sex education in schools canada

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Gender + Sexuality

Sex education in bc’s schools: an explainer, what and when do kids learn about contraception, consent, abortion, gender identity and more a sex ed primer..

Akhila Menon is a journalism fellow with The Tyee through Journalists for Human Rights inaugural Enhanced Access for BIPOC Youth in Canadian Media program.

What do British Columbia’s youth learn about sex, sexual orientation and gender identity in school, when do they learn it and how is it taught? These are questions that affect the well-being of every child in the province — and fuel debate and political action among adults.

The questions are so charged that in the most recent school board elections across the province, 28 candidates ran under the banner of ParentsVoice BC, a group with strong Christian conservative ties opposed to the current sex education approach in public schools. Some socially conservative trustee candidates also opposed B.C.’s SOGI, or Sexual Orientation and Gender Identity directives, which help educators make schools inclusive and safe for students of all sexual orientations and gender identities.

Parents and students might understandably be confused and wanting more information. Which is why The Tyee interviewed several education experts and practitioners to create this explainer.

Why do we teach sex ed in schools?

Twenty per cent of all B.C. youth in Grades 7 to 12 are sexually active according to a 2018 Adolescent Health Survey .

Comprehensive sex education in the classroom has been shown to improve decision-making outcomes. “Comprehensive” is important here. UNESCO’s 2018 Technical Guidance on Sexual Education defines comprehensive sex ed as “learning about the cognitive, emotional, physical and social aspects of sexuality. It aims to equip children and young people with knowledge, skills, attitudes and values that will empower them to: realize their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and, understand and ensure the protection of their rights throughout their lives.”   

Students who’ve had comprehensive instruction are more likely to have their first experience of sexual intercourse later, to have sex less frequently, to have fewer sexual partners, to engage less in risky sex and to use contraception, according to UNESCO.

Several of the experts The Tyee spoke to for the story stated that sex education is a human right. Yet in 2013, the BC Adolescent Health Survey found that the majority of young British Columbians in its sample reported that they were not learning where to get tested for a sexually transmitted infection (57 per cent) or where to get emergency contraception if they needed it (52 per cent). Many had not learned where to get free condoms or contraception (38 per cent) or where to access birth control (47 per cent).

Such findings prompted the province to update its approach to teaching sex ed in schools.

The province’s Physical and Health Education, or PHE curriculum, was redesigned and implemented between 2016 and 2019, including new standards for sexual education, developed by a team of teachers from public and independent schools and government experts.

“The language in the current PHE curriculum [in terms of sexual health content] is meant to destigmatize mental and sexual health and ensure non-judgemental language is used,” a spokesperson for the Education Ministry told The Tyee. “Rather than talking about the risks of certain activities, the focus is on promoting overall healthy sexual decision-making.”

What are kids taught about sex and when?

Sex ed starts in elementary school and progresses in a “developmentally appropriate way” as students get older, the ministry told The Tyee.

Kindergartners are taught to respond to unsafe and/or uncomfortable situations and demonstrate respectful behaviour.

From first to third grade, some of the important elements of sex ed include establishing boundaries, such as saying no without guilt.

In Grade 5, students learn about “physical, emotional and social changes that occur during puberty, including those involving sexuality and sexual identity, and changes to relationships.”

The curriculum recommends that sixth, seventh and eighth graders are taught about practices that reduce the risk of contracting STIs, reliable sources of health information and awareness of how to respond to risky situations.

And in Grade 10, the learning standards include an emphasis on healthy sexual decision-making as well as the intricacies of healthy relationships. 

Currently, topics on human sexuality and reproduction in the PHE curriculum are mandatory for all B.C. students from kindergarten to Grade 10.

However, precisely what they learn in sex ed classes depends on who is doing the instruction.

Who teaches sex ed in BC schools?

In secondary schools, it was supposed to be mainly gym teachers when the B.C. sex ed curriculum was moved from health and career to physical and health education in 2015. But often it's staff teachers or school counsellors who teach the curriculum and in many circumstances the responsibility is contracted out to independent sex ed facilitators.

In elementary schools, classroom teachers or resource teachers deliver the health-related curriculum, including the portions of it pertaining to puberty, the reproductive system, etc.

So what students are taught in sex ed can vary from one school to another?

Yes, significantly. “Individual school districts, schools and educators are responsible for determining resources used in classrooms and ensuring that they meet B.C.’s curriculum standards,” the Education Ministry spokesperson told The Tyee. So, each school district decides who does the sex ed teaching, including who might be contracted to do the job. 

What might students be told about abortion, for example? Students in schools in Abbotsford, Langley and other nearby cities may be taught by facilitators from Advokate Life and Education Services. Advokate operates “crisis pregnancy centres” which actively counsel pregnant women against seeking an abortion.

Or consider how abstaining from sex is presented compared to explaining how to practice safe sex.

An Advokate job posting from August 2022 to hire a sex ed presenter requires the candidate to be “fully committed to Advokate’s vision, mission and values, including a commitment to teaching and affirming abstinence as the best way to avoid sexually transmitted infections and unplanned pregnancies.”

Research shows that an abstinence-only focus when teaching sex ed can contribute to shame and stigma.

Jared White, executive director of Advokate, told The Tyee that “part of healthy decision-making is recognizing that sex has adult consequences.” Teens engaging in premarital sex not only risk pregnancy and contracting disease, they go on to have higher rates of divorce, he claimed, citing a book his organization uses in teaching sex ed titled Hooked: The Brain Science of How Casual Sex Affects Human Development .

The Instagram account for Advokate’s sex-ed program Sexual Health and Integrity for Teens seeks to convince teens that if you have sex with someone who you decide you dislike, “Whether your [sic] like it or not you will naturally connect to that person.”

The Tyee shared the Advokate Sexual Health and Integrity for Teens presentation outline with Kristen Gilbert, a sex ed facilitator for over 18 years who is the education director for the non-profit Options for Sexual Health . Her judgement of the Advokate approach? “Rather than offering relevant, useful information on sexual decision-making, [they claim] that the opposite of abstinence is casual sex/sex addiction. They’re essentially offering abstinence-only education.”

Contrast Advokate’s offerings with how Saleema Noon, with the organization Sexual Health Educators, teaches sex ed in many Vancouver schools. Her “primary goal is to aid young people with the knowledge and the skills they need to enjoy their sexuality, both physically and emotionally, and stay safe and healthy. Whereas abstinence-only sex ed is fear-based. And problem-focused.”

“We start with the basics,” says Noon. “And we scaffold information as kids get older in a way that's relevant to their stage of development and their experience.”

For kindergarteners and first graders, the basics include a review of the three private parts of the body: mouth, breasts and genitals, as well as a discussion about consent. Students are taught the scientific terms related to anatomy and reproduction (i.e., vulva, penis, testicles, vagina, urethra, anus, uterus), that the baby is born through the vagina, and that families are formed in different, unique ways.

Tenth graders receive a more comprehensive three-hour session, split in two parts, that provides information about “healthy sexuality, self-care, safer sex, sexual decision-making, consent, healthy relationships and online safety.”

How Noon teaches evolves with the times, she adds. It’s important to adjust and ensure that the content being provided is relevant to young people’s lives, using language that is inclusive and helps every student feel seen and heard while being medically accurate, she says.

A comprehensive, inclusive sex ed program, according to Noon, makes no assumptions about, for example, penetrative vaginal sex being the only type of sex. It recognizes the breadth of sexual experiences, and how we're all unique, in terms of our sexual orientation and gender identity.

“We know from research that it delays sexual activity. Because it’s so much more than just having sex or not having sex,” she told The Tyee. “It’s about intimacy and communication and healthy relationships and connection, and pleasure and consent, and all that good stuff.”

Some B.C. school boards have attempted to standardize their sex ed courses. Vancouver’s trustees mandated  that sex education delivery must be ethical and avoid a reflection of the facilitator's own values and present information that is unbiased and factual, for example.

Gilbert questions whether programs like Advokate’s would meet these standards.

Where is there room for improvement in BC’s sex ed curriculum?

As we’ve seen above, there can be a range of views on this one.

“Our curriculum is more current and reflective of the needs of students than many other provinces,” says sex ed facilitator Noon. “But it has become vaguer and less prescriptive in its learning objectives.” For teachers who are comfortable “running with it,” according to Noon, this is a good thing. “But there’s little guidance and support for teachers who may not be comfortable or don’t have as much experience teaching sex ed.”

“An ideal sex ed curriculum would be an evidence-based, comprehensive one,” says Brandy Wiebe, Noon’s colleague and a sexuality professor at the University of British Columbia.

Wiebe notes that while the current curriculum makes an effort to address issues around gender and sexual identities, “The tough thing about the curriculum is that it’s quite broad.”

Gilbert believes some of the content should be taught earlier. “According to the curriculum, I don’t talk about how babies are made until Grade 6,” she told The Tyee. “That is absolutely bananas. There are sometimes one or two kids in a Grade 6 or 7 class who I can tell by their faces are learning about it for the first time. And that’s far from ideal.”

She adds: “It isn’t harmful or inappropriate for children to understand how babies are made. It’s perfectly normal for children to be curious about this and it’s quite simple to explain using age-appropriate language.”

In addition, Gilbert says that being informed can help “protect children from abuse, as the parent can clarify the rules about touching, and establish themselves as an ‘askable adult’ who the child can come to with any concerns or questions.”

Predators who target children are more likely to look for a child who doesn’t know the rules about touching, and who hasn’t learned the scientific names for their body parts.

According to the 2018 Adolescent Health Survey , about 20 per cent of all girls surveyed, ages 12 to 19, had experienced sexual abuse.

Taylor Arnt, an MA student at UBC and participant in the Level Youth Policy Program comprising Indigenous and racialized immigrant and refugee youth across B.C., wrote a policy proposal for comprehensive sex ed in B.C. Arnt pointed out that the current curriculum doesn’t use the term “consent.”

The Tyee reported on this issue earlier this year.

“Schools need to explicitly mention the word consent in their sexual education lesson. It’s important that be included because, in cases of sexual violence involving the law, the issue of consent always comes up,” Arnt said.

Research backs up Arnt. A recent Canadian Women’s Foundation study found that 55 per cent of Canadians don’t fully understand consent when it comes to sexual activity.

A recent Ministry of Education press release mentioned updated health guides and the expansion of kindergarten-to-Grade-12 curriculum resources that will support educators in teaching consent with an age-appropriate and non-discriminatory approach in the classroom.

Starting in early 2023, “the province will offer additional learning sessions through Safer Schools Together for parents and students about consent, online safety and healthy relationships.”

What is the difference between sex ed and SOGI instruction in BC schools?

In the recent past, a number of socially conservative groups have voiced concerns about SOGI 1 2 3.

In an email interview with The Tyee, Reg Krake, the executive director for SOGI 1 2 3, clarified that while sex education and SOGI 1 2 3 are often confused, the latter is a set of tools and resources to help create safer and more inclusive schools for students of all sexual orientations and gender identities, rather than a set education program.

“[SOGI 1 2 3] includes policies and procedures, inclusive learning environments and age-appropriate teaching resources that are aligned to B.C.'s K-12 curriculum, and that are designed to be woven into the delivery of B.C.’s curriculum, not as additional requirements of the curriculum.”

When asked about the public response to SOGI 1 2 3, Krake said that as per their internal evaluation process, educators who are part of the SOGI Educator Network are increasingly reporting that they have both the support and resources needed to deliver SOGI-inclusive education in their school or district. 

“Each year we have tens of thousands of people accessing tools and resources from our website to help them create safer and more SOGI-inclusive schools, which speaks to the need that SOGI 1 2 3 helps address within the education field,” he added.

SOGI 1 2 3 does not, as some have claimed, “take away” from delivering math, language, arts, social studies or other core elements of the curriculum.

A recent EGALE survey of 4,000 students found that 62 per cent of 2SLGBTQIA+ respondents reported feeling unsafe at school. Schools have a responsibility to create safe and inclusive spaces for all students and SOGI 1 2 3 helps achieve that, Krake said.

It encourages inclusivity — and all students need to see themselves reflected in the world around them and to be seen for who they truly are — so that they can be free to be their most authentic selves and live their best possible life.

Can parents prevent their children from learning about sex ed in school?

In instances where students and their parents feel that topics like reproduction and sexuality might cause discomfort if addressed in a classroom setting, there is the capacity for students with parental/guardian consent to learn about the topics by an alternative means, a spokesperson for the Ministry of Education told The Tyee.

However, “The alternate delivery policy does not allow students to opt-out of learning about these topics.”

Students are still expected, in consultation with their school, to demonstrate their knowledge of the topics arranged by alternative means.

White, who also ran for school trustee under the banner of Abbotsford ParentsFIRST in last month’s school board elections, strongly believes that parents should have an equal say in their children’s education.

“I think parents are typically the people who know their kids the best and love their children the most,” White said about his stance. “And they're in the best position to be able to guide their children when it comes to healthy sexual decision-making.”

He told The Tyee that many districts have policies that require parents to be informed when their children are receiving sex education in school. Informing parents of what their children are being taught will help them reinforce those things at home.

“I know a lot of parents don’t feel equipped to speak about it with their children. And it might be good for schools to go a step further and have evening or weekend sessions for parents, where the parents can be informed because they may also have some gaps in their own knowledge.”

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Human Development and Sexual Health education by grade

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Below are details on what students will learn about human development and sexual health (Grades 1-8) and why these concepts are being taught at certain age levels.

When children know how to care for and use the correct names of their body parts, they build understanding and respect for themselves and their bodies and can communicate clearly and ask for help in case of illness, injury or abuse.

Students will learn:

• to identify body parts, including genitalia, by their proper names
• to use positive language when describing their bodies
• about their senses and how they function
• basic good hygiene habits (for example, washing your hands, using tissues)

Helping children to understand that their bodies will change (for example, losing baby teeth) can help them:

• prepare for and adjust to those changes
• appreciate what their bodies are able to do and perceive them positively
• communicate about these changes with a trusted adult if they ever feel confused
• the basic stages of human development (infancy, childhood, adolescence) and related body changes
• good hygiene habits for oral health (for example, brushing your teeth, flossing, visiting the dentist regularly)
• to appreciate what their bodies can do

To foster healthy relationships, students will learn what healthy relationships look like. Students also learn about what makes them unique and how to show respect for all.

• about characteristics of healthy relationships and consent (for example, accepting differences, listening, stating and respecting personal boundaries, being respectful, being honest, communicating openly)
• describe ways to respond to bullying and other challenges (for example, peer pressure, being left out)
• about factors and habits that can affect physical and emotional development (for example, safe environment, caring adults, feeling like you belong, appreciating what your body can do and building a healthy body image, sleep, food, physical activity)
• how visible differences (for example, skin, hair and eye colour, clothing, physical ability) and invisible differences (for example, learning abilities, cultural values and beliefs, different types of families) make each person unique
• ways of showing respect for differences in others

Today, children enter puberty earlier: on average, girls enter puberty between the ages of 8 and 13 and boys enter puberty between the ages of 9 and 14. Learning about puberty before students may fully experience it helps prepare young people for changes in their bodies, emotions and social relationships.

• the physical changes that happen during puberty, and the emotional and social impact these changes can have on a developing child
• how personal hygiene needs may change during puberty (for example, the increased importance of regular bathing)

By Grade 5, students have developed some self-awareness and coping skills, and have also learned critical thinking and reflective skills.

Puberty can be stressful and helping students to understand changes in their bodies can help them cope. Students will also continue to learn the importance of showing acceptance and respect for themselves and others, including those who may be entering puberty earlier or later than their peers.

• about factors that may affect the development of a person's understanding of themselves and their personal identity, including their sexual orientation (for example, body image, self-acceptance)
• about the reproductive system, and how the body changes during puberty
• about the process of menstruation and sperm production
• to describe emotional and interpersonal stresses related to puberty

As children grow older and enter adolescence, understanding how they and their peers may be affected by the many changes they are experiencing helps them build a healthy sense of who they are.

By Grade 6, students have developed more self-awareness and coping skills, as well as critical thinking and reflective skills, to solve problems and examine issues. They will apply these skills to learning about stereotypes and assumptions.

By examining and challenging these stereotypes and assumptions, they continue to learn about respect for others, and build self-confidence to build a foundation for healthy relationships.

• an understanding about the impacts of viewing sexually explicit media, including pornography
• the physical, social and emotional changes that may occur in adolescence (for example, body growth, skin changes, increasing influence of peers, increased intensity of feelings) and how students can build a healthy foundation for relationships
• to make decisions in their personal relationships that show respect for themselves and others, recognizing the importance of consent and clear communication
• how stereotypes — and assumptions about gender, race, sexual orientation, ethnicity, culture and abilities — can affect how a person feels about themselves, their feelings of belonging and relationships with others
• appropriate ways to respond to and challenge assumptions, stereotypes, homophobia and racism

Students need information and skills to make sound decisions about their health and well-being before they face a situation where they may need that information.

Research has shown that teaching about sexual health and human development does  not  increase sexual behaviour and can actually prevent risky activity.

• the importance of having a shared understanding with a partner about: reasons for delaying sexual activity until they are older, the concept of consent and how to communicate consent, and the need to clearly communicate and understand decisions about sexual activity in a healthy relationship
• to identify common sexually transmitted and blood borne infections ( STBBIs ) and describe their symptoms
• how to prevent STBBIs and avoid becoming a parent before they are ready, including delaying first intercourse and other sexual activities until they are older, and using condoms and other forms of protection consistently
• about the physical, emotional, social and psychological factors to consider when making sexual health decisions (for example, the risk of STBBIs or of becoming a parent before they are ready, emotional readiness, sexual orientation, moral and religious considerations, cultural teachings, and impact on other relationships)
• how relationships with others and sexual health may be affected by physical and emotional changes in puberty and adolescence

Students continue to build their understanding of factors that support positive, healthy choices, including building a deeper understanding and appreciation of themselves and their identity. Students are also exploring healthy ways to engage in evolving and new relationships.

Students will learn about:

• things that could affect someone's ability to make safe and healthy decisions about sexual activity
• sources of support with respect to sexual health (for example, parents, health professionals, in-school resources, local community groups and religious, spiritual, and cultural leaders)
• gender identity, gender expression and sexual orientation, and to identify factors that can help all young people to develop positive personal identities
• abstinence, contraception and consent in order to make safe and healthy decisions about sexual activity
• benefits, risks and drawbacks associated with relationships involving different degrees of sexual intimacy

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Beyond the Basics

Beyond the Basics is a resource for educators on sexuality and sexual health. It offers the tools to teach young people about sexuality and sexual health from a sex positive, equity, and human rights perspective. It covers anatomy, consent, healthy relationships, and more! Choose from a wide range of chapters, modules, and activities that fit the different age, grade, and curricular goals for your students

Beyond the Basics approaches sexuality education across all gender identities and sexual orientations with activities that help move students from receiving information to making decisions based on critical thinking skills and empowerment.

Once you have your copy, make sure to sign up for the online hub , designed specifically for educators! It will give you access to student handouts and activities, educator resources, definitions, answer keys, as well as a private online forum where you can exchange questions and ideas with other educators in the field.

This app features content from the Your Sexual Health Hub and is available if you are offline. To visit the full Action Canada for Sexual Health and Rights website, go to www.actioncanadashr.org.

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Questions and Answers: Sexual Orientation in Schools

Table of contents.

• Preface and Acknowledgements

Introduction

• What do we know about sexual orientation?
• There are no sexual minority youth in my school. Why address these issues?
• Homophobia and Harassment
• Mental Health
• Other Health Risks
• What do I do if a student discloses their sexual orientation to me?
• What you can do
• In the Schools
• In the Community
• What can I do to support the parents/caregivers of sexual minority youth?
• How can I help to build the resiliency of sexual minority youth?
• Concluding Perspective
• Additional Resources

First published in 1994 and revised in 2003 and 2008, the Public Health Agency of Canada’s Canadian Guidelines for Sexual Health Education (Guidelines) were developed to assist professionals working in the area of health promotion and sexual health education in programming which supports positive sexual health outcomes. Feedback from a national evaluation of the Guidelines indicated the need for companion documents to provide more detailed information, evidence and resources on specific issues. In response, the Public Health Agency of Canada ( PHAC ) identified a ‘question and answer’ format as an appropriate way to provide information to educators and other professional working with school-aged populations. The Questions and Answers styled documents are intended to cover a range of topics reflecting current issues in sexual health education with school-aged populations, are evidence-based and use inclusive language as reflected in the Guidelines .

This document, Questions & Answers: Sexual Orientation in Schools , is intended to address the most commonly asked questions regarding the sexual orientation of youth in school settings. The goal of this resource is to assist educators, curriculum and program planners, school administrators, policy-makers and health professionals in the creation of supportive and healthy school environments for youth struggling with issues of sexual orientation.

Acknowledgements

The Public Health Agency of Canada would like to acknowledge and thank the many contributors and reviewers who participated in the creation of Questions & Answers: Sexual Orientation in Schools . The development of this document was made possible through the valuable input provided by experts working in the field of sexual health education and promotion across Canada, including the members of the Sexual Health Working Group of the Joint Consortium for School Health. A complete list of the external reviewers can be found online.

In addition, the Public Health Agency of Canada would like to acknowledge the staff of the Sexual Health and Sexually Transmitted Infections ( STI ) Section, Centre for Communicable Diseases and Infection Control, for their contribution to the development of this document.

In 1996, the Canadian Human Rights Act formally included “sexual orientation” among the prohibited grounds of discrimination and in 2009, Canada marked the 40th anniversary of the decriminalization of homosexual activity in Canadian law and legislation. Lesbian, gay, and bisexual individuals (collectively, sexual minorities) now have the same rights and responsibilities as all Canadian citizens. In the span of those forty short years, Canada has emerged as one of the most progressive Western countries in recognizing basic human rights of sexual minorities, including equal partner benefits, equal adoption and foster-parenting rights, non-discriminatory workplace policies, inclusive health care, and the legalization of same-sex marriage. Despite these measures of progress, individuals are still discriminated against on the basis of their actual or perceived sexual orientation Footnote 1 .

QUESTIONING: A person who is unsure of his or her sexual orientation.

These Questions and Answers are designed to support the implementation of the Canadian Guidelines for Sexual Health Education Footnote 2 . The Guidelines are based on evidence that broadly-based sexual health education should reflect the diverse needs and realities of all people in ways that are age-appropriate, evidence-based, scientifically accurate, rights-based, culturally sensitive, respectful and inclusive of sexual orientation and gender diversity. It is the view of the Guidelines that inclusive “sexual health education should be available to all Canadians as an important component of health promotion and services” Footnote 3 .

These answers to frequently asked questions about sexual orientation Footnote 4 in Canadian schools are based on evidence-based research. This resource is targeted at helping curriculum and program planners, educators (in and out of school settings), administrators, policy-makers, and health care professionals implement the current Guidelines to ensure that:

• sexual health educational programming is inclusive of the pressing health, safety, and educational needs of sexual minority and questioning youth;

the experiences of sexual minority youth are included in all facets of broadly-based sexual health education; and

educators, administrators, and school board personnel are provided with a more thorough understanding of the goals and objectives of broadly-based and inclusive sexual health education.

Page details

Parents can benefit as much as their kids from Ontario’s new sex ed

Associate Professor, Education, York University, Canada

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Jen Gilbert receives funding from SSHRC.

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In time for back-to-school 2019, the Ontario government released a revised health and physical education curriculum. Commentators have noted that despite Premier Doug Ford having stressed the need for an overhaul, the new curriculum is strikingly similar to the one from 2015 , prompting some to call it a backtrack of election promises.

But what is new is that the Ontario government is now touting an opt-out policy for parents who want to remove their children from certain lessons on human development and sexual health .

The new policy requires schools to implement a more detailed process to “ provide parents with a list of all Human Development and Sexual Health expectations by grade .” It also give parents at least 20 school days notice before students are taught human development and sexual health.

With regards to the new opt-out policy, there are significant concerns about potential threats to children’s access to inclusive, accurate sexual education. However, progressive responses that criticize the new parental opt-out policy must be careful to not get stuck inside the government’s framing of sex education as a potential violation of parents’ rights.

Parents as partners

The majority of parents in Ontario support progressive, inclusive and comprehensive sex education. A large study by Alex McKay, executive director of the Sex Information and Education Council of Canada, and colleagues found that 87 per cent of Ontario parents agreed that sexual health education should happen in schools . The study was conducted during earlier conflicts over the Ontario sex education curriculum.

Even the government’s own consultation process received overwhelmingly positive support for sex education in schools .

But what about the parents who don’t support the curriculum, and might be contemplating the opt-out?

Many advocates of progressive sex education oppose opt-out policies — and for good reasons.

Education researcher Lauren Bialystok, from the Ontario Institute for Studies in Education at the University of Toronto, for instance, writes that Ford’s olive branch opt-out policy to those at odds with liberal norms is about framing democratic policy-making as an adversarial struggle between “the people” and “the elite.”

Read more: Doug Ford's reboot of sex education in Ontario: Same as it ever was

She has argued that parents’ rights to determine how their children are raised shouldn’t override students’ right to learn about sexuality . I agree with her. However, my concern is that focusing now on the opt-out policy might reinforce the misleading belief that parents are only an obstacle to their children’s sex education.

Why, we might ask, are schools not concerned about parents who might complain or opt out if their children are not receiving a progressive — and inclusive —enough sex education? What would sex education look like if progressive sex ed advocates took those concerns more seriously?

Larger issues

Discussions of sex education should begin from the assumption that all parents are invested in their child’s education. Even when parents — conservative or liberal — have concerns about the sex education their child receives at school, they act out of love and care, not just political convictions.

The government has cynically positioned sex education as a potential violation of conservative parents’ rights. In response to this strategy, progressive advocates must be careful not to repeat and reinforce that antagonism.

I know of no studies documenting how many parents opt their children out of sex education in Canada. But qualitative research from the United States suggests the number is very small .

If sex ed advocates, researchers or educators acquiesce to the government’s framing of this issue and make the opt-out policy the problem, they may lose sight of the larger issues.

For instance: How can our society provide teachers with the resources to implement this curriculum? How will schools ensure all students, including racialized and Indigenous students, girls and LGBTQ students, are able to explore their ideas about sexuality and gender both in and out of the classroom?

Sex ed in the playground

Even still, sex education researchers and advocates know that sex education is never confined to a single class. Even as parents, politicians, educators and researchers debate what should or shouldn’t be included in a formal sex education curriculum, young people are taking the lessons they receive from their teachers out into the playground.

There, the formal curriculum is modified by the informal sex education students receive at school about gender and sexuality. Sex education happens in the cafeteria, locker room, on Instagram, in movies, through music and on Netflix.

Sex education includes all these teachers. And if schools are going to help young people navigate these lessons, both in and out of the classroom, they should enlist the help of parents.

Schools have a responsibility to offer students comprehensive, inclusive, medically accurate sexual health education regardless of who their parents are. But this mission is enhanced when schools, and sex education advocates, recognize parents as resources for sex education.

Let’s not be afraid of sending home notices about the sexual health education students will be receiving. Let’s invite parents to share their concerns and hopes with schools and teachers. Let’s opt parents into sex education. They may benefit from it as much as their kids.

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Canadian guidelines for sexual health education

The Canadian Guidelines for Sexual Health Education provide guidance to educators and policy makers for the development and evaluation of comprehensive evidence-based sexual health education in Canada. The revised 2019 Guidelines include new content: a section documenting the importance of comprehensive sexual health education in Canada, Core Principles of Comprehensive Sexual Health Education, a list and description of appropriate educators and settings for the provision of comprehensive sexual health education, and benchmarks for the provision of STI prevention education and linking to STI testing in schools.

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Health Reports Where do 15- to -17-year-olds in Canada get their sexual health information?

by Michelle Rotermann and Alexander McKay

DOI : https://www.doi.org/10.25318/82-003-x202400100001-eng

What is already known on this subject?

What does this study add, introduction, definitions, strengths and limitations, correction notice.

In the article “ Mortality inequalities of Black adults in Canada ” published on June XX, 2022, an error was found in PPP.

The following correction has been made :

Sexual health education delivered in school, provided by parents, or provided by other formal sources has been associated most closely with increased rates of condom use and improvements in many other sexual risk behaviours. Friends and the internet are other information sources, although quality and accuracy are not always as high. Nationally representative Canadian data about where adolescents obtain their sexual health information are lacking.

Data and methods

Weighted data from the 2019 Canadian Health Survey on Children and Youth were used to examine the sources typically used to obtain sexual health information by 15- to 17-year-olds, as well as the prevalence and characteristics of adolescents reporting not having an adult to talk with about sexual health and puberty.

Most 15- to 17-year-olds in Canada reported having at least one source of sexual health information (96.6%). More than half identified school (55.6%) and parents or guardians (51.2%) as sources of sexual health information. The internet (45.9%), friends (36.2%), and health care professionals (20.9%) were other common sources. Whereas 61.2% of adolescents identified more than one source of sexual health information, 3.4% reported not having any source. Nearly 15% of adolescents reported not having an adult to talk with about sexual health or puberty. Differences in sources consulted and having an adult to talk with depended on many factors, including sexual attraction and/or gender diversity, sex, immigrant status, racialized status, lower-income status, strength of parent–adolescent relationship, region of residence, and mental health.

Interpretation

An improved understanding of the sources of sexual health information used by adolescents and identification of characteristics associated with adolescents reporting not having an adult to talk with could help develop strategies to improve sexual health outcomes via better access to sexual health promotion and educational resources.

sex-ed, sexuality education, contraception, condoms, puberty 

Michelle Rotermann is with the Health Analysis Division, Analytical Studies and Modelling Branch, Statistics Canada, Ottawa. Alexander McKay is the Executive Director of the Sex Information and Education Council of Canada.

• Many studies assessing the efficacy of sexual health education indicate that it contributes to safer sex practices, including increased rates of condom or contraceptive use, fewer sexually transmitted infections, reduced teen pregnancies, delayed sex, and fewer sexual partners.
• The quality, accuracy and completeness of sexual health information can differ by source.
• Where adolescents get their sexual health information can influence their sexual behaviour.
• It provides updated information about sources of sexual health education for 15- to 17-year-olds in Canada.
• While 97% of adolescents reported having at least one source of sexual health information, some adolescents reported not having an informational source. Males, immigrants, residents of some regions, adolescents who are sexually and/or gender diverse, and some racialized populations could be more vulnerable to experiencing negative sexual health outcomes in the absence of more support and education.

Establishing healthy behaviours to prevent disease and support well-being is easier and more effective during childhood and adolescence than it is later in life. Adolescence is an important development period in which adolescents reach sexual maturity. It is also when youth, on average, begin engaging in sexual activities for the first time. Note  1 Because adolescents and young adults experience some of the highest rates of sexually transmitted infections (STIs) and unplanned pregnancies, Note  2 , Note  3 , Note  4 it is important to ensure access to appropriate resources and related sexual health information to support more knowledgeable decision making and the adoption of healthy sexual behaviours. Sexual health is a key component of overall health and well-being. Note  5

Sexual health education provided via formal instruction (sometimes called curriculum-based sexual health education programs) often includes information about the biological aspects of contraception, STI s, condom use, sexual identity, reproductive health, etc. Note  6 More recently, content on individual and interpersonal (e.g., self-acceptance, healthy relationships) aspects of sexuality has been incorporated. Note  5 Many studies assessing the efficacy of sex education or condom education programs, typically taught in school, find they contribute to safer sex practices, including increased condom or contraceptive use, fewer STI diagnoses, reduced teen pregnancies, delayed sex, fewer sexual partners, etc. Note  7 , Note  8 , Note  9 , Note  10 , Note  11 Parents and other family members are another common resource that can help adolescents with their sexual health questions, Note  12 , Note  13 , Note  14 although not all adolescents are comfortable talking with their parents. Note  15 Mothers tend to be more effective teachers than fathers; having discussed sex-related questions with them was associated with a small protective role by increasing rates of contraceptive and condom use.16 Other sources of sexual health information may not be as effective, Note  16 , Note  17 , Note  18 p and sometimes the quality, accessibility, and impact on outcomes differs. Note  15 For some sources, such as the internet, the quality and completeness of the information vary widely from comprehensive sexual health websites to pornography.  In summary, where adolescents get their sexual health information is important and can influence their sexual behaviour. Note  12 , Note  17 , Note  18

The objective of this study was to update Canadian information about sources of sex education self-reported by adolescents and the related resource of having an adult to talk with about puberty and sexual health. This information can help to identify gaps and monitor changing access to sex information. Disaggregating results by sociodemographic and other characteristics can identify differences between groups.

Data sources

The cross-sectional 2019 Canadian Health Survey on Children and Youth (CHSCY) collected detailed data on the physical health, mental health and related determinants of children and youth in Canada. Note  19 The CHSCY used a sampling list frame created from the Canada Child Benefit (CCB) files. The CCB files contain a list of all program beneficiaries, along with their names and corresponding contact information. This list was used to directly select the random sample of children and youth. Data were collected using a primarily self-completed electronic questionnaire, although interviewer assistance via the telephone was also available. Collection took place from February to August 2019 and covered the population aged 1 to 17 years living in the 10 provinces and the 3 territories.

Excluded from the CHSCY ’s survey coverage were children and youth living on First Nations reserves and other Indigenous settlements in the provinces, in foster homes, or in institutions. The CHSCY covers approximately 98% of the Canadian population aged 1 to 17 years in the provinces and 96% in the territories.

Two questionnaires were administered. The first was administered to the person most knowledgeable (typically a parent) and the second was administered directly to the selected respondents aged 12 to 17 years. The overall CHSCY response rate was 52.1%, while that for the 6,915 respondents aged 15 to 17 years was 41.3%. The questions on the sources of sex information were asked only of the 15- to 17-year-olds. The study sample for having an adult to talk with about sexual health information excluded another 60 respondents because they did not answer the question. The sample used for the analyses on the different sources of sex education excluded 61 additional respondents because of non-response. For covariates, “not stated” responses were set to missing and excluded from the frequency analyses, with missingness varying from none (e.g., for the province or territory) to nearly 5% on the sexual and/or gender diversity measure. 

Main outcomes

Not having an adult to talk with about sexual health, puberty, and sexual development was based on responses to the question: “If you had a question or concern about puberty, your sexual development or sexual health, is there an adult that you could talk with to get help or advice?”

Adolescents were also asked about the sources they used to obtain sexual health information: “Where do you typically get sexual health information?” Eight sources were provided, and respondents could select all that applied: (1) school, (2) a parent or caregiver, (3) friends, (4) printed books or pamphlets, (5) the internet, (6) a health care professional such as a doctor or nurse, (7) nowhere, and (8) other. Responses to these questions were used to distinguish adolescents who reported having at least one source of sexual health information from others who reported not having any source (i.e., nowhere). They were also used to examine the characteristics of adolescents reporting different sources of sexual health information.

The selection of covariates was guided by the literature and data availability in the CHSCY and included sociodemographic, adolescent, and adolescent-household characteristics.

Sex at birth was coded as male or female. Gender (referring to the current gender that may be different from sex assigned at birth) was coded in the CHSCY as male gender, female gender, and gender diverse and was based on answers provided by the adolescent. It is acknowledged that the gender response categories boy and girl (for children and youth) are preferable. Note  20 Preliminary analysis of the gender modality of CHSCY respondents found that over 99% of 15- to 17-year-olds in this study who were assigned male at birth also selected “male gender”. Similarly, nearly 99% of adolescents in this study who were assigned female at birth selected “female gender”. These results create some analysis challenges because of the small numbers of transgender and non-binary youth in the CHSCY . For that reason, a sexual and/or gender diversity variable was included to minimize data suppression and allow some analysis of the experiences of transgender and non-binary youth. This categorization follows the example set by another CHSCY study. Note  21 This composite variable combined each respondent’s self-reported sex at birth, gender and sexual attraction information. Sexual attraction was based on responses to the question: “People are different in their sexual attraction to other people. Which best describes your feelings? Would you say you are: 1: Only attracted to males, 2: Mostly attracted to males, 3: Equally attracted to females and males, 4: Mostly attracted to females, 5: Only attracted to females, 6: Not sure.” Adolescents who said they had at least some same-gender attraction and adolescents who were coded as transgender or non-binary were grouped together and compared with the subset of cisgender teens who reported they were only attracted to a different gender (Appendix Table A). Cisgender adolescents who were unsure about the target of their attraction (4% of all 15- to 17-year-olds) were coded as missing. Being unsure about their attraction did not result in the exclusion of any records pertaining to transgender adolescents, because group membership could be ascertained based on being transgender or non-binary, despite missing information about attraction. Other dimensions of sexual orientation (including sexual identity or behaviours) were not available in the CHSCY .

The CHSCY included the concept of racialized population using racial and cultural group information collected in accordance with the Employment Equity Act and its regulations and guidelines. Respondents who identified as non-Indigenous were asked to identify which ethnocultural population group they belonged to. Indigenous respondents were coded as missing for these variables. Thirteen response categories were available and used for two separate variables (racialized or non-racialized and non-Indigenous [White]) and five population groups (South Asian, Black, Chinese, non-racialized and non-Indigenous [White], and “other racialized” [composed of individuals identifying as Filipino, Arab, Latin American, Southeast Asian, West Asian, Korean, Japanese, groups not defined elsewhere, and people identifying multiple population groups]). Respondents were also categorized as immigrants or non-permanent residents versus Canadian-born people. 

Indigenous identity was based on information provided by the adolescent. Respondents identifying as First Nations, Métis and Inuit were identified as Indigenous people. Further disaggregation was not possible because of limited sample size.   

Canada does not have a coordinated sexual health curriculum. Note  22 Instead, each province or territory is responsible for its own programming. Geographic differences related to sociodemographics can also affect regional differences in the sources of sexual health information reported. Analyses were disaggregated by province or territory of residence where the sample allowed. In one analysis (Table 6), it was necessary to create a territories estimate (three territories combined), since the territory-specific estimates would have required suppression. 

Household income (self-reported total from all sources and before taxes and deductions) was categorized as below the 2019 median market income of $58,300 (also called income before taxes and transfers in 2019 constant dollars) or at the median or above. Note  23

Family structure , describing the living arrangements of the adolescent, was categorized as living with two parents (biological, step, adoptive, etc.) or not living with two parents (other). The strength of the parent–adolescent relationship was based on information about how often the adolescent talked to their parents or guardians about what they did during the day. Adolescents could report having these exchanges regularly (most of the time or often) or irregularly (never, rarely, or sometimes).

The self-perceived mental health of adolescents was classified as fair or poor versus good, very good, or excellent based on responses to the question: “In general, how is your mental health?”

The number of hours of screen time was categorized as 0 to less than 3 hours, 3 to less than 7 hours, 7 to less than 14 hours, 14 to less than 21 hours, or 21 hours or more based on responses to the question: “In the past 7 days, how much time in total did you spend using any electronic device such as a mobile device, computer, tablet, video game console or television while you were sitting or lying down?”

Analytical techniques

Descriptive statistics using weighted data, adjusted for non-response, were used to examine the prevalence of nothaving an adult to talk with about sexual health, puberty, and sexual development and to study the sources adolescents typically used to obtain sexual health information by selected covariates. Bootstrap weights were applied to account for the underestimation of standard errors resulting from the complex survey design. Note  24 Analyses were performed using SAS 9.4 and SUDAAN 11.0.3. Differences between weighted estimates were calculated with t-tests. Reported differences in the text are statistically significant at the p < 0.05 level (meaning that they were not likely to have occurred by chance alone). To improve readability, the term “statistically significant” is not typically repeated.

Sources of sexual health information

According to the CHSCY , most 15- to 17-year-olds reported having at least one source of sexual health information (96.6%) (Tables 1 and 2). More than half of adolescents in Canada identified school (55.6%) and parents or guardians (51.2%) as sources of sexual health information (Table 2). The internet (45.9%), friends (36.2%) and health care professionals (20.9%) were also common sources. Books or other printed materials (7.0%) and other sources (1.7%) were less frequently cited.

More than 6 in 10 adolescents (61.2%) identified more than one source of sexual health information (Table 1). Just over one-quarter (25.8%) identified two sources, nearly one in five (18.7%) identified three sources, and one in six (16.7%) identified four or more sources. More than one-third (35.4%) of adolescents reported a single source, and 3.4% reported not having any (Table 1).

While both males and females reported consulting many of the same sources for sexual health information, there were some differences by sex. For example, it was more common for males to report having one source (37.7% versus 33.0% for females) or no typical sources (4.6% versus 2.1% for females). Reporting three (20.6% for females versus 17.0% for males) or four or more (18.6% for females versus 14.8% for males) sources was more common among females.

Also, more males (58.5%) than females (52.7%) identified school as a source of sexual health information. However, higher percentages of females identified parents or guardians (55.7% versus 46.9% for males), friends (40.9% versus 31.7% for males), health care professionals (25.3% versus 16.7% for males), and books (7.8% versus 6.1% for males) (Table 2). The internet (45.2% for males versus 46.6% for females) and other sources (1.6% for males versus 1.7% for females) were identified by similar percentages of males and females.  

Other characteristics of the adolescents were also associated with sources of sexual health information. For example, those who are sexually and/or gender diverse relied more on the internet (58.3%), health professionals (25.9%), and printed materials (10.4%) than their cisgender counterparts with exclusive different-gender attraction (43.9%, 20.3% and 6.3%, respectively) (Table 2). Among adolescents born outside Canada, over 6 in 10 (61.9%) reported getting sexual health information from school, and fewer than half (44.7%) relied on their parents or caregiver. The pattern was different with respect to these sources for Canadian-born adolescents, with fewer reporting school as a source (54.2%) and more reporting their parents (52.6%). 

The amount of time adolescents spent online was also associated with identifying the Internet as a source of sexual health information (Table 3). For example, fewer than 3 in 10 adolescents who reported less than 3 hours of screen time per week (28.7%) identified the internet as a sexual health information source—about half the estimate (56.1%) for those reporting 21 or more hours of weekly screen time.

There were also some geographic differences in identifying school as a source of sexual health information (Table 4). For example, 60.2% of adolescents living in Ontario and about two-thirds of adolescents from Manitoba (66.9%) and the Northwest Territories (66.7%) identified school as a typical source, significantly above the estimates for the rest of Canada (other provinces and territories combined). By contrast, 39.6% of adolescents from Quebec reported school as a source, which was significantly lower than the corresponding estimate for the rest of Canada.  

Prevalence of not having an adult available to talk with about sexual health or sexual development

According to the 2019 CHSCY , 14.9% of adolescents aged 15 to 17 in Canada reported not having an adult available to talk with about sexual health or puberty (Table 5). More males than females reported not having an adult available (16.6% versus 13.2%, respectively). A higher percentage of sexually and/or gender diverse adolescents compared with cisgender adolescents (with exclusive different-gender attraction) also reported not having an adult available (18.3% versus 13.2%, respectively).

Nearly one-quarter (23.0%) of racialized adolescents reported not having an adult to talk with about sexual health or puberty, more than double the estimate for their non-racialized and non-Indigenous (White) peers (11.2%). Similarly, a higher percentage of adolescents who were not born in Canada, compared with those who were, reported not having an adult to talk with (22.5% versus 13.3%, respectively). By contrast, the percentage of Indigenous respondents (13.4%) who reported not having an adult available to talk with about their sexual health or puberty was comparable to the estimate for their non-Indigenous peers (15.0%). 

At 24.6%, the prevalence of not having an adult to talk with about their sexual health was about three times higher for adolescents who did not regularly talk about their day with their parents or guardians than it was among those who did (8.5%). Additionally, reporting not having an adult to talk with was more common among those from lower-income households (below the 2019 median market income of $58,300) (19.3%) and those not living with two parents (17.8%) than it was for adolescents from higher-income households (13.2%) and those living with two parents (13.8%).

Mental health was also related to reporting not having an adult available to talk with about sexual health or puberty. Adolescents who reported worse mental health were more likely to indicate not having someone to talk with than those who considered their mental health to be better (22.9% versus 13.4%, respectively).

There was some variation across the country, with about one in five adolescents in British Columbia reporting not having an adult available, significantly above the estimates for the rest of Canada (other provinces and territories combined) (Table 6). By contrast, fewer adolescents in New Brunswick (10.3%) and Nova Scotia(9.9%) reported not having an adult available, lower than the rest of Canada.

Considerable research suggests that adolescents who have received sexual health education are better at making informed sexual health decisions, thereby contributing to healthier sexual development and safer sexual behaviours. Note  7 , Note  8 , Note  9 , Note  10 , Note  11 According to this study, most adolescents in Canada reported having access to sexual health information, and the majority had an adult to talk with about this topic.

People from racialized and some ethnic groups, and sexual minorities can be disproportionately affected by negative sexual and reproductive health outcomes. Note  4 , Note  25 , Note  26 , Note  27 , Note  28 Gaps in sexual health education for some populations may have contributed to these differences. The current study indicated, for example, that nearly twice as many foreign-born adolescents and adolescents from racialized population groups reported not having an adult available to discuss sex-related concerns as their Canadian-born or non-racialized and non-Indigenous (White) peers. Higher percentages of adolescents who are sexually and/or gender diverse versus their cisgender counterparts (with exclusive different-gender attraction) also reported not having an adult to talk with about sexual health. Youth who belong to some ethnic or racialized groups, who are immigrants, or who are sexually and/or gender diverse may not always have the understanding and support of family—therefore, they may not be able to discuss their sexual and reproductive health. Note  27 , Note  28 , Note  29 The provision of sexual health education at school, particularly if it is culturally sensitive and inclusive, can help ensure adolescents who might not otherwise have access to this valuable information can obtain it. Similarly, for adolescents born outside Canada, school can be an especially important source of sexual health information.

Results from this study align with others showing that any youth, regardless of sexual experience, sexual attraction, gender identity, race or ethnicity, can find talking with their parents about sex embarrassing. Note  17 , Note  30 Parents can also find these conversations challenging, owing to their limited knowledge, discomfort with the subject, or concerns about appropriateness or necessity. Note  31 This helps to explain why nearly half of adolescents do not identify their parents as a source. Talking regularly with parents does, however, seem to help foster communication between parents and children, Note  32 a finding echoed in this CHSCY study showing that adolescents who talked regularly with their parents were less likely to report not having an adult to talk with about their sexual health concerns.

Male and female adolescents also tended to differ in where they obtained their sexual health information. Females tended to rely more often on their parents, friends and health professionals, whereas more males reported school as a source. Also, not having an adult to discuss their sexuality questions with was more than twice as common among males than females. Other research suggests that this sex difference can matter because the subjects covered have been shown to differ depending on the provider and sex of the recipient (e.g., more females receive guidance on how to say no and where to obtain birth control, whereas males are more likely to learn how to use condoms). Note  13 , Note  33 , Note  34 These sex differences can put adolescents not receiving a more complete sexual health education curriculum at risk.

This study found some regional differences in the reporting of school as a source of sexual health information and in the rates of not having an adult to talk with about this topic. Education is a provincial or territorial responsibility; as a result, the curriculum is not standardized and varies across Canada. For students aged 17 in Quebec, the existence of pre-university and vocational career programming offered by Collège d'enseignement général et professionnel (CEGEP) might mean courses with sexual health education content are not always taken. This could help explain the lower numbers of Quebec adolescents reporting school as a source, although other factors may also have contributed.

This short study has several strengths, including that the CHSCY is a national, population-based survey that covers a wide range of subjects, allowing for a detailed look into the health and sociodemographic characteristics of Canadian adolescents’ use of different sources of sexual health information. Nevertheless, results of this study should be interpreted in light of several limitations.

Some variables relevant to the study of sexual health and related information were not collected by the CHSCY , including religiosity, Note  33 details about the sexual health education provided, the timing of the sexual health education, and information about an adolescent’s previous sexual behaviours and experiences.

The data are cross-sectional and thereby permit the observation of associations between variables at only one point in time. Information was self-reported and has not been verified, and it can be subject to recall and social desirability biases. The use of survey weights adjusted for non-response helped to ensure that the dataset more accurately represented the target population. 

While the CHSCY was designed to study the health of children and youth and boasts a comparatively large sample, the problem of small sample sizes was not completely eliminated. This issue sometimes necessitated the use of dichotomized variables and meant the study could not examine certain at-risk and understudied subpopulations, including people with intellectual disabilities, Note  35 people with autism, Note  36 and Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer and/or Questioning + (2SLGBTQ+) adolescents. Note  27 Disaggregated data about gender and sexual diversity can be of lower quality if the collected sample size is too small. In such cases, it is helpful to combine gender and sexually diverse respondents to produce estimates related to the broader 2SLGBTQ +population. Small samples or effect sizes in other parts of the analysis may also have affected significance testing.

Concluding remarks

This study provides an updated picture of the sources used by adolescents in Canada to obtain sexual health information. It also examines the characteristics of adolescents who reported not having an adult to talk with about their sexual health or puberty. While the majority reported having access, there were some adolescents who reported not having an adult they could talk with or another informational source. Adolescents who were male, were born outside Canada, were sexually and/or gender diverse, were racialized, were experiencing fair or poor mental health, were from lower-income households, talked infrequently with their parents, and resided in some regions could be more vulnerable to experiencing negative sexual health outcomes in the absence of more support and education. The differences identified in this study could help develop more tailored curricula or other resources to help all adolescents have the information and support they need to make more informed choices about sex.

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Sex education and gender identity in schools rife with controversy

Sexual health education and gender identity policies in schools have prompted heated debates across Canada.

Lui Xia Lee

In B.C., a sexual orientation and gender identity program for educators, called SOGI 123, has drawn some opposition. Credit: Jon Gilbert Leavitt/Flickr

The Ontario government faces a human rights challenge over the scrapping of its new 2018 sex-education curriculum in favour of a version developed in 1998. In B.C., a sexual orientation and gender identity program for educators, called SOGI 123, continues to draw protests as school boards across the province vote for its adoption.

Steve Mulligan, coordinator of sexual orientation and gender identity (SOGI) inclusive education in the UBC faculty of education, helped develop the SOGI 123 inclusive schools model and teaching resources. He and Wendy Carr, teacher education professor at UBC, discuss the importance of SOGI and sexual health education in schools, and what’s at the root of the protests.

How are sexual orientation and gender identity currently addressed in B.C. schools?

SM: Gender identity or expression was added to the B.C. Human Rights Code in 2016. In September of that year, the B.C. Ministry of Education announced that all school districts needed to have sexual orientation and gender identity policies in place, but the ministry wouldn’t dictate what those policies were. We created the SOGI 123 website, a one-stop shop where teachers can get lesson plans, and also developed the SOGI 123 model, which has since been adopted by 55 out of 60 school districts in the province.

Is sexual orientation and gender identity fully integrated into the curriculum?

SM: It is and it isn’t. The redesigned curriculum gives teachers quite a bit of autonomy and flexibility. It emphasizes competencies and things that students can do, rather than specific kinds of content. That’s a good thing generally, but when it comes to human rights, it poses a challenge because teachers who don’t want to talk about it can just avoid it.

For instance, the K-1 social studies curriculum places a big emphasis on families, and same-sex families are listed as a sample topic. But if it’s a sample topic, it’s not mandatory. I think the ministry was hoping school districts would take the lead—for instance, that librarians would put more books in the library that include different kinds of families.

Updating sexual health curriculums is often controversial. Why do you think that is?

WC: Education can be a very conservative domain. Certain traditions are reproduced generation after generation. I think the fear is that some of this information could introduce some topics to children at too early an age, and that sort of thing. Wherever there’s that fear, there can be a desire on the part of some parents and others to pull back, and I think that’s what we’ve seen in Ontario.

But if you look at the Ontario sexual health curriculum, it’s based on knowledge, not moralizing. It also includes digital literacy, making safe choices in terms of using the internet, and all sorts of things that weren’t as prevalent 20 years ago. It also has some very good professional development information for teachers. That’s really important, particularly if teachers aren’t as comfortable teaching this material because they themselves were not taught it. This is what happens in education—we often perpetuate these gaps. Trying to address it, as the new Ontario curriculum was trying to do, was a really positive step forward.

Where do misconceptions about the sex-ed curriculum come from?

WC: It’s often from individuals who haven’t had factual, age-appropriate sexual health education themselves. Typically, if you address the strongest critics and ask them a few questions, you start to notice a lack of knowledge, and the false notion that kids are going to be “converted” or drawn into different choices or patterns of behaviour.

When a province such as Ontario says we don’t value what’s being taught here, that sends a powerful message to the education system, families, educators and kids. It keeps vulnerable people vulnerable. School districts must ensure that all families, children and staff can feel safe and included.

How does the controversy over sex-ed and SOGI policies affect teachers?

SM: I think a lot of teachers feel caught in the middle, and it can lead to them avoiding the topic, which is unfortunate. On the other hand, over my career I’ve seen many gay and lesbian teachers who are increasingly comfortable being out to their students and families. Many of them feel that it’s important to be out, in the same way that it’s important to have Indigenous educators in schools as role models for Indigenous students and the general public.

Erik Rolfsen UBC Media Relations Tel: 604-822-2644 Cel: 604-209-3048 Email: [email protected]

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• Sexual Health Education
• Understanding Your Role
• Get Prepared

Curriculum Overview

• Teacher Webinars and Workshops
• Ground Rules/Group Agreements
• Using the Lesson Plans
• Inclusive Language
• Instructional Methods
• Notifying Parents and Guardians
• Health Resources & Guest Speakers
• Comprehensive School Health
• Your Values
• Gender Identity & Expression
• Sexual Orientation
• Technology & Media
• Responding to Student Questions
• Student FAQs
• Submit a Student Question
• Managing Sensitive Issues
• Lesson Plan & Resource Finder
• Differing Abilities
• CALM (10-12)
• Print Resources
• Alberta’s Education Act
• Best Practice Guidelines
• Additional Resources

The following is a summary of the human sexuality outcomes from the Alberta Education Program of Studies

• Physical Education and Wellness K-6
• Health and Life Skills 7-9

Students explain how development and puberty are connected.

• Puberty is a period of rapid growth and progression from childhood through adolescence to adulthood.
• Puberty marks the beginning of the life stage of adolescence.
• A growth spurt can be an indicator of the beginning of puberty.
• Puberty prepares the human body for reproduction.
• relationships
• Differences in physical characteristics can occur during and after onset of puberty.
• The progression of puberty can be experienced in unique ways.
• growth of body hair
• skin changes
• voice changes
• sperm production
• menstruation
• increased intensity of feelings
• friendships becoming more important
• emphasis on body image
• wanting to fit in and be liked
• Some cultures have different celebrations that recognize the transition into puberty.
• Adolescents may have questions about puberty and its associated changes.
• parents or caregivers
• health professionals
• counsellors
• spiritual leaders
• Knowledge Keepers
• using deodorant or antiperspirant
• showering or bathing more frequently
• changing clothes regularly

Understanding

• Puberty can allow individuals to take on new roles and responsibilities and experience new learning opportunities.
• Puberty is a process of maturation that includes physical and social-emotional changes.
• Awareness of changes that happen in puberty can support mental health and emotional well-being.
• Cultural traditions can mark the transition from childhood to adulthood. 
• Sources of support are available for adolescents during puberty.
• Puberty can require changes in personal hygiene practices.

Skills & Procedures

• Recognize that puberty marks the beginning of a new life stage as individuals move toward becoming mature adults.
• Describe changes that happen during puberty.
• Explore how transitions into puberty are acknowledged in different cultures.
• Recognize that First Nations, Métis, or Inuit entry into puberty can be accompanied by ceremony that supports the ongoing transition into adulthood.
• Identify credible sources in the community to support individuals through the changes that occur during puberty.
• Identify how personal hygiene practices may need to be modified as the body changes.

Students connect puberty to the capacity for human reproduction.

• Each part of the human reproductive system serves a specific function.
• The human reproductive system and other body systems are interconnected.
• Human reproduction occurs when a sperm cell and egg cell join together (fertilization) and implant in the uterus (implantation).
• change in functioning of the testicles and ovaries
• maturation of the reproductive organs
• appearance of secondary sex characteristics
• production of hormones
• Menstruation is the monthly cycle that prepares the body for a possible pregnancy.
• The female reproductive system includes ovaries that contain egg cells.
• Ovulation occurs when an egg releases from an ovary.
• Hormonal changes regulate the menstrual cycle and ovulation.
• The egg travels to the uterus and is released with the lining of the uterus, if unfertilized.
• Fertilization is more likely to occur at a specific point in the menstrual cycle.
• The male reproductive system includes testicles that produce sperm.
• Sperm travels through the vas deferens and is combined with other fluid to produce semen.
• engaging in physical activity
• eating nutritious foods
• reducing stress
• Well-being is supported through knowledge and awareness of human reproduction.
• Human reproduction includes a sequence of biological processes.
• Puberty signals changes in a person’s reproductive capability.
• Puberty is often associated with the processes of menstruation and sperm production.
• Positive health practices during puberty support a healthy reproductive system.
• Identify the components of the human reproductive system.
• Describe the functions of the components of the human reproductive system.
• Describe how physical changes during puberty affect reproductive capability.
• Describe the processes of menstruation and sperm production.
• Identify positive health practices during puberty.

Students investigate human reproduction from fertilization to birth.

• Pregnancy can occur as a result of sexual intercourse.
• Pregnancy can be confirmed by a test.
• Abstinence means choosing not to have sexual intercourse.
• Any sexual activity always requires consent.
• Self-control can support decision making related to human reproduction.
• Different types of birth control can have varying levels of effectiveness and risks.
• Sexual activity can expose individuals to the risk of sexually transmitted infections and blood-borne infections.
• Some birth control measures can lower the risk of sexually transmitted infections and blood-borne infections.
• financial preparedness
• family, caregiver, and community supports
• The length of pregnancy is approximately 40 weeks and is divided into three stages called trimesters.
• A child born before 37 weeks of pregnancy is called a pre-term birth.
• poor nutrition
• alcohol use
• getting adequate sleep and rest
• attending early and consistent medical visits
• parents and caregivers
• There are diverse traditional, cultural, and religious beliefs regarding reproductive health.
• Pregnancy is a natural human process.
• Abstinence is the most effective way to prevent pregnancy.
• Sexual activity without consent is sexual assault and can have physical, emotional, social and/or legal consequences.
• Birth control and natural family planning can help prevent pregnancy and sexually transmitted infections.
• In Canada, individuals have the right to make decisions about reproductive health and can decide if, when, and how often to reproduce.
• Fetal development occurs in stages throughout a pregnancy.
• Supportive health practices can enhance reproductive health, a healthy pregnancy, and safe childbirth.
• Credible sources can provide accurate information on reproductive health and support healthy reproductive decisions.
• Traditional, cultural, and religious beliefs can affect understandings of human reproduction.
• Identify effective ways to prevent pregnancy and sexually transmitted infections.
• Examine factors that can influence decisions related to reproductive health.
• Examine fetal development in each of the three trimesters.
• Examine factors that can adversely affect fetal development.
• Identify health practices that support a healthy pregnancy.
• Identify credible sources of reproductive health information.
• Consider ways that human reproduction can be influenced by traditional, cultural, and religious beliefs.

W-7.3 Examine the human reproductive process, and recognize misunderstandings associated with sexual development.

W-7.12 Identify the effects of social influences on sexuality and gender roles and equity; e.g., media, culture.

W-7.13 Examine the influences on personal decision making for responsible sexual behaviour.

W-7.14 Examine abstinence and decisions to postpone sexual activity as healthy choices.

W-8.3 Recognize and accept that individuals experience different rates of physical, emotional, sexual and social development.

W-8.7 Determine the signs, methods and consequences of various types of abuse; e.g., neglect, physical, emotional, sexual abuse.

W-8.12 Identify and describe the responsibilities and consequences associated with involvement in a sexual relationship.

W-8.13 Describe symptoms, effects, treatments, prevention for common sexually transmitted diseases; i.e., chlamydia, HPV, herpes, gonorrhea, Hepatitis B/C, HIV.

W-8.14 Identify and describe basic types of contraceptives; i.e., abstinence, condom, foam, birth control pills.

W-9.3  Apply coping strategies when experiencing different rates of physical, emotional, sexual and social development; e.g., positive self-talk.

W-9.7 Evaluate implications and consequences of sexual assault on a victim and those associated with that victim.

W-9.12  Determine ‘safer’ sex practices; e.g., communicate with partner, maintain abstinence, limit partners, access/use condoms/contraceptives properly.

W-9.13 Identify and describe the responsibilities and resources associated with pregnancy and parenting.

W-9.14 Develop strategies that address factors to prevent or reduce sexual risk; e.g., abstain from drugs and alcohol, date in groups, use assertive behaviour.

• Career and Life Management (Grades 10, 11 or 12)

P11   Examine the relationship between commitment and intimacy in all its levels

• identify expectations and commitments in various relationships
• examine a range of behaviours for handling sexual involvement
• describe how personal values play a role in relationships
• explain the role of trust and ways to establish trust in a relationship
• develop strategies for dealing with jealousy

P12  Examine aspects of healthy sexuality and responsible sexual behaviour

• explain the ongoing responsibility for being sexually healthy
• examine a range of behaviours and choices regarding sexual expression
• describe sexually healthy actions and choices for one’s body, including abstinence
• analyze strategies for choosing responsible and respectful sexual expression
• describe the ways in which personal values influence choices
• assess the consequences of being sexually active

N.S. schools stuck between polarized opinions on gender, sexuality

Province has given scripts to educators for responding to concerned parents.

Social Sharing

As public debate over sex education in schools has been escalating across the country, Nova Scotia teachers and administrators have been fielding more questions and complaints, and in some cases, struggling to respond.

Documents obtained by CBC News through access to information laws provide a glimpse into what the Department of Education and Early Childhood Development and regional centres for education have recently heard from parents.

Some are worried LGBTQ youth are not safe at school and are calling for stronger policies to ensure the gender identity of students is respected.

• N.S. poised to change guidance for teachers on supporting gender-diverse students

Others are worried their children are being exposed to inappropriate material, in secret, and want conversations about gender and sexuality to be either restricted, or left out of classrooms entirely.

A French elementary school in Bedford offers an example of how schools are caught in the middle.

Neither side happy

In April 2023, students at Ecole Beaubassin attended sex-ed workshops put on by a guest.

According to a letter sent to Beaubassin families by the director of the French school board, the Conseil scolaire acadian provincial (CSAP), the workshops covered the topics of DNA, biological sex, gender identity, non-cisgender terminology and gender expression.

"Sessions with students on diversity seem to have generated strong reactions from members of the community," the letter said.

The CSAP stopped offering the workshops and apologized to families for not advising them about the content ahead of time.

How Nova Scotia's education curriculum introduces gender identity to students

But it seems the school board could do no right. The apology generated a strong reaction of its own. One parent said in an email to the education minister that the CSAP was failing to maintain a "safe, positive and inclusive learning environment for LGBTQIA+ students."

Halting the program, the parent said, "deprives students of vital education and it signals to them that their dignity and well-being is not a priority."

'A growing number of inquiries' 

The dispute at Beaubassin is not unique. A September 2023 email between staff with the education department refers to a "growing number of inquiries related to health education" and the need for a cohesive response.

More than a dozen of those inquiries were included in documents released to CBC dating back to the start of the 2022-2023 school year. 

One parent in Fall River emailed the deputy minister of education to say they were shocked when their two daughters had come home from school one day saying they'd learned they could be a boy or a girl. 

"We are now having to 'un-teach' the brainwashing & damage that was done," they said.

"You are supposed to be supporting the education of our children, and by teaching them false biology its extremely unethical. You may as well tell the kids the world is flat!"

The name of the parent and all members of the public were redacted from the documents.

The department responded to the parent with assurances that all material is age-appropriate and follows national and international guidelines.

Opting out of sex ed

In another case, a parent in Antigonish emailed their daughter's junior high asking for a conversation, and later for their daughter to be excused from health classes because they didn't want her to participate in conversations about "pronouns, transgenderism and LGBTQ."

"I don't think it is your responsibility to teach this. I WILL!!! The only things that I want taught to my kids is Science, Math; History; skill trades and so forth," the parent said.

• Protesters, counter-protesters march in Halifax over LGBTQ rights in schools

The school principal responded saying someone would have to pick the student up and return her after health class because she couldn't be left unsupervised, to which the parent responded: "Well let me know when this crap is being taught and I will come there and supervise her myself."

CBC spoke to several parents about sex education, but none wanted to go on the record for fear that their children would be alienated by their peers or their views would be misunderstood, given how contentious the topic has become.

Province providing scripts

The documents released to CBC also show discussions between educators about how to handle the issue.

In an email last August, a staff member of the Strait Regional Centre for Education advised teachers and principals to narrow in on the specific concerns of parents, and to have discussions early in the school year about the topics that would come up in health classes. 

"I don't believe that exempting [students] from the classroom is the solution as all students will miss an integral part of cultural understanding," the email said.

In early September 2023, department staff discussed ongoing work to create canned responses for questions and complaints about health education.

"The school regions have been looking for the statements to ensure their staff can respond similarly," an internal email said.

Later that month, the province sent six pages of scripted responses to all the regional centres and the CSAP. Inclusivity and the importance of imparting comprehensive and factual sexual health information are common themes in the scripts.

Kids deserve information, advocate says

Abbey Ferguson, executive director of the Halifax Sexual Health Centre, said the debate around sex education in schools has her on "high alert."

She's worried that some parents' aversion to sex education could lead to formal restrictions on third-party educators entering classrooms, which happened in Saskatchewan last year .

"All kids deserve to have the information across the board. No matter what your moral or philosophical or religious reasons are," she said.

Ferguson said when sex education is restricted, either because experts aren't allowed to enter schools or because parents opt out of health class, kids and youth remain curious and will seek answers to their questions, but they risk finding incorrect or incomplete answers.

In Ferguson's eyes, the biggest problem with sex education in Nova Scotia is inconsistency. 

She often goes to schools, by invitation, to provide resources and give presentations to students on sexual health, and while she meets some students who are well informed, others are behind. 

Ferguson said the provincial curriculum "looks pretty OK," but she doesn't think it's always adequately delivered.

She said she's encountered students in high school who misunderstand the basics of human anatomy and reproduction, signalling they didn't hit important benchmarks in earlier grades. 

Ferguson said concerns about sex education are natural and understandable. She said some parents are simply "not ready to picture their youth as sexual beings, even though that is a reality."

"That can be challenging, though I think that can be addressed in more holistic ways like conversations with the school board and with educators to reassure folks, like, this is what the information is, it's not a secret."

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ABOUT THE AUTHOR

Taryn Grant covers daily news for CBC Nova Scotia, with a particular interest in housing and homelessness, education, and health care. You can email her with tips and feedback at [email protected]

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• Paediatr Child Health
• v.18(2); 2013 Feb

Language: English | French

Sexual knowledge of Canadian adolescents after completion of high school sexual education requirements

Maya m kumar.

1 Department of Pediatrics, Schulich School of Medicine and Dentistry; London, Ontario

Rodrick Lim

2 Pediatric Emergency Medicine, London Health Sciences Centre; London, Ontario

3 Children’s Health Research Institute, University of Western Ontario; London, Ontario

Cindy Langford

Jamie a seabrook, kathy n speechley.

4 Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario

Timothy Lynch

Background:.

Formal sexual education is a mandatory component of the high school curriculum in most Canadian provinces. The present study was a preliminary assessment of sexual knowledge among a sample of Ontario adolescents who had completed their high school sexual education requirements.

A questionnaire, testing understanding of the learning objectives of Ontario’s minimally required high school sexual education course, was distributed in a paediatric emergency department to 200 adolescent patients who had completed the course.

Respondents demonstrated good understanding of pregnancy physiology and sexually transmitted infections, but poor understanding of concepts related to reproductive physiology, contraception, HIV/AIDS and sexual assault. Most respondents could not identify Canada’s age of sexual consent.

CONCLUSIONS:

Respondents demonstrated concerning gaps in sexual knowledge despite completion of their sexual education requirements. Further studies must determine whether a representative, population-based student sample would exhibit similar findings. Sexual education currently offered in Ontario may require investigation.

HISTORIQUE :

L’éducation sexuelle est un élément obligatoire du programme d’études secondaires de la plupart des provinces canadiennes. La présente étude visait à obtenir une évaluation préliminaire des connaissances en matière de sexualité d’un échantillon d’adolescents ontariens qui avaient terminé leur cours d’éducation sexuelle au secondaire.

MÉTHODOLOGIE :

Lors de leur visite au département d’urgence pédiatrique, 200 patients adolescents qui avaient terminé leur cours d’éducation sexuelle ont reçu un questionnaire afin de vérifier leur compréhension des objectifs d’apprentissage du cours d’éducation sexuelle de base offert dans les écoles secondaires de l’Ontario.

RÉSULTATS :

Les répondants ont démontré une bonne compréhension de la physiologie de la grossesse et des infections transmises sexuellement, mais une mauvaise compréhension des concepts liés à la physiologie de la reproduction, à la contraception, au VIH-sida et aux agressions sexuelles. La plupart des répondants ne pouvaient pas préciser l’âge du consentement sexuel au Canada.

CONCLUSIONS :

Les répondants ont démontré des lacunes préoccupantes en matière de connaissances sexuelles, même s’ils avaient terminé leur cours d’éducation sexuelle obligatoire. D’autres études devront déterminer si un échantillon d’étudiants représentatifs en population donnerait des résultats similaires. Les cours d’éducation sexuelle actuellement offerts en Ontario méritent peut-être d’être évalués.

Adolescence is a crucial period for learning about healthy sexuality ( 1 , 2 ). As teenagers struggle to complete the developmental tasks of adolescence, such as accepting their changing bodies and defining their sexual identities, they are at risk for negative sexual consequences ( 3 ). Sexually active Canadian teenagers commonly engage in risky sexual behaviours, including unprotected sex, multiple sexual partners and intercourse, before 15 years of age ( 4 ). Canadians 15 to 24 years of age also have the country’s highest incidences of chlamydia and gonorrhea infections ( 5 ). Such statistics raise concerns about whether young Canadians have sufficient knowledge to make responsible sexual decisions. Comprehensive sexual education for adolescents effectively reduces the incidence of negative sexual outcomes ( 6 , 7 ). The Canadian Paediatric Society and the American Academy of Pediatrics ( 8 , 9 ) recommend that paediatricians participate in the development and implementation of comprehensive sexual education programs in schools.

In Canada, education is under provincial jurisdiction and almost every province’s high school curriculum contains formal sexual education. Within the province of Ontario, sexual education is a subcomponent of health and physical education courses; each course is comprised of approximately 110 h of instruction. However, only a fraction of course time, determined by each school, is dedicated to sexual education; consequently, there is potential for significant variability among schools. Ontario’s Ministry of Education has outlined six course expectations ( Table 1 ) for its Grade 9/10 Healthy Growth and Sexuality unit ( 10 ). Completion of this unit is the minimum sexual education required for a high school diploma or certificate in Ontario.

Course expectations for Ontario’s Grade 9/10 Healthy Growth and Sexuality course ( 10 )

There are currently no standardized examinations or evaluation processes to assess the knowledge of students who have completed their sexual education requirements and no other standardized assessments of sexual education quality.

Several studies have attempted to assess the sexual knowledge of Canadian adolescents. The majority of these studies, however, limited the scope of their assessment to knowledge of HIV/sexually transmitted infections (STI) alone ( 11 – 16 ) or HIV/STI, contraception and limited reproductive physiology ( 17 ).

The present study will expand on previous Canadian work in two ways. First, it will assess student knowledge in multiple domains using an assessment questionnaire addressing all major topics included in Ontario’s high school human sexuality curriculum, including reproductive physiology throughout life (not just adolescence), HIV/STI, contraception and responsible sexuality including sexual consent. Second, unlike most previous Canadian studies, participants will be recruited from many different schools.

The objective of the present study was to conduct a preliminary assessment of sexual knowledge related to the learning objectives of Ontario’s minimally required high school sexual education course, among a sample of adolescents presenting to an emergency department who had completed their provincial high school sexual education requirements.

The present descriptive study used a convenience sample of adolescent patients (see patient eligibility below), from the paediatric emergency department of the London Health Sciences Centre, a tertiary care facility located in London, Ontario, whose catchment is two million people and which treats 37,500 patients annually. Ethics approval was obtained from the Health Sciences Research Ethics Board at the University of Western Ontario (London, Ontario) and the Clinical Research Impact Committee at the Lawson Health Research Institute (London, Ontario).

Questionnaire development

A questionnaire ( Appendix A ) designed to test expectations 1 through 4 outlined in the Ontario Ministry of Education’s Grade 9/10 Healthy Growth and Sexuality course ( Table 1 ) was developed (achievement of expectations 5 and 6 was not considered objectively testable by the authors.) Specific questions pertaining to each objective were developed using the Guidelines for Comprehensive Sexuality Education, 3rd Edition published by the Sexuality Information and Education Council of the United States (SIECUS) ( 18 ). This guideline, created by a national task force of health care professionals, educators and experts in adolescent development, contains recommendations for subject matter to be included in a comprehensive sexual education curriculum. Questions were also created using Canadian laws relevant to responsible sexuality ( 19 – 21 ) and Canadian health guidelines ( 22 – 25 ).

Questions were arranged into six categories: pregnancy; reproductive physiology and puberty; STI; contraception; HIV/AIDS; and sexuality and the law. Questions were true/false/unsure or multiple-choice. Participants were not asked about their personal experiences or values related to sexuality.

Additionally, participants used a seven-point Likert scale to rate the usefulness of various sources of sexual information ( Table 2 ), in which 1 = not at all helpful, 4 = somewhat helpful and 7 = extremely helpful.

Frequencies of respondents’ ratings of usefulness for six common sources of sexual information on a seven-point Likert scale

Data presented as n (%)

Baseline characteristics were assessed, including age and sex; whether currently in school, and current/highest grade successfully completed; the number of high school health courses completed; whether the school in which these courses were taken was private or public, religious or secular; municipality in which the school was located; household structure (eg, two-parent, single-parent or alternative arrangement); and reason for presenting to the emergency department.

The questionnaire was piloted among a convenience sample of adolescents before distribution. Feedback was obtained about readability, time required to complete the survey, printed layout of the questionnaire, subject matter covered by the questions and whether any questions were perceived as invasive; further revisions were consequently made. The questionnaire took 10 min to 15 min to complete. Its Flesch Reading Ease score was 68% and its Flesch-Kincaid Grade level was 6.8.

Patient eligibility

Adolescent patients attending London Health Sciences Centre’s paediatric emergency department were considered eligible if they had completed at least one credit of health education in an Ontario high school (minimum provincial requirement), and triage scores upon presenting to the emergency department were neither resuscitative nor emergent (ie, Canadian Pediatric Triage and Acuity Scale score of 3 [urgent], 4 [less urgent] or 5 [non-urgent]). No age minimum was set as long as the educational requirement was met, but all participants were younger than 18 years of age (maximum patient age accepted by the paediatric emergency department). Exclusion criteria included incapacity to provide one’s own consent (assessed by the attending physician); insufficient fluency in written English (as self-reported by patient after inquiry); and acute pain, psychiatric or psychosocial crisis of such severity that recruitment was deemed inappropriate (assessed by the attending physician).

Questionnaire distribution

Once deemed eligible, the patient received the questionnaire with an accompanying letter of information. Completion of the questionnaire implied informed consent. Participants could complete the questionnaire in the presence of parents/guardians but were asked to refrain from discussion while completing it. However, respondents and parents/guardians were informed that upon return of the questionnaire, they would receive an answer key with explanations for each question that they could review together and take home. This allowed parents/guardians to let their child complete the questionnaire privately, knowing that the answer key would be available shortly for review and discussion.

If an eligible patient did not wish to participate, their reason for declining was documented.

Statistical analysis

Because this was a descriptive study without primary or secondary end points, a sample size calculation was not performed. It was decided that a sample size of 200 would obtain a sufficient cross-section of adolescents from different socioeconomic backgrounds and types of schools, while acknowledging that the convenience sample of emergency department patients may not be representative of the general adolescent population. Mean (± SD) scores were calculated for each question category and each question. Categorical variables were reported as percentages. A χ 2 test was used to assess associations between categorical variables; P<0.05 was considered to be statistically significant.

Of the 206 patients approached who met eligibility criteria, 200 agreed to participate. The six patients who declined cited disinterest in the subject matter as their reason. Respondents experienced a variety of presenting complaints, but the most common were musculoskeletal complaints (31%), minor trauma (13.5%) and abdominal pain (13.5%). Other baseline characteristics are summarized in Table 3 . Ages ranged from 14 to almost 18 years; the mean (± SD) age was 16±0.9 years. The mean current grade was 10.6±1.8. Fifty-six per cent were girls. Almost all were currently in school, with most attending a publicly funded school. Of the five available health/physical education courses offered in Ontario schools, almost one-half of respondents had completed one course (the minimum requirement) and approximately one-fifth had completed two courses.

Baseline characteristics of participants (n=200)

Data presented as n (%) unless otherwise indicated

Mean scores within each question category are summarized in Table 4 . Respondents correctly answered most questions relating to pregnancy physiology (79.6%), but performed less well on questions related to general reproductive physiology (61.6%). For example, 27% of respondents reported that pregnancy could result from oral sex, anal sex or mutual masturbation; 40% agreed with the statement that when a couple cannot conceive, the woman usually has a medical problem; and 55% could not identify when a woman is most likely to get pregnant during her menstrual cycle.

Mean scores within each question category

Respondents demonstrated good understanding of STI prevention (79.6% of questions correct). Each of the following were correctly identified by 75% to 90% of respondents: the need for regular sexual health examinations in both sexes; the potential for untreated STI to cause infertility or fetal harm during pregnancy; that STI are transmittable through oral sex; that condoms do not protect against all STI; and that STI may be asymptomatic. However, the majority (almost 60%) did not know that human papillomavirus may cause genital cancer in males in addition to females. Respondents also performed relatively poorly on questions related to HIV/AIDS (51.4% correct). Only 54% knew that HIV is not transmitted through all types of skin-to-skin contact, and when presented with a list of activities that included tattooing, piercing, sexual intercourse, intravenous drug use and blood transfusion, only 43% correctly selected blood transfusion as an uncommon method of contracting HIV in Canada.

Respondents held several misconceptions regarding common contraceptive methods (43.1% of questions correct): 78.5% erroneously agreed that the ‘morning-after pill’ terminates an existing pregnancy; 38% overestimated the contraceptive efficacy of male condoms with typical use; and 37.5% did not agree with the statement that oral contraceptives can be dangerous for women who smoke.

When presented with four scenarios, each depicting an instance of sexual assault, only 29.6% of respondents identified all four incidents as assault and 29.1% only recognized two or fewer as assault. Only 42.5% correctly identified Canada’s age of sexual consent as 16 years.

Girls scored better than boys in the pregnancy category (81.7% versus 76.9% correct; P=0.03) and the reproductive physiology/puberty category (64.5% versus 57.9% correct; P=0.04); other baseline characteristics did not correlate with any significant differences in scores. With respect to different types of schools attended (eg, private versus public, urban versus rural, religious versus secular) or the number of sexual education courses taken, no statistically significant differences were detected between the subgroups.

Respondents’ ratings of the usefulness of six common sources of sexual information are shown in Table 2 .

The present study built on previous Canadian assessments of student sexual knowledge in several important ways. Only one previous study attempted to assess sexual knowledge in multiple domains ( 17 ), and still failed to assess knowledge of reproductive physiology throughout life (including pregnancy), any STI other than chlamydia or HIV, abortion, sexual assault or sexual consent. Another weakness of earlier Canadian studies was that most recruited students from only one or two schools, making them vulnerable to selection bias. Three studies were performed on a national level with large samples ( 11 , 12 , 16 ) but all limited their assessment to knowledge of HIV/STI. The current study’s questionnaire was more comprehensive and included most of the topics recommended by an internationally recognized body of experts (ie, SIECUS).

Similar questionnaire-based studies have been performed in other nations to assess general sexual knowledge among youth ( 26 – 30 ), but the current study was the first to use a questionnaire systematically designed to correspond to our provincially mandated sexual education curriculum.

Sexual knowledge

Although respondents performed well on questions related to pregnancy physiology, they carried several concerning misconceptions related to general reproductive physiology, which could lead to negative outcomes throughout their lifespan.

Respondents were knowledgeable about STI prevention but performed less well on questions related to HIV/AIDS transmission. A previous study showed that most surveyed Canadian teenagers could identify major risk factors for HIV transmission (eg, sharing needles, unprotected sex, multiple sexual partners) ( 31 ). However, our results suggest that teenagers may have a poorer understanding of minor risk factors for HIV transmission (eg, that HIV is not transmitted through all skin-to-skin contact, and is rarely contracted via blood transfusions in Canada).

Many respondents held misconceptions about contraception that could lead to unsafe choices. Belief that the ‘morning-after’ pill causes abortion may lead to underuse of emergency contraception. Overestimation of the contraceptive efficacy of male condoms may explain why many sexually active Canadian girls use condoms without back-up contraception ( 32 ). Failure to understand the risk of smoking while taking oral contraceptives may increase the risk of thromboembolism in later adulthood.

No previous Canadian studies have assessed understanding of sexual consent laws among high school students. Canadians 15 to 24 years of age have an incidence of sexual victimization almost three times higher than the general population ( 33 ). Although learning to engage in ‘responsible sexual relationships’ is an expectation of Ontario’s sexual health curriculum ( 10 ), our findings suggest that Ontario students may have a poor understanding of sexual consent laws despite completing their course requirements. The relationship between this knowledge gap and the risk of sexual victimization could represent a potential area for future study.

Sources of sexual knowledge

High school sexual education classes received the highest average rating of usefulness among all listed sources. Ontario students appear to place great importance on their high school sexual health courses, which should motivate educators and policymakers to ensure that educational quality is maintained.

Interestingly, 17% of respondents rated the usefulness of the Internet as 6 of 7 or 7 of 7, putting it ahead of sexual health classes received before high school and popular media. A decade ago, many young Canadians were already using the Internet as their main source of sexual information ( 31 ). Given the recent explosion of social networking, further studies could explore how the ‘Facebook generation’ uses the Internet for sexual information, to determine whether it would be advantageous to incorporate modern online venues (eg, social networking sites) into sexual education.

Study limitations

The present study used a convenience sample of 200 adolescents from a southwestern Ontario paediatric emergency department. The emergency department setting permitted recruitment of students attending many different schools, an important advantage given the potential for variability in sexual education among schools. However, it is uncertain whether the sample was sufficiently representative to generalize the data to other adolescents in our region. Even more caution is needed before generalizing the data to adolescents from other parts of Canada where cultural, socioeconomic and municipal factors may affect local delivery of sexual education.

Teenagers did not have a separate space in which to complete the questionnaire without the presence of parents. Although parents were asked to refrain from discussing any questions with their children until provided with the answer key, their physical presence may have caused respondents to answer some questions differently. We observed that the study design frequently fostered healthy discussions about sexuality between participants and their parents; however, we must acknowledge that it may have also created bias.

Our questionnaire had an uneven distribution of questions from each category, which may have affected validity through its heterogeneity. For example, there were only two HIV-specific questions; therefore, answering one correctly produced a subscore of 50%; subscores may have been different had there been more HIV-specific questions.

Emergency department patients may also have other risk factors, such as lower socioeconomic status and/or more risk-taking behaviour ( 34 ), which may have affected their scores. While the results may not generalize well to youth outside of the emergency department, they at least suggest that this subset of students has gaps in sexual knowledge.

An important limitation was the use of a previously unvalidated assessment questionnaire, necessitated by the absence of standardized examinations or evaluation methods for sexual education courses in Ontario. Unlike the United States, where the SIECUS guidelines have long existed, Canada lacks national guidelines for content and delivery of school sexual education, which could have provided a benchmark for investigators to use when assessing the sexual knowledge of Canadian students. The Canadian Guidelines for Sexual Health Education, while providing general principles for administering sexual education, provide no specific suggestions for curriculum content or teaching strategies ( 35 ). In the absence of national standards and existing assessment tools, we had to create an original tool. A strength of the present study, however, was the systematic development of its questionnaire based on objective resources (ie, Ontario’s sexual education curriculum, SIECUS guidelines, and Canadian health laws and guidelines). Piloting the questionnaire among a sample of adolescents before its distribution was also a strength of the study; an additional pilot among health care providers experienced in working with adolescents may have further ensured accuracy and inclusion of an appropriate range of topics.

Although respondents disclosed the number of sexual education classes they had taken and the types of schools they attended (urban versus rural, private versus public, religious versus secular), the sample size was inadequately powered to detect significant differences between subgroups. Larger population-based studies are required to determine whether meaningful differences exist.

Finally, the present study could not assess the respondents’ knowledge of topics missing from Ontario’s sexual education curriculum, including sexual orientation, masturbation, sexual fantasy and sexual dysfunction. These topics are excluded despite SIECUS’s recommendations that they be included in any comprehensive sexual education program ( 18 ). Additional studies should assess understanding of these topics among Canadian adolescents, and intervention is required to incorporate these topics into Ontario’s curriculum.

The present study demonstrated significant gaps in sexual knowledge among a sample of Ontario adolescents who had completed their high school sexual education requirements. Subsequent studies are necessary to determine whether these findings can be replicated, and whether clinically meaningful differences exist between subgroups, by using a representative, population-based sample. Educators and policy-makers should consider conducting formal evaluations of high school sexual education courses that are currently being offered.

APPENDIX A. Children’s Hospital Sexual Education Assessment Survey

DISCLOSURE: The authors do not have any real, potential or perceived conflicts of interest to disclose. No honorarium, grant, or other form of payment was given to anyone to produce this article. Dr Maya M Kumar presented the results of this study in an oral platform presentation at the Canadian Paediatric Society Annual Conference on June 16, 2011, in Quebec City, Quebec.

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CANADIAN GENDER REPORT

How the Sex Ed Curriculum has changed

Comparing Sex Education in Nova Scotia from 2012 to 2021 – Parents and Biology are Now Out

This article is reprinted with permission by anonymous parent Shooting Star @turnthetide2018.

On July 7, 2021, Twitter user Shooting Star published the following tweet thread on July 7, 2021. In it, they compared the Nova Scotia sex education curriculum documents for 11-12 year-old/Grade 7 students from the years 2012 and 2021. To see the side-by-side comparison is quite an eye opener. It is clear that parents are now out and gender ideology is now in.

Following is a comparison of certain topics in the 2012 and 2021 editions of the book. 

The Nova Scotia website shows the 2016 edition.

2012: 

In 2012, sexuality and gender are each given their own pages.  Advice on medicalizing gender distress is offered. 

In 2021, sexuality and gender are given more room, particularly for the development of gender concepts, and the section contains a new guide for LGBTQQ2S+ terms.

Once again in 2021, a page is devoted to gender distress with the option to consider changes to your body with hormones and surgeries. 

In 2012, students are directed to their parents as a source of information and help because “No one cares about more than they do, and it’s worth listening to different points of view. “Parent” is used six times.

In 2021, someone’s “relationship to you does not automatically make them knowledgeable, trustworthy, or safe.” The word “parent” is used once, in a list also including teacher, friend of the family, and coach. 

If the child does not feel safe talking to their parent, a definition for “Chosen family” is helpfully provided in the Useful Information section. 

Regarding biology, in 2012, we have the use of “female” and “male” along with specific risks per each sex, organized with cervical cancer after the female diagram and testicular cancer after the male.  Girls, women, and young men are also mentioned. 

In 2021, we have “Genitalia and Gonads” separated by “likely assigned M or F at birth.”

The two diagrams are together, and the cancer pages come after. Students are referred to as youth with cervixes or people with testicles. 

And lastly, for kids wondering about confidentiality, parents are #1 on the list in 2012. 

In 2021, parents don’t appear in that section at all, except to say that information can be kept secret from them. 

Thank you, Shooting Star, for taking the time to make very clear exactly how much has changed in less than 10 years.

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LGBTQ+ students may need to seek sex ed outside of school

• Feinberg School of Medicine

Children across the U.S. who identify as LGBTQ+ say the sexual health-education curricula they receive is leaving them without essential information to make informed decisions about their sexual health, which could force them to seek potentially inaccurate or dangerous advice elsewhere.

The results of a new national survey in part by Northwestern researchers show these young people — aged 13 to 17 — believe crucial topics surrounding sexual orientation and gender identity are being omitted from sexual health-education programs.

In the new study, published in The Journal of Sex Research , one survey respondent said, “I wish I was taught about gay sex, sexual orientation, and all the other controversial topics that [are deemed] ‘grooming.’ When kids aren’t taught good sex ed, they learn how to do it in an unhealthy way from other sources like the internet or word of mouth. If we teach children about these topics, they’ll be safer when they become teenagers.”

Experts who led the study say the addition of key items in the curricula could be “life-saving.”

“LGBTQ+ youth expressed a strong desire to learn more about topics related to their sexual orientation and gender identity, highlighting a critical gap in existing curricula,” said study author Erica Szkody , a postdoctoral research associate at Northwestern University Feinberg School of Medicine who led the data collection for the study.

“Despite the well-known benefits of comprehensive sexual health education, the majority of school sexual health-education curricula in the U.S. is non-comprehensive and excludes LGBTQ+ students,” she said. “Our analyses underscore the extent of this exclusion.”

Szkody works in the Lab for Scalable Mental Health , which is directed by Jessica Schleider, associate professor of medical social sciences and pediatrics at Feinberg.

Of more than 800 survey respondents, most participants reported a lack of LGBTQ+ content in their sexual health-education experiences.

“I wish others understood that while the anatomy-related knowledge is important, we need sexual [health] education that is relevant to today’s world,” a survey respondent said. “This involves sexual [health] education [about] dangers and safety on the Internet, [same-sex/gender] relations, and education geared towards attraction and feelings rather than a lesson only [regarding] heterosexual procreation. I wish they took our real-life experiences and insecurities into account.”

To educate themselves on sexual health, most respondents were using extracurricular sources including online spaces, friends and personal experiences with sexual exploration. The authors found these extracurricular sources are frequently preferred by LGBTQ+ youth but may lack accuracy and reliability.

Overall, participants described feeling marginalized by curricula that were based on abstinence-only approaches, religious principles or contained oppressive and suppressive elements, such as negative remarks about LGBTQ+ individuals or skipping required LGBTQ+ content altogether.

The survey provided LGBTQ+ young people the opportunity to openly share on their experiences and recommendations for change regarding sexual health education. These suggestions included:

• More LGBTQ+ content in sexual health education curricula, as well as more detail on healthy and diverse relationships (e.g., non-monogamy, polyamory), consent, safety in relationships and communication skills.
• Creating safe and supportive spaces while considering legitimate fears due to a possible increase in bullying, as they had heard students make fun of the material or use discriminatory language during past implementation.
• Updating sexual health-education materials to reflect LGBTQ+ lived experiences, history and risk factors.
• Creating sexual health interventions focused on LGBTQ+ experiences and concerns. Improving access to reliable sexual health information.
• Creating more accessible sexual-health information via other avenues, such as online and through mobile applications.

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