The Hawaii Board of Education voted on June 16 to make sex education mandatory starting in the 2015–2016 school year. The decision comes after years of efforts by educators to make the state’s sex education program more comprehensive and counter lawmakers’ attempts to make it more restrictive.

It also comes on the heels of data that suggest broadened sex education may have been partially responsible for the reduction of teen pregnancy and abortion in Hawaii.

Until now, Hawaii schools were not required to teach sex education at all. Efforts to improve how schools handle the topic began in 2009 with a state law requiring all sexual health programs in schools to provide medically accurate information. Under this rule, schools that chose to teach sex education were required to stress the benefits of abstinence and encourage sexually active students to become abstinent, but they also had to include education on methods of contraception and disease prevention.

Before 2009, many schools in the state were relying on Catholic charities that provided Try Wait, an abstinence-only-until-marriage program. The program, which was supported with federal funding, used the Choosing the Best curricula.

This popular series contains very little information about contraception and STDs, promotes heterosexual marriage, relies on messages of fear and shame, and includes biases about gender, sexual orientation, and pregnancy options, according to the Sexuality Information and Education Council of the United States. (SIECUS).

Other materials used in Hawaii schools were outdated and culturally inappropriate.

Judith Clark, executive director of Hawaii Youth Services Network, told the Associated Press that schools were using videos from the 1980s and at least one of them featured actors who were ice skating in heavy sweaters. “It was very didactic, very boring and very inappropriate for Hawaii because nothing looked familiar,” Clark said.

Clark explained that the state was awarded a $5 million grant to spend on sex education programs over five years beginning in 2010, which has led to the creation of new, more appropriate resources, and a focus on teen pregnancy prevention both in and out of schools.

Clark’s organization, for example, created new DVDs using local actors on the beach and at a Polynesian tattoo shop. In one video, the actors even speak in the local pidgin dialect throughout the story.

One new program that was designed to be culturally appropriate, however, became controversial. Pono Choices was created by the University of Hawaii for 11- to 13-year-old students. It is described by the university as being “culturally responsive,” and introducing “students to Hawaiian cultural terms, practices and concepts that stress positive character development, including making ‘pono’ or ‘right’ choices.”

Originally introduced as a pilot program in 12 schools across the state, the program was pulled twice in large part due to the efforts of Rep. Bob McDermott (R-Kapolei, Makakilo).

The state Department of Education first pulled the program in late November 2013 to review it after McDermott and a few other legislators complained, along with some parents. But after just two weeks, the department not only reinstated the sex ed program, but expanded it to other schools.

McDermott wasn’t satisfied and continued efforts to get the program changed or canceled.

He released a 21-page report in February 2014 charging that the program was too explicit, not medically accurate, and did not adequately explain the risk of homosexual sex.

“The program normalizes a homosexual lifestyle and anal sex, while failing to warn students of the extreme dangers of anal sex; it references multiple sex partners, while failing to inform students about the health benefits of monogamy; it fails to warn students about the ineffectiveness of condoms against HPV, herpes, and anal sex; and fails to educate students on the stages of human reproduction,”McDermott told WatchDog.org.

McDermott seemed very concerned that the curriculum referred to the anus as part of the genitals.

The GOP legislator introduced an amendment in 2014 that would have prevented the education department from describing the anus as a sexual organ in the program. Though the amendment failed with just seven of 51 members voting for it, the floor debate apparently got so heated that vice speaker John Mizuno had to call for a recess twice to resolve personal disputes between members.

Though the amendment was unsuccessful, continued controversy caused the state education department to temporarily suspend the program again in June 2014 while the University of Hawaii made some changes. Ten changes were made to the curriculum before it was reinstated in September. Changes included no longer calling the anus part of genitals, emphasizing the dangers of unprotected anal sex, and rewriting language on condom efficacy rates.

The other change made at the time: a switch to an opt-in system of parental permission for sex education programs. Previously, students were automatically enrolled in sex ed, but parents could choose to take their child out of the course by sending a form to the school. Under the opt-in policy, which was in place for the 2014–2015 school year, no student would be allowed to participate in the program unless their parent signed a permission slip.

Educators often worry that opt-in requirements will prevent some students from receiving sex education for administrative reasons, such as a permission slip that never made it out of a kid’s backpack.

McDermott called the changes to the curriculum and the policy a partial victory, but others worried that the stricter rules indicated a step backward in the progress made toward providing better sex education in Hawaii’s schools. These advocates noted that improved sex education deserved at least partial credit for the lower rates of abortion and teen pregnancy in the state.

Recently released data show that the Hawaii had the steepest abortion rate decline of any state, with the number of terminated pregnancies falling almost 30 percent from 2010 to 2014. The state’s historically high teen pregnancy rate has also been on the decline.

The Hawaii Youth Services Network’s Judith Clark told the Associated Press she believes the increased focus on sex ed has made a marked impact on teen pregnancies in Hawaii.

“I would certainly hope those efforts reduced the incidents of abortions by reducing the rate of pregnancies,” Clark said.

Dr. Donald Hayes, epidemiologist with the Hawaii Department of Health, agreed sex education could be one reason for the decline, but also pointed to high use of long-acting reversible contraception methods such as intrauterine devices (IUDs) or hormonal implants.

McDermott credited something else entirely. “It’s the availability of the morning-after pill,” he told the Associated Press. “The need for surgical abortions is diminished.”

Those who feel sex education is part of the teen pregnancy solution were concerned that controversy over the past few years would diminish that success. Hayes said, “All these gains could be lost if the education in the schools was a big portion of the reductions here.”

But the June 16 decision may allay these fears because the state Board of Education not only voted to mandate sex education in all schools, it denied the Hawaii Department of Education’s request to keep the opt-in policy. Sex education will once again be operating under an opt-out policy when the 2015-2016 school year begins.

Sex education advocates across the country are pleased with the decision. “Kudos to the Hawaii Board of Education for stepping up to ensure the health of Hawaii’s young people by requiring that their schools provide them with age appropriate and medically accurate sexuality education,” Monica Rodriguez, president of SIECUS, told Rewire. “Now begins the hard work of implementing that policy in schools across the state and making sure that schools and teachers have the resources and training they need to deliver high quality lessons.”

Of course, not everyone is pleased. McDermott called the implementation of fact-based sex education “a travesty.”