Domestic Violence Against Sex Workers in Cambodia

Chan Dyna and Keo Sichan and Melissa Cockroft

Little attention is given to violence experienced by sex workers from those closest to them: their husbands, boyfriends and partners.

This article is part of a series published by Rewire in partnership with the Global Network of Sex Work Projects (NSWP) to commemorate the International Day to End Violence Against Sex Workers, December 17th, 2010. It is excerpted from Research For Sex Work 12, published 17 December 2010 by the NSWP, an organization that upholds the voice of sex workers globally and connects regional networks advocating for the rights of female, male, and transgender sex workers. Download the full journal, with eight more articles about sex work and violence, for free at nswp.orgSee all articles in this series here.

Much attention related to sex workers in Cambodia in recent times has focused on violence committed by police and local authorities since the passing of the Law on the Suppression of Human Trafficking and Sexual Exploitation in 2008.1 In sharp contrast, little attention has been given to violence experienced by sex workers from those closest to them: their husbands, boyfriends and partners. This article provides a brief discussion of intimate partner violence experienced by Cambodian sex workers and some of the challenges for the Cambodian Prostitute Union (CPU) to support them in addressing this issue. Established in 1998, the CPU is the first sex workers collective in Cambodia, providing support, advocacy for sex workers rights, and education on HIV prevention and health care to sex workers based in Phnom Penh.

My husband regularly beats me, every day. Usually he uses his belt or his hand, sometimes he kicks me too. He beats me because we have problems with our income. He doesn’t have a job and relies on me to support him. Even though we don’t have much money, he gambles and plays cards. He also uses yama [methamphetamines]. Sometimes I stay in a guesthouse or at my relatives’ house to try and escape his violence but he always finds me. He follows me everywhere so I cannot escape him. Every night he follows me to the long road where I get my clients. My husband says I should charge $10 per client. He always comes with me and waits for me. After I am finished with the client he collects the money from me. He says that I cannot be trusted with the money because I am stupid.

These are the words of CPU member Song Vann, 28 years of age. She has a 7-year old son who lives with her mother. Song Vann has been with her current husband2 for over two years. She vividly remembers one particularly violent incident:

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One night I only received $5 from a client. When my husband saw that I only had $5 he became very angry. He argued with me, saying that I had kept $5 for myself. He cursed me and pushed me onto the road. I was lying face down. He repeatedly stamped on the back of my head with his foot, banging my face into the road. It didn’t bleed but I got a very large bump on my forehead and scratches across my face. This happened on the side of the main road where sex workers stand to get clients. Maybe ten other women saw my husband do this but they didn’t do anything. It’s normal for a husband to beat his wife. You don’t interfere in one’s family business… 

Karma

Like many other Cambodian women, Song Vann believes that she deserves to be beaten:

‘I think I experience violence because I am illiterate and not clever, also because of my past life. Maybe I committed a lot of sins in my past life and now I have to pay for them.’

The CPU sees cases like Song Vann’s all the time. Many members believe that they experience violence and other hardships in their lives because of karma, even though others realise that violence is not because of their sins but because their husbands are bad and Cambodian society tolerates violence against women and sex workers. Solving violence committed by husbands and partners is very difficult. Sometimes the CPU calls the police to intervene when members have experienced domestic violence. Officers then come to the house and say to the husband: ‘If you do this again, we will arrest you.’ But the next day they will say that domestic violence is a family matter that should be resolved in the family, and that they do not want to encourage divorce. 

Weak Enforcement of the Law

The 2005 Law on the Prevention of Domestic Violence and the Protection of the Victim provides legal protection for women in Cambodia. However for Cambodian women more generally, social and cultural attitudes that encourage silence around reporting of domestic violence and reconciliation between couples, combined with corruption and a lack of understanding of the law by police and local authorities, result in weak enforcement and implementation of the law. As a result, few cases of domestic violence make it to court and where formal complaints are made, frequently out-of-court settlements and non-legally binding divorce contracts are made.

For Cambodian sex workers it is even more difficult. As many Cambodian sex workers typically have no ID card and no permanent address,3 it is difficult for them to make a complaint to the local authorities. Sex workers are also commonly not legally married, which creates difficulties for proving the existence of the relationship to authorities. As sex workers often experience violence at the hands of the police, they are understandably reluctant to approach the police for assistance and do not trust them. Police officers are also likely to discriminate against sex workers, refusing to assist women once they become aware that they are sex workers. Due to the prevalence of corruption within Cambodian society, for sex workers who seek to make a formal complaint, they must also pay unofficial ‘fees’ every step of the way to the police, local authorities and court officials, which many sex workers cannot afford.

How Sex Workers Fight Back

The CPU provides education to sex workers and their abusive husbands about the domestic violence law as well as counselling between husbands and members. The CPU also assists the women to make a formal complaint to the local authorities and will accompany them to ensure that they are not discriminated against. Safe shelter with relevant women’s legal and human rights organisations will also be sought for women who experience extreme violence, at the request of the women. Whilst the CPU cannot provide direct legal assistance, it refers sex workers to supportive local legal or human rights organisations that can provide advice and a lawyer if a sex worker wishes to take the case to court. The CPU leader (Chan Dyna) also regularly talks on public radio to advocate for sex workers’ rights and to stop discrimination and violence against sex workers.

And what happened to Song Vann? The CPU had referred her to a local organisation that could assist her in accessing a safe house, legal services and support, but Song Vann decided to stay with her husband. We understand that it is difficult for her to escape the cycle of violence common in cases of domestic violence and we cannot force her to leave her husband. The CPU continues to provide counselling and support for Song Vann and her husband to try and minimise harm caused to her. We hope that in the future, with the support of other CPU members, she will have the strength and confidence to leave her husband.

About the Authors

Chan Dyna is the leader of the Cambodian Prostitute Union. Keo Sichan and Melissa Cockroft are with the Cambodian Women’s Development Agency, a local women’s NGO which provides technical support and assistance to the CPU.

Notes

1 How this law has provided justification for the use of force against sex workers has been highlighted through both local advocacy efforts and the report Off the Streets: Arbitrary detention and other abuses against sex workers in Cambodia, published by Human Rights Watch in July 2010.

2 Like many sex workers in Cambodia Song Vann refers to her partner as her ‘husband’ although they are not legally married.

3 In Cambodia to obtain an ID card you need to have a permanent address. Because sex workers frequently move to try to find work or escape crackdowns, they often do not have a fixed address, or they have no relatives whose address they can use. They are also reluctant to go to the authorities to obtain an ID card due to discrimination and mistrust.

Much attention related to sex workers in Cambodia in recent times has focused on violence committed by police and local authorities since the passing of the Law on the Suppression of Human Trafficking and Sexual Exploitation in 2008.1 In sharp contrast, little attention has been given to violence experienced by sex workers from those closest to them: their husbands, boyfriends and partners. This article provides a brief discussion of intimate partner violence experienced by Cambodian sex workers and some of the challenges for the Cambodian Prostitute Union (CPU) to support them in addressing this issue. Established in 1998, the CPU is the first sex workers collective in Cambodia, providing support, advocacy for sex workers rights, and education on HIV prevention and health care to sex workers based in Phnom Penh.

 

‘My husband regularly beats me, every day. Usually he uses his belt or his hand, sometimes he kicks me too. He beats me because we have problems with our income. He doesn’t have a job and relies on me to support him. Even though we don’t have much money, he gambles and plays cards. He also uses yama [methamphetamines]. Sometimes I stay in a guesthouse or at my relatives’ house to try and escape his violence but he always finds me. He follows me everywhere so I cannot escape him. Every night he follows me to the long road where I get my clients. My husband says I should charge $10 per client. He always comes with me and waits for me. After I am finished with the client he collects the money from me. He says that I cannot be trusted with the money because I am stupid.’

 

These are the words of CPU member Song Vann, 28 years of age. She has a 7-year old son who lives with her mother. Song Vann has been with her current husband2 for over two years. She vividly remembers one particularly violent incident:

‘One night I only received $5 from a client. When my husband saw that I only had $5 he became very angry. He argued with me, saying that I had kept $5 for myself. He cursed me and pushed me onto the road. I was lying face down. He repeatedly stamped on the back of my head with his foot, banging my face into the road. It didn’t bleed but I got a very large bump on my forehead and scratches across my face. This happened on the side of the main road where sex workers stand to get clients. Maybe ten other women saw my husband do this but they didn’t do anything. It’s normal for a husband to beat his wife. You don’t interfere in one’s family business…’

 

Karma

 

Like many other Cambodian women, Song Vann believes that she deserves to be beaten: ‘I think I experience violence because I am illiterate and not clever, also because of my past life. Maybe I committed a lot of sins in my past life and now I have to pay for them.’ The CPU sees cases like Song Vann’s all the time. Many members believe that they experience violence and other hardships in their lives because of karma, even though others realise that violence is not because of their sins but because their husbands are bad and Cambodian society tolerates violence against women and sex workers. Solving violence committed by husbands and partners is very difficult. Sometimes the CPU calls the police to intervene when members have experienced domestic violence. Officers then come to the house and say to the husband: ‘If you do this again, we will arrest you.’ But the next day they will say that domestic violence is a family matter that should be resolved in the family, and that they do not want to encourage divorce.

 

Weak Enforcement of the Law

 

The 2005 Law on the Prevention of Domestic Violence and the Protection of the Victim provides legal protection for women in Cambodia. However for Cambodian women more generally, social and cultural attitudes that encourage silence around reporting of domestic violence and reconciliation between couples, combined with corruption and a lack of understanding of the law by police and local authorities, result in weak enforcement and implementation of the law. As a result, few cases of domestic violence make it to court and where formal complaints are made, frequently out-of-court settlements and non-legally binding divorce contracts are made.

 

For Cambodian sex workers it is even more difficult. As many Cambodian sex workers typically have no ID card and no permanent address,3 it is difficult for them to make a complaint to the local authorities. Sex workers are also commonly not legally married, which creates difficulties for proving the existence of the relationship to authorities. As sex workers often experience violence at the hands of the police, they are understandably reluctant to approach the police for assistance and do not trust them. Police officers are also likely to discriminate against sex workers, refusing to assist women once they become aware that they are sex workers. Due to the prevalence of corruption within Cambodian society, for sex workers who seek to make a formal complaint, they must also pay unofficial ‘fees’ every step of the way to the police, local authorities and court officials, which many sex workers cannot afford.

 

How Sex Workers Fight Back

 

The CPU provides education to sex workers and their abusive husbands about the domestic violence law as well as counselling between husbands and members. The CPU also assists the women to make a formal complaint to the local authorities and will accompany them to ensure that they are not discriminated against. Safe shelter with relevant women’s legal and human rights organisations will also be sought for women who experience extreme violence, at the request of the women. Whilst the CPU cannot provide direct legal assistance, it refers sex workers to supportive local legal or human rights organisations that can provide advice and a lawyer if a sex worker wishes to take the case to court. The CPU leader (Chan Dyna) also regularly talks on public radio to advocate for sex workers’ rights and to stop discrimination and violence against sex workers.

 

And what happened to Song Vann? The CPU had referred her to a local organisation that could assist her in accessing a safe house, legal services and support, but Song Vann decided to stay with her husband. We understand that it is difficult for her to escape the cycle of violence common in cases of domestic violence and we cannot force her to leave her husband. The CPU continues to provide counselling and support for Song Vann and her husband to try and minimise harm caused to her. We hope that in the future, with the support of other CPU members, she will have the strength and confidence to leave her husband.

 

About the Authors

 

Chan Dyna is the leader of the Cambodian Prostitute Union. Keo Sichan and Melissa Cockroft are with the Cambodian Women’s Development Agency, a local women’s NGO which provides technical support and assistance to the CPU.

 

Notes

1 How this law has provided justification for the use of force against sex workers has been highlighted through both local advocacy efforts and the report Off the Streets: Arbitrary detention and other abuses against sex workers in Cambodia, published by Human Rights Watch in July 2010.

2 Like many sex workers in Cambodia Song Vann refers to her partner as her ‘husband’ although they are not legally married.

3 In Cambodia to obtain an ID card you need to have a permanent address. Because sex workers frequently move to try to find work or escape crackdowns, they often do not have a fixed address, or they have no relatives whose address they can use. They are also reluctant to go to the authorities to obtain an ID card due to discrimination and mistrust.

Commentary Politics

On Immigration, Major Political Parties Can’t Seem to Agree on What’s ‘Un-American’

Tina Vasquez

As far as immigration is concerned, neither the Democrats nor Republicans are without their faults, though positions taken at the conventions were clearly more extreme in one case than the other.

Read more of our coverage of the Democratic National Convention here.

Immigration has been one of the country’s most contentious political topics and, not surprisingly, is now a primary focus of this election. But no matter how you feel about the subject, this is a nation of immigrants in search of “el sueño Americano,” as Karla Ortiz reminded us on the first night of the Democratic National Convention (DNC). Ortiz, the 11-year-old daughter of two undocumented parents, appeared in a Hillary Clinton campaign ad earlier this year expressing fear that her parents would be deported. Standing next to her mother on the DNC stage, the young girl told the crowd that she is an American who wants to become a lawyer to help families like hers.

It was a powerful way to kick-start the week, suggesting to viewers Democrats were taking a radically different approach to immigration than the Republican National Convention (RNC). While the RNC made undocumented immigrants the scapegoats for a variety of social ills, from U.S. unemployment to terrorism, the DNC chose to highlight the contributions of immigrants: the U.S. citizen daughter of undocumented parents, the undocumented college graduate, the children of immigrants who went into politics. Yet, even the stories shared at the DNC were too tidy and palatable, focusing on “acceptable” immigrant narratives. There were no mixed-status families discussing their deported parents, for example.

As far as immigration is concerned, neither the Democrats nor Republicans are without their faults, though positions taken at the conventions were clearly more extreme in one case than the other. By the end of two weeks, viewers may not have known whether to blame immigrants for taking their jobs or to befriend their hardworking immigrant neighbors. For the undocumented immigrants watching the conventions, the message, however, was clear: Both parties have a lot of work to do when it comes to humanizing their communities.  

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“No Business Being in This Country”

For context, Republican presidential nominee Donald Trump and his running mate Mike Pence are the decidedly anti-immigrant ticket. From the beginning, Trump’s campaign has been overrun by anti-immigrant rhetoric, from calling Mexicans “rapists” and “killers” to calling for a ban on Muslim immigration. And as of July 24, Trump’s proposed ban now includes people from countries “compromised by terrorism” who will not be allowed to enter the United States, including anyone from France.

So, it should come as no surprise that the first night of the RNC, which had the theme of “Make America Safe Again,” preyed on American fears of the “other.” In this case: undocumented immigrants who, as Julianne Hing wrote for the Nation, “aren’t just drug dealers and rapists anymorenow they’re murderers, too.”

Night one of the RNC featured not one but three speakers whose children were killed by undocumented immigrants. “They’re just three brave representatives of many thousands who have suffered so gravely,” Trump said at the convention. “Of all my travels in this country, nothing has affected me more, nothing even close I have to tell you, than the time I have spent with the mothers and fathers who have lost their children to violence spilling across our borders, which we can solve. We have to solve it.”

Billed as “immigration reform advocates,” grieving parents like Mary Ann Mendoza called her son’s killer, who had resided in the United States for 20 years before the drunk driving accident that ended her police officer son’s life, an “illegal immigrant” who “had no business being in this country.”

It seemed exploitative and felt all too common. Drunk driving deaths are tragically common and have nothing to do with immigration, but it is easier to demonize undocumented immigrants than it is to address the nation’s broken immigration system and the conditions that are separating people from their countries of originconditions to which the United States has contributed. Trump has spent months intentionally and disingenuously pushing narratives that undocumented immigrants are hurting and exploiting the United States, rather than attempting to get to the root of these issues. This was hammered home by Mendoza, who finished her speech saying that we have a system that cares more about “illegals” than Americans, and that a vote for Hillary “puts all of our children’s lives at risk.”

There was also Maricopa County Sheriff Joe Arpaio, a notorious racist whose department made a practice of racially profiling Latinos and was recently found to be in civil contempt of court for “repeatedly and knowingly” disobeying orders to cease policing tactics against Latinos, NPR reported.

Like Mendoza, Arpaio told the RNC crowd that the immigration system “puts the needs of other nations ahead of ours” and that “we are more concerned with the rights of ‘illegal aliens’ and criminals than we are with protecting our own country.” The sheriff asserted that he was at the RNC because he was distinctly qualified to discuss the “dangers of illegal immigration,” as someone who has lived on both sides of the border.

“We have terrorists coming in over our border, infiltrating our communities, and causing massive destruction and mayhem,” Arpaio said. “We have criminals penetrating our weak border security systems and committing serious crimes.”

Broadly, the takeaway from the RNC and the GOP nominee himself is that undocumented immigrants are terrorists who are taking American jobs and lives. “Trump leaned on a tragic story of a young woman’s murder to prop up a generalized depiction of immigrants as menacing, homicidal animals ‘roaming freely to threaten peaceful citizens,’” Hing wrote for the Nation.

When accepting the nomination, Trump highlighted the story of Sarah Root of Nebraska, a 21-year-old who was killed in a drunk-driving accident by a 19-year-old undocumented immigrant.

“To this administration, [the Root family’s] amazing daughter was just one more American life that wasn’t worth protecting,” Trump said. “One more child to sacrifice on the altar of open borders.”

It should be noted that the information related to immigration that Trump provided in his RNC speech, which included the assertion that the federal government enables crime by not deporting more undocumented immigrants (despite deporting more undocumented immigrants than ever before in recent years), came from groups founded by John Tanton, a well-known nativist whom the Southern Poverty Law center referred to as “the racist architect of the modern anti-immigrant movement.”

“The Border Crossed Us”

From the get-go, it seemed the DNC set out to counter the dangerous, anti-immigrant rhetoric pushed at the RNC. Over and over again, Democrats like Congressional Hispanic Caucus Chair Rep. Linda Sánchez (D-CA) hit back hard against Trump, citing him by name and quoting him directly.

“Donald Trump believes that Mexican immigrants are murderers and rapists. But what about my parents, Donald?” Sánchez asked the crowd, standing next to her sister, Rep. Loretta Sánchez (D-CA). “They are the only parents in our nation’s 265-year history to send not one but two daughters to the United States Congress!”

Each speech from a Latino touched on immigration, glossing over the fact that immigration is not just a Latino issue. While the sentiments were positiveillustrating a community that is thriving, and providing a much-needed break from the RNC’s anti-immigrant rhetoricat the core of every speech were messages of assimilation and respectability politics.

Even in gutsier speeches from people like actress Eva Longoria, there was the need to assert that her family is American and that her father is a veteran. The actress said, “My family never crossed a border. The border crossed us.”

Whether intentional or not, the DNC divided immigrants into those who are acceptable, respectable, and worthy of citizenship, and those—invisible at the convention—who are not. “Border crossers” who do not identify as American, who do not learn English, who do not aspire to go to college or become an entrepreneur because basic survival is overwhelming enough, what about them? Do they deserve to be in detention? Do their families deserve to be ripped apart by deportation?

At the convention, Rep. Luis Gutiérrez (D-IL), a champion of immigration reform, said something seemingly innocuous that snapped into focus the problem with the Democrats’ immigration narrative.

“In her heart, Hillary Clinton’s dream for America is one where immigrants are allowed to come out of the shadows, get right with the law, pay their taxes, and not feel fear that their families are going to be ripped apart,” Gutiérrez said.

The Democratic Party is participating in an all-too-convenient erasure of the progress undocumented people have made through sheer force of will. Immigration has become a leading topic not because there are more people crossing the border (there aren’t) or because nativist Donald Trump decided to run for president, but because a segment of the population has been denied basic rights and has been fighting tooth and nail to save themselves, their families, and their communities.

Immigrants have been coming out of the shadows and as a result, are largely responsible for the few forms of relief undocumented communities now have, like Deferred Action for Childhood Arrivals, which allows certain undocumented immigrants who meet specific qualifications to receive a renewable two-year work permit and exemption from deportation. And “getting right with the law” is a joke at this point. The problem isn’t that immigrants are failing to adhere to immigration laws; the problem is immigration laws that are notoriously complicated and convoluted, and the system, which is so backlogged with cases that a judge sometimes has just seven minutes to determine an immigrant’s fate.

Becoming a U.S. citizen is also really expensive. There is a cap on how many people can immigrate from any given country in a year, and as Janell Ross explained at the Washington Post:

There are some countries, including Mexico, from where a worker with no special skills or a relative in the United States can apply and wait 23 years, according to the U.S. government’s own data. That’s right: There are people receiving visas right now in Mexico to immigrate to the United States who applied in 1993.

But getting back to Gutierrez’s quote: Undocumented immigrants do pay taxes, though their ability to contribute to our economy should not be the one point on which Democrats hang their hats in order to attract voters. And actually, undocumented people pay a lot of taxes—some $11.6 billion in state and local taxes last year, according to the Institute on Taxation and Economic Policy—while rarely benefiting from a majority of federal assistance programs since the administration of President Bill Clinton ended “welfare as we know it” in 1996.

If Democrats were being honest at their convention, we would have heard about their failure to end family detention, and they would have addressed that they too have a history of criminalizing undocumented immigrants.

The 1996 Antiterrorism and Effective Death Penalty Act and the 1996 Illegal Immigration Reform and Immigrant Responsibility Act, enacted under former President Clinton, have had the combined effect of dramatically increasing the number of immigrants in detention and expanding mandatory or indefinite detention of noncitizens ordered to be removed to countries that will not accept them, as the American Civil Liberties Union notes on its site. Clinton also passed the North American Free Trade Agreement, which economically devastated Mexican farmers, leading to their mass migration to the United States in search of work.

In 1990, then-Sen. Joe Biden introduced the Violence Against Women Act, which passed in 1994 and specifically excluded undocumented women for the first 19 of the law’s 22 years, and even now is only helpful if the victim of intimate partner abuse is a child, parent, or current/former spouse of a U.S. citizen or a permanent resident.

In addition, President Obama is called by immigrant rights advocates “deporter in chief,” having put into place a “deportation machine” that has sent more than two million migrants back to their country of origin, more than any president in history. New arrivals to the United States, such as the Central American asylum seekers coming to our border escaping gender-based violence, are treated with the same level of prioritization for removal as threats to our national security. The country’s approach to this humanitarian crisis has been raiding homes in the middle of the night and placing migrants in detention centers, which despite being rife with allegations of human rights abuses, are making private prison corporations millions in revenue.

How Are We Defining “Un-American”?

When writing about the Democratic Party, community organizer Rosa Clemente, the 2008 Green Party vice president candidate, said that she is afraid of Trump, “but not enough to be distracted from what we must do, which is to break the two-party system for good.”

This is an election like we’ve never seen before, and it would be disingenuous to imply that the party advocating for the demise of the undocumented population is on equal footing with the party advocating for the rights of certain immigrants whose narratives it finds acceptable. But this is a country where Republicans loudly—and with no consequence—espouse racist, xenophobic, and nativist beliefs while Democrats publicly voice support of migrants while quietly standing by policies that criminalize undocumented communities and lead to record numbers of deportations.

During two weeks of conventions, both sides declared theirs was the party that encapsulated what America was supposed to be, adhering to morals and values handed down from our forefathers. But ours is a country comprised of stolen land and built by slave labor where today, undocumented immigrants, the population most affected by unjust immigration laws and violent anti-immigrant rhetoric, don’t have the right to vote. It is becoming increasingly hard to tell if that is indeed “un-American” or deeply American.

Commentary Sexual Health

Parents, Educators Can Support Pediatricians in Providing Comprehensive Sexuality Education

Nicole Cushman

While medical systems will need to evolve to address the challenges preventing pediatricians from sharing medically accurate and age-appropriate information about sexuality with their patients, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Last week, the American Academy of Pediatrics (AAP) released a clinical report outlining guidance for pediatricians on providing sexuality education to the children and adolescents in their care. As one of the most influential medical associations in the country, AAP brings, with this report, added weight to longstanding calls for comprehensive sex education.

The report offers guidance for clinicians on incorporating conversations about sexual and reproductive health into routine medical visits and summarizes the research supporting comprehensive sexuality education. It acknowledges the crucial role pediatricians play in supporting their patients’ healthy development, making them key stakeholders in the promotion of young people’s sexual health. Ultimately, the report could bolster efforts by parents and educators to increase access to comprehensive sexuality education and better equip young people to grow into sexually healthy adults.

But, while the guidance provides persuasive, evidence-backed encouragement for pediatricians to speak with parents and children and normalize sexual development, the report does not acknowledge some of the practical challenges to implementing such recommendations—for pediatricians as well as parents and school staff. Articulating these real-world challenges (and strategies for overcoming them) is essential to ensuring the report does not wind up yet another publication collecting proverbial dust on bookshelves.

The AAP report does lay the groundwork for pediatricians to initiate conversations including medically accurate and age-appropriate information about sexuality, and there is plenty in the guidelines to be enthusiastic about. Specifically, the report acknowledges something sexuality educators have long known—that a simple anatomy lesson is not sufficient. According to the AAP, sexuality education should address interpersonal relationships, body image, sexual orientation, gender identity, and reproductive rights as part of a comprehensive conversation about sexual health.

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The report further acknowledges that young people with disabilities, chronic health conditions, and other special needs also need age- and developmentally appropriate sex education, and it suggests resources for providing care to LGBTQ young people. Importantly, the AAP rejects abstinence-only approaches as ineffective and endorses comprehensive sexuality education.

It is clear that such guidance is sorely needed. Previous studies have shown that pediatricians have not been successful at having conversations with their patients about sexuality. One study found that one in three adolescents did not receive any information about sexuality from their pediatrician during health maintenance visits, and those conversations that did occur lasted less than 40 seconds, on average. Another analysis showed that, among sexually experienced adolescents, only a quarter of girls and one-fifth of boys had received information from a health-care provider about sexually transmitted infections or HIV in the last year. 

There are a number of factors at play preventing pediatricians from having these conversations. Beyond parental pushback and anti-choice resistance to comprehensive sex education, which Martha Kempner has covered in depth for Rewire, doctor visits are often limited in time and are not usually scheduled to allow for the kind of discussion needed to build a doctor-patient relationship that would be conducive to providing sexuality education. Doctors also may not get needed in-depth training to initiate and sustain these important, ongoing conversations with patients and their families.

The report notes that children and adolescents prefer a pediatrician who is nonjudgmental and comfortable discussing sexuality, answering questions and addressing concerns, but these interpersonal skills must be developed and honed through clinical training and practice. In order to fully implement the AAP’s recommendations, medical school curricula and residency training programs would need to devote time to building new doctors’ comfort with issues surrounding sexuality, interpersonal skills for navigating tough conversations, and knowledge and skills necessary for providing LGBTQ-friendly care.

As AAP explains in the report, sex education should come from many sources—schools, communities, medical offices, and homes. It lays out what can be a powerful partnership between parents, doctors, and educators in providing the age-appropriate and truly comprehensive sexuality education that young people need and deserve. While medical systems will need to evolve to address the challenges outlined above, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Parents and Caregivers: 

  • When selecting a pediatrician for your child, ask potential doctors about their approach to sexuality education. Make sure your doctor knows that you want your child to receive comprehensive, medically accurate information about a range of issues pertaining to sexuality and sexual health.
  • Talk with your child at home about sex and sexuality. Before a doctor’s visit, help your child prepare by encouraging them to think about any questions they may have for the doctor about their body, sexual feelings, or personal safety. After the visit, check in with your child to make sure their questions were answered.
  • Find out how your child’s school approaches sexuality education. Make sure school administrators, teachers, and school board members know that you support age-appropriate, comprehensive sex education that will complement the information provided by you and your child’s pediatrician.

School Staff and Educators: 

  • Maintain a referral list of pediatricians for parents to consult. When screening doctors for inclusion on the list, ask them how they approach sexuality education with patients and their families.
  • Involve supportive pediatricians in sex education curriculum review committees. Medical professionals can provide important perspective on what constitutes medically accurate, age- and developmentally-appropriate content when selecting or adapting curriculum materials for sex education classes.
  • Adopt sex-education policies and curricula that are comprehensive and inclusive of all young people, regardless of sexual orientation or gender identity. Ensure that teachers receive the training and support they need to provide high-quality sex education to their students.

The AAP clinical report provides an important step toward ensuring that young people receive sexuality education that supports their healthy sexual development. If adopted widely by pediatricians—in partnership with parents and schools—the report’s recommendations could contribute to a sea change in providing young people with the care and support they need.