What We Fail to Teach: A Systematic Review of Sexual Health Education in the Deep South

Given the disproportionately high rates of sexually transmitted infections (STIs) among adolescents in the Deep South, a closer look at sexual health education, a fundamental element of sexual health, is crucial to understanding and addressing the problem. This article explores attitudes, policies, practices, and impacts of sex education (sex-ed) on Southern adolescents. We systematically searched seven electronic databases for articles published between 2002 and 2022 that investigated school-based sex-ed for youth <25 years old in Alabama, Georgia, Louisiana, Mississippi, and South Carolina. Hand search of references, risk of bias, and quality assessments were also completed. Four main themes emerged across 37 included studies: Attitudes, Policies, Curricula, and Impact. Surveyed parents and constituents supported sex-ed that incorporates abstinence and other health topics including STIs, human immunodeficiency virus (HIV), and contraception. Sex-ed policies and curricula overwhelmingly emphasized abstinence, whereas only a minority of schools addressed other critical sex-ed topics. Some studies impacted students' knowledge or behavioral intentions; others failed to alter adolescents' sexual health behaviors. Despite strong support from key stakeholders for sex-ed that goes beyond abstinence, abstinence remains the primary focus of sex-ed across the Deep South. Studies and advocacy efforts are needed to understand why we fail to harness sex-ed in the Deep South as a real tool for change.