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Jessica M. Polny

PHIL 5005, K. Mathiesen

24 April 2020

Equitable Distribution of Sexual Health Information in the United States

with Human Rights Informed Comprehensive Sex Education

I. Introduction

The United States does not require that sex education be taught in all schools, nevermind

a comprehensive sex education (CSE) framework that considers cultural context and accurate

representation of social groups. But before we can address ethical issues of representation, we

need to address injustices of distribution of information regarding sexual health and well-being.

Sex education is a human rights interest, for expression, education, and personal health. This

information is also necessary to safely participate in socio-cultural activities, such as intimate

relationships and family planning. Implementing a national mandate for comprehensive sex

education (CSE) in schools, and policies for sex education in private institutions, will improve

distribution of information sexual health in the United States.

II. Description

Currently, the United States has very inequitable distribution of information in regards to

sexual health. The Guttenmacher Insitute constantly updates their report on Sex and HIV

Education in the United States, and currently 29 states out of 50 currently mandate sex

education. The total of these sex ed-informed states adds up to 39 only when including states that

mandate, at least, HIV education. Not only is the sheer geographically-instilled policies creating

boundaries for information access, but also socio-economic issues that affect information
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distribution in formal education. Dr. Laura Duberstein Lindberg of the Guttmacher Institute

stated in a 2015 report of the National Survey of Family Growth that rural districts have less

education resources available, and in prioritizing high-stakes testing subjects, other curicculums

such as sex education are neglected as a low-priority subject. Therefore, even in states which do

mandate sex education, the public funding or priorities of the district are not regulated to the

extent that requires fully implemented CSE. According to the U.S. Department of Education,

private schools are also not required to follow any, or minimal, curriculum mandated by the

state, including sex education even if mandated by the state. Private education on sexual health

may be more subject to scientific inaccuracies or incomplete cultural context, depending on the

institution’s ideology and resources.

Important cultural and representative context is provided by human-rights informed CSE

programs, which have yielded better results in providing more engaging and relevant information

compared to non-comprehensive programs. A coalition of researchers from public health and

adolescent health institutes conducted a randomized survey of high school students in

low-income, urban Los Angeles in 2015, and recorded the immediate reactions and education

evaluations when a Sex Education Initiative was implemented. All students in both programs

showed incresed test scores across nine framework measures, but “ For seven of these outcomes,

students who received the SEI’s rights-based classroom curriculum showed statistically

significantly greater improvements than did students who received a basic sex education

(control) curriculum” (Constantine et.al. 10). While there was knowledge to be gained for both

the SEI and the control group, the results are a compelling fact of providing equal, quality sex

education, and a beginning of how to measure where the minimum standards should lie. Dr.

Sharon Lamb, Professor of Counseling and School Psychology at the University of

Massachusetts Boston, wrote an essay on how CSE developed in light of sex education

legislation during the Obama administration. She states that “CSE advocates took the position
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that it is unethical to withhold information from students that would benefit their health and

well-being, implying that the information itself has no ethical standpoint but simply exists as ‘the

facts’” (Lamb 449). Therefore, distribution persists as the utmost important issue regarding sex

education, and how it should be implemented with CSE and human-rights informed frameworks,

and should be set as the sufficient standard for a national mandate for sex education.

III. Ethical Evaluation

The United States overall is not distributing information on CSE in a just manner, when it

is scrutinized according to the rules of equitable distribution of information.

Firstly, information on sex education is not maximized. According to the Guttmacher Sex

and HIV Education report, “27 states and DC mandate both sex education and HIV education. 2

states only mandate sex education. 10 states only mandate HIV education” (Guttmacher

Institute). This alone makes clear that all 50 states are not maximized to a reasonable minimum

standard of mandated sex education. The maximization is even more troubling when considering

the distribution of a CSE framework, in which case educational content is scattered

inconsistently. For instance, only “17 states require program content to be medically accurate”

(Guttmacher Institute), which makes the evidence-based content of other states questionable.

Also, three states have made explicit rules to not promote religion, which may serve some

discrepancies with science-based teaching but may not be so open to the cultural and religious

context integrated in a comprehensive curriculum (Guttmacher Institute).

Second, it is not equitable, as level of access varies on a broad spectrum of factors such

as the state the student lives in, the resources of the school a student is enrolled in, the

socio-economic factors of their community, and even the student’s personal or cultural identity. I

have provided examples from the Guttmacher Institute for how maximization is impacted by
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uneven mandates and curriculum, and this continues to be an issue for equitable access and

quality of information as well. For example, abstinence has been an important informatic in sex

education as the only fool-proof method to prevent sexually transmitted diseases and pregnancy.

But while 39 states “require provision of information on abstinence”- also the total number of

states that offer sex education and/or at least HIV education - the extent and nuance of

information on abstinence is inequitable (Guttmacher Institute). “29 states require that abstinence

be stressed” while “10 states and DC require that abstinence be covered,” according to the Sex

and HIV Education report, and the implications of “stressed” and “covered” can be further

interpereted to various standards depending on the district or educator.

There is individual access available these days, even for those who live in regions where

sex education is not mandatory in their schools. Amaze is a non-profit organization that

particularly focuses on acessability for sex education independently online, with workbooks on

their website for parents and educators, and a YouTube channel for students K-12 to engage in

sex education topics (Amaze.org). However, the availability of these independent resources

depends on technological access, which can be a barrier if a student doesn’t have internet access

outside of school.

Even the identity of race, gender, or culture plays a role in how information on sexual

health is distributed to individuals. Human Rights specialist Meghan Campbell at Oxford

University in ​The Challenges of Girls’ Rights to Education​ identifies global examples of women

being subjected to conformity with harmful “traditional gender roles” by means of misinformed

sex education (Campbell 1222). Furthermore, misinformation for women in cultures and

communities where their sexual needs and health are not highly regarded “makes it less likely

that they will use contraception, which in turn increases their risks of STIs and pregnancy.”

(Campbell 1222). Educational bias against gender, or homosexuality or people of color, will be

detrimental to a student’s quality of health and also cause harm against their well-being.
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Third, distribution of sexual health information does not prioritize those in greatest need,

that is economically disparaged and marginalized groups, who are often more vulnerable to

health risks. Dr. Laura Duberstein Lindberg of the Guttmacher Institute observed in a 2015

report of the National Survey of Family Growth that “declines in formal sex education [occurs]

among teens residing in nonmetropolitan areas, encompassing both genders and many topics of

instruction” (Lindberg 625). Educators already have intense guidelines for curriculum, and if

there is an economically deprived area where one school nurse or health instructor is shared

between multiple institutions, because other areas important for college admissions take

precedent, then even state-accessible information is buried under many obstacles outside of a

student’s control. Lindberg further explained in her report observations that low quality

education, including a lack of sex education, in economically disparaged areas means that poor

teens experience “lower school quality and less access to health services, and to have higher rates

of STDs, teen childbearing, and early onset of sexual activity” (Lindberg 626). It can be one

thing to further educate with improved academic resources, but basic sex education won’t have

an immediate impact on the cost of contraceptives, or requiring access to a health professional

for STI testing and natal care, without the context of the community’s available resources.

Fourth and finally, distribution is not sufficient, since a minimum standard is not

equitably set for sex education on a national scope, especially considering that the United

Nations Declaraion of Human Rights should serve as a minimum standard for CSE. Topics of

health, relationships, and identity are addressed in CSE that pertain to the United Nations

Declaration of Human Rights. The United Nations Education, Scientific, and Cultural

Organization (UNESCO) published a revised edition of the ​International Technical Guidence on

Sexuality Education: An Evidence Based Approach​ in 2018, which presents the reasons for a

human rights approach to sex education as a “right to the highest attainable standard of health,

including safe, responsible and respectful sexual choices free of coercion and violence, as well as
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their right to access the information that young people need for effective self-care” (UNESCO

16).

Many human rights articles directly and fundamentally support an equitable distribution

of CSE in the United States. Protection of marriage and families in Article 16 is a core informatic

of CSE, to encourage healthy relationships and knowledge for family planning. Of course,

Article 16 in enforcing a standard of health, also includes sexual health in CSE; such as

knowledge of contraceptives to protect from sexually transmitted infections, and safety resources

to assist in reporting instances of rape and abuse. Then there is Article 26, the right to education

itself. Sexual health is part of human development, and requires a comprehensive curriculum,

willing educators, and students participating within a tolerant space, in which a right to education

includes “understanding, tolerance, and friendship.” Sex education promotes these values: being

able to understand the experiences and perspectives of varying social groups, to tolerate other

people whose sexual orientation or identity may differ from one’s own, and to make meaningful

social connections with other people intimately while being safe. Furthermore, Article 29 which

protects freedom of development, should also protect sex education, since CSE topics such as

orientation and identity will help further develop one’s personality and sense of being, as well as

develop their choice to engage in safe sexual activity. It should be mentioned that empowerment

of identity and expression is important according to Articles 18 and 19, and will continue to be

supported by CSE with information on topics such as expressions of sexual and romantic

pleasure, sexual orientation, and gender identity.

IV. Proposed Solution

Before going forward with distribution itself, a unified framework and curriculum must

be evaluated and chosen as a united standard. Having a framework and curriculum formally

acknowledged as a national standard by the U.S. Department of Education will increase the
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quality of comprehensive sex education standards that would be accessable to every state. My

proposed document to be considered is the National Sexuality Education Standards: Core

Content and Skills, K-12 (Second Edition) (NSES) a publication of FoSA that was very recently

updated in March 2020. FoSA is a non-profit organization coalition, whose mission is to create a

national dialogue and to promote CSE in public schools. The NSES resources provide a

comprehensive curriculum approach to sex education, and states its purpose as “To provide

clear, consistent, and straightforward guidance on the essential, minimum, core content and skills

needed for sex education that is age-appropriate for students in grades K–12 to be effective”

(FoSA 7). The structure of the document is not only a conceptual framework, but a very clearly

framed instructions to creating a comprehensive curriculum. Sufficient requirements are outlined

at every grade level, and FoSA also provides educators with a guide on​ National Teacher

Standards for Sexuality Education​ with a curriculum glossary to accompany the Second Edition

NSES. The framework for NSES is also comprehensive in its consideration of human rights and

socio-cultural context, as they state “The goal of sex education is to help young people navigate

sexual development and grow into sexually healthy adults. To be effective, sex education must

include medically accurate information about a broad range of topics” (FoSA 6).

The UNESCO technical guide will also be an essential document to inform CSE in the

United States, as it is directly structured with the United Nations Standards of Human Rights

within a CSE and evidence-based framework. UNESCO’s guide offers a sex education program

“informed by evidence, adapted to the local context, and logically designed to measure and

address factors such as beliefs, values, attitudes, and skills” that relate to and inform sexually

health and well-being (UNESCO 12). Evidence-based education will be nationally mandatory as

well, as CSE equally considers the comprehensive inclusion of both scientific fact and cultural

context.
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The United States Department of Education would take responsibility to distribute the

national standard, to be reviewed by state legislation and state education departments. With

formal national acknowledgement, more states would be likely to adopt a CSE program. In 2011

under the Obama Presidency, the “Repelling Ineffective and Incomplete Abstinence-Only

Program Funding Act” was put into place, in which “all funded programs must be

evidence-based, medically accurate, and age-appropriate, but they do not have to be

comprehensive’ (Lamb 448). However, this only applied to states who already have adopted a

sex education program, and is not a national mandate. To continue to make progress in this

direction will require invigorated state representatives and educators to gather and lobby. These

representatives, alongside non-profit organizations on behalf of CSE, who wish to progress

national standards would rally to propose a national mandate to federal powers in the House and

Senate. With continuing efforts to construct a bill with state politicians, educators, and non-profit

representatives, the U.S. Department of Education would mandate that Comprehensive Sex

Education be included in all curriculums across the fifty states, if only according to the logic of

public health and safety as informed by human rights. When it comes to national standards, the

U.S. Department of Education states in its mission an obligation to “Supplement and

complement the efforts of states, the local school systems and other instrumentalities of the

states, the private sector, public and private nonprofit educational research institutions,

community-based organizations, parents, and students to improve the quality of education”

(ed.gov). It is then a vested interest of the national authority on education to propose the highest

quality of education possible, including the quality of comprehensive sex education programs.

Though sex education cannot be further implementted in private insitutions by curriculum

policy, sex education can be mandated by addressing state’s regulations for private institutions in

health regulations. According to the U.S. Department of Education’s publication of State

Regulations of Private Schools from 2009, every state addresses the health requirements of
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private education institutions. Since sex education is a concern of health and well-being,

according to human rights and comprehensive informed frameworks, it could very well be

mandated directly into these health policies within the states.

Once a national standard is unified and agreed upon, an additional step to ensuring equal

distribution of materials and resources would be addressing socio-economic inequalities.

Financial support for sex education could utilize existing organizations and coalitions - such as

UNESCO, FoSE, and Amaze - to raise funds for sex education programs, as many of them are

already gathering resources for distribution outside of schools. Then, with the funds and grants

collected, the departments of education within each state could evaluate the number of

communities with greatest economic disparities for health programs in education. NSES

acknowledges that “Curriculum planners should implement existing or develop new curricula

based on local health needs. It is up to curriculum developers, administrators, and educators to

ensure all students have the opportunity to learn and meet the same high standards” (FoSE 10),

and so it would be a collaborative effort with local educators to propose a program for which

resources would provide the most positive impact. Distribution of economic support would then

be implemeted to the communities in greatest deprivation of education standards for sex

education, in which mprovement on quality of CSE will improve with the hiring and training of

qualified professionals, and providing workbooks and technology to students for improved

engagement.

V. Conclusion

Standards for sex education both nationally and internationally are, as I call it, a floor and

not a cieling. There are minimum requirements for what must be addressed - puberty and

contraceptives, for instance. The intent of implementing CSE as a national standard of education
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will bring the floor up to a more equitable plane, for people to access a sufficient distribution of

information on sexual health and relationships.

But very few explicit boundaries to ensure fair framing and contextualizing of

information - such as the “immorality” of abortion, “superiority” of male physicality, or the

concept of “virginity” - and generally othering doctrines that can be harmful to academic,

personal, and sexual development. There are also issues of representation of LGBTQ and

cultural identities in current sex education programs, as well as how accessibilty of sex education

directly affects an individual’s capacity to safely engage socially. Education on sexual health and

well-being is lacking a nuanced discussion on certain “othered” LGBTQ and identity groups. For

instance - the persisting assumed ethics of monogomy over polyamory; a lack of insight

regarding gender-dysphoria; also including asexuality and abstinance as normal and acceptable,

and not just required for health or safety. Having a national standardized CSE will continue to

improve on cultural and identity contexts that inform sexual health and relationship dynamics.
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