Analysis Abortion

Ideological Crisis Pregnancy Centers Receiving Hundreds of Thousands in Federal Funding

Sofia Resnick

Federally funded crisis pregnancy centers bring mazes, game shows, and questionable health information to teens.

Published in partnership with The American Independent

To bring down the high rate of chlamydia among teenagers in Tennessee, an anti-choice pregnancy center in Athens, Tenn., has proposed spending federal tax dollars on a life-sized version of the Game of Life.

The “Teen Life Maze” is just one of the ideas put forth by a cluster of crisis pregnancy centers that are receiving government grants to conduct abstinence education as part of President Obama’s health-care reform law.

Records obtained by The American Independent show that the government is paying for abstinence programs run by centers that promote dubious medical information. For example, crisis pregnancy centers (CPCs) receiving funding through the program claim that “reliable studies” have shown a link between abortion and breast cancer.

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One of the centers says it seeks to help students understand “the lack of effectiveness of condoms/birth control in STD protection and pregnancy.”

TAI previously reported that a South Dakota anti-abortion CPC that requires its volunteers to be Christians received funding under a program created by Obama’s stimulus bill.

Between 1996 and 2009, taxpayers spent more than $1.5 billion on abstinence-only education, paid for by federal grants and state matching funds, according to the Sexuality Information and Education Council of the United States (SIECUS). In 2004, Rep. Henry Waxman (D-Calif.) released a report that found that these programs often contained false or distorted information about sex and reproductive health, such as claiming that condoms have a high failure rate at preventing HIV and pregnancy, women who have abortions have a high risk of becoming sterile, and HIV can be transmitted through sweat and tears.

Shortly after taking office, Obama moved to cut off federal funding for most abstinence-only education.

However, during the intense negotiations over the health-care-reform bill in 2009 and 2010, Congress attached a $250 million grant program for abstinence-only instruction (granting up to $50 million annually, through 2014). Under the program, state health departments apply for abstinence funding and can then allocate sub-awards to various organizations across the state, including county health departments, schools, community groups, and faith-based nonprofits.

So far, at least three anti-abortion CPCs have received funding through this provision. They’re all in Tennessee, which has the nation’s 11th highest teen birth rate, according to new data from the Centers for Disease Control and Prevention (CDC).

In January, the Tennessee Department of Health announced it was dividing $3.2 million in abstinence funding among 13 agencies through 2014 to “support comprehensive, evidence-based and medically accurate community-based education programs.”

A total of about $650,000 of that money was awarded to the three CPCs: Full Circle Women’s Services in Athens, Life Choices Pregnancy Support Center in Dyersburg, and Women’s Care Center of Rhea County, Inc., in Dayton. Per the terms of the grant program, each grant recipient has to match 75 percent of the award.

When they’re not teaching teens not to have sex, these centers are seeing women – sometimes teens – facing unplanned, and often unwelcomed, pregnancies. They seek to discourage abortion, offering women various services including counseling and free pregnancy tests. The websites of two of the centers – Full Circle Women’s Services and Life Choices Pregnancy Support Center – feature an array of misinformation about abortion, including claims that abortion causes breast cancer and depression.

Despite widespread rejection of an abortion-breast cancer link from major medical institutions such as the American Cancer Society, the American Congress of Obstetricians and Gynecologists, and the National Cancer Institute, these CPCs continue to mislead women on this connection, claiming on their websites that “a number of reliable studies have demonstrated connection between abortion and later development of breast cancer.”

According to the American Cancer Society, “At this time, the scientific evidence does not support the notion that abortion of any kind raises the risk of breast cancer or any other type of cancer.”

Both Full Circle Women’s Services and the Women’s Care Center are affiliated with Care Net, a national network of crisis pregnancy centers that prohibits its members from recommending, offering, or referring “single women” for contraception.

Whereas proponents of comprehensive sex education encourage teaching teens how to protect themselves against unplanned pregnancy and diseases while acknowledging that condoms are not guaranteed to work 100 percent of the time, abstinence-education advocates often claim that teaching about proper condom use offers young people a “false sense of security.”

On their websites, Full Circle, Life Choices Pregnancy Resource Center, and the Women’s Care Center cite identical statistics emphasizing what they portray as the lack of effectiveness of condoms. These centers tell readers that “consistent” condom use during vaginal sex reduces the risk of “HIV by 85%”; human papillomavirus “by 50% or less”; and gonorrhea, Chlamydia, herpes, and syphilis “by about 50%.” The statistics come from various studies compiled by the Medical Institute, a nonprofit organization whose advice for preventing STDs is: “Avoid sexual activity if you are single. Be faithful to one uninfected partner for the rest of your life.”

Richard A. Crosby, a professor and chair at the Department of Health Behavior at the University of Kentucky College of Public Health, told TAI that these statistics are misleading.

“These are not statistics that are widely supported by the literature,” Crosby said. “They are confounded by a lack of accounting for the correct use of condoms. Consistent use alone is not enough. … When you do not account for the correct use, you have an underestimate of the effectiveness.”

Crosby, who has received federal grants to conduct research on HIV prevention, is currently working on a “highly controlled, rigorous” study funded by the National Institutes of Health to determine the value of consistent and correct condom use in preventing three common STIs: Chlamydia, gonorrhea, and trichomoniasis.

“All of these numbers are way low,” Crosby said, referring to the pregnancy centers’ statistics (with the exception of the rate of condom-use effectiveness at preventing HPV, which he said is supported by studies). He said the claim that condoms are 85 percent effective in reducing HIV infection is “really misleading” and not supported by many research studies that isolate for consistent and correct use.

“Innovative Approaches”

Full Circle Women’s Services – awarded $154,200 – is the anti-abortion pregnancy center that proposed trying to curb teen sex with a giant “Teen Life Maze.” The center cited the game as one of its “innovative approaches” to abstinence instruction in a grant application submitted to the Tennessee health department in May 2011. The maze is described as:

“[a] large game board of rooms designed to let teens experience the consequences – both positive and negative – of life choices. It is effective in that teens get to play along in seeing firsthand the results of good decisions and bad decisions ranging from making trips to the doctor for a lifelong STD or the satisfaction in staying on course and graduating from high school.”

In a subsequent document, the center explained that inspiration for the game comes from Georgia, where life mazes have been hosted in several schools across the state, and that Full Circle was “in the planning stages of bringing this event to Athens.”

Other innovative approaches proposed by Full Circle include hosting a game show about the risks of having sex and screening the film Look Before You Leap, described in the proposal as “an adrenaline rush of drama, action, and humor that takes relationship education to extreme heights.”

Full Circle, founded in 1998, has been offering privately financed abstinence-education services to mostly elementary and middle schools in McMinn County for a few years now. In its grant proposal, the center explained that the extra cash would be used to hire more educators. Currently, the center’s program, called On TRAC (Teaching Teens Responsibility and Consequences), relies on abstinence curriculum called “Think on Point” and “Life on Point,” created by On Point, a youth-development group in Chattanooga, Tenn. 

“Think on Point” is a five-day program offered once a year to sixth- through ninth-graders during physical education class. According to the program description:

“[t]he curriculum includes homework assignments, in-class handouts, role-playing activities, and focused small-group discussion. … Lessons at every grade level discuss the topics of abstinence, sexually transmitted diseases, media influence, and standards and boundaries; other more specific themes include pregnancy, pornography, abuse, value and self-worth, and the essence of real love.”

“Life on Point” is designed to dig deeper into risky activities. The center also proposed bringing five-day abstinence instruction to older teens in high school life skills and health classes.

All of the abstinence-only programs funded under Tennessee’s Affordable Care Act grant had to submit short- and long-term program objectives. Full Circle Women’s long-term goals include curbing rates of teen pregnancy, school dropouts, and STDs in McMinn and Meigs counties, and also a “decrease in percentage of children being raised by single mothers below the poverty line.” Short-term goals include “increased knowledge of STDS and pregnancy risks” and “understanding the lack of effectiveness of condoms/birth control in STD protection and pregnancy.”

To make the case for giving Full Circle money to target 10-to-17-year-olds in McMinn, Meigs, and Polk counties (in southeastern part of the state), Full Circle’s grant application cited statistics showing STD rates among teens are high in the area, including “Tennessee Department of Health reports that the number of reported cases of Chlamydia in McMinn County has increased a staggering 1200% from 1994-2007.”

Full Circle Women’s Services Executive Director Anne Montgomery turned down TAI’s request for an interview.

In line with the eight-point federal guidelines of abstinence education, the other two CPCs receiving Affordable Care Act funding similarly offer plans to educate teens about the repercussions of sexual activity and advocate abstinence as the only means to avoid those repercussions. 

Here is part of how the Women’s Care Center promotes its abstinence program, called The Edge:

While “until marriage” may sound like practically forever, let’s get a little perspective on this. The average age of initial marriage in the United States is 26 years old. That gets even lower in more rural areas. And the payoff of sexual abstinence is that you have the rest of your married life to enjoy your sexuality without having to suffer the consequences of emotional baggage, crotch-crippling STDs, or teen pregnancy. That sounds to me like a pretty good deal.

Among the desired outcomes of Life Choices Pregnancy Resource Center’s abstinence-until-marriage program, Right Choices of West Tennessee, are “increased knowledge regarding the effects of teen sexual behavior and sexually-transmitted diseases” and “increased commitment to abstinence until marriage.”

The directors of Life Choices Pregnancy Support Center and the Women’s Care Center did not return requests for interviews.

Earlier this month, the CDC released new data showing that America’s teen birthrate is the lowest it has been since 1946. The Guttmacher Institute, a proponent of comprehensive sex education, credited that drop, in part, with improvements in contraceptive use.

But Valerie Huber, executive director of the National Abstinence Education Association, said high rates of STDs among teens means the abstinence-only message is still necessary.

“While teen birth rates have reached historic lows, STD rates among teens are at historic highs, so condom-centered education is certainly not sufficient to deal with even the physical consequences of sexual activity since 2 of the 4 most common STDs are easily transmissible with a condom,” Huber told TAI in an email. “Sexual Risk Avoidance (SRA) abstinence education makes sense from a public health perspective and also as an approach that both resonates with teens and protects them from any of the consequences of sexual activity, not the least of which is pregnancy.”

Culture & Conversation Maternity and Birthing

On ‘Commonsense Childbirth’: A Q&A With Midwife Jennie Joseph

Elizabeth Dawes Gay

Joseph founded a nonprofit, Commonsense Childbirth, in 1998 to inspire change in maternity care to better serve people of color. As a licensed midwife, Joseph seeks to transform how care is provided in a clinical setting.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

Jennie Joseph’s philosophy is simple: Treat patients like the people they are. The British native has found this goes a long way when it comes to her midwifery practice and the health of Black mothers and babies.

In the United States, Black women are disproportionately affected by poor maternal and infant health outcomes. Black women are more likely to experience maternal and infant death, pregnancy-related illness, premature birth, low birth weight, and stillbirth. Beyond the data, personal accounts of Black women’s birthing experiences detail discrimination, mistreatment, and violation of basic human rights. Media like the new film, The American Dream, share the maternity experiences of Black women in their own voices.

A new generation of activists, advocates, and concerned medical professionals have mobilized across the country to improve Black maternal and infant health, including through the birth justice and reproductive justice movements.

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Joseph founded a nonprofit, Commonsense Childbirth, in 1998 to inspire change in maternity care to better serve people of color. As a licensed midwife, Joseph seeks to transform how care is provided in a clinical setting.

At her clinics, which are located in central Florida, a welcoming smile and a conversation mark the start of each patient visit. Having a dialogue with patients about their unique needs, desires, and circumstances is a practice Joseph said has contributed to her patients having “chunky,” healthy, full-term babies. Dialogue and care that centers the patient costs nothing, Joseph told Rewire in an interview earlier this summer.

Joseph also offers training to midwives, doulas, community health workers, and other professionals in culturally competent, patient-centered care through her Commonsense Childbirth School of Midwifery, which launched in 2009. And in 2015, Joseph launched the National Perinatal Task Force, a network of perinatal health-care and service providers who are committed to working in underserved communities in order to transform maternal health outcomes in the United States.

Rewire spoke with Joseph about her tireless work to improve maternal and perinatal health in the Black community.

Rewire: What motivates and drives you each day?

Jennie Joseph: I moved to the United States in 1989 [from the United Kingdom], and each year it becomes more and more apparent that to address the issues I care deeply about, I have to put action behind all the talk.

I’m particularly concerned about maternal and infant morbidity and mortality that plague communities of color and specifically African Americans. Most people don’t know that three to four times as many Black women die during pregnancy and childbirth in the United States than their white counterparts.

When I arrived in the United States, I had to start a home birth practice to be able to practice at all, and it was during that time that I realized very few people of color were accessing care that way. I learned about the disparities in maternal health around the same time, and I felt compelled to do something about it.

My motivation is based on the fact that what we do [at my clinic] works so well it’s almost unconscionable not to continue doing it. I feel driven and personally responsible because I’ve figured out that there are some very simple things that anyone can do to make an impact. It’s such a win-win. Everybody wins: patients, staff, communities, health-care agencies.

There are only a few of us attacking this aggressively, with few resources and without support. I’ve experienced so much frustration, anger, and resignation about the situation because I feel like this is not something that people in the field don’t know about. I know there have been some efforts, but with little results. There are simple and cost-effective things that can be done. Even small interventions can make such a tremendous a difference, and I don’t understand why we can’t have more support and more interest in moving the needle in a more effective way.

I give up sometimes. I get so frustrated. Emotions vie for time and energy, but those very same emotions force me to keep going. I feel a constant drive to be in action and to be practical in achieving and getting results.

Rewire: In your opinion, what are some barriers to progress on maternal health and how can they be overcome?

JJ: The solutions that have been generated are the same, year in and year out, but are not really solutions. [Health-care professionals and the industry] keep pushing money into a broken system, without recognizing where there are gaps and barriers, and we keep doing the same thing.

One solution that has not worked is the approach of hiring practitioners without a thought to whether the practitioner is really a match for the community that they are looking to serve. Additionally, there is the fact that the practitioner alone is not going to be able make much difference. There has to be a concerted effort to have the entire health-care team be willing to support the work. If the front desk and access points are not in tune with why we need to address this issue in a specific way, what happens typically is that people do not necessarily feel welcomed or supported or respected.

The world’s best practitioner could be sitting down the hall, but never actually see the patient because the patient leaves before they get assistance or before they even get to make an appointment. People get tired of being looked down upon, shamed, ignored, or perhaps not treated well. And people know which hospitals and practitioners provide competent care and which practices are culturally safe.

I would like to convince people to try something different, for real. One of those things is an open-door triage at all OB-GYN facilities, similar to an emergency room, so that all patients seeking maternity care are seen for a first visit no matter what.

Another thing would be for practitioners to provide patient-centered care for all patients regardless of their ability to pay.  You don’t have to have cultural competency training, you just have to listen and believe what the patients are telling you—period.

Practitioners also have a role in dismantling the institutionalized racism that is causing such harm. You don’t have to speak a specific language to be kind. You just have to think a little bit and put yourself in that person’s shoes. You have to understand she might be in fear for her baby’s health or her own health. You can smile. You can touch respectfully. You can make eye contact. You can find a real translator. You can do things if you choose to. Or you can stay in place in a system you know is broken, doing business as usual, and continue to feel bad doing the work you once loved.

Rewire: You emphasize patient-centered care. Why aren’t other providers doing the same, and how can they be convinced to provide this type of care?

JJ: I think that is the crux of the matter: the convincing part. One, it’s a shame that I have to go around convincing anyone about the benefits of patient-centered care. And two, the typical response from medical staff is “Yeah, but the cost. It’s expensive. The bureaucracy, the system …” There is no disagreement that this should be the gold standard of care but providers say their setup doesn’t allow for it or that it really wouldn’t work. Keep in mind that patient-centered care also means equitable care—the kind of care we all want for ourselves and our families.

One of the things we do at my practice (and that providers have the most resistance to) is that we see everyone for that initial visit. We’ve created a triage entry point to medical care but also to social support, financial triage, actual emotional support, and recognition and understanding for the patient that yes, you have a problem, but we are here to work with you to solve it.

All of those things get to happen because we offer the first visit, regardless of their ability to pay. In the absence of that opportunity, the barrier to quality care itself is so detrimental: It’s literally a matter of life and death.

Rewire: How do you cover the cost of the first visit if someone cannot pay?

JJ: If we have a grant, we use those funds to help us pay our overhead. If we don’t, we wait until we have the women on Medicaid and try to do back-billing on those visits. If the patient doesn’t have Medicaid, we use the funds we earn from delivering babies of mothers who do have insurance and can pay the full price.

Rewire: You’ve talked about ensuring that expecting mothers have accessible, patient-centered maternity care. How exactly are you working to achieve that?

JJ: I want to empower community-based perinatal health workers (such as nurse practitioners) who are interested in providing care to communities in need, and encourage them to become entrepreneurial. As long as people have the credentials or license to provide prenatal, post-partum, and women’s health care and are interested in independent practice, then my vision is that they build a private practice for themselves. Based on the concept that to get real change in maternal health outcomes in the United States, women need access to specific kinds of health care—not just any old health care, but the kind that is humane, patient-centered, woman-centered, family-centered, and culturally-safe, and where providers believe that the patients matter. That kind of care will transform outcomes instantly.

I coined the phrase “Easy Access Clinics” to describe retail women’s health clinics like a CVS MinuteClinic that serve as a first entry point to care in a community, rather than in a big health-care system. At the Orlando Easy Access Clinic, women receive their first appointment regardless of their ability to pay. People find out about us via word of mouth; they know what we do before they get here.

We are at the point where even the local government agencies send patients to us. They know that even while someone’s Medicaid application is in pending status, we will still see them and start their care, as well as help them access their Medicaid benefits as part of our commitment to their overall well-being.

Others are already replicating this model across the country and we are doing research as we go along. We have created a system that becomes sustainable because of the trust and loyalty of the patients and their willingness to support us in supporting them.

Photo Credit: Filmmaker Paolo Patruno

Joseph speaking with a family at her central Florida clinic. (Credit: Filmmaker Paolo Patruno)

RewireWhat are your thoughts on the decision in Florida not to expand Medicaid at this time?

JJ: I consider health care a human right. That’s what I know. That’s how I was trained. That’s what I lived all the years I was in Europe. And to be here and see this wanton disregard for health and humanity breaks my heart.

Not expanding Medicaid has such deep repercussions on patients and providers. We hold on by a very thin thread. We can’t get our claims paid. We have all kinds of hoops and confusion. There is a lack of interest and accountability from insurance payers, and we are struggling so badly. I also have a Change.org petition right now to ask for Medicaid coverage for pregnant women.

Health care is a human right: It can’t be anything else.

Rewire: You launched the National Perinatal Task Force in 2015. What do you hope to accomplish through that effort?

JJ: The main goal of the National Perinatal Task Force is to connect perinatal service providers, lift each other up, and establish community recognition of sites committed to a certain standard of care.

The facilities of task force members are identified as Perinatal Safe Spots. A Perinatal Safe Spot could be an educational or social site, a moms’ group, a breastfeeding circle, a local doula practice, or a community center. It could be anywhere, but it has got to be in a community with what I call a “materno-toxic” area—an area where you know without any doubt that mothers are in jeopardy. It is an area where social determinants of health are affecting mom’s and baby’s chances of being strong and whole and hearty. Therein, we need to put a safe spot right in the heart of that materno-toxic area so she has a better chance for survival.

The task force is a group of maternity service providers and concerned community members willing to be a safe spot for that area. Members also recognize each other across the nation; we support each other and learn from each others’ best practices.

People who are working in their communities to improve maternal and infant health come forward all the time as they are feeling alone, quietly doing the best they can for their community, with little or nothing. Don’t be discouraged. You can get a lot done with pure willpower and determination.

RewireDo you have funding to run the National Perinatal Task Force?

JJ: Not yet. We have got the task force up and running as best we can under my nonprofit Commonsense Childbirth. I have not asked for funding or donations because I wanted to see if I could get the task force off the ground first.

There are 30 Perinatal Safe Spots across the United States that are listed on the website currently. The current goal is to house and support the supporters, recognize those people working on the ground, and share information with the public. The next step will be to strengthen the task force and bring funding for stability and growth.

RewireYou’re featured in the new film The American Dream. How did that happen and what are you planning to do next?

JJ: The Italian filmmaker Paolo Patruno got on a plane on his own dime and brought his cameras to Florida. We were planning to talk about Black midwifery. Once we started filming, women were sharing so authentically that we said this is about women’s voices being heard. I would love to tease that dialogue forward and I am planning to go to four or five cities where I can show the film and host a town hall, gathering to capture what the community has to say about maternal health. I want to hear their voices. So far, the film has been screened publicly in Oakland and Kansas City, and the full documentary is already available on YouTube.

RewireThe Black Mamas Matter Toolkit was published this past June by the Center for Reproductive Rights to support human-rights based policy advocacy on maternal health. What about the toolkit or other resources do you find helpful for thinking about solutions to poor maternal health in the Black community?

JJ: The toolkit is the most succinct and comprehensive thing I’ve seen since I’ve been doing this work. It felt like, “At last!”

One of the most exciting things for me is that the toolkit seems to have covered every angle of this problem. It tells the truth about what’s happening for Black women and actually all women everywhere as far as maternity care is concerned.

There is a need for us to recognize how the system has taken agency and power away from women and placed it in the hands of large health systems where institutionalized racism is causing much harm. The toolkit, for the first time in my opinion, really addresses all of these ills and posits some very clear thoughts and solutions around them. I think it is going to go a long way to begin the change we need to see in maternal and child health in the United States.

RewireWhat do you count as one of your success stories?

JJ: One of my earlier patients was a single mom who had a lot going on and became pregnant by accident. She was very connected to us when she came to clinic. She became so empowered and wanted a home birth. But she was anemic at the end of her pregnancy and we recommended a hospital birth. She was empowered through the birth, breastfed her baby, and started a journey toward nursing. She is now about to get her master’s degree in nursing, and she wants to come back to work with me. She’s determined to come back and serve and give back. She’s not the only one. It happens over and over again.

This interview has been edited for length and clarity.

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.