Sex Education Across U.S. State Lines: How Does This Affect HIV, Teen Pregnancy, and Domestic Violence Rates?

Written By Nikki Mahendru

Laura Norman

Sexual health education can include a variety of topics, including growth and development, sexually transmitted infections, contraception, consent, elements of healthy relationships, sexuality, and gender identity. The presence and comprehensiveness of sex education varies significantly depending on an area’s values and beliefs. Developed countries, such as the Netherlands and Denmark, tend to teach their children about comprehensive sexual health education. However, unlike other developed countries, the United States does not have a federally mandated sexual health education curriculum. Therefore, sex education varies widely across the 50 states. In order to compare the quality of sex education, I have developed a point system based on what I believe are important elements of a good sexual health curriculum. Below I will describe each element of the point system and why it was included:

  1. Condition One: Is sexual health education required? Yes: 1 point, No: -1 point

Many states, such as Kansas, have a recommended sexual health curriculum, but that curriculum is not required to be taught to the fullest extent. Therefore, some Kansas counties do not teach high quality sex education despite the state government having a relatively comprehensive curriculum. If a state does not require sexual health education, then many students will not get the information they need. 

  1. Condition Two: Is HIV AND STI prevention required? Yes to both: 1 points, No to one: 0 points, No to both: -1 point

Education on sexually transmitted diseases, including transmission, symptoms, and treatments, are important for reducing spread of STIs and reducing mortality from more severe illnesses such as HIV. Ensuring that all students are receiving equal education regarding these topics can help prevent disparities across county lines. For example, In North Carolina, Mecklenburg County (where Charlotte is located) has higher rates of HIV than Wake (Raleigh) and Durham County.

  1. Condition Three: Does the curriculum have to be provided by trained professionals providing accurate information? Yes: 1 point, No to trained professionals: 0 points, No to both OR no to just accurate info: -1 point

It is important that those giving sex education are trained to do so and are required to provide accurate information to ensure that students are getting correct and relevant information. It is even more important that the information be accurate because even if teachers receive training, their own personal biases may prevent them from teaching the most accurate information possible.

  1. Condition Four: Does the curriculum follow the federal recommendations for sex ed education? Yes: 1 point, No: 0 points

The federal sex education curriculum outlined by the CDC is very comprehensive and inclusive; therefore, it is ideal that states follow it. However, it is understood that a state can have a good curriculum without following every recommendation from the CDC, so points are not lost or gained for a “No” to this condition.

  1. Condition Five: Does the curriculum promote correct and safe usage of contraception with abstinence? Yes: 1 point, No because it primarily emphasizes abstinence: 0 points, No because it doesn’t emphasize anything: -1 point

Teaching students about types of contraceptives, their success rate, and general tips to maximize effectiveness is important, but it is also important to note that abstinence is the only guaranteed method to avoid sexually transmitted infection or unwanted pregnancy. Curricula that stress abstinence are not very effective because students that choose not to abstain will have little to no information on the best contraceptive methods to use and could potentially use contraceptives in an incorrect or unsafe manner. A curriculum that doesn’t stress anything is not effective at all.

  1. Condition Six: Does the curriculum include LGBTQ students? Yes: 1 point, No: 0 points, It’s outright homophobic/transphobic: -1 point

It is important to create a curriculum that is inclusive of LGBTQ students to ensure that they are having safe sex and to combat stigma surrounding the community. Curricula that do not acknowledge LGBTQ students will only make these students feel more isolated and could make them more vulnerable to STIs. Some states require that their curricula teach the health benefits of heterosexual relationships, which reinforces the negative stereotype that LGBTQ people are more likely to get STIs simply because they are LGBTQ and not because of social factors. 

  1. Condition Seven: Does the curriculum require lessons on how to give proper consent and the elements of a healthy relationship? Yes to both: 1 point, No to one: 0 points, No to both: -1 point

In addition to avoiding unwanted pregnancy and STIs, it is important for students to understand laws surrounding consent, know what proper consent actually means, and recognize the “green” and “red” flags of a romantic, platonic, or other type of relationship. If students grow up not understanding these things, they are more likely to commit sexual assault or be in unhealthy relationships.

  1. Condition Eight: Are at least 80% of public secondary schools “providing those who teach sexual health education with strategies that are age-appropriate, relevant, and actively engage students in learning?” Yes: 1 point, No: -1 point

This condition, taken directly from the CDC’s school based health education law summary reports, indicates whether or not the majority of schools are actually teaching students relevant and accurate information, regardless of whether or not the state requires it by law.

Results

I applied the above conditions to all 50 states (plus District of Columbia). Below are the detailed results and a picture of the overall spread of the data (each point is represented by each state’s abbreviation). 

Interpreting the graph: The above graph has an approximate bimodal shape. The mean quality score of sex education is 0.5, which means that sex education in the United States is typically slightly below average. The standard deviation is 4.76, which indicates that there is a lot of variance in the quality of sex education across different states. The mode values are -4, -3, and -1, which means that they were the most common scores.


Table 1: Scores for each state for each condition

Why is this data significant? 

Studies from the American Journal of Managed Care and Harvard Health Policy have shown that comprehensive sexual health education correlates with lower teen pregancy rates, lower HIV rates, and lower intimate partner violence rates. In addition, the data shows a lot of variance in the quality of sex education in the United States. This makes it very difficult to tackle national issues such as the HIV epidemic and rape culture. The United States would benefit from having a federally mandated sexual health education curriculum because this would create consistency and could be a great way to tackle disparities across regions. However, it is important to note that there are some potential factors unrelated to sexual health education quality that could impact these rates. For example, most states have an “opt in” or “opt out” policy that allow parents to decide whether or not their kids participate in their school’s sex ed curriculum. The percentage of parents who choose to opt their kids out is unknown and may impact their knowledge of contraceptives. In addition, some states, such as New York, have neighborhoods that are extremely segregated by race/class due to the state’s history of redlining. This and New York City’s policy on school funding mean that poorer/black schools get less funding. Less funding in schools results in lower quality sex education. This results in severe discrepancies in rates of HIV between different races and classes in New York City. There are several other potential factors that can contribute to HIV, teen pregnancy rates, and domestic violence rates across states. Nevertheless, to understand sexual health education quality is to understand one piece of the solution to reducing these numbers.

Visuals

Below are some visuals that allow for a more direct comparison of sex education quality to correlating factors: Below is a map based on the point system I created. Each color category is represented by four points worth of states (i.e. states given -7 to -4 points are included in the “Worst Quality” category).

Teen pregnancy per 1000 females age 15-19. This could be relevant to sex education because preventative measures for pregnancy can be a part of a sex education curriculum.

STD and HIV occurrence per 100k people (Mississippi has highest STD rate in general, New York has highest HIV rate). This could be relevant to sex education because preventative measures for STDs can be part of sex education curricula.

The frequency of reported rapes in each state per 100,000 people. This could be relevant to sex education because lessons on giving consent, recognizing elements of a healthy relationship, and making safe choices can be a part of a sex education curriculum.

Nikki Mahendru
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