If you would like teenagers to not get pregnant, not get someone else pregnant, and not get a sexually transmitted infection, the education they need may not be happening in the classroom. Let me explain.

In the past, "formal" sexual health education had been an important source of information for teenagers and took place in schools, youth centers, churches or other community-based locations. This type of education may soon be a history lesson.

Between 2006–2010 and 2011–2013 there were significant declines in adolescent females' reports of having received formal instruction about birth control and sexually transmitted infections, according to research from the Guttmacher Institute, a reproductive health organization. There was also a significant decline in adolescent males' reports of having received formal instruction about birth control. During the same time frames, the number of teens who had received formal instruction about how to say no to sex, but had received no instruction about birth control methods, increased for both females and males.

Whether they're receiving sex education or not, the statistics teach us important facts. Forty percent of high schoolers surveyed said they've had sexual intercourse, according to the Centers for Disease Control and Prevention. The 2017 survey also noted that 10 percent had four or more sexual partners. About 7 percent had been physically forced to have sexual intercourse when they did not want to. Other alarming statistics include the 46 percent who did not use a condom the last time they had sex, 14 percent who did not use any method to prevent pregnancy, and 19 percent who had drunk alcohol or used drugs before their last sexual intercourse. Also, half of the 20 million new STDs reported each year were among those age 15 to 24.

Teaching teens to say "no" is not enough. If you read the research (there's a lot), you'll understand why abstinence-only-until-marriage (AOUM) programs are challenged. Luckily, a recent article published in the Journal of Adolescent Health summarized the relevant research and evaluated the evidence. Most of the scientific evidence shows that AOUM programs are not effective in delaying the start of sexual intercourse or changing other sexual risk behaviors. AOUM programs may actually have the opposite effect, according to the article. This was highlighted by data from the National Longitudinal Survey of Youth, known as Add Health, that examined the virginity pledge movement — many adolescents who intend to be abstinent fail to do so, and  when they do start sexual intercourse, many fail to use condoms and contraception to protect themselves.

AOUM education made the news recently when a 17-year-old Wallingford-Swarthmore School District student told the school board last month that faith-based Amnion Pregnancy Center had been invited to her health class, and offered medically inaccurate information, exaggerated the dangers of sex, and offered a Bible to a girl who stayed after class. The district is currently investigating these claims.

A case for comprehensive sexual health education. A significant 2012 study by the CDC examined 66 comprehensive risk reduction (CRR) sexual health programs and 23 abstinence programs. The CDC concluded that CRR programs were an effective strategy for reducing adolescent pregnancy and STI/HIV among adolescents. On the other hand, "no conclusions could be drawn on the effectiveness of group-based abstinence education."

CRR programs have long been supported by public health and medical professionals, including societies I belong to, such as the American Academy of Pediatrics and the Society for Adolescent Health and Medicine. We believe that adolescent sexual and reproductive health education should be based on scientific evidence and understanding, public health principles and human rights, and that young people need access to accurate and comprehensive sexual health information to protect their health and lives.

The new three R's. The community advocacy team at Advocates for Youth supports a sexuality curriculum based on the new three R's: Rights, Respect, Responsibility. These three R's extend outside of the classroom. More than ever, with formal sexual health education declining overall, parents need to start teaching the new three R's in the home. Advocates for Youth also has some useful educational tools for parents. As a parent and a physician, I encourage everyone to be an advocate for younger generations to receive formal comprehensive sexual health education programs in our schools, youth centers, churches, and other community-based locations.