ANNALS OF HEALTH LAW Advance Directive VOLUME 26 SPRING 2017 PAGES 49-69 Why Planned Parenthood® is Better than Un- Planned Parenthood: Why United States Sexual Education Should Remain Modernized Lauren Batterham* I. INTRODUCTION Teen pregnancies are currently at an all-time low in the United States, but the rates are still much higher than in other developed countries1 and result in negative health consequences for the women and children affected.2 While abstinence-only sexual education is a form of sexual education that is commonly taught in American schools,3 it is unclear whether abstinence-only curricula is the most effective form of sexual education.4 In part due to our prevailing culture and norms, abstinence is no longer the most popular method of pregnancy prevention among teens.5 Conversely, statistics show that comprehensive sexual education curricula decrease risk-taking behavior in teens and are shown to reduce teen pregnancies, in contrast to its abstinence-only counterpart.6 Thus, the underutilization of comprehensive * Loyola University Chicago School of Law Juris Doctor Candidate, 2018 1 About Teen Pregnancy: Teen Pregnancy in the United States, CTRS. FOR DISEASE CONT. & PREVENTION, https://www.cdc.gov/teenpregnancy/about/ (last visited Mar. 31, 2017). 2 See infra note 67 and accompanying text. 3 Johannah Corblatt, A Brief History of Sex Ed in America, NEWSWEEK (Oct. 27, 2009, 8:00 PM), http://www.newsweek.com/brief-history-sex-ed-america-81001. 4 Karen Perrin & Sharon Bernecki DeJoy, Abstinence-Only Education: How We Got Here and Where We’re Going, 24 J. OF PUB. HEALTH POL’Y 445, 450–453 (2003); Henry Waxman, Politics and Science: Reproductive Health, 16 HEALTH MATRIX 5, 6 (2006). 5 Sexual Risk Behaviors: HIV, STD, & Teen Pregnancy Prevention, CTRS. FOR DISEASE CONT. & PREVENTION (last visited Mar. 31, 2017), https://www.cdc.gov/healthyyouth/sexualbehaviors/. 6 PLANNED PARENTHOOD, HISTORY OF SEX EDUCATION IN THE UNITED STATES 1, 4 (2012), https://www.plannedparenthood.org/files/3713/9611/7930/Sex_Ed_in_the_US.pdf. 49 50 Annals of Health Law Vol. 26 sexual education programs in the primary school environment may be detrimental to teens without access to alternative forms of sexual education other than abstinence-only programs. In the United States, teen pregnancy is a public health crisis that the federal government can solve through unified government action and the commonsense efforts of public health officials.7 The Centers for Disease Control and Prevention (“CDC”) lists teen pregnancy as one of its top seven priorities in public health and supports comprehensive, evidence-based sexual education programs for teens.8 While the federal government has historically supported abstinence-only programs over comprehensive sexual education programs,9 the Obama Administration began to shift federal funds from the former towards the latter due to comprehensive programs’ ability to engender positive results for teens.10 However, the individual states govern education curricula through their police powers; therefore, the federal government must ensure that other forms of sexual education remain available to teens when state governments fail to provide adequate education through their school systems.11 Further, outside of school-administered programs, Planned Parenthood Federation of America, Inc. (“Planned Parenthood”) is the largest provider of sexual education in the United States, and provides preventative services and sexual education to those in need.12 7 See Gabriel Scally, Too Much Too Young? Teenage Pregnancy is a Public Health, Not a Clinical, Problem, 31 INT’L J. OF EPIDEMIOLOGY 554, 554 (2002); see, e.g., Reproductive Health: Teen Pregnancy, Communitywide Initiatives, CTRS. FOR DISEASE CONT. & PREVENTION, https://www.cdc.gov/teenpregnancy/projects-initiatives/communitywide.html (last updated Aug. 4, 2016). 8 About Teen Pregnancy: Teen Pregnancy in the United States, supra note 1. 9 John Santelli, Abstinence-Only Education, 73 SOC. RES. 835, 840 (2006); see also Perrin & DeJoy, supra note 2, 446–449. 10 Kelly Percival & Emily Sharpe, Sex Education in Schools, 13 GEO. J. GENDER & THE L. 425, 425 (2012). 11 State Policies on Sex Education in Schools, NAT’L CONF. OF STATE LEGISLATURES (Feb. 16, 2016), http://www.ncsl.org/research/health/state-policies-on-sex-education-in-schools.aspx; Sex and HIV Education, GUTTMACHER INST., https://www.guttmacher.org/state- policy/explore/sex-and-hiv-education (last updated Apr. 1, 2017). 12 See PLANNED PARENTHOOD, supra note 6, at 10. 2017 Why Planned Parenthood® is Better 51 Since a comprehensive approach to sexual education is more realistic and efficient than rigid abstinence-only curricula, the federal government should continue to support and emphasize its efficacy in the prevention of teen pregnancy. This is because teen pregnancy can be solved by consistently providing practical and effective options through strong sexual education programs at the primary school level, supplemented by the availability of alternative programs outside of school. This supports the idea that health providers such as Planned Parenthood, youth services providers, and community-based organizations should remain available as resources to teens. This article begins with Part I’s discussion of sexual education in the United States, providing an overview of its history and discussing the origins of Planned Parenthood. Part II then contrasts abstinence-only and comprehensive sexual education curricula, explains why teen pregnancy is a public health issue, and examines current approaches to sexual education in the United States. Next, Part III discusses Planned Parenthood’s success as a health care provider and educator, and the influence of the federal and state governments on sexual education. Finally, Part IV discusses the current obstacles Planned Parenthood faces as a health care provider and how it can continue to implement widespread sexual education programs for teens in the future. I. BACKGROUND: SEXUAL EDUCATION IN THE UNITED STATES A. General Overview First generation sexual education programs in the United States were largely abstinence-only based, with an emphasis on religion rather than health.13 However, the subsequent urbanization of the United States led to a 13 JOHN D’EMILIO & ESTELLE FREEDMAN, INTIMATE MATERS: A HISTORY OF SEXUALITY IN AMERICA 68–69 (2012); SYLVESTER GRAHAM, A LECTURE TO YOUNG MEN ON CHASTITY: INTENDED ALSO FOR THE SERIOUS CONSIDERATION OF PARENTS AND GUARDIANS 66 (1837), 52 Annals of Health Law Vol. 26 more public conversation about sexual education, albeit one that focused on the physical consequences of non-marital sex such as sexually transmitted diseases.14 Alongside urbanization, the early twenty-first century brought the moral reform and social hygiene movement, which insisted that sexual problems arose from ignorance and emphasized the importance of educating the young.15 Despite this recognition, sexual education efforts were focused on married couples rather than teens.16 In time, a disparity arose between what teens needed to learn regarding their reproductive health and what educators wanted to teach in the classroom; this was primarily a consequence of educators’ desire to avoid “polluting” teen minds or interfering with parental rights to control their children’s education.17 As such, sexual education was largely omitted from American primary education.18 The resistance to sexual education began to weaken in the early twentieth century with the first attempts to implement sexual education in public school systems.19 The sexual revolution became more prominent later in the twenty-first century, paired with the Supreme Court holding for affirmative rights to contraception and abortion for women.20 Historically, the federal government has traditionally been conservative in its approach to sexual education, beginning with the 1981 passage of the https://collections.nlm.nih.gov/bookviewer?PID=nlm:nlmuid-7704062-bk; see Corblatt, supra note 3. 14 See JAMES CIMENT, SOCIAL ISSUES IN AMERICA: AN ENCYCLOPEDIA (2015) (eBook); see Corblatt, supra note 3. 15 Valerie Huber & Michael Firmin, A History of Sex Education in the United States Since 1900, 23 INT’L J. OF EDU. REFORM 25, 27 (2014). 16 See CIMENT, supra note 14. 17 Id. 18 Id.; Jeffrey Moran, “Modernism Gone Mad”: Sex Education Comes to Chicago, 2013, 83 J. AM. HIST. 481, 481 (1996). 19 See Moran, supra note 18, at 482; Corblatt, supra note 3. 20 See Griswold v. Connecticut, 381 U.S. 479, 485–86 (1965); Eisenstadt v. Baird, 405 U.S. 438, 446–47 (1972); see also Roe v. Wade, 410 U.S. 113, 164 (1973), Modified by Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833 (1992). 2017 Why Planned Parenthood® is Better 53 Adolescent Family Life Act (“AFLA”), which set aside funds for abstinence- only sexual education.21 AFLA created the Adolescent Family Life Program (“AFL Program”), which was specifically designed to address teen pregnancy via care and preventative services.22 In addition, the AFL Program provided participating entities with the opportunity to apply for research grants if they remained within the program’s mandates; this included promoting abstinence as the sole preventative service.23 There was also a religious undercurrent to the legislation, which was an integral component of its program applications; entities applying for AFL Program funding were required to provide a description of how they would incorporate religious or charitable organizations into their efforts.24