Sexuality is a common human trait, but the ways that schools teach about sex varies radically around the globe, from comprehensive sex education in progressive countries like the Netherlands and Sweden to abstinence-only programs in some parts of the United States.
Recent data suggests, however, that schools in many nations are falling short in educating young people effectively about sex and relationships. Students and young adults in different countries express frustration at school-based sex education programs, according to a new review published earlier this week in the British Medical Journal.
Researchers in the United Kingdom analyzed 48 studies conducted from 1990 to 2015 that reported on young people's impressions of school-based sexual education for the review, which is titled, "What do young people think about their school-based sex and relationship education? A qualitative synthesis of young people's views and experiences."
The review looks at surveys of students aged 4 to 19; youth age 19 and under not necessarily in school; and young adults reflecting on their schooling. They were from 10 countries around the globe -- the United Kingdom, Ireland, the U.S., Australia, New Zealand, Canada, Japan, Iran, Brazil and Sweden.
Consistent themes arose from the surveys, including that young people regard current teachings as negative about sexuality and biased based on gender and toward heterosexuality.
Pandora Pound, lead author of the review and a research fellow at the University of Bristol’s School of Social and Community Medicine in the United Kingdom, told ABC News, “Although we knew that young people were dissatisfied with their [school-based sex education], the reasons for their dissatisfaction were less clear … We were surprised that young people's views were so consistent across all the different countries [over] 25 years.”
One common theme to emerge is that many teens want teachers to acknowledge that sexuality can be an uncomfortable or embarrassing topic for instruction and can’t be taught like other subjects or with a disapproving tone. Many teens surveyed indicated they dislike having sex education taught by their regular teachers "due to blurred boundaries, lack of anonymity, embarrassment and poor training," the study said.
"Young people report feeling vulnerable in [sex and relationship education], with young men anxious to conceal sexual ignorance and young women risking sexual harassment if they participate," the authors wrote in their summary of results. "Schools appear to have difficulty accepting that some young people are sexually active, leading to [sex education] that is out of touch with many young people’s lives."
None of this surprises Barbara Velategui, a veteran health educator who taught at Newport High School in Bellevue, Washington, for 41 years before retiring.
“[Sexual] health education in the academic setting is very much like the ugly stepchild," Velategui told ABC News. "[Schools] do it if the state requires it, but it’s delivered like a core subject, and it doesn’t work.”
Velategui started teaching sex education in 1974 with a brief lesson that was part of a wedding-planning course called “Two for Tomorrow.” Young men did not enroll in the course. Over the course of four decades, she noticed a palpable shift in her students’ desire to actively learn about and take command of their sexual health.
“The biggest change I’ve seen in my career is kids’ comfort level with [lesbian, gay, bisexual, transgender, or queer issues] … I don’t think sexuality education can be taught without it because otherwise there are too many kids you leave out," she said.
The study found that schools struggling to recognize that some students are already engaging in sexual practices often fail to provide practical information such as on the pros and cons of different contraceptives, health services available for students who become pregnant or contract sexually transmitted diseases, and how to handle the intense emotions that may arise in a sexual relationship.
In the U.S., 24 states and the District of Columbia require public schools to teach sex education, according to the National Conference of State Legislatures. The content varies widely among states from an abstinence-only approach to a comprehensive review, and only 20 of these states mandate that information taught to students be “medically accurate,” according to the conference.
When Washington State mandated in 1993 that all students in grades 5 through 12 receive education about HIV, Velategui created a peer-led program called AIDS Student Peer Educators at Newport High School (ASPEN). Students with a passion for social justice, medicine, and peer counseling were trained to deliver 90-minute interactive presentations to their classmates about sexual health, including how to prevent sexually transmitted diseases, choose contraceptives and access community resources.
Over the next 21 years, the peer education program was regularly asked to present at the other area high schools and was recognized by the World Affairs Council as an effective model, which drew attention from international health education groups.
“There are teachers around the country who want to teach this sensitive topic but aren’t getting the backing they need from their school districts,” Velategui said.
For many U.S. teens, school is the primary source of sexual health information. Health experts generally agree that classroom-based sexual education is a tremendous opportunity to safeguard and empower the next generation to make informed decisions about their physical and emotional health. However, this study warns that unless instructors adapt their curriculum to the lives of today’s teens, young people will continue to disengage.
"While it is important to get the content of sexual and relationship education right, it's also vitally important to get the right people to deliver [it]," said Pound.
Dr. Kathryn J. Horton is a senior internal medicine resident at the University of Washington in Seattle and is currently working in the ABC News Medical Unit.