With spike in STDs, should Michigan force all schools to teach sex ed?

A dramatic rise in sexually transmitted diseases among young people in Michigan has public health experts questioning whether the state needs to reconsider what schools are teaching — or not teaching — in sex education programs.

State law requires students to be taught about HIV — and about the benefits of abstinence until marriage, if they take sex ed. But Michigan does not require districts to teach sex education, or address contraception, despite studies showing such instruction reduces rates of STDs and unplanned pregnancies when compared to programs that focus solely on the benefits of abstinence until marriage.   

Related: HPV cancer rates are up. Yet many Michigan doctors won't talk about it.

Related: With spike in STDs, should Michigan force all schools to teach sex ed?

Laurie Bechhofer, an HIV/STD education consultant at the Michigan Department of Education, said Michigan’s laws give local districts “a lot of leeway to offer a very comprehensive curriculum.” 

But Michigan’s sex education laws also allow schools to avoid components of what public health officials say are comprehensive tools for sexual safety and decisionmaking. In addition to not requiring sex education, there is no requirement for school districts to discuss sexual orientation. Schools are not allowed to make condoms or other contraceptives available to students. And they can lose funding if they discuss abortion as an option for an unplanned pregnancy. 

The Guttmacher Institute, a New York-based research and policy organization that supports reproductive rights, periodically reviews and compares state sex education laws. It found that Michigan:

• Is one of 10 states that require school districts to teach about HIV but does not require them to teach sex ed  

• Is one of 29 states that requires educators to stress abstinence in sex education and one of 19 that stress the importance of sex only in marriage.

• Is among 35 states that require parents to be notified if sex ed is taught and allow parents to “opt-out” children from instruction.

• Is silent when it comes to sexual orientation

• Prohibits information that is “medically inaccurate.” (Seventeen other states require program content to be medically accurate)

• Requires information on sexual decision-making and self-discipline, personal boundaries, and dating and sexual violence prevention. 

Elizabeth Nash, Guttmacher’s senior state issues manager, said Michigan’s laws fall short by stressing abstinence without requiring comprehensive sex education.

“That’s not how humans work. People have sex,” she said. “Young people have sex. And instead of scaring them and talking about only abstinence, we need to help young people have healthy relationships they deserve and have all the information about contraception and protection they need. That includes absentences and whether you want sex. You have to have all those tools.” 

But an advocate for one popular program that stresses abstinence said its curriculum provides healthy choices to young people. Even if teens don’t wait until marriage to have sex, advocate Natasha Mueller said, abstinence programs may influence students to delay sexual activity until they are older and can make better decisions. 

The federal government continues to pour money into abstinence-only programs, even though studies suggest abstinence-only curricula do not stop teens from having sex. In a 2011 study, University of Georgia researchers reviewed state laws and compared pregnancy rates, concluding that abstinence-only programs fail to reduce pregnancy and in fact “may actually be contributing to the high teenage pregnancy rates in the U.S.”

In a separate review, the Indiana University School of Medicine and Columbia University Mailman School of Public Health reviewed reseach on sexual health education, public attitudes toward sex education and student perspectives on sex, and concluded that “abstinence-only policies violate the human rights of adolescents because they withhold potentially life-saving information on HIV and other (STDs).”

Earlier this year, a study in the American Journal of Public Health found that federal abstinence-only funding had no effect on adolescent birth rates overall but corresponded to an increase in adolescent birth rates in ideologically conservative states.

Nash said Michigan’s sex education laws may also have a chilling effect on educators as well because the state can penalize a district up to 1 percent of its funding if it fails to follow the law.

This year, East Lansing Public Schools’ board of education is challenging a part of the state law that requires districts to discipline educators who “refer a pupil for an abortion or assists a pupil in obtaining an abortion” when the educator is not the student’s guardian or parent.

The board voted 6-0 against adopting such an employee disciplinary policy in September, and went a step further: voting 6-0 on a resolution calling the requirement “vague, overbroad, and an overreach by the state” and asking the legislature and Gov. Gretchen Whitmer to repeal that part of the law.

“The community has overwhelmingly supported the Board's position on this issue,” board president Erin Graham, told Bridge Magazine in an email.

Meanwhile, a measure by Sen. Jon Bumstead, R-Newaygo, would eliminate the requirement of a credit hour of health education physical education to graduate high school. 

Less sex. Less protection, too.

Whatever the feelings on how sex ed should be taught, data show that teens are having sex less often these days.

In 2014, 34 percent of teens reported being sexually active compared to just under 29 percent in 2017, according to the federal Youth Risk Behavior Surveillance System, or YRBSS, a national school-based survey.

But when teens do have sex, they’re more often doing so without condoms, according to the same survey, which found that just under 42 percent of students used a condom during their last sexual encounter prior to the 2013 survey, compared to more than 46 percent in 2017.

Barb Flis, founder of the Parent Action Network, which works with schools, community organizations and parents to teach youth about sexuality, said Michigan’s laws work against equipping students with the information and confidence they need if they become sexually active, or decide to abstain. 

For the most part, she said, educators try to offer a comprehensive curriculum and most offer at least some sex education. But she and others say they worry that other school priorities, such as standardized testing, can squeeze out time that might be devoted to health and sex education.

“I’m not saying our teachers don’t care. They’re plugging away as much as they can, but they don’t have the time, and they don’t have the funding,” Flis said.

Tory Ervin, a nurse practitioner at the Corktown Health Center in Detroit, said another important aspect of sex education involves teaching young people about choice, respect, and the skills of talking.

Too often, young people visiting her clinic are sexually active and being screened for sexually transmitted diseases when they hear for the first time about healthy relationships, their right to control their own bodies, and how to negotiate the conversation about protection, or even how to say “no.”

Being able to tell a new partner, “‘We’re going to enter a new relationship, so let’s get tested.’...(is) a difficult conversation, and it can be an empowering conversation,” Ervin said. “But you need to hear how to have that conversation from more than your medical provider,” she said.

But Natasha Mueller, education director for the Grand Rapids-based Pregnancy Resource Center, which has ties to the anti-abortion movement and provides a range of services for pregnant women, including counseling on whether to get an abortion, defended programs like Willing to Wait, noting that while it does stress abstinence, it also discusses STDs, pregnancy and options for contraception. 

The curriculum, taught in more than two dozen school districts in four western Michigan counties, encourages discussions on whether to engage in sex in the same one way an educator would discuss the risks of underage drinking, or the decision to forego exercise, Mueller said.

“We talk about it within the framework of avoiding risk, acknowledging there is risk with sex,” she said.

Even for students who don’t choose to wait until marriage, Willing to Wait may persuade them to delay sexual activity until they’re older; that, in turn, means they’re more developmentally ready to have thoughtful discussions with their partners and insist on infection protection and contraception, Mueller said.

She said students may feel that Google can give them the upper hand in understanding physical anatomy, but some things — negotiating skills and respect, among them — are better learned in person by trusted educators, parents and others.

“High schoolers are really interested in the relationship-building… and that  goes into that negotiation and being able to identify unhealthy relationships,” Mueller said. “If someone doesn't respect your boundaries (and) that conversation about contraception, then that's not a healthy relationship.”