Hi readers! I’m excited to be able to share this opinion piece by epidemiologist April J. Bell, where she reflects on one of my favorite subjects - sexuality education in schools. I’d love to know what you think of her ideas - please share your thoughts in the comments!
Big love,
Christopher
As Students Head Back To School, Let’s Rethink What’s Success in Sex Education
By April J. Bell, The 74.
As millions of young people head back to school this fall, parents are buying backpacks, teachers are preparing lesson plans, and policymakers are once again debating what belongs in the classroom.
One topic will predictably return to the center of those debates: sex education.
Too often, the conversation begins and ends with one question: How do we prevent teenagers from becoming pregnant or acquiring sexually transmitted infections?
Young people are asking something different.
They want to know how to build healthy relationships, communicate boundaries, recognize misinformation, make decisions they feel good about, and imagine futures where their sexuality is a source of confidence rather than fear.
That disconnect matters.
While adults continue designing policies and programs around what we hope adolescents avoid, many young people are focused on who they hope to become.
For decades, our public conversation about adolescent sexual health has been dominated by prevention. Success is typically measured by declining pregnancy rates or lower rates of sexually transmitted infections. Those outcomes matter. They always will.
But they tell only part of the story.
What are the real aims of sex ed?
If preventing harm is our only goal, we overlook the very capacities that help young people make healthy decisions in the first place: confidence, communication, agency, access to trustworthy information, supportive relationships and the ability to envision futures they value.
Research consistently shows that adolescents define sexual well-being far more broadly than adults often assume. They talk about respect, trust, communication, emotional readiness and feeling informed.
My own research with Black adolescents supports this. Young people are eager for conversations about sexual health that extend beyond avoiding pregnancy and sexually transmitted infections. They want space to talk about relationships, pleasure, communication, consent, identity and how to navigate conflicting messages from peers, social media, families, and schools.
For Black adolescents, this narrow focus is especially consequential. Their sexuality is too often approached through risk, control and surveillance rather than possibility, agency and support.
They are not simply asking for more information. They are asking for guidance that helps them make sense of that information, align decisions with their values and build healthy relationships. Those insights suggest that preparing young people for sexual well-being requires more than delivering facts. It requires equipping them with the skills, confidence and support to navigate the complexities of adolescence.
Yet these priorities rarely shape how we design programs, evaluate success or decide what belongs in the classroom.
What approaches really work?
Research examining three decades of school-based sex education shows that comprehensive programs can help young people develop healthy relationship skills, recognize misinformation, respect sexual diversity and strengthen their ability to recognize and respond to dating violence and sexual abuse. The most promising approaches are not one-time lessons focused only on risk. They are age-appropriate, inclusive and designed to build knowledge and skills over time.
But access to that kind of education still depends heavily on where a young person lives. In its 2025 state report cards, SIECUS: Sex Ed for Social Change gave only seven states grades an A, while more than one-quarter received an F. Oregon and Washington earned A grades. The scores reflect whether state policies support medically accurate information, contraception, healthy relationships and LGBTQIA+-inclusive instruction, among other measures.
State policies do not tell us exactly what happens in every classroom. Still, some school districts are showing what a broader approach can look like. Seattle Public Schools uses a curriculum and supplemental lessons that address consent, communication and healthy relationships alongside pregnancy and sexually transmitted infection prevention. Families can preview the lessons and access resources to support conversations at home.
To be clear, preventing pregnancy and sexually transmitted infections remains critically important. No one is arguing otherwise.
But prevention should not be mistaken for the ultimate goal.
Keeping our desired outcomes in focus
Back-to-school season reminds us what we expect education to accomplish. We don’t judge schools solely by whether students avoid dropping out. We also ask whether they are learning, growing, thinking critically and developing the skills they need to thrive.
Adolescent sexual health deserves the same standard.
Yet we continue to evaluate success largely by what young people don’t do. Did they avoid pregnancy? Did they avoid infection?
Those are important outcomes, but they are not the only ones that matter.
What if we also asked whether young people left school feeling more prepared? More confident communicating with a partner? Better able to recognize misinformation online? More equipped to make decisions that reflect their own values? More capable of building relationships grounded in mutual respect?
Schools and districts should evaluate whether students leave sex education better able to communicate, assess information, establish boundaries and make decisions consistent with their values, not only whether pregnancy and infection rates decline.
These are not “soft” outcomes. They are foundational skills that support lifelong sexual health and well-being.
Ironically, they are also some of the strongest tools for preventing the very outcomes our policies are designed to reduce.
This all works together
The choice is not between prevention and well-being.
Well-being is one pathway to prevention.
Expanding what schools teach and measure will require meaningful engagement with families. Parents should receive clear information about what will be taught, how lessons differ by grade level and how they can review the materials. Schools should make space for questions, communicate in the languages families use and be clear that sex education is not intended to replace conversations at home.
Schools and families have different but complementary roles. Schools can provide medically sound information and practical skills. Families can help young people understand that information in the context of their beliefs and values.
Schools should take parental concerns seriously without treating the loudest opposition as representative of all families. In a 2021 survey of Minnesota parents, approximately 90% said comprehensive sexuality education should be taught in schools. Where families have a legal right to opt their children out, schools can respect that right without allowing individual objections to narrow what is available to every student.
If we truly want healthier futures for young people, especially Black adolescents who too often encounter systems built around surveillance instead of support, then we have to stop asking only how to prevent harm.
We also need to ask how to prepare young people to flourish.
As students return to school this year, we should expect more from sex education than the absence of negative outcomes. Like every other part of education, it should give young people with the knowledge, skills, confidence, and agency they need to navigate the world they live in.
April J. Bell is an epidemiologist, founder and director of Girlx Lab, and assistant professor in the Department of Family and Community Medicine at the University of California, San Francisco. She is a Public Voices Fellow on Public Health with The OpEd Project and Blue Shield of California Foundation
This story was produced by The 74, a non-profit, independent news organization focused on education in America.
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I really appreciate the emphasis on schools and families having complementary roles in sex education. I’d love to see us take that idea even further. It’s not enough to tell parents what their children are learning or send resources home—we also need to equip parents and caregivers with the language, knowledge, and confidence to continue these conversations. Schools can provide accurate information and skills, while families provide the ongoing relationship where young people make sense of what they’re learning in the context of their lives and values. Sex education shouldn’t end when health class ends; we need to intentionally build the bridge between school and home.