Fewer NC students are expected to receive sex ed. Why that worries health experts

Experts often credit comprehensive sex education, along with access to birth control, with reducing teenage pregnancies and sexually transmitted infections. Some schools are responding to a new state law in a way that could lead to fewer students taking sex ed, unless their parents or guardians sign them up.
Posted 2023-10-13T18:44:33+00:00 - Updated 2023-10-18T00:57:07+00:00
The present and future of sex education in North Carolina

At the Alice Aycock Poe Center for Health Education, high school students pair off for a course called “Mountain Climbing: Reducing Risk and Setting Boundaries.”

Teacher Paige Schildkamp asks the students to plan a mountain climbing trip. What would they need to pack and prepare for?

The students realize they’ll need quite a few supplies, including ones that are just in case of emergencies. Then, because group members have different fitness levels, they’ll have to think of a climb that they can all do and enjoy.

They realize the risks of not planning beforehand and not talking together about their individual needs, sharing concerns not everyone necessarily might have thought about.

“There's quite a bit in common with any kind of sexual activity and this sort of mountain climbing scenario,” Schildkamp tells the students. “There's no way to safely have a relationship that has any kind of sexual activity in it without having that open and clear communication.”

The course asks teenagers to think more critically about their choices, and the advantages and disadvantages of the different choices before them. That’s the curriculum at the Poe Center, where schools in and near Raleigh send students to learn about the birds and the bees. The course is based on what state law requires for schools to teach; the message for the teenagers is to know the risks and be responsible but to also look at their choices through the lens of what they and others want.

Experts often credit comprehensive sex education with helping to drastically reduce the rates of teen pregnancies in the past two decades, though access to birth control may play a bigger role.

A new state law has caused school districts to review their sex ed policies, and some interpretations could mean thousands fewer students might not take classes like the one at the Poe Center.

Some school districts initially took Senate Bill 49 to mean that parents and guardians must now opt in to reproductive health education.

After enactment of the bill in August, which Republican lawmakers titled the Parents’ Bill of Rights, Charlotte-Mecklenburg Schools — the state’s second-largest school system, with 130,000 students — changed to an opt-in policy.

State Sen. Amy Galey R-Alamance, a sponsor of the legislation, says the law wasn’t intended to change state policy, which has long given school districts the power to determine whether parents need to opt in or opt out. And the North Carolina School Boards Association agrees that the law doesn’t change that.

State education officials, meanwhile, are still reviewing what the law requires.

Nonetheless, Charlotte-Mecklenburg, is sticking with its decision to require parents’ permission before allowing students to take sex ed, saying they want to ensure parents are fully aware of the lessons. So far, families of just 33.4% of students in fifth through ninth grades have opted in, or 18,925 students out of 56,617 students enrolled in those grades. That percentage is well below districts that have an opt-out policy.

Not every system is changing, though. Chapel Hill-Carrboro City Schools, for instance, is still only asking parents to sign forms to opt their children out of sex education.

Influential conservative groups have promoted opt-in policies. And some lawmakers have pushed to require them.

Recent laws in other states have placed restrictions on sex education. A handful of other states have required families to now opt in to sex education instead of opting out.

"Opponents of parents rights always assume parents aren’t capable of raising their own children responsibly, so the school system needs to fill the gap, but the fact is parents know what’s right for their own children and should be given the option of school or home instruction of sex ed,” said Laura Macklem, a spokeswoman for the NC Values Coalition, which regularly lobbies the General Assembly.

Others are skeptical about opt-in policies and worry that even well meaning adults might not have all of the right information.

“This will limit some students’ access to sex education,” said Dr. Clayton Alfonso, a gynecologist at Duke University Hospital. “I already see a lack of education in patients that I see in the current setting. Now with sexual education becoming highly politicized, I worry that there will be a certain portion of young people who don’t know how to have safe, consensual sex.”

WRAL News asked area school systems whether they already required parents or guardians to opt in or out during the past school year. Most gave families a choice to opt out, in which children were automatically enrolled unless their parents’ decided otherwise.

Families have rarely opted out of sex education. Just 3% of students in Wilson County Schools were opted out last year. No families opted out in Bladen County. Three students were opted out in Person County Schools. Just a couple of students were opted out at each school in Chapel Hill-Carrboro City Schools. Less than 10% were opted out in Moore County Schools.

Duplin County Schools, by contrast, has required families to opt in, resulting in higher rates of students not receiving sex education. About 10% of fifth graders and sixth graders, when the curriculum is more focused on puberty versus sex, didn’t receive it. Closer to 20% of seventh graders and eighth graders didn’t receive sex education.

At the Poe Center, after asking students to plan their mountain climbing trips, Schildkamp begins another exercise. She asks the students to stand by one wall if something is important to them, another wall if it’s only somewhat important to them and a third wall if it’s not important at all to them. Things that matter to students: happiness, money, freedom to do what they want, an interesting career, college, good grades and reaching personal goals.

The rest of the course is focused on risks with sexual activity and how to avoid or minimize them, and how to make sure other people are safe, too. They discuss abstinence, contraception, sexually transmitted infections, consent and intimate partner violence — all within the context of the students’ overarching life goals.

Legal requirements of sex education

Schools’ health curricula must follow several requirements outlined in state law. The standards must emphasize abstinence from sexual activity first and foremost and promote monogamous heterosexual relationships.

State law outlines many things standards must include. Here’s what the law says:

  • Schools can, but don’t have to, start reproductive health education before seventh grade. They are required to teach reproductive health beginning in seventh grade — after many students have reached puberty.
  • School boards can choose either an opt-in or opt-out method for families to decide whether their child should receive reproductive health education. Most chose an opt-out method, although some chose opt-in.
  • Families must be able to review instructional materials before instruction begins.
  • Instruction must be medically accurate.
  • Reproductive health and safety education heavily emphasizes abstinence and promotes the idea that “a mutually faithful monogamous heterosexual relationship in the context of marriage is the best lifelong means of avoiding sexually transmitted diseases, including HIV/AIDS.”
  • Schools are required to teach about all U.S. Food and Drug Administration-approved methods for preventing pregnancy and sexually transmitted infections. That includes condoms, birth control pills and other ways to reduce the risk of unintended pregnancies or sexually transmitted infections.
  • Schools are required to teach about sexual assault and sexual abuse, including what it is, common misconceptions and stereotypes of sexual assault and abuse, ways to report it and what healthy relationships look like. Schools are also required to teach about “causes of those behaviors” and reducing the risk of becoming a victim. Consent, and how it is given, is not mentioned.
  • Schools are required to teach about sex trafficking and prevention.

The state law’s requirements don’t get too specific, however. Schools could spend differing amounts of time talking about each topic or approach each topic using differing lesson plans or texts.

Most schools in the Triangle and nearby counties use the state standards as the main backdrop of their curriculum planning.

In Franklin County, school nurses help develop guides for implementing the state’s standards.

Granville County Schools uses a curriculum from consumer goods company Procter & Gamble, called “Always Growing and Changing.”

Before 2009, state law focused on abstinence-only education, which has been rejected by many experts as being ineffective at preventing pregnancy or sexually transmitted infections when compared to comprehensive sex education. Back then, it was up to school systems to decide whether they wanted to teach more than just abstinence.

In 2009, the North Carolina General Assembly passed the Healthy Youth Act, expanding the law to include education about contraceptives, reducing risk of sexually transmitted infections and sexual violence. Anything taught must be medically accurate, a requirement most U.S. states don’t have, according to the Guttmacher Institute, a research and policy group that advocates for reproductive rights.

“Research has shown time and time again that students who receive sexual education, they have a delayed onset of sexual activity,” Pittman said. The rates of teen pregnancy and sexually transmitted infections go down, and getting tested for infections rises.

“A lot of times people think, ‘Oh, if they receive sex education, they're going to go out and have sex.’ It's actually the opposite,” Pittman said. Having more knowledge and making “those informed decisions and realizing, ‘Hey, maybe I don't want to have sex,’ and giving them the tools of why they might not want to typically help some delay that sexual activity.”

‘Learning the hard way’

More than 40% of North Carolina’s high school students report having sexual intercourse, or roughly 200,000 students, according to the federal Youth Risk Behavior Survey conducted by school systems every other year. About 40% of those students report not using a condom. About 8% of high school students report being a victim of sexual assault. About one in eight say they have been the victim of an attack, verbal or physical, for identifying as LGBTQ.

Not using a condom can increase the risk of sexually transmitted infections or pregnancies. Both can have life-long consequences.

Teenagers have the highest-risk pregnancies among all age groups.

North Carolina’s birth rate among teenagers has declined over the years. It’s lower than most other Southern states but higher than the national average. In 2021, according to the U.S. Centers for Disease Control and Prevention, the state had 16 births for every 1,000 teenagers, down from 48.5 births for every 1,000 teenagers in 2005. Nationally, teen births have dropped dramatically.

“Education, of course, plays a part in it,” said Kristen Carroll, head of the reproductive health branch of the North Carolina Department of Health and Human Services. “Access to health care … including contraceptives, certainly plays a part. And for adolescents, knowing what's available to them, and how they can seek those out is certainly a piece of it.”

After the class featuring the mountain climbing exercise, some of the students say they’re glad to have attended. They’ve received some of this education before in their Wake County schools but think a refresher is always good.

From their perspective, too many teenagers still don’t think before they act. That’s why the education matters, they say.

They cite stories.

One friend had unprotected sexual contact and panicked later about having a sexually transmitted infection.

Another friend had sex with someone they later wondered if they should really be taking risks with.

A lot of young people don’t plan for sexual scenarios because they haven’t had to, Shaurya Sharma, a Green Level High School sophomore said. Then, they make a snap decision in an unexpected moment.

“The problem is that people are learning the hard way, and not taking those steps earlier, so that they can be safe in advance,” Sharma said.

Sharma thinks knowledge also makes young people more likely to speak maturely about sexual topics. He’s noticed that high school students take sex more seriously.

Sumedh Kotrannavar, an Enloe High School junior, thinks an educational setting is better than social media or other websites, where young people spend a lot of time.

“The problem with social media and websites is that there's a lot of misinformation on the internet,” he said. “A lot of times the information isn't presented adequately [and] isn't presented towards youth audiences.”

Where young people get their information matters, and they should feel comfortable speaking with adults, said Saanika Agarwal, a senior at Green Level High School.

“This is a thing that oftentimes children don't want to talk about with their parents, and many parents don't know what's happening,” she said. “And parents can play a big role in what a child chooses to do, and they have a big influence in their child's life.”