The state famous for Mardi Gras is ground zero for the fight to educate teenagers about safe sex.
Louisiana's middle and high schoolers have some of the country's highest rates of pregnancy, HIV, syphilis, and other sexually transmitted infections (STIs). And thanks to a law that prohibits asking students about their sex lives, health care providers are hobbled in their search for answers.
"If we don't know what the behaviors are, we have no basis to develop policy or identify priorities," Freda Patterson, a public health researcher at Temple University, told BuzzFeed News.
Every two years since 1991, U.S. states have given public school kids between sixth and twelfth grades an anonymous questionnaire called the Youth Risk Behavior Survey (YRBS).
The questions cover all kinds of risky behaviors, from seatbelt wearing to drug use. The sexual behavior section includes questions about number of partners, contraceptive use, age of first sexual experience, and whether kids have been forced to have sex against their will.
To ensure that the survey responses can be compared to one another, each state must ask at least two-thirds of the original questions, and may also add their own. Four states have consistently refused to include questions about sex: Utah, Georgia, Virginia, and Louisiana.
"We wish that all four states would add sexual risk behaviors," Laura Kann, who manages the YRBS as part of her job at the Centers for Disease Control and Prevention, told BuzzFeed News. "It's important to have data on the sexual behaviors that kids practice."
Louisiana's reluctance stems from a 1993 law, which says that "students shall not be tested, quizzed, or surveyed about their personal or family beliefs or practices in sex, morality, or religion."
That law also says that sex education in Louisiana public schools must stress abstinence, and that teachers cannot distribute contraceptives.
"These are decisions that are best made by parents and local communities, not state government," Louisiana governor Bobby Jindal said in opposition to a 2014 state bill that would have introduced contraceptive use to sex ed curricula. That measure failed.
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These surveys often uncover information about more than just sex.
"Asking these questions provides critical information about who is at risk" of pregnancy or disease, Brian Mustanski, an associate professor and director of the IMPACT LGBT Health and Development Program at Northwestern University, told BuzzFeed News by email.
Certain demographic groups, Mustanski added, may be less likely than others to protect against STIs, "in which case we can then study why these differences exist and how to address them."
Sex behaviors are also often closely tied to teens' mental health, note Katharine Anatale, a nurse at Robert Wood Johnson University Hospital in New Jersey, and Sarah Kelly, a public health researcher at Rutgers University. The two have studied YRBS data from states across the country and discovered, for example, that girls who report symptoms of depression are much more likely to be having sex without condoms.
That's important information because it helps guide useful interventions, the researchers say.
"A girl with symptoms of depression can also be counseled about sexual health since we know the concepts are intertwined," Anatale and Kelly said in an email to BuzzFeed News.
Sexual health may also point to rape or physical abuse. Adolescent women who are in physically abusive relationships are three and a half times more likely to get pregnant than are young women who are not experiencing that kind of violence, according to the American College of Obstetricians and Gynecologists. Women who are abused are also three times more likely to get an STI.
Although Louisiana does ask whether teens are subjected to intimate partner violence, without the sex behavior questions, there's no way to see if those abusive relationships are correlated with condom use, HIV, or other health issues.
With sky-high rates of STIs, Louisiana is one of the states that most needs to talk about sex, some say.
"Louisiana is in a public health crisis," Raegan Carter, who used to be the coordinator of the YRBS in Louisiana and is now senior director of external services for Planned Parenthood in Louisiana, told BuzzFeed News. "We're one of the only states with increasing teen pregnancy rates. Our HIV and STI rates among adolescents continue to climb."
For example, the rate of gonorrhea among young people in Louisiana is .9%, more than twice the national average, according to the CDC.
"What is driving this?" asked Mustanski of Northwestern. Is it because kids are engaging in risky behaviors, or getting less STI testing and treatment? "Without knowing the answer we cannot mount an informed response," he said.
In New Orleans, where pregnancy is the most common reason girls drop out of high school, lawmakers have asked the state several times if the city can teach students about birth control and add sex questions to the YRBS. But the legislature has turned them down.
In other states, public health researchers, policymakers, and teachers have taken advantage of the YRBS data, which is freely available. They use it to understand what trouble teens are getting in, and ultimately to develop programs to help kids make healthier choices.
"From the survey that's been given in states across the country, we've been able to develop policies around drugs, tobacco use, obesity — all of those were gleaned from information from the Youth Risk Behavior Survey," Patricia Smith, a Louisiana state representative for Baton Rouge, told BuzzFeed News.
Smith has introduced a number of bills about sexual education and health over the years, including several attempts to add sex questions to the YRBS. With current law, she says, Louisiana policymakers aren't just missing out on useful data, but on federal funding for HIV and STI prevention programs that can only be applied for using YRBS data.
"By not asking the sexual behavior questions, we're not getting federal dollars that could help us with high STD and high pregnancy rates," Smith said. "We're leaving them on the table."
The most prominent group lobbying against comprehensive sexual education in the state is the Louisiana Family Forum, a Christian organization that opposes abortion, gay marriage, and comprehensive sex education.
Earlier this year, the group sent out a mailing to its listserv urging their members to send a form letter to their representatives to stop a bill that would allow New Orleans to survey kids about sexual behavior.
The letter claimed that the bill "potentially exposes students to intrusive questions with no guarantee that this private information would be held secure," even though the YRBS is an anonymous survey. The legislature ultimately voted against allowing the questions.
Louisiana Family Forum did not return several requests for comment from BuzzFeed News. Some lawmakers share the organization's concerns.
"Won't we desensitize children when asking them about sexual activity?" Lenar Whitney, a state representative for Houma, Louisiana, asked Smith when she brought the YRBS bill before the state House.
The issue is bigger than the specific questions asked by YRBS. Smith recently helped pass a resolution demanding that the Department of Health and Hospitals, the school system, and the Department of Children and Family Services put together a joint report on what ages kids are getting STIs and having babies. Before that law, those departments didn't share that information with each other.
The Louisiana legislative session closed Thursday, without passing any measures to reform sex education.
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Cat Ferguson is a writer based in Oakland, California. You can follow her on Twitter @biocuriosity or email her at firstname.lastname@example.org.
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