Oct. 21 2021

Adolescent Health Professionals Critique New Abstinence-Only Sex Ed Standards

K-12 “standards” from the Medical Standards Institute of Health are woefully incomplete, inaccurate, and wrongly focus on marriage and abstinence as solutions to adolescent sexual health

Members of the Society for Adolescent Health and Medicine (SAHM) are calling attention to a crisis in sex education, specifically the continued creation and endorsement of abstinence-only curricula being taught across the U.S. The commentary in the Journal of Adolescent Health is in response to the Medical Institute for Sexual Health’s recently released K-12 Standards for Optimal Sexual Health (M-SOSH), which the authors find deeply flawed for its scientific inaccuracies, omitted topics, and misdirected focus on marriage and abstinence as solutions to adolescent sexual health. 

The authors, led by John Santelli, MD, MPH, at Columbia University Mailman School of Public Health, sound the alarm on the decline in sex education across the country. Despite substantial evidence that comprehensive sex education works to promote sexual health among adolescents, as well as strong support for its implementation from health professionals and parents alike, delivery of sex education in the U.S. has declined over the last 25 years, they write. 

“It is our duty as adolescent health professionals to implement the tools we have to do better in providing comprehensive sex education to young people,” said Santelli, lead author, and professor of population and family health and pediatrics. “Promoting abstinence-only curriculum goes against the evidence and is unequivocally a step in the wrong direction.” 

The authors argue that M-SOSH ignores science and instead promotes an ideological agenda of abstinence until marriage. Abstinence-only-until-marriage approaches to sex education have been proven time and again to be not only ineffective but also harmful as they often withhold important health information from young people, they write.

By contrast, comprehensive sex ed curricula provide adolescents with accurate information, opportunities to explore their identities and values, and skillsets in communication and decision-making. The commentary endorses the National Sex Education Standards (NSES) for its clear, age-appropriate instruction to reduce risk behaviors among adolescents and improve their overall health and wellbeing. 

The authors provide a side-by-side comparison of NSES and M-SOSH’s glossaries, highlighting critical topics missing from M-SOSH such as sexual orientation and gender identity, social determinants of health; disabilities; reproductive justice; PrEP therapy for HIV infection; and adolescent rights and minor consent laws. 

“Sexual orientation and gender identity are foundational to any sex education program,” said David Bell, MD MPH, president of SAHM, and professor of population and family health at and pediatrics. “We cannot simply pay lip service by mentioning the terms. Adolescents need clear guidance to explore these topics both in the exploration of their own identities and to be able to navigate the world around them.”

The authors provide examples of M-SOSH inaccuracies, including misinformation about adolescents’ cognitive development and how it affects their decision-making abilities. The risks of sex outside of marriage to an adolescents’ physical and mental health are also grossly exaggerated, the authors write.

“The emphasis on marriage throughout M-SOSH is cause for concern,” said Santelli. “The vast majority of Americans have sex before they are married. The notion that marriage is the ideal setting for sexual activity is unrealistic, lacks scientific backing, and is frankly outdated.”