Does Sex Ed Work?

In prepping for a graduate class I'm teaching on sexuality education and social policy, I recenlty reread Kristen Luker's book, When Sex goes to School, in which she analyzes and describes the 100+ interviews she conducted over twenty years with individuals on both sides of the sex education debate that have been warring for the past half century.  I think she does a good job summing up the history of these battles as well as provides some interesting insight into the players, particularly how they became passionate about this issue, on both sides. The only major problem I have with her books, and one she points out as a major limitation to this work, is the lack of non-white voices and an analysis of race and ethinicity - I think this is highly likely due to the fact that issues regarding race and ethinicity are often excluded as are voices from communities of color and other so-called "minority" groups when it comes to sex ed.  Having worked in sexuality education for almost twenty years, I can honestly say that there wasn't much that was surprising or anything that I hadn't heard before, at least until I reached the last chapter. "Chapter Nine: Sex education in America and whether it works or doesn't -- and why that's not the right question"

While reading it, I came to a realization that answers a question that I've been struggling with for a very long time. In fact, the realization was so strong it felt as though the idea was brightly illuminated and I felt a warm glowing sensation in my head.  You see, for my job as well as my professional and personal convictions regarding sexual health and healthy sexuality, I spend a great amount of time talking to educators, researchers, students, friends, family members, and many others about why I think it is important that we reframe the ways that we think about sexuality education and sexuality research, shifting away from a model that focuses on disease and prengancy prevention that I believe pathologizes sexuality and sexual behavior in a way that is harmful and confusing.  One of the responses I constantly receive regards the evidence of such an approach and whether or not it will continue to work; and to be honest, this is a part of the conversation where I tend to flounder a bit.  "Chapter Nine" allowed me to understand why I have such a hard time answering this question, and I disagree with Dr. Luker about whether or not this is the right question.  The problem is not whether or not it works but how we (and I mean everyone from researchers to students to politicians to parents to teachers) decide whether or not it works. 

For example, I was sitting in a talk being given by Dr. Douglas Kirby, whose name and work is the most oft-cited as evidence that comprehensive sexuality education (CSE) works, at the sex::tech conference last year, and  I felt that something wasn't quite right with his evidence that these programs work because the young people who participated in them waited an average of eighteen months longer to become sexually active than those who didn't.  All I could think was, "So what?"  For years, I was what I call a "Kirby Disciple" meaning that I spoke in my community, at school boards, in classes, at cocktail parties, basically wherever anyone would let me talk about sex education, and I would extol the findings of Dr. Kirby as PROOF that CSE worked.  While I have not completely fallen from grace from the Church of CSE, I realized at some point in my career that this simply was not enough, that there must be something more that allows individuals  work towards lifelong sexual happiness and fulfillment in their lives and relationships and not just avoid a disease or unwanted pregnancy, at least I hope that is possible.

Hence the struggles over trying to answer the question about how we can evaluate programs that use a sex-positive model of sexuality education focusing on promoting healthy sexuality across the lifespan, and my inability to answer those tough questions about things such as evidence and other stuff needed to convince people to give you money.  It wasn't until I was rereading Dr. Luker's book that the solution became brilliantly clear.  We are not using the appropriate criteria to determine whether or not a sexuality education program works or not.  Don't get me wrong, of course we want there to be less disease and less unwanted pregnancy through behavior modifications, but I don't think these biological measures and behavioral indicators are the only evidence we want to show whether a program works or not! 

A portion of Dr. Luker's book is devoted to discussing the differences in biological outcomes and behaviors in other countries, specifically Sweden and France.  Much like the work of Amy Schalet in the Netherlands and others, conclusions are drawn that the sexuality education students receive is not necessarily that much better than those in the U.S. or that young people's behaviors are drastically different when it comes to contraceptive use, age of sexual initiation (or my favorite, sexual debut), or number of sexual partners. The biggest factor seems to be the fact that they are not American.  This is usually followed by discussions of homogeneous versus heterogeneous groups as well as the size difference in national populations, and, as Dr. Luker points out, that young people in these Western countries have not made sexuality problematic or pathological in the ways that Americans do (and do so well - in other words, they aren't as fucked up about sex as we are).  This is the ANSWER.  We know that they have lower rates of STIs and unwanted pregnancies (and not just during the teen years but across the lifespan when compared to Americans) not because their behaviors are so different but because their feelings and attitudes about sex and sexuality are so different!!!

We are not going to stop collecting data on teen pregnancy and sexually transmitted infections, particularly in evaluating projects that receive federal funding, until Hell freezes over, thaws out again, and freezes one more time. This is the "real scientific proof" that sex education programs work or don't work.  I propose that in addition to these measures we incorporate additional instruments that look at some of the psychological aspects regarding sex and sexuality, such as self-esteem, self-confidence, self-worth, personal satisfaction, relationship satisfaction, control, shame, guilt, fear, etc., so that we can get a better picture of what is happening with regards to the types of programs that we develop and how they effect the way people feel.  A program that has an outcome of a young woman waiting to have sexual intercourse eighteen months later than her peers and who is more likely to use a condom at the end of those eighteen months, may still have the effect of making this same young woman feel shame, guilt, and fear about her sexuality and the sexual behaviors in which she has chosen to engage.  At the same time, a young man who feels confident about his decision to have sexual intercourse because he receives social support to do so through his abstinence-only sex ed program may not be prepared to prevent an unwanted pregnancy when he and the woman he plans to marry become sexually active.  We need to know more about what types of sexuality education not only allow individuals, couples, and groups to make physically healthy and appropriate decisions about their sexual behaviors but to feel happy and fulfilled about those sexual behaviors and their lives.