The Effectiveness of Sex Education in Reducing Adolescent Pregnancy and Birth Rates in Rural US Communities: A Scoping Review of Outcomes, Barriers, and Facilitators

Adolescent pregnancy remains a persistent public health concern in the United States, with disproportionately higher birth rates in rural communities driven by limited access to healthcare, cultural and religious opposition to sexuality education, and broader structural inequities. This scoping review, conducted in accordance with the Arksey and O’Malley framework and PRISMA-ScR guidelines, examined peer-reviewed studies published between 1980 and 2024 on the effectiveness of sex education in rural U.S. settings. Searches of PubMed, CINAHL, and ERIC, supplemented by reference and citation searching, identified 12 eligible studies. A mixed-methods convergent approach was used to synthesize quantitative outcomes and qualitative findings. Comprehensive sexuality education demonstrated more consistent evidence than abstinence-only education in improving sexual health knowledge, contraceptive use, and parent-child communication and, in some cases, reducing adolescent pregnancy rates. Abstinence-only education showed mixed or limited effectiveness, with outcomes influenced by cultural fit and implementation fidelity. Key barriers included cultural and religious resistance, policy constraints, limited educator training, geographic isolation, and technological challenges. Facilitators included community engagement, cultural tailoring, innovative delivery models, program fidelity, and parental involvement. These findings underscore the need for continued research in and implementation of culturally responsive, evidence-based sexuality education and adolescent friendly health services as essential strategies for advancing reproductive health equity.