Clinicians Criticize Alberta’s Proposed Sex Ed Policy Change

For decades, Canadian public health officials, researchers, and clinicians have worked hand in hand with government officials to stem the rise of preventable and treatable sexually transmitted infections (STIs) such as syphilis, gonorrhea, and chlamydia. But Alberta legislators are working to change the rules governing sexual health education even as the province is experiencing high and rapidly increasing rates of STIs in adolescents.

The potential rule change focuses on the provision of sexual education in grades K through 12. A key element of the proposed policy, which was first introduced on social media by Premier Danielle Smith, would flip the script on current parental “opt-out” requirements and instead ask parents to opt in to each sexual health education module separately.

“These types of policy decisions set us back decades and fly in the face of scientific evidence showing that comprehensive sex education provided early is the way to go,” said Ameeta Singh, BMBS, a clinical professor of infectious diseases at the University of Alberta in Edmonton, Alberta, Canada. “STIs have increased across the world, and certainly here in Canada and Alberta, we’re seeing rates that have not been seen since the 1940s,” she said.

The increase is especially notable for STIs that directly affect fertility, congenital outcomes, and neurologic and cardiologic outcomes. Data released in early 2023 by Health Canada indicated that diagnosis rates had increased by 26% for chlamydia, 171% for gonorrhea, and 389% for infectious syphilis.

Potential Fallout

A recent report from the World Health Organization (WHO) not only highlighted an alarming decline in condom use in sexually active teens but also emphasized the impact of sexual education restrictions across the globe. “Age-appropriate comprehensive sexuality education remains neglected in many countries, and where it is available, it has increasingly come under attack in recent years on the false premise that it encourages sexual behavior,” said Hans Henri P. Kluge, MD, WHO regional director for Europe, in a statement. “The truth is that equipping young persons with the right knowledge at the right time leads to optimal health outcomes linked to responsible behavior and choices.”

The literature bears this out. A recent literature review found sound and substantial evidence that sexual health education could improve sexual, social, and emotional health, as well as academic outcomes. Other data have shown that comprehensive education in sexuality does not increase or promote sexual activity but rather significantly delays sexual initiation in adolescents more than fourfold compared with traditional sex education.

Moreover, findings from a 2023 qualitative systematic review further reinforced the importance of several features of Alberta’s and other provinces’ sexual health curricula. These programs provide the opportunity to develop strategies to prevent unwanted pregnancies, create intimate and healthy partner relationships, learn negotiation skills (eg, consent, safe sex, and STI testing), navigate peer pressure, and have a safe space to learn about sexual health and sexuality within a trusting educator relationship.

Eliminating access to these programs, either directly or through tactics like opt-in consent, ultimately has the opposite effect. “If you don’t talk about it, it doesn’t prevent children and youth from exploring their sexuality; it means that they are not going to have the tools they need to even have a chance of protecting themselves,” said Lynora Saxinger, MD, professor of medicine and infectious disease specialist at the University of Alberta.

Downstream Effects

It’s unclear who would provide sex education if parents choose to ignore the opt-in request, if children forget to bring forms home from school, or if the forms are unclear. The ramifications of the policy change might be long-lasting.

“If kids are not going to be getting adequate sex education at school, and won’t necessarily be getting it at home, where will they be getting educated?” asked Dina Kulik, MD, a pediatrician, emergency room physician, and founder/director of Kidcrew, a multidisciplinary children’s health clinic in Toronto, Ontario, Canada. “Kids are already getting educated in nonscientific ways that promote a lot of misinformation: For example, Google, TikTok, and other social media venues that are not moderated by health experts or parents,” she said.

Previous reports, most notably a 2021 article in The Wall Street Journal, have substantiated Kulik’s concern. TikTok algorithms have been developed with the specific intent of promoting sexual content to teens and adolescents, and viewing this content has been linked to a fear of missing out that pushes teens into engaging in sexual behaviors for which they are not fully prepared.

Clinicians are similarly unprepared to fill the educational gaps that might open if the legislature ratifies the policy change. “It’s not a reasonable expectation, and I’m hoping that parents and politicians don’t think it’ll fall to the doctor. We don’t have the time to provide all needed sex education in a 10-, 20-, 30-minute visit,” said Kulik. She noted the benefits that established and vetted curricula offer.

“You’d also expect that domino effect of something that’s already a problem becoming a bigger problem, like the decreasing number of family physicians,” added Saxinger. One in five Canadians lack a dedicated primary care clinician or nurse, and dwindling numbers of providers raise questions about the wisdom of shifting the responsibility for sexual education to doctors.

For now, clinicians like Singh, Saxinger, and Kulik are keeping their heads down and focusing on their work. “We’re in a situation where, unfortunately, we feel helpless in the face of some of the decisions being made,” said Singh.

Singh, Saxinger, and Kulik reported no relevant financial relationships.

Liz Scherer is an independent health and science journalist based in the United States.