Mississippi again leads the nation in teen births despite declining rates both in the state and across the country. 

Mississippi’s rate dropped significantly over the past two decades but still lags behind the rest of the country. In 2020, the most recent year for which data was available, teenagers in Mississippi gave birth at a rate of almost double the national average, according to th4e Centers for Disease Control and Prevention data.

Advocates and a former state senator point to Mississippi’s unchanging – and in their view, lackluster – sex education law. 

Though the curricula for core subjects like math and science are reviewed and updated every five years, the Mississippi Department of Education has not approved any new sex-ed curricula in over a decade. 

Josh McCawley, deputy director of Teen Health Mississippi, a policy and advocacy group focused on the sexual and reproductive health of teenagers, said this inaction means Mississippi’s sex ed content is wildly out of date, with issues like consent and relationship violence largely absent.

“It’s really difficult to do really good sex education in 2022 when you're working with curricula that was written in the 1990s,” McCawley said. 

Even if more curricula were approved by the state education department, there’s no guarantee schools would switch to a new one.

“Once a school picks a curriculum, they tend to stick with it,” said Scott Clements, state director of MDE’s School Health Programs.

Many of Mississippi’s teen mothers are 18 or 19 years old and out of reach of the primary school system. The birth rate among that age group is three times higher than that of 15- to 17-year-olds. 

While reforming Mississippi's sex education policy is an important piece of the puzzle, McCawley said the need to address major issues like intergenerational poverty means it’s not the end-all, be-all for addressing the state’s high teen birth rate.

“It’d be great if there was one solution, but unfortunately, there's many contributing factors that create an environment in which Mississippi has the highest teen birth rate in the country,”  McCawley said. “It’s going to take a lot of people from a lot of different sectors: education, health, social services, housing. It will take a lot of factors to address what we're seeing.”

The national teen birth rate has declined 75% from its 1991 peak, a trend attributable to lower rates of sexual activity among young people and the increased use of contraception. 

The birth rate for teenagers ages 15–19 dropped in 31 states but increased in Mississippi in 2020. Rates among the states ranged from a low of 6.1 per 1,000 births in Massachusetts to a high of 27.9 in Mississippi. 

Mississippians, however, are less likely to use highly effective forms of contraception like intrauterine devices (IUDs) and implants. As of 2018, the number of patients at publicly funded Title X clinics who used such contraception was just 7%, compared to 18% nationally. In recent years, people have sometimes struggled to reach the clinics over the phone and have waited months for an appointment or been told that it’s up to the doctor on staff to determine what kind of birth control they receive.

Lawmakers passed the state's sex education law in 2011, which required each school district to choose between  “abstinence-only” or “abstinence-plus” curricula. All must stress that abstaining from sex is the only method that offers foolproof protection from out-of-wedlock pregnancies and sexually transmitted infections. 

Attempts to change the law to require the curricula be medically accurate or evidence-based have failed. One of those attempts was by former Sen. Sally Doty, a Republican from Brookhaven and one of the few Republicans who supported changing the law.

Doty introduced the “Personal Responsibility Act” in 2016 which passed through the Senate Education Committee but was never brought up for a vote. The bill would have required sex ed curricula be evidence-based and would have also required that sex ed be taught twice in primary school, once in middle school and once in high school. The 2011 law did not set specific age requirements.

Doty, who is now the executive director of the Mississippi Public Utilities Staff, still supports those changes being made. She also advocates for changing to an opt-out rather than opt-in policy, ending the segregation by gender for sex ed instruction and removing the curricula requirements in state law that prevent evidence-based curricula used in other states from being used in Mississippi.

“I don't think sex among teenagers is different in Mississippi than in any other state,” Doty said. 

Doty said that the absence of comprehensive sex ed in schools, or parents providing it at home, is detrimental to a teenager’s development, and means that many young people are only getting their sex education from pornography on the internet. Doty said that inaction by the Legislature isn’t helping either. 

“There's some real problems with the law as it stands … it's a difficult situation to talk about. But I don't think anyone can look at the numbers in the state, and say that we don't need to talk about it,” Doty said. 

Some of the restrictions in the state law also place an undue burden on school districts, according to McCawley. Mississippi's law requires parents to opt-in their child to sex ed, which creates a logistical barrier that keeps kids with parents who support sex ed out of the classroom.

“If a student isn't opting in, it's mostly not because of parental disagreement, but because of the lack of efficiency of getting permission slips home and back,” McCawley said. 

Keeping boys and girls separate during sex ed instruction places another burden on schools that especially harms rural, short-staffed school districts, according to McCawley. 

The law also bans the demonstration of condoms and other methods of contraception. Teachers can tell students how to use them, but not show them. This has led to creative workarounds by advocates like Sanford Johnson, who went viral in 2012 for a video where he teaches students “how to put on a sock.” 

While Johnson, now the executive director of Teach Plus Mississippi, a nonprofit that trains teachers in understanding education policy, believes that more comprehensive, sex-positive services and resources are available to young people now than there were a decade ago, there’s a lot of work to be done. According to the sate health department’s 2015 Youth Risk Behavior Survey, 54% of Mississippi high school students have had sexual intercourse, and 39% did not use a condom the last time they had sex. 

Johnson says policy that treats young people like they’re not worthy of the truth contributes to these risky behaviors. 

“We know what works,” Johnson said. “When you present kids with all the information, they are going to make better decisions.” 

Eleven sex ed curricula were approved by the state education department in 2011. Of 142 public school districts in the state, 80 have chosen abstinence-only instruction and 62 have chosen abstinence-plus, according to current data from MDE. 

The approved curricula vary in substance and tone. The Game Plan curriculum, currently in use by Wilkinson County School District, was co-developed with former professional basketball player A.C. Green and is sports-themed. 

The REAL Essentials WAIT curriculum is currently used by 12 school districts and describes the proper use of a male condom as an “at risk” behavior for contracting HIV/AIDS. The curriculum includes activities like an STD crossword puzzle and prompts for classroom discussions like: “When it comes to sex, men are like microwaves and women are like crockpots!”

Ninety school districts teach Choosing The Best curriculum. Of those, 61 are using an abstinence-only version and 26 are using an abstinence-plus version. Abstinence-plus curricula teaches students about the risks and failure rates of contraceptive methods that aren’t abstinence.

The second most popular curriculum is Draw The Line/Respect The Line, an evidence-based, abstinence-plus curriculum currently in use by 26 school districts across the state. 

The contents and quality of sex ed instruction vary by district. While two districts might be using the same curriculum, there’s no guarantee that they teach the same lessons. The state sex ed law lists six components of abstinence-only instruction but does not require each be covered. 

While organizations like Teen Health Mississippi and Mississippi First have lobbied for legislators to update the state’s sex ed law for years, no action has been taken. The law was re-authorized as written in 2016 and 2021.

“The state Legislature really doesn't want to touch something like sex education until they have to,” McCawley said. 

Another concern among advocates is that Mississippi’s sex ed law, as imperfect as it is, isn’t being followed. McCawley said that the sense of urgency and level of oversight that existed after the law was passed isn’t present anymore, and it’s likely many districts are no longer in compliance with the law.

“As time has gone on, the oversight has decreased, and districts have really caught on to that,” McCawley said. “They kind of realized that they can do whatever they want, if anything, and there's going to be no repercussions for that.”

Clements, whose office oversees sex ed compliance, said that monitoring is done every three years but hasn’t occurred since the onset of the COVID-19 pandemic. Monitoring will resume next year and includes reviewing which curriculum is being used and which teachers are providing the instruction. 

With all the challenges schools have faced due to COVID-19, sex ed hasn’t been a top priority, he said. 

“Unfortunately, like a lot of things with COVID, the focus has been making sure kids can get to school.” Clements said. 

Mississippi Today reporter Isabelle Taft contributed to this story.


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Will Stribling covers healthcare and breaking news for Mississippi Today.