necessary step here? And how would that potentially change things?

It would absolutely be a necessary step if all young people got the sex education that they deserve, sex education that is comprehensive, inclusive, culturally congruent and age appropriate, then we, as a society have the potential to raise a generation of young people who not only know how to love and take care of their own bodies, but we'd work towards a world where all people including people who are in power making decisions for others.

Everyone would understand the importance of things like respecting bodily autonomy respecting people's differences and the basic understanding of how pregnancy happens and how it works.

Some of these bills that we mentioned would ban discussions around gender identity and sexual orientation. Some would remove instruction on contraception, and emphasize abstinence. Some lawmakers who are in favor of these bills would say these are to protect the age appropriate nature of the sex education content that's in the classrooms. What do you see as the impact of those steps that are limiting the topics that can be discussed?

It's really important to understand that sex education is under attack. And it is under attack by the same groups that are trying to ban books stop trans youth from being able to play sports or use the bathroom that they need, and the same groups that are trying to ban teaching accurate history. The bands are all connected, and which tells us that these groups are actually working to exert power and control our kids. They are not trying to keep kids safe and healthy.

Parents can do something about these bands. You can start by finding out what's currently taught in your kids school. And if it's not sufficient, ask for better. Now we did mention that there are people who live in states and communities where sex education is not permitted to be taught in schools.

In those areas, parents and families can reach out to their local Planned Parenthood to find out if their education department can connect you with sex education programs, sex education can happen on after school programs and on weekends. It doesn't have to happen in schools.

Sara Flowers, Vice President of Education at Planned Parenthood Federation of America, thank you so much for being here.

Thank you so much for having me.

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What exactly are our children being taught about sex and what is changing?

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Sex education in UK schools is changing (Picture: Getty)

A controversial government proposal to ban sex education for children under the age of 13 has been revealed.

The new age limit is set to ban teaching children about ‘explicit’ topics, including changing their gender until they are 13, The Times reports.

Currently, children can be taught about sex and sexual health , including contraception, when they start secondary school at the age of 11.

Schools could be limited on discussions the government considers ‘explicit,’ such as contraception and changing gender identity.

It means children would not be taught about contraception, STIs and abortion until the age of 13.

Sorry, this video isn't available any more.

Discussions of sexual acts would be delayed until year 9, meaning some children might not learn about abortion or STIs until they are 13 or 14.

Schools should not teach young people about domestic violence until year 9.

The revised sex education guidance due to be announced by the education secretary Gillian Keegan is expected to put other restrictions on teaching about gender and identity.

It is thought teachers will be told to explain ‘biological’ facts when discussing gender, The Guardian reports.

She is also expected to consult on a ban to stop schools from teaching sex education of any type before children are nine.

While the details are being finalised, The Telegraph reports that the guidance is set to describe ‘gender ideology’ as a ‘contested subject,’ and that teachers must say that there are two biological sexes.

Schools will also be required to show parents samples of the material they use to educate their children, which is already a requirement in some cases.

It reportedly comes after concerns that some children are being taught age-inappropriate relationships, sex and health education, according to The Times.

However, critics have described the move as political.

Caroline Lucas, MP for Brighton Pavilion said on X (formerly Twitter ) that ‘politicising sex education is unforgivable dangerous and reactionary,’ adding that it is always age appropriate to teach children how to stay safe.

What age does sex education start in schools in the UK?

The new guidelines are expected to be more detailed on what can be discussed at what age.

Currently, all children must be taught relationships, sex and health education.

But the style and content vary depending on the school year and where in the UK you live.

In primary schools, children must now receive relationships education after changes to the law in September 2020.

Female Student Raising Hand To Ask Question In Classroom

Young people in secondary school must be taught relationships, sex and health education (RSHE).

However, the quality and scope of sex education can vary ‘widely’ between schools, the Family Planning Association has warned.

What do you learn at what age?

The existing guidance sets out broad topics for children aged five to eleven in primary school.

They will learn about different types of families and healthy relationships, including friendships and boundaries.

Currently, primary schools are allowed to teach additional sex education, but it is not a requirement, the guidance says.

However, they already have to consult parents before the final year of primary school about what sex education is being taught.

Primary school, ages five to 11

By the end of primary school, children should know about:

  • Healthy and caring family and friendships  
  • Other families and relationships may look different to theirs and they should respect differences
  • Marriage is a formal and legally recognised commitment of two people and it is intended to be lifelong
  • How to recognise if relationships are making them feel unsafe
  • Self-respect
  • Different types of bullying, including cyber bullying, its impact and responsibilities of bystanders and how to report it or get help
  • Harms of stereotypes
  • Being safe online and in the real world
  • That each person’s body belongs to them and differences between inappropriate and appropriate contact
  • How to seek help and reporting concerns, abuse, and learning the words to do so

Because sex education in primary schools is not mandatory, the current guidance to schools focuses on relationship education.

However, schools are allowed to teach sex education in primary school under the current guidance.

And if that goes beyond the national science curriculum, schools have to set it out in their policy and consult with parents.

Then in secondary school, children are taught more complex topics such as puberty, sexual relationships, consent, unsafe relationships and online harms.

In secondary school when children are aged between 11 and 16, they can be taught about sex, sexuality and gender identity ‘in an age-appropriate and inclusive way,’ the current guidance says.

The official guidance says that when teaching these topics, schools must recognise that ‘young people may be discovering or understanding their sexual orientation or gender identity.’

Secondary school, 11 to 16

In secondary school, children are taught more about sex and relationships.

It includes:  

  • Different types of relationships
  • What marriage is, including legal rights
  • Other types of relationships
  • Responsibilities of parents
  • Relationships and friendships, including trust, respect, reconciliation and ending relationships
  • Harmful stereotypes relating to sex, gender, race, religion, sexual orientation and disability
  • Online safety and risks, including not sharing material to others they want to keep private
  • That sexually explicit material like pornography presents a distorted picture of sexual behaviours
  • That sharing and viewing indecent images of children is a criminal offence

When it comes to sex, sexual relationships and health, they are taught:

  • How to recognise positive intimate relationships
  • Their choice when it comes to sex and relationships and wellbeing
  • Facts about reproductive health, including potential impact of lifestyle on fertility and menopause
  • How to manage sexual pressure, including peer pressure
  • That it is their choice to delay sex or to enjoy intimacy without sex
  • Contraceptive choices and options
  • Facts around pregnancy and miscarriage
  • Sexually transmitted infections
  • How the use of alcohol and drugs can lead to risky sexual behaviour
  • Where to get advice

Children should be given an ‘equal opportunity to explore the features of stable and healthy same-sex relationships,’ it says.

The guidance leaves room for schools on how they decide to teach sex education.

But it does say young people in secondary school should be ‘made aware’ of the relevant legal aspects around marriage, consent, violence against women and girls, sharing nudes and ‘sexting’, pornography, abortion, sexuality and gender identity among others.

Reaction to the sex education proposal

Lucy Emmerson, chief executive of Sex Education Forum, told that the proposal is ‘so out of reality’ and it leaves young people, schools and parents confused.

She said: ‘This is going to build a gap, where young people are forced to find out information online instead of having answers from their teachers at school.’

The charity boss said what she has read so far is ‘quite confusing.’

‘And schools will be feeling quite confused: don’t say anything about sex, but keep children safe. It’s hard to make head or tail about that,’ she said.

What age do you start to learn about sex in school and what do you learn at what age?

She said all children 12 to 13 are offered the HPV vaccination in schools, but under the proposal, children should not be taught about STIs until they are 13 or 14.

‘Young people know about STDs, they have alternative methods, but raising questions at school in safety is important,’ she said.

She feared that banning talking about certain topics like gender identity gives a ‘very strong message to young people, the message that this it not allowed,’ which can lead to a culture of secrecy.

‘Saying certain things are not allowed to be discussed is a strange approach. Young people with genuine questions can’t raise them.

‘What does that mean about talking about other parts of identity?’

Imposing a ‘culture of fear’ on schools would be ‘taking a step back,’ Emmerson warned.

She continued: ‘We would like to see what evidence has gone into these proposals in order to take them seriously. We are yet to see what research-based evidence has gone into it.’

The Department for Education declined to comment.

Campaigner Evie Plumb has previously said that sex ed in schools is nowhere near the level it should be.

Speaking to podcast Smut Drop , she said people need to understand bodily autonomy to help them ‘advocate for yourself, whether that’s in the bedroom or at the GP.’

She warned that sex education needs to start early – despite parents’ fears as a lot of early sex ed should be about consent in all aspects of life.

How UK sex education compares to other countries?

Sex education varies from country to country, but some are further ahead than others.  

Sweden made sex and gender education mandatory in 1955 and it has kept updating the curriculum regularly.

It is said to go beyond just sex as children learn about alcohol and mental health and attempts to eliminate ‘prejudices and taboo,’ the European Academy of Religion and Society reports.

Italy is a bit of an anomaly compared to the rest of Europe when it comes to sex ed.

Schools in the largely Catholic country can decide if they want to teach it at all and how they do it.

A national survey carried out by the Ministry of Health in 2019 showed that majority of young Italians get their information online.

What about the US ?

As most policies and laws in the country, the 50 states can decide how they want to cover sex education.

What is covered varies widely from state to state, so getting quality or any sex education is a postcode lottery in the US.

Only 39 states and the Washington, District of Columbia, have ‘mandated sex-education,’ the Duke Centre for Global Reproductive Health said.

It warned that the sex education in the country is in ‘shambles.’

Are you a teacher or a parent? Please email [email protected] to share your thoughts on the sex ed proposal.

Get in touch with our news team by emailing us at [email protected] .

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Premier says sex education group will be banned from giving school presentations

Organization disputes suggestion that material delivered was outside curriculum.

sex education in schools review

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Premier Blaine Higgs says he will ban a Quebec-based sex education group from presenting at schools in New Brunswick after a presentation he believes was "clearly inappropriate." 

The premier took to X, formerly Twitter, to express his displeasure with a presentation given at several New Brunswick high schools. 

"To say I am furious would be a gross understatement," he said. "This presentation was not part of the New Brunswick curriculum and the content was not flagged for parents in advance.

"The fact that this was shared shows either improper vetting was done, the group misrepresented the content they would share ... or both."

Higgs said the Department of Education told his office the presentation was supposed to be about the sexually transmitted infection human papillomavirus – but it went beyond that. 

A pink and purple presentation slide with four text bubbles.

He shared and criticized a presentation slide that includes questions like "do girls masturbate" and "is it good or bad to do anal?"

Teresa Norris, who delivered the presentation to several New Brunswick schools last week, denied that schools were misled about what the presentation would cover. 

The president and founder of the charity HPV Global Action, which also operates a youth sexual education resource called Thirsty for the Talk, said she was surprised and disappointed at Higgs's reaction.

She said the slide Higgs shared was the presentation's cover slide. She said it reflects actual questions her group receives from students. 

"That excerpt that was taken is an extraction of something that's very grossly misrepresenting what this presentation is about," Norris said.

A presentation slide that reads "4 out of 5 have had HPV at some point in their life," with cartoon people shaded in red and green.

"All of the topics that we cover are supporting the learning areas. This is something that your province has decided ... We're not creating something that the province hasn't already put in place."

Norris said she has been giving presentations at New Brunswick schools for several years. All schools receive an outline of the topics to be covered and the school must give its consent prior to the presentation, she said.

The presentation is called Healthy Relationships 101. Norris said it is an "A to Z" about relationships and sexuality.

"We are not promoting any of these sexual behaviours ... we talk about abstinence in the presentation, we empower students to help them make decisions about their relationships," she said.

A presentation slide about healthy relationships.

"We teach them to understand when they are not comfortable, or that they don't feel ready, and to pay attention so that they have those boundaries. Our goal is always to destigmatize conversations about sexual health." 

Objectives in the province's high school sex education curriculum include having students define sexuality, discuss safe sex practices that include abstinence, masturbation, condom use and birth control options, and how to handle sexual feelings and sexual pressure.

Andrea Anderson-Mason, MLA for Fundy-the Isles-Saint John West, said she has heard about the presentation from teachers and constituents with family members who attend Fundy Middle-High School.

The Anglophone South School District has not responded to a request for comment.

Anderson-Mason said she has a daughter in Grade 12 at the school, but the presentation was only delivered to Grade 9 to Grade 11 students.

The MLA said reaction has been mixed and she is hoping to see a balanced conversation on the issue.

A person speaking to reporters.

"When I was in high school, I had a male teacher teach me about breast self-examination, and at 47 years old I am still grateful for that information and use it," she said. "There is a time and a place and an appropriateness to talk about our bodies."

For Norris, the ultimate goal is to help students stay informed and avoid getting into relationship situations they are not ready for.

Despite Higgs's statement, she has not been given any formal message from the province banning the presentation. 

Requests to the premier's office for comment have not been answered.


sex education in schools review

Savannah Awde is a reporter with CBC New Brunswick. You can contact her with story ideas at [email protected].

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Department of Education releases final Title IX rules

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The U.S. Department of Education released its final Title IX rules on April 19, which will come into effect on Aug. 1, 2024. This means that schools across the nation must update their policies and processes for addressing sex discrimination to align with the revised federal law.

Title IX and Colorado law are encompassed in Regent Law under the University of Colorado’s Sexual Misconduct, Intimate Partner Violence, and Stalking Policy (APS 2015) , which applies to all CU campuses. For the Boulder campus, the Office of Institutional Equity and Compliance (OIEC) is responsible for preventing and addressing incidents under this policy and other university policies ensuring nondiscrimination .

Impact of the Title IX rules on CU Boulder

The revised Title IX rules will require a review of existing university policies to ensure compliance.  This includes:

Expanded protections

The federal rules strengthen protections against all forms of sex-based discrimination, which will reinforce CU’s existing policy prohibiting discrimination and harassment based on sexual orientation and gender identity.

Safeguards to protect students from discrimination related to pregnancy and childbirth will need to be expanded.

Review of complaint processes

CU Boulder will review existing resolution processes to determine what, if any, changes are needed to ensure a timely, fair, transparent and reliable process based on the updated federal law.

Clear reporting guidelines

The rules outline a requirement for clear and consistent reporting guidelines for employees who are obligated to report alleged incidents. This will require additional education to ensure employees understand their obligation based on the expanded protections and how to refer students, faculty and staff to appropriate support resources.

For more information, please visit the Title IX Policy Information Page .

A commitment to systemwide policy changes

“We are committed to maintaining robust policies that ensure alignment with state and federal law and meeting the needs of our campus to foster a fair and inclusive environment for all members of the CU Boulder community,” says Llen Pomeroy, associate vice chancellor and Title IX coordinator in OIEC.

CU has a systemwide working group led by Valerie Simons, vice president of compliance and equity and system Title IX coordinator, to ensure engagement with campus stakeholders and compliance with the new rules. All of the campus equity offices, including OIEC, and university legal counsel are part of this working group.

CU is also moving to a systemwide nondiscrimination policy (APS 5065) to ensure alignment with these changes and create consistency across all campuses. APS 5065 is expected to go into effect on Aug. 1, 2024.

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  1. Reasons Why Sex Education is Important and should be Taught in Schools

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  2. 9 Ways to Teach Sex Education

    sex education in schools review

  3. 6 Important things to know about Sex education

    sex education in schools review

  4. Sex Education in Schools: Here's What Your Kid Is Learning

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  5. 21+ Pros and Cons of Sex Education (explained)

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  6. Sex Education

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  1. Three Decades of Research: The Case for Comprehensive Sex Education

    School-based sex education plays a vital role in the sexual health and well-being of young people. Little is known, however, about the effectiveness of efforts beyond pregnancy and sexually transmitted disease prevention. The authors conducted a systematic literature review of three decades of research on school-based programs to find evidence for the effectiveness of comprehensive sex education.

  2. School-based Sex Education in the U.S. at a Crossroads: Taking the

    School-based sex education in the U.S. is at a crossroads. The United Nations defines sex education as a curriculum-based process of teaching and learning about the cognitive, emotional, physical, and social aspects of sexuality [1]. Over many years, sex education has had strong support among both parents [2] and health professionals [3-6], yet the receipt of sex education among U.S ...

  3. Sex Education in the Spotlight: What Is Working? Systematic Review

    Aims. (1) To systematically review existing reviews of Sex Education (SE) of school-based (face-to-face), digital platforms and blended learning programs for adolescent populations in high-income countries. (2) To summarize evidence relating to effectiveness. 2.2.

  4. Full article: Assessing the role of school-based sex education in

    School-based sex education interventions are implemented as a part of the formal curriculum and they have the potential to educate young people to make healthy decisions about ... The findings of this review have shown that school-based sex education interventions are giving greater attention to information relevant to risk reduction strategies ...

  5. Three Decades of Research: The Case for Comprehensive Sex Education

    Purpose: School-based sex education plays a vital role in the sexual health and well-being of young people. Little is known, however, about the effectiveness of efforts beyond pregnancy and sexually transmitted disease prevention. The authors conducted a systematic literature review of three decades of research on school-based programs to find evidence for the effectiveness of comprehensive ...

  6. Sex Education in School, are Gender and Sexual Minority Youth Included

    This review indicated that schools are still presenting sexual health education exclusive of gender and sexual minority needs. Sex education is a public health necessity, ... Sex education in schools needs to be medically accurate, affirming, and reflect all genders and sexual orientations to help reduce health disparities and increase the ...

  7. Three decades of research: The case for comprehensive sex education

    Purpose: School-based sex education plays a vital role in the sexual health and well-being of young people. Little is known, however, about the effectiveness of efforts beyond pregnancy and sexually transmitted disease prevention. The authors conducted a systematic literature review of three decades of research on school-based programs to find evidence for the effectiveness of comprehensive ...

  8. Comprehensive Sex Education—Why Should We Care?

    Fonner et al 7 conducted a systematic review and meta-analysis of the existing evidence for school-based sex education interventions in low- and-middle-income countries to understand the efficacy of these services in changing HIV-related risk behaviors and knowledge. CSE adapted based on the local milieu integrated into community and school ...

  9. Effectiveness of relationships and sex education: A systematic review

    This paper presents a systematic review on published research on universal school-based relationships and sex education for children aged 4-18 years. The review excludes papers focused solely on targeted cohorts, specific content areas and approaches such as abstinence-only education.

  10. Frontiers

    Teachers, and their professional learning and development, have been identified as playing an integral role in enabling children and young people's right to comprehensive sexuality education (CSE). The provision of sexuality education (SE) during initial teacher education (ITE) is upheld internationally, as playing a crucial role in relation to the implementation and quality of school-based ...

  11. The effectiveness of school-based sex education programs in the

    The search for school-based sex education interventions resulted in 12 research studies that complied with the criteria to be included in the review and for which effect sizes could be estimated. The overall effect size ( d +) estimated from these studies was 0.05 and the 95% confidence interval about the mean included a lower bound of 0.01 to ...

  12. Effectiveness of relationships and sex education: A systematic review

    134 papers were included on school-based relationships and sex education for children aged 4-18 years from 2000 to 2020. • Terms used in the field are vast; however, 'sexuality education' was the most frequently defined term.

  13. (PDF) Assessing the effectiveness of school-based sex education in

    Objective: To systematically review and synthesise evidence on the effectiveness of school-based sex education interventions on sexual health behaviour outcomes and to identify Behaviour Change ...

  14. The State of Sex Education in the United States

    With widespread implementation of school and community-based programs in the late 1980s and early 1990s, adolescents' receipt of sex education improved greatly between 1988 and 1995 . In the late 1990s, as part of the "welfare reform," abstinence only until marriage (AOUM) sex education was adopted by the U.S. government as a singular ...

  15. UN publishes new report on Comprehensive Sexuality Education

    UN publishes new report on Comprehensive Sexuality Education. Despite good progress in some countries, too many are failing to ensure children and young people have the knowledge and skills they need for good health and well-being, according to findings from a new UN report on comprehensive sexuality education (CSE). Too often, teachers are not ...

  16. What Works In Schools: Sexual Health Education

    Quality sexual health education programs teach students how to: 1. Analyze family, peer, and media influences that impact health. Access valid and reliable health information, products, and services (e.g., STI/HIV testing) Communicate with family, peers, and teachers about issues that affect health. Make informed and thoughtful decisions about ...

  17. PDF Pros and Cons of Sex Education in School Children: Review

    In this article, we review major impact of sex education in school and ways it benefits the society. Though Sex education taught in one school is not the same as that taught in the other, it is pertinent to consider it as a recreational course rather than a serious subject in school. Keywords: Sex education, human anatomy, recreational course.

  18. PDF Importance of sex education in schools: literature review

    Abstract. According to the National Association for the Education of Young Children, early childhood also includes infancy, making it age 0-8 instead of age 3-8. At this stage children are learning through observing, experimenting and communicating with others. Childhood is the age span two years to adolescence.

  19. Three Decades of Research: The Case for Comprehensive Sex Education

    School-based sex education plays a vital role in the sexual health and well-being of young people. Little is known, however, about the effectiveness of efforts beyond pregnancy and sexually transmitted disease prevention. The authors conducted a systematic literature review of three decades of research on school-based programs to find evidence ...

  20. What Good Is School-Based Sex Education?

    In 2016, the American Journal of Public Health published a supplement containing evaluations of 15 school sex education programs, involving 60,000 teens at 250 sites in 200 cities, including roll ...

  21. New RSHE guidance: What it means for sex education lessons in schools

    In 2020, Relationships and Sex Education was made compulsory for all secondary school pupils in England and Health Education compulsory for all pupils in state-funded schools. Last year, the Prime Minister and Education Secretary brought forward the first review of the curriculum following reports of pupils being taught inappropriate content in ...

  22. State Policies on Sex Education in Schools

    As of October 1, 2020: Thirty states and the District of Columbia require public schools teach sex education, 28 of which mandate both sex education and HIV education. Thirty-nine states and the District of Columbia require students receive instruction about HIV. Twenty-two states require that if provided, sex and/or HIV education must be ...

  23. Sex education review announced after MPs raise concerns

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  24. Sex education 'is under attack' by a wave of proposed ...

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  25. Sex education bills: States restricting abortion access have been ...

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  26. Plan to ban sex education for children under nine

    At secondary school, relationships, sex and health education is mandatory - and covers content on a wider range of key topics. It includes sex, sexual relationships, consent, online abuse ...

  27. Young girls leave school with no clue about sex education

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  28. What age does sex education in school begin in the UK?

    Sex education in UK schools is changing (Picture: Getty) A controversial government proposal to ban sex education for children under the age of 13 has been revealed.. The new age limit is set to ...

  29. Premier says sex education group will be banned from giving school

    Premier Blaine Higgs has said he will ban a Quebec-based sex education group from presenting at schools in New Brunswick after a presentation he believes was "clearly inappropriate."

  30. Department of Education releases final Title IX rules

    The U.S. Department of Education released its final Title IX rules on April 19, which will come into effect on Aug. 1, 2024. This means that schools across the nation must update their policies and processes for addressing sex discrimination to align with the revised federal law.