A class of fifth-graders are sitting through an hour-long sex-ed lesson at Louis B. Russell Jr. School 48 in Indianapolis. Some fidget, others giggle. And they have a lot of questions.
How old do you have to be to start using tampons?
It's April, and sex ed teacher Haileigh Huggins does her best to answer them all.
One boy asks, "Can boys have babies?"
"No, they cannot get pregnant," she tells him.
"Because they both would have sperm cells right? There wouldn't be an egg cell."
Huggins is trained to teach age-appropriate, comprehensive sex education. But she only has an hour with these students — and that's just enough time to cover the basics, like puberty and reproduction.
When most people think of sex ed, those are the lessons that often come to mind. But comprehensive sex ed goes beyond that. It's defined by sex ed advocates as a science-based, culturally and age-appropriate set of lessons that start in early grades and go through the end of high school. It covers sexuality, human development, sexual orientation and gender, bodily autonomy and consent, as well as relationship skills and media literacy.
With abortion access changing in many states, advocates for comprehensive sex ed say it's more important than ever. But, like so many things related to schools, sex education is highly politicized.
Only three states require schools to teach age-appropriate, comprehensive sex education: Washington, California and Oregon. That's according to SEICUS, a group that advocates for progressive sex education policies. In other states, what students learn about sex ed depends on what school leaders choose to teach.
And yet, research shows these lessons can lead to better health outcomes for students.
"The major finding of the research is that comprehensive sex education scaffolded across grades, embedded in supportive school environments and across subject areas, can improve sexual, social and emotional health, as well as academic outcomes for young people," says Eva Goldfarb, a researcher at Montclair State University in New Jersey. She is co-author of a 2020 paper on the topic.
"Even though it may seem like sex education is controversial, it absolutely is not," says Nora Gelperin, director of sex education and training at Advocates for Youth — an organization that promotes access to comprehensive sex education.
She says comprehensive sex ed is "always in the best interest of young people."
Here's what it looks like, for different age levels from grades K-12:
Elementary school: Consent, personal boundaries and healthy relationships
Age-appropriate sex ed for kindergartners introduces topics like consent, identifying who is in your family and the correct names for body parts.
"When we're talking about consent with kindergartners, that means getting permission before you touch someone else; asking if it's OK if you borrow somebody's toy or pencil or game, so that kids start to learn about personal boundaries and consent in really age- and developmentally appropriate ways," says Gelperin, who was part of a team that released the first national sex education standards in 2012.
Gelperin loves to use hula hoops to teach young kids about bodily autonomy: Each student gets one, and is instructed to ask for permission to go inside someone else's hula hoop. The hoops are an analogy for boundaries.
"If someone is touching you inside your boundary in a way that makes you uncomfortable, it's OK to say no and talk to a trusted adult," Gelperin tells students.
Another good lesson for younger children is how to identify those trusted adults. Mariotta Gary-Smith, a sex ed instructor based in Oregon, asks students to write a list of people they trust in their communities: "People that you know care about you, people who are accessible to you, people who could support you."
The list can include peers, immediate and extended family members or chosen family members. Then Gary-Smith, who co-founded the Women of Color Sexual Health Network, asks students to think about how they would talk to the people on their list about safety, respect and boundaries.
"When they knew that they had trust and safety in their circle, they felt like they could express themselves without judgment," she explains.
As students head into third grade, Gelperin says they should start learning the characteristics of healthy relationships with friends and family.
"Sometimes there's teasing and bullying that's going on in those grade levels. So you want to talk about how to interrupt teasing and bullying and how to stand up for others that may be getting teased or bullied," she explains.
There should also be a focus on respecting others' differences, including different family makeups, cultural backgrounds and faith traditions.
Gelperin says lessons on consent should continue throughout elementary school. And she recommends lessons on puberty begin in fourth grade, because that's when some students begin to see and experience changes in their bodies.
Middle school: Real talk about puberty
As students transition from elementary school to middle school, they should learn about the details of reproduction, including biological terms and why some people menstruate while others create sperm.
"That for me is a real hallmark of middle school sex education, is kind of really starting to understand how those parts and systems work together for reproduction," Gelperin says.
It's also a good time to connect the physical effects of puberty and hormones with the feelings of attraction that come along with them.
"Who gives you butterflies in your stomach? Who makes your palm sweaty?" Gelperin says. "Because we know with puberty, one of the changes is experiencing new hormones that make us feel feelings of attraction often for other people in a new and different way."
Students should also learn about sexually transmitted infections, like HIV, and how they're transmitted.
And middle school is a good time to start learning about gender expression and sexual orientation, as well as gender stereotypes. One Advocates for Youth lesson includes a scavenger hunt homework assignment where students look for gender stereotypes in the world around them, like a sports ad that only features men or an ad for cleaning supplies that only features women.
High school: When conversations about healthy relationships get deeper
Healthy relationships are a "hallmark" of comprehensive sex education, Gelperin says. As students move into high school, the conversation should expand from family and friends to partners and intimate relationships.
"What makes a relationship healthy? How do you know if a relationship is not healthy?" Gelperirn says.
Those conversations should also cover sexual abuse, sexual harassment and sexual assault.
At Mountainside High School in Beaverton, Ore., school health teacher Jenn Hicks shares statistics with students about the disproportionate rates of sexual violence for women, women of color and members of the LGBTQ communiity.
"Sexual violence can happen to anyone," she tells her class, "but it doesn't happen equally to everyone."
That leads to a conversation about consent.
"We have to talk about how we treat each other better, why consent is so important and why we need to listen to each other and protect each other," Hicks says. "Again, violence is used as a form of control to keep groups of people disempowered and fearful."
And then, of course, come the classic lessons of high school sex ed, about pregnancy, how to prevent sexually transmitted infections and how to use contraception – a lesson Gelperin says is especially important.
"We can't expect young people to know how to use condoms correctly unless we help them learn how to do that."
One classic method: bananas. Specifically, having students practice placing a condom on a banana, as one Advocates for Youth lesson recommends.
Finally, there are lessons that don't have anything to do with sex (or fruit) — like how to find credible sources of information.
Think about all the rumors about sex that can circulate in a high school – those rumors are also all over the internet. And for a kid looking for information, it can be hard to know what to believe.
"We're allowing children to learn what's out there, and they are," says sex ed researcher Lisa Lieberman, who co-authored that Montclair State University paper. "They are accessing pornography; they are accessing the internet. They are learning in ways that are not the message that most parents and schools want children to have."
Advocates for Youth recommends asking students to evaluate different sexual health websites, and identify the ones that are trustworthy.
For Hicks, the goal of all this is to give every student the tools they need to stay safe.
"It's recognizing everybody that's in the room and giving them the knowledge and skills to make the best possible decisions for themselves and to lead a happy, fulfilled life."
Sex ed recommendations are always evolving
Mariotta Gary-Smith, with the Women of Color Sexual Health Network, says 10 years ago sex education wasn't culturally reflective or respectful to everyone, including to communities of color.
"The images that are used, that have been used historically ... you don't see bodies that are not white, able-bodied, cis, slender, slim," she explains. "You don't see or hear about young people who choose to parent if they become pregnant. You hear about teen pregnancy as this thing to be stopped, but not honoring that there are cultures and communities where young people who choose to parent are celebrated."
Gary-Smith has helped create more inclusive lessons through the Women of Color Sexual Health Network, and the sex ed standards Gelperin helped create in 2012 were updated in 2020 to include racism, inequality and their impact on sexual health. An Advocates for Youth lesson points students to examples of how racism has impacted the health and reproductive rights of low-income women of color, among other groups.
The national sex ed standards were also updated to touch on gender identity, sexual orientation, reproductive justice and sexually explicit media.
"It really allowed us to reflect the times in 2020 and what young people were saying was their lived experiences that they were so hungry to learn and talk about," Gelperin says.
Keeping sex ed inclusive and culturally reflective means teaching about systemic oppression, discrimination and the history and impacts of racism on certain communities, Gary-Smith explains. For example, a lesson on reproductive health might discuss historical examples of forced sterilization of Indigenous women or Black women, or the criminal justice system as it connects to family relationships.
These lessons may seem a far cry from those on consent or gender, and Gary-Smith understands that.
"Everything I'm talking about now, 10 years ago, we weren't talking about it," she explains.
That highlights one of the most important characteristics of sex ed for Gary-Smith: It should always be evolving.
"It needs to shift and change because things shift and change."
Lee Gaines is from member station WFYI, and Elizabeth Miller is from member station OPB. Nicole Cohen edited this story for broadcast and digital.