Evidence-based Approaches to Sexuality Education

A Global Perspective

James J. Ponzetti, Jr., James J. Ponzetti, Jr.

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317626558
• Edition: 1
• Topic: Bildung
• Subtopic: Gesundheit & Sexualität unterrichten

This is the first book to provide a multidisciplinary and global overview of evidence-based sexuality education (SE) programs and practices. Readers are introduced to the fundamentals of creating effective programs to prepare them to design new or implement existing programs that promote healthy sexual attitudes and relationships. Noted contributors from various disciplines critically evaluate evidence –based programs from around the globe and through the lifespan. Examples and discussion questions encourage application of the material. Guidance for those who wish to design, implement, and evaluate SE programs in various social contexts is provided. Each chapter follows a consistent structure so readers can easily compare programs: Learning Goals; Introduction; Conclusion; Key Points; Discussion Questions; and Additional Resources. The editor taught human sexuality and family life education courses for years. This book reviews the key information that his students needed to become competent professionals.

Highlights of the book's coverage include:

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• Interdisciplinary, comprehensive summary of evidence-based SE programs in one volume.

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• Prepares readers for professional practice as a Certified Family Life Educator (CFLE) or sex educator by highlighting the fundamentals of developing and implementing SE programs.

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• Exposes readers to evidence-based SE programs from various social contexts including families, schools, communities, and religious institutions.

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• Considers the developmental context of SE across the lifespan along with programs for LGBT individuals and persons with disabilities.

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• Critically reviews SE programs from around the world including the US, Europe, Asia, Africa, Latin America, and other developing countries.

The book opens with an historical overview. Part I focus on general frameworks of sexuality education including UNESCO's International Technical Guidelines. How to develop, deliver, and implement evidence based SE programs, including ethical concerns, are explored in Part II. Part III exposes readers to evidence-based programs in various social contexts--families, schools, communities, and religious institutions. Part IV considers the developmental context of SE from early childhood through adolescence and adulthood along with programs for LGBT individuals and persons with disabilities. Part V examines diverse global contexts from the US, Latin America, Europe, Asia, Africa, and other developing countries. The book concludes with future trends and directions.

Ideal for graduate or advanced undergraduate courses in sex education, sexual health, human sexuality, sex or marriage counseling, intimate relationships, family life education, or home, school, and community services taught in human development and family studies, psychology, social work, health education, nursing, education, and religion, and in seminaries and family clinics, the book also serves as a resource for practitioners, counselors, researchers, clergy members, and policy makers interested in evidence based SE programs, or those seeking to become CFLEs or sexuality educators.

1

Sexuality Education: Yesterday, Today, and Tomorrow

James J.Ponzetti, Jr.

Learning Goals

• Describe the historical development of sexuality education.
• Differentiate comprehensive and abstinence-based sexuality education.
• Comprehend ideologies and activities that impede sexuality education.

Introduction

Sexual development is a vital but multifaceted part of human experience. Human sexuality reflects shifts in gender relations, ongoing cultural diversification, ambivalence towards erotic expression, and current globalization of sexual information. Various responses to sexuality and sexual expression are manifest in response to an array of dialectical tensions that arise within a complex global cultural ecology: e.g., sexual freedom or restraint, conformity or diversity of sexual behavior, and eroticism as pleasure or danger (Maddock, 1997).

Historically, sexuality education represents assorted activities that attempt to convey information about sexuality to distinct audiences. The opportunities and methods to learn about sexuality have changed and expanded in form and scope over time. Ubiquitous worldwide attention to sexual issues and behavior attest to keen interest in learning about sexuality and sexual health. Innovations in form are reflected in the wide array of topics included in various programs. The scope of sexuality education has widened in response to new diseases, technologies, and greater interaction in a global milieu. Nevertheless, disagreement ensues over what is or should be included in sexuality education programs. Contemporary sexuality education is offered in many ways, using a range of approaches, forms, pedagogies, and resources, that are not always in concurrence.

Definition of Sexuality Education

Sexuality education (hereinafter referred to as SE) is subject to various social trends, public health concerns, cultural norms, and sundry controversies at different times and in incongruous ways. Scant attention has been given to sexuality as a positive experience through nonexploitative sexual exploration. Instead, concerns such as controlling reproduction, preventing sexually transmitted infections, or treating sexual dysfunction are typically emphasized (Wampold, 2014).

Diverse approaches to SE have generated several descriptors for this litigious area of education. The primary descriptor, “sex education,” is actually the most restrictive. Learning objectives and curricula development offered the definition of the subject matter. Accordingly, sex education focuses attention on the biological characteristics that define humans as female or male. While these characteristics are not mutually exclusive, it is naïve to make use of only biological markers and create a dichotomy between men and women. Further, many languages restrict the term sex in common parlance to mean genital activity. Given such limited conceptions, the scope of sex education is reduced to instruction on subjects such as sexual anatomy, reproduction, birth control, and disease prevention.

A second descriptor, “sex and relationship education” (or SRE), is commonly used in the U.K. It extends sex education by contextualizing the subject matter within sexual relationships and interaction (Aggleton & Crewe, 2005; Kane, 2008; Turnbull, van Schaik, & van Wersch, 2010). So, SRE includes information on such topics as body image, sexual orientation, decision-making, sexual communication, and personal values. Yet, SRE has been a contentious subject wrapped up in turbulent and wide-ranging debates in the U.K. since the latter decades of the 20th century (Monk, 2001). Because it elicits such controversy, SRE requires a courageous pedagogical approach to curriculum design and content (Mason, 2010). At the beginning of the 21st century, the British government published Sex and relationship education (SRE) guidance in light of the revised National Curriculum, published in 1999, and to provide guidance for the new Personal, Social and Health Education (PSHE) framework (DfEE, 2000). This document encouraged schools in England, Scotland, and Wales to take a coordinated approach to teaching SRE involving parents, educators, and health professionals. SRE bridges the distinction between sex education and sexual health education.

"Sexual health education” (or SHE) is similar to sex education, only framed as a crucial public health strategy. Education from a public health perspective considers sexuality as risky behavior due to the possible negative outcomes with which it is associated: specifically, diseases, deficiencies, or dysfunction that interfere with sexual and reproductive function. A pragmatic, harm reduction approach is considered an essential tool to mitigate these negative outcomes. However, SHE is also concerned with emotional and mental well-being in relation to sexuality (Schaal, Abraham, Gillmore, & Kokma, 2004). The definition of sexual health proposed by the World Health Organization (1975; 2006) diverted attention away from earlier limited notions of sex education. The concept of sexual health included three basic elements: knowledge and understanding, personal and social skills, and attitudes and values.

The three descriptors of sex education, SRE, and SHE are integrated under the rubric of “sexuality education.” Sexuality education offers the most expansive term that unifies key elements of the others for an enriched description. Sexuality is a central part of being human encompassing gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, coitus, and reproduction across the life cycle. It is a multidimensional experience that involves what women and men, boys and girls consider sexual, how they comprehend it, the degree of control and agency they feel over it, and the import and value ascribed to it. Sexuality is experienced in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles, and relationships. Thus, “sexuality education” is an inclusive descriptor that recognizes the interaction of historical, social, political, cultural, psychological, legal, ethical, religious, and moral factors.

When referring to SE, two distinct approaches prevail. These are comprehensive education or abstinence-based programs. In reality, most programs offer some combination of these two descriptors. Comprehensive sexuality education includes accurate, age-appropriate information beyond that covered in sex education. The broad set of topics addressed as a part of SE includes human development, relationships, affection, intimacy, sexual expression, and gender roles. These programs consider sexual learning as a lifelong process of acquiring information and forming attitudes, beliefs, and values. SE uses a sex-positive approach in acknowledging personal desires and the possibilities for pleasure while perceiving the boundaries where the two might impinge upon each other. On the other hand, abstinence-based programs focus on self-discipline and restraint. These programs emphasize information about nongenital sexual expression and continence, rather than penetrative sex, contraceptive use, and disease prevention. These programs are also referred to as abstinence-plus, abstinence-centered, or abstinence-only. The difference between these descriptors is subtle, but the details influence the breadth and depth of educational endeavors.

These descriptors are based on the premise that individuals are motivated to learn about their sexuality, however it is construed. This presumption further implies that what constitutes sexuality, in the fullest sense, can be transmitted in the same way as mathematical or composition skills. Yet, SE encompasses sexual development, reproductive health, affection, intimacy, body image, and gender roles, to name a few of challenging provocative ideas considered. While there is promising evidence that specific skills can be learned, the integration and application of these skills and information may not be as easy as it appears. Evidence-based programs offer significant benefits from a global perspective, such as supporting reproductive rights, tackling overpopulation, and influencing the spread of sexually transmitted infections and disease. However, the evidence in support of these benefits is not readily accessible, widely dispersed, or easily found due to limited resources, geographical dispersion, varying ideological groups, and diverse cultural norms around the world.

Sexual activity typically elicits strong emotions. In addition to the eclectic emotional responses associated with sexual behavior, uneducated or misinformed individuals can experience unintended consequences, such as STIs or pregnancy, that yield social as well as personal implications. Cultural and religious standards aim to minimize the occurrence of these consequences through the regulation of sexual behavior. However, within the boundaries set by these prescribed regulations, families and home life have traditionally been considered the “appropriate” place to proscribe issues related to sexual expression and behavior. Even though young people sometimes engage in premarital sex, family expectations and social norms generally discourage such practices. The effectiveness of leaving the responsibility for learning about sexuality solely to families is imprudent and unreliable.

A significant amount of sexual learning takes place in venues other than home and family life. Schools are obvious places to offer SE efforts that augment sexual learning occurring away from the auspices of close kin. Yet, this is not a foregone conclusion. Although the pursuit of SE is taken for granted by some, it is still deemed immoral by others (Grossman, 2013). Disparate opinions regarding when, where, and how to teach sexuality remain pervasive. The ubiquitous debates about SE are important in that SE is defined by how human sexuality is perceived and conceptualized. The content and methods vary considerably depending on sexual taboos, religious beliefs, cultural attitudes towards sexuality, and sexual insight. However, not all SE takes place in a formal classroom setting.

SE occurs in conversations with friends and emerges from other sources, such as television, music, magazines, other media, and the Internet, as well as in schools, religious organizations, and public health campaigns (Goldman & Bradley, 2001; Richman, Webb, Brinkley, & Martin, 2014). Once a person is no longer going to school, for whatever reason, there are fewer opportunities to learn about sexuality in a reliable coordinated manner.

History of Sexuality Education

Very little overt interest in sex education occurred before the middle of the 19th century. Gradually, various reformers and ministers in the United States and England began printing brochures and books for men that directed them to control their sexual urges until marriage provided a proper context for its expression. These publications seldom addressed women, as societal views considered them to be under the protection of their fathers and then their husbands. In comparison, the literature that began appearing in France in later decades of the 19th century was usually addressed to middle-class mothers. It focused on mothers’ duty to instruct their daughters to be sexually abstinent until marriage but prepared for sexual contact thereafter. Despite these unpretentious efforts, later reformers complained that a “conspiracy of silence” about sexual matters existed well into the 20th century. Overall, there was little material about sex education before 1900 (Pearsall, 2001).

SE began in earnest as a social movement under the rubric of social hygiene in the early 20th century. The social hygiene movement grew alongside home economics, social work, and other public health efforts characteristic of the era. Progressive-era reformers directed their undertakings at the regulation of prostitution, control of STIs, and promotion of strict self-discipline and sexual restraint, preferably abstinence (Farrand, 1913). The goals of social hygiene and moral purity activists eclipsed wide-ranging sexual concerns during the early decades of the 20th century.

Professional organizations such as the American Society for Social and Moral Prophylaxis were founded to rectify social ills through education aimed at sexual behavior and development, which many perceived exacerbated the maelstrom (Keyes, 1905; Muren, 1907). These early haphazard attempts at SE were not formally organized and tended to be authoritarian and moralistic, warning of dire consequences of sexual indulgence (Money, 1985; Young, 1964). Although the activists involved in this endeavor identified with progressive reforms, they were morally conservative and represented an older mainstream sexual ethos. Their primary aim was to maintain a moral standard that demanded the repression of sexual activities except those designed for procreation rather than an enhanced comprehension of sexuality (Strong, 1972). Nevertheless, the Bureau of Social Hygiene was notably engaged in research, education, and policy initiatives pertaining to sexuality issues from 1911 to 1934 (Tupper, 2013).

The American Social Hygiene Association (ASHA), founded in 1914, grew out of a merger of analogous organizations to act in response to social anxieties over hygiene. The ASHA embarked zealously to usurp presumably distorted knowledge or ideas about sex in order to prevent any moral degradation. Public health and social reform advocates exploited the progressive education movement and nascent public schools as opportune spaces in which to advance lauded, albeit circumspect, SE programs. Churches and quasi-religious organizations, such as the YMCA/YWCA, also responded to shifting social conditions with hygiene education—personal, social, and moral—a major target of which was various sexual practices.

Much of the activity that targeted sexuality in the early decades of the 20th century dealt with fostering school-based programs. The National Education Association in the U.S. appealed for teacher training programs in SE as early as 1912. But early educational efforts were mixed at best. Given the sexual double standard, sex education for girls did not seem as imperative because they were expected to remain chaste until marriage. American reformers, like their counterparts in England at roughly the same time, were more focused on the related dangers of medical and moral decline. However, sex education in France differed in certain respects. French society was more concerned about preparing young middle-class women for the sexual aspects of marriage and reproduction. Although the French occasionally supported sex education for men, sex education mainly encouraged French families to bear children to repopulate the country after World War I.

SE was problem-centered until after World War I. The post–World War I era witnessed a surge in nonmarital sex (and STIs) and spread of psychoanalytic writings with an emphasis on childhood sexuality that set the stage for a period known as the Roaring Twenties. The focus of SE shifted to a more liberated, pragmatic approach to sexuality (Maddock, 1997).

In the Progressive era, sex education made progress into the curricula of both the United States and France. American sex education typically took place in high school biology classes, but leaders in the movement also faced for the first time a clear divergence between societal expectations for youth and adult sexual ideals. Through the early 20th century, it was easy to denounce sex when sexual gratification was not considered a proper standard even for married adults. But as more Americans came to believe that sexual fulfillment was important in marriage, educators faced a dilemma. Sex was recognized as positive in marriage while at the same time its expression was negative anywhere else. Sex educators responded partly by reemphasizing the health dangers linked to sex and sexuality, but also by incorporating the new beliefs. Greatly concerned over the sexual freedom of youth in the 1920s and 1930s, educators looked to social scientists for evidence that sexual experimentation jeopardized chances f...