“Value-neutral sexuality education, which in practice is not neutral at all, conveys hidden values about expected sexual behaviour and attitudes and so feeds the adolescent’s fears about being abnormal.”[Comparison of value-based and value-neutral approaches. History of value-neutral education. Adolescents and values. Adolescent sexual activity. Associated
risks. Efficacy of ‘safe sex’ practices. Harm minimisation. Implications for sex education.]
What is value-based approach?
Drug education – an illustration
What about sex education?
Value-neutral model: a buffet lunch
Challenge: Is the value-neutral model actually neutral?
Adolescents are vulnerable – cognitively, emotionally
Challenge: are all options equal?
Background to value-neutral approach: Kinsey
The Birth of Values Clarification
Adolescent Sexual Health Decline
Educate to protect
Teenage sexual involvement: at-risk lifestyle
What about contraception?
Sexuality education and the teaching of values – historically this has been a minefield for schools as the concept of values has been irrevocably (and inaccurately) tied to the concept of religion. Classroom support of traditional sexual values has been overtaken by the secularisation of schools and society in general, social changes due to the sexual revolution, the influence of an increasingly permissive multi-media, the mainstreaming of pornography and the effect of HIV/AIDS on the direction of school based sexuality education.
This article examines the values component of sexuality education. It compares the two main philosophical models for teaching children and teenagers about sexual matters – the value-based and the value-neutral models. A rationale in support of the value-based model for sexuality education will be established as being the model that best meets the developmental needs of the adolescent.
What is a value-based approach?
A value-based approach to sexuality education is one in which the teaching of specific, stated values forms the context for student learning – for lesson design, choice of resources, selection of teaching staff and development of the curriculum as a whole.
The value-based model assumes:
1) a specific value position is adopted by school community
2) a statement of belief/position is made to students
3) particular option/s promoted as `best’, i.e. of greater health value
In other words, all teaching materials and approaches reflect that value position and uphold it to students as desirable.
Drug education – an illustration
Drug education is an example within the Health Education field that we can use to illustrate this model. In school based drug education our aim is prevention, therefore our specified stance is ‘a drug-free lifestyle is good’. This is the position that as a school community we openly value and stand by because it is clear, on the evidence, that a drug-free lifestyle is healthier and safer than a lifestyle of drug using.
Thus, we design a curriculum and choose resources that not only give correct information about drugs, but which support this value position. This position is communicated openly to students as part of our endeavour to maximise each child’s chances of recognising its value, and we help them learn skills and attitudes to choose that position for themselves.
We know that not all students will keep away from drugs. Some will drift in and be lucky enough to drift out. Some will get stuck in that lifestyle, unable to make genuine choices because of underlying problems in their lives that motivate them towards self-destructive behaviour.
Despite this, we don’t demonstrate to the whole class the safest way of shooting up, or the best way to clean needles, just in case some do take up drugs. These are targeted Harm Minimisation strategies for continuing drug users, not the classroom. It makes sense that such an approach would undermine our stated aim or value, that of a drug-free lifestyle for the students in front of us. It would give all students the message that we were expecting them to be drug users one day. It would give them the message that we believe risk taking with drugs is OK.
So, even though we are aware that some students won’t be reached with pro-active drug education, we as adults and as health educators still know that to properly serve all our students we have to stand by this value position about drug use. We have to reiterate to teenagers `your best option is to say no to drugs, and this is why I believe that…’
They may choose that option or they may not, but we have provided them with a valuable role model, with reasons for saying no, and with skills to say no and stay safe.
What about sex education?
Is it possible to relate this value-based model to sexuality education? Do we have a right to `impose’ values about sexuality onto a varied school community? Which value position do we choose? The value-based model applied to sexuality education seems to present problems. Usual arguments against this approach include:
- We’ve got to present all the options
- The individual teacher’s values don’t/can’t/shouldn’t enter into classroom discussion about sex
- The school can’t/shouldn’t take a particular stance about sexual behaviour
- Our school community is too diverse
- In this day and age we can’t/shouldn’t preach or moralise
- Our role is to help students clarify their own value systems, not impose our own.
The heat of this sort of debate varies widely between state and independent school systems, from school to school within those systems, and from teacher to teacher in any school. Conflict can occur between teachers and parents. By and large, the popular solution in schools today to the problem posed by such pluralism, is to adopt a value-neutral approach to sexuality education. The term ‘Harm Minimisation’ has come to represent the intentions behind this approach.
Value-neutral model: a buffet lunch
The value-neutral model assumes:
- No specific value position adopted as context
- No statement of belief/position made to students
- No value is promoted as ‘best’: all options are equal – students choose on the basis of accepting consequences
A value-neutral model sounds both pragmatic and easy to present to students as it encourages them to examine all the options and values and select the one or ones they would like, rather like a smorgasbord. It can be particularly attractive to staff because theoretically no one need feel as though their lifestyle is being judged or ignored. To assess the worth of this approach in the classroom, we need to examine:
- does the value-neutral model hold up in practice?
- does it actually meet the developmental needs of the adolescent?
Challenge: Is the value-neutral model actually neutral?
Can we be value-neutral? No.
Where no overt references to values surrounding sexual behaviour are made, indirect value messages are always communicated. For example, typical ‘safe sex’ information for teenagers follows these lines:
i) Talk with my partner(s)
ii) Use condoms in my sexual relationships
iii) Have regular check ups
iv) Look for symptoms.
The unstated values within this information are that it is okay for adolescents to be sexually active and with more than one partner. The value position underlying such teaching is one that accepts and expects adolescent sex and multiple partners.
Because this value position is implied rather than identified or explained openly, neither teachers nor students are invited to critically examine the values that are being transmitted. (There is also misinformation here – as none of these four steps will literally prevent the spreading of sexually transmitted infections (STIs). At best they may only reduce risk.)
Common class activities ask students to practise rolling condoms over bananas and to come to agreement on questions such as – Who should carry condoms? How old should you be? Does a condom reduce sexual pleasure? In what types of sexual activity would a condom be used? How can you negotiate using a condom with a partner who is reluctant?
There are inherent dangers in activities like these. In any one group of young adolescents there will be a variety of sexual experience and emotional development, plus all the usual anxieties and natural embarrassment about sex which are part and parcel of adolescence. Some may be sexually active in destructive or abusive relationships or have been coerced or affected by drugs or alcohol at the time; the majority will not be sexually active at all; some of these may be worried that they are not. There may be anxiety or questioning about sexual orientation.
The pressure such activities produce is unlikely to encourage honesty. `Agreement’ becomes another word for `coercion’ to the point of view of the dominant member of the group, and to the unstated value implied in the activities, which is that teenagers are expected to be sexually active. This is not a neutral position.
Hidden value messages are powerful because we tend to absorb them without being given the opportunity to examine them openly and decide whether or not we want to accept them.
Adolescents are vulnerable – cognitively, emotionally
Discerning hidden value messages comes easier as we get older. As adults we learn to read between the lines. Adolescents, however don’t think like adults. Normal adolescence is characterized by incomplete brain development which affects the brain’s ‘executive’ functions -understanding cause and effect, assessing consequences, abstract thinking and impulse control (Winters & Arria, 2011; Hall, 2004).
“Good judgement is learned, but you can’t learn it if you don’t have the necessary hardware. Teenagers need guidance as their brains develop, especially in the realm of controlling emotional impulses in order to make rational decisions” (Talukdor, 2000). Furthermore, emotional and psychological trauma (such as parental death or divorce, sexual or other abuse) can further delay or disrupt adolescent cognitive development.
Adolescents are also in a normal developmental stage of uncertainty about identity, of which sexuality is a part. This increases their vulnerability to hidden values and messages about sexuality. They are less likely to subject them to critical assessment. Unstated values that imply teenage sexual activity is the expected norm send a message to non-sexually active teens that they are ‘different’. This then clashes head-on with the big questions of adolescence: Do I measure up? Am I inferior? Do I fit in?
Value-neutral sexuality education, which in practice is not neutral at all, conveys hidden values about expected sexual behaviour and attitudes, and so feeds the adolescent’s fears about being abnormal. This in turn pushes him/her towards `safe’ conformity to the prevailing pressure which, in our society, is to be sexually active.
The transmission of implied values in this way puts the adolescent at risk of exploitation as he/she is not invited to assess their worth.
If we could be neutral, would it be a good thing? No.
To aid the development of his or her own personal value system, an adolescent needs up-front, genuine declarations of values by adult role models. These can be chewed over, digested, retained or discarded as the adolescent sees fit and eventually integrated into his or her emerging adult identity. But without a solid ‘adult’ wall off which to bounce their thought processes and test their hypotheses, it is difficult to hone these emerging skills.
So, not only is neutrality about values impossible, but if we could teach that way, we would not be aiding the psychological development of our adolescent students.
Challenge: are all options equal?
The third assumption of the value-neutral model we must also challenge, on the basis of the available evidence about human sexuality, relationships and health. Some sexual options are clearly not as healthy as others, either emotionally or physically, particularly for adolescents.
A value-neutral approach encourages decision-making about sex on the basis of information, life-skills, values clarification and assessing the possible consequences of the various options. However, in the absence of clear direction from the teacher as to which option is best, students are left with the tacit message that all options are equal. The proviso is that they should understand the consequences of their actions, and should avoid pregnancy and STIs. (Note the moral imperative to avoid pregnancy and STIs within the supposedly `neutral’ approach.)
This sounds a bit like telling a drug education class that any decision they make about drugs is okay, as long as they don’t get addicted or catch HIV/AIDS through needle sharing. This is not a primary prevention approach to health education. It is promoting the acceptance of risk. Current ‘harm minimisation’ strategies in health education are flawed in just this way.
Background to value-neutral approach: Kinsey
From where has the value-neutral approach to sexuality education emerged? The Kinsey reports of the late 40s and early 50s took the world by storm, fuelling the sexual revolution of the 60s and exerting a major effect on the direction of sexuality education in Western societies (Grossman, 2009; Reisman and Eichel, 1990).
Alfred Kinsey was the first scientist to research human sexuality on a mass scale. A biologist who studied gall wasps, he applied his zoological theories to a study of human sexual behaviour. From the data he collected he put forward the theory that there was no such thing as `normality’ or `abnormality’ in sexual behaviour, no `rights and wrongs’.
The validity of his research was challenged immediately it was published. Although he claimed to have studied a balanced sample of over 18,000 adults and several hundred children from babyhood up, he used volunteers, not a random sample. Furthermore, of Kinsey’s volunteers, 25% were criminals, including sex offenders, pedophiles and men whose homosexual contacts had occurred in prison.
Kinsey’s research experiments included using sex offenders to stimulate the genitals of babies a few months old and children up to the age of puberty, for up to 24 hours at a time. He claimed his experiments showed bisexuality is the typical human condition, that 10% of the population is exclusively homosexual (a statistic that is still relied upon today), and that children need and want adult sexual partners to lead them into fulfilling sexual relationships.
His work and conclusions were immediately challenged as being fraudulent, misleading and heavily biased towards `proving’ the normality of his own sexual preferences and activities (Kubie, 1948; Mead, 1948). However, his reports were taken up enthusiastically by activists seeking to change social attitudes towards homosexuality and by pedophile organisations which used his results to promote their preferences as normal.
The media also took Kinsey up enthusiastically, channelling his conclusions about human sexuality through to the general population. The founder of Playboy magazine, Hugh Hefner, paid a glowing tribute to Kinsey in his first edition, saying Kinsey was his inspiration (Reisman and Eichel, 1990).
The wheels have turned to the extent that current social trends endorse sexual exploration of any kind for any age as long as both partners agree and are ‘protected’. The rising incidence of teenagers having both oral and anal intercourse with multiple partners is linked to these changing social trends which are widely depicted and normalised in pornography, music videos, song lyrics, magazines and many internet advice sites. Kinsey’s work was also pivotal in the direction taken by organisations such as Planned Parenthood and SIECUS in the USA whose influence on modern sex education cannot be underestimated (Grossman, 2009).
The Birth of Values Clarification
Another important factor in the emergence of the value-neutral approach to sexuality education came from the Western Behavioural Science Institute (WBSI) in California, USA. Abraham Maslow, Carl Rogers and W.R. Coulson, were psychologists trained in the methods of non-directive psychotherapy, an approach appropriate for counselling, as it is client-centred, and the values of the counsellor are not imposed on the client.
However, during the late 60s and early 70s Maslow, Rogers and Coulson developed the idea that the non-directive approach could also be applied to the classroom. They theorised that a non-directive approach would assist young people to decide what they wanted to do in the area of sex and drugs.
At that time, Coulson later reported, the popular idea was that recreational drug-use was a good thing. The sexual revolution, fuelled by Kinsey, also caught up with them, carrying with it the idea that children needed more sexual freedom; that whatever adults do, children ought to be allowed to do too.
Drug education and sexuality education at that time, in their dominant forms, were based on the thinking and writing of these three psychologists from the WBSI. They suggested that children can and should make their own decisions about drugs and sex without guidance from either parents or teachers. To give guidance was seen as an imposition on the young person’s freedom and rights. Consequently, the techniques of values-clarification were developed, as opposed to the teaching of specific values. Teachers were trained not to `lead’ in these areas, but to `facilitate’.
Coulson, Maslow and Rogers all eventually concluded, quite individually, that they had been wrong to try and apply this non-directive therapy approach to the classroom. Carl Rogers did not raise his own children non-directively although he advocated it to the nation. In Coulson’s words, “we tried to talk a whole generation of parents out of giving their children guidance” (Coulson, 1988).
Adolescent Sexual Health Decline
Nature has made it quite clear that drug-use is not healthy. Nature is also making it clear that sex is not for children or adolescents. The sexual `freedom’ experiments and theories of the 60s and 70s have backfired when we consider the serious decline in the sexual health of adolescents, indicated by the high incidence of sexually transmitted infections, pregnancy and abortion for this age group in Australia, as in other developed countries.
It is difficult to estimate teenage pregnancy rates in Australia. Rates of birth, spontaneous miscarriage and elective abortion would all need to be recorded and reported. There is no requirement for mandatory reporting of abortion nationally or in any state, with the exception of South Australia. Many miscarriages occur before the pregnancy is known and require no medical intervention while the availability since 2004 of over-the-counter ‘emergency contraception’ (which has an abortifacient function as well as a contraceptive function) means a further unknown number of pregnancies are untrackable.
What we know is that the teenage birth rate sits currently at 16 births per 1,000 females aged 15 – 19 (ABS, 2013). South Australian birth and abortion data indicate that teen pregnancy rates could be at least twice birth rates (Chan, Scott, Nguyen and Sage, 2007). This is supported by estimates derived from Australian Bureau of Statistics and Australian Institute of Health and Welfare data, which suggest that Australia’s rate of teenage pregnancy is around 38.9/1,000 women aged 15-19 years and rate of abortion 20.8 per 1,000 (AIHW, 2005). The likelihood of a further pregnancy (referred to as Rapid Repeat Pregnancy) – within two years of a previous pregnancy has been found to be between 35 – 42% (Raneri & Weimann, 2007) and many will have a further abortion. In short, Australia has one of the highest teenage pregnancy and abortion rates in the developed world.
Sexually transmitted infections
It is estimated that 1 in 20 Australians aged 15 to 29 have an STI and rates are increasing dramatically (Annual Surveillance Report, 2012). Over the last few decades the number of STIs circulating widely in the community has increased from a handful to more than 24. These include incurable viruses such as herpes and genital warts (linked to cervical and oral cancers), chlamydia (often undetected and linked to infertility) and HIV/AIDS. Apart from painful and debilitating physical effects, diagnosis of an STI is also linked to significant depression, social isolation and relationship breakdown in some people. “Our experience at The STD Project has shown that those who are diagnosed experience intense trauma, emotional distress, and often seek mental health care” (“You Know What’s Depressing,” 2013).
The freedom of healthy limits
The value neutral approach to drug education disappeared in the 80s and early 90s with the emergence of programs such as the Drug Offensive and the Quit campaign – very obviously value-based and promoting abstinence from drugs as the preferred value for this age group. Other value based health promotion strategies around drink-driving (‘Bloody idiot’ campaign) and bullying (‘Bullying.No Way!’) also assume there is a ‘best’ choice to be made in these areas of human behavior and decision making.
In contrast, the non-directive or value-neutral model clearly still dominates in the area of sexuality education through the media in general, and also in the majority of specific education resources targeting school aged teens. Adolescents are offered a range of options from which to choose with the implication that each is innately equal as a sexual choice, and that they may decide because they are sexual beings. The notions of direction and guidance, sexual restraint, etc, tend to be linked negatively to words like `religion’, `repression’, `intolerance’, `moralistic’ and `judgemental’. They are not seen, as Coulson (1988) put it, as the means of protecting adolescents and giving them the freedom of healthy limits during their most vulnerable developmental years.
Educate to protect
The ‘value-neutral’ model is both unrealistic and unhelpful when applied to the education of immature adolescents. It is, as Dr Miriam Grossman argues (Grossman, 2009), an outdated relic of 60s social experimentation and it’s time its proponents grew up and faced facts. It’s time they put the health of the next generation before the politics of their own. And so we return to the alternative – the value-based model.
Clearly, our guidelines must be the promotion of the values that will best protect young people during the vulnerable years of childhood and adolescence, particularly those young people who are most at risk, ie: those who are unable to reason, and those who have underlying emotional issues which make them vulnerable to risk-taking lifestyles. For all adolescents we must promote the safest option.
On the evidence, the option that offers that best protection for an adolescent from physical and psychological risk is to postpone sexual involvement at their stage in life and to lay the foundation for the development of mature committed adult relationships.
Our personal reaction to such a statement may be affected by our own needs and experiences, our fears and our politics. However, whatever our own position, we must consider this in the light of the needs of the student. A teacher might use drugs or tobacco at home but he or she would be negligent as an adult, as a teacher and as a health educator, to give any other message to adolescents other than smoking and using drugs are not the healthiest options for them.
Likewise, in the area of sexual behavior and lifestyle options we must emphasise the difference between tolerating diverse views and esteeming them equally. Our goal must be to provide correct information and opportunities for discussion of issues from within an explicitly stated framework – a framework which clearly upholds a single overriding message to adolescents – how and why to postpone sexual activity. Clearly it is negligent to promote any other value message to adolescents, either directly or indirectly, other than the option to wait, to say ‘no, not now’ because any other sexual lifestyle involves risk.
Teenage sexual involvement: at-risk lifestyle
Apart from the high risk of pregnancy and STIs previously noted, there is the potential for emotional damage from each broken relationship being carried into subsequent relationships. The rise in sexual activity apart from intercourse is also a source of emotional harm for adolescents. Random oral sex at adolescent gatherings, sexting and posting photos on social media are all sources of distress, depression and cynicism for both girls and boys.
Teenage girls are more susceptible to infection due to the immature development of the adolescent cervix compared to the cervix of an adult female which is thicker and more resistant to viruses. Encouragement to postpone sexually activity is an important health message for all teenage girls for this reason alone.
Teenagers are reporting more coercion into unwanted sex and regret about early sex (Smith et al, 2009). Research also shows a dramatic relationship between sexual activity among adolescents and multiple indicators of adolescent mental health. Risk for depression is “clearly elevated” for the sexually active of either gender (Halfors et al, 2004). The earlier an individual engages in sexual activity, the more risk he or she has for negative mental and physical health outcomes.
The provision of guidance towards postponing sexual involvement, plus life-skills and correct age-appropriate information, is clearly vital in helping adolescents achieve optimal marriage and family relationships in the future. This sort of information and guidance is missing from many publications aimed at teenagers and the teachers of teenagers.
What about contraception and ‘safe sex’?
The contraceptive pill in one form or another has long been promoted as a very effective means of preventing pregnancy (99.7% for the combined pill) but there is more to this picture, especially for adolescents. Similarly, since the HIV/AIDS epidemic of the 1980s, condoms have been the lynch-pin of the ‘safe sex’ approach to disease prevention. This ‘harm minimisation strategy’, originally targeting at-risk adults, has been assumed to be an appropriate model for adolescents as well.
Correct age appropriate information is important, including information about contraception, but such information must be correct and complete and with an understanding of the adolescent’s developmental needs.
There are two considerations:
1) failure rates in practice
2) the adolescent context
Failure rates –
‘Method’ failure rates and ‘typical use’ failure rates are different. Method failure rates are established via clinical trials that determine the number of pregnancies that occur as a result of a failure of the method, not an action of the couple. However, in sexual relationships, human behaviour is always the overriding factor, so the failure rate in practice (‘typical’ use) is the relevant consideration. Someone relying on the Pill as a contraceptive would need to understand that in any one year, about 9 out of 100 couples using the Pill can expect to become pregnant (“Contraceptive Use in the United States,” 2013).
Condom manufacturers state a method failure rate of about 2-3%. Already this is not a `safe sex’ guarantee and the ‘typical use’ failure rate is much higher. In preventing pregnancy, condoms have a ‘typical use’ failure rate of 18 percent over the course of a year (“Contraceptive Use in the United States,” 2013; Eisenberg, 2012). Furthermore, pregnancy can only occur on a very few days of a woman’s cycle whereas the organisms that cause STIs can be passed on any day. Therefore in terms of exposure to infection the consequences of a condom leaking, splitting or slipping off during intercourse are even greater.
Condoms are not a complete barrier to two of the most commonly occurring STIs, herpes and HPV (genital wart virus) because the viruses can live on the surrounding skin not covered by the condom. (The HPV inoculation introduced into Australia in 2007 for school aged girls protects against 2 high risk strains of HPV but other strains exist.)
Anal intercourse carries a higher risk again of condom failure than vaginal intercourse. With or without a condom, anal intercourse is high risk behaviour due to the anatomy and physiology of the anus compared to the vagina, leading to higher transmission rates of infections and physical damage. An article published in the International Journal of Epidemiology states “there is an 18 times greater risk of HIV transmission through anal sex than through vaginal sex (Baggaley, 2010).
(2) The Adolescent Context –
We might well say, but isn’t safe sex education better than nothing? Isn’t it more realistic? After all, they’re all doing it anyway.
Despite general media representation to the contrary, teenagers are not all ‘doing it’. Non-sexually active young people themselves are commonly misled into believing they are the only one – “46% young people mistakenly believe that most young people have sex before they are 16” (“Evaluation” 2003).
The 2008 Secondary Students and Sexual Health study carried out by La Trobe University, revealed just over half of year 12 students and just over a quarter of year 10 students surveyed had experienced sexual intercourse (Smith et al, 2009). To put it differently, almost half the student population by year 12 have not had sexual intercourse – an important statistic for normalizing the postponement of sexual activity for school aged teens.
Unwanted and regretted –
Regret over early sexual involvement, particularly amongst girls, is consistently recorded (Osorio et al, 2012; Martino et al, 2009). The Latrobe study above showed that for young women, the experience of unwanted sex has increased significantly between the 2002 and 2008 surveys, from 28% of young women reporting in 2002 ever having unwanted sex to 38% in 2008 (Smith et al, 2009). The effects of alcohol and pressure from partner were named as the most common reasons.
The phrase “sexually active” can be misleading. Oral sex and genital touching have become more common amongst school aged teenagers. Mutual masturbation has been promoted for years through school based sex education and teenage magazines as a ‘safe sex’ alternative. However, there remains a psychological barrier to describing oneself as sexually active if intercourse has not taken place, preventing some young people from recognising the continuing risk of STIs and emotional hurts through these activities. The young teenager is vulnerable to exploitation if fear of pregnancy is removed as a reason to say no to unwanted sexual activity and they know of no other ‘acceptable’ reason for choosing otherwise.
Is ‘safe-sex’ education the best we can offer adolescents?
Non-sexually active students are without doubt in the safest lifestyle. They are not served by promoting the impression that most teenagers are ‘doing it’ or soon will be, and that condoms and contraception provide a ‘safe sex’ option. They need correct information about the limitations of contraception, (particularly for their age group). They need to learn about the nature of relationships, the adolescent’s search for identity and overwhelming desire to belong, and how to safely navigate through a changing time of life. They need the adults around them to promote values, attitudes and life-skills that will help them maintain the safest possible lifestyle by saying “no – it’s ok to wait”.
The amount and degree of detail about STIs and contraception needs to be presented appropriately, according to the age and cognitive development of the student and with due consideration to the student’s sense of privacy. For example, requesting students to examine and practise rolling on condoms would, as well as conveying a message about expected sexual involvement, also be an intrusive exercise. Moreover, if they are `concrete’ thinkers (not yet able to think in the abstract) they are unlikely to translate the lesson into a real life situation when in a highly charged situation.
Sexually active adolescents are in an at-risk lifestyle, whether or not they are using contraception. Research shows that they are unlikely to be using contraception correctly or consistently. Dr Terri Foran, Medical Director of FPA Health in Australia commenting on a French study of contraception failure rates confirmed “contraception has an inherent failure rate in certain groups of people. In the case of adolescents [the failure rate of the Pill] goes up to between 16 and 18%. They traditionally miss several pills per month” (“Contraception less reliable than you think”, 2003).
More than hormones –
Dr. David Elkind, a US psychologist and professor specialising in child and adolescent studies states in his book Parenting Your Teenager in the 1990s: “Contrary to popular opinion, most young people engage in sexual activity for psychological rather than hormonal reasons” (Elkind, 1993). Research continues to confirm this apt summarization, pointing to a high proportion of sexually active adolescents are propelled into sexual relationships and into unconsciously actively seeking pregnancy by underlying problems such as family breakdown and depression. Here the sexual activity is a vehicle for expressing anger, frustration, for acting out, or is a cry for help. “Depressed adolescents are more likely to engage in sexual risk behaviors than their non-depressed peers” (Blood & Shrier, 2013).
Studies reveal the impact of risk-taking behaviours and the presence of depression, suicide ideation, suicide attempts, low self-esteem and a decreased sense of control in its participants who engaged in early sexual activity (Hallfors, 2004). Long term studies of nearly 800 girls from New Zealand and the US revealed the absence of the biological father from the home was “an over-riding risk factor for early sexual activity and teenage pregnancy” (Ellis, 2003). Studies have also found that boys raised in homes with a battered mother, or who experienced physical violence directly, were significantly more likely to impregnate a girl (Anda et al, 2001).
Maltreatment of any kind has been increasingly implicated as a strong factor in adolescent pregnancy. Survivors of sexual abuse may accept some level of aggression in intimate relationships as appropriate or normal. A study by Noll, et al (2003) showed sexually abused females expressed a heightened desire to become pregnant compared to non-abused adolescents. This was in turn linked to early and risky sexual behaviours and teen motherhood.
Another study by Noll, et al (2008) showed women who had a history of child sexual abuse were more than two times more likely to have experienced a pregnancy in adolescence than women who did not experience abuse. The study concluded that assessment and monitoring of abuse survivors should extend into adolescence and specifically address issues related to sexual development, sexual decision-making, and other factors associated with sexual risk-taking and early pregnancy.
Concentrating on preventing conception is treating a symptom rather than a cause; it does not address the issue of why teenagers are having early and unprotected sex (Neville, 2003). These adolescents are unlikely to use contraceptive/safe sex information correctly due to these unconscious motivations. And, as mentioned earlier, childhood emotional and psychological trauma such as parental death or divorce, sexual or other abuse, can further delay or disrupt adolescent cognitive development. They are more likely to remain `concrete thinkers’, unable to make the necessary abstractions about behaviour and consequences in order to correctly use contraception consistently and correctly. Decision-making is likely to be problematical for them. Clearly power and manipulation issues will be evident in relationships involving the emotionally immature and psychologically needy.
A hard discipline
Even without such complicating factors, it could be said that the discipline of contraception is the hardest discipline sexually active teenagers will ever have to learn and they must learn it at a time in life when they are naturally most disorganised and undisciplined.
Knowledge and access to contraception are clearly not the issues. They are not solving the problems of teenage pregnancy and STI. Safe sex education doesn’t meet the developmental needs of the adolescent and in fact promotes the acceptance of adult-approved risk.
Adolescents are by definition not adults, neither cognitively, emotionally or psychologically. Their newly acquired fertility, search for identity and, for some, personal history, can leave an adolescent in a vulnerable position. The responsibility remains with the adult to provide concrete guidance as to the safest course of action (delaying sex) and skills to achieve that choice during this time.
A ‘best choice’ message –
“Abstaining from intercourse should be encouraged for adolescents, because it is the surest way to prevent STDs, including HIV infection, and pregnancy. Adolescents who have been sexually active previously should also be counseled regarding the benefits of postponing future sexual relationships” (American Academy of Pediatrics, 2013).
All teenagers, whether sexually active or not, deserve correct, age-appropriate information about the limitations of contraception and ‘safe sex’. They need encouragement and empowerment to embrace the safest possible lifestyle. They need the adults in their lives and in the wider community to expect they will delay. They need to know they have the right to say “No!” when they feel under pressure. They need opportunities to discuss and role-play effective strategies to use in pressure situations.
Other essential elements include thorough coverage of the emotional and situational factors in new and established relationships that may influence sexual responses and behaviour, including the interplay of drugs, alcohol, romantic settings and peer pressure. Those not yet emotionally or romantically involved in a relationship may be totally unprepared for the potential force of a sexual advance. There is an urgent need for education around issues such as: identifying sexualising cultural pressures; valuing self and others; practising assertive responses to likely situations including the power of simply saying No; watching out for vulnerable friends; identifying ‘trigger’ factors in self, eg: loneliness and loss; understanding the powerful role/action of oxytocins in the female brain; understanding gender differences in relationship expectations, understanding brain development and its impact on decision making.
A half-hearted nod to abstinence as being a safe but unusual choice for most people (except ‘religious fundamentalist’ and the ‘sexually repressed’) is not sufficient. Teenagers need to have the safest option presented and reinforced in dynamic, creative ways; not ignoring their need for information and their desire to argue, but always returning to the goal of postponing sexual involvement. The message is the same for adolescents who are questioning their sexuality. Whether a student identifies themselves as homosexual or heterosexual, their best choice is to wait before becoming sexually active. Disease and emotional hurts do not discriminate.
Non-sexually active teenagers in the classroom setting need to know they are not alone, but in fact are part of the majority. Some teenagers with underlying problems will need access to effective counselling, probably long-term, to sort out the issues that may drive them towards sexual involvement and pregnancy, or indeed other risk-taking behaviours.
Not even the most effective teacher using the most effective program will prevent some teenagers from sexual experimentation and the problems this can bring. We accept this when we teach about drugs, smoking and alcohol too. We can, however, still give these teenagers, along with the whole class, a comprehensive, encouraging, pro-active sexuality education, and we can look for opportunities to refer those with deeper concerns for counselling.
On the evidence, the promotion of contraception/safe sex as a viable option for adolescents is not realistic. It is an adult reaction to past social upheaval and current social problems but it does not match the developmental abilities of the adolescent or meet the needs of either the sexually active or the non-sexually active young person. Nor does it discharge our responsibilities to actively promote the health of the adolescent and protect the young from exploitation.
Information and discussion about contraception or condoms should never undermine the primary goal of postponing sexual activity, and promoting lifestyles that will ultimately benefit stable adult committed relationships and families into the future. Postponing sexual involvement for the sake of future health and relationships should be the over-riding goal of a Health and Human Relations course.
This value, which protects the health of the individual, families and society, should and can be the stated context of a primary prevention sexuality education program in any school. It should guide curriculum development, and ideally, teachers who are committed to teaching within that context should be the ones to take it on, as their personal values will inevitably be transmitted to the student.
There is clearly a difference between tolerating diverse views and esteeming them equally. Dr Trevor Stammers, expresses the sense of this obligation unequivocally when he states: “Just as doctors who smoke should advise their patients not to do so on the basis of the overwhelming medical evidence that it causes harm, so should all healthcare professionals, irrespective of personal sexual experience, promote the message that it is medically unsafe for individuals under the age of 17 to have sexual intercourse” (Stammers, 2000).
Promoting the value of postponing sex for teenagers shouldn’t be confused with teaching religion. It is not to be written off as just another tactic of the religious right who are allowing their biases to cloud their judgement. It is clearly a contemporary health issue that crosses both cultural and religious boundaries. It fulfills our obligations towards the health and protection of the young. It makes sense.
A Health and Human Relations course which ultimately seeks to protect the physical, sexual and emotional health of the adolescent, which supports and upholds the family, and prepares adolescents for healthy adult relationships and parenting, will have the highest probability of acceptance among parents across the school community.
This is not preaching, it is good teaching practice.
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