In 1988, the South Carolina legislature passed the Comprehensive Health Education Act (CHEA) which was designed to standardize health education instruction in the state in order to “reduce substantially the amount of money the state spends to care for teenage mothers and their often sickly babies.” We can argue about the language and motives behind the legislation but the process of standardizing how young people learn about health is an important one that many states still have not undertaken.

South Carolina was certainly ahead of the curve passing such a bill so long ago (I was still in high school in 1988), but 25 years later there are questions as to how effective the law has been since sexual health statistics show South Carolina struggling with teen birth rates and sexually transmitted disease (STD) rates higher than the national average.   

A new report assesses the current status of health education with a focus on the reproductive health component. A Sterling Opportunity: 25 Years After the Comprehensive Health Education Act was conducted by Health Advocates LLC and the New Morning Foundation using a Department of Education survey of school districts in the state. The authors wanted to determine whether districts were following the parameters of the CHEA, what they were teaching, how well those teaching the subject were trained, and what materials they were using. The authors found a number of places where schools were failing to follow the law and providing inadequate—and in some cases inaccurate and outdated—information to students.

While the findings are not as outrageous as some found in other states, they shed important light on the situation in South Carolina which is struggling with a few issues: a law that has some good components and some highly restrictive ones, misunderstandings about what the law does and doesn’t require, and a complete lack of accountability.  

The Law

The CHEA is very prescriptive in what is required as well as what is prohibited in health education including reproductive health education and teen pregnancy prevention. For example, it requires that each year students in grades nine through 12 receive comprehensive health education that includes at least 750 minutes of reproductive health education and pregnancy prevention education. Sixth through eighth graders are also supposed to receive reproductive health education which must include STD information. It may also include information on contraception, though this is up to the local school board. 

The law does restrict sexuality education to a certain extent. It requires an emphasis on abstinence, says that contraception information must be provided in the context of future planning, and directs schools to present adoption as a “positive alternative.” In addition, schools cannot provide any information about abortions, distribute contraception of any kinds, or show films that portray actual or simulated sexual activity. Finally (and I’d argue most disturbingly), the law states that “health education classes may not include discussions of alternate sexual lifestyles from heterosexual relationships” except in the context of STDs.

Despite these conservative aspects, the sexuality education component of the law has been controversial since the law was passed. In fact, there have been a number of attempts to change that part of the law. The report notes one amendment to the law proposed in 1998 that sought to change the purpose of the CHEA from “promote responsible sexual behavior,” to “the goal of this act is to reduce the incidence of sexual activity among school aged youth.” In 2004, there was an attempt to reduce the amount of sex education instruction from a minimum of 750 minutes per year to a maximum of 200 minutes. These challenges have failed.

The law also has administrative aspects such as teacher training requirements; an “opt-out” provision that allows parents to remove their children from the reproductive health portion of the course; and a requirement that districts assemble an advisory board of parents, teachers, and clergy to review materials.

Even though the law remains in place, according to the report many school districts are not following it. In fact, the study found that 75 percent of the districts surveyed were out of compliance with some piece of the reproductive health portion of the CHEA.

The Findings

Schools were out of compliance on issues related to time spent on reproductive health, teacher training, and administration. For example:

• 66 percent of districts that responded did not teach STD and HIV prevention in all three middle school grades.
• 23 percent of districts that responded did not have the appropriate community members on their advisory boards.
• 12 percent of districts that responded did not provide the required teacher training.

Interestingly, 96 percent of districts that responded reported teaching all 750 required minutes of reproductive health in high school. 

Districts reported other issues that showed they were either not understanding the law or deliberately defying it. A number of districts, for example, seem to have misinterpreted the “opt out” provision which essentially says that students will be enrolled in the class unless their parents choose to exempt them. Many school districts, 26 of the 69 that responded, were using a much more strict “opt-in” policy which requires parents to sign permission slips before a child can attend the course or the sexuality education portion of the course. Opt-in requirements put an administrative burden on the school and can result in young people missing out on a course not because their parents object but because they forgot to sign the permission slip or it never made it out of the kid’s backpack. 

The most disturbing finding, however, was that eight districts were using materials that were out of compliance with the law, including abstinence-only-until-marriage curricula and outdated programs. 

What Kids Are Learning

A few months ago, the New York Civil Liberties Union undertook a similar review of sex education in their state and we learned that some districts were defining vaginas as sperm depositories and reminding kids that HIV leads to AIDS and certain death within three months. The South Carolina findings were somewhat less outrageous but inadequate nonetheless.

Only one of the high school textbooks used provides information about condoms or other forms of contraception. Some give lessons on abstaining from sex until marriage instead while others leave out vital information or just get it wrong. For example, one mentions “unprotected sex” but never defines it. Another inaccurately says that “barrier protection” is “not effective against HPV-human papilloma virus.” In fact, there is a great deal of research to suggest that condoms reduce the risk of contracting HPV as well as the risk of HPV-associated health issue such as cervical cancer. 

And then there is Holt Lifetime Health, which was part of a controversy in Texas, mentioned in the New York report, and is the subject of a California lawsuit. It famously says that the way to avoid STDs is to “get plenty of rest.”

Other school districts are using strict abstinence-only-until-marriage curriculum including Heritage Keeper’s and Worth the Wait. These are both fear-based programs that focus exclusively on saving sex for heterosexual marriage. Heritage Keeper’s, for example, tells young people:

“Sex is like fire. Inside the appropriate boundary of marriage, sex is a great thing! Outside of marriage, sex can be dangerous.”

Worth the Wait has this to say:

“Teenage sexual activity can create a multitude of medical, legal, and economic problems not only for the individuals having sex but for society as a whole.”  

And both programs include a slew of gender stereotypes and biases. 

Unfortunately, the report found that some districts that are not using these commercially-available curricula are nonetheless giving students similar messages. One district, for example, created a worksheet entitled “Protection Against Date Rape,” which explained:

 “A female may dress and act ‘sexy’ because she wants the male to find her attractive… The male may misinterpret her dress and actions as wanting more. This type of miscommunication sets up problems.”

This age-old idea that boys will be boys and girls should not “ask for it” has been used for years to blame rape victims for what happened to them. The authors note that this victim-blaming is misguided and dangerous:

“Instead of putting the brunt of responsibility on females to protect themselves against sexual assault, we should instead teach our youth—both women and men—that healthy relationships foster open communication, understanding, respect, and freedom of choice.”

One positive finding of the report is that despite the law’s assertion that schools cannot discuss “alternative lifestyles” to heterosexuality, the report did not find many materials that actively discriminated against LGBTQ students or their families. The authors write:

“Fortunately, blatantly discriminatory or homophobic materials are relatively rare in South Carolina sexuality education instruction and there has been more of an effort to make schools safer, more welcoming environments for all students, regardless of sexual orientation.“

Still, they acknowledge that the CHEA statute ignores non-heterosexual students and that this can contribute to a homophobic environment in schools.     

Multi-Prong Remedy

The CHEA is important in that it mandates that young people receive health education that includes reproductive health components but the law itself is not without its flaws. This means that there needs to be a multi-pronged approach to improving sex education in South Carolina.

In general there needs to more accountability; though the law directs the Department of Education to oversee compliance, there is even disagreement as to whether the survey it created to do so is required of all districts. Elizabeth Schroeder of Answer, a national sexuality education organization, points out that few laws of this kind have any teeth: “Just saying that our state has a sex education mandate isn’t the answer.” She noted research she had done years ago in a northern state with one of the best mandates in which she discovered that many districts were simply ignoring the law because there were no consequences of doing so. 

In a potential move to boost compliance, the authors of the South Carolina report suggest that health education become a requirement for graduation arguing that this would force schools to be more accountable in providing it. In addition, the report focuses on teacher training and recommends that health education only be taught by certified teachers and that health teachers be required to get periodic updated training on sexuality related topics. As Kathryn Zenger, a research analyst at New Morning Foundation who contributed to the report, put it: “We require math teachers to be certified in math and science teachers to be certified in science, health is no different.”  Zenger also noted that it’s important to change the law and its enforcement in ways that will be most effective for students. Having the information delivered by trained teachers, she said, is one of those changes that will have a direct effect in the classroom.

Other important changes recommended in the report speak to the law’s current restrictions on content. For example, the authors think that the law should be changed to remove the requirement that contraception education be provided only in the context of future planning. They note that given that almost 60 percent of high school seniors in South Carolina are sexually active this context isn’t realistic. Schroeder adds that many teens are still concrete thinkers who cannot think in terms of future planning. She notes that this is why course requirements should be crafted by educators and people with child development experience rather than policymakers.

The CHEA has now been in place for 25 years but it has clearly not met its goals even when we remember that those goals were written in terms of cost. The report’s authors note that birth to teen mothers cost the state $197 million each years.

This report is the first step for taking a multi-prong approach to fixing sex education in South Carolina. It also should serve as a reminder to advocates in other states that a law is a first step but we have to stay vigilant.