BILL ANALYSIS SENATE HEALTH COMMITTEE ANALYSIS Senator Sheila J . Kuehl, Chair BILL NO: AB 629 A AUTHOR: Brownley B AMENDED: April 16, 2007 HEARING DATE: June 27, 2007 6 REFERRAL: Health & Education 2 FISCAL: Appropriations 9 CONSULTANT: Diaz/Tadeo/cjt SUBJECT Sex education programs: requirements SUMMARY This bill would require sexual health education programs that are funded or administered, directly or indirectly, by the state, to provide information that is age appropriate, medically accurate, current and objective, and to fulfill other requirements as specified. CHANGES TO EXISTING LAW Existing law Existing law, the Comprehensive Sexual Health and HIV/AIDS Prevention Education Act, authorizes school districts to offer age-appropriate comprehensive sexual health education in kindergarten through grade 12. Commencing in grade seven, a sexual health education program must offer information on sexually transmitted diseases (STDs), including HIV/AIDS, and their prevention, and information on the prevention of unintended pregnancy, as specified. Existing law requires instructional materials for a Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 629 (Brownley) Page 2 comprehensive sexual health education program to be age appropriate, medically accurate, and objective. The materials must be accessible to English learner pupils and must not teach or promote religious doctrine, or bias against any person on the basis of race or ethnicity, gender, sexual orientation, or disability, as specified. Existing law requires a school district to notify a parent or guardian that his or her child will receive comprehensive sexual health education and HIV/AIDS prevention, and empowers a parent or guardian to excuse his or her child from all or part of that instruction. Existing law changes the name of the Department of Health Services (DHS) to the Department of Health Care Services (DHCS) and transfers certain public health responsibilities to the newly established Department of Public Health (DPH) as of July 1, 2007. This bill: This bill would require that any sexual health education program conducted, operated, or administered by any state agency, or that receives financial assistance from state funds, adhere to the following: Provides age appropriate, culturally and linguistically appropriate, medically accurate, current, and objective information, using the most current scientific data on human sexuality, human development, pregnancy, and sexually transmitted diseases; Does not teach or promote religious doctrine, or promote bias against any person on the basis of disability, gender, nationality, race or ethnicity, religion, or sexual orientation; Provides information about the effectiveness and safety of at least one or more drug or device approved by the Food and Drug Administration for the prevention of pregnancy and for reducing the risk of contracting sexually transmitted diseases. This information may be included, but is not required, in programs directed toward minors under the age of 12; and For programs directed at minors, include information on abstinence as the only certain way to prevent unintended pregnancies, and that the only certain way to prevent sexually transmitted diseases (STDs) is to abstain from STAFF ANALYSIS OF ASSEMBLY BILL 629 (Brownley) Page 3 activities that have been proven to transmit sexually transmitted diseases. This bill would exempt from these provisions, any program offered by a school district, a county superintendent of schools, or a community college district. The bill also exempts from these provisions one-on-one interactions between a health practitioner and his or her patient in a clinical setting. This bill would require an outside agency that is receiving state funding, and that is teaching a sexual health education program at a publicly funded school, to indicate in writing that the program meets the requirements of the California Comprehensive Sexual Health and HIV/AIDS Prevention Education Act. For the purposes of this bill, a "publicly funded school" includes a charter school. This bill states that compliance with these requirements would be integrated into the grant monitoring and compliance procedures of the state agency. This bill authorizes a state agency to terminate the contract or take other appropriate action if a grantee is not in compliance with any requirements of this bill. FISCAL IMPACT According to the Assembly Appropriations Committee, there will be an estimated one-time cost of $150,000 to DPH to hire staff for oversight purposes and technical assistance. There will be minor absorbable costs to DPH beyond the first year of program implementation. BACKGROUND AND DISCUSSION The author states that, although California has been the national leader in protecting reproductive health by adopting a comprehensive sex education curriculum, state-funded programs are not currently required to operate under consistent standards with what is required to be taught in schools. According to the author, all state-funded programs should provide medically accurate, comprehensive, and bias-free information. AB 629 sets a floor of basic standards for state-funded or administered community-based sexual health education programs. STAFF ANALYSIS OF ASSEMBLY BILL 629 (Brownley) Page 4 Teen birth rate and STD prevention A study by the Public Health Institute, "No Time for Complacency: Teen Births in California 2006," found that, although California has experienced a decrease in teen birthrates statewide, rates remain high in Senate districts primarily located in Los Angeles County, the Central Valley, and the Imperial Valley. In addition, California's teen birth rate is still four to ten times higher than rates for France, Spain, Italy, the Netherlands, and Japan. While abstinence is accepted as an effective way to prevent pregnancy and sexually transmitted diseases, several studies have shown that abstinence-only education curricula is ineffective, and that teaching about the effectiveness of both abstinence and contraception has proven more effective. A study commissioned by Congress, released this year by Mathematica Policy Research Inc., concluded that youth in abstinence-only programs were no more likely than youth not participating in these programs to have abstained from sex. Those who pledged to abstain, when compared to non-pledgers, were less likely to use condoms or other contraception if they had sex, and experienced similar rates of sexually transmitted diseases when compared to their counterparts. California is one of a number of other states that has continually rejected Title V, Section 510 of the Social Security Act funds for abstinence-only programs. These programs prohibit the dissemination of information on contraception and their exclusive purpose is to teach that a mutually faithful, monogamous relationship in the context of marriage is the expected standard of human sexual activity. State-funded sex education programs This bill would primarily affect state-funded programs administered directly or indirectly by the DHS Office of Family Planning (OFP), which currently has four different types of community-based programs for teen pregnancy prevention, and other programs for HIV/AIDS prevention that are operated by DHS' Sexually Transmitted Diseases Control Branch and the Office of AIDS Education and Prevention. The four continuing outreach and education programs include the Male Involvement Program, the Community Challenge Grants Program (CCG), the TeenSMART Program, and the STAFF ANALYSIS OF ASSEMBLY BILL 629 (Brownley) Page 5 Information and Education Program. These programs are provided with the goal of reducing teenage pregnancy and STDs, promoting responsible parenting and the involvement of the biological father, and providing enhanced reproductive health care counseling and pregnancy prevention education to equip teens at high risk for pregnancy with the knowledge, understanding, and behavioral skills necessary to make responsible decisions regarding at-risk behavior. CCG, for example, includes 117 community-based grantees located throughout the state. A majority of these types of programs are taught in either a school setting or other community setting and service historically underserved communities with high teen birth rates. OFP also administers family planning services which include contraceptive methods, natural family planning, abstinence methods, infertility management, preconception counseling, maternal and fetal health counseling, and general reproductive health care, including diagnosis and treatment of infections and conditions, including cancer, that threaten reproductive capability, and other services. Related legislation AB 708 (Huff), 2006-2007, requires DPH to develop and implement an abstinence education program that would maximize federal financial participation. This bill failed passage in the Assembly Health Committee. AB 1511 (Leno), 2006-2007, requires DPH to establish a statewide continuing public education program, to encourage parents to talk with their teens about sex and sexual health to promote well-informed decision making by teens. This bill is set to be heard in the Senate Health Committee on June 27, 2007. Previous legislation SB 71 (Kuehl), Chapter 650, Statutes of 2003 enacted the California Comprehensive Sexual Health Education and HIV/AIDS Act, which requires sexual health education that is taught in public schools kindergarten through grade 12, inclusive, to be comprehensive, bias-free, medically accurate, and age appropriate. SB 1471 (Kuehl), 2005-2006, would have expanded upon SB 71 STAFF ANALYSIS OF ASSEMBLY BILL 629 (Brownley) Page 6 (Kuehl) to provide further guidance for state-funded or administered sexual health education programs to comply with specified requirements. This bill was vetoed. The veto message stated that this bill would impose restrictions on community-based pregnancy prevention programs and would encroach on local decision making. Arguments in support The American Civil Liberties Union (ACLU), Planned Parenthood Affiliates of California, and the American Association of University Women, the sponsors of this bill, state that, although California has made great strides in promoting comprehensive sex education, a significant percentage of state-funded programs are providing biased, incomplete, and medically inaccurate information, putting young people's health at risk. The ACLU cites an analysis showing that at least 25 percent of the CCG programs sampled provided "abstinence-focused" instruction in public school settings and included misleading information about abortion, condom effectiveness, and STDs, and promoted bias relating to sexual orientation. Supporters contend that state-funded programs are directed to local communities that have high rates of unintended pregnancies and sexually transmitted diseases, which are the communities most in need of accurate and effective information. Furthermore, supporters state that health care costs due to teen pregnancy and sexually transmitted diseases cost California taxpayers $1.5 billion each year. Arguments in opposition Concerned Women for America of California (CWA) believes that including information on the "effectiveness and safety" of at least one contraceptive would discriminate against parents who would expect schools to emphasize abstinence. CWA further contends that no contraceptive or STD-reducing device makes sex "safe" for teens. According to CWA, the bill would need to include an opt-in provision to provide for adequate parental notification. Additionally, CWA expresses concerns that charter schools would be impacted by this bill, resulting in less local control over decision making and limiting parents' rights to tailor their child's education. PRIOR ACTIONS STAFF ANALYSIS OF ASSEMBLY BILL 629 (Brownley) Page 7 Assembly Health Committee:12-5 Pass Assembly Appropriations: 12-5 Pass Assembly Floor: 47-32 Pass POSITIONS Support: Planned Parenthood Affiliates of California (sponsor) American Civil Liberties Union (sponsor) American Association of University Women (sponsor) ACCESS/Women's Health Rights Coalition Ally Action American College of Obstetricians and Gynecologists, District IX Asian Communities for Reproductive Justice California Commission on the Status of Women California Latinas for Reproductive Justice California Medical Association California National Organization for Women California Nurses Association California Women Lawyers Center for Research on Gender and Sexuality Family Violence Law Center Family Violence Prevention Fund Gay and Lesbian Adolescent Social Services, Inc. Gay-Straight Alliance Network Los Angeles Free Clinics NARAL Pro-Choice California National Asian Pacific American Women's Forum National Sexuality Research Center Pharmacy Access Partnership Physicians for Reproductive Choice and Health Planned Parenthood, Shasta-Diablo Planned Parenthood of San Diego & Riverside Counties Project 10, Inc. Public Health Institute Southern California HIV Advocacy Coalition Women's Foundation of California Oppose: Concerned Women for America of California STAFF ANALYSIS OF ASSEMBLY BILL 629 (Brownley) Page 8 -- END --