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6 things sex educators want you to know about a post-Roe America

Quality sex education will be more important than ever. But it too faces challenges.

Employees and volunteers dismantle exhibits at the Robert Crown Center for Health Education in Hinsdale, Illinois, in January 2018, as it converted to a mobile model to travel to schools to provide sex education.
Zbigniew Bzdak/Chicago Tribune/Tribune News Service via Getty Images
Keren Landman, MD is a senior reporter covering public health, emerging infectious diseases, the health workforce, and health justice at Vox. Keren is trained as a physician, researcher, and epidemiologist and has served as a disease detective at the US Centers for Disease Control and Prevention.

On Friday, the US Supreme Court struck down Roe v. Wade, the legal decision that has for decades granted Americans the right to an abortion.

For young people, the prospect of dramatically reduced access to abortion creates enormous uncertainty — not only about their options in the event of an unplanned pregnancy, but because the political movement that brought us the end of Roe is also seeking, in many cases, to limit quality sex education overall.

I reached out to three sex educators to hear what they want all of us — not just young people — to remember as we head into a post-Roe future. Their responses fell into two categories: concerns about the overlap between the political movements to restrict abortion and sexual literacy, and advice for people who think they might one day need an abortion.

Here’s what they said.

Sex education is a target of the same politics that threatens abortion access

First, let’s be clear that what we mean when we talk about comprehensive sex education is sex ed that hinges on a deep understanding of physical and sexual autonomy. This type of sex ed helps prevent teen pregnancy and sexually transmitted infections, in contrast with the abstinence-focused “sexual risk avoidance” programs that do not. The educators I spoke with are all proponents and teachers of comprehensive sex education.

Many of the educators I spoke with see the assault on abortion access as part of a much broader, long-term strategy geared toward consolidating white male power. That strategy also includes anti-trans legislation, book bans, and efforts to do away with medically accurate sex education, said Michelle Slaybaugh, a former school sex educator who directs social impact and communications at SIECUS, a nonprofit comprehensive sex ed advocacy organization.

All of those movements have something in common, said Slaybaugh: “It’s about controlling women’s bodies,” she said. “When you don’t know about your body, you cannot make decisions that will allow you opportunities to advance.”

Opponents of a proposal to make changes to the sex education guidance for teachers in California rally at the state capitol in Sacramento in May 2019. The California State Board of Education was voting on new, non-mandatory guidance for teaching sex education in public schools, which would give teachers ideas about how to teach a wide range of health topics including speaking to children about gender identity.
Rich Pedroncelli/AP

In contrast to “sexual risk avoidance” education, which focuses on sexual abstinence as prevention, comprehensive sex education is medically accurate, inclusive of diverse sexual orientations and gender identities, and focused on giving learners a sense of autonomy — that their bodies and behaviors are under their control. While the more comprehensive approach is proven to reduce teen pregnancy, it isn’t a requirement in most states. (According to SIECUS, only 11 states mandate school-based sex education and require that it be medically accurate when taught. That said, there are a lot of ways sex ed can be categorized — see this chart — and overall, the sex education picture in the US is an inconsistent patchwork.)

Where good sex education does exist, it often faces attacks. In 2021, state legislators across the US proposed 23 bills seeking to restrict sex education, by requiring an emphasis on abstinence-only programming, making the content “opt-in,” or in other ways. The political reality is that political movements that denounce abortion also denounce comprehensive sex ed: States that restrict comprehensive sex ed are more likely to also restrict abortion.

High-quality sex ed is still extremely popular among teachers, students, and parents

Although some conservative lawmakers are working hard to get abstinence-only messaging into school health classes, they may be out of step with even conservative voters in right-leaning states, who have historically favored comprehensive, medically accurate sex education.

In a 2018 survey from the Public Religion Research Institute, more than half of Republicans surveyed agreed that comprehensive sex education is more effective than abstinence-focused education at lowering youth rates of unintended pregnancies and sexually transmitted infections. Two separate polls conducted in 2013 showed that 90 percent of residents in deeply red South Carolina supported comprehensive sex education, and in North Carolina, 72 percent of parents favored teaching students about birth control. The pattern has repeated itself in other broadly conservative states.

More recently, a boom in state legislation has given parents and other community members the power to censor the educational content that schools provide on the basis of ideological objections. Many of these bills have already led schools to avoid teaching age-appropriate content on LGBTQ sexuality, a cornerstone of comprehensive sex ed.

Posters are displayed in the classroom of a high school in North Hills, California, in May 2018.
Frederic J. Brown/AFP via Getty Images

But on these bills, too, right-leaning elected officials may be more conservative than their own constituents. Nationally, parents — even conservative ones — are split on support for this kind of legislation: In a recent Morning Consult poll of parents, one-quarter of Republicans supported teaching about sexual orientation and gender identity. Meanwhile, 58 percent of Democrats and 38 percent of independents favored teaching on these issues in schools.

If parents want to see their children get medically accurate sex ed in school, “it’s now time for them to move their feet,” said Slaybaugh. “Go to the board meeting, voice your opinion, advocate.”

Sex ed will be more important than ever after Roe

The educators we spoke with agreed that as restrictions on abortion access increase, enabling young people to prevent unwanted pregnancies will become even more important.

In places where public schools provide comprehensive sex education, teen pregnancy rates are significantly lower than in places where they don’t. And while after-school programs may fill some of the gaps in districts where public schools are restricted from providing comprehensive sex education, these programs generally require students and parents to opt in. That raises the possibility that the lowest-income kids — who arguably benefit most from in-school programming — will get left out.

TikTok is also filling in some gaps: Although internet sex ed sources can be rife with misinformation, a growing number of sex educators and health care providers are distributing medically accurate and inclusive sex ed content to large audiences on several social platforms. For example, the account of OB-GYN Jennifer Lincoln, which recently featured a sentient uterus begging to be spared something called “herbal rejuvenation pearls,” has 2.8 million followers.

In the long term, broader access to high-quality sex education is what young people need to make the best decisions for their health and their future. However, the quality and content of sex education isn’t held to a national standard.

As much as sex education has suffered already, Julia Feldman-DeCoudreaux, an Oakland, California-based school sex educator, fears that it will suffer even more now that anti-abortion activists are seeing wins. That would leave a lot of young people with big deficits in pregnancy prevention skills — and without access to resources for dealing with the consequences of those deficits, she said. “If that happens, we’re going to have a catastrophic situation.”

It’s about to be particularly important to avoid unwanted pregnancy — and to act on it quickly

As abortion access becomes more restricted, preventing unwanted pregnancy becomes particularly important, said the educators.

That’s why Hanne Blank Boyd, a women’s and gender studies professor at Denison University in Granville, Ohio, has her students make a list of ways to have sex that can’t get you pregnant. These discussions start out awkward, she said, but it’s worth it to ensure “their definition of what sex is is expansive enough that they know that they have sexual options that are not potentially procreative.”

Feldman-DeCoudreaux said she’ll be encouraging people to use long-acting reversible methods of contraception like IUDs and implantable contraception. “The failure rate is a lot lower than just things like condoms,” she said.

Although it’s impossible for people to predict how they’ll feel in the event of an unplanned pregnancy, it may become particularly helpful to think through the logistics of obtaining an abortion in advance of needing one.

If contraception does fail or isn’t used, Feldman-DeCoudreaux also expects availability for abortion appointments will tighten as the number of providers falls. She therefore plans to advise people to make plans for an abortion faster than they might have previously. “The windows of opportunity for unmedicated abortions or surgical abortions are going to be a little bit pushed up,” she said, “because of a congested system.”

She also tells her students to think about their access to a working car and their networks of friends and family members in places where abortion will remain accessible.

The farther people have to travel to get abortion care, the less likely they are to receive it, Boyd said. “This is the time to start thinking about the practicalities.”

Legal abortions rarely require clinic visits and are safer than pregnancy and giving birth

These days, most abortions happen in the comfort of a person’s home — something many young people don’t realize, said Feldman-DeCoudreaux. “In their minds, it involves going into a clinic, and it involves your legs in the stirrups, and involves something maybe painful or gruesome,” she said.

The concept of abortion as something invasive and expensive is not only scary and alienating but also inaccurate.

Doses of mifepristone, the abortion pill, and misoprostol, which is taken the day after to cause cramping and bleeding to empty the uterus, are pictured at Women’s Reproductive Clinic in Santa Teresa, New Mexico, in May. The clinic has been a provider of abortion pills to mostly women from Texas, where abortion was made largely illegal by Texas Senate Bill 8.
Paul Ratje/The Washington Post via Getty Images

In reality, medication abortions account for more than half of all US abortions, and that number is on the rise. These kinds of abortions involve taking medicines that induce the body to pass the pregnancy similar to the way it would pass a very heavy period. If those pills are provided by mail or at a pharmacy after a telehealth visit, they allow the people using them to make an end run around the travel, cost, and potential for harassment of a visit to an abortion clinic.

It’s important to shift the narrative about what an abortion looks like, said Feldman-DeCoudreaux. “In talking with students, that’s also really comforting information for them,” she said.

Preconceptions involving stirrups and pain make legal abortion seem unsafe, when it is in fact far safer than carrying and delivering a pregnancy, especially for Americans. In the US, 17 birthing parents die for every 100,000 babies born — more than twice as many as in other high-income countries. Meanwhile, legal abortions, including medication abortions, are extremely safe, with only 0.4 deaths for every 100,000 abortions performed between 2013 and 2018.

Don’t think of abortion restrictions as the norm

“Roe might be ending, but abortion in America is not.” That’s the mantra Feldman-DeCoudreaux has been repeating to herself lately.

Thirteen states have trigger laws designed to ban abortions entirely in the event of a decision to overturn Roe. But other states are moving to expand abortion access to accommodate the anticipated rise in demand, and public opinion still broadly supports the right to abortion access.

Boyd says it’s important for her students to understand that rights are not the same things as laws. That is, regulating abortion isn’t what determines whether you have an innate right to decide on your own terms to continue or end a pregnancy.

She also reminds her students that abortion was not always illegal or even controversial in the US, and that other religions and countries regulate abortion very differently than the US does. It’s all part of helping them understand how the fight over abortion fits into our particular place and time, she said: “Don’t ever assume that the way it is in this moment is the way it has to be.”

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