State Policy on School-based Sex Education: A Content Analysis Focused on Sexual Behaviors, Relationships, and Identities.

Objectives: Adolescents in the United States face crucial sexual health behavior issues, including consequences of sexually transmitted infections and diseases, pregnancy, and sexual violence. Lesbian, gay, bisexual, and transgender youth are disproportionately affected by these issues. State policies about sex education in K-12 schools shape what is taught to students about sexual health. In this study, we analyzed the content of school-based sex education policies of all 50 states and focuses on sexual behaviors, relationships, and identities. Methods: Policies analyzed include state statutes, state board of education policies, and state department of education or public instruction curriculum standards. Data were analyzed using content analysis. Results: Most state policies emphasized abstinence from sexual behavior and did not require education about contraceptive and barrier methods. Few policies required detailed information about contraceptive and barrier methods to prevent pregnancy and sexually transmitted infections. Around half of states addressed relationship issues (ie, healthy relationships, sexual decision-making, and sexual violence); however, few states required content on communication about sexual consent. Eight state policies explicitly stigmatized homosexuality. Conversely, 12 states were inclusive of diverse sexual orientations and 7 states were inclusive of diverse gender identities. Conclusion: Sex education policies should be evidence-based and inclusive of sexual diversity.

The no-go zone: a qualitative study of access to sexual and reproductive health services for sexual and gender minority adolescents in Southern Africa.

BACKGROUND: Adolescents have significant sexual and reproductive health needs. However, complex legal frameworks, and social attitudes about adolescent sexuality, including the values of healthcare providers, govern adolescent access to sexual and reproductive health services. These laws and social attitudes are often antipathetic to sexual and gender minorities. Existing literature assumes that adolescents identify as heterosexual, and exclusively engage in (heteronormative) sexual activity with partners of the opposite sex/gender, so little is known about if and how the needs of sexual and gender minority adolescents are met. METHODS: In this article, we have analysed data from fifty in-depth qualitative interviews with representatives of organisations working with adolescents, sexual and gender minorities, and/or sexual and reproductive health and rights in Malawi, Mozambique, Namibia, Zambia and Zimbabwe. RESULTS: Sexual and gender minority adolescents in these countries experience double-marginalisation in pursuit of sexual and reproductive health services: as adolescents, they experience barriers to accessing LGBT organisations, who fear being painted as "homosexuality recruiters," whilst they are simultaneously excluded from heteronormative adolescent sexual and reproductive health services. Such barriers to services are equally attributable to the real and perceived criminalisation of consensual sexual behaviours between partners of the same sex/gender, regardless of their age. DISCUSSION/ CONCLUSION: The combination of laws which criminalise consensual same sex/gender activity and the social stigma towards sexual and gender minorities work to negate legal sexual and reproductive health services that may be provided. This is further compounded by age-related stigma regarding sexual activity amongst adolescents, effectively leaving sexual and gender minority adolescents without access to necessary information about their sexuality and sexual and reproductive health, and sexual and reproductive health services.

Sustainability and power in health promotion: community-based participatory research in a reproductive health policy case study in New Mexico.

Health promotion programs are commonly viewed as value-free initiatives which seek to improve health, often through behavior change. An opposing view has begun to emerge that health promotion efforts, especially ones seeking to impact health policy and social determinants of health, are vulnerable to political contexts and may depend on who is in power at the time. This community-based participatory research study attempts to understand these interactions by applying a conceptual model focused on the power context, diverse stakeholder roles within this context, and the relationship of political levers and other change strategies to the sustainability of health promotion interventions aimed at health policy change. We present a case study of a health promotion coalition, New Mexico for Responsible Sex Education (NMRSE), as an example of power dynamics and change processes. Formed in 2005 in response to federal policies mandating abstinence-only education, NMRSE includes community activists, health promotion staff from the New Mexico Department of Health, and policy-maker allies. Applying an adapted Mayer's 'power analysis' instrument, we conducted semi-structured stakeholder interviews and triangulated political-context analyses from the perspective of the stakeholders.We identified multiple understandings of sustainability and health promotion policy change, including: the importance of diverse stakeholders working together in coalition and social networks; their distinct positions of power within their political contexts; the role of science versus advocacy in change processes; the particular challenges for public sector health promotion professionals; and other facilitators versus barriers to action. One problem that emerged consisted of the challenges for state employees to engage in health promotion advocacy due to limitations imposed on their activities by state and federal policies. This investigation's results include a refined conceptual model, a power-analysis instrument, and new understandings of the intersection of power and stakeholder strategies in the sustainability of health promotion and health in all policies.

Do State-Based Policies Have an Impact on Teen Birth Rates and Teen Abortion Rates in the United States?

OBJECTIVES: The United States has one of the highest teen birth rates among developed countries. Interstate birth rates and abortion rates vary widely, as do policies on abortion and sex education. The objective of our study is to assess whether US state-level policies regarding abortion and sexual education are associated with different teen birth and teen abortion rates. METHODS: We carried out a state-level (N = 51 [50 states plus the District of Columbia]) retrospective observational cross-sectional study, using data imported from the National Vital Statistics System. State policies were obtained from the Guttmacher Institute. We used descriptive statistics and regression analysis to study the association of different state policies with teen birth and teen abortion rates. RESULTS: The state-level mean birth rates, when stratifying between policies protective and nonprotective of teen births, were not statistically different-for sex education policies, 39.8 of 1000 vs 45.1 of 1000 (P = .2187); for mandatory parents' consent to abortion 45 of 1000, vs 38 of 1000 when the minor could consent (P = .0721); and for deterrents to abortion, 45.4 of 1000 vs 37.4 of 1000 (P = .0448). Political affiliation (35.1 of 1000 vs 49.6 of 1000, P < .0001) and ethnic distribution of the population were the only variables associated with a difference between mean teen births. Lower teen abortion rates were, however, associated with restrictive abortion policies, specifically lower in states with financial barriers, deterrents to abortion, and requirement for parental consent. CONCLUSION: While teen birth rates do not appear to be influenced by state-level sex education policies, state-level policies that restrict abortion appear to be associated with lower state teen abortion rates.

Sexuality education in a representative sample of Portuguese schools: examining the impact of legislation.

OBJECTIVES: To share Portugal's experience with school-based sexuality education, and to describe its implementation at a local level, following an ecological model and using a mixed methodology approach. The study also examines the impact of the latest policies put into effect, identifying potential weaknesses and strengths affecting the effectiveness of sexuality education enforcement. METHODS: A representative sample of 296 schools in Portugal was analysed. Teachers representing the school completed a questionnaire and were asked to share any kind of official document from their sexuality education project (such as curriculum content). A subsample of these documents was analysed by two coders. Quantitative analysis was carried out using descriptive statistics. RESULTS: The majority of Portuguese schools delivered sexuality education, in line with Portuguese technical guidelines and international recommendations. There were common procedures in planning, implementation and evaluation of sexuality education. Some strengths and weaknesses were identified. Results highlighted the impact of the various systems on the planning, enforcement and evaluation of sexuality education in school. CONCLUSIONS: The latest policies introduced valuable changes in school-based sexuality education. A way of assessing effectiveness of sexuality education is still needed.

South African life orientation teachers: (not) teaching about sexuality diversity.

Although South Africa is one of the most progressive countries in the world in terms of constitutional and legislative rights for LGBT individuals, education is one of many social arenas where these ideals are not carried out. Interviews with 25 practicing teachers revealed very little description of practice, but widely divergent understandings around sexual diversity that drew on various authoritative discourses, including religious teachings, educational policy, science, and the powerful human rights framework of the South African constitution. Implications for teacher education include directly engaging with these discourses and providing training, teaching materials, and practical guidelines based on existing policy.

Claiming comprehensive sex education is a right does not make it so: a close reading of international law.

The international community is currently debating whether international law requires States to educate adolescents about their sexuality. Various nongovernmental organizations, United Nations Special Rapporteurs, and treaty-monitoring bodies assert a right to comprehensive sex education, a controversial approach to sex education that arguably encourages adolescents to experiment with their sexuality. This assertion of a right to comprehensive sex education is erroneous and misleading. International human rights are created in two ways: by treaty and by custom. Treaties do not mention comprehensive sex education, or any other form of sex education or training. Custom, found in international consensus documents and other declarations of political will, and confirmed by State practice, holds no universal agreement on sex education. Because neither treaty nor custom creates a right to comprehensive sex education, no such right exists.

Office of Adolescent Health medical accuracy review process--helping ensure the medical accuracy of Teen Pregnancy Prevention Program materials.

The Office of Adolescent Health (OAH) developed a systematic approach to review for medical accuracy the educational materials proposed for use in Teen Pregnancy Prevention (TPP) programs. This process is also used by the Administration on Children, Youth, and Families (ACYF) for review of materials used in the Personal Responsibility Education Innovative Strategies (PREIS) Program. This article describes the review process, explaining the methodology, the team implementing the reviews, and the process for distributing review findings and implementing changes. Provided also is the definition of "medically accurate and complete" as used in the programs, and a description of what constitutes "complete" information when discussing sexually transmitted infections and birth control methods. The article is of interest to program providers, curriculum developers and purveyors, and those who are interested in providing medically accurate and complete information to adolescents.

Reproductive rights of mentally retarded persons.

Mental retardation denotes sub-average intellectual functioning, based on IQ, i.e. the inability of normal learning, accompanied by behavioral and developmental disorders. Persons with impairments (cognitive, motor, sensory or psychiatric) have often been, both through human history and today victims of discrimination and deprived of their basic human rights, both in the public and the private life spheres. Since the end of the 20th century, throughout the developed world, many disabled persons can accomplish their dreams and rights. However, the issue of sexuality is still an obstacle in realizing oneself as a whole person, of course in accordance with personal psychophysical abilities. The greatest problem is present in persons with severe disablement, considered not apt enough for information on sexuality and for expressing themselves as persons with their own sexual needs. Thus it is desirable to observe each disabled person individually and flexibly enough in order to establish parameters for the functioning of an intimate affair on the level of understanding and assent. The legal system must protect the most vulnerable and ensure for them the right of choice and consent, as well as the possibility of fulfilling their sexual needs, so that they could love and be loved. Naturally, the system must be built on foundations that satisfy the needs of its users, but also of persons engaged in work with them. Sex education should contain information regarding biological, socio-cultural and spiritual dimensions of sexuality, including cognitive, affective and behavioral domains. Unfortunately, very few educational programs with such aims provide sex education, not only for the disabled young population but also for the healthy. This review article is based on international investigations and Croatian legislative postulates. Its aim is to focus the attention of both professionals and non-professionals on this delicate problem.

[Sexual and reproductive rights in adolescence]. / Direitos sexuais e reprodutivos na adolescência.

OBJECTIVE: To present legal milestones to ensure the Brazilian adolescent autonomy indealing with their sexual and reproductive health. METHODS: Literature review of national legislation published on the official sites of governmental organs (Ministry of Health and Ministry of Education) and Class Associations (Federal Council of Medicine [Conselho Federal de Medicina--CFM] and the Federal Council of Nursing--COFEN). RESULTS: We found 8 legislations, of which 3 were from Class Associations (COFEN and CFM), one Interministerial Ordinance (Ministries of Health and Education), one Technical Note of the National STD/AIDS Program, and 3 Federal Laws. Many of the legal guarantees directly affect the adolescent population (guarantee of schooling during pregnancy and puerperal period or maternity leave, condom distribution, no discrimination in the school environment on the basis of serology). They are important tools for the preservation of sexual and reproductive rights, privacy of medical care, search for reliable health information, and access to inputs such as condoms and contraceptive methods. CONCLUSION: The analysis of the legislation listed in the present study demonstrated that these legal milestones are essential to ensure the safe and healthy experience of sexuality, and all health and education professionals involved in adolescent counseling should know them comprehensively.

Direitos sexuais e reprodutivos na adolescência / Sexual and reproductive rights in adolescence

OBJETIVO: Apresentar marcos legais brasileiros que garantam ao adolescente autonomia no trato com sua saúde sexual e reprodutiva. MÉTODOS: Levantamento bibliográfico das legislações nacionais publicadas em site dos órgãos oficiais (Ministério da Saúde e Educação) e Associações de Classe (Conselho Federal de Medicina - CFM - e Conselho Federal de Enfermagem - COFEN). RESULTADOS: Encontraram-se oito legislações sendo três de Associação de Classe (CFM e COFEN), uma Portaria Interministerial (Ministério da Saúde e Educação), uma Nota Técnica do Programa Nacional de DST/AIDS e três Leis Federais. Muitas das garantias legais afetam diretamente a população adolescente (garantia de escolarização durante a gestação e período puerperal ou licença maternidade, distribuição de preservativos, não discriminação por sorologia em ambiente escolar). São instrumentos importantes de preservação dos direitos sexuais e reprodutivos, da privacidade no atendimento médico, na busca por informações seguras de saúde e no acesso a insumos como preservativos e métodos contraceptivos. CONCLUSÃO: As análises das legislações levantadas demonstraram que estes marcos legais são imprescindíveis na garantia da vivência da sexualidade de forma mais segura e saudável, e todo profissional de saúde envolvido no acompanhamento de adolescentes deve conhecê-los profundamente.

OBJECTIVE: To present legal milestones to ensure the Brazilian adolescent autonomy indealing with their sexual and reproductive health. METHODS: Literature review of national legislation published on the official sites of governmental organs (Ministry of Health and Ministry of Education) and Class Associations (Federal Council of Medicine [Conselho Federal de Medicina - CFM] and the Federal Council of Nursing - COFEN). RESULTS: We found 8 legislations, of which 3 were from Class Associations (COFEN and CFM), one Interministerial Ordinance (Ministries of Health and Education), one Technical Note of the National STD/AIDS Program, and 3 Federal Laws. Many of the legal guarantees directly affect the adolescent population (guarantee of schooling during pregnancy and puerperal period or maternity leave, condom distribution, no discrimination in the school environment on the basis of serology). They are important tools for the preservation of sexual and reproductive rights, privacy of medical care, search for reliable health information, and access to inputs such as condoms and contraceptive methods. CONCLUSION: The analysis of the legislation listed in the present study demonstrated that these legal milestones are essential to ensure the safe and healthy experience of sexuality, and all health and education professionals involved in adolescent counseling should know them comprehensively.

Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the U.S.

The United States ranks first among developed nations in rates of both teenage pregnancy and sexually transmitted diseases. In an effort to reduce these rates, the U.S. government has funded abstinence-only sex education programs for more than a decade. However, a public controversy remains over whether this investment has been successful and whether these programs should be continued. Using the most recent national data (2005) from all U.S. states with information on sex education laws or policies (N = 48), we show that increasing emphasis on abstinence education is positively correlated with teenage pregnancy and birth rates. This trend remains significant after accounting for socioeconomic status, teen educational attainment, ethnic composition of the teen population, and availability of Medicaid waivers for family planning services in each state. These data show clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S. In alignment with the new evidence-based Teen Pregnancy Prevention Initiative and the Precaution Adoption Process Model advocated by the National Institutes of Health, we propose the integration of comprehensive sex and STD education into the biology curriculum in middle and high school science classes and a parallel social studies curriculum that addresses risk-aversion behaviors and planning for the future.