It Takes Two (or More): How Interprofessional Advocacy Could Help Remove Misinformation

by Tori DeLaney, Associate Member, University of Cincinnati Law Review Vol. 91

I. Introduction

Sex education is a highly controversial topic that involves social values, public health, and litigation at all levels of government, particularly the state and local level.¹ Sex education is only mandatory in twenty-eight states and the District of Columbia with an additional nine states mandating HIV/AIDS education.² The thirty-seven states that address sex education handle access to this education and its topics differently.³ Despite mandating sex education, these states may not require their courses to be taught equally across all counties or require information to be medically and legally accurate.⁴ States that do not provide overarching statutory rules for sex education leave it to the discretion of school districts.⁵ This lack of uniformity can lead to unequal access to sex education and the possibility of inaccurate sexual health information.⁶

This article recognizes the importance of state and local control over sex education but argues that states and local policies must require accuracy in sexual health curricula. Section II briefly explains the history of sex education before noting the areas where misinformation⁷ has been most prevalent. Section III discusses policy advocacy from various professional positions and why interprofessional collaboration is one of the best ways to reform sex education. Nationwide state mandates requiring sex education would ensure impactful change, but this article focuses on reforming current sex education programs through inter-profession collaboration.⁸ Finally, Section IV concludes that state-sanctioned misinformation in sex education should be addressed as soon as possible through policy advocacy and student-parent involvement.

II. Background

Thirty-seven states and the District of Columbia require some form of sex education.⁹ States like Missouri, Massachusetts, Virginia, Colorado, Arizona, and Louisiana do not require public schools to teach sex education but create mandatory curricular guidelines for when the subject is taught.¹⁰ A majority of states with curricular guidelines insist that sex education follow the ideology of abstinence-until-marriage.¹¹ Abstinence-until-marriage sex education emphasizes the importance of teens refraining from any sexual activity until they are married.¹² States like Alaska and Idaho do not have any requirements around sex education but still protect the parents’ right to “opt-out” (remove) their child from a sex education class for moral or religious reasons.¹³ Sex education’s instability across states is rooted in its adversarial history and states, communities, and organizations’ desire to control the narrative of sex education in public schools, sometimes at the expense of accuracy.¹⁴

A. A Brief History of Sex Education in the United States

Until the 1900s, sex education was primarily taught at home with an emphasis on Christian values, social rules, and legal mandates that confined sex to heterosexual marriages.¹⁵ Sex education became more widespread during World War I, when the spread of sexually transmitted infections (“STIs”) created public health concerns.¹⁶ Sex education in public schools mirrored the previous at-home sex education, namely focusing on abstinence until marriage.¹⁷ Abstinence-until-marriage programs dominated school-based sex education from 1920 to 1960.¹⁸ The 1960s and 70s saw a shift in the social consciousness, legal landscape, and the creation of organizations like the Sexuality Education and Information Counsel of the United States (“SIECUS”) who “supported value-neutral, comprehensive sex education . . . and taught students how to access contraceptives.”¹⁹ An anti-sex education movement quickly sprouted as a counter movement to comprehensive sex education.²⁰ The anti-sex education movement initially tried to ban sex education.²¹ When bans failed, the movement focused on reaffirming and strengthening the presence of abstinence-only education in public schools.²² This movement has also fostered litigation around free exercise and parental involvement in educational decision making related to sex education.²³ The federal government has provided states with funding for public schools using abstinence-until-marriage sex education programs since 1981.²⁴ Forty-nine states have accepted Title V abstinence-only-until-marriage funds since the fundings’ inception.²⁵ Unfortunately, an investigation of federally funded, abstinence-until-marriage programs found that eighty percent of these programs “contained false, misleading, or distorted information about reproductive health.”²⁶ While the federal government has rebranded these programs,²⁷ they continue to disseminate the same message of abstinence-until-marriage.²⁸

B. Loopholes: Misinformation and Sex Education

State statutes outline whether public schools can teach sex education, what content can be covered, and when.²⁹ Some states and localities use silent or vague statutes to propagate misinformation through their sex education programs.³⁰ The misinformation disseminated through public schools can include medically and legally inaccurate information.³¹

Only seventeen states require medically accurate information in sex education curricula.³² For example, North Carolina requires information to be “factually accurate biological or pathological information . . . related to the human reproductive system” and “accurate statistical information” about contraceptives or prophylactics.³³ Similarly, California declares “all factual information presented shall be medically accurate and objective.”³⁴ Some states, like Tennessee, say that sex education must be medically accurate but heavily restrict sex education curricula to abstinence, often distorting medical accuracy through the narrative of abstinence.³⁵ Finally, some states’ statutes give public schools the discretion to teach or not teach medically accurate information through their silence on the issue.³⁶

States similarly perpetuate misinformation by suggesting unconstitutional statutes continue to dictate the social and legal lives of young people in that state.³⁷ For example, Arizona and Mississippi require public schools that teach sex education to inform students they could be criminally liable under the states’ unconstitutional sodomy laws.³⁸ Twenty states continue to promote abstinence-until-marriage while implying marriage does not include LGBTQ+ relationships.³⁹ This means more states allow or mandate public schools to teach that unconstitutional statutes are enforceable than require medically accurate sex education.⁴⁰

III. Discussion

Misinformation is harmful to individuals and to democracy.⁴¹ Yet the misinformation perpetuated by states through sex education programs has not been discussed or addressed. One solution for dealing with misinformation in sex education courses is interprofessional legislation drafting and community advocacy.⁴²

A. Educators

Students, and their parents, trust schools to provide accurate information related to literacy and mathematics. They should also be able to expect the same accuracy from their public school’s sex education programs. However, states are increasingly restricting what educators can teach students, which may make some educators hesitant to provide accurate information that could be interpreted as contrary to law.⁴³ Educators and parents willing to advocate for medically and legally accurate information would not only better serve students but could put a check on state and school-board level censorship more generally. Educators can work alongside legal and healthcare professionals to ensure their advocacy reflects peer-reviewed, objective research.

B. Public and Medical Professionals

Similarly, healthcare professionals should be motivated to advocate for accurate sex education courses because of the public health risks posed by inaccurate sex education or no sex education.⁴⁴ Public health risks include rampant STI transmission and high teen pregnancy rates.⁴⁵ Parents increasingly favor comprehensive education, which studies suggest lowers teen pregnancy rate and STI transmission compared to abstinence-only programs.⁴⁶ Even if healthcare professionals do not feel their local communities would embrace a comprehensive sex education program, they could advocate for sex education instruction that is expansive enough to require medical accuracy.⁴⁷ Sex education in public schools began as a public health measure and should continue as such.⁴⁸ Healthcare professionals can work alongside educators and lawyers to ensure young adults receive enough information to keep themselves and their community healthy.

C. Legal Professionals

Legal professionals are also incentivized to advocate for accurate sex education in public schools because of our policy responsibilities to “seek improvement of the legal system” and use our knowledge “in reform of the law and work to strengthen legal education.”⁴⁹ By combating misinformation in sex education, legal professionals are helping negate the spread of bad legal information. Advocacy around sex education also creates opportunities to expand on existing legal struggles because of the various legal areas that intersect within sex education. For example, sex education touches on juvenile law, education law, reproductive rights, parental decision-making rights, and civil rights related to gender and sexuality. Legal professionals should work alongside educators and healthcare professions to ensure any sex education policy, legislation, or regulation proposed is medically accurate, supports young people’s development, and does not allow states to perpetuate legally dubious or wrong information.

D. Collaboration

Interprofessional and interdisciplinary advocacy are vital to reforming the current sex education structure because of the intersectional nature of sex education. This advocacy should be for practical changes to remove misinformation and implement textual changes. A practical change might entail educators planning sex education curricula using peer-reviewed, accurate, and objective information provided by healthcare professionals while legal professionals ensure these educators will not face disciplinary or employment consequences for teaching the material. Legal professionals could push for textual and practical change by including accuracy language in draft legislation or school-board policies made in consultation with healthcare professionals and educators. Interprofessional collaboration may be difficult to implement because professions, like other institutions, are made of individuals with their own opinions. Professionals will not always agree on how much change to demand, but they should recognize the harm misinformation in sex education perpetuates, including medical and legal issues. The process may be arduous, but professionals should advocate for the removal of inaccurate information from sex education courses to protect our youth.

IV. Conclusion

Sex education is a controversial and interdisciplinary subject that should be handled at the state and local level. However, states that completely lack sex education statutes or do not mandate medically and legally accurate sex education do a disservice to today’s young people. Interprofessional collaborations can help remove detrimental misinformation by proposing nuanced, well-informed policies and state legislation. Interprofessional solutions will need to consider both the social values and health needs within specific communities while advocating for accuracy.⁵⁰ These policies or legislation should ensure practical access, not just textual promises.⁵¹ Professionals at the local and state level, alongside students and parents, can advocate for practical solutions that hold public schools accountable for providing accurate and objective information in sex education.

Cover Photo by cottonbro studio on Pexels

Tori DeLaney

Tori DeLaney focused their undergraduate research on how "acceptable" gender identities fluctuated in novels and, by extension, society over time. Tori later worked as a Family Law and Guardianship paralegal where they observed the impact of gender on the law and vice versa. Tori hopes Law Review can be an avenue to examine the obvious and subtle ways gender and law mingle.

References

1
Sex Education in Schools, 20 Geo. J. Gender & L. 467, 467 (Melody Alemansour et al. eds.) (2019); Clifford Rosky, Anti-Gay Curriculum Laws, 117 Colum. L. Rev. 1461, 1486 (2017); John E. Taylor, Family Values, Courts, and Culture War: The Case of Abstinence-Only Sex Education, 18 Wm. & Mary Bill of Rts. J. 1053, 1078 n.123 and accompanying text (2010).
2
I will be referring to the HIV/AIDS programs as “sex education” because they are regulated and treated with the same suspicion as other models of sex education and are frequently mixed with sex education programs. See Sex and HIV Education, Guttmacker Inst. (Feb. 1, 2023), https://www.guttmacher.org/state-policy/explore/sex-and-hiv-education [https://perma.cc/EP4A-UXKZ].
3
Sex Education in Schools, supra note 1, at 468.
4
Sex Education in Schools, supra note 1, at 472; Sex and HIV Education, supra note 2 (showing Tennessee only requires sex education to be taught in counties where the teen pregnancy rate among 15–17-year-olds is at least 19.5 per 1000 students).
5
Sex Education in Schools, supra note 1, at 468.
6
Landes Bauter, Oklahoma’s Health Education Act and the Benefits of Comprehensive Sex Education Curriculum, 21 Seattle J. Soc. Just. 249, 249 n.2 and accompanying text (2022); Sex Education in Schools, supra note 1, at 468; Patrick Malone & Monica Rodriguez, Comprehensive Sex Education vs. Abstinence-Only-Until-Marriage Programs, Am. Bar Ass’n (Apr. 1, 2011), https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/human_rights_vol38_2011/human_rights_spring2011/comprehensive_sex_education_vs_abstinence_only_until_marriage_programs/ [https://perma.cc/3ZBX-SDGH].
7
Misinformation in this article will encompass information that may have elements of truthfulness but are ultimately false and disinformation – information that is false and intended to mislead.
8
For more information on why accuracy alone may not be enough see Bauter, supra note 6, at 250-52; Malone & Rodriguez, supra note 6, at “Mandating Education and Topics.”
9
Sex and HIV Education, supra note 2.
10
Id.
11
This is compared to the number of states that mandate a comprehensive sex education format where public schools emphasize a variety of contraceptive methods like hormonal and non-hormonal birth control, condoms, and abstinence. Sex Education in Schools, supra note 1, at 472-76; Rosky, supra note 1, at 1463-64.
12
Sex Education in Schools, supra note 1, at 469 n.4.
13
Sex and HIV Education, supra note 2; Sex Education in Schools, supra note 1, at 477.
14
Sex Education in Schools, supra note 1, at 476-77, 483-84, 486, 496; Bauter, supra note 6, at 252; Sex and HIV Education, supra note 2.
15
Bauter, supra note 6, at 250-51.
16
Id. at 251.
17
Id.
18
Id.
19
Id. at 252.
20
Id.
21
Id.
22
Id.
23
Sex Education in Schools, supra note 1, at 483-84, 486; Taylor, supra note 1, at 1061, 1068, 1072 (arguing sex education is a battle of nomoi and reflects conflicting values rather than disparate beliefs around public health issues like teen pregnancy and STI rates).
24
The Obama administration attempted to create federal funding guidelines for a comprehensive sex education program. However, this program was scaled back under the Trump administration. See Sex Education in Schools, supra note 1, at 479, 481-83.
25
The only state that has not used abstinence-until-marriage funding is California. Id. at 481.
26
Id. at 496 (original quotation marks omitted).
27
Abstinence-only programs have been rebranded as sexual risk avoidance education (“SRAE”). Id. at 480.
28
Jack Malamud, Ending Federal Funding for Abstinence-Only Education, Brown Pol. Rev. (May 22, 2020), https://brownpoliticalreview.org/2020/05/ending-federal-funding-for-abstinence-only-education/ [https://perma.cc/5KP7-RRS6]; Sex Education in Schools, supra note 1, at 480.
29
Malone & Rodriguez, supra note 6; Sex Education in Schools, supra note 1, at 478-79, 483 (noting no federal regulations related to sex education as of 2019); Sex and HIV Education, supra note 2.
30
Sex Education in Schools, supra note 1, at 496; Malone & Rodriguez, supra note 6.
31
Sex and HIV Education, supra note 2; Sex Education in Schools, supra note 1, at 476-77.
32
Sex and HIV Education, supra note 2.
33
North Carolina provides abstinence-plus sex education while California provides comprehensive sex education. Both states require information to be medically accurate. However, the narratives they tell students differ. See N.C. Gen. Stat. § 115C-81.30(a)(8), (d) (2023).
34
Cal. Educ. Code §§ 51933(b), 51934(a)(3) (2023).
35
Malone & Rodriguez, supra note 6, at “Mandating Education and Topics”; Tenn. Code Ann. §§ 49-6-1303 to -1304 (LexisNexis 2022).
36
Taylor, supra note 1, at 1066-67.
37
For example, Ohio still statutorily defines marriage as between one man and one woman despite the decision in Obergefell v. Hodges, 576 U.S. 644 (2015) (holding that States must recognize same-sex marriages under the Constitution’s due process and equal protection clause of the 14th amendment). Ohio Rev. Code § 3101.01(A) (“A marriage may only be entered into by one man and one woman.”), (B)(1) (“[M]arriage between persons of the same sex is against the strong public policy of this state. Any marriage between persons of the same sex shall have no legal force or effect in this state . . . .”), (B)(2) (“[M]arriage entered into by persons of the same sex in any other jurisdiction shall be considered and treated in all respects as having no legal force or effect . . . .”); Louis Knuffke, 35 States Have Laws Against Same-Sex ‘Marriage’ that Would Be Enforceable if Obergefell Falls, LifeSiteNews (July 14, 2022), https://www.lifesitenews.com/news/35-states-have-laws-against-same-sex-marriage-that-would-be-enforceable-if-obergefell-fell/ [https://perma.cc/E45T-SXRL]; Sex Education in Schools, supra note 1, at 476-77.
38
Sex Education in Schools, supra note 1, at 476-77; see Lawrence v. Texas, 539 U.S. 558 (2003) (holding sodomy laws to be unconstitutional and overturning).
39
N.C. Gen. Stat. § 115C-81.30(a)(5) (requiring public schools to “teach that a mutually faithful monogamous heterosexual relationship in the context of marriage is the best lifelong means of avoiding sexually transmitted diseases”); Rosky, supra note 1, at 1469-72; Knuffke, supra note 37.
40
Rosky, supra note 1, at 1469-72; Sex and HIV Education, supra note 2.
41
Dorit Rubinstein Reiss & John Diamond, Measles and Misrepresentation in Minnesota: Can There Be Liability for Anti-Vaccine Misinformation that Causes Bodily Harm?, 56 San Diego L. Rev. 531, 532 (2019) (discussing the measles outbreak in Minnesota that occurred as a result of anti-vaccination misinformation); Edward Lee, Moderating Content Moderation: A Framework for Nonpartisanship in Online Governance, 70 Am. U.L. Rev. 913, 916-18 (2021) (noting the misinformation campaigns occurring around elections and other political issues).
42
Other sources note solutions like building abstinence-plus education programs or the importance of student movements for extracurriculars related to gender and sexuality. Taylor, supra note 1, at 1078 n.123; Sex Education in Schools, supra note 1, at 469 n.4, 490-92.
43
See Dustin Jones & Jonathan Franklin, Not Just Florida. More Than a Dozen States Propose So-Called ‘Don’t Say Gay’ Bills, NPR (Apr. 10, 2022, 7:01 AM), https://www.npr.org/2022/04/10/1091543359/15-states-dont-say-gay-anti-transgender-bills [https://perma.cc/CA5P-9J5C]; Peter Greene, Teacher Anti-CRT Bills Coast to Coast: A State by State Guide, Forbes (Feb. 16, 2022, 2:00 PM), https://www.forbes.com/sites/petergreene/2022/02/16/teacher-anti-crt-bills-coast-to-coast-a-state-by-state-guide/?sh=69f187cb4ff6 [https://perma.cc/KLK4-F88H]; H.B. 616, 134th Gen. Assemb., Reg. Sess. (Ohio 2022); H.B. 322, 134th Gen. Assemb., Reg. Sess. (Ohio 2021).
44
Bauter, supra note 6, at 250, 252; Sex Education in Schools, supra note 1, at 492-93.
45
Bauter, supra note 6, at 250, 252; Sex Education in Schools, supra note 1, at 492-93.
46
Taylor, supra note 1, at 1064, 1066; Sex Education in Schools, supra note 1, at 463; but see Malone & Rodriguez, supra note 6, at “Why Comprehensive Sexuality Education Instead of Abstinence-Only-Until-Marriage Programs?” (noting that while parents and policymakers want to delay young adult’s sexual activity, they continue to support abstinence-until-marriage programs even though data that suggests young adults are more likely to delay sexual activity if they receive a comprehensive sex education).
47
See Malone & Rodriguez, supra note 6, at “Mandating Education and Topics.”
48
Bauter, supra note 6, at 251; Taylor, supra note 1, at 1073 (discussing the value judgments inherent in sex education courses regardless of their religious lean).
49
These are non-binding responsibilities but do imply a policy that the American Bar Association wishes to instill among practitioners. Model Rules of Pro. Conduct pmbl. (6) (Am. Bar Ass’n 2020).
50
See Taylor, supra note 1, at 1078 n.123 (noting the boundary terms).
51
See Malone & Rodriguez, supra note 6, at “Mandating Education and Topics.”