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 options. Sex is already part of many adolescents’ lives, and they deserve to receive high-quality information to inform their decision-making. 

Unfortunately, just 36 states and the District of Columbia require sex education to be taught in schools. Even fewer mandate that curricula include key topics, such as contraception and consent, or convey medically accurate information. 

The federal government does not mandate sex education for youth or dictate what is taught—such decisions are made on the state and local levels—but it does support programs to reduce adolescent pregnancy. Two of these are evidence-based sex education programs. However, the federal government also spends up to $110 million per year on misleading and harmful abstinence-only-until-marriage programs that deny young people necessary and even lifesaving information about their own bodies, reproductive health and sexuality, and that fail to achieve their stated goals.

While the US Department of Health and Human Services (HSS) administers federal funding for sex education programs, the US Department of Education plays a key role by supporting  the implementation of evidence-based programs in schools and promoting research initiatives and best practices across a range of subjects. Dismantling the Department of Education would place additional strains on schools and could weaken federal support for comprehensive sex education programs, making it easier for states to adopt more restrictive or medically inaccurate curricula. This would widen existing inequities in students’ access to evidence-based information, especially in states with weak or minimal sex education standards. 

Federal policymakers must preserve evidence-based sex education, resist efforts to end programs that provide young people with essential information about their health and their bodies and eliminate funding for abstinence-only programs.

How federal evidence-based programs work

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

Teen Pregnancy Prevention program

The TPP program, established in 2010 and run by HHS, supports the implementation and evaluation of evidence-based programs and innovative approaches to reducing pregnancy among adolescents. Its stated purpose is to build an evidence base of effective sex education programs.

Since 2014, Congress has appropriated $101 million each year in funding for the program. 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).

As of April 2025, the program supports Tier 1 grants in 26 states and Puerto Rico and Tier 2 grants in nine states and Washington, DC. Grantees include for-profit and nonprofit organizations, clinics, hospitals, state and local governments, schools and universities.

TPP program impacts

• HHS has identified 52 programs funded by the TPP program 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 rates.
• 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

Established in 2010, 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 youth 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.

Congress has funded PREP at $75 million per year. The program supports three types of grantees—state, tribal and nongovernmental—across 50 states, DC 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 (97%), healthy life skills (86%) and adolescent development (83%).

PREP impacts

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 2020–2021: 

• More than half (56%) of participants said they were more likely to abstain from sex for the next six months. 

• Among those who said they might have sex, 59% reported they were more likely to use birth control and 65% were more likely to use a condom than before participating.

PREP curricula also resonate with young people: 

• About 69% of participants expressed interest in the content.

• Roughly 88% felt respected by the program.

• More than 77% said that they were more likely to better understand what makes a relationship healthy.

How federal abstinence-only programs work

The goal of federal abstinence-only programs is to prevent adolescent pregnancy by discouraging young people from having sex before marriage. Though these programs purport to encourage “sexual risk avoidance,” this terminology reflects an attempt to disguise abstinence-only messaging and ineffective abstinence-only approaches with a more appealing public health framing. Predecessor abstinence education grant programs were simply rebranded.

While the curricula funded through these federal programs must provide information that is medically accurate, they are far from comprehensive. For example, the Title V Sexual Risk Avoidance Education program allows grantees to discuss contraception, but they are barred from providing demonstrations of how specific methods work. In addition, abstinence-only programs typically overemphasize the risks associated with contraception and downplay or overlook its benefits beyond pregnancy prevention, such as reducing pregnancy-related mortality and morbidity, reducing the risk of developing certain reproductive cancers and treating menstrual symptoms and disorders.

There are two main federal funding streams dedicated to abstinence-only programs: the Title V Sexual Risk Avoidance Education (SRAE) grant program, and the Discretionary Sexual Risk Avoidance Education (SRAE) grant program, which receives funding through annual spending bills. Both are managed by HHS.

• The Title V Sexual Risk Avoidance Education program promotes abstinence as the primary method for preventing teen pregnancy and STIs. It emphasizes avoiding all sexual activity outside of marriage and typically excludes instruction on contraceptive use beyond failure rates. Since 2017, it has been funded at roughly $75 million per year. Grantees in 36 states and territories received $49.2 million for fiscal year (FY) 2024.

• The Discretionary Sexual Risk Avoidance Education program is a rebranding of the Competitive Abstinence Education grant program and was established by the 2016 appropriations bill. Funding for the program, initially $5 million per year, has grown steadily to $35 million annually. The program awarded $9.6 million to 28 recipients in 13 states and territories for FY 2024.

• The general departmental-funded Sexual Risk Avoidance Education (GD-SRAE) program awarded grants for a three-year project period. This program is funded by the appropriation for the General Departmental Management for the Office of the Secretary under HHS. The program awarded $13.6 million to 29 recipients in 16 states for FY 2024.

Impacts of abstinence-only programs

Research shows that federal abstinence-only funding does not lower adolescent birth rates. In fact, the more that state policies emphasize abstinence-only programs, the higher the incidence of adolescent pregnancies and births. An HHS-funded analysis found that abstinence-only programs do not affect the incidence of pregnancy, HIV or other STIs in adolescents. In addition, abstinence-only programs are often heteronormative and portray LGBTQ+ students as deviant. Stigma and discrimination against LGBTQ+ students increase their risk of HIV infection, substance use disorder, suicide and experiencing violence.

Federal programs omit comprehensive sex education

No federal programs specifically fund and expand 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.

Impacts of 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.

Policy recommendations

Federal policymakers should:

• 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 would follow standards established by experts and cover a variety of reproduction 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.
• Resist efforts to dismantle or defund the Teen Pregnancy Prevention program. The first Trump administration halted funding to the Teen Pregnancy Prevention Evidence Review, which informs TPP program grantmaking by systematically reviewing teen pregnancy prevention research. It is critical to maintain the TPP program, which prioritizes the role of evidence in support of initiatives to help people avoid pregnancies that they do not want and plan and space pregnancies that they do.
• 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.
• 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, or reinforce harmful gender norms.