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The Evolving State of Sexuality Education Around the World

The Evolving State of Sexuality Education Around the World

By Steph Auteri | From the August 2015 Issue

This month's feature delves into our history of defining sexual health, and into all of the manifold considerations that go into that process. If you've already read our feature, you've seen that this history shows a clear evolution in thinking, an evolution in which sexuality has finally begun to be seen as an integral part of overall health and well-being. It's an interesting evolution to observe as, concurrently, sexuality education offerings—at least within the context of traditional educational settings—have seemed to devolve.

In this piece, we look at the limitations those teaching sexuality within the educational system often come up against, both in the United States and abroad, and also explore the alternative forms of education that have begun to crop up that provide a more holistic view of sexuality, one that acknowledges that sexuality starts in the womb and proceeds all the way to the tomb.

Sexuality Education for Adolescents

Heather Boonstra, Director of Public Policy at the Guttmacher Institute, conducts research on adolescence as it relates to sexual and reproductive health. She and her team have tracked the teen pregnancy rate going back to the early 1970s, and have looked at the predominance of premarital sex going all the way back to the 1940s. They then bring their research findings to policy makers, which can sometimes have an effect on the sexuality education that is then made available to various populations.

"A lot of these decisions are made at the local level," says Boonstra. "It's very hard to track policies and what's happening in the classroom." But Boonstra is able to give a general overview of the U.S. approach to sexuality education based upon our goals over time.

"The problem of teen pregnancy really became a problem in the 1960s and '70s," says Boonstra. "As people started to marry later, this rose to the level of a social problem. Sexuality education as we know it grew out of a need to solve this teen pregnancy problem. And then also the AIDS crisis. People started to look to the schools to educate the public on HIV and AIDS."

Still, the federal government wasn't very involved in sexuality education until the creation of a small chastity program, which died out but eventually led to the Title V State Abstinence Education Grant Program. Billions of dollars in federal money have been spent on this program over the course of a decade. It promotes abstinence until marriage and talks about contraception only in terms of their failure rates.

In time, it was found that these programs were ineffective. As a result, there was an attempt to shift the funds being used for these programs to more evidence-based approaches. Congress ultimately stepped in and, in the end, both types of programs were funded. "So we've ended up with this kind of bifurcated system," says Boonstra.

In 2012, the Journal of School Health published the National Sexuality Education Standards: Core Content and Skills, K - 12. This document was the result of an ongoing initiative called the Future of Sex Education (FoSE). Forty individuals from the fields of health education, sexuality education, public health, public policy, philanthropy, and advocacy convened for a two-day meeting in December 2008 in order to create a strategic plan for sexuality education policy and implementation. This team of professionals hoped to address the inconsistent implementation of sexuality education nationwide, in addition to the limited time allocated to teaching the topic. What they developed contains suggestions for "minimum, essential content and skills" for sexuality education across the span of a K - 12 education. Suggestions were based upon professional expertise and research.

But if we look at sexuality education on a state-by-state basis, we see that programs across the country continue to be inconsistent. The Guttmacher Institute recently published a document that gives an overview of state policies in regard to sex and HIV education. Among the highlights of this document:

  • Only 22 states and the District of Columbia mandate sex education.
  • Only 27 states and the District of Columbia mandate that, when sex education is provided, it must meet certain general requirements.
  • Of these 27 states, 13 require that the instruction be medically accurate.
  • 18 states and the District of Columbia require that information on contraception be provided.
  • 25 states require that abstinence be stressed.

You can find more statistics within the document itself, including a breakdown of these statistics by state. The National Conference of State Legislatures (NCSL) has also published information about state policies on their website, providing more in depth information on the legislature adopted within each state.

Sexuality Education for Professionals

What all of this means is that, going into adulthood, people continue to have a limited grasp on sexuality and sexual health. This becomes much more than just a personal problem when one decides to pursue a profession in which sexuality is an essential component.

In an article published in the Journal of Sexual Medicine in 2008, survey responses showed that the majority of medical students (75.2 percent) felt that taking sexual history would be an important part of their future careers, yet only 57.6 percent felt adequately trained to do so. In addition, 68.8 percent felt that addressing and treating sexual concerns would likely be an important part of their careers, yet only 37.6 percent felt adequately trained to do so.

A more recent piece resulting from a summit on medical school education in the area of sexual health, also published in the Journal of Sexual Medicine, provided further information that still found educational offerings lacking. The authors of this report referenced a 2003 study of 101 U.S. medical schools, wherein it was found that most medical schools provided only 3 - 10 hours of instruction on the topic of sexuality. It mentioned that, out of the 101 schools, human sexuality courses were offered in only 31 of them, and required by only 26 of the schools that responded. The authors also reported that, of the sexual health curricula that do exist, there is "little consensus about the content and skills students should master."

There have been some attempts to improve the state of sexuality education within medical schools. In 2009, the Journal of Sexual Medicine published a study containing recommendations for improving sexual health curricula. In 2010, the International Society for Sexual Medicine education committee met to develop global standards on sexual health education in medical schools. In 2011, Public Health Reports published a piece that offered suggestions on how this lack might be improved upon. But this fight can often be an uphill battle.

"Some schools do incorporate sexuality into the medical curriculum," says Beverly Whipple, Ph.D., RN, FAAN, a certified sexuality educator, "but it's not where it used to be, and we have so much more information now that I think it's important to disseminate." And it's not just the schools themselves, and the limited curricula, that are holding professionals back. "One of the things we're working on right now, with the National Coalition for Sexual Health (NCSH)," says Whipple, "is incorporating sexual health as part of health assessments. I'm finding there's resistance from many physicians."

This resistance is something we've covered in previous issues of Contemporary Sexuality. Just over a year ago, in the June 2014 issue of Contemporary Sexuality, we published a piece on "How Sexuality and Non-Sexuality Professionals Can Better Work Together," touching upon the ways in which a variety of professionals might further educate themselves on issues of sexuality. And it's a topic that seems to come up again and again.

What's Happening Abroad

With all of the limitations that have been placed upon sexuality education programs in the United States, it has become quite common to imagine all other countries as Edenic bastions of open-mindedness. Are these beliefs well-founded? The answer: it depends.

Patti Britton, Ph.D., A.C.S.E. and an AASECT Past President is a sexologist and sex coach who leads Sexual Attitude Reassessments (SARs) around the world. In some countries, in which religion plays a large part in cultural attitudes and behaviors, "sexuality education is fear-based," says Britton. "There is so much guilt and shame and fear imbued in people because they don't have any place where they can get permission to accept themselves as sexual beings."

Britton says that, in these countries, the approach toward sexuality education is similar to what we find in the United States. "This is a very conservative country," Britton says of the U.S. "In this and in other very religiously conservative countries... their religion and their culture dictate a norm that prohibits conversation or discussion about sexuality. In very few parts of the world is comprehensive sexuality education the norm," says Britton.

AASECT's International Regional Representative, D. Narayana Reddy, M.D., Ph.D. admits that, in India, he and other sexuality educators "have to walk a tightrope."

"This is because, of late, a number of fringe and fundamentalist groups have cropped up with an eye on publicity and sensationalism," says Reddy. "Even if the government wants to implement sexual health programs in schools and colleges, the opposition political parties raise objections. They oppose not because they are against the education, per se, but they have to oppose because they are in opposition. Most of them do not even know about the components of sexual health education. Yet they blindly oppose it. So sexual health educators have to work with a lot of constraints and make sure that they do not tread on the toes of these fringe groups."

Boonstra, who published a piece in the Guttmacher Policy Review on sexuality education in developing countries, speaks of how the huge influx of funding for abstinence-only-until-marriage programs lends them an added legitimacy abroad. True Love Waits, for example, a faith-based approach to sexuality education, is U.S.-based, but now has become popular in other countries. "The basic idea of abstinence-only is certainly not a U.S. idea," says Boonstra, echoing Britton's comments. "Many countries feel uncomfortable with the idea of teens having sex, and even more so as teens wait longer to get married."

Boonstra speaks of the work the United Nations Educational, Scientific and Cultural Organization (UNESCO) is doing in the interest of not only providing standalone sexuality education programs, but in figuring out how to weave it into biology and other courses, including the organization's International Technical Guidance on Sexuality Education: An Evidence-Informed Approach for Schools, Teachers and Health Educators.  "But it's a struggle for those schools," she says, "because it's a struggle to keep kids in school, let alone diversify education, have teachers trained, and have resources that are up to date when you're in a low-resource setting."

But there are signs of hope, and of growth, in some areas. There are signs that people around the world are hungry for evidence-based, holistic sexuality information. "What I have observed may be slightly biased," says Whipple, "because the groups that invite me to speak are much more open and want to learn a whole lot more. But I always speak about sexuality holistically, and I talk about what that means. I try to convey that there's a whole lot more to our sensual and sexual health than just the genitals and their function."

Britton and Boonstra speak of their own encounters with more progressive attitudes toward sex and sexuality education in Europe. "I'm really taken with how open the United Kingdom is in terms of sexual freedom," says Britton. "I'm stunned because there has always been this British reserve. They're not particularly forthcoming in commentary after a workshop. But then I'm amazed and moved by how open and inclusive they are toward multiple modalities for sexual healing and treatment, including touch-based modalities."

"In European countries," Boonstra affirms, "people tend to be more accepting of teen sexuality, and more holistic in their approach to sexuality education. There are different attitudes around contraceptive use. Here in the U.S., teens often feel it's shameful to be using contraception, whereas studies of teens in Europe show that they have very different attitudes toward contraception. They feel you're being irresponsible if you're not using contraception. Accessibility and attitude all adds up to lower pregnancy rates."

"All around the world," says Britton, "I see a quiet revolution. People claiming the right to pleasure. But I do not see that happening in the U.S. I see us clamping down on sexual rights, even though we have just legalized same sex marriages, even though we are experiencing a revolution in trans acceptance. In one two-month period, two gigantic political and social shifts have occurred but, at the same time, we're still a very conservative country."

Boonstra sees every day the impact comprehensive sexuality education can have on pregnancy rates, abortion rates, and other health statistics. "I'm certainly not a program expert," says Boonstra. "However, various resources point us to what young people should be learning." She references the aforementioned National Sexuality Education Standards, in addition to a similar document developed in Europe titled Policies for Sexuality Education in the European Union, mentioning that the latter document is much more forthright about adolescents and their rights to information, and adolescents as sexual beings. "I found it interesting even to compare and contrast the language and the kind of honesty Europeans have toward some of these subjects," says Boonstra.

Alternative Sources of Sexuality Education Around the World

Everyone quoted in this article agrees that there has been an explosion of alternative forms of sexuality education in the past few years, though they generally feel that this is in spite of—rather than in response to—the proliferation of abstinence-only-until-marriage programs.

"A huge trend I've observed as I travel," says Britton, "is that the advent of technology has created a way of breaking down the barriers and access to information. This information is not always accurate, but it is more available. Let's captivate that audience," she says. "Let's use that to give them authentic, appropriate sexuality education. Let's use the devices they're really habituated to use. Let's get through to them in that way because that's where they're hanging out and that's why we need to be savvy. We have a responsibility and an obligation to ourselves to catch up with where the world has gone so we can be a part of the global conversation and have a positive impact."

Boonstra also sees people taking advantage of these new ways in which people are seeking out information. "Technology offers young people a place to at least explore ideas and information they may be too shy to ask about otherwise," she says. "What is good is that the research that's been conducted on what young people want and need shows that they seem to be using the Internet wisely, in the sense that they report that they look out for websites that are reputable. They report not believing everything they see but trying to go to resources they think will be telling them the truth."

Britton speaks also of the sexuality education opportunities she's seeing offline. "The trends I see include an infusion of sexological bodywork training and sacred sexual training," she says. "I see a huge trend toward an advocacy for sacred work and Tantra. I see an expansion of incidences of OM-ing [Orgasmic Meditation]. It's becoming a global phenomenon. Because of fear-based sexuality education and a lack of good information, what's happened is that adults are coming out from under their own darkness and are seeking ways to find the truth. They are becoming enlightened and finding sexual empowerment for themselves, as well as for their clients and their students."

Organizations such as the Sexuality Information and Education Council of the United States (SIECUS) provide lists of even more sexuality education resources that exist in opposition to abstinence-focused programs, such as this list, which contains descriptions of evidence-based and comprehensive approaches to sexuality education.

And there is hope within school districts as well. Just the other week, we reported on AASECT Express that one mother's tweets led a Lansing, Michigan school district to adopt a whole new sexuality education curriculum. And Mimi Arbeit, Ph.D., a sexuality educator and researcher who has contributed to work in Massachusetts with regard to policy and curriculum, feels there are many people doing good work around school-based sexuality education. Boston, in particular, has a new health education policy that states that schools must provide "comprehensive sexual health education that is LGBTQ inclusive."

What Components Are Essential for True Holistic, Comprehensive Sexuality Education?

Whipple recently co-authored a chapter with Nan Wise, Ph.D., in Sexology for the Curious: Why Study Sexology?, in which she lays out her definition of holistic sexuality:

"We view and teach about sexuality holistically," they write. "According to the holistic view, an integrated whole has a reality independent of and greater than the sum of its parts. When sexuality is viewed holistically, it refers to the totality of a being. It refers to human qualities, not just to the genitals and their functions. It includes all of the qualities—biological, behavioral, psychological, emotional, social, cultural, and spiritual, that make people who they are. People have the capacity to express their sexuality in any of these areas."

When asked what components are necessary to holistic sexuality education, Whipple lists several characteristics. "To view sexuality holistically," says Whipple, "and let people see and understand what that means. To show people that there are many ways to experience pleasure. To emphasize the importance of communication. Communication is really important at any age. If you have questions, communicate them."

"I also try to help people see how they can apply the most recent research findings into the work they do," continues Whipple. "There's no sense in conducting research unless it's disseminated and unless people see how they can use the information."

"Part of the power I see in reclaiming and reconstructing sexuality education for adults," says Britton, "is the damage repair we do from the total lack of accurate sexuality education people have previously received. Suddenly, they begin to understand and experience sexual expression in its full range." To that end, Britton always has a diverse range of speakers at her SARs, such as trans speakers, those from the BDSM community, sex workers, bodyworkers, and others.

Arbeit stresses the importance of skills-based sexuality education, as it allows educators to focus on promoting "young people's ability to contribute to their own personal thriving in their sexual experiences and relationships."

"They need skills for understanding their own desires, decisions, and sense of self," says Arbeit. "They need skills for negotiating sexual consent and sexual pleasure, skills for managing sexual risks, skills for sharing their thoughts and feelings with partners and, at the same time, skills for managing boundaries with partners and for coping with personal, interpersonal, and social challenges. They also need skills for thinking critically about the mixed messages we all get about sexuality, and, potentially, for taking action to make changes in their social and sexual contexts. Furthermore, focusing on what young people know how to do shifts the focus away from normative judgments about what they are doing, which allows for education that can affirm a broader range of identities, desires, and experiences." Arbeit goes into great depth on this skills-based approach in a 2014 paper published in Human Development, "What Does Healthy Sex Look Like among Youth? Towards a Skills-Based Model for Promoting Adolescent Sexuality Development."

Arbeit also believes that sexuality education needs to be inclusive and affirming of youth who are transgender and gender non-conforming. "Sexuality education also needs to be trauma-informed," she says, "understanding that students may have histories of sexual trauma or may be experiencing sexual trauma as adolescents, which can shape how they feel and behave in the classroom. Furthermore, frameworks for sexuality education need to coincide with racial justice approaches in order to address health inequities due to structural and systemic oppressions."

Reddy gets down to even more specifics. "The components of sexuality education," he says, "should be gender identity and gender roles, family roles and social roles, body image, sexual expression, sensuousness and eroticism, affection and love."

He goes on to say that all of these components should be dealt with in a way that is mindful of the cultural values of the region. Then he continues, saying that a comprehensive curriculum should ideally also cover "biological aspects, emotional aspects, myths and misconceptions, preventive aspects (STDs, risk taking behavior, safer sex, alcohol and narcotics abuse, variant/ alternative behavior), and future life preparation (marriage, childbirth, family welfare, and parenting)."

"Throughout the educational program," he concludes, "attitudes and core values have to be built up with reference to emotional, social, psychological, ethical, and spiritual aspects of life."

Reddy's list is extensive but—for those who work within the field of sexuality and understand its place in our lives—its components are obviously necessary. And when placed alongside already existing curricula—especially curricula with a foundation in an abstinence-only-until-marriage lesson plan—it becomes clear just how much students are not learning.

At least not unless they seek it out themselves.

Our culture's movement toward a wider definition of sexual health is a positive sign, and there are many sexuality educators who are already embracing these principles of sexual health and fighting to propagate the information that is so integral to our lives.

But there is still a long way to go. Hopefully, some of the resources listed within this article can act as blueprints for additional forward motion.

We have a responsibility and an obligation to ourselves to catch up with where the world has gone so we can be a part of the global conversation and have a positive impact.