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THE BATTLE FOR EFFECTIVE 
SEXUALITY EDUCATION

The debate over sexuality education reveals important issues regard-
ing government regulation of personal behavior and the role of val-
ues in social welfare policy. While often regulated to the realm of public 
health, the promotion of effective approaches to sexuality education is 
closely aligned with social work’s mission to empower clients and in-
crease their access to resources and information. This article will cover 
historical trends in sexuality education, the current federal policy and al-
ternatives, and discuss the limitations and subsequent consequences for 
future policy. Additionally, this article will highlight the important impli-
cations of the sexuality education debate for the social work profession. 

Sexuality education for young people is no longer confined to awk-
ward family discussions or whispered conversations in the school 

hallway. The rise in teenage pregnancy, legalization of abortion, and the 
spread of HIV thrust adolescent sexual behavior into the realm of policy 
makers and government officials. Sexuality education emerged as a poten-
tial mechanism for targeting these public health issues; however, a divisive 
battle over appropriate content and structure has led to inconsistent imple-
mentation of sexuality education programs for American youth. While the 
programs seek to curb teenage pregnancy and prevent the transmission of 
sexually transmitted diseases (STDs), the debate over what kind of sexual-
ity education best achieves this goal illuminates crucial issues regarding 
the role of values and personal behavior regulation in social welfare policy. 

This article will cover historical trends in sexuality education, the current 
federal policy and alternatives, and discuss the limitations and subsequent 
consequences for future policy. Additionally, this article will highlight the 
important implications of the sexuality education debate for the social work 
profession. In response to a growing decline in the health status of adolescents 
in the United States, the National Association of Social Workers (NASW) 
has called for an increased focus on adolescent health issues and compre-
hensive prevention services, particularly around adolescent sexual behavior 
(NASW, 2004). In light of social work’s commitment to self-determination 
and access to reproductive health resources, the NASW recently declared 

Jennifer Friedman

Friedman 

   Journal of Student Social Work, Volume II  7



 8 Journal of Student Social Work, Volume II  

The Battle for Effective Sexuality Education

its intentions to co-sponsor the March for Women’s Lives in April 2004 
(NASW, 2004). Given the increasing role that reproductive health and sexu-
ality will play in the upcoming political arena, it is essential that social work-
ers be informed about sexuality education policy and effective interventions.

The sexuality education debate is complicated, as it includes concern 
over the impact of sexuality education on youth sexual behavior and the 
efficacy of such programs in preventing pregnancy and HIV/STDs. The 
concerns are important: one in five adolescents have had sex prior to age 
15, half of all 17 year olds are sexually active, and nearly 850,000 teenag-
ers become pregnant each year (Health Education Advocate, 2003). Since 
the Progressive era, sex education has mainly been a function of schools; 
89% of public school students will take sex education sometime between 
grades seven to 12 (Luker, 1996; Kaiser Family Foundation, 2000). But the 
policy debate also affects secular and religious organizations that provide 
sex education and stretches beyond moral and social prerogatives; nearly 
$100 million in government funding is available to schools and commu-
nity-based organizations that implement federally-approved sex education 
programming. Current policy dictates that available funding must be used 
for abstinence-only education programs, which seek to prevent premarital 
sexual activity and convey the message that abstaining from sexual activity 
until marriage is the “morally correct option” (Advocates for Youth, 2001, 
p.7). The policy focus on abstinence and the increase in funding has impact-
ed the nature of sex education; in 1999, 23% of secondary schools taught 
abstinence compared to 2% in 1988 (Darroch, Landry, & Singh, 2000). 

Schools and organizations that do not receive federal funding are free 
to pursue alternatives to abstinence education, frequently described as com-
prehensive sexuality education. In 1990, the Sexuality Information and 
Education Council of the United States (SIECUS) developed guidelines 
that cover the six main concepts of comprehensive sexuality education: 
human development, relationships, personal skills, sexual behavior, sexual 
health, and society and culture (SEICUS, 1996). Comprehensive programs 
emphasize abstinence, but also provide information about contraception 
and disease prevention in addition to education on adolescent development, 
relationships, sexual orientation, and other life issues. A 1999 survey con-
ducted by SEICUS and Advocates for Youth found that 93% of Americans 
supported comprehensive sexuality education (Advocates for Youth, 2001). 

History and Policy Development
The current sex education policy battle and conflict over fund-

ing reflects the historical ambiguity of  American attitudes toward teen-
age sexual behavior. Over the last thirty years, the growing awareness 
of teen pregnancy, the abortion controversy, and the reemergence of po-



litical and religious conservatism have significantly impacted sexual-
ity education politics (Goodson & Edmundson, 1994; Wilcox, 1999). 

Teen Sexual Behavior Moves to the Forefront in the 1970s
In the 1970s, the rates of abortion increased, as did the numbers of 

women having children outside of marriage. While adolescents repre-
sented a small percentage of these trends, the combination brought teen 
sexual behavior into the forefront. A 1976 report by the Alan Guttmacher 
Institute further heightened awareness around adolescent sexuality and 
the “epidemic” of teenage pregnancy (Wilcox, 1999; Luker, 1996). The 
policy approach in the 1970s embraced the provision of family planning 
services and contraception; in 1970, Congress passed the Family Planning 
Services and Population Research Act under Title X of the Public Health 
Services Act. The act did not originally target adolescents, but as a result 
of the growing awareness of teen sexual activity, Congress specified that 
adolescents should receive targeted family planning services under Title 
X. The support for family planning also stemmed from a political con-
sensus that preventing adolescent pregnancy and childbirth would aid ef-
forts to prevent poverty and decrease welfare expenditure (Wilcox, 1999). 

Focus Shifts to Abstinence Education in the 1980s
 Support for increasing adolescents’ access to contraception and family 

planning resources was short-lived. By the early 1980s, a more conservative 
administration and a growing anti-abortion movement shifted the focus to 
abstinence education. Opponents of the family planning approach claimed 
that support for contraceptive services encouraged sexual promiscuity and 
thus sought to replace these services with programs that would prevent sex-
ual activity (Luker, 1996). Furthermore, proponents of abstinence education 
argued that the prescriptive nature of abstinence programs would place sex 
within the context of committed, monogamous relationships (Goodson & 
Edmundson, 1994; Olsen, Weed, Nielsen, & Jensen, 1992). In 1981, the 
first full-fledged federal policy mandating abstinence education was passed. 

The Adolescent Family Life Act (AFLA) was passed in an effort to 
create programs that develop “strong family values” and promote “self-
discipline” (Title XX, as cited in the Office of Population Affairs, 2003b). 
The AFLA supports demonstration projects that develop and implement 
abstinence curricula, or provide support services for pregnant and par-
enting adolescents to “ameliorate the effects of too-early-childbearing 
for teen parents” (Office of Population Affairs, 2003a). The act promotes 
adoption as the preferred option for pregnant teens and prohibits funding 
for programs that provide abortions or abortion counseling/referral (Ti-
tle XX as cited in the Office of Population Affairs, 2003b). While fund-
ing for AFLA decreased during the Clinton administration, the program 

Friedman 

   Journal of Student Social Work, Volume II   9



10   Journal of Student Social Work, Volume II   

has seen a revival during recent years. In 2000, the AFLA received $19 
million — three times the funding it received in 1994 (Brindis, 2002). 

 The AFLA has faced significant challenges, most notably the lawsuit 
filed in 1983 by the American Civil Liberties Union (ACLU). The ACLU 
argued that the AFLA was a violation of the separation of church and 
state, as much of the initial funding was used to support religious-based 
programs that explicitly promoted religious values (Saul, 1998). A U.S. 
District judge found in favor of the ACLU, but the U.S. Supreme court 
reversed the decision in 1988. The court however, remanded the case for 
further fact-finding, which uncovered constitutional violations in the AF-
LA’s administration. As a result, in 1993, a five-year settlement reformed 
the grant administration process and required all AFLA grantees to submit 
curricula for review of the material’s content and accuracy (Saul, 1998). 

Increased Funding for Abstinence Education in the 1990s
In spite of constitutional concerns over the AFLA and abstinence pro-

grams, the legislature continues to increase funding for abstinence educa-
tion. The 1996 welfare reform legislation contains a specific entitlement 
program for abstinence-only-until-marriage education, allocating $50 mil-
lion per year for five years beginning in 1998. States receiving funds are 
required to match every four federal dollars with three nonfederal dollars, 
thus creating a total of nearly $500 million in spending for abstinence edu-
cation (General Accounting Office, 1998; Wilcox, 1999). The legislation 
dictates the parameters of acceptable abstinence-only programming using a 
strict eight-point definition, which includes teaching that non-marital sexual 
activity is likely to have harmful psychological and physical effects (Advo-
cates for Youth, 2001). Wilcox notes that the legislation did not originally 
allocate any funds for evaluation; after reproductive health advocates pro-
tested, Congress allotted an additional $6 million for evaluation purposes. 

The funding provided under the welfare reform act is having a signifi-
cant impact on the nature of sexuality education. In its first year of funding, 
all fifty states applied for grants under the abstinence-only-until-marriage 
provision (Advocates for Youth, 2001). Some states reported concern over 
the restrictive nature of the abstinence programs, and difficulty in match-
ing federal funds without decreasing funding for existing comprehensive 
programs (General Accounting Office, 1998). Despite these concerns, 
funding for the program was reauthorized in 2002 (Smith, 2002). States 
channel these funds for programs in school districts, community-based 
organizations, and faith-based institutions (Advocates for Youth, 2001). 
While these programs have a range of messages and some are also pri-
vately funded, many have religious affiliations and include material that 
directly refers to specific religious beliefs (Trevor, 2001). The influence of 
religious values on sexuality education policy is frequently debated; Good-

The Battle for Effective Sexuality Education



son and Edmundson (1994) argue that abstinence-only approaches were 
promoted in response to concern over the “value-free” character of previ-
ous sexuality education approaches. The intersection between religious val-
ues and approaches to sexuality education raise powerful questions about 
whether adolescent sexuality is a public health issue or a moral concern. 

Support for Comprehensive Sexuality Education 
In spite of the government’s success in promoting abstinence educa-

tion, there are many who feel abstinence-only programs are fundamentally 
flawed and support alternative ways to promote responsible sexual behavior 
among youth. Supporters of comprehensive approaches to sexuality educa-
tion argue that abstinence-only education programs promote a specific set 
of values, use fear and shame to influence young people’s sexual behavior, 
and contain biased information about family structure, sexual orientation, 
and abortion (Advocates for Youth, 2001; Trevor, 2001). Supporters also 
point to European approaches and policies towards sexuality education. 
Darroch, Frost, and Singh (2001) report that countries such as Sweden, 
France, and the Netherlands have significantly lower rates of teenage preg-
nancy and abortion, despite similar levels of sexual activity among youth. 

Unlike the U.S., however, these countries mandate comprehensive sexu-
ality education. In France and Sweden, research has shown that positive atti-
tudes about sexuality and clear expectations for behavior in sexual relation-
ships contribute to more responsible teenage sexual behavior. In addition, 
adolescents in Europe have greater access to contraceptive services and the 
media is used to promote positive sexual behavior. Despite limited support 
in the United States government, promoters of comprehensive sexuality edu-
cation often refer to the Surgeon General’s 2001 Call to Action, which states 
that adolescents need accurate information about contraceptive methods and 
that providing sexuality education in the schools is crucial for providing youth 
with a basic understanding of sexuality (Office of the Surgeon General, 2001). 

In light of these alternatives, The Family Life Education Act (H.R. 
3469, 2001) was introduced to the 107th Congress in December 2001. 
The Act called for the appropriation of $100 million each year for five 
years to fund block grants to eligible states for family life education pro-
grams, “including education on both abstinence and contraception for 
the prevention of teenage pregnancy and sexually transmitted diseas-
es, including HIV/AIDS” (H.R. 3469, 2001). The requirements for the 
program stated that funding could not be used to teach or promote reli-
gion and that information on adolescent development, healthy life skills, 
and interpersonal skills must be included in program content. In addi-
tion, the bill stipulates an extensive evaluation procedure including a na-
tional evaluation of sample family life programs as well as state evalua-
tion (H.R. 3469, 2001). The bill currently has 89 sponsors in the House, 

Friedman 

  Journal of Student Social Work, Volume II   11 



12   Journal of Student Social Work, Volume II 

but remains in the Subcommittee on Health (Advocates for Youth, 2003).

Limitations of Current Policy 
The current policies regarding sexuality education in the U.S. are 

problematic. First, despite the implementation of federal funding and 
policy for abstinence education, there is no coherent agenda for sexual-
ity education. Most education policy remains under the jurisdiction of 
state and local governments; as a result, states may have multiple poli-
cies governing sex education, leading to tremendous variation in the 
structure and content of programs. Sex education programs may also 
vary among communities depending on local preferences, values, and 
policies, particularly in schools (General Accounting Office, 1998; Kai-
ser Family Foundation, 2000). Geographic location also dictates young 
people’s access to information and resources pertaining to sexuality. 

Second, federal sexuality education policy has been implemented with 
little debate and away from the spotlight. Both the AFLA and abstinence 
education provision of the welfare reform legislation passed without ex-
tensive discussion (Saul, 1998). Such legislative tactics may be necessary 
to the success of the legislation, as recent polls show that only 18% of 
Americans support teaching only abstinence until marriage (Kaiser Fam-
ily Foundation, 2002). Advocates for comprehensive sexuality educa-
tion found there was increased discussion about sexuality education dur-
ing the recent welfare legislation reauthorization process; however, open 
public discussion is necessary for a more informed debate (Smith, 2002).

Lastly, the effectiveness of sexuality education is still open to debate 
among health and social service professionals and policy makers, largely 
as a result of limited evaluation efforts. In summary of the World Health 
Organization’s review of program effectiveness, Grunseit and Aggleton 
(1998) state that the success of HIV and sexuality education programs 
hinges on whether the programs have the capacity to change behav-
ior, whether the programs cause unintended or negative outcomes, and 
whether the programs have been adequately evaluated so that outcomes 
can be relied upon. There is an overall need for increased evaluation fund-
ing and sound evaluation methodologies, particularly for abstinence edu-
cation programs (Kirby, 2002; Grunseit & Aggleton, 1998). The General 
Accounting Office (1998) report on teen pregnancy prevention programs 
found that evaluation was often focused on process rather than outcome; 
state evaluations measured changes in knowledge, attitude, and be-
havioral intentions rather than sexual and contraceptive behavior.  

In spite of these limitations, research has shown that comprehensive 
sexuality and HIV education programs do not increase the sexual ac-
tivity of young people, nor do they hasten the onset of sexual behavior. 
In fact, the literature demonstrates that some programs increase condom 

The Battle for Effective Sexuality Education



   Journal of Student Social Work, Volume II   13

or contraceptive use among sexually active youth and may even de-
lay sexual activity for some youth (Grunseit & Aggleton, 1998; Kaiser 
Family Foundation, 2002; Kirby, 2002). Kirby also identified ten char-
acteristics of curricula effective at reducing unprotected sex, which in-
cluded, among others, using theoretical approaches to behavior change, 
incorporating clear messages about sexual activity and contraceptive 
use, and providing modeling and practice of communication skills.

Given the available research on comprehensive sexuality education 
and the limited information on the efficacy of abstinence education, it is 
significant that current federal policy solely supports abstinence-only-un-
til-marriage programs. Such policy positions raise questions over the gov-
ernment agenda and whether intentions are to reduce teen pregnancy or 
to regulate behavior and “legislate morality” (Ehrhardt, 1996, p.1524). 
Among states receiving federal funds for abstinence programs, the lack 
of evidence-based research was cited as a concern (General Accounting 
Office, 1998). A report by the National Campaign to Prevent Teen Preg-
nancy found only three published evaluations of abstinence-only pro-
grams that were rigorous enough to be included in its literature review 
(Kaiser Family Foundation, 2002). Kirby (2002) cautions that the lack 
of evidence should not be taken as a generalization about the effective-
ness of abstinence-based education; there are a diverse range of absti-
nence-only programs and further evaluation could demonstrate an impact 
on youth sexual behavior. However, until more comprehensive research 
efforts are completed, it is essential that programs be based on accurate 
information and realistic notions of adolescent sexuality (Ehrhardt, 1996). 

Conclusion
In general, concerns over the effectiveness of sexuality education pro-

grams are largely focused on behavior – what will adolescents do as a result 
of receiving such education (Grunseit & Aggleton, 1998). For supporters 
of abstinence-only education, the desired aim is the prevention of sexual 
activity until marriage. As an alternative to this limited scope, Michelle 
Fine (1988) argues that sexuality education should offer an “empower-
ing context in which we listen to and work with the meanings and expe-
riences of gender and sexuality revealed by the adolescents themselves” 
(p.36). This would include providing a safe space for exploring sexuality 
and discourse on desire (Fine, 1988). Ehrhardt (1996) adds that adoles-
cent sexuality is always presented in the context of risk behavior, rather 
than focusing on positive notions of sexual behavior and feelings as part 
of normal human development. As in other areas of educational policy, 
the goal should be to help young people become sexually competent in-
dividuals (Ehrhardt, 1996). This emphasis is important for social workers 
since the profession’s values promote the importance of human relation-

Friedman 



14   Journal of Student Social Work, Volume II   

References
Advocates for Youth. (2001). Toward a sexually healthy America. 

Washington, DC: Author. Retrieved November 20, 2003, from 
http://www.advocatesforyouth.org/publications/abstinenceonly.pdf 

Advocates for Youth. (2003). Action alert. Retrieved November 26, 2003, 
from http://www.capwiz.com/advofy/issues/alert

Brindis, C. (2002). Advancing the adolescent reproductive health policy 
agenda: Issues for the coming decade. Journal of Adolescent Health, 
31(6), 296-309.

Darroch, J.E., Landry, D.J., & Singh, S. (2000). Changing emphases in 
sexuality education in U.S. public secondary schools, 1988-1999. 
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Darroch, J.E., Frost, J.J., & Singh, S. (2001). Teenage sexual and 
reproductive behavior in developed countries: Can more progress be 
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26, 2003, from http://www.guttmacher.org/pubs/eurosynth_rpt.pdf

Ehrhardt, A.A. (1996). Editorial: Our view of adolescent sexuality-a focus
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Health, 86(11), 1523-1525.

Fine, M. (1988). Sexuality, schooling and adolescent females: The missing 
discourse of desire. Harvard Educational Review, 58(1), 29-53.

The Battle for Effective Sexuality Education

ships and enhancing an individual’s ability to meet his or her own needs. 
As practitioners, social workers can effectively provide a safe space for 
adolescents to explore issues of sexuality and make informed choices. 

While the future of sexuality education in the U.S. rests largely on im-
proved evaluation methods and demonstration of effectiveness, the values 
debate cannot be ignored. The ability to demonstrate effectiveness can help 
guide policy decisions towards evidence-based programming rather than 
value-laden agendas; however, even evaluation efforts are rarely value-
free. In addition to evaluation, it is also important to examine the under-
lying goals of social welfare policy — is the goal of sexuality education 
policy to prevent and educate or to restrict personal behavior? As social 
workers, we must understand the impact of such policies and work to sup-
port policies that promote self-determination and individual well-being. 
Rather than regulating and dictating behavior through abstinence only pro-
grams, comprehensive sexuality education programs seek to educate and 
empower young people and increase their access to resources. In this light, 
it is imperative that social workers advocate for comprehensive approaches 
to sexuality education, both by staying informed about local and commu-
nity policies and lobbying national legislators to support comprehensive 
approaches to sexuality education such as the Family Life Education Act. 



General Accounting Office. (1998). Teen pregnancy: State and federal 
efforts to implement prevention programs and measure their 
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States General Accounting Office.

Goodson, P. & Edmundson, E. (1994). The problematic promotion of 
abstinence: An overview of Sex Respect. Journal of School Health, 
64(5), 205-210. 

Grunseit, A.C. & Aggleton, P. (1998). Lessons learned: An update on the 
published literature concerning the impact of HIV and sexuality 
education for young people. Health Education, 98(2), 45-54. 

Health Education Advocate. (2003).  Fact sheet on comprehensive
sexuality education. Retrieved November 20, 2003, from http://www.
healtheducationadvocate.org

H.R. 3469, 107th Congress. (2001). Retrieved November 26, 2003, from 
http://www.thomas.loc.gov

Kaiser Family Foundation. (2000). Sex education in America. California: 
Henry J. Kaiser Family Foundation. Retrieved November 20, 2003, 
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Kaiser Family Foundation. (2002). Sex education in the US: Policy and 
politics. Issue Update, October 2002. Retrieved November 20, 2003, 
from http://www.kff.org/youhhivstds/3224-02-index.cfm

Kirby, D. (2002). Effective approaches to reducing adolescent unprotected 
sex, pregnancy, and childbearing. The Journal of Sex Research, 39(1), 
51-57. 

Luker, K. (1996). Dubious conceptions: The politics of teenage 
pregnancy. Cambridge: Harvard University Press. 

National Association of Social Workers. (2004). Adolescent health. 
Retrieved March 3, 2004, from http://www.naswdc.org/resources/
abstracts/abstracts/adHealth.asp

National Association of Social Workers. (2004). Press release: NASW is 
co-sponsoring partner of the March for Women’s Lives. Retrieved on 
March 3, 2004, from http://www.naswdc.org/pressroom/2004/022304.
asp

Office of Population Affairs. (2003a). Office of adolescent pregnancy 
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gov/titlexx/oapp.html

Office of Population Affairs. (2003b). Adolescent family life 
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opa.osophs.dhhs.gov/titlexx/xxstatut.pdf

Office of the Surgeon General. (2001).  Promoting sexual health and 
responsible sexual behavior. Retrieved November 26, 2003, from 
http://www.surgeongeneral.gov/library/sexualhealth.default.htm  

Olsen, J., Weed, S., Nielsen, A., & Jensen, L. (1992). Student evaluation 

Friedman 

  Journal of Student Social Work, Volume II   15 



of sex education programs advocating abstinence. Adolescence, 
27(106), 369-380.

Saul, R. (1998). Whatever happened to the adolescent family life act? The 
Guttmacher Report, 1(2), 1-5.

Sexuality Information and Education Council of the United States. (1996). 
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guidelines.pdf.

Smith, W. (2002). Reasons for optimism about comprehensive sexuality 
education. SEICUS Report, 30(2), 35-36. 

Trevor, C. (2001). What abstinence-only-until-marriage education looks 
like in communities today. SIECUS Report 29(6), 17-21.

Wilcox, B.L. (1999). Sexual obsessions: Public policy and adolescent girls. 
In N. Johnson and M. Roberts (Eds), Beyond appearance: A new 
look at adolescent Girls (pp.333-354). Washington, DC: American 
Psychological Association.

Jennifer Friedman is a first-year Master’s student at the Columbia 
University School of Social Work and is enrolled in the dual-degree 
program at the Columbia University School of Public Health. She 
is currently an intern at St. Luke’s Roosevelt Hospital in the Adult 
Inpatient Psychiatric Unit. She holds a Bachelor’s degree in Latin 

American Studies from Brown University. Her email address is 
jf2116@columbia.edu. 

The Battle for Effective Sexuality Education

16   Journal of Student Social Work, Volume II   


