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TUNICA, Miss. — On the streets of Sugar Ditch, a hard-worn neighborhood in this Delta town, nearly everyone recognizes Marky Holland’s grey Volkswagen Beetle. When it passes, they know Holland, a social worker, is coming with a healthy supply of free diapers and baby clothes—and an even healthier supply of free advice—for one of her dozens of clients.

 Mississippi sex education
Marky Holland, a social worker at the Delta Health Partners Healthy Start Initiative, talks with teenage parents about how to prevent child abuse at a gathering in a Coahoma County church last spring. The healthy start initiative works with young parents to provide parenting and other advice in large swaths of Mississippi, which posts the highest teen birth rate in the country. (Photo courtesy of Delta Health Partners)

Holland’s “clients” are teenage mothers enrolled in the Tougaloo College/Delta Health Partners Healthy Start Initiative, which provides parenting advice, nurse visits, psychological services, and education support to young parents throughout a large swath of the Delta. New clients find Holland almost as often as she finds them. En route one August morning for a routine visit with a 19-year-old and her two children, Holland and her colleague Chelesa Presley are flagged down by the side of the road by another teenager. La-quita, a 17-year-old with a baby in her arms, tells Holland she wants to enroll in the program. La-quita also provides a crucial link to her cousin Jasmine, a 15-year-old client who dropped out of contact a few weeks earlier after a fire gutted the family apartment.

There’s never a shortage of clients for Holland in Tunica. Located in the state’s far northwest corner, the county posted the highest average teen birth rate in Mississippi in recent years. The state, in turn, consistently posts the highest teen birth rate in the country. That gives Tunica, where casinos are the main growth industry, more teen parents per capita than any place in the U.S., according to data from the Mississippi State Department of Health.

Across the country, the teenage pregnancy rate has dropped for decades as access to contraceptives and information improves. Young people also delay having sex longer than they did in the 1990s. But in Mississippi, where teen pregnancy is a problem that affects the entire state and cuts across racial and socioeconomic lines—depressing the state’s already low high school graduation rates—teen births have declined at a much slower pace.

The nation’s teen pregnancy rate dropped 37 percent between 2005 and 2008, according to data from the Guttmacher Institute, which works to promote sexual and reproductive health. In Mississippi, the rate dropped by 20 percent over the same time period, the smallest decline of any southern state. For older teens the gap was particularly large: While teen pregnancies fell by 28 percent for 18- and 19-year-olds, the rate dropped only 2 percent in Mississippi. In 2011, 55 of every 1,000 teenage girls in Mississippi gave birth, compared to a low of 16 per 1,000 in New Hampshire.

Mississippi Learning

The Hechinger Report is teaming up with Time magazine to examine what’s behind the woeful performance of Mississippi’s schoolchildren, as well as possible solutions to help them catch up.

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Youth advocates hope the Mississippi figure will plummet in the not-too-distant future, however. Under a new state law, Mississippi public schools must start teaching sex education this fall. While a majority of the state’s districts have selected “abstinence-only” approaches that critics say may or may not be scientifically based, a sizable minority, including Tunica, have opted for “abstinence-plus” curricula that include more detailed information on condoms and contraceptives and come with a stamp of approval from the United States Department of Health and Human Services. That means thousands of Mississippi schoolchildren likely will be taught a thorough and factual sex education curriculum for the first time ever. The law does not mandate what grades should teach sex education, but all of the districts appear to be focusing on middle and high school for now.

“The kids in Mississippi have not been given medically accurate information about pregnancy and STDs,” said Jamie Bardwell, director of programs for the Women’s Fund of Mississippi, which advocates on issues affecting the state’s women and girls, including  sexually transmitted diseases (STDs). “Once we give them access to medically accurate information, we think behavior will change and the teen pregnancy rate will go down.”

Indeed, what happens in Mississippi counties like Tunica over the next few years will test the power of more comprehensive sex education to lower teen pregnancy and birth rates. Mississippi teens have comparatively restricted access to birth control and abortion: Many Mississippi drug stores keep condoms under lock and key (although it’s unclear if they are trying to limit access or prevent shoplifting). The rural nature of the state makes it more difficult for teens to solicit medical or moral advice about sex anonymously since the local pharmacist or pastor very likely knows their parents. And the state’s Republican governor and legislature have set their sights on closing Mississippi’s lone remaining abortion clinic. (Thirty years ago, 14 clinics performed abortions in Mississippi.)

Moreover, the state’s child poverty rate—which is positively correlated to teen pregnancy—rose to 33 percent from 26 percent between 2000 and 2010. No state has a larger percentage of children living in poverty than Mississippi, according to data from the Annie E. Casey Foundation.

Only about half of the states in the country mandate sex education, although most districts address “sexuality education” in some way, said Monica Rodriguez, president of the Sexuality Education and Information Council of the United States. District and school policies and approaches so run the gamut—ranging from broad discussion of relationships to detailed instruction in how to use various contraceptives—that generalizations about the efficacy of sex education are virtually impossible, Rodriguez said.

But youth advocates and educators are counting on improved sex education to make a difference for Mississippi’s teens in the short term while they work to expand health care access and economic opportunity in the long term. “It’s time for us to stop sticking our heads in the sand and pretending this isn’t happening,” said Ashley McKay, founder of Tunica Teens in Action, a grassroots organization that tries to nurture youth leaders. “We’re in a crisis.”

Revamping the curriculum

Virtually overnight, the new law and a grassroots campaign led by a small non-profit called Mississippi First have revamped the way Mississippi schools teach sex education. Up until this year, nearly all of the state’s 151 districts had no formal approach. When the Mississippi Department of Education asked districts for copies of their sex education policies or curricula in 2010, only five had anything written down, according to staff at Mississippi First.

 Mississippi sex education
Sanford Johnson, deputy director of the non-profit organization Mississippi First, explains a new sex education curriculum to parents and teachers in Greenville, Miss. last month. This year, schools throughout the state must begin teaching sex education for the first time. (Photo by Sarah Carr)

Some teachers and community organizations worked in relative isolation to ensure students received a solid grounding in sex and sexually transmitted diseases. But many schools relied for their entire curriculum on brief seminars with local pastors who preached the sins of pre-marital sex and left it at that. Or they failed to broach the subject at all.

McKay, now 24, said her only sex education at Tunica’s Rosa Fort High School consisted of a listing of different sexually transmitted diseases. “The teacher—an older gentleman who was also the football coach—would tell us, ‘If you get AIDS, you’re gonna die. Pick out your casket, because you’re gonna die.’ There was no curriculum. There was no useful information.”

The scare tactic backfired. Baby showers were weekly occurrences during parts of McKay’s four years at Rosa Fort. Nearly 20 students in McKay’s graduating class of 106 already had children—and that just included the girls.

The state law passed in 2011 required school districts to select and begin teaching a sex education curriculum by this fall. Although the law represented a breakthrough for those working to reduce the state’s high teen pregnancy rate, Mississippi still has one of the most conservative such policies in the country—if not the most conservative. Districts must choose among several abstinence-only and abstinence-plus curricula approved by the state’s department of education (some of which have not likewise been deemed “evidence based” by the U.S. Department of Health and Human Services). The law placed severe limits on the breadth of subjects that can be covered in the abstinence-plus curricula, decreeing that teachers cannot demonstrate how to put on a condom or any other form of contraceptive; it also outlawed any discussion of abortion.

Within these confines, Mississippi First, which advocates on such issues as early childhood education and teen pregnancy, set out to encourage districts—especially those with the highest teen pregnancy and STD rates—to adopt the most comprehensive and scientific sex education possible under the new law. As an incentive, the group partnered with the state health department to secure a federal grant that provided free curricula and teacher training for districts that selected an evidence-based approach.

Tunica was a fairly easy sell. There, the abstinence-plus advocates had support not only from McKay, but also from Marilyn Young, the president of the school board. “Just talking about abstinence is not enough,” Young said. “The data provided us with evidence what we were doing was not working.”

‘Some very tough fights’

Not all districts were willing to venture beyond abstinence. Just under half of the state’s districts selected an abstinence-plus curriculum. Of those, 39 (or about a quarter of districts in the state) selected a curriculum endorsed by the Department of Health and Human Services.

“We had some very tough fights at some school districts,” said Rachel Canter, the executive director of Mississippi First. Her colleague Sanford Johnson targeted Hollandale School District in the Delta with a particularly aggressive campaign. Washington County, where Hollandale is located, posts more cases of teenage gonorrhea per capita than any other county in the state.

A majority of the Hollandale School Board remained obstinate that an abstinence-only curriculum would best serve the needs of its students, however.

“My personal beliefs are simple,” said Demetric Warren, a Hollandale board member. “I believe in the Bible.” He said “abstinence-only” before marriage “is a tenet of the Bible.”

Warren argues that advocacy groups like Mississippi First inappropriately discounted abstinence-only curricula without trying them first. “The majority of school districts weren’t even dealing with sex education,” he said. “How can something fail if it hasn’t been implemented?…I have not seen a person who is not sexually active contract a sexually transmitted disease.”

The research on sex education is hotly disputed. But several peer-reviewed studies have found comprehensive sex education is more effective at reducing teen pregnancy rates than abstinence-only approaches. One 2008 study published in the Journal of Adolescent Health, for instance, reported that teenagers who received a thorough sex education were significantly less likely to become pregnant than those who received no sex education (the study controlled for such factors as income and family structure). The study found no similar effect for abstinence-only education.

The abstinence-plus curricula endorsed by Mississippi First and (and also the state’s department of health) differ from abstinence-only approaches in that they include more detailed information on condoms and birth control. But, like many abstinence-only curricula, they also emphasize negotiation skills, confidence building, and delaying sexual activity.

An Atlanta-based company sells the most popular sex education curriculum adopted in Mississippi, called “Choosing the Best.” Most health professionals consider it abstinence-only curriculum (the company’s website describes it as “abstinence centered”), but the Mississippi Department of Education placed it on both the abstinence-only and abstinence-plus lists. Rodriguez says Choosing the Best does not belong in the abstinence-plus category. “What little information there is on contraceptives is not something that would give young people good information to use to make health decisions,” she said.

State officials said the law was written in a way that allowed some curriculum to qualify as both abstinence-only and abstinence-plus since the bill offered little detail on the extent to which an abstinence-plus curriculum must discuss contraception. A spokeswoman for Choosing the Best said in an e-mail that its curriculum includes “medically accurate, complete information about the effectiveness and limitations” of different contraceptive methods. In sample pages of the curriculum she supplied, students had to answer fill-in-the-blank questions such as “Condoms are made of rubber, so they can (blank), slip off, be affected by heat and cold, and deteriorate over time.”

Even critics of an abstinence-only approach prefer Choosing the Best to the Denver-based WAIT (Why am I Tempted) Training, a curriculum from the Center for Relationship Education that some health professionals and women’s advocates have described as misogynistic and medically inaccurate. About ten Mississippi districts opted for WAIT Training, including Tupelo Public Schools, one of the largest districts in the state.

“Not only is (the curriculum) not evidence-based, it’s damaging to women and girls,” said Carol Penick, executive director of the Women’s Fund.

Joneen Mackenzie, the founder of the Center for Relationship Education, said every activity included in WAIT Training has been “focus-grouped” by kids. “When people say, ‘You want to frighten and shame kids,’ that drives me crazy,” she said. Mackenzie said WAIT Training includes information on contraception, but focuses on teaching kids “about love and how to have a healthy relationship.” She describes it as an antidote to “curriculum that come in with condoms, and dildos, and baskets, and makes the case for normalizing teen sex.”

In 2011, the Denver Westword newspaper published a probing story that described in depth the curriculum’s origins and lessons, including links to videos of one of the trainers, Shelly Donahue, teaching an auditorium full of teenagers.

During one part of the presentation, Donahue applied the same piece of tape to the arms of different male students, ripping the tape off each teenager’s arm in turn. She likened teenagers who engage in pre-marital sex to the tape: Both become dirtier, more germ-ridden, and less able to adhere to someone the more partners they have, she said. In another controversial (and biologically questionable) part of the lesson, she said teenagers are so fertile a girl’s vagina becomes like a “little Hoover vacuum” — Donahue accompanied the phrase with a quick sucking sound — whenever sperm come anywhere near it. “You’re very fertile right now,” Donahue said, gesturing toward the high schoolers in the audience. “What happens when two fertile kids get together? How do you spell child support?”

Polling the parents

More Mississippi parents than policy makers appear to support abstinence-plus sex education over abstinence-only.

In a 2011 survey of 3,600 Mississippi public school parents commissioned by the Center for Mississippi Health Policy, most parents said they wanted a comprehensive sex education curriculum. Although 90 percent of parents said schools should talk about the benefits of abstaining from sex, 92 percent said they favored sex education that covers HIV, AIDS, and other STDs; 78 percent said they wanted instruction on birth control methods; two-thirds said health instructors should tell teenagers where to obtain contraceptives; and more than half said they would prefer condom demonstrations in class.

Over the past year, Mississippi First’s Johnson has traveled throughout the state, first to convince school districts to adopt an evidence-based abstinence-plus curriculum, and more recently to convince parents to let their children attend the classes. The state law specifies that parents must be allowed to opt out of sex education. Moreover, boys and girls must be taught separately, meaning schools need to have three instructors available for each sex education class: one for the girls, one for the boys, and one for the students whose parents opt them out.

Johnson has little difficulty winning over most of the parents who come out for the meetings. Presenting in Greenville one August evening, he told about a dozen parents they lived in a “priority one” community because of the high gonorrhea, syphilis, and HIV rates among teenagers.

“There are a lot of students who are virgins,” he said. “They might wait until next week to have sex. They might wait until next month. Or they might wait until their wedding day. But there are students in middle school who, believe it or not, are already sexually active.”

He outlined the major topics covered in the new abstinence-plus curricula adopted in Greenville—from teaching students refusal skills to instructing them verbally (since hands-on demonstrations were outlawed) in how to put on a condom. The Greenville schools would be using the new curricula with its sixth through ninth graders, but only the older children would learn about birth control and contraceptives. In the 9th grade, for instance, they learn the steps for putting on a condom.

Eshaela Smith, a parent who attended the meeting, said she had no problem signing her seventh-grade daughter up for sex education classes. “(My daughter) just told me about a boy she has a crush on,” she said. “We talked about how it’s OK to have a crush on someone from a distance…I would like her to be educated, but will continue to do my part at home and pray that she’ll come to me with any questions about what she’s learning.”

Not all parents talk with their children openly or knowledgeably about sex, however. And since most Mississippi schools historically failed to address the subject, many teenagers have relied on each other for their information.

The staff members at the Southeast Mississippi Rural Health Initiative see the effects of this mis-education often. Teenagers might believe they can’t get pregnant if it’s their first time having intercourse or if they shower immediately afterward. Many of them think it’s impossible to contract an STD through engaging in oral sex. They do not know that all sexually transmitted diseases are different, and that most do not equal a death sentence.

“Most of them haven’t gotten accurate information…and their perceptions are unbelievable,” said Ivie Pulliam, director of grants at the initiative.

‘Focus on you and your education’

In Tunica, after the chance meeting with La-quita on the Sugar Ditch street, Holland and Presley continued on to the home of their intended target, Teara Clinton. The 19-year-old lived at a grandmother’s house with her 2-year-old and 4-month-old. Clinton was one of the Healthy Start Initiative’s success stories: She had graduated from Tunica’s Rosa Fort High School the previous spring and recently started taking online classes to become a nurse’s assistant. Unlike many young fathers, Clinton’s boyfriend was actively involved in his children’s lives. Her grandmother helped watch the babies so Clinton had time to study at a local library.

Holland gave Clinton an armful of onesies, baby socks, diapers, and bottles. She reminded her to read and talk with the children. She advised her about the kind of food the baby should be eating. And she told Clinton again and again how proud she was of all the teen has accomplished.

Starting in a few weeks, a new sex education curriculum at Clinton’s alma mater would debut. For now, however, Holland tried to make up for the gap—a few years too late. As much as she loved working with the girls and their babies, she also yearned for fewer clients—particularly repeat ones. With this in mind, Holland reminded Clinton to stay on birth control.

“The main thing we’re going to work on is not having babies anymore,” Holland said. “It’s time to focus on you and your education.”

Sarah Carr, a contributing editor at The Hechinger Report, is the author of Hope Against Hope: Three Schools, One City, and the Struggle to Educate America’s Children, which tells the story of the New Orleans schools post-Katrina. It will be published in February 2013.

A version of this story also appeared on as part of an exclusive partnership. Reproduction is not permitted.

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