The Importance of Evidence-Based Practice in Sex Education

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By Tori Culler, senior Social Work student at Appalachian State University

You may have heard it once or twice: the United States has one of the highest teen pregnancy rates among the developed nations. And you may not be surprised to learn that young people in the United States account for half of all new STD diagnoses each year – despite the fact that they only account for a quarter of the sexually active population.

The impacts of teen pregnancy and STD transmission among youth are far reaching. Poor outcomes in education, income, and overall health for teen parents and their children are just a few of the consequences. What’s more is that social stigmas associated with teen pregnancy and STDs make it hard for young people to overcome these obstacles, while annual costs to the public remain in the billions.

The intuitive solution to a problem of this scope is to examine and fundamentally reform the nation’s approach to school-based sex education, right? It’s not a new idea; one that has, in fact, sparked a heated debate in the United States for decades.

At its most basic level, the debate has centered on the division between abstinence-only and comprehensive sex education. Abstinence-only advocates promote a sex education curriculum that presents refraining from all sexual activity outside of marriage as the only effective way to prevent unwanted pregnancy and STDs. Comprehensive advocates promote a curriculum that presents multiple strategies beyond abstinence, such as proper contraceptive use. Both sides cling to their convictions, convinced that their way is the best way and should inform social policy.

While values and morals certainly have their place in political discourse, should the impetus for action not be more strongly grounded in logic and evidence?

Evidence-based practice is an ethical precept for nearly every profession, and it holds a particular importance within any human-services field – such as public health education. The concept is simple: constantly drawing upon an ever expanding database of knowledge, future procedures/programs/interventions should use only the elements that have been proven to work. Such a framework sets the stage for constant revision and improvement of services, recognizing that when something is broken, it should be fixed. For any issue, utilizing what works is the only way to garner the desired results.

When it comes to sex education, a large body of research exists on both abstinence-only and comprehensive programs. Trends in the research indicate that abstinence-only (AO) sex education does not work. Students who receive AO education are no more likely to remain abstinent than their peers who do not receive an AO education, with some studies indicating that they are also less likely to use contraception when they do have sex. The research favors comprehensive curricula, which leads to consistent contraceptive use and results in fewer teen pregnancies. Neither type of program has resulted in significantly improved STD transmission rates, indicating that there is still great room for improvement within sex education as a whole.

Despite the evidence, the United States government has a long history of funding abstinence-only education. Federal dollars were first allocated to AO education under the Reagan administration in 1981 and funding continues today under the Affordable Care Act. Between 1996 and 2010 alone, over $1.5 billion tax dollars were funneled into ineffective abstinence-only education.

The U.S. didn’t allocate federal funding streams for comprehensive education until the implementation of Obama’s Teen Pregnancy Prevention Initiative in 2010. This initiative provides grants to comprehensive sex education programs, emphasizing the importance of evidence-based practice and consistent, rigorous evaluation of such programs. While this is certainly a step in the right direction, the initiative is not widespread enough to nullify the continued funding of abstinence-only programs.

The evidence is clear: abstinence-only sex education does not improve the issue it was designed to address. Further, public opinion polls indicate that the vast majority of American citizens across a wide array of demographics support comprehensive sex education. Regardless of religious or political affiliation, more than 8 in 10 parents believe that comprehensive sex education is the way to go. It would therefore seem that the continued federal support for AO education is unjustifiable from every angle. Why, then, is it still supported?

The answer lies in political rhetoric and strategy that places control over sex education curricula in the hands of a vocal and extreme conservative minority. At the legislative level, it is this powerful minority who desire to see a strict, uniform abstinence-only-until-marriage policy that aligns with their personal value system that continue to prevail at the expense of young-people nationwide.

There must be an appeal to reason here: we cannot continue to use a strategy we know doesn’t work and expect different results. Personal values and philosophies should not distract from the goal at hand, which is to provide a healthy future for the coming generations. This should serve as a call to action for advocates who understand that sex education policy should rely on evidence-based principles in order to achieve reproductive justice for the nation’s youth. Those who are passionate about seeing positive and effective change in the arena of sex education must realize their potential for working across political differences to become a force for change.


This post is part of NARAL Pro-Choice North Carolina’s Student Perspectives on Reproductive Justice blog series. To write a post for the series, please contact our Advocacy & Organizing Manager at


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