Talking About This One Topic Can Reduce Teen STIs and Pregnancy

By Kait Scalisi, MPH

Beyond containing complete, medically accurate information and discussing condoms and contraception, comprehensive sex education programs vary widely in their content. A new review in the journal International Perspectives on Sexual and Reproductive Health sought to determine whether these differences matters. By evaluating 22 programs, the author determined that the inclusion of one specific topic—gender and power dynamics—made a big difference in programs’ efficacy in reducing pregnancy and STIs in adolescents.

Adolescents have a higher risk of both STIs and unplanned pregnancy. When these data are broken down further, vast gender and race disparities emerge. Therefore, to successfully reduce this risk, curricula must address these disparities. While comprehensive sex education has come a long way, there is still room for improvement. Currently, only 13 states require that sex education be medically accurate. Beyond this, individual programs vary quite a bit in the topics they discuss. Additionally, much of the research conducted on these programs has relied solely on adolescents’ self report, giving less insight than desired into why the program worked.

Any study that provides insight into what makes curricula effective is kind of a big deal. This particular review, inspired by decades of conversations about gender and power, sought to determine whether teaching about these topics is a key component of effective curricula.

The review evaluated 22 programs that:

were group- and curriculum-based
assessed effects on adolescents 19 or younger
were published between 1990 and 2012
used rigorous study designs
had a sample size of at least 100
measured the effect of the intervention on health outcomes including STIs and pregnancy
were not abstinence-only
were not conducted among special populations (e.g., MSM).

To qualify as addressing gender and power inequalities, curricula had to include at least one lesson, topic, or activity covering an aspect of gender or power in sexual relationships.

The studies varied in location, study design, sample size (n=148-9000), gender, setting where the curriculum was conducted (e.g., school, community, or clinic), and content included in the curriculum. Ten studies showed significant decreases in STIs and/or pregnancy, and eight of them included information on gender and power.

Of the many program characteristics examined, only a few had a clear impact on whether the programs were effective. These included:

being a randomized control trial
follow-up lasting at least one year
being evaluated in 2000 or more recently
being conducted in a clinic
including content on gender and power.

Inclusion of gender and power content led to significant decreases in STIs and/or pregnancy. Of the programs that included this content 80% saw the desired outcomes along with several additional positive effects. On the contrary, of the programs without at least one lesson on gender and power, only 17% led to these outcomes. In a recent article about the study, The Atlantic magazine staffer Julie Beck writes:

Teaching about power and gender roles was a consistent predictor of better health outcomes, even when [researchers]accounted for other variables like sample size and whether the studies were longitudinal. The Atlantic, April 27, 2015

Unsurprisingly, the programs that addressed gender and power and saw positive results had common characteristics. These included:

explicit attention to gender or power in relationships
fostering critical thinking about how gender norms or power manifest and operate
fostering personal reflection
valuing oneself and recognizing one’s own power.

Teaching health information alone is not enough. We need to take a more intersectional approach. This shouldn’t come as too big of a surprise. Just a few weeks back we shared two studies examining the various intersections of gender, violence, and contraceptive use. The Atlantic piece links to several more studies looking at HIV and STI rates and condom use. Lastly, we know that pregnancy and STI concerns are not top of mind for adolescents deciding to have sex. Instead, they worry about whether they will get in trouble for having, whether it will feel pleasurable, and what their peers will think of them.

Furthermore, bringing these conversations into sex education curricula opens up space for discussions of sexuality and gender identity. Adherence to gender norms play a huge role in the increased rates of bullying and harassment that LGBTQ individuals experience; therefore, addressing these gives schools one more opportunity to address the bullying and provides further support for bullied students.

Like all systemic reviews, this study has its limitations. Eligible studies could be missed and confounding variables could be overlooked. In my opinion, these don’t make the study any less of a big deal. By unlocking another key to what makes comprehensive sex education programs successful, the study gives educators their next step. The Atlantic‘s Beck puts it best:

There are emotions and social pressures at play, and it seems that when teachers address them, sex ed gets a little closer to being truly comprehensive. The Atlantic, April 27, 2015