When Ashley Bever learned from family friends that her 11-year-old daughter would receive sexual education at her San Diego public school, she asked the program coordinator for the district to let her see the curriculum. The coordinator was “reluctant,” said Bever, a substitute teacher in the local school district, but Bever was eventually able to see the material—called “Rights, Respect, Responsibility.”

What Bever read shocked her. The sixth-grade curriculum said children could be attracted to any gender. “We don’t choose our feelings just like we don’t choose who we find attractive,” the curriculum reads. The curriculum gives detailed information about anal sex and oral sex, as well as talking about mutual masturbation as a way to avoid sexually transmitted infections (STIs).

“We’re so far past the condom or not condom debate,” said Bever. “It’s like, are you going to send my kid home with lubrication?”

Several times the curriculum tells middle schoolers that they can self-refer to a clinic “like Planned Parenthood” without informing their parents or teachers. The curriculum mentions Planned Parenthood as a resource several times. (“You’re taking this huge corporation with this huge policy agenda and giving them direct access to our children,” Bever responded.)

The curriculum uses “they” as a pronoun instead of “him” and “her” and says “someone with a vulva” or “someone with a penis” instead of saying girl or boy. The curriculum defines abstinence as “a penis not going inside another person’s vagina.” The lessons use scare quotes around the word abortion, saying “end a pregnancy” instead, and the eighth-grade curriculum explains that minors can have abortions without notifying their parents.

What really annoyed Bever was that the final lesson in the curriculum told kids which websites were reliable for sex ed questions, lecturing that abstinence sites were lying to them.

San Diego is one of the more extreme examples in a nation where sex ed is patchy, or an afterthought. But Advocates for Youth, an organization that regularly partners with Planned Parenthood, developed the curriculum and successfully placed it in San Diego public schools. Some other liberal school districts accept curricula from Advocates for Youth and other groups affiliated with Planned Parenthood; the Gay, Lesbian, and Straight Network (GLSEN); and the Sexuality Information and Education Council of the United States (SIECUS).

Such groups argue in their curricula that gender is on a spectrum and that teens should follow wherever their feelings and attractions lead, while downplaying the risks of casual sexual encounters. They call programs based on such values “comprehensive sexuality education” (CSE).

“It’s a different philosophy about life,” said Joe McIlhaney, an OB-GYN and the head of the Medical Institute for Sexual Health, an organization that researches teen sexual health and emphasizes the health risks of casual sex. “There’s nothing above what you can see, eat, or touch.”

Sex ed is scattershot throughout the country, with some conservative school districts skittish about the subject altogether. Twenty-four states mandate sex education, and 21 of those require HIV education alongside sex education, according to the National Conference of State Legislatures. Sex ed curriculum is often determined through a battle of PowerPoint presentations at the school board meeting. Conservative districts have rejected CSE curricula, and CSE groups have in certain areas ousted abstinence-based education groups.

Has the nature of these battles changed over the last few decades? “Honestly, no,” said McIlhaney, 82.

In this environment, abstinence groups have rebranded. The new in-vogue term, “sexual risk avoidance,” means classes teach that abstinence is the best way to avoid health risks associated with sex. Last year the National Abstinence Education Association, the main advocate for abstinence education, changed its name to “Ascend.” Mary Anne Mosack, the head of Ascend, said the term sexual risk avoidance “changes the conversation—it takes it out of that realm that this is just a moral message. It’s a health message.”

The shift to “sexual risk avoidance” is partly a political calculation, but it is also a reflection of how abstinence educators offer a more holistic approach to sex education now that includes discussions about conflict resolution, pornography, dating violence, and sexual abuse (see sidebar).

“Healthy relationships—that’s the direction [sex education] is heading now,” said Kimberly Danon, who manages high-school curriculum for a federally funded sex education program affiliated with Elizabeth's New Life Center in Ohio, a network of pregnancy resource centers. Danon’s program is in both public and private schools in 11 counties as part of a larger course on healthy relationships. In student surveys that the program has received, students said the most useful class was the one about conflict resolution in relationships.

ONE BIG CHANGE is evident over the last 30 years: Teenagers are having much less sex, according to the Centers for Disease Control and Prevention (CDC). The number has shown a steady and marked decline, along with the teen pregnancy and abortion rate. In 1988, 60 percent of male teenagers and 51 percent of female teenagers reported having had sex in the CDC survey. In the 2016 survey, only 41 percent of teenagers had ever had sex.

At the same time that teenagers are having less sex, the number of teenagers who reported receiving sex education to the CDC hasn’t changed very much—which calls into question the influence of sex ed (whether abstinence-based or CSE). Cultural voices likely influence teens more than a health class.

Fifty-nine percent of 12- to 17-year-olds use Snapchat regularly, according to research firm eMarketer. Snapchat often features articles on sex ed topics. One recent example: “Why This Form of Birth Control Is RISKY.” (The story was about the withdrawal method, the second-most-common form of birth control teenagers report using after condoms.) Trends that push teens away from spending social time together in person, like sexting and the increase in pornography usage, might also help explain the decline in sex.

Meanwhile, SIECUS—founded by Planned Parenthood medical director Mary Calderone in 1964—has been promoting “National Sexuality Education Standards” (NSES) the last few years from “leading health organizations” that include lessons about gender identity and sexual orientation. The name cleverly parallels the official “National Health Education Standards” (NHES), standards for health classes from the CDC. The NSES committee includes representatives from Planned Parenthood and GLSEN.

Red states have fiercely opposed NSES curricula like the Advocates for Youth material in San Diego, successfully tying NSES to the dreaded Common Core standards—even though the NSES isn’t a government initiative and has not been widely adopted.