Formal school-based sex ed in the United States was born of the turn of the century social hygiene movement, a hybrid medical and moral project that hoped to eradicate social ills of the day. These ills included sex work and “social diseases” — a euphemism for STIs — which were sweeping the nation. Made up of Christian reformers and medical idealists, this reform movement was populated by individuals who shared both a goal — reducing rates of STIs — and practical advice: don’t have sex until you get married, and then only have sex with that person. This was the soundest medical advice of the day for a nation that didn’t freely endorse the use of condoms nor even freely admitted the sexual practices of its citizens. 

By the 1920s, social hygienists were convinced of the value of teaching “social hygiene” or “sex hygiene” to young people — ideally at home, perhaps through churches, and as a last resort, in schools. This was highly controversial, and the beginning of the fissure that would dictate the debates we are still having and that I explore in my new book, The Fight for Sex Ed: how much information are young people owed? Does teaching about sex — and how to make sex safer — lead to more sex? Who should teach young people and sex, and where, and when? This debate in its many iterations raged on through the decades, and two primary factions formed: the “abstinence-only” camp, which held — and still holds — that young people should be instructed to wait until marriage to have sex, and are given little information other than that; and what is now called “comprehensive sex ed,” which is most crucially marked by the inclusion of information about contraception (and today is marked by being medically accurate, age appropriate, and inclusive.) 

By the 1980s, this debate had crystallized into a political, religious, legal, and educational firestorm, though one that not many know about. The religious right came to embrace the term and concept of “abstinence only” sex ed, which was branding itself as a new concept. In 1981, thanks to political machinations on behalf of the religious right, federal funding was made available for abstinence only sex ed through the “adolescent family life act,” (AFLA) which provided funding for “research on teen-age chastity” as well as “the prevention of promiscuity.” This excerpt recounts some of the outcomes of that AFLA funding. 

In 1982, Adolescent Family Life Act (AFLA) funding became available for the first time. One of the recipients was Teen-Aid, Inc., an abstinence-only education group based in Washington State and led by LeAnna Benn. Teen-Aid’s goal, as stated in its charter, was to “reduce the many adverse consequences of premarital sexual activity among teens by encouraging abstinence as a premarital lifestyle.” Benn explained, “We want to help marriage be the most beautiful thing possible.” Teen-Aid was actively opposed to what it called “contraceptive education”—that is, classroom sex ed that included information about contraceptives. Teen-Aid argued that typical sex ed, or “contraceptive education,” was a “band-aid approach,” as opposed to the “long-term solution” that the abstinence-before-marriage lessons offered. As such, Teen-Aid “did not advise teens regarding contraceptives or abortion.” It even rejected the label of “sex education,” the Associated Press reported, favoring language like “programs that encourage abstinence.” 

By 1983, with help from a $140,000 grant from AFLA, Teen-Aid produced a high school curriculum called Sexuality, Commitment and Family. The Tri-City Herald out of Pasco, Washington, explained that this curriculum’s emphasis was not “on the consequences of teenage sexual activity but rather on the advantages of abstinence.” By May 1983, Teen-Aid reported that its curriculum had been sold to three hundred private and public high schools. By 1986, Teen-Aid had produced a film meant to pitch its approach to administrators at prospective client schools. Benn, who appeared in the film, revealed much about the curriculum’s underlying sexism when she explained its value. She explained that “young men respond best to the Teen-Aid course, because they are more likely to have set goals for themselves and look toward their own future.” Benn also stated that sixteen-year-old males tended to be most receptive to the curriculum’s message, because “they want the girls they are going to marry to remain virgins.” 

Another key AFLA-funded project from this time period was Coleen Kelly Mast’s curriculum Sex Respect: The Option of True Sexual Freedom. Mast worked as an education consultant for the Catholic diocese in Joliet, Illinois. Until the mid-1980s, her work in sex ed had been geared primarily toward Catholic schools. But in 1986, with help from an AFLA grant, she published a curriculum intended for public school audiences. Though Sex Respect was marketed to public schools and therefore ostensibly free of overt religious messaging, it was arguably free of any practical messages at all. It contained no anatomical information and certainly no information about birth control. The slim “textbook” simply bombarded the reader with catchphrases and slogans that urged them to wait until marriage to have sex. Among them were “Sex is like driving—you need a license to do Both,” “Don’t be a Louse; Wait for your Spouse,” and “Pet your dog, not your Date!” 

Mast and Benn, along with other abstinence-forward proponents gaining in popularity through the 1980s, argued that their positive emphasis on abstinence was a welcome change from the assumption that all young people would have sex, which they claimed was the foundation of “traditional” sex ed programs. 

Not everyone bought their arguments. The Shreveport Journal reported that when the sex ed subcommittee in Caddo County, Louisiana, examined Sex Respect in July 1986, some members “said the program underestimated the sophistication of teens and took a negative approach.” A Louisiana State University Medical Center doctor on the committee was quoted as saying that it “promotes guilt, fear and self-hatred” and “doesn’t invite you to have self-respect and learn to make decisions. 

But for many conservatives, programs like Teen-Aid and Sex Respect offered attractive alternatives to what they had long decried as amoral, or immoral, sex ed curricula. So now, when school boards were faced with decisions about sex ed—whether to implement it at all, what textbook to use, and so on—they could choose between “abstinence only” or traditional sex ed. And thanks to AFLA funding, abstinence-only programs now had the endorsement of the American government and the appearance of legitimacy. 

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The School-Based Clinic Model

While [some] young people were receiving government-funded platitudes about abstinence, other American students were getting government-funded sex ed and comprehensive care through school-based clinics. Although this model didn’t gain national momentum until the 1980s, one of the earliest school-based clinics had opened in 1973, in a junior-senior high school in Saint Paul, Minnesota. The city had been home to the Saint Paul Maternal and Infant Care (MIC) Project since 1968. An article in Family Planning Perspectives described the MIC Project as offering “comprehensive, multidisciplinary health care to adolescents.” By 1980, the MIC Project had established clinics in two “inner city” senior high schools. Each clinic was staffed with a family planning nurse practitioner, a clinic attendant, and a social worker, among others. There were on-site day-care programs affiliated with the clinics, meant to “give the adolescent parents an opportunity to complete high school, and at the same time learn good parenting skills.” Funding for the project came from a number of sources, including Title V Maternal and Child Health (MCH) block grants, Title XIX funds, and Title XX funds for the day-care facility. State funding came from the Minnesota Community Health Services Act. 

The MIC Project set out to “address the total health care needs of adolescents” and also “developed a comprehensive medical and educational program.” The results seemed promising. After two years, Laura Edwards, the director of the MIC Project, reported that “the clinic was being used by about two-thirds of 12th grade students and by more than nine in 10 pregnant students,” and “fertility rates among female students fell by 56 percent between 1973 and 1976—from 79 to 35 births per 1000.” Subsequent research found that the dropout rate for student parents fell “from 45 percent in 1973 to 10 percent in 1976,” and further, that “no repeat pregnancies occurred among those students who delivered with the project and returned to school.” 

The MIC Project served as a model for other clinic projects nationwide. By 1985, Joy Dryfoos in the journal Family Planning Perspectives noted that “in at least 14 American cities . . . comprehensive health services—including family planning services—are being offered in clinics located in or near public high schools and junior high schools.” These clinics, Dryfoos noted, served patients who tended to be “from low-income families, a reflection of the neighborhoods in which programs are located.” Dryfoos also reported that, in a study of nine school-based clinics, all surveyed provided not only general medical care, like treatment of “minor acute illnesses” and physical exams for sports and employment, but also “individual counseling about sexuality [and] gynecological examinations. . . . They either offer contraceptive prescriptions in the clinic or refer students to off-site birth control clinics. . . . They perform laboratory tests, screen for [STIs], provide nutrition education and refer students . . . to social service agencies.” 

Other clinics varied school to school. Some served as classrooms for sex ed. Most provided pregnancy tests, and many provided prenatal care. Many offered referrals to abortions, although lack of public funding for abortions made it hard for low-income students to actually receive them. And clinics that received funding through AFLA were, of course, prohibited from providing abortion counseling. One researcher noted that while such clinics would refer pregnant students to information about adoption, “teenagers appear to have little interest.” Although there was no long-term data on the clinics, as they were still so new, Dryfoos noted that the “school-based programs [had] been credited with improving students’ health, lowering their birthrates, raising their levels of contraceptive use and improving their school attendance.” 

At last, here in the school-based clinic was an evidence-based, research-backed solution to reducing adolescent pregnancies—the avowed goal of so many programs, organizations, municipal officials, federal policymakers, public healthcare workers, medical professionals, educators, and parents. The clinics were meeting young people where they were, providing them with the active care they needed to address their specific situations. As such, it was only a matter of time before the religious right began to decry them. 

Attacks on the Clinic Model

“In Room 165 at DuSable High School, teenagers can receive not only general medical care but also birth control pills and condoms,” read an article in the Sunday New York Times on September 22, 1985, entitled “Sex and School Clinic: A City at Odds,” by E. R. Shipp. Three months earlier, DuSable High School, a majority-Black school located on Chicago’s South Side, had opened a clinic in conjunction with Provident Medical Center.⁴⁰ It was funded by the Illinois Department of Public Aid and, the Associated Press reported, “a coalition of private foundations.” The year prior, the same article reported, “about 300 DuSable girls—one-third of the female students—gave birth.” In the clinic’s first two months, Shipp reported it “saw 476 students, and dispensed contraceptives, mainly condoms, to 169 of them.” The manager of the clinic, a nurse practitioner, explained that receiving contraceptives required parental consent. “We don’t just pass out birth control pills and condoms. . . . Family planning is just one of 10 health functions we perform,” she said in an interview. 

Local protest against the clinic occurred in the months after it opened. The Associated Press reported that anti-abortion groups and others opposed to “family planning” asked that the clinic be shut down. But the school board, after a multi-hour debate in September 1985, remained strong on the side of the clinic. The board did concede that there could be stronger guidelines around parental consent, which it planned to implement. 

The clinic at DuSable remained a topic of controversy as the year went on. The AP’s reporting on the clinic found its way into local newspapers, and “letters to the editor” pages were filled with the same old arguments against sex ed. In January 1986, the Black economist and commentator Walter E. Williams—who often espoused libertarian and unorthodox views—cited DuSable’s clinic as an example of the way that he believed that Black Americans were being used as political pawns. Williams charged that putting the clinic in a majority-Black school was no accident. “People wishing to lace public schools with sex clinics,” he wrote, “have discovered a new use for Blacks.” 

In April, the Scripps Howard News Service, a wire service that supplied content to papers across the country, published two head-to-head op-eds on the controversy, both penned by stalwarts of the sex ed world: Phyllis Schlafly against school clinics and the president of Planned Parenthood; Faye Wattleton, for them. “These sex clinics in public schools,” Schlafly wrote, “promote the promiscuity of minors by giving them devices to assist in engaging in illicit acts with ‘sex partners.’ . . . They are saying ‘Step right up, little girl, and get your contraceptives here; have fun with your sex partner; the only thing that’s wrong is having a baby.’” Schlafly cited Sex Respect as a good alternative to these houses of promiscuity, lauding the curriculum for its “creative lessons, cartoons and jargon that appeal to teen-agers.” 

Wattleton, on the pro side, pointed to data showing that communities with school-based clinics tended to have declining pregnancy and childbirth rates among teenagers. She added that parents in those communities typically supported the clinics. Further, the clinics not only proved that family planning worked; they were also providing other healthcare services—like physicals, nutritional counseling, and treatment of minor injuries—that students may not be able to get any other way. Wattleton’s and Schlafly’s views mapped neatly onto Democratic and Republican policies, respectively. In February 1986, the House Select Committee on Children, Youth, and Families released a study on teenage pregnancy that recommended, among such other measures as sex ed and contraception, “comprehensive health care through school-based clinics.” The Democrats on the committee said, “We know contraception works. We know sex education can make a real contribution. We know comprehensive care is essential.” 

The Republican minority report on the same study came to different conclusions altogether—ones that favored what one journalist called “a family-oriented approach that encourages children to refrain from sexual activity.” It argued that teaching young people to embrace abstinence was hard, while teaching them about contraception was easy. Therefore, they concluded, the Democrats had merely taken the easy way out. “We have, as a nation,” the minority report read, “decided that it is easier to give children pills than to teach them respect of sex and marriage.” The report falsely attributed the nation’s rising rates of teen pregnancy, “drug abuse, venereal disease, suicide and other forms of self-destructive behavior” to the liberal practice of “[giving] children pills.” 

It was easy to tick off these sobering statistics, but it was simply not accurate to attribute them to birth-control access or to birth control itself. The research of the 1980s had shown that if the goal was to lower teen pregnancy rates, the solution was to give young people clinics through which they could access birth control or, at the very least, information about birth control. However, if the goal was to prevent young people from having sex—which seemed to be what the Right wanted, whether they would say it or not—that was an entirely different story. 

Excerpted from The Fight for Sex Ed: The Century-Long Battle Between Truth and Doctrine by Margaret Grace Myers. Copyright 2025. Excerpted with permission by Beacon Press.