Parents will now have to opt their children in to participate in the controversial middle-school sex education pilot program, Pono Choices, which was undergoing a second review amid complaints from some lawmakers and parents about it being medically inaccurate and inappropriate for students as young as 11 years old.

The move to an opt-in versus opt-out decision is one of a dozen changes the Department of Education announced Friday, when it released a report by a working group convened in February to review Pono Choices.

Pono Choices, billed as a "culturally responsive" teen pregnancy and disease prevention program, has been under fire since last year’s special session on gay marriage for classifying the anus as genitalia and including explicit lessons that allegedly minimize dangers associated with anal sex.

The program was developed and is owned by the University of Hawaii-Manoa’s Center on Disability Studies.

It was implemented in five schools this past semester.

The working group’s report makes 11 recommendations to improve the curriculum and address concerns, including: characterization of the anus as a genital; increasing information about the risks of anal sex; and improvements to the Parent Night Guide to provide more transparency to families about the curriculum to inform decision-making.

"Let’s not forget that the goal of this curriculum and our sexual health education standards, Board (of Education) policies, and state laws, is to reduce unintended teen pregnancies and the spread of sexually transmitted infections (STIs) including HIV," schools Superintendent Kathryn Matayoshi said in a statement. "Given the statistics about Hawaii’s youth — the rate of sexual activity, failure to use protection, rate of pregnancy, and the spread of disease — we must work together to ensure students are educated to make better choices."

The DOE briefly halted the program for two weeks last year before reinstating it in December after a department review deemed it medically accurate and aligned with state law and DOE policy. The department then convened a working group Feb. 20 to further evaluate the program.

The DOE said schools will not implement Pono Choices until the department has received a revised version of the curriculum for review and approval.