DES MOINES, Iowa (AP) — A dozen state or county agencies have parted ways with tens of thousands of dollars in federal grants meant to help monitor teenagers’ sexual behaviors and try to lower rates of teen pregnancy and sexually transmitted diseases.

The withdrawals reflect a shift in many states that is further complicating and polarizing sex education in K-12 schools as some Republican-led legislatures more strictly regulate when and what students learn about their bodies. The new laws are part of a broad push to fortify “ parents’ rights ” and strike LGBTQ+ content from the classroom, core themes that have flooded the campaign for the GOP presidential nomination.

Experts are concerned students won’t reliably learn about adolescence, safe sexual activity or relationship violence, topics they say are especially important since sexually transmitted diseases rose after the pandemic and access to abortion is increasingly restricted.

Anne-Marie Amies Oelschlager, a pediatric and adolescent gynecologist at Seattle Children’s Hospital, said a trained, trusted adult is critical for young people to get good information versus other, less trustworthy sources like social media.

“When we stop talking about these things or … try to push things under the rug, we just increase risk,” she said.

Fewer teens are sexually active, a 2021 government survey showed, but federal data that year also suggest teens and young adults made up half of all people with STDs. For the youngest generations, the language about sex is evolving.

This year, lawmakers passed bans on teaching human sexuality before fourth grade in Indiana and sexual reproduction or sexual intercourse before fifth grade in Arkansas. In Kentucky, educators can’t teach sexuality or sexually transmitted diseases before sixth grade, and parents must provide consent for older students. A handful of states require parents to opt in to instruction instead of opting out.

In Florida, materials about reproductive health, human sexuality and sexually transmitted diseases for any grade must be approved by state officials. A letter from the state agency indicates curriculum was due for review by the end of September.

Advocates for comprehensive sex education say the restrictions in early education may prevent kids from getting age-appropriate foundational knowledge that they build on each year, said Alison Macklin, director of policy and advocacy at the progressive sex education organization SIECUS.

“You were never going to teach a first grader a trigonometry lesson, right?” she said. “But they have to have foundational knowledge in first grade to be able to get to that in high school.”

“Sex education is exactly the same,” Macklin continued, suggesting young people aren’t prepared for puberty if they haven’t already learned “foundational things like correct terminology for body parts.”

Puberty for girls begins between ages 8 to 13 and typically two years later for boys. To comply with the new law in Kentucky, for example, the state’s education agency advised schools eliminate fifth-grade lessons on puberty and reproductive body parts.

The consensus was sex education in elementary school “wasn’t necessary or appropriate in any context,” said David Walls, executive director of The Family Foundation, a Christian organization in Kentucky that advocated for the law.

Many parents disagree with the boundaries around what is considered age appropriate by sex ed advocates, he said, particularly when it comes to gender identity and “the idea that biological sex is not an immutable characteristic.”

The law “sets a base level of protection for parents to be able to be the ones that can review the curriculum and make a decision as to whether that’s something they’d like their child to participate in,” Walls said.

There is federal guidance for developing evidence-based and age-appropriate sexual health curricula, but state laws and local implementation run the gamut.

Twenty-eight states require sex education, and 35 require HIV education, according to tracking by the Guttmacher Institute, a research group that supports abortion rights. Most states require any instruction on sex or disease prevention to include abstinence, and most states allow parents to opt out.

While many states have curtailed sex education, others have codified comprehensive and inclusive standards. Massachusetts, for example, recently announced new sexual health education guidelines, which were last updated in 1999.

The U.S. Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services award millions of dollars for programs designed, in part, to track teen behavior and teach abstinence and contraception with the goal of creating safe environments and preventing pregnancy and diseases.

Idaho’s Division of Public Health said it no longer administered the HHS grant for personal responsibility education programs, or PREP, as of July 1 after lawmakers did not approve the spending during the legislative session.

New Hampshire withdrew from PREP funding after a five-member Republican-led council that approves contracts repeatedly blocked funding in 2022. However, PREP funding doesn’t necessarily disappear if a state’s officials reject it; instead, it can be awarded directly to local organizations, which is now the case in New Hampshire.

A different grant is provided by the CDC’s Division of Adolescent and School Health for a biennial youth survey. Since March 2022, six states have discontinued the agreement to conduct the survey: Alabama, Colorado, Florida, Idaho, Iowa and South Carolina. Some of those states also have new laws restricting schools’ ability to administer surveys.

Four Florida counties encompassing parts of the Tampa, Orlando, Jacksonville and Miami metro areas also withdrew from another CDC grant to expand student health resources and education.

The CDC will “always promote the best available science,” said Kathleen Ethier, director of the agency’s Division of Adolescent and School Health. The agency said it is committed to collecting data revealing youth health challenges and recommending evidence-based programs addressing them.

Ethier said there is always a “disconnect” between their recommendations and state and local policies, but she is less focused on any given health class “than the whole school environment.”

“I worry any time educators don’t feel able to thoughtfully answer young people’s questions,” Ethier said.

Teenagers’ curiosity drives Teen Health Mississippi, a organization that trains educators and offers supplemental programs for parents and teens.

About a quarter of the state’s counties work with the nonprofit and the state’s health agency to implement an “abstinence-plus” program, an option schools have to teach about contraception in addition to the now-permanent requirement to teach abstinence.

Hope Crenshaw, the organization’s director, said low percentage of counties suggests “a lot of young people aren’t getting that information and many of them are getting it based on their zip code.”

“Young people want information to protect themselves,” Crenshaw said.

Kayla Smith is among them. The 18-year-old freshman at the University of Mississippi volunteered to be a youth advocate with Teen Health Mississippi, engaging her peers and answering their questions.

The topic of sex in Mississippi is “taboo,” Smith said. She remembers just one optional day of sex education in middle school.

“I wanted to learn information about healthy relationships, contraceptive options,” she said. Instead, she believes abstinence-only curriculum is “withholding information about those important details that can help people make safe and informed health choices.”

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This is the first of two stories about sex education in the U.S. A story publishing Saturday looks at concerns around inclusion of LGBTQ+ students in health classes.

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Associated Press writers Holly Ramer in Concord, New Hampshire, and Rebecca Boone in Boise, Idaho, contributed to this report.