In the United States, education is controlled by the individual states which may leave decisions to the local level or may set guidelines for curricula and subject matter. Twenty-two states and the District of Columbia require schools to provide both sexuality and STD/HIV education; another 15 states require STD/HIV education; and 13 states have no requirements.40 Before 1998, 10 states required that sexuality education programs teach abstinence and did not require the inclusion of information about contraception. Thirteen states required that sexuality education teach abstinence in addition to information about condoms and contraception.41 Most mandates for abstinence education came from state legislatures rather than from state departments of education.
In the United States, instruction about sexuality varies widely because decisions about curricula are usually determined locally; however, some general observations can be made. Most schools concentrate sexuality education in grades seven through nine and confine the unit to the health or science curriculum. Often, instructors have little or no training in sexuality education. The curricula often range from one to 15 classes, and average five classes.42 Sexuality education is seldom integrated with other aspects of health education, such as drug education, or with other courses such as social studies, literature, and humanities.
In the 1990s, sexuality education in the United States took a behavioral focus with two distinctive and widely separated approaches. The first, abstinence-until-marriage, limits instruction to why young people should not have sex until they are married. The second, balanced and realistic sexuality education, encourages students to postpone sex until they are older and to practice safer sex when they become sexually active. Studies of sexuality education in the United States show that most frequently taught subjects include factual information about growth and development, reproductive systems, dating and setting limits, abstinence and refusal skills, pregnancy and parenting, and STDs, including HIV.
In 1996, as a part of the Welfare Reform Act, Congress for the first time passed legislation setting national policy for sexuality education and appropriated 250 million dollars over five years to implement abstinence-until-marriage programs. A funded program must adhere strictly to the following:
Abstinence-until-marriage programs do not acknowledge teen sexual behavior because proponents believe that sex outside of marriage is immoral. Consequently, these programs do not teach young people how to protect themselves when they become sexually active. Contraception and condoms may be mentioned only when discussing failure rates. The consequences of STDs, guilt, and shame are used to frighten youth into abstinence. Despite these limitations, 48 of 50 states have applied for and accepted the abstinence-until-marriage funds.41
A union of conservative advocacy groups have joined together to form the National Coalition for Abstinence Education (NCAE). The NCAE monitors expenditures in the states and materials purchased, requests copies of purchase receipts from school districts, charges teachers it perceives to be violating the abstinence-until-marriage mandate, and publishes a report card of its evaluations for each state in regional newspapers. The intensity of the scrutiny by the NCAE and its harassment in some cases have caused some local districts to return the funding or not to apply for funding.43 Some schools now limit their instruction to abstinence-until-marriage, often omitting lessons on sexual intercourse, condoms, contraception, and protective sexual behavior.
The second U.S. approach, defined by proponents as accurate and balanced sexuality education, takes a broader perspective. Students are encouraged to postpone sex until they are older and then to lower their risk of negative consequences by using safer sex practices. These programs utilize principles of social learning theory and emphasize communication, negotiation, and problem-solving skills. They also provide information and skills development to reduce exposure to STDs, HIV, and pregnancy among sexually active teens. Unlike abstinence-only or abstinence-until-marriage programs, many of the balanced, realistic programs have undergone rigorous evaluation and have been shown to be effective with targeted groups.
The World Health Organization and UNAIDS have each reviewed the research on abstinence-only and balanced, realistic sexuality education programs. The reviews found that no abstinence-only (or abstinence-until-marriage) programs has been proven effective, while some balanced, realistic programs have been effective in delaying first intercourse and in increasing the use of protection by sexually active youth. Additionally, balanced, realistic sexuality education programs have not increased the level of sexual activity, caused earlier sexual activity, or increased the number of sexual partners among sexually active youth.44,45
The unfortunate reality is that politics polarizes sexuality education in the United States. While polls consistently indicate that the majority of U.S. parents want their youth to receive accurate sexuality education in the schools, a belligerent minority threatens administrators with community controversy and negative media attention if sexuality education actually deals with sexuality.
The most recent national poll found that 89 percent of public school parents feel that the public high schools should include sex education in their programs:43 87 percent of adults think high school students should learn about birth control; 77 percent say students should learn about premarital sex; 70 percent support teaching about abortion; 65 percent support teaching about homosexuality; and 92 percent think youth should learn about HIV and other STDs.46
Education is highly valued in the Netherlands. Officials credit parental choice in education with encouraging competition between schools for students, improving the quality of teaching, decreasing levels of bureaucracy in and around schools, and reducing costs.47 School sexuality education plays a "matter of fact" role in young people's psychosexual development. The Netherlands has no sexuality education curriculum and no single national textbook for student instruction. The content of sexuality education has never been mandated. Until 1993, sexuality education was not an obligatory part of the school curricula. Yet research shows that nine out of 10 Dutch youth receive school sexuality education, regardless of the schools they attend, and approximately half of the primary schools and almost all secondary schools address a wide range of sexuality related issues.2,48
The general philosophy of sexuality education in the Netherlands is not to teach but to talk about sex.3 Dutch teachers approach sexuality issues with their students, no matter what subject they teach, and sexuality education is integrated into many school courses. All teachers have complete freedom to teach anything the students want to learn about sexuality.2,18,48 Because the Dutch believe students should be active in their own education, students' questions drive the lessons and any topic may be openly discussed, including homosexuality or masturbation. Teachers emphasize communication and negotiation skills but direct little attention to negative consequences of sexual behavior.48,49
In Germany, sexuality education must be comprehensive and address the widest range of age and target groups.21 Germany has no national curriculum or special course on sexuality education.50 Teachers and principals have the freedom to conduct their programs in any manner they desire.51 Often, teachers will invite guest lecturers from community-based reproductive health organizations such as ProFamilia.52
The German Federal Constitution Court Schools gave responsibility for sexuality education to schools, community-based organizations, and the highest health authorities.22 Three tasks assigned to the Federal Center for Health Education include: 1) developing concepts for sexuality education—each geared toward individual age and social groups—for the purpose of promoting preventive health care and avoiding or resolving conflicts in pregnancy; 2) disseminating uniform educational materials throughout the nation; and, 3) distributing free educational materials to schools, vocational training schools, counseling centers, and all other institutions involved with youth and education.52 This responsibility rests on a belief that sexuality is an integral part of physical and psychological health, and sexuality education is an integral component of health education.
Germany now ascribes to emancipatory sex education, a positive, non-repressive, and dialogue-based approach which gradually introduces sexuality and provides information and support for sex as an expression of emotion and tenderness. Relationships are a primary concern and provide a dual responsibility for sexual behavior. The strategies of this sexuality education are theme-centered interaction, role playing, and exploration, rather than traditional lectures.51
Sexuality education should provide:
Sexuality education should motivate students to:
Sexuality education is a relatively new subject for French teachers and is not carried out as systematically as many other subjects in France. National policy requires two hours of instruction during each of the lower secondary years; but efforts are under way to lengthen this requirement. Until the AIDS epidemic, sexually education rarely occurred in France. With the advent of AIDS, the French began teaching sexuality education as disease prevention.54
Most sexuality discussions in schools begin around the age of nine, and at 13, students get the nationally mandated program. The national curriculum contains five chapters dedicated solely to STDs and HIV/AIDS. Most of the sexuality education starts with questions raised by the students.39 Biology instructors cover reproductive anatomy and physiology and invite community specialists or volunteers from family planning agencies to discuss other issues with the youth. Some topics are seldom discussed in French schools.
The HIV/AIDS epidemic provided an opening for family planning organizations to work in the schools of this largely Catholic nation and allows presenters to discuss the health concerns of young people and to address their misunderstandings. Organizations that assist in the schools include the Mouvement Francais pour le Planning Familial (MFPF), Couple et Familia, and the Regional Center for the Prevention of AIDS (CRIPS). Together, these organizations and the schools aim, not to delay sex, but to inform teens about their bodies and to assist teens to develop skills and social norms for protective sexual behavior.
In France, close ties exist among the efforts in schools, mass media campaigns, and community efforts. Schools and communities sponsor poster and scenario contests for adolescents whose creative work undergirds television, billboard, and poster campaigns. Teens from school drama programs sometimes help in developing radio spots, CDS, and music and lyrics for community-based sexuality education. Young people's questions are later used as the basis for educational materials developed for youth. Leaders in sexuality professions sponsor day-long debates on issues such as HIV infected people having babies and AIDS related suicide. Press coverage from these debates sparks classroom discussions.
Because sexuality education is nationally mandated, no French parent may withdraw a teenage student from the sexuality education program.39 While parents may remove elementary school children, by age 13, the young person's right to information vital to personal and public health takes precedence over parental rights.