Utah's sex education controversy: Is it relevant today?

Utah's policy of abstinence only sex education is a contentious issue. Some worry that, if not taught in school, young people will not obtain accurate information on sex, contraceptives, and Sexually Transmitted Infections (STIs). Others fear that teaching safe sex will encourage adolescent sexual activity, breaking norms of society. Currently, Utah sex education excludes discussion of contraceptive use, homosexuality, and sex outside of marriage. However, with today's culture of communication and information accessibility providing information on all matters including sexual health, is policy concerning the specifics of sex education curriculum even a relevant concern? Through qualitative, open-ended interviews, this project looks at how young people in Utah learn about sexual health, from whom they learn, and how accurate and complete the information they gain is. The 40 interview participants were Utah High School graduates, ages 18 to 27, equally representing both sexes. Interview responses were noted by hand, and answers were coded for quantitative analysis reflecting the overall perspective of participants. The majority of participants felt their formal sex education had been largely unhelpful, with courses focusing mostly on anatomy, STIs, and abstinence and fidelity. Outside of classes, participants reported getting the most information from parents, friends, and the Internet. Parents were recalled as mostly discussing health information, condom/contraception use, and maturation; friends talked about health information, relationships, and sex; and most participants mentioned looking up health information and terms on-line. All participants reported gaining the majority of their information from outside sources, but varied in what information they got from which sources, the breadth and depth of information, and their ease of finding accurate information. This project has greater implications concerning what is taught in Utah sex education classes. Sex education classes could be utilized to foster positive discourse surrounding sexual health, to encourage student questions, and to teach students research methods and provide them with resources for answering future questions. The information from this study may help educators to structure sex education courses in such a way as to fill students' gaps in knowledge and engage students in discussions that are appropriate and relevant for today's changing society.

UTAH’S SEX EDUCATION CONTROVERSY: IS IT RELEVANT TODAY? By Alexandra D. Butler A Senior Honors Thesis Submitted to the Faculty of The University of Utah In Partial Fulfillment of the Requirements for the Honors Degree in Bachelor of Science In Anthropology Approved: ____________________ Polly Wiessner Supervisor ____________________ Leslie Knapp Chair, Department of Anthropology ____________________ Faculty Honors Advisor Name Department Honors Advisor ____________________ Dr. Sylvia D. Torti Dean, Honors College May 2015 ABSTRACT Utah’s policy of abstinence only sex education is a contentious issue. Some worry that, if not taught in school, young people will not obtain accurate information on sex, contraceptives, and Sexually Transmitted Infections (STIs). Others fear that teaching safe sex will encourage adolescent sexual activity, breaking norms of society. Currently, Utah sex education excludes discussion of contraceptive use, homosexuality, and sex outside of marriage. However, with today’s culture of communication and information accessibility providing information on all matters including sexual health, is policy concerning the specifics of sex education curriculum even a relevant concern? Through qualitative, open-ended interviews, this project looks at how young people in Utah learn about sexual health, from whom they learn, and how accurate and complete the information they gain is. The 40 interview participants were Utah High School graduates, ages 18 to 27, equally representing both sexes. Interview responses were noted by hand, and answers were coded for quantitative analysis reflecting the overall perspective of participants. The majority of participants felt their formal sex education had been largely unhelpful, with courses focusing mostly on anatomy, STIs, and abstinence and fidelity. Outside of classes, participants reported getting the most information from parents, friends, and the Internet. Parents were recalled as mostly discussing health information, condom/contraception use, and maturation; friends talked about health information, relationships, and sex; and most participants mentioned looking up health information and terms on-line. All participants reported gaining the majority of their information from ii outside sources, but varied in what information they got from which sources, the breadth and depth of information, and their ease of finding accurate information. This project has greater implications concerning what is taught in Utah sex education classes. Sex education classes could be utilized to foster positive discourse surrounding sexual health, to encourage student questions, and to teach students research methods and provide them with resources for answering future questions. The information from this study may help educators to structure sex education courses in such a way as to fill students’ gaps in knowledge and engage students in discussions that are appropriate and relevant for today’s changing society. iii TABLE OF CONTENTS ABSTRACT ii INTRODUCTION 1 METHODS 4 RESULTS 7 DISCUSSION 12 REFERENCES 17 iv 1 INTRODUCTION Sex education, the organized teaching of matters concerning sex and reproductive health, has been a topic of public concern since the early 1900s. In 1912, the National Education Association issued a recommendation that teachers be trained to provide students with information concerning sexuality and sexual health (Huber, 2009). By 1940, sex education had become a national concern; the US Public Health Service issued a statement in support of the importance of sex education in schools (History of sex education, 2014). Borne largely out of the fear of STIs spreading among soldiers returning from war, the concern for sexual health became a public health topic. The advent of the birth control pill in the 1960s added to the conversation surrounding sexual health and brought new controversy over what should be taught in schools (Huber, 2009). Most recently, the 1980s brought rapid change to the conversation surrounding sex education as the spread of HIV and AIDS became a national concern (Huber, 2009). In 1986, US Surgeon General Koop issued a report that called for sex education, including HIV prevention and condom use, in all US public schools beginning at an elementary level (Huber, 2009). This was a significant shift from the hushed conversations of the 1800s encouraging strict adherence to the puritan values of chastity, purity, and manhood. Sex and sexual health had transitioned from a private moral concern to a public health issue. As sexual health developed into more of a public issue, sex education programs became more commonplace. By 1988, over 90% of US schools provided their students with sex education in some form as part of the curriculum (History of Sex Education, 2014). Today, 22 states have mandated sex education as part of school curriculum, 33 2 have mandated HIV education, and 17 states require that discussion of contraception be included when sex education courses are offered (Hamilton, 2013). Utah code mandates sex education, including HIV education, although parental consent is required for any student participating in the class (Utah, 2000). Contraception is not a mandated part of sex education. To the contrary, these courses are required to stress abstinence and the importance of sex only within the confines of marriage and include lessons to develop skills for avoiding coercion, for healthy decision-making, and for family communication (Hamilton, 2013). In addition, Utah code strictly prohibits the teaching of: 1) The intricacies of intercourse, sexual stimulation, or erotic behavior; 2) The advocacy of homosexuality; 3) The advocacy or encouragement of the use of contraceptive methods or devices; or 4) The advocacy of sexual activity outside of marriage. (Utah, 2000) Classes cover reproductive anatomy and focus on teaching abstinence and skills for maintaining student chastity until marriage. This often takes the form of lessons and role-playing focusing on communication, decision-making, and resisting peer pressure. The importance of abstinence is often emphasized through discussions of the value of purity and the use of analogies. One such analogy relates a young woman’s virginity to a piece of gum, the core message being that a girl loosing her virginity is akin to a piece of gum being chewed; no one wants to eat gum that someone else has already chewed (Siddique, 2013). Such messages have raised alarm as being overly negative and having 3 damaging consequences on young women’s self-value, especially for victims of sexual assault or rape (Siddique, 2013). Although sex education is now an accepted national public topic and important part of public health, it is still a controversial issue. The main conversation currently concerns which program works best: abstinence only or comprehensive sex education. Supporters of abstinence only programs, such as those promoted in Utah, worry that teaching students about contraception will make them more likely to have pre-marital sex and encourage promiscuity, abortion, and homosexuality. Beyond that, there is worry that increases in sexually active teenagers will cause increases in teen pregnancy and STI rates and weaken traditional family values. Advocates for comprehensive sex education argue that students are unlikely to abstain from pre-marital sex, and that teaching them about contraception gives them the knowledge to prevent STI transmission and unwanted pregnancy. Numerous studies have also shown that teaching students about contraception does not lower the age of, or increase, student sexual activity (Reppucci & Herman, 1991). Advocates further claim that comprehensive sex education, in partnership with parents, helps students gain the knowledge and personal and interpersonal skills to talk about, and make their own decisions with regards to, sexual activity (Knowles, 2012). While this has been a conversation since sex education first started to become institutionalized, its relevancy in today’s world may be in question. On average, an individual in the US receives approximately 38 sexual media messages a day (Education, 2001). Students have access to information from the Internet, TV, magazines, pop culture, friends, parents, community leaders, and myriad other sources. In light of today’s ease of information access, is the debate over sex education even relevant? If young 4 people are procuring accurate information on sex, contraceptives, and STIs from outside sources, then what are they getting out of formal sex education in school? Through a series of qualitative interviews with young adults from Utah, this study aims to gain insight into these questions and address the role of formal sex education courses in modern society. Knowing where young people are getting their information can be a powerful tool, and has further implications for what is taught in sex education courses. This can allow educators to fill the gaps in students’ knowledge, and help students to develop an individualized, holistic, mature, healthy knowledge of sex, STIs, contraception, and relationships. Sex education curriculum may benefit by becoming more responsive to the current culture of information accessibility. This study looks at whether the current system of sex education is appropriate for the issues of today and, as the cultural environment changes, whether it would be most beneficial to students, and therefore public health, for the system of sex education to be able to respond to such changes. This would allow formal sex education programming to remain relevant and to have a positive influence on students’ sexual health. METHODS Research was conducted in the form of a series of standardized, open-ended interviews. On average, interview duration was approximately 20 minutes. Approval was obtained through the University of Utah Institutional Review Board, and all participants gave informed consent. 40 young adults (20 male and 20 female), ages 18 to 27, were interviewed. All participants attended high school in Utah. While Utah education code, 5 including that regarding sex education, only applies to schools receiving state funding (i.e. public and charter schools), participants included students from both public and private high schools. Participants were recruited through the use of a flyer, which was distributed via e-mail and in person. Primary avenues for recruitment included University of Utah classes, the University of Utah LGBT Resource Center, the University of Utah Women’s Resource Center, the University of Utah Honors College, and the University of Utah Anthropology Department. Qualitative, open-ended interviews allowed for a more open format than a quantitative survey and for participants to speak to what they felt was most important regarding their personal experience. Thus participants, rather than the interviewer, were able to prioritize within the context of the interview. All interviews were conducted in person. Participants were asked to answer questions to the best of their ability but were informed that, if they did not wish to answer a given question, they could decline to do so without needing to provide justification or being removed from the study. Initial questions were asked to confirm participant’s eligibility and establish sample statistics before proceeding to the interview portion. The following questions were asked, and the interviewer noted answers by hand. 1. Do you identify as male, female, or other? 2. What are your parent’s occupations? 3. Where did you attend high school? 4. What year did you graduate? 5. Do you recall participating in a sex education portion of your high school health class? 6 * * * 6. What was your opinion of your formal sex education? Did you feel your sexual-education was helpful and constructive? 7. What did you take away from your sex education in high school? Was there anything covered that you didn’t already know? What do you recall learning about contraceptives and STIs? 8. What information concerning contraceptives or STIs have you learned from external sources and where did you learn it? Ex: friends, family, doctor, Internet, etc. What other information concerning sex and/or relationships did you learn from these sources? Do you feel that you got reliable information from these sources? 9. Do you feel there are things you don’t know or understand concerning sex that you would like to know? Where would you go to get reliable information and answers? At the conclusion of the interview, participants were thanked for their time and given information to contact the primary researcher if they had any follow-up information that they wished to add. Upon completion, interview answers were compiled and grouped according to common themes or ideas expressed by participants. Different answers for each question were numbered and grouped into relevant categories. This coding scheme allowed for compilation of quantitative results reflecting the overall perspectives expressed by interview participants, broken down according to gender. Coded data were compiled into tables. 7 RESULTS The majority of participants found their formal sex education to be largely unhelpful (Table 1). Students found their sex education to be ‘not very specific or in depth’, ‘uninformative’, and that it ‘did not account for students who were already sexually active, or intended to become sexually active.’ Table 1 Participant’s opinions of their sex education courses. A few students recalled glaring gaps in their knowledge of basic anatomy due to incomplete or vague information being presented in class. One female student recalled her misconception of testicles residing inside the pelvis in adult men, similar to ovaries in a woman. Another participant recalled peers asking her for clarification on whether women had separate urinary and reproductive tracts, not understanding the separate but proximal relationship of the vagina and urethra. Students mainly recalled courses focusing on STIs, reproductive anatomy, abstinence and fidelity, and condoms (Table 2). Of those whose classes included discussion or mention of condoms, many did not recall any discussion of proper use or advocacy for condom usage. In most cases, classes that did cover condoms or contraception still taught abstinence and fidelity in marriage as the most effective methods of preventing STIs and unplanned pregnancy. These courses tended to 8 emphasize failure rates of condoms and contraception, or the inability of many forms of contraception to protect against STIs. Some participants recalled their teacher telling the class that they were not allowed to cover contraception or condoms, but that they encouraged students to look up information outside of class and educate themselves. A few recalled teachers openly breaking with the Utah code or with school policies against teaching contraception. Table 2 Topics covered in sex education courses, as recalled by participants. Outside of formal sex education courses, the most common sources for information on sexual health were the Internet, friends, parents, media, and other family members including siblings, cousins, and grandparents (Table 3). The most common information participants sought out online was sexual health information and terminology. The majority of individuals recalled looking up information to answer their own questions and curiosities, or to gain clarification on things they had stumbled across through media outlets or among their peers. The Internet was often viewed as a comfortable resource in its anonymity, but questionable in its reliability. Some 9 participants specifically limited themselves to academic and health related sites, avoiding forum based information, while others vetted reliability and accuracy of information based mostly on what ‘seemed reasonable’ and ‘fit with what [they] already knew.’ Table 3 Main information sources, outside of formal sex education, as recalled by participants. Friends were mentioned mostly as discussing health information, sex, and relationships, with most conversations being casual discussions of individual experiences and shared concerns or questions. Many recalled feeling more comfortable talking to peers than to teachers, parents, or other adult authority figures. Most often, parents were recalled as having talked with participants about sexual health information, condoms or contraception, and maturation. Participants varied greatly in their level of comfort in talking with their parents and the amount of information they received from them. For many, the amount of information they received from their parents was determined by their own curiosity and willingness to go to their parents with questions. The most common responses as to where participants would go for information or assistance today were the Internet, family, and health care providers including primary 10 physicians, gynecologists, and Planned Parenthood clinics (Table 4). Most participants expressed feeling much more capable of finding information and resources currently, as young adults, than they did as teenagers. Table 4 Resources participants would use today for help or information regarding sexual health. The sample size for this study is too small to determine any significant statistical difference between genders’ responses. However, observed response differences do present intriguing hypothesis and could be studied in future ventures. Overall, most of the responses were similar for male and female participants. However, there were notable discrepancies in some areas. Regarding class instruction, more male participants recalled information on condoms being mentioned. Other differences were seen in participant responses concerning what information they got from outside sources. Female participants were more likely to report receiving information on sexual health and maturation from parents and friends. However, this did not fully negate the possibility of their being misinformed or having gaps in knowledge, as previously mentioned. Male participants were more likely to report talking with family members, other than their parents, about condoms or contraception and sexual practices. Regarding what sources they would utilize today, 11 both genders’ primary resource was the Internet, but female participants were much more likely to talk with their families. Predictably, most female participants expressed getting more information and feeling more comfortable talking about sexual health with their mothers or other female relatives, and male participants with their fathers or male relatives. Previous investigations have found significant gendered differences in attitudes towards sex (Reppucci & Herman, 1991). Differences between male and female responses in this study may point to how differences in attitudes towards sex influence teens’ pursuit of outside information on sexual health. Gendered response differences could also be indicative of how attitudes towards sex are shaped by differences in how discussion of sexual health is approached with girls versus boys. The cumulative results of this study indicate that most students get the majority of their information on sex and sexual health outside of formal sex education courses. However, students vary in what information they obtain from which sources. While all students reported feeling informed and capable of getting information as young adults, many also stated that they had difficulties finding information, were uncomfortable seeking out information on their own or discussing sex with others, and had to learn to filter information from peers, media, and the Internet for reliability. As one participant articulated, “I should not feel more comfortable having sex with someone than I feel talking about sex with that person (… but I do).” Almost all reported dissatisfaction with their formal sex education and felt that it left much to be desired regarding information scope and specificity. The opinion that “we should teach kids to be safe and smart, not scared,” was echoed by many. 12 DISCUSSION The main goals of formal sex education are to reduce teenage pregnancies and contraction of STIs and to promote healthy decision-making, communication, and relationships. As shown in the Utah Department of Health’s Adolescent Reproductive Health Report, Utah’s teen pregnancy rate is significantly lower than the national rate and is decreasing (Sundwall, 2010). However, Utah’s rate of decrease is much lower than the national rate and, despite these decreases, the US and Utah both have significantly higher teen pregnancy rates than other comparable nations. In 2008, approximately 18% of pregnancies to teens in Utah were repeat pregnancies; this figure had changed little from the previous ten years. Of Utah teenage pregnancies in 2008, 58% of girls having abortions reported not having used any contraception in the past year. This is a marked increase from 1997, when 37% reported no contraception use. While STI rates in Utah are lower than the national average, they are still a prevalent issue. Chlamydia is the number one reported communicable disease in Utah, and gonorrhea is fourth (Sundwall, 2010). Of reported cases of chlamydia and gonorrhea in Utah, approximately 2/3 and 1/2 respectively are from individuals between the ages of 15 and 24. These issues of unplanned pregnancy and STIs are indicative of deficiencies in young adults’ accurate knowledge of contraception and consistent, proper condom use. Sexual health not only concerns physical health, as it relates to pregnancy and STIs, but also the health of relationships. From 2002 to 2010, nation wide incidents of assault and non-consensual sex involving dating partners increased 49% and 147% respectively (Sundwall, 2010). In Utah, 2007 data showed that boyfriends or ex- 13 boyfriends committed 15.7% of rapes and 17.8% of attempted rapes. This suggests a need for greater emphasis on education relating to healthy relationships, assault, and consent, especially for young men. The current system of sex education ignores the effects of cultural changes and outside sources of information. While its goals of decreasing teen pregnancy, reducing the spread of STIs, and promoting healthy relationships have remained consistent, the role of formal sex education has changed. Its assumed role, as the primary educational entity on sexuality and sexual health for youth reaching maturity, is clearly no longer the current case. With so many varied sources of information, sex education courses and parental values are reduced in their influence as gatekeepers of what information teens gain concerning sexuality, sex, and sexual health. The increase in information accessibility brought on by technological innovations has changed how people communicate and how they learn about important issues, including sexual health. Today’s sex education programming does not take this change into account and has failed to adapt. American youths, on average, spend over 38 hours a week using various forms of media including television, music, and the Internet (Education, 2001). Many of these media outlets include sexual references, resulting in the average American teen having viewed approximately 14,000 sexual references a year (Education, 2001). This means that many young people are getting much of their impression about sex from media sources. As we have seen, students get much, if not most, of their information on sexual health outside of the classroom setting. When information from peer groups, the Internet, and other community resources are added together, students are inundated with 14 information, which may or may not be complete and accurate in answering their questions. Formal sex education courses are no longer teens’ primary information source, but they do have the opportunity to retain relevancy. Currently, students are by and large dissatisfied with their formal sex education, but express trepidation and frustration with finding and vetting information from exterior sources. Modernizing sex education to account for changes in information accessibility could better prepare students to capably answer their own questions and identify resources beyond their sex education class. While there are many barriers, both practically and culturally, to restructuring sex education code, courses can easily be altered to address changes in information accessibility and to promote healthy, positive discourse. In the classroom setting, many different approaches can be taken to incorporate changes in the culture of information access. Restructured courses could focus on teaching young people how to use the available resources and to judge sources’ reliability and validity. Teachers could discuss research methods, including Internet safe-search practices and how to verify the reliability of information or of a source. Programs could also include information concerning resources available to teens and young adults including school health services, Planned Parenthood, and other community resources. Students could learn methods and techniques for talking to their doctor or partner about sex, sexuality, and sexual health. These topics would serve to open healthy discourse concerning sexual health, and to teach students how to approach whatever questions may arise outside of what is covered in class. 15 Aside from this, courses could also help by providing a safe environment for students to ask questions and discuss sexual health and cultural views of sex and sexuality. Many individual interview participants recalled a lack of participation and engagement of students in asking questions of their sex education teacher and a general fear and discomfort around asking questions and possibly seeming naive or deviant. While it is very difficult to get teenagers to talk openly about their questions and concerns regarding sex and sexual health, classes should make an effort to create an environment in which students feel safe and comfortable asking questions without fear of ridicule or retribution. This may be best achieved through the facilitation of an anonymous forum for students to pose questions without fear of judgment by their peers. Restructuring of sex education code would be required for classes to fully include comprehensive information on contraception and positive discussion of sexuality, gender identity, and gender expression. However, classes can and should include information and discussion on assault and consent, relationships and abuse, and sexism and harassment without necessitating any change to Utah code. Very few interview participants recalled any discussion of sexual assault or consent in their sex education courses. Of the participants who did recall discussion of sexual assault, some found that their class was focused on discussing ways for young women to avoid being assaulted and to discourage the advances of men, and omitted any discussion of young men honoring consent and respecting a woman’s rights to her body. These are important issues confronting society as a whole and could be greatly helped by including young people in the conversation. Sexual harassment and violence are pervasive issues, which most young people have encountered or will encounter at 16 some point in their lives. If classes can provide a positive environment for students to discuss these issues and how they relate to them, young people will be better able to consider and change the societal norms that perpetuate such issues. It is important to educate teens about these issues, not only to give them the resources for handling such situations, but also to foster attitudes that do not tolerate sexism and sexual violence. Such shifts in culture take time, and can be most effective if implemented with younger generations. Adjustments in sex education code and curriculum could greatly improve the impact of formal sex education on students. The role of school sex education programming has changed with the growing use of new information sources. Therefore, it must be altered to fit its new role in order to maintain relevancy and functionality. Students still have much to gain from formal sex education courses, but these classes must be restructured to take into account changes in culture and information accessibility. If sex education programming is able to employ a range of resources, students will achieve a holistic education that provides them with accurate information on sexuality and sexual health. Restructured sex education can prepare students to answer their own future questions, make their own decisions, and communicate positively and effectively regarding sex, sexuality, and sexual health. In adapting to changes in culture, sex education may retain its relevancy and grow in its role as an important part in a young person’s education. 17 REFERENCES Baksh, L., Bloebaum, L., McGarry, J., Carapezza, D., Galloway, K., Hossain, S., & Satterfield, R. (2007). Births from unintended pregnancies and contraceptive use in Utah. PRAMS perspectives. 2014, from http://health.utah.gov/mihp/pdf/UIP_BC.pdf CDC Fact Sheets. (2013). 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