Time to Revamp Sex Education in Texas!

Our teenagers face some unique challenges that few young people have faced in the generations before them. As they go through the usual hum-drum of physical and psychological changes, they also face changing family and gender norms, a disconcerting amount of violence, increasing rates of mental health disorders, suicide attempts, and drug use among their peers. With this backdrop of stressors that today’s cyber world brings, our children bravely work through the complexities of entering relationships, understanding sexuality, accepting different gender identities, and the myriad of sexually transmitted infections(STIs) and contraceptive options out there. It’s a lot to put on their shoulders.

Unfortunately, the way things stand in Texas, our state government ignores this tough reality for our children. Instead our laws shortchange them by not giving them the tools to navigate through this nuanced, complicated picture of reproductive health. Per Texas sex education laws, the only mandate is an emphasis on abstinence until marriage.¹This simply does not align with the reality that 95% of us are already sexually active before marriage. On average, our adolescents start having sex at 17 but don’t get married until their mid to late 20s.² Also, this is not just about the birds and bees anymore. Our state has no mandate for education on STIs, contraception, maintaining boundaries of mutual respect, changing gender, sexual or social norms, or any of the other intricacies of today’s Me-Too world. Because of this, sadly 58% of Texas schools still teach an abstinence-only curriculum. Only 17% of schools have some sort of curriculum beyond this. And the number of schools offering no sex education at all is alarmingly at 25%! ³

Texas’ sex education policy just doesn’t work and the proof is in the numbers. Young Texans experience rates of chlamydia, gonorrhea, and syphilis that are all well above the national average.¹ Heartbreakingly, ten percent of our highschoolers admit to having been physically forced to have sex. Six percent of our young boys and nine percent of our young girls have been hit, slammed into something, or injured with an object by someone they dated or went out with, while they are in grades 9 through 12!⁴ Texas ranks among the top 10 states for of new HIV and HPV mediated cervical cancer cases.¹Moreover, Texas ranks third highest in teen pregnancy rates in the country and has the highest prevalence of repeat teen births.¹ Also, abortions after unintended pregnancies continue at the same rate as the national average, despite having more restrictive abortion policies in our state.¹ This is not what any of us want for our budding Texans. It is difficult to watch the shame and stigma some of our teenagers experience for any of these unfortunate health outcomes that happen way too often on our watch. Many times these experiences can forever change the trajectory of their lives. As a mother and as a physician, I want to do everything possible to protect each and every one of our Texan children from whatever potentially puts them in harm's way. 

As Texan parents, healthcare providers, educators, or community members, we could continue to bury our heads in the sand and refuse to acknowledge the injustice to our children. Or we can be advocates for our children, try to understand and mitigate these threats to their well being. The American College of Obstetrics and Gynecology, the American Academy of Pediatrics, the Society of Adolescent Health and Medicine, and the CDC all recommend a comprehensive program of sex education. This would consist of age-appropriate, medically accurate, sexuality education that begins from early childhood, and continues throughout their lifespan.^3,5,6 What this means is that our young children from a very early age, understand their bodies better and  how to protect themselves from being touched or treated inappropriately, and set boundaries of respect around themselves. As they grow up to be young men and women, strong evidence shows that comprehensive sex education is actually what delays sex, reduces frequency of sex, promotes having fewer sexual partners and having safe sex with increased condom and contraceptive use.^3,5,6

Starting with a strong fund of knowledge about sexuality translates into lifelong healthy patterns that minimize reproductive health risks for our young adults. These skills help them understand responsible sexual behavior, create and sustain healthy relationships, set boundaries they are comfortable with, and understand and accept gender equality and diversity. It even helps decrease intimate partner violence. It educates them about when and how to access health information, and how to engage in preventive services to protect them for STIs and unwanted pregnancies until a time they are ready. ^5,6 We want our young men and women to remain healthy and explore their full personal and professional potential.

We need to revamp sex education at the policy level in Austin, and then at the classroom level in our schools, and keep up with the pace of our changing worlds. Until then, I urge my fellow physicians to reach out to their patients and their families and start the conversation about healthy sexuality. We can’t simply stand behind the lines and react to the consequences of a broken system. We are duty-bound to fix it. We need to all come together, raise our voices to our elected representatives, and tell them that the status quo just doesn’t work and that we want a better future for our communities. Its time we align ourselves with reality. Since when have we Texans ever been afraid to make some noise and stand up for what is good for our children?

(1)Guttmacher Institute KH. The State of Sexual and Reproductive Health and Rights In the State of Texas: A Cautionary Tale. 2014;17(2):https://www.guttmacher.org/gpr/2014/03/state-sexual-and-reproductive-health-and-rights-state-texas-cautionary-tale.

(2) Guttmacher Institute, Donovan MK. The Looming Threat to Sex Education: A Resurgence of Federal Funding for Abstinence-Only Programs?. 2017;20:https://www.guttmacher.org/gpr/2017/03/looming-threat-sex-education-resurgence-federal-funding-abstinence-only-programs.

(3) Wiley D, Miller F, Quinn D, Valentine R, Miller K. CONSPIRACY OF SILENCE: SEXUALITY EDUCATION IN TEXAS PUBLIC SCHOOLS IN 2015-16. 2017:http://a.tfn.org/sex-ed/tfn-sex-ed-report-2016-web.pdf.

(4) U.S. Department of Health & Human Services, Office of Adolescent Health. Texas Adolescent Reproductive Health Facts. 2016:https://www.hhs.gov/ash/oah/facts-and-stats/national-and-state-data-sheets/adolescent-reproductive-health/texas/index.html.

(5) American College of Obstetricians and Gynecologists’ Committee on Adolescent Health, Stacey, Joanna H, MD. Committee Opinion,  
Comprehensive Sexuality Education. 2016:https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Comprehensive-Sexuality-Education?IsMobileSet=false.

(6) Centers for Disease Control, Divison of Adolescent and School Health. CDC  DASH Strategic plan 2015-2020. May 2016:https://www.cdc.gov/healthyyouth/about/pdf/strategic_plan/dash_strategic_plan.pdf.