Comprehensive sex education (CSE) is a sex education instruction method based on-curriculum that aims to give students the knowledge, attitudes, skills and values to make appropriate and healthy choices in their sexual lives. The intention is that this understanding will prevent students from contracting sexually transmitted infections in the future, including HIV and HPV. CSE is also designed with the intention of reducing teenage and unwanted pregnancies, as well as lowering rates of domestic and sexual violence, thus contributing to a healthier society, both physically and mentally. Comprehensive sex education ultimately promotes sexual abstinence as the safest sexual choice for young people. However, CSE curriculums and teachers are still committed to teaching students about topics connected to future sexual activity, such as age of consent, safe sex, birth control, abortion, and use of condoms.
Comprehensive sex education is often defined by its very opposition to abstinence-only education. It is routinely praised by its supporters as accepting the reality that the student population will be sexually active in their future. Acknowledging this rather than ignoring it (which abstinence-only is often criticized for) allows educators to give the students the necessary information to safely navigate their future sexual lives. CSE advocates argue that promoting abstinence without accompanied information regarding safe sex practices is a disregard of reality, and is ultimately putting the student at risk. This ideology of arming students to most successfully survive their future sexual experiences underlies the majority of topics within CSE, including condoms, contraception, and refusal skills. While CSE implementation is on the rise in the United States, it remains difficult for state officials to regulate what is and is not taught in the classroom. This is due in large part to the undefinability of CSE; CSE has the potential to comprise such a wide range of sexual information, and over-all focus varies widely between curriculums. Because of the umbrella terminology of "comprehensive", CSE means something radical for some institutions while it can mean something moderate and even conservative for others.
The most widely agreed benefit of using comprehensive sex education over abstinence-only sex education is that CSE acknowledges the student population will be sexually active in their future. By acknowledging this, CSE can encourage students to plan ahead to make the healthiest possible sexual decisions.
There is clear evidence that CSE has a positive impact on sexual and reproductive health (SRH), notably in contributing to reducing STIs, HIV and unintended pregnancy. Sexuality education does not hasten sexual activity but has a positive impact on safer sexual behaviours and can delay sexual debut. A 2014 review of school-based sexuality education programmes has demonstrated increased HIV knowledge, increased self-efficacy related to condom use and refusing sex, increased contraception and condom use, a reduced number of sexual partners and later initiation of first sexual intercourse. A Cochrane review of 41 randomized controlled trials in Europe, the United States, Nigeria and Mexico also confirmed that CSE prevents unintended adolescent pregnancies. A study in Kenya, involving more than 6,000 students who had received sexuality education led to delayed sexual initiation, and increased condom use among those who were sexually active once these students reached secondary school compared to more than 6,000 students who did not receive sexuality education.
UNAIDS and the African Union have recognized CSE’s impact on increasing condom use, voluntary HIV testing and reducing pregnancy among adolescent girls and have included comprehensive, age-appropriate sexuality education as one of the key recommendations to fast track the HIV response and end the AIDS epidemic among young women and girls in Africa.
As the field of sexuality education develops, there is increasing focus on addressing gender, power relations and human rights in order to improve the impact on SRH outcomes. Integrating content on gender and rights makes sexuality education even more effective. A review of 22 curriculum- based sexuality education programmes found that 80 per cent of programmes that addressed gender or power relations were associated with a significant decrease in pregnancy, childbearing or STIs. These programmes were five times as effective as those programmes that did not address gender or power. CSE empowers young people to reflect critically on their environment and behaviours, and promotes gender equality and equitable social norms, which are important contributing factors for improving health outcomes, including HIV infection rates. The impact of CSE also increases when delivered together with efforts to expand access to a full range of high- quality, youth-friendly services and commodities, particularly in relation to contraceptive choice.
A global review of evidence in the education sector also found that teaching sexuality education builds confidence, a necessary skill for delaying the age that young people first engage in sexual intercourse, and for using contraception, including condoms. CSE has a demonstrated impact on improving knowledge, self-esteem, changing attitudes, gender and social norms, and building self-efficacy.
Young people’s access to CSE is grounded in internationally recognized human rights, which require governments to guarantee the overall protection of health, well-being and dignity, as per the Universal Declaration on Human Rights, and specifically to guarantee the provision of unbiased, scientifically accurate sexuality education.
These rights are protected by internationally ratified treaties, and lack of access to sexual and reproductive health (SRH) education remains a barrier to complying with the obligations to ensure the rights to life, health, non-discrimination and information, a view that has been supported by the Statements of the Committee on the Rights of the Child, the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) Committee, and the Committee on Economic, Social and Cultural Rights.
The commitment of individual states to realizing these rights has been reaffirmed by the international community, in particular the Commission on Population and Development (CPD), which – in its resolutions 2009/12 and 2012/13 – called on governments to provide young people with comprehensive education on human sexuality, SRH and gender equality.
As CSE gains momentum and interest at international, regional and national levels, governments are increasingly putting in place measures to scale-up their delivery of some form of life skills-based sexuality education, as well as seeking guidance on best practice, particularly regarding placement within the school curriculum. Sexuality education may be delivered as a stand-alone subject or integrated across relevant subjects within the school curricula. These options have direct implications for implementation, including teacher training, the ease of evaluating and revising curricula, the likelihood of curricula being delivered, and the methods through which it is delivered.
Within countries, choices about implementing integrated or stand-alone sexuality education are typically linked to national policies and overall organization of the curricula. The evidence base on the effectiveness of stand-alone vs. integrated sexuality education programming is still limited. However, there are discernible differences for policy-makers to consider when deciding the position of CSE within the curriculum.
As a stand-alone subject, sexuality education is set apart from the rest of the curriculum, whether on its own or within a broader stand-alone health and life skills curriculum. This makes it more vulnerable to potentially being sacrificed due to time and budget constraints, since school curricula are typically overcrowded.
However, a stand-alone curriculum also presents opportunities for specialized teacher training pathways, and the use of non-formal teaching methodologies that aim to build learners’ critical thinking skills. The pedagogical approaches promoted through sexuality education – such as learner-centred methodologies, development of skills and values, group learning and peer engagement – are increasingly being recognized as transformative approaches that impact on learning and education more widely. As a standalone subject, it is also significantly easier to monitor, which is crucial in terms of evaluating the effectiveness of programming, and revising curricula where it is not delivering the desired learning outcomes.
When sexuality education is integrated or infused, it is mainstreamed across a number of subject areas, such as biology, social studies, home economics or religious studies. While this model may reduce pressure on an overcrowded curriculum, it is difficult to monitor or evaluate, and may limit teaching methodologies to traditional approaches.
Achieving universal access to good quality CSE requires specific strategies for reaching marginalized young people who are out of school. Young people who face discrimination and abuse of their human rights – including the right to education – are at greatest risk of poor SRH outcomes. Young people who face particular challenges in accessing education may also be at increased risk of HIV (re)infection and sexual and gender-based violence. This includes young people with disabilities, young people without parental care, young migrants, young workers, pregnant and married girls, and those from key populations such as young people who sell sex, young people living with HIV, young transgender people, young people using drugs and young men who have sex with men.
Failing to provide marginalized adolescents and young people with CSE can deepen the social exclusion that many experience, limiting their potential and putting their health, futures and lives at greater risk. NGOs have played an important role in developing innovative strategies for reaching vulnerable and hard-to-reach young people through internet and mobile technologies, new media, community and youth centres, as well as sport. Many of the most successful interventions have been developed in partnership with young people. These complementary delivery methods capitalize on existing CSE mechanisms by accurately assessing what young people want, use and can currently access. CSE that includes community-based components – including involving young people, parents and teachers in the design of interventions – results in the most significant change.
LGBT advocates have long been critical of the ways in which comprehensive sex education generally promotes marriage as the end goal for students. Even when curriculums claim to be inclusive of LGBT experiences, they often promote heteronormative lifestyles as "normal."  Inclusion of LGBT identities and health topics is necessary for LGBT students to feel safe and seen in their sex ed classrooms. When these students do not have access to or an interest in marriage they are practically erased from the CSE narrative. Educators have also accused CSE as fundamentally operating as a form of "abstinence-plus," due to the reality that CSE often involves minimal body related information and excessive promotions of abstinence. "So-called Comprehensive Sex Ed" says Sharon Lamb, a professor at the University of Massachusetts Boston, "has been made less comprehensive as curricula are revised to meet current federal, state, and local requirements."
This article incorporates text from a free content work. Licensed under CC-BY-SA IGO 3.0 License statement: Emerging evidence, lessons and practice in comprehensive sexuality education: A global review 2015, 14, 15, 25, 29, UNESCO, UNESCO. UNESCO.