Roundups Sexual Health

Sexual Health Roundup: Blacks, Latinos Support Contraception; Mississippi Chooses Failed Sex Ed Programs

Martha Kempner

New poll finds African Americans and Latinos support broad access to contraception and sex education; Mississippi school districts overwhelmingly choose failed sex ed.

Poll Shows Wide Support for Contraception and Sex Ed Among Blacks and Latinos

In this election year in which birth control is front and center and both side are courting the African-American and Hispanic vote, there is new information that suggests a majority of people in these communities support access to contraception and sex education.

The Public Religion Research Institute (PRRI) surveyed a random sample of 810 non-Hispanic black American adults and 813 Hispanic American adults who are part of the Knowledge Networks’ KnowledgePanel. Interviews were conducted online in English among the black American sample and in both English and Spanish among the Hispanic sample. The poll focused on views about abortion and contraception, and also asked about sex education. Below are some of the findings.

Findings on Abortion

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  • 67 percent of black Americans and 46 percent of Hispanic Americans believe that abortion should be legal in all or most cases.
  • 51 percent of black Americans believe having an abortion is morally wrong compared to 33 percent who believe it is morally acceptable while 61 percent of Hispanic Americans believe that having an abortion is morally wrong compared to 25 percent who believe it is morally acceptable.
  • 78 percent of black Americans and 60 percent of Hispanic Americans believe that it is possible to disagree with their religion’s teachings on abortion and still be considered a person of good standing in their faith.
  • 72 percent of both black Americans and Hispanic Americans say that the concept of “not judging other people” is important in shaping their views on abortion. Similarly, 69 percent of both black Americans and Hispanic Americans believe that the concept of “showing compassion for women in difficult circumstances” is very important in shaping their views on the issue of abortion. In addition, 70 percent of Hispanic Americans and 63 percent of black Americans say that the concept of “promoting personal responsibility” is a very important value shaping their views on the legality of abortion. 

Findings on Contraception

  • 81 percent of black Americans and 79 percent of Hispanic Americans believe contraception is morally acceptable and strongly support expanding access to it.
  • 61 percent of black Americans and 64 percent of Hispanic Americans say that religiously affiliated colleges and hospitals should be required to provide their employees with birth control at no cost.
  • 92 percent of black Americans and 85 percent of Hispanic Americans favor expanding birth control access for women who cannot afford it.
  • 59 percent of black Americans and 54 percent of Hispanic Americans believe that methods of birth control should be available to teenagers age 16 and older without parental approval.

Findings on Sex Education

  • 84 percent of black Americans and 79 percent of Hispanic Americans support comprehensive sex education in public schools.

Jessica González-Rojas, executive director of the National Latina Institute for Reproductive Health, said these results show that:

Contrary to many troubling news narratives, we know that Latino/as have compassionate views on abortion…The bottom line is that most Latino/as believe a woman has the right to make personal, private decisions about abortion, without politicians interfering and that we shouldn’t judge someone who feels they’re not ready to be a parent.

Mississippi Schools Pick Their Sex Education; Majority Chose an Abstinence-Only Approach

A few months ago, I noted that Mississippi school districts were up against a deadline imposed by a new law that required districts to choose between an abstinence-only approach and a slightly broader abstinence-plus approach. Though both approaches seem to be grounded in a philosophy that believes abstinence-until-marriage is best, districts that choose “abstinence-plus” can also addresses additional topics such as “the nature, causes and effects of sexually transmitted diseases,” and other aspects of STD/HIV-prevention education.

Regardless of which approach a school districts takes, students cannot be taught that “abortion can be used to prevent the birth of a baby;” all classes must be separated by sex; and students must present a signed permission slip from their parents before they can attend. This referred to as an “opt-in” policy and is in place in very few states.

With these parameters in mind, 81 school districts chose the abstinence-only approach, 71 chose abstinence-plus, and three chose to take a split approach with abstinence-only programs for younger students and abstinence-plus for older grades. The state’s largest school district, DeSoto County, chose abstinence-only but the second-largest district, in the city of Jackson, chose abstinence-plus. Interestingly, the state Board of Education chose abstinence-plus for the four specialty schools it governs.

Mississippi consistently has the highest teen pregnancy and birth rates in the country and a 2011 study found that births to teen or preteen mothers cost the state $154.9 million in 2009. Despite this and the overwhelming evidence that abstinence-only programs are not effective, the state’s governor “has said repeatedly that he believes abstinence-only is the best approach to teaching young people about sex.”

And while that approach did win out, many schools did choose to take the broader approach. Jamie H. Bardwell, program director for the Women’s Fund, an advocacy group that supports more comprehensive sexuality education, said

We are pleased and excited that so many districts decided to go with abstinence-plus. It definitely shows a need and a desire for more than just abstinence-only. It reflects the reality that 76 percent of Mississippi 12th-graders have already had sex.

New Vaginal Ring May Protect Women from HIV

There is more potentially good news in the fight to prevent HIV. A vaginal ring designed to protect women against HIV infection is undergoing a large, multinational trial. The silicone ring is similar to the vaginal birth control ring, it is inserted into the vagina and sits near the cervix for a month after which time it is removed and replaced.  This ring releases “an experimental antiretroviral drug to prevent HIV infection.”

A number of health institutions, including the U.S. National Institutes of Health, are working together to test the ring on over 3,000 participants in five countries; Malawi, South Africa, Uganda, Zambia, and Zimbabwe.  In this blind study, women ages 18 to 45 who are not HIV infected will receive a vaginal ring –some with the antiretroviral drug and others with a placebo. All participants will also receive regular counseling on how to prevent HIV as well as HIV testing.    

Public health experts are excited about the possibility of the ring as it provides women with a method of prevention that, unlike condoms, they have control over.  The rings can even be used without their partner’s knowledge.

Results of the study are expected in 2015.     

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.

Commentary Sexual Health

Fewer Young People Are Getting Formal Sex Education, But Can a New Federal Bill Change That?

Martha Kempner

Though the Real Education for Healthy Youth Act has little chance of passing Congress, its inclusive and evidence-based approach is a much-needed antidote to years of publicly funded abstinence-only-until-marriage programs, which may have contributed to troubling declines in youth knowledge about sexual and reproductive health.

Recent research from the Guttmacher Institute finds there have been significant changes in sexuality education during the last decade—and not for the better.

Fewer young people are receiving “formal sex education,” meaning classes that take place in schools, youth centers, churches, or community settings. And parents are not necessarily picking up the slack. This does not surprise sexuality education advocates, who say shrinking resources and restrictive public policies have pushed comprehensive programs—ones that address sexual health and contraception, among other topics—out of the classroom, while continued funding for abstinence-only-until-marriage programs has allowed uninformative ones to remain.

But just a week before this research was released in April, Sen. Cory Booker (D-NJ) introduced the Real Education for Healthy Youth Act (REHYA). If passed, REHYA would allocate federal funding for accurate, unbiased sexuality education programs that meet strict content requirements. More importantly, it would lay out a vision of what sexuality education could and should be.

Can this act ensure that more young people get high-quality sexuality education?

In the short term: No. Based on the track record of our current Congress, it has little chance of passing. But in the long run, absolutely.

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Less Sexuality Education Today

The Guttmacher Institute’s new study compared data from two rounds of a national survey in the years 2006-2010 and 2011-2013. It found that even the least controversial topics in sex education—sexually transmitted diseases (STDs) and HIV and AIDS—are taught less today than a few years ago. The proportion of young women taught about STDs declined from 94 percent to 90 percent between the two time periods, and young women taught about HIV and AIDS declined from 89 percent to 86 percent during the same period.

While it may seem like a lot of young people are still learning about these potential consequences of unprotected sex, few are learning how to prevent them. In the 2011-2013 survey, only 50 percent of teen girls and 58 percent of teen boys had received formal instruction about how to use a condom before they turned 18. And the percentage of teens who reported receiving formal education about birth control in general decreased from 70 percent to 60 percent among girls and from 61 percent to 55 percent among boys.

One of the only things that did increase was the percentage of teen girls (from 22 percent to 28 percent) and boys (from 29 to 35 percent) who said they got instruction on “how to say no to sex”—but no corresponding instruction on birth control.

Unfortunately, many parents do not appear to be stepping in to fill the gap left by formal education. The study found that while there’s been a decline in formal education, there has been little change in the number of kids who say they’ve spoken to their parents about birth control.

Debra Hauser, president of Advocates for Youth, told Rewire that this can lead to a dangerous situation: “In the face of declining formal education and little discussion from their parents, young people are left to fend for themselves, often turning to their friends or the internet-either of which can be fraught with trouble.”

The study makes it very clear that we are leaving young people unprepared to make responsible decisions about sex. When they do receive education, it isn’t always timely: It found that in 2011-2013, 43 percent of teen females and 57 percent of teen males did not receive information about birth control before they had sex for the first time.

It could be tempting to argue that the situation is not actually dire because teen pregnancy rates are at a historic low, potentially suggesting that young people can make do without formal sex education or even parental advice. Such an argument would be a mistake. Teen pregnancy rates are dropping for a variety of reasons, but mostly because because teens are using contraception more frequently and more effectively. And while that is great news, it is insufficient.

Our goals in providing sex education have to go farther than getting young people to their 18th or 21st birthday without a pregnancy. We should be working to ensure that young people grow up to be sexually healthy adults who have safe and satisfying relationships for their whole lives.

But for anyone who needs an alarming statistic to prove that comprehensive sex education is still necessary, here’s one: Adolescents make up just one quarter of the population, but the Centers for Disease Control and Prevention estimate they account for more than half of the 20 million new sexually transmitted infections (STIs) that occur each year in this country.

The Real Education for Healthy Youth Act

The best news about the REHYA is that it takes a very broad approach to sexuality education, provides a noble vision of what young people should learn, and seems to understand that changes should take place not just in K-12 education but through professional development opportunities as well.

As Advocates for Youth explains, if passed, REHYA would be the first federal legislation to ever recognize young people’s right to sexual health information. It would allocate funding for education that includes a wide range of topics, including communication and decision-making skills; safe and healthy relationships; and preventing unintended pregnancy, HIV, other STIs, dating violence, sexual assault, bullying, and harassment.

In addition, it would require all funded programs to be inclusive of lesbian, gay, bisexual, and transgender students and to meet the needs of young people who are sexually active as well as those who are not. The grants could also be used for adolescents and young adults in institutes of higher education. Finally, the bill recognizes the importance of teacher training and provides resources to prepare sex education instructors.

If we look at the federal government’s role as leading by example, then REHYA is a great start. It sets forth a plan, starts a conversation, and moves us away from decades of focusing on disproven abstinence-only-until-marriage programs. In fact, one of the fun parts of this new bill is that it diverts funding from the Title V program, which received $75 million dollars in Fiscal Year 2016. That funding has supported programs that stick to a strict eight-point definition of “abstinence education” (often called the “A-H definition”) that, among other things, tells young people that sex outside of marriage is against societal norms and likely to have harmful physical and psychological effects.

The federal government does not make rules on what can and cannot be taught in classrooms outside of those programs it funds. Broad decisions about topics are made by each state, while more granular decisions—such as what curriculum to use or videos to show—are made by local school districts. But the growth of the abstinence-only-until-marriage approach and the industry that spread it, researchers say, was partially due to federal funding and the government’s “stamp of approval.”

Heather Boonstra, director of public policy at the Guttmacher Institute and a co-author of its study, told Rewire: “My sense is that [government endorsement] really spurred the proliferation of a whole industry and gave legitimacy—and still does—to this very narrow approach.”

The money—$1.5 billion total between 1996 and 2010—was, of course, at the heart of a lot of that growth. School districts, community-based organizations, and faith-based institutions created programs using federal and state money. And a network of abstinence-only-until-marriage organizations grew up to provide the curricula and materials these programs needed. But the reach was broader than that: A number of states changed the rules governing sex education to insist that schools stress abstinence. Some even quoted all or part of the A-H definition in their state laws.

REHYA would provide less money to comprehensive education than the abstinence-only-until-marriage funding streams did to their respective programs, but most advocates agree that it is important nonetheless. As Jesseca Boyer, vice president at the Sexuality Information and Education Council of the United States (SIECUS), told Rewire, “It establishes a vision of what the government could do in terms of supporting sex education.”

Boonstra noted that by providing the model for good programs and some money that would help organizations develop materials for those programs, REHYA could have a broader reach than just the programs it would directly fund.

The advocates Rewire spoke with agree on something else, as well: REHYA has very little chance of passing in this Congress. But they’re not deterred. Even if it doesn’t become law this year, or next, it is moving the pendulum back toward the comprehensive approach to sex education that our young people need.

CORRECTION: This article has been updated to clarify Jesseca Boyer’s position at the Sexuality Information and Education Council of the United States.