Comprehensive sex ed improves health, decreases inequities, research says

Throughout the debate on Referendum 90 – the controversial sex ed question on November’s ballot – supporters have argued that comprehensive sexual health education keeps students safe and allows them to make healthy decisions when it comes to sex.

The research on comprehensive sexual health education is clear: it has many positive health benefits, including lowering rates of youth pregnancy, sexually transmitted infections, and sexual abuse and reducing health inequities.

“These are really, really critically important skills for young people to have,” said Eva Goldfarb, Montclair State University professor of public health. Goldfarb has researched and developed sexuality health education for the last 25 years.

Most recently, Goldfarb co-authored a Journal of Adolescent Health article titled “Three Decades of Research: The Case for Comprehensive Sex Education.”

Goldfarb and Lisa Lieberman, Montclair State University Department of Health chair, reviewed three decades of literature surrounding sexual health education.

Their research found that, along with lowering youth pregnancy and sexually transmitted infection rates, comprehensive sex ed also prevents domestic violence and sexual abuse and improves healthy relationship development and social emotional learning.

A January health impact review done by the state Board of Health found similar evidence that implementing comprehensive sexual health education would improve sexual and reproductive health outcomes for students. Board of Health impact reviews are requested by a member of the Legislature for further analysis on a topic or bill, said health policy analyst Caitlin Lang-Perez.

The reports are nonpartisan, objective and don’t include recommendations, she said.

The report used existing literature and conversations with the Office of the Superintendent of Public Instruction as well as education departments in Oregon and Rhode Island to support its findings.

Starting sex ed early is importantIn Washington, 9% of students in eighth grade, 26% of students in 10th grade and 47% of students in 12th grade reported having sex at least once, according to the state Healthy Youth Survey. The survey, which is conducted every other year, asked 32,271 students across 182 schools about their health and safety behaviors.

In Spokane County alone, 8% of eighth-graders, 26% of 10th-graders and 48% of 12th-graders reported having sex, according to 2016 regional health district data.

Keeping children ignorant of sex does not protect them, Goldfarb said. Kids will still find access to information about sex.

“There’s no other topic area where we value ignorance over knowledge,” she said.

According to the Centers for Disease Control and Prevention, people aged 15-24 acquire half of all new sexually transmitted infections. One in 4 sexually-active adolescent women has an STI, according to the CDC.

According to the Healthy Youth Survey, condoms are the most widely used prevention method among students, although 6% of students in Grade 10 and 8% of students in Grade 12 use no birth control.

A 2015 global review from the United Nations Population Fund found that comprehensive sexuality education can delay the first time a student has sex as well as reduce the number of sexual partners. It can also improve condom or contraceptive use, which reduces STIs, HIV and unintended pregnancy.

Madeline Schneider and Jennifer Hirsch, researchers at Columbia University, found sexual health education beginning in kindergarten prevents child sexual abuse and interrupts gender stereotype formation.

Intervention beginning in kindergarten could mitigate harm that comes from gender stereotypes and hypermasculinity, according to their research. It could also create safer climates for LGBTQ students.

The new Washington law would require social emotional learning to be taught in K-3.

Similar to other subjects, sex ed should be what Goldfarb calls “scaffolded learning.” Communication and emotional intelligence should be the basis for the more complicated sex ed discussions, she said.

“Sex education is just like any other content we teach,” said Dan Rice, executive director at Answer at Rutgers University, which offers sex ed resources and training. “You can’t teach multiplication without teaching addition.”

Decreasing rates of sexual violenceMany opponents of the bill have expressed concerns that teaching comprehensive sexual health education would actually increase the rate of sexual assault among students.

The state Board of Health found no evidence that comprehensive sexual health education would contribute to an increase in youth sexual assault. Instead, the report found evidence that a lack of sexual health education could contribute to more sexual violence.

“The evidence has been clear for a very, very long time that sex education does not increase sexual activity,” Goldfarb said.

Data from the National Intimate Partner and Sexual Violence Survey shows that intimate partner violence often begins in adolescence.

According to the 2018 Healthy Youth Survey, nearly 25% of eighth-graders, 31% of 10th-graders and 31% of 12th-graders reported seeing someone around their age pressure someone else to kiss, touch or have sex when they did not want to. About 12% of eighth-graders, 19% of 10th-graders and 25% of 12th-graders reported being in a situation where someone made them engage in kissing, sexual touch or intercourse when they did not want to.

Goldfarb’s research strongly supports the idea that consent education early prevents sexual assault and promotes healthy relationships.

Young people get messages about their bodies at a very early age, Rice said. It’s important to teach them about bodily autonomy early, about how to say no.

“Those pieces all tie together,” he said.

Improving health inequitiesThe state Board of Health review found very strong evidence that implementing inclusive, comprehensive sexual health education would reduce health inequities across the state.

Researchers looked at 10 groups of students facing various inequities related to sexual health education.

For example, students with a developmental disability are more likely to be sexually abused than their peers, according to the report. The lack of sexuality education among young people with developmental disabilities could lead to increased rates of STIs and sexual abuse and decreased access of reproductive care.

Researchers also looked at youth experiencing homelessness, and found they are more likely to have sexual intercourse but are much less likely to have access to health care.

Students of color are more likely to experience unintended teen pregnancy and higher STI rates. In Washington state, Hispanic youth and Native American/Alaska Native youth experience the highest rates of teen pregnancy, according to the report. STI rates continue to increase among Latino adolescents.

LGBTQ youth often disproportionately experience poor sexual health outcomes and mental health concerns, according to the report.

Often LGBTQ youth don’t see themselves represented in sexual health education curriculum, Rice said. When they see themselves represented, they are often safer, healthier and experience less bullying or hostile environments.

Marginalized communities are affected by the lack of knowledge, education and resources, Goldfarb said.

Access to health care and sex ed plays into the outcomes that people see in their lives, such as pregnancy or STI rates, Rice said.

“We can’t say that all of the inequities around sexual health exist because of a person’s decisions,” Rice said.