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No Sex in School!

By Chris Rangel MD ⋅ February 26, 2006 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

High school = Sex-free zone?
Our national debate on sex education.

(Via Fark). An Indiana public school superintendent has axed plans to publish an article about oral sex in the school paper of Nobelsville High. What? Huh? What is an article on Lewinskyism supposed to be doing in a public high school student newspaper in the first place?

Then again, why not? After all, a high school newspaper is for the students (or at least for the cliquish students to publish stories about themselves and pad their college applications). According to the CDC about half of high school age teens are sexually active ergo an article on fellatio should be of interest to at least 50% of high school students (actually about 100% in reality since nothing quite captures teenager’s attentions like sex).

So what’s all this about an article on oral sex not being appropriate for high schoolers when so many are already doing the deed? Our puritan sensibilities often lead to odd juxtapositions. Our society continues to remain in massive denial about teen sexual activity despite the numbers and the biological sexual maturity of teenagers. We continue to believe in and adhere to the idea that sexually naive childhood can and should continue until a definitive and arbitrary cut off point (i.e. 18 years old or high school graduation).

Don’t get me wrong. Avoidance of unintended pregnancy is a great and rational reason for delaying sexual activity until after high school but this is an historical aberration. Throughout history adolescent pregnancy has been the norm but beginning in the ladder half of the 19th century we decided that everyone should get an education and that marriage and reproduction should be delayed until afterwards. However, what this also led to was a concept of delayed adulthood and extended childhood. The societal taboo of childhood sexuality was extended well into adolescence as a moratorium on all things sexual despite the fact that this makes little sense from either a biological or societal perspective.

What we end up with is a morass of mixed messages to our teens. Rather than emphasize the importance of avoiding pregnancy and finishing their education our simplified puritanical cultural elements kicked in and this message became the avoidance of all things sexual at all costs! And why not? A complete moratorium on anything sexual in high school avoids a lot of awkward parent-child or teacher/councilor-student moments when the newly sexually mature and curious teen looks for answers and guidance from the adults in their lives. What they get is either avoidance, silence, or something like the following from the 1986 movie “Peggy Sue Got Married”;

“Peggy, you know what a penis is? Stay away from it!”

Oh and this strategy has worked so dam well! Despite similar rates of sexual activity, the effective use of contraceptives by American teenagers is much lower than teens in other industrialized nations and as such our teen pregnancy rates are much higher. And yet such failures have only spurred policy makers even further in the wrong direction as if convinced that they will ultimately find the fabled Shangri La of sex-free teenage existence.

Instead of just saying “no” as we did in the 1980’s (to sex and drugs), in the 90’s some asshats came up with the idea of abstinence only education and signed pledges of virginity until marriage (what I call the ostridge head in the sand or the “see no evil, hear no evil, do no evil” approach). The result; No change in pregnancy rates or attitudes towards sex and while virginity pledgers 12-18 years old delayed the start of sexual activity by an amazing 18 months and had fewer partners than teens who did not pledge there was no or little statistical difference in sexually transmitted diseases rates between the two groups.

What? How can that be? Well it turns out that not only were pledgers less likely to use condoms (especially at first coitis), they were also more likely to engage in oral or anal intercourse in the belief that this is not “sex”. Pledgers appear to be less likely to be educated about sex and have less access to contraception.

Despite these poor outcomes (and the fact that it appears to confirm that the stick your head in the sand approach is at the root of the problem) it was the “successes” of this data, i.e. delayed sexual activity and fewer partners, that conservative groups crowed about. The message from these groups is that it is adolescent or premarital sexual activity that is bad rather than the consequences of adolescent pregnancy, STD transmission, and harm to educational opportunity and career advancement. So it’s the premarital sex act itself and not necessarily the consequences that concern conservatives. No wonder American teenagers are confused.

And yet ironically abstinence has played a role over the last several decades. The teenage pregnancy rate has declined gradually since a high in the 1950s (believe it or not) along with a similar decline in abortion rates in teenagers. The recent declines started in the late 1980s and early 90s and coincides with a decline in teenage sexual activity in this same time period. According to the Guttmacher Institute increased abstinence among teens accounted for about one-forth of the decline in the teen pregnancy rate from 1988 to 1995.

However, the frequency of sexual activity among sexual active teens appears to have increased slightly from 1988-95. What is to account for the rest of the decline in teen pregnancy rates? While the percentage of teens using a form of contraception at first coitis increased 65-75% (from an increased use of condoms at first coitis of 15%), overall compliance with contraception use continues to be suboptimal (about 78-83% where optimal is as close to 100% as possible).

It appears that while condom use has remained about constant more teens adopted the use of longer acting hormonal contraceptive methods like Depo Provera injection and this has contributed to a 9% decline in the teen pregnancy rate. Yet it is the overall inconsistent use of contraceptives (particularly condom use) that continues to keep the rate of teenage pregnancy in this country much higher than other industrialized nations despite similar rates of sexual activity and hormonal contraceptive use.

But how do we account for the decline in sexual activity? Does teaching teens abstinence and isolating them from the reality of their existence as sexual beings (or ignoring such reality) really work? Unlikely. Abstinence only programs and virginity pledges do not appear to be effective enough nor nearly wide spread enough to have influenced the activity of millions of teens and most of these programs became trendy only after the decline in teen sexual activity had started.

Moreover, sexual activity and teen pregnancy rates are significantly tied to socioeconomic status. In this country both of these rates are higher in black and Hispanic teens who tend to more disadvantaged*. There are many reasons for this trend but probably a big contributor is that the perceived negative consequences of pregnancy are less for a teen who is disadvantaged. I.e. they believe they have less to lose from early pregnancy and this contributes to a callous and more reckless attitude towards sexual activity. It is possible that the prolonged economic growth of the 1990s (including reductions in unemployment) contributed significantly to the decreased rates of both of these rates though direct causative evidence is lacking.

What is clear is that this decline in teen sexual activity and pregnancy occurred during a time of unprecedented expansion in modalities of mass media including cable and satellite television, digitally recorded media (DVDs, CDs, digital cameras), and most importantly, the Internet (or the “Internets” if you are a republican). All of these modalities allow teenagers to be exposed to more sexually explicit material (much of it very graphic) than ever before and yet national trends continue to conflict with commonly held delusions about sex in media increasing teen sexual activity. A 0.16 second Google search for “fellatio” yields 4.5 million web pages on this topic and yet an article about oral sex from a human health/sexuality from a non-pornographic perspective is not allowed in a high school newspaper. Hear no evil, see no evil, read no evil?

This belief in the myth of the asexual adolescent and the inherent badness of teenage sex is so ingrained in our culture that it continues to influence policy decisions that go counter to the evidence. Bush II has continued to push for funding for abstinence only public education programs despite the lack of evidence for effectiveness (apparently being a born-again Christian also means believing that you are permanently stuck in the year 1955).

What works? As bad as abstinence only education is, pure sex education is not much better. What appears to work is more comprehensive programs that include not only information on reducing risky behavior but also information on communication skills, obtaining contraception and protection, the values of delaying sexual initiation and pregnancy, and taking pride and a sense of empowerment in making decisions on personal sexual behavior. Just as important is data that suggests that providing contraceptives to students via high school health clinics improves compliance without increasing sexual activity (sexual activity among teens has never been proven to be connected to the level of their access to contraceptives - another myth). However, only a minority of high school student health clinics provide access to contraceptives and those that do have not been proven to be responsible for any decrease in STD or pregnancy rates. Less studied is the option of providing long-term hormonal contraceptives at school clinics on pregnancy rates (although this may increase STD risk).

Why we continue to treat our public high schools as sex-free zones to the extreme of censoring student publications when half of its students are sexually active is beyond me. This squeamishness about intentionally exposing teenagers to anything sexual is just another symptom of how the majority of our school administrators, teachers, councilors, parents, and even students (many of who adopt the same avoidance of sexual discussion that their parents display) are reality challenged. Regression to a 1950s style of abstinence only education is simply another way of increasing our common avoidance of the issue of teenage sexuality. Until we wake up and stop being so dammed puritanical we are never going to be able to deal with this effectively.

Perhaps a little clarification would be useful. Now repeat after me;

• Sex itself is not bad and it is part of being human.
• Risky sexual activity is bad because it has consequences.
• Education is good.
• Abstinence is also good and never wrong.
• Taking responsibility and being empowered in your decisions about your sexual behavior is always good!

If we can just agree to start with these basic principles then maybe we can start to raise generations of educated, mature, informed, and sexually responsible young adults rather than pretending that teenagers are just children with bigger clothing sizes.

*A disadvantaged teen = “Living in poverty; being poorly educated; having poorly educated parents; being raised in a single-parent family or in an economically struggling neighborhood; and lacking educational and job opportunities.”