Globally, adolescents and young adults account for high rates of STIs, HIV, and unplanned pregnancies. Many adolescents do not use any form of contraceptives, and many are unable to even identify effective contraceptives. A leading cause of these issues is the lack of a comprehensive approach to sexual health education. This lack has also lead to generations of misinformed adolescents who are unequipped to develop healthy relationships, unsure of how to give or receive consent, and lacking the ability to convince their partners to use condoms for their safety.

Many studies have been conducted to investigate these issues, as well as potential solutions, and two cases are presented below. de Castro et al. (2018) demonstrate the benefits that comprehensive sex education has on Mexican teenagers in their PLOS article. Shrivastava et al. (2017) outline the public health concerns that result from poor sex education worldwide, then propose community-developed and community-led comprehensive sex education programs as the most cost-effective and powerful solution. Their findings help contextualize the findings of Santelli et al. (2017) in their Journal of Adolescent Health article which compares the efficacy of abstinence only to that of comprehensive sex education programs in the U.S..

 

PROBLEM

Sexually transmitted infections (STIs) have been identified as a major public health concern. Patients with STIs are often reluctant to undergo treatment due to the stigma associated with having an STI. The failure to treat can eventually lead to infertility or mother-to-child transmission. The rate of infection is particularly high among young adults and adolescents, with over 111 million cases of STIs, 16 million births worldwide, and 15% of new adult HIV cases being among adolescents (de Castro et al., 2018). Adolescents in the United States have been found to have the highest age-specific risk for many STIs and the highest age-specific proportion of unintended pregnancy. Countries that provide adolescents with routine access to contraceptive education and counseling as well as the socioeconomic resources they need, have teen pregnancy and birth rates that are a fraction of those of the U.S. (Santelli et al., 2017).

 

EFFECTS OF COMPREHENSIVE SEX EDUCATION – A STUDY

De Castro et al. (2018) conducted a study to investigate the effects of exposure to comprehensive sexual education in Mexican high-school students. In this study they conducted a survey on public and private school students who had varying sex education backgrounds, asking about their knowledge, attitudes, and behavior regarding sexual health. They found that students who had comprehensive sex education (CSE, as defined by the International Planned Parenthood Federation, IPPF) had a decreased risk associated with HIV, due to their increased HIV knowledge and condom usage. Students who received CSE also reported feeling more prepared to face important health decisions compared to other students, and were the strongest group at identifying effective contraceptives. Furthermore, these students had a 20% higher chance of being able to convince their partner to use condoms. A significantly higher proportion of female students who had CSE reported being able to say no to sex unless their partner used a condom.

Additionally, CSE was found to affect students’ relationships and interpersonal skills beyond their sexual activity. Students who had CSE were 20% less likely to suffer from or cause bullying due to skin color, disability, or religion (de Castro et al., 2018).

 

COMPARISON TO ABSTINENCE ONLY PROGRAMS

The current alternative to comprehensive sex education is “abstinence only until marriage” or AOUM programs. These programs are heavily used in schools across the nation and have received millions of dollars in federal funding every year, beginning in 1981 (Santelli et al., 2017). These programs often use fear and shame tactics, informing students that if they are sexually active, they are less worthy than their abstinent peers and their premarital sex could cause sexual dysfunction later in their life. Santelli et al. (2017) note that these methods fail to recognize that some young people “do not have the choice to remain abstinent due to intimate partner violence, sexual abuse, rape, and/or molestation”.

In their article, Santelli et al. (2017) cite a CDC meta-analysis from 2012 which examined 66 comprehensive risk reduction (CRR) sexual health programs and 23 abstinence programs. This study found that the CRR programs had positive effects on the current sexual activity, number of sexual partners, frequency of sexual activity, and rates of STIs and pregnancy in teenagers, but was inconclusive about the effects of AOUM programs (Chin et al., 2012). A later study summarized 224 trials of school-based sex education programs and concluded that AOUM interventions did not actually promote positive changes in adolescents’ sexual or other behaviors (Denford, 2016). Santelli et al. (2017) found no scientific evidence that AOUM programs are effective in delaying adolescents’ initiation of sexual intercourse, reducing their number of sexual partners, frequency of vaginal sex, condom usage or occurrence of unprotected vaginal sex.

 

COST-EFFECTIVE AND MORAL SOLUTION TO MANY PROBLEMS

Shrivastava et al. (2017) argue that school-based sex education is the most cost-effective approach to ameliorating the major public health concern of STIs. They believe that one of the best ways to minimize the risk of negative reproductive outcomes (such as unwanted pregnancies and STIs) is to have conversations regarding sexual health early, and frequently, and that implementing comprehensive sex education programs is a great way to encourage and normalize these conversations. Shrivastava et al. (2017) also found that community-developed and community-led programs have a higher chance of acceptance in communities due to their relevance and socio-cultural appropriateness.

The study by de Castro et al. (2018) provides evidence of the beneficial effects that CSE can have on the attitudes, knowledge, and behaviors regarding sexual and reproductive health in adolescents. As they found, not only does CSE improve students’ condom usage, self-advocacy, understanding of consent, and ability to make smart health-related decisions, but it also improves their interpersonal skills and respect they have for themselves and others.

While Shrivastava et al. (2017) and de Castro et al. (2018) highlight the benefits of comprehensive sex education to both the individual adolescent and to society as a whole, Santelli et al. (2017) focused on the moral obligation of teachers and health educators to accurately educate adolescents. They argue that under the U.N. Committee on the Rights of the Child, all teens have the human right to information about their health, particularly access to adequate HIV/AIDS and sexual health information. The authors assert that many sex education programs (including AOUM programs) that are currently taught in schools withhold information on contraception or barrier protection to induce the adolescent to become abstinent, which is “inherently coercive”. They further argue that it is ethically problematic that our government provides abstinence as the only option for sex education. They elaborate, writing that “governments in the United States and elsewhere should support medically accurate, evidence-based, and scientifically justified approaches to sexuality education for young people. AOUM as a basis for health policy and programs should be abandoned” (Santelli et al., 2017).

 

CITATIONS

• Castro, F. D., Rojas-Martínez, R., Villalobos-Hernández, A., Allen-Leigh, B., Breverman-Bronstein, A., Billings, D. L., & Uribe-Zúñiga, P. (2018). Sexual and reproductive health outcomes are positively associated with comprehensive sexual education exposure in Mexican high-school students. Plos One,13(3).
• Chin, H.B., Sipe, T.A., Elder, R. et al. (2012). The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted Infections: Two systematic reviews for the Guide to community preventive services. Am J Prev Med. 42(3). 272–294
• Denford, S., Abraham, C., Campbell, R. et al. (2016). A comprehensive review of reviews of school-based interventions to improve sexual-health. Health Psychol Rev. 11(1). 33–52
• Santelli, J. Kantor, L., Grilo, S. et al. (2017). Abstinence-Only-Until-Marriage: An Updated Review of U.S. Policies and Programs and Their Impact. Journal of Adolescent Health. 61(3). 273-280.
• Shrivastava SR, Shrivastava PS, Ramasamy J. (2017). Responding to the sensitive issue of sexual health by improving awareness and sexual education. Ann Trop Med Public Health. 10. 799-800.