Special Seminar S3  Sexual Education -   Training in Family Life Education

Barbara Huberman

My name is Barbara Huberman, I am Director of Speciality Education for organisation in Washington DC called “Advocates for Youth”. We are a third national organisation that provides advocacy training, research and dissemination of resources in the field of adolescent reproductive health. Our pioneering mission is adolescent reproductive health and believe me with some of the stuff that’s going on in the United States right now it’s a good thing I think that we are there. We are staff of 35 in our Washington office and the staff of 4 in our Los Angeles office, we have a very special project called Media Project and as a first step we are now in partnership with the Keiser Family Centre to try and re-frame some of the media messages produced by Hollywood, produced by television into much more positive healthy look at sexuality. So our staff people there work with the writers and producers in Hollywood and in New York to develop story lines, to incorporate strong healthy positive sexuality messages and disseminate good information, for instance I staffed for very instrumental in getting ER, the big big show, to incorporate a story about an emergency contraception which increased knowledge in the matter simply by watching this 14 second interlude on emergency contraception in the story line which increased by almost 35% the knowledge of women in the viewing public about the availability of emergency contraception.

It’s not easy, we know the kind of messages that we want are somewhat controversial sometimes, we’re working with several of them right now, so that when a couple is in bed make sure there is a condom on the night stand, make sure that there is some conversation about using contraception in a relationship when no pregnancy is wanted and certainly conversations around the prevention of sexually transmitted infections in any relationship. What I’d like to share with you this afternoon is some of my own now ideas, number one a little bit about some of the principles of training people in the filed of sexuality education, formal sexuality education as well as informal kind that occurs between families, between religious institutions and between agencies of organisations, share with you very briefly because we only have an hour, to major studies that if you don’t know about, that support what we call in America balanced, accurate, some people used to call it comprehensive sexuality education, to share with you those two major studies that ultimately  affected my practice. First I would like to tell you how bad things are going to some extent and share with you two pieces of legislation that certainly are affecting our ability to train teachers, youth workers, camp leaders, top providers in sexuality education, but also the kind of information that young people are now being forced to have in our country. Then, I’d like to share with you the model of that I’ve been involved in for the past seven years of training sexuality education. Three countries Germany, the Netherlands and France are approaching adolescent sexuality, adult sexual health and reproductive health for adolescents. Just to learn about some of that and also some of the current messages and approaches that are developed in the United States. If sex education is dangerous, try ignorance that is certainly I think one of the first things that is important to me as I have tried to develop programmes to reach people, to improve ability and knowledge in sexuality education.

When we look at things that are effective, the teenager studies that I talked about, one of the first ones done by the World Health Organisation, looked at different programmes around the country, around the world, compared them against what we in America call the Abstinent Until Marriage Only Curricula and Programmes which means that by the definition the only thing you can tell the young people who are not married that they must not have sex until they are married. Generally in these tight educational programmes you are not allowed to talk about contraception, in some cases you are, but the only thing you can tell the young people is how dangerous they are and how ineffective they are, to try and scare them away. The world Health Organisation looking at programmes, this was actually done in 1993 when they were probably even more especially in the United States than programmes that there are today, but looked at these kinds of programmes and looked at the accurate balanced programmes and found these results: did any of the programmes cause earlier sexual intercourse? - No. Did any of the programmes caused more frequent sexual intercourse? - No, either type of them. Did any of them delay the first intercourse in adolescence? - Yes, and what were they? - They were the accurate balanced curriculum, they were not the Abstinent Only or Abstinent Until Marriage Curriculum. Did any of the programmes caused less frequent sexual intercourse? - Yes, they were 16 of them, almost half of them that did and again you know which programmes that were that caused that, not the abstinence programmes, but the programmes that were accurately balanced. Did any of the programmes if they looked at the matter of increased heterosexual intercourse ? the use of contraception and/or condom? - Yes, absolutely, and - It was the comprehensive programmes. What was the least effective was the Abstinence Until Marriage Only or the Abstinence until Marriage Programmes that don’t give young people complete and accurate information.

In the European Studies tour, when I was talking yesterday, I said that Dutch and the French and German teenagers said, it’s stupid to have sex and not use contraception. That was a very clear precise message that they got not only from their educational programmes but they got it from their families, they got from their friends and as a result in a very short period of time that has become very clear behaviour that’s expected of young people.

In America today you’ve had to be in a closet somewhere not to know that for the past probably two and a half years we’ve done nothing but deal with sexuality and especially oral sex, we know today in our country probably for the first time in a long time we’ve had incredible exposure to sexuality information. A lot of people are not happy with it, they do not like it and especially carers are very very concerned, confused and seeking help today, how do I explain these things as my child is learning about them. You can turn the television set off, but the children still hear it from their classmates and their friends. You can take the newspapers and you can hide them with the Starr report but you’d better believe somebody has got that report near here and will share it with the young person.

The welfare report measures decided in its wisdom that one of the ways in which we can reduce unplanned, unwanted pregnancies that require public assistance especially and also that most of these pregnancies which is a foul thing that occurs to teenagers decided that they would restore America to traditional values. So they meant it, not only that they meant it, but they meant it with 50 million dollars a year for Abstinence Until Marriage Only education. If they took the money, and they gave them out whether to schools or to youth agencies or to community organisations whoever the state decided would get the money they have to adhere to these criteria all of which in some ways are troubling especially to those of us in the field of sexual health but there are a couple that very troubling I think, one is “You have to tell young people that they will suffer physical and psychological harm or damage of they have sex outside or before marriage.” Now in America less than7% of our first time marriages are virginal marriages. Can you imagine, our health department, a public health agency taking this money and then having to implement programmes, whether they are in the schools, whether they are in community organisations, at the clinic centres giving this propaganda with all the wrong models in our country virtually where young people admire movie stars, rock stars, pop shows, the people in the public eye certainly have not adhered to this closed value. It may be of religious value and I will certainly respect that if that is your religious value or someone else’s religious value but it is not a public value not only in America but in most countries of the world any more.

In America average fees to go to physician the average family planning visit costs 75 dollars in our country, the pill costs $22 in our country at pharmacies, Depo-provera is £65 a shot. Norplant Is anywhere between $ 700 and $ 1500.  But young people tell us that the reason they don’t use family planning, the two major reasons are fear of loss of confidentiality and all of the research that we’ve done of why young people, especially those who did not access family planning when they first tried to have sex the loudest reason that came across was, “I was afraid my parents would find out” and in some cases misinformation, “I thought my parents had to give permission, I thought they had to know”. The second reason is embarrassment. And I think it was someone yesterday also from America, one of the physicians who did say that our big office has now relaxed the requirement, the requirement was to give someone oral contraception they had to have a pelvic examination. But there are still many many practitioners in our country who will not give that up.

Two thirds of our pregnancies in America come to 18 and 19 year olds, so we talk about intervention especially in family planning services, we are going to eliminate perhaps some of the 18 year olds, we are going to be in trouble at least in the term of numbers if that happens. 

As I said Abstinence Until Marriage in no longer a societal value in our country, if you are in legislation, if you have to be self-sufficient does that mean that just because you are trying to be self-sufficient and not use public assistance that you are not allowed to have sex? What about the people who don’t use public assistance? Does this legislation apply to them? Imagine how classrooms of young people sixteen year olds feel sitting there in that classroom hearing this message when maybe their mothers never got married, maybe they are living in the house where one of their parents has a live-in or sleep-in girlfriend or boyfriend after divorce, I mean, these are realities in our world today. What about the young people who are living in a home where there are two parents but those parents for whatever reason chose co-habitation and not legal marriage. How they feel, seeing this, hearing this kind of morality being talked to them? The other problem thing in America is that we have strong history that’s written down here that separated the church and the state and unfortunately for most of us what we are seeing happen in our country is that in some of the states the money is being given directly to religiously-based organisations who support this message. I worked with young people that have information and have experience as to learn about sex and sexual health that are positive, that are affirming, that are respectful that give young people choices, that understand that normal adolescents themselves, that are helping young people to grow and move and take different half-ways, also understand that a part, a normal part of adolescence is taking risk. And what we are doing is helping young people in their inter-sexual relationships whenever they occur to be respectful of themselves and their bodies and their partners, to be responsible for themselves and their partners and to understand what their values are and to never do anything that takes away even one little bit of their self-esteem when having sexual relationships.

Do I believe in abstinence? Absolutely, I do. I think it’s one of the most important skills that in any of our health behaviours and any of our life behaviours that we need to be aware of how to implement that skill. Does that mean that I believe in abstinence until marriage personally? No, I don’t any more, and I am not speaking from organisational view point I am speaking personally from my view point. I don’t. My daughter is 28 years old and she got married and I was thrilled that she was that age. It means I’ve got to remember I am doing to be a very old grandmother, but I was thrilled because she had all those years. She had three very serious relationships between high school and being 28 and marrying the man she loves. And everyone of those relationships taught her something about herself and about what it means to be in a partnership relationship and then what it means to be in a marriage. I am thrilled that she had that chance. But I know a lot of women who are my age as does occur in America over this abstinence and waiting until marriage who got married to justify the sex they were either having or wanted to have and were just so frustrated they just got married so that was legal in that sense. Got to remember our generation, the pill came on the market when I graduated from college so I did not have that available to me in my generation. The abortion was not legal until 1973 in our country. We are talking here about very very recent control ability for women to decide whether or not they will bear children.

“Saying birth control and sex education promote sex  is like saying airbags promote head-on collisions“ And we know that’s not true. And I think we have a  responsibility to train people as professional as people who somewhere touch the lives of young people, but also to ourselves in our families and in our extended families. Those young people who are important to us in our lives whether it’s professionally or personally to be there for them, to help them to become the generation that is not raised with fear, shame and guilt messages.

Until I came to Washington 3 years ago for 15 years I had built teen pregnancy prevention programmes in Carolina. What we’ve recognised over that 15 year programme was that we have very few professional opportunities for people who were involved in sexuality education in the world to support each other and to become advocates really for accurate, balanced sexuality education. We wanted to invest to train people and to give them an opportunity to expand what they have to offer to young people in the area of sexual health. And so we came up with the idea of a summer institute. A summer institute that would select 30 participants. We wanted a racial balance, we wanted a gender balance, we wanted geographical balance. We wanted people who were actually on the ground, who would be sexuality educators in some kind of sense. We started in 1993, we got a formal University recognition for a ninety six-hour graduate course of people who are taking or coming to the institute. It’s a very intensive process. We developed a complete syllabus that’s used during the classroom periods.

What are goals? Definitely one is to extent people’s knowledge about sexual health and find that a lot of people come to us in the institute are years behind, really don’t have the up-to-date current knowledge We want to increase people’s comfort, especially people’s comfort in the area of what we in America would call controversial issues and how to address them, how to be an advocate for making sure that issues like masturbation, homosexuality, oral sex, these are hot hot words in America, believe me. So we want to increase people’s ability to deal with some of these controversial issues in the classrooms or in the community. A lot of my time is spent building skills with people doing specific exercises and interactive work with the participants, in groups, in small groups, in pairs and individually. There is videotaping of skills goes on in the institute and then after they leave the institute they can take what they learnt, go home, they have to design a programme and they have to videotape themselves  and send it back to us for viewing and absorption and then we assign grades after that part of their course is met.

At the end of last year when we had done the fifth institute we decided that we had long long since heard how other countries were approaching sexuality education and especially risk reduction in terms of sexual behaviour. So to give ourselves a brightening and also kind of expand our knowledge we decided that this year we would not run the regular institute but that we would work with a facility a University in the Netherlands to design with us a two-week study tour to look at France, Germany and the Netherlands and why their rates of teen pregnancy and sexuality transmitted diseases and abortions were so so much lower than ours. So I am going to share with you some of the lessons learnt about that experience.

First take a look very quickly at the data. And you can see that there is an incredible difference between the United States, Germany, Denmark, France and the Netherlands in terms of their data on berths to teenagers. We are far far ahead of other developed countries in terms of addressing sexuality, adolescent sexual health. This was a project that we designed working with an organisation in the Netherlands that really is non religious even though it is called Catholic, but does a lot of continuing education and in-service education for teachers. And they organised in a lot of countries about 180 study tours to European countries each year, so this is one of their main functions. Linda and I designed what we wanted in terms of the experience, we wanted to have an opportunity to meet the policy makers, and we wanted people to have the opportunity not just to meet with researchers and programme people, but people, parents, teenagers, on the street kind of opportunity so that they could really see whether or not things that we were learning in the classroom or on the sites that were actually things that were reality to the people who lived in those countries. So, we initially had 18 graduates from 6 Universities in 6 States who again self-selected and paid for the trip and to go with us, we had 22 national and local advocates from 12 States. We took with us 2 teenagers, so we took 17 year old young women with us. One is the reporter for teen journalism organisation, national in our country, called Children’s Express. The other one was a teen reporter for Teen People magazine. And if you get a Teen People magazine in any of your countries, she is doing a four page spread in the next issue on how it was for the  teenagers in European Tour Study , so it will be very interesting I think to see what her perceptions were. People were encouraged to do this: the things we arranged for them to do in the groups but also in looking at themselves in the countries and talking with people. We call them issue areas, we wanted them to go home with information that they felt confident about in these areas, the role of media and public education, the influence of family and community on adolescent sexual health, access to health care, education with an emphasis on sexuality education, public policy and controversy management and religion and its influence on public policy.

Well, to share with you very quickly some of the lessons learnt. I said yesterday, one of the huge differences that these countries have invested in massive public education campaigns. Have they did it on teen pregnancy prevention? - No. They didn’t even know really what we were talking about when we said, prevent teen pregnancy, because their rates are so much lower. Their public education campaigns which have been treated into reductions in teen pregnancy they’ve learnt had been around STIs and primarily HIV. And their public education campaigns have mainly revolved around condom use. Something that has been long term, consistent, professionally produced, numerous, I wish I had time to show you some of the tapes, because I brought back some four hours of tapes  of some of the public education campaigns in the three countries, just incredible. Some parents during the interviews told us, “yeah, my mother told me I should wait for marriage”, I didn’t wait for marriage and why should I say that to my nineteen year old, why should I say that. The incredible thing in these countries is their young people start having sex even with the media, even with a lot of the things that we talk about in terms of abstinence and contraception over a year later than our youths in the United States. So in spite of this infiltration in the influence that they have of open sexuality they are waiting longer than our kids to get no-no messages, you shouldn’t.

The next lesson really was, it really was the need to reduce abortion, the desire to reduce abortion that led these countries into promoting and putting in place some of the education campaigns that they did, but also their access to contraception that they see as a way to reduce abortions. So if we really want to reduce the need for, the availability of, the need for abortions and the reduce the numbers, we know that if we can give people what they need to prevent the pregnancy in the first place then we can prevent the abortions.

Sexual responsibility is not a religious value any longer. Sexual responsibility is a public health responsibility. Since World War II virtually the influence of religion on public policy in these three countries is almost nil. You just got to see across the border that a lot of it especially when it deal with reproductive health. This was difficult question for the interlock but we started and once we’ve got the way of little bit and again to think about our experience this came out loud and clear: the young people in these countries are valued, the young people in our country are looked at as disease, as weird, as demons, as delinquent, all the D-words in my vocabulary that I can think of. We Americans don’t have a very positive view of our young people. We are trying to re-frame that but when we think about young people in our country very seldom do we applause the strengths that they have and for most other strengths, and one of those strength is sexual responsibility. Young people here are expected to respect their bodies and to act responsibly. I think that in America what has been happening to expect our people to delay sex rather than help them to act responsibly and positively.

In the Netherlands and Germany there appear to be in the parent interviews a much more higher comfort level in terms of sharing information within the family structure and in the community as a whole with young people. The system in the Netherlands and Germany you go to the post office and there are racks of literature and all kinds of literature about sexuality and sexual health. I cannot imagine this happening in the United States’ post offices in our country.

Being in an intersexual relationship especially for older adolescents is a normal part of their maturation. The Dutch speak of their sexual career history which we kind of get all trepidation from because we don’t really understand it, really what they meant was learning about sex from birth till death and expecting that you will be a sexual person from birth till death. We also have a much stronger emphasis here on helping young people to be self-sufficient people not just as adults.

And the last one, certainly important. They all have national health insurance which provide health care and contraceptive access as little or no cost and accessible to young people without a lot of barriers. The transportation systems in Europe are much better than they are in America where it is difficult for young people to access public health systems and their cost certainly is one of the  biggest drawbacks in our country for young people accessing the contraceptive service system.