My thesis in this unit is that a major contributing factor to teenagers' having unprotected sex which results in unwanted pregnancy (and disease) is the schizophrenic attitude toward sexuality in the United States. The dictionary gives one definition of schizophrenia as a separation between thoughts and emotions. What I mean here is a separation between what adults, society, cultural mores say about sex and sexuality and what they actually do in their lives. We say, for instance, that sex should wait until marriage while most people have sex before they get married. We say that it's too embarrassing or too private to talk about sexual matters, yet we include them publicly in every piece of media and entertainment. As a result, most young people receive no calm, rational, accurate education or thoughtful discussions about sexuality, but instead are bombarded constantly with sexually stimulating news, films, TV shows, music. This leaves them with a distorted and unrealistic idea of what sex and sexuality are all about. The objectives of this unit are threefold: to raise student awareness of this schizophrenic attitude by comparing teen sexual activity and teen pregnancy rates of several countries and analyzing the differences; to increase student understanding of sexuality as a natural and positive attribute of being human from the moment of birth throughout the rest of their lives; and to encourage their ongoing development as sexually healthy adolescents.
Raising Student Awareness
Students need to know that far too many teenagers are getting pregnant unintentionally in this country. One way to learn this is to compare the USA with other, similar countries. The book, "Teenage Pregnancy in Industrialized Countries," by Elise F. Jones, describes a study that attempted to understand the causes of teenage pregnancy in the USA and to identify means to prevent it by comparisons with the experience of other developed countries. When comparing five developed countries (Sweden, France, USA, Wales/England, and the Netherlands), it is clear that the percentage of young people who are sexually active by age 19 (defined as having sexual intercourse) is similar. According to statistics from Jones and presented by Advocates for Youth in Washington, DC, at a conference on Global Issues in Adolescent Health, the percentages for these countries in order of prevalence from highest to lowest are:
Sweden-88%, France-70%, USA-65%, Wales/England- 63%, Netherlands-55%
The median age (which is when 50% have had sex) of first intercourse, which is also similar in the five countries, is 16.2 years for girls and 15.7 years for boys. This can be as much as one to three years earlier if the following factors come into play: the teens live in a single parent household, their mothers or sisters gave birth as teens, their socio-economic status is low, they experience high residential turnover, they live in high poverty areas, they get low grades or have dropped out of school, they are heavy drug or alcohol users, they are members of a racial or ethnic minority, or they have low expectations for the future. Statistics from Connecticut (The Voice of Connecticut Youth) and from New Haven (the Social and Health Assessment - SAHA) support the fact that adolescents are becoming sexually active at young ages.
Assuming that unintended teen pregnancy is a problem, we can see by looking at these same countries' rates of teen pregnancies (number of pregnancies per 1000 population) that a significant problem exists in the US. The countries are arranged again in order of prevalence, highest to lowest.
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USA-96, Wales/England:45, France-43, the Netherlands-14, Sweden-39.
What are some of the possible causes of this high incidence of pregnancy among US teens when there is so little difference in the percentage of teens who are having sex? What are the differences between what happens in the USA and what happens in the other countries when it come to adolescent sexuality? There is not a simple answer. There are the obvious differences in population makeup with its various cultural, family, religious and ethnic traditions. The book also devotes an entire chapter to each country with a special focus on describing and comparing the following:
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attitudes toward sexuality, approaches to sex education, access to contraceptive services and sources of information about pregnancy prevention, differences of understanding about reproductive processes, how birth control works and skill at obtaining and using it correctly.
It becomes clear that a fundamental difference in attitude between the other countries and the US can be summed up in this quote: "One notable difference between the American and Dutch attitudes is that the former feel that the value of the family would be violated by the open recognition of teenage sexual activity while the latter feel that the value of the family would be violated by not openly recognizing the sexual relationships of the teenage members."
Attitudes and beliefs about adolescent sexual activity are reflected in and reinforced by laws and regulations, and by medical, educational and media policies and practices. In many of the other countries, for example, family planning services are fully integrated into the practice of general practitioners, as opposed to being the domain of specialists as in the US. This means that contraceptive services are more available geographically and less costly. In another example, the US does not allow condoms to be advertised on television despite a constant stream of sexual situations and innuendoes in television programming. In the other countries, sexuality is openly discussed on TV and condoms are advertised and available everywhere. Whereas the United States attempts to reduce sexual activity among adolescents, the governments of the other countries see teenage pregnancy as the problem to be solved. The US government has recently made 50 million dollars available to the states only for education programs which promote abstinence from sexual intercourse until marriage. This is despite the data which are repeatedly collected showing that the majority of the US population no longer believes or acts in a way consistent with that position. Most have had sex before getting married. The Dutch (who have the lowest teen pregnancy rate and a very low abortion rate as well), in contrast, have a more liberal and open attitude allowing for freer and more pragmatic discussions in a less moralistic manner. The government there supports public information campaigns, school sex education, and more open and realistic media coverage. A national desire and commitment to reducing reliance on abortion as a birth control method led to widespread sex and birth control education, open discussions of sexuality in the media, and accessible family planning services. (More information about each of these and other industrialized countries can be found in the Jones book.)
The US has a heterogeneous population with many different attitudes towards sex. Some puritanical and moralistic traditions have led to an adult fear of adolescent sexuality, seeing it as dangerous and in need of control, rather than as a natural and normal progression of development and growth. We take a public (and I would argue, hypocritical) stance that adolescents should not be sexual, that sex should not happen until marriage. Adolescents watch adult behaviors and see the contradictions. I want students to analyze these conflicting attitudes and arrive at the conclusion that sexual development can be integrated into their total development.
One strategy I will use to achieve this is examining data from the five countries, and providing information about the various factors. Students will then try to identify the causes of teen pregnancy. Another strategy I will use throughout the lessons is having students read and report back to the class on what they read. Each student will then talk about his/her selection and how it relates to the general topic. The selections will be brief, in an adolescent's own voice, and pertaining to some aspect of adolescent sexuality, such as getting pregnant and sexual orientation. For the topic of teen pregnancy, students will read selections from the books "Going All The Way: Teenage Girls' Tales of Sex, Romance and Pregnancy" by Sharon Thompson, "When Children Want Children" by Leon Dash or "Young, Poor and Pregnant" by Judith Musick. Then each will lead a discussion of what influenced the choices made by the young people in the stories.
In summary, a first indication of the schizophrenic attitude towards sexuality in the US is evidenced by the inordinately high rate of teen pregnancy. Although teenagers in other industrialized countries have similar rates of sexual activity, they don't get pregnant as often. Many policies and practices in fields as varied as health care and the media contribute to teens having or not having unprotected sexual intercourse which leads to pregnancy. Although we decry the terrible situation here, we are hindered in any effort to increase adolescent sexual responsibility by the blinders we refuse to take off, which leaves us able to believe that teens are not or should not be sexually active even though they have matured physically and most don't get married until years later.
A second indication of the schizophrenic attitude is evident in looking at the way the media depicts sexuality, and contrasting that to what teens are told about how to behave. Studies of daytime soap operas, television talk shows, movies and music lyrics demonstrate a pervasive reliance on sexual innuendoes, sexual situations and depictions of people having sex in every one of these media. Sex sells. All these media rely for their continued existence on people buying the sponsoring products. The more people watch, the more they're likely to buy the product. And the sexier the content, the more people watch. Students will analyze magazine ads, keep a log of television series, specials, soap operas, and talk shows for sexual messages. Students will watch a video entitled, "The Glitter: Sex, Drugs and the Media" and design their own ads/commercials for abstinence and safer sex practices.
The third indication to explore in raising student awareness about the schizophrenic attitude toward sexuality in the US is to identify and analyze the contradictory messages students receive about sexuality from society. It is possible to compare and contrast sex-positive and sex-negative messages. Some examples of conflicting messages are contained in the following opposing statements:
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"Sex is dirty...vs...save it for the one you love,"
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"I better not get an STD from him/her...vs...I won't tell her/him about this little rash I have,"
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"Sex is wonderful, fantastic and one of the best things in life...vs...but we shouldn't talk about it,"
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"My mother (or sister) is wonderful and deserves respect...vs...it's okay to force girls into having sex, they're chicks, it's okay to take advantage of them,"
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"If you carry condoms, you're a slut...vs...If you're going to have sex, always use protection."
Students will participate in an exercise where they remember the messages they received in growing up, as toddlers, preschoolers, children and pre-adolescents. They will talk in small groups about how they learned about the changes of puberty, about sexual intercourse, about pregnancy and contraception. Students will dissect the messages they've received for the underlying values and attitudes, which the class as a whole will then discuss. Classes will watch the video, "Raising Healthy Children." Students will then write an essay describing their own values about sexuality for themselves and for their future children.
Increase the Understanding and Acceptance of Humans as Sexual Beings from Birth to Death
A second objective of this unit is to broaden the concept of sexuality in people's lives beyond the notion of sexual intercourse during adolescence and early adulthood. One can begin to consider this concept by looking at the physiological operation of the sexual response system. Both male and female sexual response systems are operating in human babies when they are born. Boys have erections, girls have lubricated vaginas. Of course, these physiological attributes are not due to any overt sexual thoughts or actions, nor to any intent to reproduce. They are evidence, rather, that the systems are already intact and functioning from the moment of birth. From a very young age, both boys and girls express healthy curiosity by and derive pleasure from exploring their bodies, including their genitals. Whether children associate positive or negative feelings with these explorations depends upon how the adults around them react. Children learn that their bodies, including their genitals, are good and healthy when adults are open and accepting of such behavior as normal and when they acknowledge the existence of the good feelings which come from touching. Children learn there is something shameful about themselves and their bodies when adults react in a punishing and scolding way to such touching. Children already know that it does feel good, so they are confronted with a contradiction which can be confusing, to say the least. They also learn to associate feelings of shame or guilt with touching their bodies.
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The urge to have sexual contact with another is the natural result of the normal process of the physical and sexual maturation not begun but rather accelerated during puberty. Puberty occurs at a younger age now than 100 years ago, and society has set the age for marriage and childbearing at an older age than that of 100 years ago. This period of physical readiness but social restriction has shifted from one to three years then to ten to thirteen years now. So here is another contradiction for young people between what their bodies (and instincts?) are telling them, and what their parents, guardians, churches and society may be telling them. The urge to have sex is the species' way of carrying out the need to reproduce. What's instinctual is the sexual drive. Humans are capable of controlling their instincts. This is easier to understand and achieve when humans are consciously aware of which part of their drives are instinctive and then make a choice to follow or moderate these instincts.
The species' drive to reproduce itself is connected to the concept of survival of the fittest. This means that individuals who have the most offspring are the ones whose genetic characteristics are passed on to the most offspring. In almost all species, males produce abundant sperm while females produce few eggs. This leads to differing behaviors when it comes to sex. Males aim to inseminate as many eggs as possible, while females exercise choice over which male(s) will inseminate her eggs. Reading about the behavior of certain primates might offer insight to students about the ability of humans to control their own behavior. I will have the students read articles about chimpanzees, gorillas and bonobos to identify parallels and differences between animal behavior and that of humans.
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In this context, it is appropriate and important to introduce a discussion about sexual attraction. The result of sexual maturation, it is a natural response. Feelings of sexual attraction can be caused by and felt towards the same, the other or both genders. One cannot control the feeling of being attracted. Humans can always control their behaviors but the feelings of attraction arise on their own (pardon the pun). One adult gay friend describes being surprised during high school to discover that he had gotten an erection while looking at another boy. The term sexual orientation is more accurate than sexual preference because it better describes the reality as the direction in which one is leaning or drawn. In his studies of human sexuality, Alfred Kinsey proposed thinking of sexual attraction along a continuum. Understanding this idea can illustrate for young people the concept of not necessarily fitting into one category or the other, meeting the requirements of one label or the other. According to Kinsey, the majority of people feel attracted to members of both sexes, to a lesser or greater degree according to where they fall along the continuum from heterosexual to homosexual. Here again, it may be instructive to read about other primates. The bonobos have sex with every other member of their group. Among the bonobos, homosexual sex serves the function not of reproduction but of diluting or replacing aggression between males. Reading about the behavior of chimps, gorillas and bonobos is an interesting and less personal way to discuss sexual behaviors than talking directly about human beings. And it can allow students to begin discussing sensitive topics in a less embarrassing or threatening context.
Adolescents in US society have probably grown up with profoundly negative attitudes towards homosexuality, since that is the pervasive attitude in this society. Talking about what is known about homosexuality and personalizing the "issue" by reading stories may break down some taboos or barriers. Students will select one story to read and discuss from the book, "One Teenager in Ten: Writings by Gay and Lesbian Youth." As uncomfortable as it may be for students to talk about this issue, they will benefit from breaking down stereotypes and learning that discrimination or harassment of their fellow students due to the perception that they're gay is neither acceptable nor legal. They will read and discuss the new Connecticut legislation which prohibits discrimination against a public school student based on her or his sexual orientation. They will also read the article in the July 9, 1998 New Haven Advocate, called "They're Here, They're Queer - The Struggle to Make Connecticut Schools Safe for Gay Teens," by Leigh Bardugo. Discussion will elicit what students have heard or witnessed themselves regarding the treatment of homosexuals.
Another concept to emphasize is that lifelong pleasure can be derived from intimate relationships with others. Students will participate in an activity which has them placing sexual events along a timeline with many different ages demarcated from birth to death. Sex is not the only thing in life for adolescents, and adolescence is not the only time in life when sex plays a role. Helping adolescents to realize that people continue to engage in intimate sexual relationships throughout their lives might alleviate the pressure cooker feeling of being under the microscope with the whole world watching.
Development of Sexually Healthy Adolescents
The Sexuality Information and Education Council of the United States (SIECUS) published (in the August/September 1995 SIECUS Reports) an article describing sexual health for America's adolescents. It provides a checklist of several categories to think about in identifying what constitutes sexual health. These include characteristics about oneself (appreciates own body, takes responsibility for own behaviors, is knowledgeable about sexuality issues), about relationships with parents and family members (communicating effectively and understanding parents' and family values), about peers (interacting with both genders in appropriate and respectful ways), and about romantic partners (expressing love and intimacy appropriately and having the skills to evaluate readiness for mature sexual relationships). It is my contention that if society focused on raising sexually healthy adolescents, those adolescents would make choices about their sexual activity which would result in a decrease in unintended pregnancy and disease transmission. (See Whitehead in Resources for article and refutation about the failure of comprehensive sex education.)
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The first step is helping young people to know, accept and acknowledge their own sexuality, from their biological identity (what their genitals look like) to accepting their sexual orientation as an integral part of their identity. When this step is not taken, young people are likely to feel it is okay to "be swept off their feet" but it's not okay to plan on having sex. Carrying condoms because you want to have sex and you want to do it responsibly and safely should be seen as the act of a mature, trustworthy and reliable individual. Too often it is seen instead as the behavior of a slut. The primary goals of sex education should be to help young people develop a healthy lifetime sexuality, to have healthy values regarding their sexuality, to evaluate and look for positive relationships, to gain competency in life management skills, to delay the onset of first intercourse, to prevent unintended pregnancies and sexually transmitted diseases. Notice how far down the list preventing problems is placed. It is easily acceptable to most people to provide education which scares or threatens young people with dire outcomes and terrible consequences if they have sex. It is much harder to find support for an education program which presents a positive, accurate and comprehensive view of human sexuality.
Studies have identified the characteristics of effective sex education programs. These studies define "effective" as reducing the incidence of problems like unintended pregnancy and disease acquisition. They are important to keep in mind while teaching about human sexuality, as proven ways to enable adolescents to act responsibly in their sexual lives.
Effective sex education programs:
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* have a narrow focus on reducing sexual risk taking, specifically delaying intercourse initiation and using protection.
* use social learning and social influence theories as a foundation for program development. Social learning theory recognizes that learning is an interactive process between the learner and his/her environment. It occurs not merely within the learner but also in a particular social context. Learners are influenced by the actions of others, by their expectations about outcomes and by beliefs about their own ability to act. Social influence theory emphasizes the role of social norms in influencing individual behavior. If an individual perceives that certain behaviors are acceptable within his or her peer group, s/he is more willing to engage in them. The successful programs focus on recognizing social influences, changing individual
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values, changing group norms, and building social skills.
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* provide basic, accurate facts about the risks of unprotected sex and the methods of avoiding unprotected sex. They include lessons which provide experiential activities such as small groups, games, simulations, and role plays designed to personalize the information.
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* address social and media influences on sexual behavior.
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* reinforce clear and appropriate values in order to strengthen individual values and group norms against unprotected sex.
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* model communication and negotiation skills and provide training for teachers and/or peer leaders who teach the programs.
The expected outcomes of an effective sex education program are young people who know and accept themselves for who they are, and who make responsible decisions about their sexual behavior. They communicate with partners, are able to differentiate high and low risk behaviors, protect themselves and their partners from unwanted pregnancy and disease, and know how to gain access to and use health care information and services.
To reduce the incidence of teenage pregnancy (and the rate of reproduction, thus confronting the crisis of global overpopulation on the personal, individual level), and to lower the incidence of sexually transmitted diseases among young people, we have to acknowledge that adolescents are sexual beings just as all humans are throughout their lives. We need to accept sexuality as a positive feature in our and their lives that is neither evil nor unclean. We need to realize that the period from puberty to marriage is too long for most people to abstain. We need to quit expecting behavior from young people that we don't really expect from ourselves or even believe in anymore. We need to address sexuality issues openly and honestly, and not only by means of innuendoes, jokes and the fantasy life of movies.