"A" is for AbstinenceAnd "F" is for Fear - which is what many Knox County sex-education teachers feel about what they can and can't teach
by Janet Tate
The slanting sun of an early August morning lights their way as health teachers James Hudson and Susan Perkins walk through the familiar glass-lined, cinderblock corridors of Bearden Middle School in west Knox County.
Within one very short week, these eerily quiet halls will be chaotically wall-to-wall with Hudson's and Perkins's sixth-, seventh-, and eighth-grade charges: adolescents representing just about every socioeconomic, cultural, and religious background to be found in Knoxville, all of whom are stumbling with leaps and halts from childhood into adulthood. They wear chains that jingle-jangle-jingle when they walk; they sound like Beavis and Butthead when they talk. They play soccer and sing in the choir. They'll be football stars and drug dealers and parents and teachers someday; right now, they're potential class presidents, possible dropouts, cheerleader wannabes, Courtney Love imitators.
Somehow, at some time during the next nine months, the two health educators will do their best to teach crucial information to each of these kids in the one subject area that interests them all: sex.
Along with their spiral notebooks and No. 2 pencils, these students, like middle-school and high-school kids everywhere, bring to school as many different levels of sexual knowledge and experience as human nature allows. An unfortunate few will have already been introduced to sex involuntarily, perhaps at the hands of a family friend or relative. A fortunate few will have felt comfortable enough with their parents from early childhood to have asked for and received straightforward, nonjudgmental information about sexual behavior, contraception, and responsible decision-making. But many will be relying solely on whatever information they've gleaned from the usual sources: disinclined parents perhaps, the media probably, and most certainly other kids.
It's not as though Hudson and Perkins and their colleagues particularly relish their state-mandated mission of filling the gaps in their students' sexual knowledge. Some health teachers are admittedly reluctant to talk about human sexuality in school; they'd rather be teaching gym. Others ache to reach beyond the boundaries of the school's core sex-ed curriculum but, frustrated and intimidated, they check their attitudes at the classroom door and stick with the basics. All, however, must adhere to the sex-ed components of what's known in middle school as the Family Life curriculum and in high school as the Wellness curriculum--programs that are heavy on "just say no" and skimpy on specifics of when or how to say yes intelligently.
Regardless of what Tennessee's adolescents learn about sex in health class in middle school, by their first day of high school half of them have already had sex, according to the state's Youth Risk Behavior Survey. By the time they're seniors, three out of four will have had sex, and more than one-third of them will have had at least four sex partners.
"By the time we get them, it's really too late," says one high school health teacher. "There needs to be a broader spectrum of what these students hear in eighth grade--and more consistency among what they hear--than what we're seeing on the whole when they enter ninth grade."
Unfortunately, most of the school administrators, teachers, and concerned community health directors we spoke with agree that's not the case, and it's not likely to be anytime soon.
What exactly can Knox County teachers teach? In a nutshell, here are the state-approved Family Life guidelines for middle schools:
"The Family Life program is abstinence-based," explains Dave Huntsinger, supervisor of health, wellness, and physical education for Knox County Schools. "We stress abstinence as the main thing in preventing unwanted pregnancy and communicable diseases; not just AIDS, but STDs [sexually transmitted diseases] as well. We pretty well follow the state curriculum guidelines."
"We say, 'these are things that are out there and the only way you can be sure of no pregnancy [is through abstinence],' " says Perkins.
Now, Tennessee's public schools are also required to teach HIV/AIDS prevention in grades kindergarten through 12. It's a separate requirement, and it's also abstinence-based. But nowhere in the Family Life curriculum for middle school is the actual topic of sexual activity really broached; that doesn't happen until high school, when, along with how to break a date and reasons for abstaining from sexual activity ("fear of unwanted pregnancy, guilt, fear of contracting disease, and fear of disapproval of family and peer group," reads one content blurb), teens are offered a "Sexuality and Family Life" component in health class, which does include exploring "alternatives to and consequences of teenage pregnancy, including adoption, abortion ... and teenage marriage" and "comparison and contrast of various methods of contraception and the degrees of effectiveness or lack thereof."
But compare these state guidelines--which are, admittedly, the bare-bones requirements--to the recommendations for a successful sex health education program put out by the Sex Information and Educational Council of the United States (SIECUS), a national nonprofit organization of health educators and medical professionals. Their suggested topics for age-appropriate discussion throughout the elementary, middle, and high school years include: marriage and lifetime commitments; abstinence; sexuality throughout life; contraception; abortion; sexual fantasies; sexuality and religion; sexual dysfunction; sexuality and the media; STDs and HIV transmission; and masturbation (yes, the very taboo that ultimately toppled ex-surgeon general Jocelyn Elders).
The school officials we talked to are familiar with the SIECUS framework for a comprehensive sex education curriculum. Nearly all agreed that their recommendations are sensible and would go a long way toward improving Tennessee's sex education curriculum. And each expressed the opinion that there is no way such guidelines would ever find their way into our state-approved curriculum.
"Technically, there's no board policy prohibiting [those topics], but it's never going to happen in Knoxville," says ex-school board member Ann Woodle. "I wouldn't even advise a teacher to do that, because of the [political and religious] climate."
Says Huntsinger: "That's just not going to happen in Knox County schools, much as we might want it to. Teachers in middle school cannot talk about contraception or abortion unless it's brought up by a child, and then it's usually discussed by them privately. There's no problem with giving that information to a child one-on-one; that way you're not offending those people who don't want to hear that--and there are some people who don't want to hear that."
Indeed there are, but then, they don't have to hear it if they don't want to (or, more to the point, their children don't have to hear it if they don't want them to).
"There are provisions in the state law that say, if a parent does not want their child to participate in family life or AIDS education, it's automatically granted," Huntsinger points out, "as long as we have publicized the fact that the state law says that a child can be exempt from those portions of the wellness curriculum."
And in fact, it's an option that's rarely exercised, says Perkins: "I'd say in the past five years we've had maybe 10 or 12 [students] whose parents have opted for them to be out of the program. A couple of those were sixth grade students, and then by seventh grade their parents decided maybe they ought to be in it; by the eighth grade most of those kids went through the program."
Still, that's apparently not good enough for the Christian Coalition and other conservative political-religious pressure groups that have noisily shown up at Knox County school board meetings in the past and otherwise captured media attention with claims that condom-hander-outers have taken over the public schools.
"Sex education has become such a hot topic in this area, as I'm sure it has everywhere, with the influence of conservative Christian groups that do not want sex education addressed at the school level but feel very strongly that this is moral education that should be dealt with at home," says one Knox County school board member.
But school officials claim conservative religious influence is not really so pervasive that teachers aren't protected by what they choose to explain beyond the state's basic guidelines.
"It's not as though the school board would fire somebody, even if the majority didn't agree with what the teacher had done," says Woodle. Still, even the perceived threat of conservative religious disapproval is enough to intimidate a lot of teachers into playing it safe.
"It's a very real concern," says Woodle. "They're afraid of parents getting angry with them, then making their complaints public by going to the principal, then to the school board, then to the media. The feeling is that somehow that would cast aspersions on their morality or their teaching qualifications. It's a pretty powerful fear."
Health teachers can supplement the state guidelines with outside speakers and programs if they want to and if their principal agrees with their choice. Part of the problem with that is timing. Teachers with a higher comfort level may devote two or three weeks to the subject; others spend as little as two days. If they choose to use outside speakers and programs, they'll need to add as much as one to two weeks for the really comprehensive, decision-making-to-contraception series.
Then there's the plethora of resources to choose from. The Knox County Health Department's Adolescent Pregnancy Prevention Initiative (KAPPI) has a program. The Junior League offers TAPP, an AIDS awareness program. There's STARS, the Florence Crittenton agency's well-received teen peer group presentation; a puppet show known as Kids on the Block; Planned Parenthood's Sexuality Education series; Campaign for Our Children; Free Teens; Teen Aid; Sex Respect, Safe Sex, Reasonable Reasons--the list goes on and on.
The programs usually fall into one of two camps: abstinence-only or comprehensive. The theory behind abstinence-only thinking is that if our children just don't have sex, there's no need to get into all that contraception and disease-prevention stuff. Comprehensive programs, on the other hand, tend to regard teen sexuality as inevitable; they stress abstinence but also explain contraception--barrier methods, condoms, birth control pills, Norplant--and disease prevention, and feel that educators should be value-neutral with regard to sexual activity.
"One of the biggest problems with abstinence-only programs is that they seem to emphasize guilt, shame, and fear," says one health department official. A high-school health teacher adds: "The messages of the [abstinence-only] Sex Respect approach and other programs like it conflict with mass advertising and consumerism aimed at teens to be sexually attractive, that sexy is healthy and good. This only reinforces the idea in many teenagers' minds that adults can't really be trusted, that what you're taught in school and what you see in real life are often two very different things."
Nevertheless, in 1991 the Knox County school system purchased the Sex Respect materials, ostensibly as a resource for health teachers but primarily as a sop to the Christian Coalition, whose loudly held (and wildly inaccurate) claim that schools were handing out condoms sufficiently intimidated educational officials into buying (literally) the religion-based, abstinence-only program materials.
Now, five years later, school officials and program providers are quick to distance themselves from it and other abstinence-only agendas.
"Sex Respect does not fulfill the state mandate," Huntsinger points out. "It's available for teachers to use to supplement the family life/wellness curriculum mandated by the state of Tennessee."
"It's fear-based," says Debbie Blair, executive director of Planned Parenthood of East Tennessee. "It's not explaining and educating; it's controlling by intimidation."
"It's old, outdated," says Cynthia Hudson, KAPPI's coordinator. "I don't even know if anybody uses it anymore. When Sex Respect first came out, it had a religious connotation. I think they've since pulled most of that out, because they knew it was shutting doors to them."
Quasi-religious, abstinence-only sex ed may be becoming passe, but groups such as the East Tennessee Nurses for Health Education, with their self-described message of "purity only," are still a favorite choice in many area schools. The organization, formerly known as Tennessee Nurses for Life, claims to have spoken to 7,000 area school students during the past school year.
"We talk about the medical facts from a purity standpoint," says director Nan Sprouse. "We do get into contraception, and we don't make any judgments. We're not fear-based; we're reality-based. Purity is our goal, and we encourage girls [who have already had sex] to start over." (Revirginate themselves, if you will.)
"If you talk about abstinence or purity, how do you deal with the teens sitting in the classes you're giving who are sexually active?" asks Hudson. "We know what reality is--that it's virtually impossible for some of our teens in abusive or statutory rape situations--so how does that make them feel?"
Judith Roitman of Planned Parenthood echoes her concern: "Purity is an odd way of putting it, especially in view of the fact that for many young women, the first sexual encounter isn't necessarily a voluntary one."
While claiming to have no religious affiliation and to be school-board approved, the East Tennessee Nurses for Health Education insist that the "facts on abortion" are among the information they offer.
"We wouldn't refer [a pregnant girl seeking information about her options] to a provider," says Sprouse. "We don't do that. It's not in our mission statement to do that, and we don't believe from a medical viewpoint that that's a good choice for a girl."
What they would do and have done, though, is refer a pregnant teen to the Crisis Pregnancy Center of Knoxville--an outfit that is clearly religiously-oriented and adamantly antiabortion.
As to their claim of being school-board approved, "We do not have a preapproved list of outside speakers," says school board member Margaret Maddox. "The gamut would be so vast we'd be constantly adding to and deleting from it. I don't remember that issue ever coming before the school board. I don't really know where they get that, to tell you the truth. [The approval of outside sex education programs] is an on-site decision made by the individual school administration." (Hudson and Perkins note that Knox County's school system maintains a library of approved resources for them to choose from if they want to supplement the core curriculum.)
In response to the "fear-based" criticism, East Tennessee Nurses for Health Education's Mary LePage, a psychiatric nurse, says: "Well, it's so dangerous out there now. You're not just talking about possible unwanted pregnancy but all these diseases and viruses there are no cures for, that you're left with for life. Very often females end up with cervical cancer, or infertile. The diseases, the emotional pain ... we in mental health have for years looked at sexual promiscuity in youth as a sign of depression. Now it's become more like a normal developmental thing: You know, they're all doing it, so let's just throw birth control at them and throw up our hands. There's far too much discussion over it and visibility of things sexual on TV; it's all over the place. It's harder and harder to keep children focused on things that are developmentally appropriate for them."
"I think we have to be open to all points of view," says Maddox diplomatically. "We've tried to provide the broadest base of resources for the teachers that they feel comfortable with ... but it's always going to be frustrating because we're talking about, in some cases, extremely conservative beliefs, yet we're talking about the need to educate these children."
But if the fear is that talking about sex will encourage kids to become sexually active, why do we have drug awareness programs in schools? And since when did it become a good idea to withhold information from students in schools? A 1994 Alan Guttmacher Institute study showed that half of the 15-to-19-year-olds it surveyed felt that the average student today doesn't get adequate, accurate sex and reproduction information. (One-third of the 15-year-old girls said neither parent had ever discussed birth control with them.)
Henry Foster, President Clinton's would-be surgeon general who now acts as the president's special adviser on teen pregnancy, recently told an appropriations subcommittee considering funding for abstinence-only education that such sex ed just doesn't work unless information on contraception is included. But abstinence-only advocates insist that including contraception information sends kids a mixed message: Why tell kids they shouldn't do something, then tell them how to do it safely?
"Well, how could it be a mixed message if they're already engaged in sexual activity?" Huntsinger posits. "If they're already sexually active, we can say, look--and we don't preach this to them, I don't necessarily advocate this--but if you are engaged in sexual activity and you're not going to cease, then you need to take some kind of precaution to protect yourself. I think you look at it from the standpoint of, if you get a person pregnant, then you have another responsibility. I think that's what we've got to make them aware of. There are all these other repercussions. For one thing, I think we don't put enough emphasis on the male responsibility; we're trying to alleviate that."
The way it's set up, middle-school teachers cannot bring up contraception on their own in the classroom. They must wait for an individual student to ask a particular question, which is then answered in private by the teacher. That's the theory, anyway. (Planned Parenthood answers presubmitted, anonymous questions.)
"We've had several eighth-graders after we've had the Nurses' program come up and stay after class and ask questions," says Perkins. "They're really worried because they've already done something."
But this is a theory that presupposes a certain amount of adult knowledge and articulation on the student's part: that they already know enough about how, for example, fertilization of the egg occurs to pose a pointed question about how to prevent it from happening during sexual intercourse. And as teachers and parents well know, kids will say the darndest things. So instead of asking, "If I use over-the-counter spermicide in addition to a condom, does this increase the likelihood of avoiding disease and pregnancy when I have sex?", they're more inclined to want to know, "Is it true if I have sex standing up I won't get pregnant?" (Among the questions Blair has fielded during her sex ed presentations: "Can you get pregnant the first time?" "When you're on your period?" "Can you get pregnant from oral sex?" and, inevitably, "How do you get pregnant?" "And these are high school students!" she exclaims.)
"We're in a real Catch-22," says one health teacher, "damned if we do, damned if we don't."
She and many of her colleagues express great frustration, not only with the current state guidelines, but also with what several term the conservative element in our community. Adds Hudson: "We may talk about condoms, but we can't show how they're used. We can't do demonstrations in the classroom. There's a great video that features Arsenio Hall and Sinbad that talks about condom safety, and Sinbad is shown wearing a full-body condom. But we can't show that in class; it's not approved. The best we can do then is say, 'go home, ask your mom or dad.'"
"I think if there's an organized effort on behalf of people who are advocates for children, and those people who believe that knowledge is power, there could be some changes made," says Woodle. "I think kids could certainly receive more concrete technical, physiological information without stepping into morality issues. We teach kids from elementary school how to protect themselves in case of fire: stop, drop, and roll. Yet this crucial information about how their bodies work, it gets limited by this whole issue of controversy. It's unfair to the kids. Morality, the issues of abstinence--those things belong at home and in church, but the information about them needs to be taught in the classroom."