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Introduction

Taking into consideration the reproductive health of women, Obama’s administration introduced the Affordable Care Act (ACA), which took effect on August 1, 2012. According to the ACA, all insurance policies cover birth control, and there is a number of other policies that cover policyholder’s children until the age of 26 as dependents, which ensures that additional 1.3 million young people are protected (Marcotte, 2012). This provides coverage for 47 million women (U.S. Department of Health & Human Services, 2012; The New York Times, 2012). The ACA of 2012 introduced eight new birth-prevention-related services, namely: well-woman visits; gestational diabetes screening for pregnant women; domestic/interpersonal violence check and consultations; HPV DNA testing for women over 30; contraceptive methods and contraceptive education and counseling; HIV screening; STI screening; breastfeeding support (counseling and supplies); contraceptive education and counseling; and FDA-approved contraceptives (U.S. Department of Health & Human Services, 2012).

The last point states that within the ACA funds will be allocated in order to implement and support sex education. The Affordable Care Act defines contraceptive education as comprehensive sex education, as it should cover both abstinence and methods of contraception, which will decrease the levels of HIV/AIDS, STIs, and pregnancy among adolescence and young adults (Catalog of Federal Domestic Assistance, 2012; Alford, 2001). The state provides financial support on the competitive basis for any plans or programs that introduce comprehensive sex education programs on different levels.

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Until now, sexual education in schools existed, but it was not a compulsory subject. Moreover, there were two main options: abstinence-only education and comprehensive sex education (Alford, 2001). Although according to both types of sex education, abstinence is a way to prevent HIV, STIs and pregnancy. Comprehensive sex education also focuses on different types of contraception, tools for building healthy relationships, importance of family communication on the issue of sexuality, etc. (SIECUS, 2009). By learning all about contraceptive medicaments, youth is able to use them and, thus, prevent various diseases and unwanted pregnancies. Health education in one of the mentioned forms that already exists in many educational institutions throughout the country. However, the Affordable Care Act is the first document that introduces comprehensive sex education on the state level.

There are already proofs of the success of the comprehensive sex education (Weiss, 2012). Such educational programs have gained wide support of parents, healthcare organizations, NGOs, and young Americans (Weiss, 2012; SIECUS, 2009). Statistics show a significant decrease in teenage pregnancies over the past decades, and scientists attribute it to the introduction of comprehensive sex education programs (Weiss, 2012; SIECUS, 2009).

At the same time, such institutions as Catholic Church express their strong opinions against comprehensive sex education and the whole Affordable Care Act because the idea of contraception and birth control contradicts a number of religious beliefs (Brown & Eisenberg, 1995). Although the comprehensive sex education programs have proven to be efficient, still not all the states and educational institutions support them. Religious schools and colleges strongly oppose the program of comprehensive sex education classes. It is emphasized that the ability to use contraception encourages adolescents and young adults to have a more active sexual life than in case of abstinence-only education (Brown & Eisenberg, 1995). Moreover, the Republican Party opposes the ACA and the education of young adolescents on contraception (The New York Times, 2012).

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Economic and Non-Economic Costs

With the extended number of services provided by insurance, the healthcare costs are obviously rising. With the nationwide introduction of the ACA, the expenditures will increase. In 2011, only the Medicare beneficiaries were receiving pregnancy preventive services, and within a year, more than 24 million have used at least one service (U.S. Department of Health & Human Services, 2012). With the introduction of ACA the numbers will double, in consequence, the expenditures will increase.

The implementation of the ACA will significantly improve the accessibility of contraceptive medicine to the low-income population. Adolescents and young adults along with sex education lessons will receive the possibility to access contraceptive medicine. Yet, at the same time, it will significantly increase the budgets, because the prices are significant. The table below states the price-per-year for different types of contraceptives in 2011, according to PPFA (cited in Weiss, 2012, p. 5):

Pills

$180-$600

Injections

$140-$300

Implants

$800

IUDs

$500-$1000

 

Although the prices of contraception may seem not to be directly related to the comprehensive sex education program, they are at the same time are under its strong influence. With improved understanding of the benefits and side effects of various contraceptives, teenagers will be more interested in purchasing this medication (U.S. Department of Health & Human Services, 2012). This will result in the growth of demand. Moreover, those youngsters who are currently deterred by the relatively high price of contraceptive medication will increase their demand, because the drugs are available within the ACA.

Except for the price of contraceptive medication, additional costs are required to establish the nationwide system of comprehensive sex education programs. Despite the fact that many educational institutions have already introduced similar study plans, states still need guidance from the Department of Health and Human Services in order to adjust their healthcare programs and healthcare education to the ACA standards (Pittman, 2012). States may require not only financial help, which can be provided within the Affordable Care Act in the form of grants, but expert opinions and experiences will be as essential as the actual monetary contribution.

At the same time, the introduction of comprehensive sex education is a possibility to cut costs. The majority of schools that provide abstinence-only sex education show no positive results. Three out of four abstinence-only programs in Texas schools show no results (Weiss, 2012, p. 3). Despite that, the programs still get funding. The introduction of comprehensive sex education will use the funds of the old programs but, at the same time, show actual results. Thus, it will be possible to eliminate the inefficient programs and relocate their funds.

Stakeholders

This issue is a controversial one because, along with healthcare problems, it involves a number of moral and religious values. Therefore, the group of stakeholders is quite versatile. The whole structure is presented in a table, which names the stakeholder and describes some facts and arguments that each side presents.

Barak Obama and the Democratic Party

- Barak Obama has supported the introduction of birth control as a part of insurance policy throughout his career.

- President Obama supports pro-choice policies.

- ACA shows care for women’s health.

- ACA gets strong support of women.

- 91 per cent of parents support sex education in schools, which means that Obama and the Democrats have the support of voters (Weiss, 2012, p. 2).

- 56 per cent of Americans do not believe in efficiency of abstinence-only programs (Weiss, 2012, p. 2).

Healthcare institutions and NGOs

- All prominent sex education organizations and a number of nationwide healthcare organizations state that abstinence-only programs are not efficient.

- National Coalition to Support Sexuality Education has 140 member organizations that stand for comprehensive sexual education (Weiss, 2012, p. 3).

- Pro-ACA organizations are American Medical Association, the American Public Health Association, the American Psychiatric Association, the YWCA of the USA etc. (SIECUS, 2009).

Catholic Church

- Catholic Church strongly opposes the ACA.

- Bishops have already involved other Churches (conservative evangelicals, Eastern Orthodox, two Orthodox Jewish groups) (The New York Times, 2012).

- Church representatives believe that contraception as an obligatory part of all insurance plans as well as birth control violates religious freedoms of Catholics.

- Catholic educational institutions are strongly against comprehensive sex education.

- Schools should stick to the abstinence-only sex education.

Republican Party

- The party failed to block the ACA.

- It tried to introduce an amendment that would limit birth control, but it failed (The New York Times, 2012).

- Republicans support the Catholic Church.

- The party topped active opposition to the ACA in order to keep female voters for the Presidential elections 2012.

Parents

- The majority of parents support comprehensive sex education (SIECUS, 2009).

- Even in more conservative states, such as Texas, the majority of parents supported the inclusion of contraception information and instruction on condom use in school plans (Weiss, 2012, p. 3).

Self-Insured organizations

- ACA puts self-insured organizations in an uncomfortable position, as they remain insurance providers for all employees, but the number of spheres that have to be ensured increases.

- The Affordable Care Act does not provide enough information on the actions of self-insured organizations.

- Religiously affiliated organizations in this case are stuck between the ACA legislation and the values of the organization (The New York Times, 2012).

Insurers

-  Birth control costs are, in fact, lower than the pregnancy costs. Therefore, it is more profitable to provide financial assistance with contraception.

 

Schools

- Not all schools currently have sex education. In many schools, sex education is abstinence-only.

- Educational institutions with religious background are not ready to move to comprehensive sex education.

- Additional financial and human resources are required for the implementation of new sex education programs.

 

Policy options

- A step-by-step implementation of the comprehensive sex education can be implemented in some conservative schools. Schools with strict religious background may have a multistage program that will be adding small parts of new information each year.

- Schools without sexual education can have abstinence-only classes as the first step to the implementation of the full-fledged program.

- Comprehensive sex education classes can exist as extra-curriculum activities that have to be offered by each school.

- Schools have to be encouraged by state and federal funding to implement comprehensive sex education.

Recommendations and Costs

The role of comprehensive sex education in the decrease of adolescent pregnancy is significant. Between 1990 and 2008, teenage pregnancy has decreased almost in half (SIECUS, 2009). Taking into consideration that the US has the highest teenage pregnancy rate among all developed states, the significant influence of comprehensive sex education should be constantly emphasized (Weiss, 2012, p. 1). Childbirth at an early age leads to the negative patterns in development of both mother and child, such as poverty due to the inability to provide for the family. Hence, the decrease in child pregnancy leads to the creation of a healthier nation. This idea should be constantly emphasized on all meetings and presented in all arguments. In fact, the decrease in pregnancy rates will have a very positive impact on the economic state of the country.

There is a point to establish a number of test-programs in different educational institutions. It will be essential to take schools with different backgrounds: without any sex education, with abstinence-only sex education classes, and with comprehensive education programs. These schools can be used for a case study research. The result of this research will be presented in order to show the success of the new comprehensive sex education program.

Scientific studies play a significant role in the implementation of comprehensive sex education programs in the US. The solid results of such research show that in Netherlands, sex education starts in preschool and is an integrated part of the curriculum, which has resulted in teen birthrates six and half times lower than in the US (Weiss, 2012, p. 3). German sex education has also resulted in five times lower teenage abortion rate and six times lower HIV prevalence rate when compared to the US (Weiss, 2012, p. 4). Such comprehensive studies provide solid results that prove the effectiveness of the comprehensive sex program. The case study may provide the same positive basis for further changes in the United States. A small number of schools will set a positive example for others. Although there will be no immediate results, the long-term ones will prove to be worthy.

Educational institutions throughout the country should be invited to participate in informational exchange. Through special panels supported by state and federal governments, educators, and healthcare professionals will be able to share opinions on the issue as well as introduce some successful practices. Moreover, representatives of different stakeholder groups have to be invited in order to discuss the issue of comprehensive sex education from contrasting points of view. Consequently, instead of providing specialists to each school, it will be possible to create an interactive panel for all educators.

The creation of a government-funded platform for sharing experience will be a great economic success. The main issue will be the involvement of all educators in the discussion. By conducting a number of general meetings on a national level followed by local-level conferences, it will be possible to save money on the comprehensive sex education tutors in all the US schools. Instead, teachers will receive additional training and will be able to teach with a minimum wage increase. At the same time, this educational option will give teachers a possibility to share opinions, learn the lasted educational practices, and later implement them in own educational institutions. This will be the way to establish strong cooperation between schools as well as to keep all teachers well informed and updated.

Implementation and Timeline

Implementation of comprehensive sex education varies from state to state. Thanks to the ACA, it can be reinforced on the federal level. Nonetheless, local governments have a lot of possibilities to influence the process. Thanks to the ACA grants, state authorities and smaller local organizations can apply for the federal funding (Catalog of Federal Domestic Assistance, 2012). Thereby, implementation of the comprehensive sex education will be a complex task of federal, state, and local powers.

The timeline will vary from state to state as local legislation as well as attitudes towards the ACA might differ. It might take less than a year for states that have already implemented comprehensive sex education programs in their schools. It might take two years for schools with abstinence-only educational programs or schools with no sex education programs. Still, one can be sure that, until the end of the President’s term, it will be possible to implement the comprehensive sex education programs nationwide.

Enforceability

As the complex sex education is a nationwide program, it should be enforced by the US Department of Education in collaboration with the United States Department of Health and Human Services. In fact, the ACA presents a joint project for the two departments. Nevertheless, all the work should be done in cooperation with corresponding state authorities. Thus, controlling functions should belong to the two mentioned departments, while each state should be able to establish its own responsible body or give this task to an existing governing institution. 

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