Commentary Sexual Health

Rates of HIV and Teen Pregnancy Highlight Sexual Health Education Gap Among Jamaica’s Youth

Gwen Emmons

HIV won’t disappear overnight. Unintended pregnancy won’t magically cease. But by working with and through young people to gradually change Jamaicans’ access to sexual and reproductive health information and services, JFPA is ensuring that the next generation of Jamaicans will be knowledgeable and empowered to demand and the care they deserve.

Until just six years ago, sex education was virtually invisible in some of Jamaica’s secondary schools. Even after the Ministry of Education incorporated sexuality and sexual health information into the curricula of the nation’s schools in 2006, young people still weren’t getting all the facts they needed make informed and healthy choices.

The long-held taboos in Jamaican culture that prevent people from talking openly about sex die hard. Teachers who were raised in an era when issues of sex and sexuality were met with silence find it challenging to overcome years of socialization to deliver the material in the new curriculum to students. They get tongue-tied when talking about certain aspects of sexuality or intentionally leave out information that they believe may encourage young people to become sexually active.

The teachers aren’t alone in their views. There are others who share their concerns throughout the country. Parents, community members, church leaders, and even teens themselves lack access not only to basic sexuality information, but also guidance about how to talk about it. These cultural obstacles mean that many Jamaican youth recieve  incomplete or inaccurate information about sex, putting them at risk for unintended pregnancy and sexually transmitted infections, including HIV.

The increased risk of HIV among Jamaica’s youth was a particularly compelling reason for local officials to decide to incorporate sexuality education programming into secondary school curricula. Recent data show that 1.7 percent of Jamaicans between 15-49 years old are living with HIV and the region is second only to sub-Saharan Africa in the rate of HIV infections. Early initiation of sexual activity, unprotected sex, sexual abuse, multiple partners, and transactional sex with older men leave Jamaica’s teen women more than three times as likely to contract HIV than teen men. Lack of knownledge of the basics of transmission, or how to keep themselves safe, presents a huge barrier to protecting adolescents.

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“If we do not teach our kids about sex, we will be receiving kids who are HIV-positive or pregnant, and we are putting them into the grave if we do not educate them properly,” Easton Williams, head of the Planning Institute of Jamaica’s Social Policy, Planning, and Research division noted at a recent  World Population Day symposium.

Realizing that a holistic and accurate sex education program relies on more than just the school system, NGOs have stepped in to fill the gap. The Jamaica Family Planning Association (JFPA) is one organization working to empower young people–and the institutions that serve them–to access sexual and reproductive health services. “Youth is a priority area of work at JFPA,” says St. Rachel Ustanny, JFPA Executive Director.  “[Our work] builds young people’s capacity to access sexual and reproductive health services and make informed decisions. We promote access to services as a human right.”

The belief that having access to sexual health services is a human right, and not just information about the biology of reproduction, guides JFPA’s Youth Advocacy Movement (YAM). YAM meets young people where they are – in schools – and offers safe, peer-directed spaces where adolescents can receive additional sexuality education from people their own age and ask questions they might be too timid to ask their teachers during class. Since many teens look to peers for information on sexuality and sexual health, several NGOs across Jamaica rely on peer-driven programs like YAM to share sexual health information.

“Establishing the YAM in schools is an attempt to increase youth access to sexual and reproductive health information. By carrying out its work within schools, rather that requiring students visit the JFPA clinic, the young people are better able to have successful meetings and educate their peers,” Ustanny says.  

The YAM curriculum complements what is taught in Jamaica’s Health and Family Life Education program. It uses dynamic methods to convey information, including computer games, round-table discussions, and film. JFPA peer health educators connect young people to resources within their schools and in their communities, including giving referrals to JFPA clinics in St. Ann’s Bay, Montego Bay, and Kingston. YAM also seeks to rally support for youth sexual and reproductive health services among Jamaicans of all ages.

Students who attend YAM meetings share information with their peers and communities, extending JFPA’s reach beyond the three schools in which they work. They are also encouraged to bring the information home to their families. This dissemination process beings valuable feedback to JFPA on which resources and services young people in Jamaica need, which allows them to tailor their programs and services to best meet the needs of youth and make the case to government officials for more funding.

“It’s important to develop broad-based support among young people to advocate for their sexual and reproductive rights,” Ustanny notes. “Without this support, the advocacy work is patronizing and will result in decisions that are not congruent to the needs of young people.”  

Comprehensive sex education advocates like Ustanny scored a major victory when the Ministry of Health mandated that sex education be taught in primary and secondary schools. But it’s clear that the Jamaican government isn’t doing all they can to transform that mandate into a reality for Jamaican students. Only a few teacher training institutions offer HFLE curriculum training, so many new teachers graduate from their training programs without knowing the most effective ways to engage their students on this subject matter. And while the Ministry of Health has been offering workshops to train teachers in HFLE, it’s unclear how many teachers are taking advantage of these workshops–or how effective they are in helping teachers overcome cultural taboos on talking about sex.

The Ministry of Health has also restricted some funding avenues for sexual health services, making it challenging for NGOs to expand their work. JFPA used to provide free vaccines in their clinics, thanks to government funding. However, JFPA is now considered a private facility by the Ministry of Health and is no longer eligible for the free vaccine distribution program. Furthermore, limited funding opportunities across the country mean that NGOs like JFPA must make difficult choices about their programs. JFPA can only host the YAM in a few schools because funding is so tight, limiting the reach of a valuable, high impact program. Panelists at the recent symposium also noted that pregnant teenage women still lack the supports they need to complete high school–surely an issue the government could champion, if they were willing to devote additional resources to it.

The high level of bureaucracy in Jamaica’s government makes it nearly impossible for activists and NGOs to reach key officials–effectively isolating decision makers from those who are working on the ground. Ustanny reports that she must wait nearly nine months –or more–before Ministers will schedule meetings with JFPA. Her letter to the Ministry of Health about the vaccine distribution program, for example, has gone unanswered for 11 months now.  The follow up process eats up NGOs’ time and resources, Ustanny says, but the meetings are one of few avenues NGOs have for making their case to the government. This inaccessibility raises serious questions about how committed government officials are about implementing change on behalf of Jamaica’s students. But since the Jamaican government is the gatekeeper to funding opportunities, policy changes, and the like, NGOs are reluctant to publicly critique these practices.

More alarmingly, though, the very cultural taboos that challenge Jamaica’s sex education program are ingrained in the Jamaican government, coloring policy decisions and putting adolescents at risk. Jamaica has the highest adolescent fertility rate among English-speaking Caribbean nations, at 112 per 1,000 women ages 15 to 19 – and over 1 percent of Jamaica’s teens have HIV, according to Advocates for Youth.  Yet the government remains entrenched in a years-long debate about permitting schools to distribute condoms. Instead, school administrators must refer students to off-campus resources, an extra step and an added burden for teens trying to make informed decisions about their sexual health.

These challenges reaffirm Ustanny’s commitment to adolescent sexual health. And through the YAM program, she’s helping to inform a new generation of Jamaicans – future educators, parents, and government officials–who can talk freely about sexual and reproductive health. HIV won’t disappear overnight. Unintended pregnancy won’t magically cease. But by working with and through young people to gradually change Jamaicans’ access to sexual and reproductive health information and services, JFPA is ensuring that the next generation of Jamaicans will be knowledgeable and empowered to demand and the care they deserve.

News Sexual Health

Alaska Bill Restricts Sexual Health Education in Schools

Nina Liss-Schultz

Alaska lawmakers are moving forward with a bill that would bar Planned Parenthood outreach programs from teaching sex education in public schools and allow parents to opt their children out of sex education classes and standardized testing.

Alaska lawmakers are moving forward with a bill that would bar Planned Parenthood outreach programs from teaching sex education in public schools and allow parents to opt their children out of sex education classes and standardized testing.

Proponents of the bill, SB 89, say the legislation is about protecting parents’ freedom to “direct the education of a child,” according to the bill’s text.

“Parents have rights, parents have always had rights, those rights have never been extinguished, it’s the basis of what our country is built upon,” state Sen. Mike Dunleavy (R-Mat-Su Valley), who introduced the bill, told KTUU.

The bill, introduced in late March, originally included language that would allow parents to withdraw their children from any portion of school, including standardized testing, that the “parent believes is harmful to the child.”

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The material considered potentially harmful by the bill’s authors? Any activity that might question “beliefs involving human reproduction, health, or sex education.”

After a week of back-and-forth, the senate education committee approved the bill on April 9 with additional language that would prohibit Planned Parenthood from participating in sex education in schools.

Dunleavy said during a committee meeting that the bill is not about restricting Planned Parenthood. “We’re not outlawing abortion services providers. We’re saying, ‘Take it out of the school,'” he said.

Though the bill does not specifically mention the organization, officials from Planned Parenthood of the Great Northwest and Hawaii, which has provided sexual health education in Alaska for more than 20 years, said in a statement that the proposal is specifically targeted at them.

“Countless women, men, and teens have turned to us to provide nonjudgmental, unbiased, medically accurate information and education on reproductive health and relationships,” said Jessica Cler, Alaska public affairs manager at Planned Parenthood Votes Northwest. “These facts are apparently irrelevant to certain legislators who are so blinded by their hatred of Planned Parenthood that they will put the health of Alaska youth at risk.”

“We fill an important gap left by the state’s inaction on ensuring students have access to the information they need to make educated decisions about relationships and sex,” Cler said. “Until the state steps up in providing medically accurate sexual health education to all students, communities rely on us to provide that information.”

Both chambers of the Alaska legislature are dominated by Republicans.

Analysis Sexual Health

Millennial Attitudes on Reproductive and Sexual Health Show Promise for Advocates

Elizabeth Dawes Gay

A new survey suggests that advocates have an opportunity to engage millennials in working toward unfettered access to reproductive health information and services.

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

Last week, the Public Religion Research Institute (PRRI)—a nonprofit, nonpartisan organization that conducts research to better understand debates on public policy issues—released its new survey, How Race and Religion Shape Millennial Attitudes on Sexuality and Reproductive Health. One of the largest of its kind, the survey sought to examine how race, religion, and politics shape young people’s attitudes on reproductive and sexual health, as well as on morality and stigma.

Millennials—young adults born in the 1980s and 1990s—came of age during a time when antibiotic-resistant sexually transmitted infections became a public health threat, racial disparities in reproductive and sexual health outcomes persisted, and politicians continued to systematically deny and attack their ability to access sexual health information and health care services, such as contraception and abortion. That may be why, when compared to the general public, so many of the 2,314 young adults ages 18-to-35 in the survey were less likely to identify with either of the two major political parties, and have a pessimistic view about the direction of the country.

Also, my generation is the first generation to have not known a world before the risk of HIV and AIDS became a widely known epidemic—a sobering reminder of the context in which today’s young people were born and still live. This could explain why 87 percent of millennials believe health plans should cover HIV and STD testing.

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Fortunately, the report suggests that millennial attitudes about reproductive and sexual health are promising, especially around sexual health education, contraception, and abortion. Further, the findings of this poll and others published recently suggest advocates have an opportunity to engage millennials—estimated to be the nation’s largest living generation—in working toward unfettered access to reproductive health information and services.

Sex Ed

Seventy-five percent of millennials surveyed support comprehensive sex education in public schools. They want accurate information about their bodies, about sex and relationships, and about how to protect their health. That’s a big deal because one in four of those surveyed were not taught any sex education, and, among those who were, four in ten said their sex ed classes were not helpful to them in making sex and relationship decisions. In a nation where half of states require health educators emphasize abstinence-only, our policymakers are clearly out of touch with what young people want and needcomprehensive sex health education that is scientifically accurate and teaches young people how to protect themselves and have healthy relationships.

SisterReach, an organization based in Memphis, Tennessee, focused on empowering Black women and girls around their reproductive and sexual health, also released a report last week that emphasizes the need for comprehensive sex education, especially in a state that promotes abstinence-only education. The report, Our Voices and Experiences Matter, found that misinformation often fills the gaps abstinence-only education leaves behind. According to the report, one teen in a focus group said, “Guys talk about trying to make their own condoms—Saran Wrap.”

The focus groups found that teens, their parents, and their teachers show a desire and need for curriculum that provides young people with scientifically accurate information and equips them to make healthy decisions.  The report concludes that Tennessee must change its sex ed curriculum and include input from young people, parents, and teachers.

Lack of appropriate and accurate sexual health education ultimately affects the health and life outcomes of the young people. For example, researchers found that young people who received comprehensive sex ed were less likely to report pregnancy than those who received abstinence-only education.


According to the report, millennials want access to contraception even more than they want comprehensive sex education taught in public schools. More than half (55 percent) of those surveyed are opposed to requiring a prescription for emergency contraception. Seventy-eight percent support making all forms of contraception readily available on college campuses, and 82 percent think prescription birth control should be covered by health insurance. Additionally, 81 percent support increasing access to contraception for women who cannot afford it. The availability and affordability of contraception matters to millennials and a large majority—both Democratic and Republican millennials alike—believe using contraception is morally acceptable.

Support for the increased availability and affordability of contraception is nothing new. Specifically, a 2013 poll found that African Americans of all ages and religious and political affiliations overwhelmingly view contraception as basic health care that should be covered, along with testing for sexually transmitted infections and abortion care, by health insurance.

All of this recent research suggests millennials want to decide whether and when to have children, and want people to have ready access to the information and services they need to carry out their decisions.


At first glance, survey respondents appear to be divided ideologically among religious and political lines when it comes to abortion, but a closer look yields some encouraging insights. Amongst all respondents, just over half (55 percent) think abortion should be legal in all or most cases and oppose making abortion more difficult to obtain. But those who know someone who had an abortion are more likely to oppose restricting access to safe abortion care. Among those who have had an abortion themselves, 73 percent oppose making it more difficult to access, and 79 percent say abortion should be legal in all or most cases.

Data from the reproductive health field confirm that individuals are willing to be non-judgmental and support those who seek abortion care. As recently as 2014, polling commissioned by the National Latina Institute for Reproductive Health showed that—among Latino voters in Texas—78 percent agree that a woman has the right to make her own personal decisions about abortion, and eight in ten would offer support to a loved one who had an abortion.

These data, as well as other data in the PRRI report not covered here, demonstrate that individual reproductive and sexual health decision making is important to young people and that they value having access to helpful information and health-care services. In fact, millennials are speaking up online, in the streets, and even on the steps of the U.S. Supreme Court to fight for the health care they need. As a generation that was born into a world with a growing number of health concerns and lives in a political environment that is hostile to reproductive health decisions, millennials recognize there is still a great deal of progress to be made. Our engagement, our advocacy, and our votes could turn the tide.

There will be opportunities to use this and other data to inform reproductive and sexual health policymaking. I hope those opportunities are taken and include the voices and perspectives of young people, because they could help improve the health outlook in the country for generations to come.