Missouri is above average in teen pregnancy, STDs. Could comprehensive sex education help?

In recent months, the concept of "comprehensive sex education" has been a popular point of discussion among legislators, school districts, sex education advocates and parents nationwide.

These conversations have been sparked by several different catalysts, including the recent overturning of Roe v. Wade by the U.S. Supreme Court in late June. Minutes after the federal ruling, a "trigger law" was activated in Missouri, making abortion illegal in the state.

Missouri was one of 22 states that did not require school districts to teach sex education in 2020, per SEICUS, the Sexuality Information and Education Council of the United States. But HIV/Sexually Transmitted Infection prevention and some healthy relationship content are mandated.

Because sex education, specifically, is not required by the state, districts have flexibility for what it looks like.

Parents fall on both sides of the sex education discussion. Some are in favor of its presence in school and others are not, believing this education should occur at home.

Meanwhile, data indicates states − like Missouri − that do not mandate sex education in school have higher teen pregnancy and STD rates.

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Lack of sex education correlated with higher rates of teen pregnancies, STDs

The Centers for Disease Control and Prevention reported 18.8 births per 1,000 females ages 15-19 in Missouri during 2020. Among states with similar sex health standards, Missouri is near the top of the list for teen birth rates.

Over the years, the federal government has funded two types of sex education: abstinence-only sex education that promotes abstinence before marriage and comprehensive sex education which includes scientifically and medically accurate information about contraception and reproductive health.

According to the American Public Health Association, abstinence-only programming proved ineffective in reducing teen birth rates. In fact, this programming displayed a "perverse effect, increasing adolescent birthrates in conservative states."

Brea Ford, now 29, was 17 years old when she became a mom.

At age 13, Ford and her mother moved to the Springfield area from a larger city in northern Oklahoma. Ford said at her old school, sex was not a popular discussion and many of her friends had never had their first kiss. When she moved to the Ozarks, this dynamic changed. Soon, she was meeting people her age who were actively having sex and some kids, a few grades above her, were getting engaged. At age 14, she lost her virginity.

Ford and her mother didn't talk about sex at home and the little she did learn at school was about "basic anatomy."

"Nobody taught me how to use a condom," she said. "If you handed me a condom and we were in a sexual act, I wouldn't have known what to do with it at that point. Asking somebody to put on a condom would have been even more intimidating because how would I know he was putting it on right?"

Today, Ford has four children between the ages four and 13 who she homeschools. Ford said homeschooling originated as a necessity during the COVID-19 pandemic, but she finds her children work better in the at-home environment.

As for what sex education looks like in her home, Ford described it as naturally-occurring conversations, rather than a structured setting like a health class. Teaching her children about bodily anatomy, using proper medical terminology, is important to her.

"I had a close friend who was involved in a really terrible childhood abuse process and one of the major factors in her case was that she was able to use anatomical words," Ford said. "In public school and day care situations, where kids will report abuse, they don't realize they're reporting abuse because they're using words like 'cookie' or 'monkey.'"

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Ford also stresses the importance of consent and self trust with her children.

"The more information your kids have, the better decisions they can make for themselves," she said.

STD rates follow the same trend as teen births among youth in the state.

In 2020, 3,765 per 100,000 women ages 15-24 in Missouri reported cases of chlamydia. For men the same age, 1,503 cases were reported, according to the CDC.

CDC data shows 1,065 cases of gonorrhea among young women and 812 cases among young men were reported the same year, placing Missouri in the highest percentile for cases of this STD.

AIDS Project of the Ozarks Director of Prevention and Outreach Nicole Massey said STD rates are traditionally higher among women because of grant funding. She said grants issued to states from the CDC typically have a focus on young women.

Up until December 2013, CDC grant money was awarded through the Infertility Prevention Project, as one symptom of having a STD as a woman is infertility.

"There have been some minor expansions to what we can use that for," Massey said. "In recent years we've been able to offer a little bit more services for men who have sex with men, but those resources have traditionally just been limited to women."

Massey added that women are often more likely to seek health services.

Narrowing the scope even further, Greene County has the fourth highest rate of reported STDs in the state of Missouri, according to the Missouri Department of Health and Senior Services.

Not all believe sex education belongs in the classroom

According to an academic article in PLOS ONE, a scientific journal published by the Public Library of Science, 93% of parents supported sex education in middle and high school settings in 2014. This research surveyed 1,633 parents of diverse backgrounds across the country.

For the parents who do not believe sex education should be taught in these settings, there are several key concerns. These include a breach of religious ideologies and concern about education centered around sexual orientation and gender identity.

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One Facebook user commented in the public Facebook group, "Welcome to Springfield, MO": "The problem I see with schools teaching them is introducing ideas that a parent may not agree with like there are more than two genders." This user did not wish to be interviewed for this report.

Another user voiced that she would prefer if sex education curriculum taught the importance of abstinence.

"Sex education does not belong in the school system!" the user commented in the public Facebook group, "Springfield Public Schools - Parents Speak Out!" "How about teaching ABSTINENCE!! No pregnancies, no STDs, and no unnecessary emotional wounds!!" This user also did not wish to be interviewed for this report.

According to the Missouri Department of Elementary and Secondary Education, abstinence is taught as the preferred choice of behavior when it comes to sexual activity.

What is 'comprehensive sex education'?

"Comprehensive sex education" is defined as science-based, age-appropriate education about human sexuality, including biological, emotional and social perspectives. Comprehensive sex education begins in early grades and continues through high school.

The Guttmacher Institute, a research and policy nonprofit whose mission is to improve sexual and reproductive health worldwide, outlines seven components of comprehensive sex education: gender, sexual and reproductive health and HIV, sexual rights and citizenship, pleasure, violence, diversity and relationships.

Inclusive teaching about human sexuality, aimed for LGBTQIA+ youth, youth of color and youth with disabilities is also a component of comprehensive sex education.

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Sex education in Missouri, the Ozarks

Per Missouri Health Education Grade Level Expectations, last updated in 2007, learning about the reproductive system begins around fourth or fifth grade.

In elementary school, students should be able to identify and describe the function of the male and female reproductive systems, along with analyze the physical, emotional and social changes which occur during puberty. HIV and AIDS are defined to students around grades three and four.

Elementary-aged students are also introduced to healthy relationships. According to SIECUS, Missouri mandates "some" healthy relationship education, which means that teachings about proper communication skills, decision-making, violence prevention and consent are lightly discussed.

In middle school, students should be able to describe how hormones impact one physically and mentally, understand how heredity and lifestyle choices impact the reproductive system, explain how to maintain a healthy system and identify cancer signs with monthly self-examinations.

Education about sexual harassment is also introduced to this age level during the communication portion of a district's health curriculum.

HIV and AIDS are expanded upon in middle school, with education focusing on the difference between the two and behaviors that could enhance transmission, such as "tattoo piercing, sex, syringe use."

In high school, students should be able to recognize normal and abnormal conditions of the reproductive system, understand how cancers associated with the reproductive system impact its function and discuss the importance of routine physical exams, such as pap smears, mammograms and prostate exams.

High schoolers also learn more about HIV and STDs, including common systems and how they are transmitted.

Lastly, the impacts of teen pregnancy are discussed in high school health curriculum. This education includes how teen pregnancy can impact one's life, the relationship between a mother and her unborn child and reliable contraceptive methods.

Springfield Public Schools Coordinator of Health and Physical Education Brad Brummel said SPS' health curriculum is aligned with these state standards. Expectations for SPS' sexual health instruction are outlined in the school board's policy, last revised in 2020.

SPS educators are trained both internally and externally, to ensure they know the best ways to create a safe environment while teaching these topics.

At the Republic School District, state standards are followed, along with the implementation of Choosing the Best curriculum, Superintendent Matt Pearce said. Established in 1993, Choosing the Best provides "abstinence-center, sexual risk avoidance education" to students and training for both educators and parents. This curriculum is used sixth through 12th grade.

Other school districts in the area outsource both their sex education curriculum and educators.

Bolivar R-I School District Superintendent T.C. Wall said the district partners with the Alpha House Pregnancy Resource Center to provide two weeks of sex health education to seventh and ninth graders. Alpha House provides the curriculum and educators.

A parent of two students at the Bolivar R-I School District, Erin Villarreal said her eldest received a workbook to bring home and complete with parents during the sex education program. Villarreal said she was "disappointed" by the workbooks' contents, which stress abstinence.

Villarreal said while she understands abstinence is the only way to 100% avoid pregnancy, she wishes the curriculum would be more realistic.

"(The workbooks) mention, 'Sure, condoms work some of the time,' and that part really had me," Villarreal said. "Teenagers, they're going to do what they're going to do, and they just need to have the most comprehensive, informational curriculum, so that they can make an informed decision when they do decide to become sexually active."

The News-Leader reached out to Alpha House with questions but did not hear back by press deadline.

At the Willard Public School District, high schoolers receive instruction from Willard educators, guided by a textbook from McGraw Hill. In addition, the Pregnancy Care Center visits and teaches their Choices Curriculum, Willard administration said.

For all public school districts in the state, guardians must be notified about the content of any human sexuality or sexual abuse instruction, with the right to remove their student.

Available educational resources

Several organizations in the Ozarks provide folks with sex education resources, whether it be through digital materials, presentations or one-on-one conversations.

Massey said prior to the COVID-19 pandemic, AIDS Project of the Ozarks worked with school districts and youth organizations to host presentations. These presentations included an introduction to STDs, how they are transmitted, how they can be prevented, and what STD and HIV testing looks like.

Today, the majority of APO's education is through one-on-one interactions.

Upon completing the necessary intake paperwork, patients meet with a prevention specialist to go over any concerns and what steps make the most sense for them. Naturally through this process, folks are able to learn more about STDs and HIV.

Jim House was a staff member of AIDS Project of the Ozarks from 1992 until his death on March 6, 2019. The public-health organization held a ribbon-cutting and open house for its new building at 1636 S. Glenstone Ave. on Thursday, Oct. 26, 2017.
Jim House was a staff member of AIDS Project of the Ozarks from 1992 until his death on March 6, 2019. The public-health organization held a ribbon-cutting and open house for its new building at 1636 S. Glenstone Ave. on Thursday, Oct. 26, 2017.

"I think it's our responsibility to arm young people with all of the knowledge and tools that they need to make the best decision for their own sexual health, whenever that time comes," Massey said. "We have 14 year olds who don't know much about sex and are not ready for sex, and that's great for them and we can provide them with information. Then we have 14 year olds who have been having sex for a couple of years and need a whole different level of education."

Massey said this tailoring of information is what makes comprehensive sex education successful.

For those interested in getting tested through APO, walk-ins are welcome at both offices. All testing is free, and youth do not need consent from a guardian.

The main office is located at 1636 S. Glenstone Ave. Testing is available Monday, Tuesday, Wednesday and Thursday from 9-11:30 a.m. and 1-3:30 p.m.

Downtown APO is located at 303 Park Central West. Testing is available Tuesday, Wednesday, Thursday from 9-11:30 a.m. and 1-3:30 p.m., along with Friday from 1-3:30 p.m. and 5-7:30 p.m.

For more structured classwork, the Unitarian Universalist Association and United Church of Christ hosts Our Whole Lives "OWL," a lifespan sexuality education program. Locally, OWL is held by First Unitarian Universalist Church of Springfield and St. John's United Church of Christ. Although OWL is hosted by religious organizations, it is often used in secular settings, too.

Through OWL, "lifespan sexuality education" prioritizes discussions about sex and related topics beyond the classroom and traditional age of learning about what sex is.

AJ Fox, director of religious education at First Unitarian Universalist Church of Springfield, compared OWL's program to youth physical education.

"It's like if we said, 'The kids who have a P.E. class at school, their families should never hike on the weekend, they shouldn't participate in any extracurricular sports,'" Fox said. "This is a lifespan thing that everybody can be engaging with in ways that are age appropriate."

OWL's interactive workshops are planned and led by trained facilitators. Each facilitator is trained to work with one of the seven OWL age groups: grades K-1, 4-6, 7-9, 10-12, young adults, adults and older adults. Each group discusses age-appropriate topics.

For example, in the grades K-1 group, children learn about family, trusted adults and the basics of human conception (a baby is made with an egg, sperm and uterus).

Fox said a unique part of OWL is that parents of children in this age group decide collectively from two curriculum paths. Children can either learn about conception metaphorically or more realistically. This decision is made completely by the parents.

In the older adult age group, curriculum may be centered around attitudes about aging, disability and chronic illness, dating as an older adult, and body image − topics not usually addressed when talking about sex education.

Fox said OWL programs are typically between six to eight weeks and each age group program is offered once a year, due to local supply and demand. Prices vary. For more information, contact Fox at dre@springfielduu.org.

History of sex education in Missouri

Missouri's sex education statute was first established in 1999 and most recently updated in 2018.

1999: Missouri's core sex education law requires that any course materials and instruction related to human sexuality and sexually transmitted diseases must be "medically and factually accurate."

Abstinence is also stressed as the preferred choice of behavior in relation to all sexual activity for unmarried students because "it is the only method that is 100% effective in preventing pregnancy, sexually transmitted diseases and the emotional trauma associated with adolescent sexual activity."

The advantages of adoption were to also be taught, in conjunction with discussions about potential "emotional and psychological consequences" of youth sexual activity.

2007: new clause about contraception was added, in addition to language about abortion. As medically factual information was taught, students were to also learn about contraceptives and pregnancy in a way consistent with the federal abstinence education law.

School districts were also not allowed to provide abortion services or allow the furnishing of materials about human sexuality or STDs to students if from an abortion services provider.

2015: New language was added about the education of online predators and consequences of inappropriate text messaging, even among friends.

2018: School districts now must incorporate education about sexual harassment, sexual violence and consent.

News-Leader reporter Galen Bacharier contributed to this story.

Greta Cross is the trending topics reporter for the Springfield News-Leader. Follow her on Twitter and Instagram @gretacrossphoto. Story idea? Email her at gcross@gannett.com.

This article originally appeared on Springfield News-Leader: Comprehensive sex education in Missouri may impact teen pregnancies