Almost everyone in both the public health and the education communities acknowledges that a paradigm shift is upon us–after years of our children being subject to dangerous, inaccurate abstinence-only-until-marriage programs, we are finally at a place where parents, educators, and even policymakers are asking for something different.  And, almost everyone agrees that that something is comprehensive education about sexuality: education that tells young people about abstinence and contraception and relationships, friendships, and decision-making.   Now, however, we are beginning to realize that having what you want within reach comes with its own pains and obstacles.

As we begin to formulate our plan for sexuality education in the future, we see a chasm between public health (which seeks ultimately to prevent negative health outcomes) and education (which seeks to provide knowledge, at least in part, for the sake of knowledge).  This raises a larger question, is the goal of comprehensive sexuality education to reduce unintended pregnancies, STDs, and AIDS, or is it to create a generation of sexually healthy, educated young people who are equipped with decision-making and relationship skills?   I believe that the bottom line on this is that we want both.  We obviously want to reduce the public health risk that our children are faced with today.  But we also want to make sure that our children are prepared to face the challenges of tomorrow.

The thing is, the divide is not new.  I’ve been at SIECUS for 17 years and this is something we’ve been grappling with for at least that long.  SIECUS has always defined comprehensive sexuality education as more than "disaster prevention" and yet we have seen over the years that it is often the public health promises that lead to change.  We saw this during the beginning of AIDS epidemic which changed the debate over sex education in schools.  Even opponents stopped arguing that kids shouldn’t learn about sex in schools.  In fact, what they did was argue that the abstinence-only-until-marriage approach was the best way to prevent AIDS, other STDs, and teen pregnancy.  In reality, they went even further; they promised it would prevent teen sex.  

This was a profitable argument for them–over the past fifteen years more than 1.3 billion dollars has been pumped into the ab-only movement.  But it was an inaccurate and short-sighted argument.  Ab-only proponents promised that teens would stop having sex-they didn’t (after a decline during the years before ab-only surged, teen sexual behavior has remained steady).  They promised that teens would stop getting pregnant-they didn’t (the teen birth rate is going up for the first time in a decade).  And, they promised that teens would stop getting STDs–they didn’t (we recently learned from CDC data that 1 in 4 adolescent girls has an STD).   It is the public health argument that built the abstinence-only industry and it is the public health reality that is going to end it.

So now as the pendulum of public opinion and public policy swing back toward a more comprehensive approach, the question is how we best secure the future of comprehensive sexuality education. Public health and policy people will argue that it will be much easier to convince policymakers to provide funding if we stick to the public health approach and arguments.  And they will argue, in my opinion correctly, that we won’t see the same fate as the abstinence-only-until-marriage industry because comprehensive programs actually can help reduce teen pregnancy and STDs.  Educators will argue that if we only take a public health approach, we will really never succeed in changing the underlying factors that have put our children in the situation that they are in today.  A public health response to disease and pregnancy prevention will only address the nuts and bolts of what they should know and how NOT to get pregnant and catch a STD.  What it will not do is truly educate our children about their sexuality, teach them relationship and communication skills, or particularly for young women, help them address self-confidence and self-esteem which are vital to making good decisions.

I reiterate that we want to do both.   We must pave the CSE road with a public health approach, and we must secure funding for targeted programs aimed at preventing teen pregnancy, STDs, and HIV, especially in communities most impacted by these issues.  But we can never lose sight of the fact that in the long run this needs to be an education product if it is truly to create change. In order to reverse the harm that has been done by more than a decade of ab-only programs and raise a generation of sexually healthy young people, we need to lay the infrastructure for comprehensive school-based sexuality education that starts in kindergarten and goes through 12^th grade.   Now is the time to ask for it all and we cannot get sidetracked by short-term disagreements.