Sexual health education will now be mandatory for Hawaii public school students, under a revised sex education policy approved Tuesday by the Board of Education that expands a long-standing abstinence-based policy to include lessons on contraception, disease prevention and skills to help students make "healthy decisions" about sexuality and relationships.

The revised policy requires that students receive sexual health education that is age-appropriate and medically accurate. It leaves it up to the Department of Education to vet curricula and adds a provision for parents to have their children not receive the instruction.

The old board policy, which was last updated in 1995, had said that the DOE "shall instruct students that abstention from sexual intercourse is the surest and most responsible way to prevent unintended pregnancies and sexually transmitted diseases."

Schools had been selecting from among seven approved sex education curricula to be taught in intermediate and high schools.

The revised policy requires schools to provide sexual health education that:

» Includes education on abstinence, contraception and methods of infection prevention to prevent unintended pregnancy and sexually transmitted infections.

» Helps students develop relationships and communication skills to form healthy relationships.

» Helps students develop skills in critical thinking, problem solving, decision making and stress management to make healthy decisions about sexuality and relationships.

» Encourages students to communicate with their parents, guardians and/or other trusted adults about sexuality.

» Informs students of available community resources.

The former policy did not have an opt-out provision. However, the Department of Education last summer implemented its own policy to make sex ed optional and require parents to opt their children in to participate amid complaints about the controversial Pono Choices curriculum — a pilot sex education program for middle-schoolers that many parents found too graphic. The new policy would supercede the department’s rules.

The updated BOE policy also includes a requirement that a description of whatever approved sex education curriculum a school selects be made available to parents and posted on the school’s website before instruction can start.

The revision is part of a months­long effort by the BOE to update and revise dozens of its policies.

Work on the expanded sex education policy proved divisive, with some parents arguing that the changes will expose their children to unwanted and inappropriate lessons, and others arguing that abstinence-based programs are outdated and ineffective.

State Rep. Bob McDermott, a leader in the charge against Pono Choices and Hawaii’s same-sex marriage law, testified that he favored keeping the abstinence-based policy, and criticized so-called "comprehensive sex education" because "it doesn’t disclose the risks of anomalous behavior," citing, for example, the risks associated with anal and oral sex.

Lisa Kimura, executive director of Healthy Mothers, Healthy Babies Coalition of Hawaii, which provides support services for pregnant women, said many of the young moms she works with say they don’t have access to contraception and lack the education to know how it can help them prevent pregnancy.

"I hear from women every single week who are having their second, third, fourth, fifth, sixth — and actually last week, seventh — child, many of them from situations where they have not received any type of education for their reproductive health," she testified in support of the policy.

Hawaii had the 10th-highest teen pregnancy rate in the nation in 2010, according to a 2014 report by the nonprofit Guttmacher Institute, which specializes in reproductive health.

Thirty-six percent of Hawaii students in middle and high school say they’re having sex, according to the 2013 Youth Risk Behavior Survey conducted by the U.S. Centers for Disease Control and Prevention. That’s lower than the national rate of 47 percent that year. But the survey, which is conducted every two years, found that most of the Hawaii teens who have sex are engaging in unprotected sex.