Which sex ed approach works best for STI and pregnancy prevention? Research remains unclear

And that’s the crux of the issue. There have been so few well-designed research that inform us if sex ed helps, making issues worse or doing nothing in any respect. Researchers must randomly assign preteens or teenagers to a sex ed class and then determine find out how to monitor subsequent undesirable pregnancies and sexually transmitted infections. Students don’t all the time disclose the reality about sex on surveys.

“It’s really challenging to do an evaluation of sex ed curriculum,” mentioned Carolyn Tucker Halpern, chair of the division of maternal and baby health on the Gillings School of Global Public Health of the University of North Carolina at Chapel Hill. “Short of rummaging around in trash cans and looking for used condoms and stuff, it’s hard to get an objective measure.”

The most up-to-date try and compile and summarize the best proof for sex training was published in 2023 by a staff of public health researchers from Dartmouth College. They aggregated the outcomes of 29 randomized managed trials (RCTs) within the United States between 1990 and 2021. Fewer than half of the research of sex ed applications occurred in colleges. Nine of them emphasised abstinence, which suggests ready till marriage to have sex. Just one examine immediately in contrast instructing abstinence solely with a complete approach. (It didn’t discover any distinction in frequency of condom use, its most important consequence measure.)

Comprehensive sex training is a catchall time period that features all the pieces that isn’t abstinence solely – from contraception use and sexual consent to the reproductive system and sexually transmitted infections. Comprehensive applications can also embody and even emphasize abstinence together with these different subjects. Because the content material of those courses varies, it’s arduous to generalize about complete sex or its effectiveness. (For extra on present approaches to sex training, learn this Hechinger Report story.)

Only seven research within the Dartmouth meta-analysis tried to trace pregnancies, and of these, simply three asked members whether or not they or their companion had gotten pregnant a 12 months or extra later. 

The general discovering was ambiguous. Three complete applications confirmed a average discount in teenage pregnancies though the impact was not statistically important. This signifies that there are too few research for researchers to be assured; the outcomes might be flukes and extra research are wanted to verify. (The largest of the three research, by far, concerned younger males who had been dwelling in group houses operated by baby welfare or juvenile justice, not indicative of typical teenagers.)

There was additionally no proof that sex ed decreased the incidence of sexually transmitted infections. Only three research on this 2023 meta-analysis tracked STIs (not the identical as those that tracked pregnancies) and all three confirmed comparable charges in each the therapy and management teams. It’s arduous to make assured conclusions based mostly on solely three research, however these outcomes are usually not promising.

“There’s a shockingly low number of studies,” mentioned Amy Bordogna, who led the analysis staff that carried out this review, revealed within the American Journal of Sexuality Education. “There needs to be more research.”

The 29 randomized managed trials tended to indicate that college students had been practising safer sex after taking part in a sex ed program. On surveys, for instance, boys mentioned they had been utilizing a condom extra usually. In idea, elevated condom use needs to be translating into decrease pregnancy and STI charges. Either teenagers aren’t being truthful on surveys or the condoms aren’t getting used accurately.

The rigorous analysis proof is at odds with the research-based suggestions of many medical and health associations, together with the American Public Health Association, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Other critiques have discovered that the proof for “comprehensive” sex ed applications is extra favorable. For instance, a 2012 paper by 20 consultants, led by researchers on the Centers for Disease Control and Prevention, reviewed 66 research of group-based “comprehensive risk reduction” applications and concluded that, on common, they had been efficient in lowering pregnancies and STIs, whereas the outcomes of 23 research of group-based abstinence applications had been inconsistent. Many of the underlying research included in these broader analysis critiques weren’t randomized managed trials and had been of decrease high quality. 

Advocates on each side of the controversy are inclined to overstate their instances. There’s little proof that sex training encourages sexual exercise or promiscuity, however there’s additionally not sturdy proof that complete sex ed applications cut back pregnancies and infections. 

There’s additionally little proof that abstinence-only approaches backfire, as some counsel, and result in greater charges of pregnancies and infections. A 2008 study of four abstinence-only programs discovered no improve within the danger of adolescent pregnancy, STIs, or the charges of adolescent sexual exercise in contrast with college students in a management group.

The worldwide proof isn’t significantly better. A Cochrane review published in 2016 aggregated the outcomes of randomized management trials that occurred in colleges in Europe, Latin America and Africa. The evaluate had the next bar for examine high quality; there needed to be some medical measure of pregnancies and sexually transmitted infections past what college students voluntarily disclosed. It discovered no proof that school-based sex ed applications by themselves lowered pregnancies, HIV or different sexually transmitted infections after reviewing eight randomized managed trials protecting 55,000 college students.

One takeaway from the lead researcher, Amanda Mason-Jones from the University of York in England, is {that a} curriculum alone, unaccompanied by freely out there contraception, isn’t terribly efficient. 

The simplest method to cut back pregnancies had nothing to do with sex ed courses. Financial incentives, resembling free uniforms or small money funds to maintain girls in class, led to a major discount in teen pregnancies. One of those research additionally documented a discount in infections. That means that training itself may be the strongest type of contraception.

Sarah Butrymowicz contributed reporting to this story.