U.S. Territories: Guam and Other Pacific Islands Profile

About the U.S. Territories

There are currently three inhabited U.S. territories in the Pacific Ocean: American Samoa, Guam, and the Northern Mariana Islands, and three Freely Associated States (FAS) nations. People living in U.S. territories and associated Pacific Island nations have a unique relationship to the U.S. government. Residents in U.S. territories are either considered “U.S. nationals” or citizens, but cannot vote for the President of the United States, and they do not have full representation in the U.S. Congress. Territorial infrastructure is generally inferior to that of the continental U.S. and Hawaii, and poverty rates are higher in the territories than in the states.

Pacific Island nations that have signed a comprehensive agreement with the United States called a Compact of Free Association (COFA), have a unique relationship that intertwines diplomatic, economic, and military relations. FAS are sovereign nations and FAS citizens are not U.S. citizens. These nations receive limited access to some public programs from the U.S. in exchange for U.S. military access to their islands

Sex ed in the Pacific Islands

American Samoa (U.S. Territory)
The American Samoa Department of Education’s health education program includes a human immunodeficiency virus (HIV) School Health Project, which provides education about HIV infection and acquired immunodeficiency syndrome (AIDS) to students. Students in grades 7-12 also receive information on sexually transmitted diseases (STDs), HIV/AIDS, and teen pregnancy through the Teenage Health Teaching Modules, which address issues affecting adolescents. This program teaches students interpersonal communication, “refusal skills, self-esteem, decision-making, and role playing.”

With the goal of reducing HIV infection, schools encourage students “to abstain from sexual intercourse, to not inject drugs, and, when deemed appropriate, to consistently and correctly use latex condoms to prevent HIV infection, if they become sexually active.”

Republic of the Marshall Islands (Freely Associated State)
Sex education is a requirement for all schools in the Republic of the Marshall Islands. The Republic of the Marshall Islands Public School System Content Standards and Performance Indicators refer to sexual activity as a risk behavior and suggest teaching refusal skills as well as “how STDs are transmitted and treated and behaviors that can protect against their transmission.” Refusal skills are taught as early as grade 4. School curriculum includes HIV education, which is taught to both primary and secondary school students. Youth to Youth in Health, Inc. partners with the Republic of the Marshall Islands Public School System to implement evidence-based curriculum, provide workshops to health clubs and engage in outreach to parents. Youth to Youth in Health, Inc. received funding from the U.S. Department of Health & Human Services (HHS) Office of Adolescent Health (OAH) Teen Pregnancy Prevention (TPP) Program for the first time in 2015.

Republic of Palau (Freely Associated State)
In Palau’s Education for All plan, “providing more effective training on HIV/AIDS issues and policies” is a suggested activity. One credit of health is required for graduation, and parental consent is required to participate in sex education instruction. It is reported that the teaching of sex education is still largely viewed as the responsibility of parents and guardians and that many educators fail to provide sex education instruction.

Commonwealth of the Northern Mariana Islands Sex Education Snapshot

In 2012, the Hawaii Youth Services assisted the Commonwealth of the Northern Mariana Islands (CMNI) in receiving their first Personal Responsibility Education Program (PREP) grant. This grant allowed the Public School System (PSS) to begin implementing evidence-based, culturally responsive curricula in each middle and high school. Students receive sex education three times during their education: once during grade 6, once during grade 7, and once in high school. Although parents and guardians must consent to their children receiving sex education curriculum, advocates report that the number of parents who refuse consent has declined. They also report that sex education is becoming increasingly accepted as a necessary component of a student’s education. To further advance sex education curriculum, advocates report that increased training, technical assistance, and evaluation support would be beneficial to educators. The PREP grant that the PSS receives is set to end in 2020 and the school system is eager to find additional funding to replace it.

Youth Sexual Health Data

Young people are more than their health behaviors and outcomes. While data can be a powerful tool to demonstrate the sex education and sexual health care needs of young people, it is important to be mindful that these behaviors and outcomes are impacted by systemic inequities present in our society that affect an individual’s sexual health and well-being.

CNMI School Health Profiles Data 

In 2019, the Centers for Disease Control and Prevention (CDC) released the School Health Profiles, which measure school health policies and practices and highlight which health topics were taught in schools across the country. Since the data were collected from self-administered questionnaires completed by schools’ principals and lead health education teachers, the CDC notes that one limitation of the School Health Profiles is bias toward the reporting of more positive policies and practices. In the School Health Profiles, the CDC identifies 20 sexual health education topics as critical for ensuring a young person’s sexual health. Below are key instruction highlights for secondary schools in the Northern Mariana Islands as reported for the 2017–2018 school year.

Reported teaching all 20 critical sexual health education topics

• 80% of Northern Mariana Islands secondary school taught students all 20 critical sexual health education topics in a required course in any of grades 6, 7, or 8.
• 83.3% of Northern Mariana Islands secondary schools taught students all 20 critical sexual health education topics in a required course in any of grades 9, 10, 11, or 12.

Reported teaching about the benefits of being sexually abstinent

• 100% of Northern Mariana Islands secondary schools taught students about the benefits of being sexually abstinent in a required course in any of grades 6, 7, or 8.
• 83.3% of Northern Mariana Islands secondary schools taught students about the benefits of being sexually abstinent in a required course in any of grades 9, 10, 11, or 12.

Reported teaching how to access valid and reliable information, products, and services related to HIV, other STDs, and pregnancy

• 80% of Northern Mariana Islands secondary schools taught students how to access valid and reliable information, products, and services related to HIV, other STDs, and pregnancy in a required course in any of grades 6, 7, or 8.
• 83.3% of Northern Mariana Islands secondary schools taught students how to access valid and reliable information, products, and services related to HIV, other STDs, and pregnancy in a required course in any of grades 9, 10, 11, or 12.

Reported teaching how to create and sustain healthy and respectful relationships

• 100% of Northern Mariana Islands secondary schools taught students how to create and sustain healthy and respectful relationships in a required course in any of grades 6, 7, or 8.
• 83.3% of Northern Mariana Islands secondary schools taught students how to create and sustain healthy and respectful relationships in a required course in any of grades 9, 10, 11, or 12.

Reported teaching about preventive care that is necessary to maintain reproductive and sexual health

• 100% of Northern Mariana Islands secondary schools taught students about preventive care that is necessary to maintain reproductive and sexual health in a required course in any of grades 6, 7, or 8.
• 100% of Northern Mariana Islands secondary schools taught students about preventive care that is necessary to maintain reproductive and sexual health in a required course in any of grades 9, 10, 11, or 12.

Reported teaching how to correctly use a condom

• 100% of Northern Mariana Islands secondary schools taught students how to correctly use a condom in a required course in any of grades 6, 7, or 8.
• 100% of Northern Mariana Islands secondary schools taught students how to correctly use a condom in a required course in any of grades 9, 10, 11, or 12.

Reported teaching about methods of contraception other than condoms

• 100% of Northern Mariana Islands secondary schools taught students about methods of contraception other than condoms in a required course in any of grades 6, 7, or 8.
• 83.3% of Northern Mariana Islands secondary schools taught students about methods of contraception other than condoms in a required course in any of grades 9, 10, 11, or 12.

Reported teaching about sexual orientation

• 80% of Northern Mariana Islands secondary schools taught students about sexual orientation in a required course in any of grades 6, 7, or 8.
• 83.3% of Northern Mariana Islands secondary schools taught students about sexual orientation in a required course in any of grades 9, 10, 11, or 12.

Reported teaching about gender roles, gender identity, or gender expression

• 80% of Northern Mariana Islands secondary schools taught students about gender roles, gender identity, or gender expression in a required course in any of grades 6, 7, or 8.
• 83.3% of Northern Mariana Islands secondary schools taught students about gender roles, gender identity, or gender expression in a required course in any of grades 9, 10, 11, or 12.

Reported providing curricula or supplementary materials relevant to lesbian, gay, bisexual, transgender, or questioning (LGBTQ) youth

• 80% of Northern Mariana Islands secondary schools provided students with curricula or supplementary materials that included HIV, STD, or pregnancy prevention information relevant to LGBTQ youth.

Guam Sex Education Snapshot

Beginning in grade 9, students in Guam learn about “Family Life and Human Sexuality.” The School Health Education Program of Guam addresses the “prevention of risk behaviors,” including “sexual behaviors that contribute to unintended pregnancy, HIV infection, and other [STDs].” The program’s goal is to “improve educational outcomes in Guam’s schools.” In the Guam Department of Education K-12 Content Standards and Performance Indicators, pregnancy, sexually transmitted infections (STIs), and HIV are mentioned in Content Standard 1: Health Promotion and Disease Prevention.

Over the past few years, sex education advocates and health providers have worked hard to develop culturally relevant and responsive resources for the indigenous populations of Guam. In 2017, a new teaching resource entitled Navigating Personal Wellbeing & Sexuality: A Facilitator’s Guide for Working with Chuukese and Chamoru Communities was published by health providers, professionals from the Office of Minority Health Resource Center, cultural advisers, and sex education researchers to serve as a guide for educators in providing culturally responsive sex education curriculum.

Youth Sexual Health Data

Young people are more than their health behaviors and outcomes. While data can be a powerful tool to demonstrate the sex education and sexual health care needs of young people, it is important to be mindful that these behaviors and outcomes are impacted by systemic inequities present in our society that affect an individual’s sexual health and well-being.

Guam School Health Profiles Data

In 2019, the Centers for Disease Control and Prevention (CDC) released the School Health Profiles, which measure school health policies and practices and highlight which health topics were taught in schools across the country. Since the data were collected from self-administered questionnaires completed by schools’ principals and lead health education teachers, the CDC notes that one limitation of the School Health Profiles is bias toward the reporting of more positive policies and practices. In the School Health Profiles, the CDC identifies 20 sexual health education topics as critical for ensuring a young person’s sexual health. Below are key instruction highlights for secondary schools in Guam reported for the 2017–2018 school year.

Reported teaching all 20 critical sexual health education topics

• No Guam secondary school taught students all 20 critical sexual health education topics in a required course in any of grades 6, 7, or 8.
• 66.7% of Guam secondary schools taught students all 20 critical sexual health education topics in a required course in any of grades 9, 10, 11, or 12.

Reported teaching about the benefits of being sexually abstinent

• 62.5% of Guam secondary schools taught students about the benefits of being sexually abstinent in a required course in any of grades 6, 7, or 8.
• 100% of Guam secondary schools taught students about the benefits of being sexually abstinent in a required course in any of grades 9, 10, 11, or 12.

Reported teaching how to access valid and reliable information, products, and services related to HIV, other STDs, and pregnancy

• 42.9% of Guam secondary schools taught students how to access valid and reliable information, products, and services related to HIV, other STDs, and pregnancy in a required course in any of grades 6, 7, or 8.
• 100% of Guam secondary schools taught students how to access valid and reliable information, products, and services related to HIV, other STDs, and pregnancy in a required course in any of grades 9, 10, 11, or 12.

Reported teaching how to create and sustain healthy and respectful relationships

• 66.7% of Guam secondary schools taught students how to create and sustain healthy and respectful relationships in a required course in any of grades 6, 7, or 8.
• 100% of Guam secondary schools taught students how to create and sustain healthy and respectful relationships in a required course in any of grades 9, 10, 11, or 12.

Reported teaching about preventive care that is necessary to maintain reproductive and sexual health

• 12.5% of Guam secondary schools taught students about preventive care that is necessary to maintain reproductive and sexual health in a required course in any of grades 6, 7, or 8.
• 100% of Guam secondary schools taught students about preventive care that is necessary to maintain reproductive and sexual health in a required course in any of grades 9, 10, 11, or 12.

Reported teaching how to correctly use a condom

• 12.5% of Guam secondary schools taught students how to correctly use a condom in a required course in any of grades 6, 7, or 8.
• 100% of Guam secondary schools taught students how to correctly use a condom in a required course in any of grades 9, 10, 11, or 12.

Reported teaching about methods of contraception other than condoms

• 12.5% of Guam secondary schools taught students about methods of contraception other than condoms in a required course in any of grades 6, 7, or 8.
• 100% of Guam secondary schools taught students about methods of contraception other than condoms in a required course in any of grades 9, 10, 11, or 12.

Reported teaching about sexual orientation

• 25% of Guam secondary schools taught students about sexual orientation in a required course in any of grades 6, 7, or 8.
• 83.3% of Guam secondary schools taught students about sexual orientation in a required course in any of grades 9, 10, 11, or 12.

Reported teaching about gender roles, gender identity, or gender expression

• 26.6% of Guam secondary schools taught students about gender roles, gender identity, or gender expression in a required course in any of grades 6, 7, or 8.
• 83.3% of Guam secondary schools taught students about gender roles, gender identity, or gender expression in a required course in any of grades 9, 10, 11, or 12.

Reported providing curricula or supplementary materials relevant to lesbian, gay, bisexual, transgender, or questioning (LGBTQ) youth

• 57.1% of Guam secondary schools provided students with curricula or supplementary materials that included HIV, STD, or pregnancy prevention information relevant to LGBTQ youth.

(Visit the CDC’s School Health Profiles report for additional information on school health policies and practices.)

***The quality of sex education taught often reflects funding available for sex education programs. To learn more about federal funding streams, click here.