Subject: A.1806/ Gottfried et al.
AN ACT to amend the public health law in relation to establishing the age-appropriate sex education grant program, to be referred to as the Healthy Teens Act.
This bill, the Healthy Teens Act, would award funding for school districts, boards of cooperative education services and community-based organizations to provide comprehensive sex education programs for young people.
The NYCLU strongly supports this legislation. Numerous studies demonstrate that comprehensive sex education -- health programs that are medically accurate, age-appropriate, and include information about contraception in addition to abstinence -- is the most effective way to help young people postpone intercourse and reduce their number of sexual partners. Comprehensive sex education also helps to increase the use of condoms and other forms of contraception among young people who are sexually active.1
In New York State, where rates of unintended teen pregnancy and sexually transmitted infections are among the highest in the country, comprehensive sex education is essential to reducing these rates. The NYCLU, therefore, strongly supports the passage of this bill to ensure that more young people have access to the information they need to protect themselves and to make responsible decisions about their sexual and reproductive health.
Recent statistics demonstrate the overwhelming need for comprehensive sex education in New York. In 2005, thirty-nine percent of female high school students and 45 percent of male high school students in New York State reported having sexual intercourse,2 and statistics from the Centers for Disease Control and Prevention show that many New York teens have sex with more partners-and earlier-than teens in the rest of the country.3 There were nearly 40,000 teen pregnancies in New York in 20054 and New York's abortion rate for teenagers between the ages of 15 and 19 was the second highest in the country.5 New York State also has the highest rates of HIV/AIDS in the country-nearly 18 percent of all American adults and teens with HIV live in New York,6 and the CDC has warned that youth are persistently at risk for infection.7 In fact, a recent CDC study on a representative sample of teenage girls across the country showed that up to 25% of them had a sexually transmitted infection,8 and a reported increase in cases of syphilis in New York City suggests that riskier sexual practices are on the rise.9 Of the 1,268 teens in the United States aged 13-19 diagnosed with HIV in 2005,10 more than 10 percent (136 teenagers) lived in New York City.11
New York can no longer afford to ignore these critical issues. It is time to give our youth the information they need to make healthy decisions, and reduce risky behaviors that lead to teen pregnancy and STI/HIV transmission. Nonetheless, the only dedicated funding for sex education comes from federal and state matching programs12 that prohibit the teaching of any methods to reduce the risk of pregnancy other than abstinence from sexual activity until marriage. Many "abstinence-only-until-marriage" programs permit mention of contraceptives only to highlight their failure rates.13 In FY 2006, New York received a total of $10,664,612 in federal abstinence-only-until-marriage funds-the third largest pool of abstinence-only dollars in the country (after Texas and Florida), and the second largest pool of Title V dollars (after Texas).14 And although New York State in 2007 joined a growing number of states that have rejected federal Title V abstinence-only-until-marriage funds, the State still receives over $6 million in abstinence-only-until-marriage dollars directly from the federal government under other funding streams. By contrast, no federal or state money was specifically earmarked for comprehensive sex education programming.
Under existing law, the only sex education curriculum the state mandates is instruction on HIV/AIDS transmission and prevention.15 It is up to local schools districts to decide whether to provide students additional sex education instruction. However, without funding or a legal mandate, school districts currently have no incentive to implement comprehensive sex education.16
"Abstinence-Only" Sex Education
Abstinence-only-until-marriage programs ("abstinence-only") often present medically inaccurate or incomplete information about contraception and safer sex practices.17 For example, programs receiving federal abstinence-only funding are required to instruct young people that sexual activity outside of marriage is "likely to have harmful psychological and physical effects."18 These programs put young people at a greater risk for unintended pregnancy and sexually transmitted infections. By ignoring the reality of teen sexual activity, the abstinence-only model fails to protect sexually active young people from pregnancy and disease. Indeed, recent studies have shown abstinence-only until marriage programs to be ineffective in lowering rates of teen sexual activity.19
In addition to endangering young people's health, abstinence-only programs raise serious civil liberties concerns. Sex education programs that focus exclusively on abstinence inhibit free expression by prohibiting the discussion of essential information about reproduction and human sexuality. Many abstinence-only programs also violate the Constitution's Establishment Clause by using religious doctrine to define "appropriate" sexual behavior and values. The Constitution forbids the promotion or preference of any religious perspective in public schools. Although federal funding guidelines prohibit abstinence-only programs from imposing religious viewpoints, in practice this is exactly what many programs do.20 Furthermore, by teaching about sex only in the context of marriage, such programs serve to marginalize gay and lesbian students and stigmatize homosexuality,21 creating a hostile learning environment for lesbian and gay students.
According to one federal funding statute, abstinence-only education should teach students that "a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity."22 Moreover, specific abstinence-only programs have spoken out against homosexuality explicitly, claiming that "one of the best ways to avoid AIDS is to ‘avoid homosexual behavior.'"23 Instead of addressing the health interests of all students, these curricula simply reinforce negative stereotypes and portray homosexuality as dangerous and immoral.Indeed, a 2007 report by the NYCLU found that federally funded abstinence-only-until-marriage programs in New York State had used curricula that have been evaluated by experts to contain medical inaccuracies, religious content, sex stereotypes, and bias against LGBT youth.24
A Better Model: Comprehensive Sex Education
While abstinence is an important component of any educational program about human sexuality, the introduction of funding for comprehensive sex education would allow for much-needed development of state curricula. In order to be eligible for funding, the proposed legislation would require grantees' sex education programs to stress the value of abstinence, but also provide information about the benefits and side effects of all contraceptives and barrier methods in preventing pregnancy and sexually transmitted infections.25 Such programs serve to delay the onset of sexual activity, increase the use of contraception among young people who are sexually active, and reduce their number of sexual partners.26
Recognizing that teen sexuality is influenced by a variety of social factors, programs would also be required to encourage parental involvement and family communication about sexuality, and to help students develop healthy attitudes and skills regarding gender roles and sexual decision-making. The proposed legislation would prioritize funding for communities most in need of comprehensive sex education, which would be based in part on the rates of pregnancy and of sexually transmitted infections among adolescents within a particular community.27
Young people need accurate information to help them delay sexual activity and to make responsible and safe decisions when they do become sexually active. Sex education programs that focus only on abstinence and ignore the real educational needs of students put the health of young people in New York at risk. The existing piecemeal approach to sex education in New York public schools is simply ineffective. The Healthy Teens Act is an important step in providing more of New York's young people the information and skills they need to protect their sexual and reproductive health. The NYCLU, therefore, strongly urges the passage of A.1806.
1 Douglas Kirby, The National Campaign to Prevent Teen Pregnancy, Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy (Summary) (May 2001), available at www.teenpregnancy.org/resources/data/pdf/emeranswsum.pdf) and Advocates for Youth, Science and Success: Supplement I; Additional Sex Education and Other Programs That Work To Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections (2006), available at http://www.advocatesforyouth.org/publications/sciencesuccess_supplement.pdf. 2 Ctrs. for Disease Control & Prevention, U.S. Dep't of Health & Human Servs. (CDC), Youth Risk Behavior Surveillance - United States, 2005, 55 Morbidity & Morality Weekly Rep.: Surveillance Summaries 1, 78-79 55, tbls. 44 & 45 (2006). 3 Id. 4 Get the Facts New York, available at http://www.getthefactsny.org/index.html. 5 Guttmacher Inst., U.S. Teenage Pregnancy Statistics, National and State Trends and Trends by Race and Ethnicity 11 tbl. 3.1 (2006), available at http://guttmacher.org/pubs/2006/09/12/USTPstats.pdf. 6 CDC, Cases of HIV infection and AIDS in the United States and Dependent Areas, 2005, 17 HIV/AIDS Surveillance Rep., 2005, at 23 (2007) [hereinafter Cases of HIV/AIDS in the U.S.], http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2005report/.... 7 See CDC, HIV/AIDS Among Youth 2 (2006) (fact sheet), http://www.cdc.gov/hiv/resources/factsheets/PDF/youth.pdf. 8 See Centers for Disease Control and Prevention, Prevalence of Sexually Transmitted Infections and Bacterial Vaginosis among Female Adolescents in the United States, abstract available at http://www.cdc.gov/stdconference/2008/media/summaries-11march2008.pdf. 9 See Sarah Kershaw, Syphilis Cases on the Increase in New York City, N.Y. Times, Aug. 12, 2007. 10 CDC, Cases of HIV/AIDS in the U.S., supra note 6, at 10. This number only includes HIV diagnoses in the 33 states that have confidential name-based HIV infection reporting. 11 HIV Epidemiology Program, NYC Dep't of Health & Ment. Hygiene, New York City HIV/AIDS Annual Surveillance Statistics 2005, tbl. 1.1 (2006), http://home2.nyc.gov/html/doh/downloads/pdf/ah/surveillance2005_tables_a.... 12 Three federal programs are currently dedicated to funding abstinence-until-marriage education: Section 510 of the Social Security Act (42 U.S.C. § 710), created by the 1996 welfare reform law; the Adolescent Family Life Act (AFLA) (see H.R. Conf. Rep. No. 107-347, at 113 (2002)); and Community Based Abstinence Education (CBAE), previously known as Special Projects of Regional and National Significance CBAE (SPRANS-CBAE) (see Military Construction Appropriations Act of 2001, Pub. L. No. 106-246, 114 Stat. 511 (2000)) and 2005 CBAE Program Announcement, 70 Fed. Reg. 29,319 (May 20, 2005). Cumulative funding for these federal programs topped $1.5 billion at the end of the 2006 fiscal year. See SIECUS, Sexuality Education and Abstinence-Only-Until-Marriage Programs in the States: An Overview, (2006) available at http://www.siecus.org/policy/states/2006/analysis.html. 13 Henry A. Waxman, U.S. House of Representatives Committee on Government Reform-Minority Staff, The Content of Federally Funded Abstinence-Only Education Programs 8 (Dec. 2004). 14 SIECUS, Abstinence-Only-Until-Marriage Funding By State, FY 2006, http://www.siecus.org/policy/states/2006/finalFundingChart.html (last visited August 30, 2007). 15 Age-appropriate HIV/AIDS instruction is required for students in grades K-12 under the State Education Commissioner's Regulations but abstinence-only-until-marriage programming conflicts with the mandate. Specifically, the regulation reads: "Such instruction shall be designed to provide accurate information to pupils concerning the nature of the disease, methods of transmission, and methods of prevention[.]" N.Y. Commissioner's Reg. Subchapter G Part 135.3(b)(2) (2002) (emphasis added). In addition, a report released in 2003 by Manhattan Borough President Scott Stringer, however, revealed that despite the mandated curriculum, many students in New York City public schools were receiving inadequate instruction. See Scott Stringer, Failing Grade: Health Education in NYC Schools, June 2003. 16 The NYCLU would strongly support legislation requiring sexuality education as part of the mandatory health education curriculum as well as regulations insuring that such instruction be provided in a manner that is comprehensive, age-appropriate, and medically accurate. 17 See e.g., Lorraine Kenny and Julie Sternberg, Abstinence-Only Education in the Courts, Sexuality Information and Education Council of the United States, (SIECUS), Report, Vol. 31, No. 6. (Fall 2003); Minority Staff of H.R. Comm. on Gov't Reform, Special Investigations Div., 108th Cong., The Content of Federally Funded Abstinence-Only Education Programs, Prepared for Rep. Henry A. Waxman (2004), available at http://oversight.house.gov/Documents/20041201102153-50247.pdf; Scott H. Frank, MD, MS, Director, Division of Public Health Department of Epidemiology & Biostatistics Dep't of Family Med., Div. of Adolescent Health, Case Western Reserve University School of Medicine, Report on Abstinence-Only-Until-Marriage Programs in Ohio (2005). 18 See, e.g., 42 U.S.C. § 710(b)(2) (2007). 19 See Christopher Trenholm et al., Mathematica Policy Research, Impacts of Four Title V, Section 510 Abstinence Education Programs: Final Report (2007), available at http://www.mathematica-mpr.com/publications/pdfs/impactabstinence.pdf. Debra Hauser, Advocates for Youth, Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact (2004), http//www.advocatesforyouth.org/publications/stateevaluations.pdf; Peter S. Bearman & Hannah Bruckner, Promising the Future: Virginity Pledges and First Intercourse, 106 Am. J. Sociology 859 (2001); Human Rights Watch, Ignorance Only: HIV/AIDS, Human Rights, and Federally Funded Abstinence-Only Programs in the United States: Texas: A Case Study, Vol. 14:5(G), Sept. 2002, at 13-15, available at http://hrw.org/reports/2002/usa0902/USA0902.pdf; Kristen Underhill et al., Sexual Abstinence Only Programmes to Prevent HIV Infection in High Income Countries: Systematic Review, 55 British Med. J. 248 (2007), available at http://www.bmj.com/cgi/reprint/335/7613/248. John Santelli et al., Abstinence and Abstinence-Only Education: A Review of U.S. Policies and Programs, 38 J. Adolescent Health 72 (2006), available at http://genderhealth.org/pubs/JAHAAbstinenceReview.pdf. 20 For example, in 2002, the ACLU successfully challenged the use of taxpayer dollars to support religious activities in the Louisiana Governor's Program (GPA) on Abstinence, a program run on federal and state funds. GPA funded programs that, among other things, presented "Christ-centered" theater skits, held a religious youth revival, and produced radio shows that "share abstinence as part of the gospel message." The case was on appeal when the parties settled. The GPA agreed to closely monitor the activities of the programs it funds and to stop using GPA dollars to "convey religious messages or otherwise advance religion in any way." Nonetheless, in 2004 the ACLU discovered that the GPA was violating the agreement and directed the state to correct ongoing problems in the program. See ACLU Reproductive Freedom Project, Abstinence-Only-Until-Marriage Education Censors Vital Health Care Information, Jeopardizing Teenagers' Health (Dec. 2004). 21 Am. Pub. Health Ass'n, Abstinence and U.S. Abstinence-Only Education Policies: Ethical and Human Rights Concerns (Nov. 8, 2006), http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1334. 22 42 U.S.C. § 710(b)(2)(D). 23 Sexuality Information and Education Council of the United States, (SIECUS), In Their Own Words: What Abstinence-Only-Until-Marriage Programs Say (2004) (citing Sex Respect, Student Workbook). 24 See New York Civil Liberties Union, Financing Ignorance: Abstinence-Only-Until-Marriage Funding in New York State (2007). 25 S1342, §3 (adding new article 14-A to the New York Public Health Law, to be codified at 1451(2)(c-f)) (introduced Jan. 19, 2007). 26 See Douglas Kirby et al., Family Health Int'l, Impact of Sex and HIV Education Programs on Sexual Behaviors of Youth in Developing and Developed Countries (2005); Advocates for Youth, Science and Success: Sex Education and Other Programs That Work To Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections (2003), http://www.advocatesforyouth.org/publications/ScienceSuccess.pdf; Advocates for Youth, Science and Success: Supplement I; Additional Sex Education and Other Programs That Work To Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections (2006), available at http://www.advocatesforyouth.org/publications/sciencesuccess_supplement.... Chris Collins at al., AIDS Policy Research Ctr. & Ctr. for AIDS Prevention Studies, AIDS Research Inst., U. Cal., San Francisco, Abstinence Only vs. Comprehensive Sex Education: What Are the Arguments? What Is the Evidence? 9 (2002), available at http://ari.ucsf.edu/science/reports/abstinence.pdf; Douglas Kirby, Nat'l Campaign to Prevent Teen Pregnancy, Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy (2001), available at http://www.teenpregnancy.org/resources/data/pdf/emeranswsum.pdf. Even opponents of comprehensive sexuality education are forced to recognize the positive impacts of many curricula. See Admin. for Children & Families, U.S. Dep't of Health & Human Servs., Review of Comprehensive Sex Education Curricula (2007) (prepared for Senators Rick Santorum and Tom Coburn), available at http://www.acf.hhs.gov/programs/fysb/content/abstinence/06122007-153424.PDF. 27 S1342, §3, supra note 25 (adding new article 14-A to the New York Public Health Law, to be codified at 1452(7)).