Only a little more than one-third of U.S. states require sexual education taught in public schools to be medically accurate, a gap researchers warn could leave tens of millions of students without reliable information about sexual health.
Although 42 states require students to receive instruction covering at least one sexual education topic at some point between kindergarten and high school, just 19 states mandate that the information be evidence-based and aligned with medical consensus, according to a new analysis by the Boston University School of Public Health. Of those 19 states, five require medical accuracy only for specific topics, such as HIV/AIDS, sexually transmitted infections, unintended pregnancy, or unhealthy relationships.
“While many students in the U.S. are required to get some form of sexual education, substantially fewer are likely receiving the comprehensive, medically accurate education recommended by public health and medical organizations,” said Kimberly Nelson, an associate professor at the school.
According to data from the U.S. Census Bureau, more than 65 million students were enrolled in public schools in 2021. Nelson noted that only 58 percent of those students live in jurisdictions that require sex education to be medically accurate, and many state mandates apply to only a limited number of topics.
“As a result, many students are unlikely to receive accurate and comprehensive information that helps them make informed and healthy decisions about their sexual behavior and relationships,” she said.
There is no federal law requiring sexual education in U.S. schools, leaving curriculum decisions largely to states and local school districts.
Among the 42 states that mandate sex education, 34 require instruction on abstinence — an approach researchers say has repeatedly been shown to be ineffective or harmful to adolescent sexual health. The same number of states require education about HIV, while fewer mandate instruction on sexually transmitted infections (32 states), child abuse prevention (31 states), or healthy relationships and dating.
Only 24 states require education about sexual assault, despite federal health data showing that one in five American women has experienced completed or attempted rape during her lifetime. Nearly one in four men has experienced some form of contact sexual violence.
Instruction on contraception is required in just 20 states, while only nine mandate teaching about sexual consent. Education related to sexual orientation is required in only 12 states, with Oklahoma and Texas requiring messaging the researchers described as stigmatizing or negative.
The study also found regional differences in sex education mandates. All Northeastern states require instruction on at least one sex education topic, compared with 88 percent of Southern states, 83 percent of Midwestern states, and 62 percent of Western states.
Parental consent policies further limit student access. Researchers found that 34 states allow parents to opt their children out of sex education, while five states require parents to opt in before instruction is provided.
The findings were based on a review of state laws, administrative regulations, court decisions, curriculum requirements, and parental notification and consent policies.
While additional research is needed to measure the full impact of parental opt-out rules, the researchers warned that current policies may prevent many students from receiving essential sexual health information.
“Because decisions about sexual education curricula are made at the state level, state-level sociopolitical forces have a substantial influence on what students ultimately learn,” Nelson said.
