Almost every day at the public elementary school she attended in Montgomery County, Maryland, Stephanie heard comments about her weight. Kids in her fifth grade class called her “fatty” instead of her name, she recalled; others whispered, “Do you want a cupcake?” as she walked by. One classmate spread a rumor that she had diabetes. Stephanie was so incensed by his teasing that she hit him and got suspended, she said.

But nothing the kids did upset her as much as the conduct of her teachers.

For years teachers ignored her in class, even when she was the only one raising her hand, said Stephanie, whose surname is being withheld to protect her privacy. “I was like, ‘Do you not like me or something?” she recalled.

She felt invisible. “They would sit me in the back. I couldn’t see the board,” she said. When Stephanie spoke up once in middle school, a teacher told her, “I can’t put you anywhere else because you’re going to block other students.” She burned with embarrassment when her classmates laughed.

Nearly 20 percent of children in the U.S. — almost 15 million kids — were considered obese as of the 2020 school year, a number that has likely increased since the pandemic (new data is expected next year). The medical conditions associated with obesity, such as asthma, diabetes and sleep apnea, are well known. Children with obesity are also more likely to have depression, anxiety and low self-esteem.

Far less discussed are the educational outcomes for these children. Research has found that students with obesity are more likely to get lower grades in reading and math and to repeat a grade, and twice as likely to be placed in special education or remedial classes. They are also significantly more likely to miss school and be suspended or receive detention, and less likely than their peers to attend and graduate from college.

Researchers have suggested different reasons for this “obesity achievement gap,” including biological causes (such as reduced cortical thickness in the brain in children with obesity, which is linked to compromised executive functioning, and higher levels of the hormone cortisol, linked to poorer academic performance). They have also examined indirect causes of poor performance, such as that kids with obesity might miss school more often because of medical appointments or bullying. 

But a relatively new area of research has shifted attention to educator bias. Studies have found that teachers often perceive children with obesity as emotional, unmotivated, less competent and non-compliant. That can lead to teachers giving these students fewer opportunities to participate in class, less positive feedback and lower grades.

Weight bias is part of American culture, said Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Health at the University of Connecticut, who has studied childhood obesity and bias. “Teachers are not immune to those attitudes,” she said. While many school districts have tried in the last 20 years to reduce childhood obesity through more nutritious meals and increased exercise, Puhl and other experts say schools also need to train teachers and students to recognize and confront the weight bias they say is hampering the education of an increasing number of children.

Some advocates argue that childhood obesity, which has steadily risen over the last 40 years, should be seen as an “academic risk factor” because of its lasting effects on educational and economic mobility. “There’s certainly been a big push for racial and ethnic diversity, for gender identity diversity, that’s so important,” said Puhl. “But weight is often left off the radar, it’s often not getting addressed.”

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Stephanie, now 18, has struggled with obesity her whole life. Within her family, being overweight never felt like a problem. But school was different.

Beginning in kindergarten, her classmates told her she looked like a Teletubby, she said. Even teachers made comments related to her weight. “If someone brought pastries for a birthday, they would ask, ‘Are you sure you want to eat that? Why don’t you try carrots and hummus?’” Stephanie recalled. Once Stephanie listened as an educator told her mother to put her on a diet. She stopped eating lunch at school after that. “When I was home, I ran to food because it was like the only place I would feel comfortable eating,” she said.

There were a handful of occasions teachers noticed her for something besides her weight. Stephanie smiled as she recalled a time when an English teacher praised an essay she wrote; when she won second place prize in a coding camp; when she was named ‘cadet of the year’ in JROTC during remote school during the pandemic. In elementary school, she received the President’s Award for Educational Achievement, designed to reward students who work hard, often in the face of obstacles to learning.

It wasn’t enough to make her feel like she had educators on her side. “In school, they want you to confide in teachers, they made us believe that we can go to teachers for anything,” she said. “If you have no friends or if there’s no one to trust — you can always find a teacher who you can feel safe with, you can always trust them. So, I would try, but they always pushed me away.”

One interaction in particular shattered her confidence. Toward the end of seventh grade, Stephanie stayed to ask a question after class. Her teacher asked if she was a new student. “‘How did you not notice I was in your class and the entire year I turned in work?” Stephanie wondered. “That’s when I started to feel like I’m a shadow.” From that point on she stopped caring about getting good grades. 

Liliana López, a spokesperson for Montgomery County Public Schools, said that teachers are not “expressly trained on weight bias,” but they “elevate all the identities individuals hold as valuable and we work with staff to identify ways they can create spaces full of affirmation, validation and significance for those identities.” Celeste Fernandez, spokesperson for the National Education Association, the nation’s largest teachers’ union, said her organization does not offer specific training or information on weight bias.

Related: A surprising remedy for teens in mental health crises

Researchers are increasingly identifying links between poor outcomes for students with obesity and teacher’s attitudes toward kids. In 2015, Erica Kenney, an associate professor of public health nutrition at Harvard University, helped lead a team that analyzed data from a representative sample of children from across the nation. The researchers examined, among other things, whether the kids’ weight gain influenced teachers’ perceptions of their abilities and their standardized test scores.

Gaining weight didn’t change a child’s test scores, the researchers found, but, based on surveys, it was significantly linked to teachers having lower perceptions of students’ ability, for both girls and boys. In other words, kids who gained weight faced a small but significant“academic penalty” from their teachers, Kenney said.

A separate study, involving 130 teachers, found that educators were more likely to give lower grades to essays if they believed a child who was obese had written them. For the study, Kristin Finn, a professor in the school of education at Canisius University, in Buffalo, New York, took four essays written at a sixth grade level and paired them with stock photographs of students who looked similar but some had been digitally altered to appear overweight. The overweight students received moderately lower scores.

Finn found that the teachers were more likely to view the students with obesity as academically inferior, “messy” and more likely to need tutoring. In surveys, teachers also predicted that students with obesity weren’t good in other subjects such as math and social studies.

“To be able to make a judgment about somebody’s mathematical abilities based on a short essay seemed pretty remarkable,” said Finn. Yet, teachers maintained that they were personally unbiased in their evaluations. “They all think that they’re treating these children fairly,” she said.

Teachers’ perceptions of children’s academic potential matters: Their recommendations can affect not only students’ grades, but also their access to higher level courses, competitive programs, specialized camps and post-secondary opportunities including college.

Girls are at particular risk of being stigmatized for being obese, research has found. In one study, nearly a third of women who were overweight said they had had a teacher who was biased against them because of their weight. Students who face other barriers including poverty are also more likely to be penalized for being overweight, what is called a “double disadvantage.”

Related: One state mandates teaching climate change in almost every subject – even PE

Covid, which hit during the spring of Stephanie’s eighth grade year, was a welcome interruption. She loved learning in the privacy of her home and not being “judged for my body,” she said.

When schools reopened in the fall of 10th grade, Stephanie couldn’t bear the thought of returning. She had gained weight during remote learning, some 100 pounds. Citing her asthma and her father’s diabetes, she applied for a waiver that would permit her to attend classes virtually. But “the real reason was because I was ashamed of what I look like,” she said.

She received the waiver and continued her high school studies at home.

After a 2022 diagnosis of Polycystic Ovary Syndrome, which had made her body resistant to insulin, Stephanie decided to undergo bariatric surgery. Following the operation, Stephanie lost more than half her body weight. When she returned to her high school to take exams, people were suddenly nice to her, she said. It frustrated her, she said: “I’m the same person.”

Negative perceptions of people with obesity start early. In one study, children as young as 3 who were shown drawings of people of varying weights perceived the obese people as “mean” more often than “nice.” In another study, when 5- and 6-year-olds were shown images of children of different body sizes, most said they did not want to invite the heavier children to their birthday party.

Experts argue that administrators and teachers must become more sensitive to and knowledgeable about the challenges facing children with obesity. Yolandra Hancock, a pediatrician who specializes in patients with obesity and a former teacher, said she frequently intervenes with educators on behalf of her patients with obesity. One 7-year-old boy was often late to class because he found it difficult to climb the three flights of stairs to get there.

“The assistant principal actually told him if he wasn’t so fat, he would be able to get up the stairs faster,” Hancock said. She explained that the student wasn’t walking slowly because of “laziness” but because obesity can cause a bowing of the leg bones, making it hard to navigate steps. Giving the student more time between classes or arranging for his classes to be on the same floor would have been simple fixes, she said.

In another case, an elementary school student with obesity was getting into trouble for requesting frequent bathroom breaks, a result of his large abdomen putting pressure on his bladder, similar to what happens during pregnancy. “He came close to having an accident,” Hancock said. “His teachers wouldn’t allow him to go to the restroom and would call his mother to complain that he wasn’t focusing.” She wrote to the school requesting that he be allowed to go to the restroom whenever he needed. “If you don’t allow them to do what it is that their body needs,” Hancock said, “you’re creating more barriers to them being able to learn.”

Research has found that teachers can play an important “buffering role” in reducing bullying for children with obesity. In one study, children who believed educators would step in to prevent future bullying did better in school than those who didn’t share this conviction.

But often teachers don’t intervene, said Puhl, the University of Connecticut researcher, because they believe that if students “want the teasing to stop, they need to lose weight.” Yet “body weight is not a simple issue of eating less and exercising more,” she added, but is instead a highly complex condition influenced by genetics, hormones, culture, environment and economics.Bullying and mistreatment don’t motivate people to lose weight, Puhl said, but often contribute to binge eating, reduced physical activity and weight gain.

One way to help, would be for schools to include body weight in their anti-bullying policies, Puhl said. At present, most schools’ anti-bullying policies protect children on the basis of race, ethnicity, gender identity, disability and religious beliefs, “but very few mention body weight.” That lack is really shocking, she added, “because body weight is one of the most prevalent reasons that kids are bullied today.”

This spring, Stephanie went back to school to attend her graduation ceremony and receive her diploma. She still struggles with body image but is determined to put her negative experiences behind her and start fresh in college this fall, she says.

She plans to study psychology. “I want to understand people better, because I didn’t feel heard and there were a lot of things I didn’t speak about,” she said. “I just want to help people.”

Contact the editor of this story, Caroline Preston, at 212-870-8965 or preston@hechingerreport.org.

This story about childhood obesity awareness was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for the Hechinger newsletter.

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This story was produced by Grist and reprinted with permission.

Three years ago, Erin Primer had an idea for a new summer program for her school district: She wanted students to learn about where their food comes from.

Primer, who has worked in student nutrition within California’s public school system for 10 years, applied for grant funding from the state to kick off the curriculum, and got it. Students planted cilantro in a garden tower, met a local organic farmer who grows red lentils, and learned about corn.

“Many kids didn’t know that corn grew in a really tall plant,” said Primer. “They didn’t know that it had a husk.” 

The curriculum, focused on bringing the farm into the school, had an effect beyond the classroom: Primer found that, after learning about and planting ingredients that they then used to make simple meals like veggie burgers, students were excited to try new foods and flavors in the lunchroom. One crowd pleaser happened to be totally vegan: a red lentil dal served with coconut rice. 

“We have had students tell us that this is the best dish they’ve ever had in school food. To me, I was floored to hear this,” said Primer, who leads student nutrition for the San Luis Coastal district on California’s central coast, meaning she develops and ultimately decides on what goes on all school food menus. “It really builds respect into our food system. So not only are they more inclined to eat it, they’re also less inclined to waste it. They’re more inclined to eat all of it.”

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Primer’s summer program, which the district is now considering making a permanent part of the school calendar, was not intended to inspire students to embrace plant-based cooking. But that was one of the things that happened — and it’s happening in different forms across California. 

A recent report shows that the number of schools in California serving vegan meals has skyrocketed over the past five years. Although experts say this growth is partly a reflection of demand from students and parents, they also credit several California state programs that are helping school districts access more local produce and prepare fresh, plant-based meals on-site. 

Growing meat for human consumption takes a tremendous toll on both the climate and the environment; the U.N. Food and Agriculture Organization estimates that livestock production contributes 12 percent of global greenhouse gas emissions. Specifically, cattle and other ruminants are a huge source of methane. Animal agriculture is also extremely resource-intensive, using up tremendous amounts of water and land. Reducing the global demand for meat and dairy, especially in high-income countries, is an effective way to lower greenhouse gas emissions and mitigate the rate of global warming. 

The climate benefits of eating less meat are one reason that school districts across the country have introduced more vegetarian — and to a lesser degree, vegan — lunch options. In 2009, Baltimore City Public Schools removed meat from its school lunch menus on Mondays, part of the Meatless Mondays campaign. A decade later, New York City Public Schools, the nation’s largest school district, did the same. In recent years, vegan initiatives have built upon the success of Meatless Mondays, like Mayor Eric Adams’ “Plant-Powered Fridays” program in New York City. 

But California, the state that first put vegetarianism on the map in the early 20th century, has been leading the country on plant-based school lunch. “California is always ahead of the curve, and we’ve been eating plant-based or plant-forward for many years — this is not a new concept in our state,” said Primer. A recent report from the environmental nonprofit Friends of the Earth found that among California’s 25 largest school districts, more than half — 56 percent — of middle and high school menus now have daily vegan options, a significant jump compared to 36 percent in 2019. Meanwhile, the percentage of elementary districts offering weekly vegan options increased from 16 percent to 60 percent over the last five years. 

Related: How colleges can become ‘living labs’ for fighting climate change

Student nutrition directors like Primer say the foundation that allows schools to experiment with new recipes is California’s universal free lunch program. She notes that, when school lunch is free, students are more likely to actually try and enjoy it: “Free food plus good food equals a participation meal increase every time.”

Nora Stewart, the author of the Friends of the Earth report, says the recent increase in vegan school lunch options has also been in response to a growing demand for less meat and dairy in cafeterias from climate-conscious students. “We’re seeing a lot of interest from students and parents to have more plant-based [meals] as a way to really help curb greenhouse gas emissions,” she said. A majority of Gen Zers — 79 percent — say they would eat meatless at least once or twice a week, according to research conducted by Aramark, a company provides food services to school districts and universities, among other clients. And the food-service company that recently introduced an all-vegetarian menu in the San Francisco Unified School District credits students with having “led the way” in asking for less meat in their cafeterias. The menu includes four vegan options: an edamame teriyaki bowl, a bean burrito bowl, a taco bowl with a pea-based meat alternative, and marinara pasta.

Stewart theorizes that school nutrition directors are also increasingly aware of other benefits to serving vegan meals. “A lot of school districts are recognizing that they can integrate more culturally diverse options with more plant-based meals,” said Stewart. In the last five years, the nonprofit found, California school districts have added 41 new vegan dishes to their menus, including chana masala bowls, vegan tamales, and falafel wraps. Dairy-free meals also benefit lactose-intolerant students, who are more likely to be students of color.

Still, vegan meals are hardly the default in California cafeterias, and in many places, they’re unheard of. Out of the 25 largest school districts in the state, only three elementary districts offer daily vegan options, the same number as did in 2019. According to Friends of the Earth, a fourth of the California school districts they reviewed offer no plant-based meal options; in another fourth, the only vegan option for students is a peanut butter and jelly sandwich. “I was surprised to see that,” said Stewart. 

Related: ‘Education is the climate solution’

Making school lunches without animal products isn’t just a question of ingredients. It’s also a question of knowledge and resources — and the California legislature has created a number of programs in recent years that aim to get those tools to schools that need them. 

In 2022, the state put $600 million toward its Kitchen Infrastructure and Training Funds program, which offers funding to schools to upgrade their kitchen equipment and train staff. This kind of leveling up allows kitchen staff to better incorporate “scratch cooking” — essentially, preparing meals on-site from fresh ingredients — into their operations. (The standard in school lunch sometimes is jokingly referred to as “cooking with a box cutter,” as in heating up and serving premade meals that come delivered in a box.)

Another state program, the $100 million School Food Best Practices Funds, gives schools money to purchase more locally grown food. And the Farm to School incubator grant program has awarded about $86 million since 2021 to allow schools to develop programming focused on climate-smart or organic agriculture. 

Although only the School Food Best Practices program explicitly incentivizes schools to choose plant-based foods, Stewart credits all of them with helping schools increase their vegan options. Primer said the Farm to School program — which provided the funding to develop her school district’s farming curriculum in its first two years — has driven new recipe development and testing. 

All three state programs are set to run out of money by the end of the 2024-2025 school year. Nick Anicich is the program manager for Farm to School, which is run out of the state Office of Farm to Fork. (“That’s a real thing that exists in California,” he likes to say.) He says when state benefits expire, it’s up to schools to see how to further advance the things they’ve learned. “We’ll see how schools continue to innovate and implement these initiatives with their other resources,” said Anicich. Stewart says California has set “a powerful example” by bettering the quality and sustainability of its school lunch, “showing what’s possible nationwide.” 

One takeaway Primer has had from the program is to reframe food that’s better for the planet as an expansive experience, one with more flavor and more depth, rather than a restrictive one — one without meat. Both ideas can be true, but one seems to get more students excited. 

“That has been a really important focus for us. We want [to serve] food that is just so good, everybody wants to eat it,” Primer said. “Whether or not it has meat in it is almost secondary.”

This story was produced by Grist and reprinted with permission.

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With five children aged 11 to 24, Cyd Detiege has sent her kids to Palm Springs Unified School District in Southern California for nearly two decades.

“It’s gotten hotter,” she said, noting record-breaking temperatures in the desert city, which hit an all-time high of 124 degrees this July. The first day of school in Palm Springs this year was August 7, when temperatures reached 109 degrees. Since around 2019, Detiege says she’s contacted district officials, spoken at meetings, and posted on local Facebook pages with one goal: moving the first day of school to after Labor Day.

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Across the U.S., climate change is influencing discussions about how, and when, kids are educated. School districts, teachers, parents, students and experts are all considering how extreme heat is transforming education, and what changes need to happen for schools to adapt to extreme heat. In some places, this now includes reshaping what “back-to-school” means, as districts attempt to schedule the academic year around extreme heat.

America’s schools are vastly underprepared for extreme heat: An estimated 36,000 public schools don’t have adequate HVAC systems, and the combined costs of upgrading or installing necessary HVAC systems by 2025 is estimated at $4.4 billion nationally, according to the Center for American Progress, a left-leaning think tank. Even school districts with air conditioning may be exposing kids to excessive heat, allowing kids to play on hot outdoor blacktops without adequate shade for recess and lunchtime.

As districts work through the lengthy process of financing and planning these infrastructure upgrades, some hope that pushing back the first day of school could reduce school closures and other effects of extreme heat on students.

The impacts of heat on students’ health and learning is well-documented; studies have found that without air conditioning, every 1 degree Fahrenheit increase in temperature during a school year reduces the year’s learning by 1 percent. Unexpected school closures can leave parents scrambling for child care, and in some cases might send students to homes that are also hot and un-air conditioned.

Since the early 1970s, demand for cooling during the back-to-school season has increased by an average of 32 percent, according to an analysis of 231 locations by the nonprofit Climate Central.

“It’s not just that we get extreme weather. It’s that our summers are literally longer,” said Joellen Russell, Thomas R. Brown Distinguished Chair of Integrative Science at the University of Arizona and member of Science Moms, a nonpartisan group of climate scientists who are also moms.

Most school districts are left on their own to plot out their state-dictated minimum days of instruction onto a calendar, while planning for holiday breaks and end-of-year testing, and balancing input from parents, teachers and students.

In Palm Springs Unified School District, this calculation has landed students with a start date in the first week of August for the past several years, according to Joan Boiko, the district’s coordinator for communications and community outreach. This allows for a three-week winter break and a two-week spring break, and allows high schoolers to finish exams before winter break.

“While it is certainly warm here in the desert in August, it is typically just as hot in early September,” wrote Boiko in an email. Detiege, meanwhile, said she remains “very disappointed” in the calendar.

The neighboring Desert Sands Unified School District made a different decision. According to Jordan Aquino, assistant superintendent for business services at the district, planning for this school year included looking into what weeks are typically hottest. As a result, the district moved its first day back from the third to fourth week of August, pushing the last day of school further into June.

The two California desert districts have air conditioning, so students are primarily affected by heat on their way to and from school, at recess, during P.E. and at lunchtime. But in other regions of the country, districts are grappling with a need for air conditioning that didn’t exist when school buildings were first constructed. Nationwide, an estimated 41 percent of districts need to update or replace HVAC systems in at least half of their schools, according to a 2020 report from the U.S. Government Accountability Office. In recent years, the lack of adequate HVAC systems has led to school closures and early dismissals as classrooms become too hot for students. School district leaders hope that proactively planning the school year around extreme heat will reduce some of these unexpected closures.

Carrie A. Olson taught in classrooms without air conditioning for three decades in Denver Public Schools. When the weather got warm, she’d leave her classroom windows open overnight, allowing cool air to flow in. But this tactic is less effective with the climate change-driven rise in nighttime temperatures.

In 2020, Denver voters approved a bond measure that set aside funding to install air conditioning at 24 schools. “But it still wasn’t everybody, and that rollover from when the bond was passed to when everything would be implemented was time-consuming,” said Olson, who has a doctorate in curriculum and instruction and now serves as president of the Denver Public Schools Board of Education. Pushing back the first day of school by a week seemed like an interim solution, so the district did just that starting in the 2021-22 school year.

“At that time, it seemed like things were cooling off in mid- to late-August, and a week later would really help,” said Olson. A total of 29 schools are still without air conditioning in the district, and another bond measure is going before voters this fall.

Related: Teaching among the ashes: ‘It’s not just your home that’s burned, it’s everyone’s’

In Milwaukee, where only about one-fourth of public school classrooms have air conditioning, the district took a similar approach this year. Previously, Milwaukee’s high schools and most middle schools started in August and most elementary schools started in September. But when the district surveyed employees, parents and students about the academic calendar last year, the biggest concern was air conditioning.

Moving all students to a September start date “would put the district in the best position to avoid excessive heat days during the upcoming school year,” said Milwaukee Public Schools Chief Human Resources Officer Adria Maddaleni during a December 2023 meeting. The change seems to have staved off some unexpected cancellations for the district, at least this school year: Heat indexes rose above 100 degrees in Milwaukee during the last week of August, forcing some private schools that were already in session to cancel classes.

“The reality is that it’s an okay solution, but it’s not perfect, because there are many school districts where you could get 100-degree days in November,” said V. Kelly Turner, associate director of the Luskin Center for Innovation at the University of California, Los Angeles, who also leads the new Center of Excellence for Heat Resilient Communities. “But the other thing is that the heat season isn’t just shifting, it’s getting longer.”

That brings up questions of how adjusting school calendars might affect summer break and students who don’t have air conditioning at home, said Turner. For example, for a student without air conditioning at home, spending a longer portion of the hottest days of summer at home would just mean staying in a hot home or apartment.

In Philadelphia, heat also came up as one of the biggest topics of discussion when the district planned the 2023-24 and 2024-25 calendars, with survey responses from parents, students, teachers and others showing a preference for a post-Labor Day start date. “Beginning school after Labor Day avoids possible school closures due to excessive heat,” according to a document prepared for a February 2023 school board meeting. The board voted that month to start 2023-24 after Labor Day, but to begin the 2024-25 school year in August due to scheduling limitations. The district now aims to start after Labor Day “whenever possible,” while also working to expand cooling systems, according to the board meeting document. 

The School District of Philadelphia has made gains in cooling its aging buildings, including through a donation from Philadelphia Eagles quarterback Jalen Hurts that added air conditioning units to 10 schools this year. But 63 schools still lack adequate cooling and close early when weather is expected to reach 85 degrees by noon, according to Monique Braxton, deputy chief of communications for the district.

Philadelphia dismissed schools early in 2023 and 2024 due to heat during the first week of school. Last year, 73 schools received early dismissal during the entire first week of school after Labor Day, and this year, the 63 remaining schools without adequate cooling dismissed early on Aug. 27 and Aug. 28.

Related: Canceled classes, sweltering classrooms: How extreme heat impairs learning

Experts on heat and schools say scheduling academic calendars around extreme heat comes with limitations. In much of the country, August typically experiences hotter days than June, but pushing back the first day of school still risks pushing the school year further into June, which also experiences temperatures high enough to cancel school. And with temperatures projected to keep getting higher on both ends of the academic calendar, relying on scheduling alone to address extreme heat would be a constant shuffle.

“I think that the degree that you would need to push back the school year will become greater and greater every year, unless we figure out how to adapt the structures that kids are learning in, and make the investments in updating this older infrastructure, because temperatures will continue to increase,” said Lindsey Burghardt, chief science officer at the Center on the Developing Child at Harvard University.

The University of Arizona’s Russell called the strategy a “temporary stopgap” to extreme heat.

Federal money is available now for HVAC upgrades; the Inflation Reduction Act included a provision that will reimburse schools that install heat pumps and other clean energy technologies, according to Jonathan Klein, co-founder and CEO of Undauntedk12, an organization focused on supporting schools’ transition to clean energy. Some districts also used federal Covid-relief aid to improve HVAC systems, according to Liz Cohen, policy director at FutureEd, although she said it’s hard to know for sure how many districts used the funds for those upgrades due to different reporting requirements in each state.

In Denver, Olson said the board hasn’t considered pushing the start date back even further into August or September.

“Just thinking about the shift in our climate across our planet, shifting the calendar isn’t going to be as helpful as it was three years ago when we passed this,” said Olson. “The solution is going to be to get more heat mitigation strategies and air conditioning in our schools with an eye toward sustainability.”

This story about excessive heat in schools was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for Hechinger’s climate change and education newsletter.

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MINNEAPOLIS — At a late August meeting in a windowless room at Minneapolis College, a handful of students barely a week into classes sat back on couches, took a breath and marveled that they were there at all.

“Gifting myself with an education is a part of my recovery,” said Nomi Badboy, 43, one of three students attending this week’s meeting of the school’s collegiate recovery program. But she admitted to feeling overwhelmed: Her four kids were trying her nerves, her ailing father was requiring more of her time, and a bad-news ex had left her with a destructive puppy and a lingering disbelief that she can pull it all off.

Ray Lombardi, 50, listened thoughtfully. “What I’m hearing is that we have three things in common: It’s hard to be a parent. It’s hard to stay sober. And it’s hard to go back to school as an adult,” he said, adding, “It would be a great tragedy to get sober, get my life in order, and then come here and have college be the cause of going back into using.”

Collegiate recovery programs began appearing at four-year institutions in the late 1970s, offering services like sober-living dorms, life skills classes and recovery coaches. Today, more than 170 programs exist across the U.S. and Canada. But it’s only in the last dozen or so years that programs began popping up at community colleges; Minneapolis College’s program, opened in 2017, was the first in Minnesota and the fifth in the nation.

Today, there are at least 23 recovery programs at community colleges, and their expansion reflects a growing awareness that many survivors of opioid addiction and those who struggled with substance use during the pandemic are now enrolling in pursuit of a fresh start. But despite the need, the programs face significant obstacles, and many are scrambling for dollars and staffing to stay afloat.

Related: More than a third of community colleges have vanished

Substance use disorder affects about 18 percent of American adults, according to national statistics. Among 18- to 25-year-olds, the share is nearly 28 percent. Meanwhile, of the 29 million adults nationwide who said they’ve ever had a problem with substance use, about 72 percent considered themselves to be in recovery or recovered.

Unlike treatment, a necessary but often short-term process, recovery is the long-term work of rebuilding a healthier and typically sober life. Education is an example of what’s called “recovery capital,” something earned that makes long-term recovery more likely.

Community colleges are a natural first step for people in recovery, said Jessica Miller, who oversees four collegiate recovery programs, including two at community colleges, for the Ten16 Recovery Network, a substance use disorder treatment provider in Central Michigan. At two-year institutions, admission is accessible, tuition is affordable, and flexible coursework fits into schedules complicated not only by jobs and families, but counseling, support groups and doctor visits.

“I don’t know why we weren’t trying to do this years ago,” Miller said.

In November, the Association of Recovery in Higher Education, which serves as a hub for the programs, launched a working group tasked in part with editing the guidelines for starting recovery programs to make them more applicable to community colleges. A new networking group for community college program coordinators held its first call in February.

Advocates say the growing number of recovery programs makes sense not just for individuals but for community colleges looking to recoup lost students. Since 2010, enrollment at two-year institutions has declined by nearly 40 percent, as more people have opted to remain in the workforce or head directly to four-year colleges, among other factors.

The downturn has pushed community colleges to broaden their approach to recruitment, resulting in an increase in the number of students requiring more support and services, said Taylor Odle, an assistant professor of education policy studies at the University of Wisconsin-Madison. The schools are pursuing their goals of serving more students, but the additional supports bring higher costs. “The price tag is not the same,” he said.

Schools investing in recovery programs do so without an abundance of research connecting the programs to improved student outcomes. But the data that exists is encouraging, said Noel Vest, an assistant professor of community health sciences at Boston University. A 2014 paper reviewing the impact of recovery programs, mostly at four-year colleges, found lower incidences of relapse for involved students and slightly higher GPAs and graduation rates compared to their peers overall.

Vest plans to complete a study this summer of five recovery programs, including Minneapolis College’s. He expects the findings to illuminate best practices for the programs and provide an evidence-based foundation for starting more of them. “Right now,” he said, “the data that says we must be doing this just isn’t out there.”

In the interim, advocates for the programs are using creative approaches to keep them alive and growing. At Tompkins Cortland Community College near Ithaca, New York, program leaders have forged connections with student groups on campus whose struggles with substance use might fly under the radar, such as student athletes.

In Central Michigan, the Ten16 Recovery Network is helping its clients enroll in colleges with recovery supports by providing pre-enrollment services at its out-patient treatment facilities. A client might meet with the collegiate recovery program coordinator, for example, to receive counseling about which career paths might be a good fit and which ones might present obstacles due to the client’s history with addiction and the legal system.

At Skagit Valley College, a two-year institution north of Seattle, Aaron Kirk runs the recovery program for formerly incarcerated students jointly with the school’s Breaking Free Club. (About 60 percent of people who are incarcerated struggle with substance use disorder, according to the Substance Abuse and Mental Health Services Administration.) In his role, Kirk has built a relationship with the local drug court, which offers alternative sentences to eligible individuals who commit to treatment for substance use. Typically, the sentences include a work or education component, making Skagit Valley a natural fit.

Related: Training people recovering from substance abuse disorders to be part of treatment teams

Genevieve Ward, 42, enrolled at Skagit Valley in the summer of 2021 after spending time in prison on a drug conviction. While taking coursework in human services, she used money earmarked for students in the recovery program to earn certification as a peer recovery coach. She uses the skills daily as a leader in the recovery housing where she lives near campus.

“In school, the number one struggle is that most of us don’t feel like we’re smart enough. That’s what I see the most, and what I feel the most,” she said. She credits the Breaking Free club with creating the community she and her peers need to beat back their insecurities and succeed in the classroom.

In the years leading up to her incarceration, Ward said she was living each day simply to survive. “But this college, this club, has given me hope for the future — I know that there is one.” After graduating this spring, she plans to transfer to nearby Western Washington University, where talks are underway to expand recovery supports thanks in part to advocacy from students in the Breaking Free club. Ultimately, Ward hopes to land in a career that helps people with struggles like the ones she’s faced.

For many students like Ward, community colleges’ flexible academic offerings make college possible. But the same flexibility creates obstacles to the success of on-campus groups. Options like part-time course loads, online classes, and short certificate programs can stymie consistent attendance and participation. Even for full-time students, the two-year window creates frequent turnover. “A lot of our work is student-led,” said Kirk at Skagit Valley. “It’s challenging to have these awesome leaders who graduate so quickly.”

It’s also hard to engage students in recovery programs when they don’t have the time to linger on campus. “These students are flying home from work, making dinner, getting their kids settled, then racing to get over here on time for class,” said Cheryl Kramer, recovery program advisor at Cape Cod Community College, in Massachusetts.

But the toughest scrambles are often for staff and funding. Jonathan Lofgren, a professor of addiction counseling at Minneapolis College, launched the college’s program in 2017 after a sabbatical year studying recovery on college campuses. School leaders provided a dedicated space for the program and allowed Lofgren a half day per week to manage it, but they stopped short of hiring a dedicated coordinator.

During the pandemic, the program moved online and participation dropped. Welcome news arrived in 2021, though, when the school won a state grant in collaboration with a nearby four-year university, providing funding for two paid interns, a peer recovery coach, and a coordinator, Lisa Schmid.

But amid a nationwide shortage of staff in the treatment and recovery field, the peer coach and one intern position remain vacant. In November, Schmid took extended personal leave, which left her role unfilled as well. While she was out, two student workers ensured the recovery program room stayed open, emails went out and weekly meetings happened. But broader goals, like increasing awareness of recovery support services on campus, lost steam.

When Schmid returned from leave in February, she prioritized spreading word of the program to likely partners, such as the college’s veteran services program and its admissions team. In March, Minneapolis College leaders reached an agreement with the campus health clinic to continue funding her position once the state grant runs out.

“The need is everywhere,” Schmid said. Recovery “has always been such a hush-hush thing. How do we normalize it?”

Related: ‘Waste of time’: Community college transfers derail students

Advocates hope that a percentage of the hundreds of millions of dollars in state opioid settlement funding can be earmarked for collegiate recovery, and that Congress might one day approve additional funding. President Biden’s stalled 2024 budget includes $10.8 billion for SAMHSA, of which 10 percent would be set aside for recovery support services.

In a handful of states, legislation has made for a rosier funding picture. Washington lawmakers passed a bill in 2019 that led to the creation of a state grant fund to support recovery. From that work grew the Washington State Collegiate Recovery Support Initiative, which has provided funding for eight colleges, including four community colleges, to open recovery programs or provide recovery services in pre-existing programs, like Skagit Valley’s Breaking Free club.

Patricia Maarhuis of Washington State University said that, ultimately, collegiate recovery supports are about propelling academic success. “People might say this is just another student group, but no. This is not the frosting; this is the cake. If you want your students to stay in school and do well, you need recovery supports.”

Back in Minneapolis, Badboy has found a new home for the destructive puppy and her kids are settled in good schools and daycares. She’s thriving in her classes and expects to graduate in 2025. The balancing act of family, school and recovery, for now, is stable.

Recovery is painstakingly hard, Badboy said. But her journey — more than 12 years sober after nine bouts of treatment — has created a firm structure in her life that supports college success as much as it supports her well-being. Her peers in the program understand that in a way few others can, she said, and she feels accountable to them.

“It’s made it so that I really want to do this — almost that I must do this, I have to do this,” she said. “Because other people like me, who’ve felt the same way about themselves, need to see that this is possible.”

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Students at Bessemer Elementary School don’t have to go far to see a doctor. If they’re feeling sick, they can walk in to the school’s health clinic, log on to a computer, and connect with a pediatrician or a family medicine provider. After the doctor prescribes treatment, students can in many cases go straight back to class – instead of having to go home.

The telemedicine program was launched in fall 2021 by Guilford County Public Schools, North Carolina’s third largest school district, as a way to combat chronic absenteeism. The number of students missing 10 or more days of school soared in the district – and nationally – during the pandemic, and remains high in many places.

Piloted at Bessemer, the program has gradually expanded to 15 of the district’s Title I schools, high-poverty schools where families may lack access to health care. Along with other efforts aimed at stemming chronic absenteeism, the telemedicine program is helping, said Superintendent Whitney Oakley. The chronic absenteeism rate at Bessemer fell from 49 percent in 2021-2022 to 37 percent last school year, an improvement though still higher than the district would like.   

“It really doesn’t matter how great a teacher is or how strong instruction is, if kids aren’t in school, we can’t do our job,” she said.

Oakley said district administrators focused on health care access because they were seeing parents pull all their children out of school if one was sick and had to visit the doctor. Rates of chronic absenteeism were also higher in areas where families historically lacked access to routine medical care and had to turn to the emergency room for non-emergency health care needs.

The telemedicine clinic is also a way to relieve the burden on working parents, Oakley said: Many parents in the district’s Title I schools work hourly wage jobs and rely on public transportation, making it difficult to pick up a sick child at school quickly.

Hedy Chang, executive director of Attendance Works, a nonprofit that combats chronic absenteeism, said that early research indicates that telehealth can improve attendance. According to one study of three rural districts in North Carolina that was released in January, school-based telemedicine clinics reduced the likelihood that a student was absent by 29 percent, and the number of days absent by 10 percent.

Some districts are also turning to virtual teletherapy services to fight chronic absenteeism. Stephanie Taylor, a former school psychologist who is now vice president of clinical innovation at teletherapy provider Presence, says the company’s work has expanded from 1,600 schools to more than 4,000 in recent years as the need for mental health services grows. Therapy can help kids cope with emotional issues that might keep them from attending school, she said, and virtual services give students more choice of counselors and a greater chance of finding someone with whom they mesh.  

At Guilford County Public Schools, the district plans to expand its existing mental health services to eventually include teletherapy, according to Bessemer Elementary Principal Johnathan Brooks. The district is also planning to roll out its telemedicine clinics to all of 50 of its Title I schools, said Oakley.

The clinic is staffed by a school nurse who helps the physician remotely examine the student and ensures that prescriptions are quickly filled. The program is funded through a partnership between the district, local government and healthcare providers and nonprofits, which allows for uninsured families to still access treatment and medicine, Brooks said.

The biggest challenge in launching the clinic was getting parents’ buy-in, he said. The district held meetings with parents, particularly with those who don’t speak English as a first language, to communicate how it would help their kids. To access the program, parents must opt in at the beginning of the school year.

Of the 300 students who received care at Bessemer’s clinic last year, 240 returned to class the same day, said Oakley. Without the program, she said, “all 300 would have just been sent home sick.”

She added: “School is often a trusted place within the community and so it helps to bridge some of those gaps with medical providers. It puts the resources where they already are.”

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South Carolina’s sweltering summer months are often the busiest time of year for the Lowcountry Food Bank, an organization that gives meals to children year-round. When school lets out in June, the group opens nearly two dozen U.S Department of Agriculture-funded feeding sites in Myrtle Beach, Charleston, Yemassee and other coastal communities where low-income families can bring their children for a meal during the day.

Last summer, the food bank provided more than 18,000 meals to families. But there are far more children in need than the sites can reach, said Misty Brady, the community meals coordinator at the Lowcountry Food Bank.

“There’s definitely a need out there, and the struggle is finding the gaps,” Brady said. “Because there’s families that aren’t getting those meals because transportation is a huge barrier.”

States had the opportunity this summer to participate in a program this year intended to fill those holes. The Summer Electronic Benefit Transfer Program — Summer EBT for short — will give eligible low-income families an additional $40 per month, or $120 per child, to pay for groceries. The summertime program is a modification of a pandemic-related emergency food benefit and is intended to make getting food easier for families who cannot get to a feeding center.

But South Carolina is one of 15 states that missed the January 1 deadline to opt in for this year. The state also has one of the highest rates of food insecurity in the nation; 15 percent of residents reported they were uncertain they could meet the food needs of all their household members at some point during the year, compared to 11 percent nationwide.

During a press conference in January, South Carolina Gov. Henry McMaster said the state decided not to participate in Summer EBT because officials are trying to move past pandemic aid.

“That was a COVID-related benefit. We’ve got to get back to doing normal business. We just can’t continue that forever, but we’re still continuing all the other programs that we have,” McMaster told reporters. Some leaders in other states couched their opposition to the program in political terms — Gov. Tate Reeves of Mississippi said that the program is an expansion of “the welfare state”—while others said they didn’t have the staffing or money.

But other summer meals programs in South Carolina are struggling to keep up with demand. The state’s biggest program is run by the USDA and relies on sponsors, like the Lowcountry Food Bank, to distribute the food. But each year since 2019, fewer sponsors have signed up to participate, going from 78 in 2019 to 45 in 2023, according to the South Carolina Department of Education.

A little more than a week after the Summer EBT deadline had passed, the South Carolina Department of Education sent out a request asking for more volunteers.

“Our 2024 goal is to increase the number of meal sites to allow more children access to nutritious meals this summer,” said Virgie Chambers, SCDE’s deputy superintendent of district operations, safety and student wellness, in a statement. “To do that, we are currently searching for more community partners, especially in rural and low-income areas.”

But there are other barriers to the program as well: Transportation is a common problem for families trying to access the meals, and since the sites are open during the morning and early afternoon, parents who work during those hours are unable to make the trip.

South Carolina participates in another, similar USDA program that allows some schools to continue providing meals for students who receive free and reduced-price lunch during the summer months, but the barriers for families remain the same – they must find a way to the school building during the day to get the meals.

“The summer meals programs really only reach a portion of students who are eligible,” said Kelsey Boone, a senior child nutrition policy analyst at the Food Research and Action Center. “So the Summer EBT program really comes in to fill the gaps that are left by those traditional summer meals programs.”

For both programs, families typically have to eat on-site, with the exception of rural areas, which were given the option last year of letting families take several meals home at a time.

Lisa Davis, senior vice president of Share Our Strength and its No Kid Hungry Campaign, is hopeful more states will opt in to the program next year because of barriers that made it harder for states this time around: The USDA did not release its rules and guidelines for Summer EBT until a few days before the deadline to opt in. And, although the federal government is covering the cost of the program’s benefits for families, states now have to pay for 50 percent of the administrative cost to run the program.

“I’m actually reassured as we’re talking to states. We’re not hearing a lot of, ‘We don’t want to do this, ever.’ We are hearing a lot of, ‘We’re not quite sure how we’re going to do this, we don’t have all of the pieces together,’” Davis said.

It’s too late for South Carolina to participate this year, but Brady, with the Lowcountry Food Bank, would like the state to consider joining the program next summer.

“That is my hope, that they see that the need is there, and the tremendous positive effect it will have on families,” Brady said.

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Much attention in the post-pandemic era has been on what students have lost – days of school, psychological health, knowledge and skills. But now we have evidence that they may also have gained something: schools that address more of their needs. A majority of public schools have begun providing services that are far afield from traditional academics, including healthcare, housing assistance, childcare and food aid. 

In a Department of Education survey released in October 2023 of more than 1,300 public schools, 60 percent said they were partnering with community organizations to provide non-educational services. That’s up from 45 percent a year earlier in 2022, the first time the department surveyed schools about their involvement in these services. They include access to medical, dental, and mental health providers as well as social workers. Adult education is also often part of the package; the extras are not just for kids. 

“It is a shift,” said Marguerite Roza, director of the Edunomics Lab at Georgetown University, where she tracks school spending. “We’ve seen partnering with the YMCA and with health groups for medical services and psychological evaluations.”

Deeper involvement in the community started as an emergency response to the coronavirus pandemic. As schools shuttered their classrooms, many became hubs where families obtained food or internet access. Months later, many schools opened their doors to become vaccine centers. 

New community alliances were further fueled by more than $200 billion in federal pandemic recovery funds that have flowed to schools. “Schools have a lot of money now and they’re trying to spend it down,” said Roza. Federal regulations encourage schools to spend recovery funds on nonprofit community services, and unspent funds will eventually be forfeited.

The term “community school” generally refers to schools that provide a cluster of wraparound services under one roof. The hope is that students living in poverty will learn more if their basic needs are met. Schools that provide only one or two services are likely among the 60 percent of schools that said they were using a community school or wraparound services model, but they aren’t necessarily full-fledged community schools, Department of Education officials said.

The wording of the question on the federal School Pulse Panel survey administered in August 2023 allowed for a broad interpretation of what it means to be a community school. The question posed to a sample of schools across all 50 states was this: “Does your school use a “community school” or “wraparound services” model? A community school or wraparound services model is when a school partners with other government agencies and/or local nonprofits to support and engage with the local community (e.g., providing mental and physical health care, nutrition, housing assistance, etc.).” 

The most common service provided was mental health (66 percent of schools) followed by food assistance (55 percent). Less common were medical clinics and adult education, but many more schools said they were providing these services than in the past.

The number of full-fledged community schools is also believed to be growing, according to education officials and researchers. Federal funding for community schools tripled during the pandemic to $75 million in 2021-22 from $25 million in 2019-20. According to the  education department, the federal community schools program now serves more than 700,000 students in about 250 school districts, but there are additional state and private funding sources too. 

Whether it’s a good idea for most schools to expand their mission and adopt aspects of the community school model depends on one’s view of the purpose of school. Some argue that schools are taking on too many functions and should not attempt to create outposts for outside services. Others argue that strong community engagement is an important aspect of education and can improve daily attendance and learning. Research studies conducted before the pandemic have found that academic benefits from full-fledged community schools can take several years to materialize. It’s a big investment without an instant payoff.

Meanwhile, it’s unclear whether schools will continue to embrace their expanded mission after federal pandemic funds expire in March 2026. That’s when the last payments to contractors and outside organizations for services rendered can be made. Contracts must be signed by September 2024.

Edunomics’s Roza thinks many of these community services will be the first to go as schools face future budget cuts. But she also predicts that some will endure as schools raise money from state governments and philanthropies to continue popular programs.

If that happens, it will be an example of another unexpected consequence of the pandemic. Even as pundits decry how the pandemic has eroded support for public education, it may have profoundly transformed the role of schools and made them even more vital.

This story about wraparound services was written by Jill Barshay and produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for the Hechinger newsletter.

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SIOUX FALLS, S.D. — The journey to Boston was more than 1,500 miles. The plane ticket cost about $500. The hotel: another $400. She felt a little guilty about going, knowing that not everyone could afford this trip. But it was important; she was headed there to learn. 

So, Amrita Bhagia, a second-year medical student from Sioux Falls, South Dakota, caught that flight to Boston to attend a weekend workshop hosted by the American College of Obstetricians and Gynecologists. There, she joined medical students from around the country for a summit on abortion care. She learned about medication abortion, practiced the technique of vacuum aspiration using papayas as a stand-in for a uterus, and sat in on a workshop about physician’s rights. 

“It was the most empowering thing I could have imagined, especially coming from a state where people don’t want to talk about this stuff, ever,” said Bhagia, an aspiring OB-GYN at the University of South Dakota, a state where abortion is banned. “Other than me flying to Boston to go to an ACOG workshop, I have no idea how to get that training.” 

Even before Roe v. Wade was overturned last summer, access to abortion training was uneven. Medical schools are not required to offer instruction on it, and students’ experiences vary wildly based on their institution. 

But for Bhagia and med students like her in states where abortion has been banned or severely restricted, those training opportunities have gone from not great to nonexistent.

As a result of this insufficient gynecological training, experts warn, a generation of doctors will be ill-equipped to meet their patients’ needs. And across the country, maternal-care deserts will likely expand, as graduating medical students and residents avoid abortion-restricted states.

More than 30,000 medical students are training in states with abortion bans. Another 1,400 OB-GYN residents, who are required to receive abortion training as part of their specialty, are studying in states where abortion is banned or severely restricted. 

“There’s a concern that in states with these restrictions, students are simply not getting enough training and exposure,” said Jody Steinauer, an OB-GYN, medical educator and director of the Bixby Center for Global Reproductive Health at the University of California, San Francisco. “There’s really a worry that if this continues, you’re going to be training a large group of OB-GYNs who can’t provide patient-centered, evidence-based care, no matter where they practice.”

“I would love to stay in Texas and train. This is a fantastic institution and I want to serve this community. But if I can’t get the training I need, I will have to leave.”

Chelsea Romero, a third-year medical student at McGovern Medical School in Houston, Texas

A related concern: Fewer medical students will choose to become OB-GYNs at all, fearing lawsuits or criminal prosecution. Figures show that OB-GYN residency applications are down across the country, but programs in states with abortion bans saw the biggest drops. Application rates for family medicine programs experienced a similar decline.

Abortion is currently banned in 14 states. All offer a narrow exception to this blanket prohibition when the mother’s life is at risk and a few of these states allow abortions in cases of rape or incest. But doctors say guidance on maternal health exceptions remains unclear, leaving physicians vulnerable to potential prosecution when treating patients.

“Students are seeing us struggle with this stuff and they’re like, ‘Yeah, why would I stay here for this?’” said Amy Kelley, a Sioux Falls OB-GYN and clinical associate professor at the University of South Dakota, a state where doctors can face up to two years in prison for violating the state’s ban.

These developments are particularly worrisome in South Dakota and other rural states that are already struggling to recruit and retain maternal healthcare providers. More than half of the state’s counties have no OB-GYNs, and rural South Dakotans with high-risk pregnancies often have no choice but travel to Sioux Falls for specialty care.

Limited access to maternal health care is reflected in troubling maternal mortality rates in abortion-restricted states across the country, where mothers are three times as likely to die due to their pregnancy, according to recent research. Barriers to abortion training could amplify physician shortages, increasing the number of maternal-care deserts and posing even greater risk to maternal health.

“We already have a physician shortage in this country,” said Pamela Merritt, a reproductive rights activist and director of Medical Students for Choice. “And we have the maternal health outcomes that come with that shortage. We have the worst pregnancy outcomes in the developed world. The last thing I want to see is people either having an insufficient education yet providing care, or people not even thinking of OB-GYN as a specialty in certain states.”

Although medical schools’ curricula vary, the Accreditation Council for Graduate Medical Education requires OB-GYN residency programs to provide access to abortion training. Residents with moral or religious objections are allowed to opt out. It’s a key component of an OB-GYN’s training, even for doctors who have no plans of becoming abortion providers.

An OB-GYN must be able to evacuate a uterus — whether the skill is used to care for a patient who’s had an incomplete miscarriage, to remove polyps for cancer diagnosis or assist someone who wants to terminate an unwanted pregnancy — and doctors-in-training can develop this ability through clinical abortion training. 

“Such training is directly relevant to preserving the life and health of the pregnant patient in some instances,” ACGME program requirements state.

Yet in states with abortion bans, direct access to that training has vanished. In the past year, program directors in those states have scrambled to find out-of-state training opportunities so their residents can fulfill OB-GYN program accreditation requirements. But identifying and coordinating those training opportunities is no small feat.

“A lot of programs are grappling with the logistics piece of partnering with another institution to send a resident somewhere else,” said Alyssa Colwill, an assistant professor of obstetrics and gynecology at Oregon Health & Science University, who directs the university’s OB-GYN Ryan Residency program. OHSU plans to host a dozen out-of-state learners for four- to six-week clinical rotations during this academic year. 

Programs like these require significant behind-the-scenes orchestration and space is limited. Visiting learners must apply for a medical license in their new state, complete required hospital training, take out new malpractice insurance, and secure housing and transportation.

More than half of South Dakota’s counties have no OB-GYNs; rural South Dakotans with high-risk pregnancies often have no choice but travel to Sioux Falls for specialty care.

In addition, programs in abortion-restricted states must often cope with the loss of a team member while residents travel for training.

“Programs really need their residents for services they provide,” said Colwill. “It’s not the easiest ask, to have a resident be gone from all clinical duties at their site for a month at a time.”

And while the overturn of Roe has had the most profound impact on residency programs, medical students who are not yet in a residency say they’re also feeling its effects. Doctors-in-training spend four years in medical school before beginning a residency in their chosen specialty.

“Bringing abortion up feels like a violation because it’s so taboo now,” said Bhagia. “I don’t know if I can even ask questions, and that’s impeding my learning.”

Chelsea Romero, a third-year medical student at McGovern Medical School in Houston, Texas, where abortion is restricted, said she has never faced repercussions for discussing abortion, but the risk of consequences is always on her mind. 

“As a student, you’re being evaluated constantly, and these evaluations can dictate if you get residency interviews or not,” said Romero, who stressed she spoke only for herself and not as a representative of her university. “If I have those conversations with a wrong person in power, I could face blowback.” 

One year after Roe was overturned, this stifled learning environment appears to be having an influence on where medical students are applying to residencies. One recent survey of medical students found that 58 percent of those responding were unlikely to apply to a residency program in a state with abortion restrictions, regardless of their specialty. 

“I would love to stay in Texas and train. This is a fantastic institution and I want to serve this community,” said Romero. “But if I can’t get the training I need, I will have to leave.”

“Where you train is where you stay. It is rare that a resident will train in California and then move to rural South Dakota; it just doesn’t happen.”

Yalda Jabbarpour, a family physician and director of the Robert Graham Center, the American Academy of Family Physicians’ policy and research center

Decisions like hers will have ripple effects for the physician workforce in the coming years, said Yalda Jabbarpour, a family physician and director of the Robert Graham Center, the American Academy of Family Physicians’ policy and research center. “Where you train is where you stay,” she said. “It is rare that a resident will train in California and then move to rural South Dakota; it just doesn’t happen.”

That’s exactly what worries Erica Schipper, an OB-GYN in Sioux Falls.

South Dakota is one of only six states in the country without an OB-GYN residency program, which means medical students who want to become OB-GYNs must leave the state to receive their training. Schipper, who also teaches medical students at the USD Sanford School of Medicine, said the state’s abortion ban will make recruitment even harder. 

“When I look at some of the brightest, up-and-coming medical students who we’ve sent away for their residency, we’re hoping they’ll come back, but I suspect they’re thinking twice,” said Schipper. 

One of those students is Morgan Schriever, a Sioux Falls native and a graduate of USD’s Sanford School of Medicine. Schriever is a second-year OB-GYN resident at Southern Illinois University who said she always planned to return to her home state. But after training in Illinois, where abortion is protected, she’s having second thoughts. 

Schriever is not only concerned that she would be unable to provide elective abortions in her home state. She’s also worried that South Dakota’s restrictive law would impede her ability to provide medically necessary abortions when treating patients experiencing pregnancy loss.

“Being in practice in Illinois, I come across these scenarios where I picture myself in South Dakota and I’m like, ‘Oh my God. How would I have handled this?’ I’m just not sure I want to put myself in that position where essentially my license is on the line.”

“There’s really a worry that if this continues, you’re going to be training a large group of OB-GYNs who can’t provide patient-centered, evidence-based care, no matter where they practice.”

Jody Steinhauer, director of the Bixby Center for Global Reproductive Health

These latest recruitment challenges particularly affect states already grappling with an OB-GYN shortage and struggling to improve maternal health care.

“Abortion-restrictive states are the same states that are traditionally rural and have a really hard time attracting physicians,” said Jabbarpour, “so any decline in those states is troublesome.”

Heather Spies, an OB-GYN who trains family medicine and general surgeon residents at Sanford Health, a hospital system in Sioux Falls, said the Sanford system is ensuring its residents are trained in basic obstetrics and gynecology care, including labor and delivery and miscarriage care. Even with the state’s abortion ban in place, she said, doctors at Sanford are able to provide miscarriage care and treat most pregnancy complications. 

“I don’t think those learning experiences have changed because the procedures that we do at Sanford haven’t changed,” said Spies. 

Still, there are some healthcare needs that require specialty care, certain medical emergencies that demand the expertise of an OB-GYN. And as abortion bans undermine training and push OB-GYNs out of restricted states, public health experts say they’re worried maternal-care deserts across the country will grow even drier.

“In the dead of a South Dakota winter blizzard, if you can’t get that helicopter to where it needs to go and that mom and that baby are in danger, you’re much more likely to save those lives if you have a doctor nearby,” said Schipper.

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There’s little consensus over the best way to teach children and teens about sexuality in this country and research provides scant guidance. Educational programs that directly target sexual behaviors and attitudes frequently fail to show reductions in unwanted pregnancies or sexually transmitted infections. 

The political debate over sex ed, meanwhile, is taking place against a perplexing public health backdrop. The teen pregnancy rate has plummeted over the past 30 years, while epidemics of sexually transmitted infections among younger Americans are showing no signs of slowing. The reasons for these divergent trends are unclear.

State data, by contrast, can sometimes look deceptively stark and clear. Consider Arkansas and Massachusetts. Arkansas, which requires abstinence to be emphasized in sex ed classes, has the highest rate of teen pregnancies in the country (30 out of 1,000 females ages 15 to 19). Massachusetts requires that sex ed be culturally appropriate and unbiased, without a mandated focus on abstinence. Its teen pregnancy rate is the lowest in the country (7 out of 1,000 female teens). 

It’s tempting to connect those dots and conclude that abstinence education increases teen pregnancies and a broad approach, including explanations of birth control, reduces them. But the demographic differences between Arkansas and Massachusetts are so great that the correlation between sex ed and unwanted teenage pregnancies could be spurious. Yet many sex ed advocates use this kind of correlational data to make their arguments.

To settle the matter, one would need to introduce a Massachusetts-style sex ed program in Arkansas and track pregnancy rates or launch an Arkansas-style abstinence program in a Massachusetts town, and see if pregnancy rates go up. No one has done either of these experiments. 

And that’s the crux of the problem. There have been so few well-designed studies that tell us if sex ed is helping, making things worse or doing nothing at all. Researchers would have to randomly assign preteens or teens to a sex ed class and then figure out how to monitor subsequent unwanted pregnancies and sexually transmitted infections. Students don’t always disclose the truth about sex on surveys.

“It’s really challenging to do an evaluation of sex ed curriculum,” said Carolyn Tucker Halpern, chair of the department of maternal and child health at the Gillings School of Global Public Health of the University of North Carolina at Chapel Hill.  “Short of rummaging around in trash cans and looking for used condoms and stuff, it’s hard to get an objective measure.”

The most recent attempt to compile and summarize the best evidence for sex education was published in 2023 by a team of public health researchers from Dartmouth College. They aggregated the results of 29 randomized controlled trials (RCTs) in the United States between 1990 and 2021. Fewer than half of the studies of sex ed programs took place in schools. Nine of them emphasized abstinence, which means waiting until marriage to have sex. Just one study directly compared teaching abstinence only with a comprehensive approach. (It did not find any difference in frequency of condom use, its main outcome measure.)

Comprehensive sex education is a catchall term that includes everything that isn’t abstinence only – from birth control use and sexual consent to the reproductive system and sexually transmitted infections. Comprehensive programs may also include or even emphasize abstinence along with these other topics. Because the content of these classes varies, it’s hard to generalize about comprehensive sex or its effectiveness. (For more on current approaches to sex education, read this Hechinger Report story.)

Only seven studies in the Dartmouth meta-analysis attempted to track pregnancies, and of those, just three asked participants whether they or their partner had gotten pregnant a year or more later. 

The overall finding was ambiguous. Three comprehensive programs showed a moderate reduction in teenage pregnancies although the effect was not statistically significant. This means that there are too few studies for researchers to be confident; the results could be flukes and more studies are needed to confirm. (The largest of the three studies, by far, involved young men who were living in group homes operated by child welfare or juvenile justice, not indicative of typical teens.)

There was also no evidence that sex ed decreased the incidence of sexually transmitted infections. Only three studies in this 2023 meta-analysis tracked STIs (not the same as the ones that tracked pregnancies) and all three showed similar rates in both the treatment and control groups. It’s hard to make confident conclusions based on only three studies, but these results are not promising.

“There’s a shockingly low number of studies,” said Amy Bordogna, who led the research team that conducted this review, published in the American Journal of Sexuality Education.  “There needs to be more research.”

The 29 randomized controlled trials tended to show that students were practicing safer sex after participating in a sex ed program. On surveys, for example, boys said they were using a condom more often. In theory, increased condom use should be translating into lower pregnancy and STI rates. Either teens aren’t being truthful on surveys or the condoms aren’t being used correctly.

The rigorous research evidence is at odds with the research-based recommendations of many medical and health associations, including the American Public Health Association, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Other reviews have found that the evidence for “comprehensive” sex ed programs is more favorable. For example, a 2012 paper by 20 experts, led by researchers at the Centers for Disease Control and Prevention, reviewed 66 studies of group-based “comprehensive risk reduction” programs and concluded that, on average, they were effective in reducing pregnancies and STIs, while the results of 23 studies of group-based abstinence programs were inconsistent. Many of the underlying studies included in these broader research reviews weren’t randomized controlled trials and were of lower quality. 

Advocates on both sides of the debate tend to overstate their cases. There’s little evidence that sex education encourages sexual activity or promiscuity, but there’s also not strong evidence that comprehensive sex ed programs reduce pregnancies and infections. 

There’s also little evidence that abstinence-only approaches backfire, as some suggest, and lead to higher rates of pregnancies and infections. A 2008 study of four abstinence-only programs found no increase in the risk of adolescent pregnancy, STIs, or the rates of adolescent sexual activity compared with students in a control group.

The international evidence isn’t much better. A Cochrane review published in 2016 aggregated the results of randomized control trials that took place in schools in Europe, Latin America and Africa. The review had a higher bar for study quality; there had to be some clinical measure of pregnancies and sexually transmitted infections beyond what students voluntarily disclosed. It found no evidence that school-based sex ed programs by themselves reduced pregnancies, HIV or other sexually transmitted infections after reviewing eight randomized controlled trials covering 55,000 students. 

One takeaway from the lead researcher, Amanda Mason-Jones from the University of York in England, is that a curriculum alone, unaccompanied by freely available birth control, isn’t terribly effective. 

The most effective way to reduce pregnancies had nothing to do with sex ed classes. Financial incentives, such as free uniforms or small cash payments to keep girls in school, led to a significant reduction in teen pregnancies. One of these studies also documented a reduction in infections. That suggests that education itself might be the strongest form of birth control.  

Sarah Butrymowicz contributed reporting to this story.

This story about sex education statistics was written by Jill Barshay and produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for Proof Points and other Hechinger newsletters.

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Climate change has been driven by human behavior. That’s why long-term success in halting it must involve large-scale changes in how we live.

Most of the behaviors we associate with preventing climate change are totally inaccessible to younger children. They can’t buy electric cars or redirect their retirement accounts away from fossil fuels.

They can’t even vote.

Limiting our kids by only offering them these types of solutions can leave them with a sense of powerlessness and futility. But there is a solution within their power, and that’s taking control of how and what they eat.

Making the connection between food and climate change could reap huge benefits for our children — and for all of us. As more states and cities officially integrate climate change education into their school curricula, we urge them to include discussion of food systems and personal eating habits as essential parts of the climate story.

The role of food systems in climate change is often ignored, as discussions tend to focus on energy production (wind turbines) and transportation (electric cars).

Yet food is a huge part of our global economy and must also be a huge part of any potential climate solution. Food waste in particular is an area of massive concern: The energy that goes into producing food that is wasted is the equivalent of 3.3 billion tons of carbon dioxide per year. By comparison, all air travel and transport globally added a little over 1 billion tons of CO2 at its 2019 pre-pandemic peak.

Most of the behaviors we associate with preventing climate change are totally inaccessible to younger children. They can’t buy electric cars or redirect their retirement accounts away from fossil fuels.

Thus, encouraging more plant-based (and less-processed) foods and reducing food waste are two of the most effective approaches we have for addressing climate change, according to Project Drawdown, one of the most comprehensive studies on potential climate solutions. Combined, they could reduce greenhouse gas emissions almost 22 times more than the switch to electric cars.

Involving children in this discussion could be an important part of building a sustainable future, especially as more states and cities officially integrate climate change into their teaching, as New Jersey has. Food is far more tangible to children than discussions of better building insulation or renewable power generation, which are both invisible on a daily basis and entirely outside a child’s control.

Better nutrition education — including promotion of better lifelong health — is badly needed in our schools for many reasons anyway.

Younger people are more open to this than adults who are set in their ways. About 65 percent of today’s children and teens “find plant-forward eating appealing and 79 percent would go meatless, one to two times a week now or in the future,” according to a study from food services company Aramark.

Related: One state mandates teaching climate change in almost all subjects – even PE

We’ve started working out how to bring all of this information to kids in New Jersey’s classrooms. As part of our work for Rutgers University’s Department of Family & Community Health Sciences and the New Jersey Healthy Kids Initiative, we’ve been piloting lesson plans that present information on both food waste and plant-based eating.

We’re teaching kids how a bean burrito can be healthier and have less of an impact on the environment than a meat taco — and be delicious. And why a piece of fresh fruit is a climate-friendly snack because highly processed snacks like flavored chips take so much energy to produce.

These lessons take students through the basic science, describe food systems from initial farming through composting of waste and every step in between, and tie all the concepts back to climate change and empowering kids with action steps that can make an impact.

These are interactive, hands-on curricula. For example, we’ve created a video game in which the central challenge is finding a way to produce food for an entire community given limited space and resources. Kids quickly learn the true nutrient values of plants vs. livestock and the costs that go into producing each.

We’re not telling kids to avoid animal foods completely, and we’re careful to discourage judgment — we will gain nothing by asking children to lecture their parents. But we are teaching students that they can be part of the climate solution, showing them the personal and global benefits of eating mostly plants and encouraging them to avoid peer pressure and marketing campaigns that discourage healthy eating.

Related: COLUMN: The world is waking up to education’s essential role in climate solutions

When we talk about these issues with students, we see an immediate response. When we do food waste audits at schools to help them figure out how much food they’re throwing away, students come forward nearly every time, asking questions and offering to help find solutions.

They recognize the importance of this issue and, in many schools, they’re the ones pushing for change. Some students have self-organized to start “share tables” in their cafeterias on which they put unopened food items to be consumed by other students or donated to local food banks.

We’ve also been careful to work closely with teachers to develop lesson plans that meet, and integrate easily, into national and multistate standards for science curriculum. When we complete our pilots, we plan to start releasing the lesson plans as open-source tools available to schools nationwide.

We feel real hope for change when we work with our children. And engaging with them on the climate benefits of sustainable food choices can give them real hope too.

Sara Elnakib is chair of the Department of Family & Community Health Sciences at Rutgers University and research associate with the New Jersey Healthy Kids Initiative.

Jennifer Shukaitis is an assistant professor and educator at the Department of Family & Community Health Sciences at Rutgers University’s Cooperative Extension.

This story about climate change education was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for Hechinger’s newsletter.

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