FACT SHEET

American Adolescents’ Sources Of Sexual Health Information

Adolescents’ reports of formal ■■ Formal instruction may not be skills- contributed to improvement in the sexual health education based; in 2011–2013, only 50% of quality and quantity of evaluation ■■ “Formal” sexual health education is females and 58% of males aged research. instruction that generally takes place 15–19 reported having received for- in a structured setting, such as a mal instruction about how to use a ■■ Strong evidence suggests that school, youth center, church or other condom. approaches to sex education that community-based location. This type of include information about both con- instruction is a central source of infor- ■■ Only about half of adolescents (57% traception and abstinence help young mation for adolescents. of females and 43% of males) people to delay sex, and also to have received formal instruction about con- healthy relationships and avoid STDs ■■ In 2011–2013, more than 80% of traception before they first had sex; and unintended pregnancies when adolescents aged 15–19 had received about four in ten (46% of females and they do become sexually active. Many formal instruction about STDs, HIV 31% of males) received instruction of these programs have resulted in and AIDS or how to say no to sex. In about where to get birth control. delayed sexual debut, reduced fre- contrast, only 55% of young men and quency of sex and number of sexual 60% of young women had received ■■ As of 2015, fewer than six percent of partners, increased condom or con- formal instruction about methods of lesbian, gay, bisexual and transgender traceptive use, or reduced sexual birth control. (LGBT) students aged 13–21 reported risk-taking. that their health classes had included ■■ Between 2006–2010 and 2011–2013, positive representations of LGBT- ■■ The federal government currently there were significant declines in related topics. provides funding to evaluate new adolescent females’ reports of hav- and innovative adolescent pregnancy ing received formal instruction about Effectiveness of formal sex prevention approaches, both in and birth control, STDs, HIV and AIDS, and education programs out of school, as well as to replicate saying no to sex. There was also a sig- ■■ Leading public health and medical pro- existing programs. Evaluations of nificant decline in adolescent males’ fessional organizations—including the programs funded under this initiative reports of having received formal American Medical Association; the have shown that roughly one in three instruction about birth control. American Academy of Pediatrics; the had a positive impact—a larger propor- American College of Obstetricians tion than typically found in evaluation ■■ The share of adolescents aged 15–19 and Gynecologists; the American efforts of this nature. who had received formal instruction Public Health Association; the Health about how to say no to sex but had and Medicine Division of the National ■■ “Abstinence education” programs received no instruction about birth Academies of Science, Engineering, that promote abstinence-only-until- control methods increased between and Medicine (formerly the Institute marriage—now termed “sexual risk 2006–2010 and 2011–2013, from 22% of Medicine); the American School avoidance” by proponents—have been to 28% among females and from 29% Health Association and the Society for described as “scientifically and ethi- to 35% among males. Adolescent Health and Medicine— cally problematic.” They systematically support comprehensive sex education. ignore or stigmatize many young people ■■ Declines in formal sex education were and do not meet their health needs. concentrated among young people ■■ There has been a shift toward residing in rural areas. For example, evidence-based interventions in ■■ Proponents of “sexual risk avoidance” the share of rural adolescents who had the United States over the last few programs have appropriated the terms received instruction about birth control decades. The first dedicated federal “medically accurate” and “evidence- declined from 71% to 48% among funding stream for evaluation of based,” though experts in the field females, and from 59% to 45% adolescent sexual health programs agree that such programs are neither among males. was established in 2010 and has complete in their medical accuracy

DECEMBER 2017 nor based on the widely of middle schools provided queer or questioning education topics: how to accepted body of scientific instruction on all 16 top- (LGBTQ) youth in 2014; say no to sex, methods of evidence. ics that the CDC considers the proportion ranged from birth control, STDs, where essential to sexual health 11% in South Dakota to to get birth control, how to ■■ Abstinence-only-until- education. 56% in Vermont. prevent HIV infection and marriage programs threaten how to use a condom. fundamental human rights ■■ In 2014, 72% of U.S. public Other sources of sexual by withholding information and private high schools health information ■■ Young women were more about human sexuality and taught pregnancy preven- ■■ Adolescents may receive likely than young men potentially providing medi- tion as part of required information about sexual to talk with their parents cally inaccurate and stigma- instruction; 76% taught health topics from a range about each of these sexual tizing information. that abstinence is the most of sources beyond formal health topics except how to effective method to avoid instruction. Here we con- use a condom, which was ■■ Research finds that pro- pregnancy, HIV and STDs; sider the role of parents, more commonly discussed grams that promote absti- 61% taught about contra- health care providers and among males (45%) than nence until marriage while ceptive efficacy; and 35% digital media as potential among females (36%). withholding information taught students how to cor- sources of sexual health about contraceptive meth- rectly use a condom. information for adolescents. ■■ Despite declines in adoles- ods do not stop or even cents’ receipt of formal sex delay sex. Moreover, absti- ■■ At the middle-school level, Parents education between 2006– nence-only-until-marriage 38% of schools taught ■■ In 2011–2013, 70% of 2010 and 2011–2013, the programs can actually place pregnancy prevention as males and 78% of females share of adolescents who young people at increased part of required instruction; aged 15–19 reported hav- had talked with parents risk of pregnancy and STIs. 50% taught that absti- ing talked with a parent about most sex education nence is the most effective about at least one of six sex topics did not change. ■■ A large body of research method to avoid pregnancy, has found no evidence that HIV and STDs; 26% taught providing young people about contraceptive effi- DECLINES IN BIRTH CONTROL EDUCATION with sexual and reproduc- cacy; and 10% taught stu- tive health information dents how to correctly use Fewer adolescents are learning about and education results in a condom. methods of birth control from formal sex increased sexual risk-taking. education sources, while more are being ■■ Among schools requiring taught how to say no to sex without ■■ Most evaluations of sexual instruction about pregnancy receiving any birth control information health programs focus on prevention in 2014, the reducing levels of adoles- average class time spent on % cent pregnancy, STIs and this topic annually was 4.2 100 the behaviors that lead to hours in high schools and Male them. But the broader goal 2.7 hours in middle90 schools. of comprehensive sex edu- 80 Female cation is to support young ■■ In 2014, 88% of schools 70 people’s development into allowed parents70 to exempt sexually healthy adults. their children from sexual 60 61 60 health education. 55 School health policies 50 and programs ■■ The share of schools provid- ■■ According to the Centers ing sexual health education 40 35 for Disease Control and declined between 2000 28 29 30 Prevention (CDC), instruc- and 2014, across topics 22 tion on sexual health topics ranging from puberty and 20 (including human sexuality abstinence to how to use a and prevention of STDs condom. 10 and pregnancy) is more 0 ■■ commonly required in high Within each state, relatively Female Male Female Male school than in middle or few high schools offered elementary school. instruction on HIV, STDs or Instruction about Say no to sex, methods of birth control no birth control instruction pregnancy prevention spe- ■■ In 2014, fewer than half of cifically relevant to lesbian, high schools and only 20% gay, bisexual, transgender, 2006–2010 2011–2013

GUTTMACHER INSTITUTE ■■ Although most parents about sexual health issues, needs may be left out of online with smartphones provide information about and many providers also traditional sex education. and other new mobile contraception or other have concerns about dis- The confidentiality of the technologies. sexual health topics, their cussing these issues. Internet may also be par- knowledge of these top- ticularly attractive for these ■■ Digital media, including ics may be inaccurate or ■■ Concerns about confidenti- adolescents, who may not social networking sites, incomplete. ality limit access to sexual be comfortable discussing apps and text messaging and reproductive health sexual health topics with services, are increasingly ■■ More than 93% of parents care, especially when parents or friends. being used to reach ado- say that sex education in young people rely on their lescents with sexual health middle and high school is parents’ health insurance. ■■ In 2010, 19% of heterosex- interventions, and studies important, and most think In 2013–2015, 18% of all ual youth, 40% of question- have demonstrated efficacy that sex education should adolescents aged 15–17 ing youth, 65% of bisexual in improving knowledge and include instruction about and 12% of young adults youth and 78% of lesbian/ behavior across a range of birth control. aged 18–19 covered by gay/queer youth aged sexual health outcomes. their parents’ insurance 13–18 reported that they Health care providers reported that they would had used the Internet to ■■ The websites adolescents ■■ Both the American not seek sexual or repro- look up sexual health infor- may turn to for sexual Medical Association and ductive health care because mation in the past year. health information often the American Academy of of concerns that their par- have inaccurate informa- Pediatrics recommend that ents might find out. ■■ Seventy-three percent of tion. For example, of 177 adolescents’ primary care adolescents aged 13–17 sexual health websites visits include time alone with ■■ Among females aged 15–17 own a smartphone. More examined in a recent study, health care providers to dis- who had ever had sex, up-to-date research is 46% of those addressing cuss sexuality and receive those who reported con- needed to document how contraception and 35% counseling about sexual cerns about confidentiality and to what extent ado- of those addressing abor- behavior. The American were one-third as likely to lescents access and utilize tion contained inaccurate College of Obstetricians and have received a contracep- sexual health information information. Gynecologists advises that tive service in the previous contraceptive counseling be year than those who did not SEX EDUCATION IN SCHOOLS included in every visit with have these concerns. adolescents, including those The percentage of high schools teaching who are not yet sexually ■■ Many young people fall sex education has declined across a range active. through the information cracks. Among adolescents of topics ■■ Despite these recommen- aged 15–19 who had ever % dations, only 45% of young had sex and who did not 100 people aged 15–17 reported get birth control instruction Methods of contraception in 2013–2015 that they from either formal90 sources spent time alone with a or a parent, only 7% of 80 Human development issues (such as reproductive anatomy and puberty) doctor or other health care females and 13% of males provider during their most talked with a health70 care recent visit in the previous provider about birth control How to correctly use a condom 60 year. in 2006–2010. 50 Resisting peer pressure ■■ Many health care provid- Digital media ers do not talk with their ■■ Access to the Internet is 40 adolescent patients about nearly universal among Abstinence sexual health issues during adolescents in30 the United primary care visits. When States. Digital media offer 20 these conversations do opportunities for youth to occur, they are usually brief; confidentially search10 for in one study, conversations information on sensitive 0 with patients aged 12–17 topics, and thus are a likely 2000 2006 2014 lasted an average of 36 source of sexual health infor- seconds. mation for young people. Abstinence Methods of contraception Resisting peer pressure How to correctly use ■■ Many adolescents feel ■■ Online sources may be a condom uncomfortable talking with particularly important for Human development issues (such as reproductive their health care provider LGBTQ adolescents, whose anatomy and puberty)

GUTTMACHER INSTITUTE Sex education policy sexual orientation, while $15 million to community- SOURCES and funding the remaining three require and faith-based groups for These data are the most ■■ Currently, 22 states and the that classes provide only “sexual risk avoidance,” current available. References District of Columbia man- negative information about to be used exclusively are available in the HTML date education about both sexual orientation. for the implementation of version: https://www. guttmacher.org/fact-sheet/ sex and HIV; two states programs that promote facts-american-teens-sources- mandate sex education ■■ In fiscal year 2017, “voluntarily abstaining from information-about-sex alone, and another 12 man- Congress provided $176 non-marital sexual activity,” date only HIV education. million for evidence-based and $75 million for the or evidence-informed, Title V state-grant “absti- ■■ A total of 37 states require medically accurate and nence education” program, that sex education programs age-appropriate adoles- whose extremely narrow include information about cent pregnancy preven- eight-point definition sets abstinence; 25 require absti- tion programs, the same forth specific messages to nence to be stressed, while amount provided in the be taught, including that 12 simply require the topic previous fiscal year. This sex outside of marriage— to be included as part of the funding included $101 mil- for people of any age—is instruction. lion for the Teen Pregnancy likely to have harmful Prevention Program physical and psychological ■■ Eighteen states and the (TPPP), a competitive grant effects. District of Columbia require program geared toward that sex education programs community-based groups include information about to support the implemen- contraception; no state tation and evaluation of requires that it be stressed. evidence-based and innova- tive adolescent pregnancy ■■ Thirteen states require that prevention approaches. It the information presented also included $75 million for in sex and HIV educa- the Personal Responsibility tion classes be medically Education Program (PREP), accurate. which primarily funds state programs that inform ado- ■■ Twenty-four states and the lescents about both absti- District of Columbia require nence and contraception for any sex education that is the prevention of pregnancy provided to be age appropri- and STIs, including HIV, as ate and three states require well as adulthood prepara- HIV education to be age tion topics such as healthy appropriate. relationships.

■■ Twelve states require ■■ Congress also provided $90 discussion of sexual million for abstinence-only- orientation in sex edu- until-marriage programs cation classes. Nine of in fiscal year 2017, an these states require increase of $5 million over inclusive discussion of the previous year’s fund- ing. This funding included

Good reproductive health policy starts with credible research 125 Maiden Lane New York, NY 10038 212.248.1111 [email protected] www.guttmacher.org

GUTTMACHER INSTITUTE DECEMBER 2017