A new analysis has discovered that sexual education programs that address gender and power in relationships are far more effective than programs that do not.
Adolescents around the world face significant reproductive health challenges, including high rates of unintended pregnancy and sexually-transmitted infections, noted Population Council researcher Nicole Haberland, M.P.H.
According to the U.S. Centers for Disease Control and Prevention, people in the United States between the ages of 15 and 24 account for half of all new sexually transmitted infections. Globally, young people in this age range account for 40 percent of all new HIV infections, according to UNAIDS.
While sex education, including education about HIV, is considered a key strategy to improving adolescent reproductive health, the results have been disappointing, despite extensive investments in these programs, the researcher noted.
Studies have shown that when people hold biased beliefs about appropriate roles and behavior for males and females, or when they report unequal power in their intimate relationships, they are more likely to experience poor reproductive health outcomes.
For example, women who report low power in their sexual relationships tend to have higher rates of sexually transmitted infections and HIV than women who report more equitable relationships, the researcher noted. That has led some researchers to theorize that sex education should help young people reflect critically about issues of gender and power in relationships.
“We wanted to know whether programs that take such an empowerment approach perform better than the majority of programs, which do not,” said Haberland.
“To do so, I wanted to set a very high bar and look at whether these curricula actually reduced rates of unintended pregnancy and sexually transmitted infections.”
For her study, Haberland searched electronic databases for evaluations of programs that were assessed by measuring impact on sexually transmitted infections or unintended pregnancy, aimed at adolescents 19 or younger, and evaluated using a rigorous study design. She identified evaluations of 22 sexuality and HIV education programs from various countries.
She divided the programs into two groups based on whether they addressed — or ignored — issues of gender and power, such as notions of masculinity and femininity, gender inequality in society, unequal power in relationships, and young women’s empowerment. She found that 10 programs addressed these issues, while 12 did not.
Haberland reports that the impact of including gender or power content was dramatic.
“The programs that addressed gender or power were five times more likely to be effective than those that did not,” said Haberland. “Fully 80 percent of them were associated with a significantly lower rate of sexually transmitted infections or unintended pregnancy.
“In contrast, among the programs that did not address gender or power, only 17 percent had such an association. It is striking that the two sets of programs — sexuality education programs that address gender and power and programs that do not — have nearly opposite outcomes.”
The impact of gender and power content held true even when considering other variables, such as program duration or whether the program had multiple components versus a single component, she noted.
Furthermore, all of the programs that included gender or power content and were associated with positive health outcomes were also significantly associated with other beneficial outcomes, such as reported safer sexual behavior or improved knowledge, she found.
After studying the common characteristics of the effective interventions, Haberland offered several recommendations for integrating content on gender equality and power dynamics into sexuality and HIV education:
- Include explicit content about gender equality and power dynamics;
- Use methods that encourage participants to reflect in meaningful ways on how gender stereotypes and power inequalities affect their own relationships, sexual and reproductive health, and HIV risk; and
- Help participants recognize their potential power in their own lives, relationships, or communities.
To enable programs to implement such an approach, the Population Council has published a resource — It’s All One Curriculum — with culturally sensitive content and 54 teaching activities. It is available in several languages at no cost at ItsAllOne.org.
The study was published in International Perspectives on Sexual and Reproductive Health, published by the Guttmacher Institute.
Source: Population Council