Federally Funded Sex Education: Strengthening and Expanding Evidence-Based Programs

All young people should have access to comprehensive sexual and reproductive health information that is medically accurate, LGBTQ inclusive, and culturally and age appropriate so that they can make informed decisions about their sexual behavior, relationships and reproductive choices. Sex is already part of many adolescents’ lives, and they deserve to receive high-quality information to inform their decision-making. Unfortunately, just 30 states and the District of Columbia require sex education to be taught in schools, and fewer states require that the school curricula include key sex education topics or even medically accurate information. The federal government also wastes $110 million per year on misleading and harmful programs that only cover abstinence. Federal policymakers have an opportunity to strengthen existing sex education programs by funding them at adequate levels and to create a new comprehensive sex education funding stream through the Real Education and Access for Healthy Youth Act.

How federally funded sex education programs work

There are currently two federal funding streams for evidence-based and medically accurate sex education: the Teen Pregnancy Prevention Program (TPPP) and the Personal Responsibility Education Program (PREP).

Teen Pregnancy Prevention Program

• TPPP supports the implementation and evaluation of evidence-based programs and innovative approaches to reducing pregnancy among adolescents. Its primary purpose is to build an evidence base of effective sex education programs.
• The program was established in 2010. Since 2014, it has been funded at $101 million each year. Ten percent of funding goes to training, technical assistance, evaluation and other forms of program support. Of the remaining funds, 75% goes to grantees that replicate effective programs (Tier 1) and 25% goes to grantees that test innovative strategies to reduce adolescent pregnancy rates (Tier 2). Both Tier 1 and Tier 2 programs are evaluated as part of TPPP.
• The program currently supports Tier 1 grants in 29 states and Puerto Rico and Tier 2 grants in 13 states. Grantees include for-profit and nonprofit organizations, clinics, hospitals, state and local governments, schools and universities.

Personal Responsibility Education Program

• PREP supports a variety of evidence-based programs that aim to prevent pregnancy and STIs among adolescents by emphasizing abstinence and contraception.
• The program focuses on young people aged 10–19 who are homeless, in or aging out of foster care, living with HIV or AIDS, victims of human trafficking or living in areas with high adolescent birth rates. It also focuses on people younger than 21 who are pregnant or parenting.
• The program was established in 2010 and has been funded at $75 million per year.
• PREP currently supports three types of grantees—state, tribal and nongovernmental—across 50 states, the District of Columbia and seven territories or countries.
• PREP-funded curricula are not required to be comprehensive, but the majority incorporate elements of comprehensive sex education: healthy relationships (98%), healthy life skills (81%) and adolescent development (73%).

Comprehensive sex education

• There are currently no federal programs dedicated to funding and expanding access to comprehensive sex education, which is considered the gold standard of sex education.
• Comprehensive sex education covers a broad range of topics, including human development, relationships, communication and decision-making skills, sexual behavior, sexual health, and cultural representations of sexuality and gender. These curricula frame sexuality as a normal part of life and are medically accurate, LGBTQ inclusive, and culturally and age appropriate.

Impact of sex education programs

Teen Pregnancy Prevention Program

• To date, HHS has identified 48 programs funded by TPPP that meet criteria for program effectiveness, including one or more favored outcomes in increased contraceptive use or reduced sexual activity, number of sexual partners, STIs or pregnancy.
• These programs and their evaluations provide useful information about where, when and with whom programs are most effective, allowing program organizers to design curricula that best fit their context and audience.

Personal Responsibility Education Program

• Curricula funded by PREP fulfill the goals of the program by changing behaviors related to pregnancy risk. For example, after taking part in PREP-funded curriculum in 2016–2017, half of participants said they were more likely to abstain from sex for the next six months. Among those who said they might have sex, 70% reported they were more likely to use birth control and 77% were more likely to use a condom than before participating.
• PREP curricula also resonate with young people: About 70% of participants expressed interest in the content, 87% felt respected by the program, and more than 70% said that PREP helped them prepare for adulthood.

Comprehensive sex education

• A 2018 review of curricula from around the world, commissioned by the United Nations, found that comprehensive sex education programs contribute to numerous outcomes for adolescents, including delayed initiation and decreased frequency of sexual intercourse, fewer sexual partners and increased use of condoms and other contraceptives.
• Research indicates that comprehensive sex education programs also can reduce homophobia, expand students’ understanding of gender and gender norms, decrease intimate partner violence and improve communication skills.

What policymakers can do

Congress and the Biden-Harris administration should take the following steps:

• Pass the Real Education and Access for Healthy Youth Act, which would—among other provisions—eliminate funding streams for abstinence-only-until-marriage programs and establish five-year grants for comprehensive sex education programs. Curricula funded through these grants must follow standards established by experts and cover a variety of sex and sexuality topics, including puberty and adolescent development; anatomy and physiology; sexual orientation, gender identity and gender expression; contraception, pregnancy and reproduction; STIs, including HIV; healthy relationships; and interpersonal violence.
• Increase annual TPPP funding to $150 million to help the Biden-Harris administration restore program integrity, high-quality evaluation and adequate technical support after years of damage under the Trump-Pence administration. Notably, the prior administration halted funding to the Teen Pregnancy Prevention Evidence Review, which informs TPPP grantmaking by systematically reviewing teen pregnancy prevention research.
• Increase PREP funding to $150 million for five years, which would allow the program to double the number of young people served, from 110,000 to 220,000 annually. Guaranteed funding for five years would enable grantees to develop programs that best fit their communities’ needs as they recover from the pandemic.
• Eliminate abstinence-only programs. Abstinence-only programs are not sex education—they are misinformation campaigns that fail to meet the needs of young people. Congress must stop funding programs that stigmatize sex, ignore or bully LGBTQ children and reinforce harmful gender norms.