The Healthy Youth Act

What it Means for Sex Education in North Carolina

Family North Carolina Magazine—Fall 2009

By Alysse ElHage

[Caution] This article is meant for mature audiences as some of the content is graphic in its description.

In September, CNN’s American Morning featured North Carolina in a special report entitled, “Educating America: Sex ed is back.”1 The report focused on the enactment of the “Healthy Youth Act” (HYA), which was narrowly approved by the General Assembly in June, after a hard-fought battle between pro-family advocates and contraceptive sex education (CSE) proponents, such as Planned Parenthood and Equality North Carolina. The HYA amends the state’s 14 year-old “Abstinence-Until-Marriage” (AUM) law to require that—beginning in 2010-11—in addition to teaching AUM, sex education instruction in North Carolina’s public schools must also include more information on sexually transmitted diseases (STDs), sexual abuse/assault, and the “effectiveness and safety” of all Food and Drug Administration (FDA)-approved methods of STD and pregnancy prevention.2

The CNN report highlighted North Carolina as one of several states in the nation that have chosen to return to a “more comprehensive sex education” approach.3 While the HYA certainly opens the door for CSE advocates—such as Planned Parenthood—to get into schools and promote “safer” sex, it should not be misconstrued as the end of AUM education in North Carolina. Thanks to the efforts of pro-family advocates, the AUM portions of the 1995 law remain intact, including the right of parents to withdraw their child from any portion of the instruction.4

The future of AUM education in this state depends on two key factors: 1) the willingness and ability of AUM educators to teach the requirements of the HYA in a manner that does not promote sexual activity; and 2) the willingness of school districts and local communities to continue to support and fund authentic AUM programs. Both factors hinge on an understanding of the HYA in the broader context of current North Carolina law regulating sex education instruction. What follows is an analysis of the HYA, including what remains intact from the 1995 law, along with an examination of the most controversial provisions of the HYA that could be used to challenge AUM programs.

What Changed
The HYA instituted the following key changes to North Carolina’s sex education program, which apply beginning in the 2010-11 school year:5
1) Changes the title from “Abstinence-until-marriage education” to “Reproductive health and safety education.”6

2) Requires local school districts to “provide a reproductive health and safety education program commencing in the 7th grade” that includes AUM and more detailed information on contraceptives.7

3) Mandates that materials used during the AUM instruction “shall be age appropriate,” and that “information conveyed during the [AUM] instruction shall be objective, and based upon scientific research that is peer reviewed and accepted by professionals and credentialed experts in the field of sexual health education.”8

4) Mandates that in addition to AUM, this instruction must also include information on:
STDs, and how they are and are not transmitted.
“the effectiveness and safety of all [FDA]-approved methods of reducing the risk of contracting [STDs], and information on local resources for testing and medical care for [STDs].”
“Instruction shall include the rates of infection among pre-teens and teens of each known [STD] and the effects of contracting each [STD].” It also mandates that this instruction include information on the Human Papilloma Virus (HPV) and its effects.
“the effectiveness and safety of all FDA-approved contraceptive methods in preventing pregnancy.”
Information on awareness of sexual assault, sexual abuse and risk reduction (healthy relationships, resources, definitions, common misconceptions, reporting requirements, etc.).
Requires that the materials used as part of the STD instruction be “age-appropriate” and “objective and based upon scientific research that is peer reviewed and accepted by professionals and credentialed experts in the field of sexual health education.”9

5) Requires local school boards to “adopt a policy and provide a mechanism to allow a parent or guardian to withdraw his or her child from” this instruction on STDs/contraceptives.10

6) Repealed a provision in the original law that allowed local school systems to implement a comprehensive sex education program only if they held a public hearing process first, which allowed for parental review and input.11

7) Requires local school systems to “provide a comprehensive school health education program that meets all the requirements of this subsection and all the objectives established by the State Board.” Allows local school boards to “expand on the subject areas to be included in the program and on the instructional objectives to be met.”12

What Did Not Change
While the debate over the HYA during the 2009 legislative session focused on the contraceptive mandate that was added to the state’s sex education program, most of the 1995 AUM law remains intact, including the following provisions:

Retains the mandate that AUM be taught. The HYA retains the definition of AUM education from the 1995 law, including the following:

  • “Teaches that abstinence from sexual activity outside of marriage is the expected standard for all school-age children.”
  • “Teaches that abstinence from sexual activity is the only certain means of avoiding out-of-wedlock pregnancy, sexually transmitted diseases when transmitted through sexual contact, including HIV/AIDS, and other associated health and emotional problems.”
  • “Teaches that a mutually faithfully monogamous heterosexual relationship in the context of marriage is the best lifelong means of avoiding sexually transmitted diseases, including HIV/AIDS.”13
  • Retains review period. The law requires the State Board of Education to “make available to all local school administrative units for review by parents and legal guardians” any “State-developed” or approved objectives, textbooks, reviewed materials or other materials that “pertain to or are intended to impart information or promote discussion or understanding in regard to the prevention of sexually transmitted diseases, including HIV/AIDS, to the avoidance of out-of-wedlock pregnancy, or to the reproductive health and safety education curriculum.”14
  • Preserves parental review and consent. The law requires that parents “be given an opportunity to review the objectives and materials” of the sex education program “before students may participate in any portion.” It also requires that local school boards “adopt policies to provide opportunities either for parents and legal guardians to consent or… withhold their consent to the students’ participation in any or all of these programs.”15
  • Limits abortion referrals, bans contraceptive distribution, and requires factual and realistic discussion of prevention methods. Specifically, it requires that:
    • “Students may receive information about where to obtain contraceptives and abortion referral services only in accordance with a local board’s policy regarding parental consent.”16
    • “Any instruction concerning the use of contraceptives or prophylactics shall provide accurate statistical information on their effectiveness and failure rates for preventing pregnancy and sexually transmitted diseases, including HIV/AIDS, in actual use among adolescent populations and shall explain clearly the difference between risk reduction and risk elimination through abstinence.”17
    • “Contraceptives, including condoms and other devices, shall not be made available or distributed on school property.”18

Understanding the Requirements for Sex Ed.
To summarize, sex education instructors must continue to teach that AUM is the expected standard of behavior for all school-age children, including that sexual activity within the context of a faithful heterosexual marriage relationship is the best and healthiest means of avoiding a myriad of negative consequences.19 Beginning in 2010-11, instructors must also teach about STDs, including HPV, how they are transmitted and not transmitted, and their negative effects. This information includes providing students with information on groups that conduct STD testing and treatment. As part of this instruction, they must also teach students about the “effectiveness and safety” of all FDA-approved methods that reduce the transmission of STDs and the risk of pregnancy. The HYA also requires that information presented during both the AUM and contraceptive portions of the instruction “be objective, and based upon scientific research that is peer reviewed and accepted by professionals and credentialed experts in the field of sexual health education.”20

The HYA’s requirements for instruction on STDs, birth control methods, and condoms must be interpreted in light of North Carolina law regarding the teaching of these issues. Following are some important points about the law to keep in mind:

1) North Carolina law still requires that any discussion of contraceptives or prophalytics (condoms) must include their effectiveness and failure rates in the context of adolescent populations, and clearly explain the “difference between risk reduction and risk elimination through abstinence.”21 This frees instructors to give students the truth about prevention methods and their inability to fully protect against the negative consequences of sexual activity, and to promote AUM as the best choice.

2) The mandate that instructors refer students to organizations that provide STD testing and treatment could open the door for students to be referred to groups, such as Planned Parenthood, that not only provide STD testing but also perform abortions and distribute contraceptives. But nothing in the law mandates that health educators refer students to Planned Parenthood clinics. In fact, some pregnancy resource centers (PRCs) that are licensed to operate as medical facilities offer STD testing as part of their free services, and can refer patients to medical facilities for care.22 In addition, the law mandates that students may receive information on abortion services or where to get contraceptives, “only in accordance with a local board’s policy regarding parental consent.”23 It is also important to remember that North Carolina law prohibits the distribution of contraceptives, including condoms, on school property.24

3) Finally, parents still have the right to review all aspects of a sex education curriculum, and to opt their children out of any portion of the instruction they deem inappropriate. While the HYA did eliminate the provision requiring school boards to hold a public hearing prior to expanding a sex education curriculum to include more contraceptive information, school districts are still required to provide parents with an opportunity to review any sex education materials and to have an opt-out policy in place.25 In addition to this, the HYA added a provision to the new section on the discussion of all FDA-approved prevention methods that requires school boards to put into place a “mechanism” for parents or legal guardians to withdraw their child from that specific section.26

Despite the positive provisions that remain in North Carolina’s sex education law, the HYA still raises some troubling questions for many parents and educators—questions that range from what instructors will be required to teach about contraceptives, to what constitutes “objective” and who qualifies as “credentialed experts.”

All FDA-Approved Prevention Methods
A red flag for many AUM educators is the HYA’s mandate that instructors teach students about the “effectiveness and safety of all FDA-approved” methods of STD prevention and birth control.27 In part, this is because the 1995 AUM law did not require instructors to discuss contraceptives but allowed them to do so only within a specific context (i.e., their effectiveness and failure rates among adolescent populations, and with an emphasis on risk reduction (with condoms) vs. risk elimination (with AUM).28

Under the HYA, instructors will be required to discuss the “effectiveness and safety” of all-FDA approved prevention methods.29 For STD prevention, this would include: the male and female condom, as well as the HPV vaccine, which is approved for use on girls as young as age nine.30 For birth control, the FDA lists the following 18 methods:31

  • Sterilization surgery for women
  • Sterilization implant for women
  • Sterilization surgery for men
  • Implantable rod
  • IUD
  • Shot/Injection
  • Combined pill
  • Progestin-only pill
  • Extended/Continuous Use pill
  • Patch
  • Vaginal Contraceptive Ring
  • Male Condom
  • Diaphragm with Spermicide
  • Sponge with Spermicide
  • Cervical Cap with Spermicide
  • Female Condom
  • Spermicide
  • Emergency Contraception (“morning-after pill.”)

It is easy to understand why AUM educators would be concerned about the HYA’s mandate that they discuss the effectiveness and safety of 18-plus prevention methods with students. But this requirement does not have to present a roadblock to authentic AUM education because, as noted earlier, North Carolina law requires that prevention methods be discussed in a manner that presents abstinence from sexual activity as the “only certain means of avoiding” the negative consequences of early sexual activity.32

And while opponents have attempted to portray AUM education as “just say no,” the truth is that contraceptive information has always been included in many AUM programs. “Many abstinence education organizations already discuss contraception in the manner set by North Carolina law—talking about contraception within the context of its inferiority to abstinence,” notes Valerie Huber of the National Abstinence Education Association.33

“We have always taught about contraceptives,” agrees AUM education pioneer, Mike Long, who has trained over 50,000 educators in the U.S. how to effectively teach AUM education using a directive approach. “The difference is we teach the facts about them.”34

“You can’t talk about sex without talking about condoms,” says Marcia Brown, director of Worth Waiting 4, an abstinence education program in Rocky Mount, which is a ministry of the local Pregnancy Care Center. She teaches the AUM program in all middle and high schools in Rocky Mount-Nash County. “While I do talk about contraception in the context of failure rates, I never encourage the use of contraceptives,” says Brown, “and I never show them how to use contraceptives.”35

The good news is that the HYA does not mandate that instructors show students how to use birth control or STD prevention methods or even encourage their use. It only requires that they present students with basic information about the methods. The bad news is that the law also does not specifically prohibit instructors from displaying how to use the methods, and it gives school districts the freedom to expand on any portion of the program without holding a public hearing first.36

Emergency Contraception (EC). Condoms are one thing, but what about teaching adolescents about more controversial forms of birth control, such as EC? For many AUM educators—especially those that operate through PRCs—presenting adolescents with information on EC is abhorrent because of its potential to end a developing human life. One of the ways EC may work, according to the FDA, is to “prevent a fertilized egg from attaching to the womb (implantation).”37

Carolina Pregnancy Center (CPC) in Greenville presents the AUM program, Why kNOw, in Pitt County schools. According to Blake Honeycutt, executive director of the CPC, they already discuss the failure rates of condoms and birth control pills with students. She says they would be willing to discuss most of the other forms of birth control in the same context, adding that they already do when students ask. But she draws the line at EC.

“We would NOT be willing to discuss emergency contraception as a choice,” Honeycutt emphasizes, “as there is medical evidence substantiating that this method acts as an abortifacient.”38

But Mike Long argues that AUM educators can present information on EC in the same manner they teach about condoms—to point young people to sexual abstinence as the healthiest choice.

“I think you discuss emergency contraceptives by simply stating exactly what they are, but emphasizing the side effects and the possibilities of terminating a life, which also creates emotional and moral trauma,” he says. “Sexual abstinence until marriage prevents young people from ever having to make such a determination in their own lives—giving them true sexual freedom.”39

Ultimately, Long believes that AUM educators can teach the facts about prevention methods, including EC, without promoting their use or sexual activity.

“What I would do is take the list of FDA-approved contraceptives from the FDA website and go through them, one by one, and simply teach the facts,” he explains. “For example, here’s what a condom will do for you, it will reduce your risk of pregnancy and STDs, but the emphasis must be, the risk is still there. Then I ask teens, what odds do you want to play when it comes to AIDS, HPV, etc? They always respond zero.”40

Objective and Expert Evidence
Another portion of the HYA that could be used by CSE proponents to challenge AUM education is the requirement that information presented during both the AUM and contraceptive portions of the instruction “be objective, and based upon scientific research that is peer reviewed and accepted by professionals and credentialed experts in the field of sexual health education.”41 NARAL Pro-Choice N.C. applauded this portion of the HYA in a press release, stating: “For the first time in more than 13 years, all students in North Carolina will receive an objective, scientifically based and proven curriculum.”42

The implication that AUM education is not “objective” or science-based is a message that CSE proponents continue to disseminate successfully, so much so they managed to get it written into state law. But a close examination of how CSE programs typically deal with issues that are central to North Carolina’s sex education law—specifically adolescent sexual activity, homosexuality, and contraceptives—raises serious doubts about their objectivity.

Teen sex. Reproductive health education in North Carolina is supposed to teach that sexual abstinence until marriage is the expected standard of behavior for all school-age children. But a core belief of CSE is that adolescent sexual activity is acceptable and even healthy. For example:

According to Planned Parenthood, “We are sexual beings from birth, and sexual expression is a basic human need throughout our lives. Sexual expression is an essential component of healthy development for individuals of all ages.”43

The CSE curriculum, Focus on Kids, tells instructors: “When discussing ‘Don’t have sex,’ be sure to help youth identify other options, such as finding fun ways to be together that don’t involve sex, or finding different ways to please a partner without sex (e.g., kissing, rubbing, mutual masturbation).”44

Homosexuality. After the HYA was signed into law, Equality N.C., a state-level homosexual advocacy group that heavily promoted it, lamented that state law still “contains problematic homophobic language that presents only heterosexual marriage as the best option for preventing sexually transmitted diseases.”45 This statement highlights another significant problem for CSE proponents, who would prefer to teach students that homosexuality is normal. Consider the following examples from two popular CSE curricula:

Reducing the Risk, which is taught in the Chapel Hill school system, includes the following scenario for students to act out: “Tony and Dylan have been to a party and then go to Tony’s home to be alone. They start to kiss and undress each other. Dylan reaches into his jacket pocket, and realizes that he doesn’t have the condom he planned to use. He says, ‘I think somebody stole the rubber I had.’ What can Tony and Dylan do to avoid unprotected sex?”46

Be Proud, Be Responsible advises teachers to encourage students to discuss issues related to condoms “in the context of same-sex partners.”47

Condoms. Most CSE curricula spend more time promoting contraceptives and safer sex activities than promoting sexual abstinence. According to a 2007 study of nine popular CSE curricula by the U.S. Department of Health and Human Services:

“…the curriculum with the most balanced discussion of abstinence and safer sex still discussed condoms and contraception nearly seven times more than abstinence.”48
Be Proud, Be Responsible instructs students: “Use condoms as a method of foreplay... Think up a sexual fantasy using condoms... Act sexy/sensual when putting condoms on... Hide them on your body and ask your partner to find it...Tease each other manually while putting on the condom...”49

CSE is based on beliefs that run contrary to the requirements of North Carolina law for sex education instruction. Can CSE proponents who believe that adolescent sexual activity is acceptable and healthy, and that homosexuality is normal be expected to objectively present sexual abstinence until marriage as the best for adolescents?

“There is no way Planned Parenthood and similar groups can effectively teach what the law requires on abstinence,” argues Long. “How can you expect an organization that has vehemently fought anything and everything that has to do with abstinence education since it’s inception in 1985, to suddenly go into a classroom and teach that very thing effectively? Planned Parenthood is the biggest purveyor of contraceptives and abortion in the world. It is not in their interest to teach a behavior and lifestyle that would put them out of business.”50

Accepted by “Experts.” What about the HYA’s requirement that information be “accepted by professionals and credentialed experts in the field of sexual health education”? The HYA does not define “credentialed experts” or specify which organizations qualify, which leaves the interpretation of this provision up for grabs. Authentic AUM programs contain medically accurate information; however, CSE advocates could challenge AUM curricula on the grounds that they are not backed by mainstream organizations—i.e., organizations that promote CSE. AUM educators should anticipate this kind of challenge and be prepared to respond, using the following suggestions:

  • Use the latest data on teen sex, STDs, and contraceptives available.
  • Whenever possible, use statistics and facts from government organizations, such as the CDC, FDA, and other similar groups whose accuracy the pro-CSE groups cannot question.
  • If possible, cite CSE organizations for statistics, such as the Guttmacher Institute.
  • Avoid using secondary sources.

Remember that North Carolina law requires instructors to present real-life effectiveness and failure rates for STD and pregnancy prevention methods that are based on adolescent use, not on laboratory tests or “perfect use” among adults.51

Who is Best Suited to Teach Sex Ed in N.C.?
The real question raised by the enactment of the HYA is not whether AUM education is dead in North Carolina, but who is best suited to teach reproductive health education going forward. Will it continue to be taught by well-trained AUM educators, who are able to factually present the contraceptive information without promoting teen sexual activity? Or will it be taught by condom distributors and abortion providers, who believe that adolescent sexual activity is acceptable and who stand to gain the most from the negative consequences associated with it? The impact of the new provisions in the law—such as whether or not students will be referred to Planned Parenthood clinics for STD testing, shown how to use condoms, or be encouraged to get the HPV vaccine or EC—will depend on who is presenting the information to students.

“What the new law does is it takes the handcuffs off CSE advocates, such as Planned Parenthood, NARAL, and radical gay rights groups,” warns Long. “It opens the door for them to go into schools and teach our children and grandchildren how to use condoms, provide abortion referral, and promote ‘tolerance’ for all sexual lifestyles.”52

In the 2010-11 school year, school districts in North Carolina will face enormous pressure from CSE advocates, such as Planned Parenthood, to replace AUM curricula with CSE curricula, or to allow CSE instructors to present sex education to students. Ultimately, school leaders will have to decide which way they are going to go with sex education. If they believe AUM educators will not teach the contraceptive portions of the program, or if AUM educators refuse to do so, Planned Parenthood educators and other radical groups will be waiting in the wings to take their place.

“Abstinence educators need to fill that gap and continue going into schools no matter what,” emphasizes Long. “If we stop going into schools as a result of this new law, CSE proponents, like Planned Parenthood, NARAL, and radical gay rights groups will have a monopoly on our kids’ sex education in North Carolina.”53


Alysse ElHage is associate director of research for the North Carolina Family Policy Council.

Endnotes

  1. Castello, Carol, “Educating America: Sex ed is back,” CNN’s American Morning, 9/3/09, as found at: http://amfix.blogs.cnn.com/2009/09/03/educating-america-sex-ed-is-back/#more-6237
  2. Session Law 2009-213/Healthy Youth Act (HYA).
  3. Op. Cit., Castello.
  4. Op. Cit. Session Law 2009-213/HYA, section 5. See also: G.S. §115C-81 (e1) (7).
  5. Ibid.
  6. Ibid. HYA, section 2.
  7. Ibid. HYA, section 4.
  8. Ibid. HYA, section 4.
  9. Ibid. HYA, section 5.
  10. Ibid. HYA, section 5.
  11. Ibid. HYA, section 7 (Repealed: G.S. §115C-81(e1)(6)).
  12. Ibid. HYA section 9.
  13. Ibid. HYA, section 4. Also refer to G.S. §115C-81(e1) (4), a. d. & e.
  14. Ibid. HYA, section 6, also G.S. §115C-81(e1)(5).
  15. Ibid. HYA, section 8, pertaining to G.S. §115C-81 (e1) (7).
  16. G.S. §115C-81 (e1) (8).
  17. Ibid.
  18. G.S. §115C-81 (e1) (9).
  19. G.S. §115C-81(e1) (4).
  20. Op. Cit., HYA, sections 4 & 5.
  21. G.S. §115C-81 (e1) (8).
  22. Lehman, Amber, “Women Have Another Choice,” Family North Carolina, Jan/Feb. 2007.
  23. G.S. §115C-81 (e1) (8).
  24. G.S. §115C-81 (e1) (9).
  25. Op. Cit. G.S. §115C-81 (e1) (7). See also: HYA, sections 5, 6,7, & 8.
  26. Op. Cit. HYA, see section 5.
  27. Ibid. HYA, section 5.
  28. G.S. §115C-81 (e1) (8).
  29. Op. Cit., HYA section 5.
  30. FDA, “HPV (Human Papillomavirus),” as found at: http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118530.htm See also: FDA, “Birth Control Guide,” as found at: http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118465.htm
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  31. FDA, “Birth Control Guide,” as found at: http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118465.htm (must cut and paste address into browser)
  32. Op. Cit., HYA, section 4 (d).
  33. Huber, Valerie, Executive Director, National Abstinence Education Association, Email Response to Author’s Questions, 8/4/09.
  34. Long, Mike, Founder/Executive Director, Everybody’s Not Doing It, Telephone Interview by Author, 7/29/09.
  35. Brown, Marsha, Director, Worth Waiting 4, Telephone Interview by Author, 8/17/09.
  36. Op. Cit., HYA, Section 5 and 9.
  37. FDA, “FDA’s Decision Regarding Plan B: Questions and Answers,” as found at: http://www.fda.gov/cder/drug/infopage/planB/planBQandA.htm
  38. Honeycutt, Blake, Executive Director, Carolina Pregnancy Center, Greenville, NC, Email Response to Author’s Questions, 7/31/09.
  39. Op. Cit., Mike Long
  40. Op. Cit., Mike Long
  41. Op. Cit., HYA, sections 4 & 5.
  42. NARAL Pro-Choice North Carolina, “NC House Concurs with Senate Sex Education Bill, Legislation Now Heads to Gov. Perdue,” Press Release, 6/25/09, as found at: http://www.prochoicenc.org/news/press/200906251.shtml
  43. Planned Parenthood Federation of America, “White Paper: Adolescent Sexuality,” January 2001, as found at http://www.plannedparenthood.org/resources/research-papers/adolescent-sexuality-26782.htm
  44. Focus on Kids, pg. 83, cited in: Martin, Shannon, et. al., Comprehensive Sex Education vs. Authentic Abstinence: A Study of Competing Curriculum, The Heritage Foundation, 2004, pg. 40.
  45. Equality N.C., “Victory! So, Now What?” 7/9/09, as found at: http://equalitync.org/news1/victory-so-now-what
  46. Reducing the Risk, pg. 149, cited in: Martin, Shannon, et. al., Comprehensive Sex Education vs. Authentic Abstinence: A Study of Competing Curriculum, The Heritage Foundation, 2004, pg. 28.
  47. Be Proud! Be Responsible!, pg. 84, cited in Op. Cit. (Heritage Foundation study), pg. 42.
  48. U.S. Department of Health and Human Services, Administration for Children and Families, “Review of Comprehensive Sex Ed Curricula,” May 2007, pg. 6.
  49. Be Proud! Be Responsible!, pg 81, cited in: U.S. DHHS 2007 study on pg. 17.
  50. Op. Cit., Mike Long.
  51. G.S. §115C-81 (e1) (8).
  52. Op. Cit. Mike Long.
  53. Op. Cit., Mike Long.

Copyright © 2009. North Carolina Family Policy Council. All rights reserved.