Wake Up and Smell the Condoms: An Analysis of Sex Education Programs in the United States, the Netherlands, Sweden, Australia, France, and Germany

The ability to control one’s sexuality and make informed, responsible decisions about one’s sexual health is a basic human right. The Netherlands, Sweden, Australia, France and Germany protect this right by providing comprehensive sex education in their schools and implementing public programs to promote sexual health. Abstinence-only education in the United States denies American youth the right to sexual autonomy and prevents them from developing healthy sexual identities. Youth in the United States are far less sexually healthy than youth in these other countries. This paper will examine sex education policies and sexual health agendas in each of these countries and look to them for inspiration in proposing a new sex education and public health agenda for the United States.

Adolescents in the United States fair consistently worse on most sexual health measures than teens in other industrialized countries. Teens in the US have higher rates of pregnancy and abortion than any European country (Lottes, 2002). Young women in the United States experience intercourse at a younger age, use less effective contraception, and report higher rates of using no contraception at all than young women in every other industrialized country (Lottes, 2002).

Nearly sixty percent of US pregnancies are unplanned or unwanted, a very high rate compared to other countries, and rates of curable STDs are higher in the US than any other industrialized country and even some developing countries (Lottes, 2002). Teens in the United States have also been shown to have higher numbers of sex partners than those in the Netherlands, France and Germany (Labauve & Mabray, 2002).

Why do teens in the US fair so poorly compared to other countries? Some factors that put US youth at risk include restrictive ideas about teenage sexuality, lack of openness and discussion about contraception and sexual responsibility, high levels of poverty and uneven distribution of wealth, high levels of religiosity, low availability of contraceptive education and family planning services, and high costs of such services (Lottes, 2002). While all of these factors certainly play a role in the sexual health of teenagers, I have taken a special interest in sex education.

Sex education has long been a controversial topic in the US. While most parents of school age children support a comprehensive approach to sexuality education in schools (Berne & Huberman, 1999), pressure from religious groups and social taboos against adolescent sexuality have led the government to encourage an abstinence-only based approach. There are no federal laws in the United States requiring that sex education be taught in schools (Weaver, Smith, & Kippax, 2005), but the government allocates funding for abstinence-only sex education that schools may choose to accept.

Abstinence-only education became the predominant means of sex education in 1981, when the US Congress passed the Adolescent Family life Act, encouraging abstinence-only be taught in schools to reduce teen pregnancy and STD rates (Weaver et al., 2005). In 1996, Congress passed Title V, providing $50 million a year to fund abstinence-only programs in schools.

Funding for these programs has since increased to $300 million a year (Weaver et al., 2005). Schools receiving funding under Title V must adhere to strict guidelines, including teaching that abstinence is the only way to avoid sexually transmitted infections, pregnancy, and psychological harm, and that childbirth outside of marriage is against social standards and harmful to individuals, parents and society (Labauve & Mabray, 2002). Title V funded programs are only allowed to address methods of contraception, such as condoms or the birth control pill, when emphasizing failure rates and ineffectiveness (Labauve & Mabray, 2002).

A study done in the 1990s showed that only 69% of US school districts has a policy in place to provide sex education, while the other 31% left it up to individual schools or teachers to determine sex education policies. Of the school districts with sex education policies in place, 14% were comprehensive, 51% were abstinence-plus (programs which include information about safe sex and contraception while still emphasizing abstinence as the best and most desired method), and 35% were abstinence only (Labauve & Mabray, 2002). It is important to note that while abstinence-based sex education is the norm, programs vary widely between individual schools, districts, and states.

Why aren’t abstinence-only programs working for US teens? First, they are simply impractical. In the 21^st century, age at puberty has decreased and age at marriage has increased, creating a greater gap between sexual maturity and marriage than ever before (Weaver et al., 2005). In Western countries, sex before marriage has become the norm, and it is statistically less normal for a woman to be a virgin at marriage than a non-virgin (Weaver et al., 2005). In the US specifically, teens begin having sex at an average of 16.3 years of age (Weaver et al., 2005). Abstinence-only sex education ignores these realities. Second, abstinence-only sex education programs have never been shown to be effective in altering teen sexuality activity (Labauve & Mabray, 2002). Abstinence only programs do not prevent teens from having sex, but they do deny them accurate information on STD prevention and contraception, therefore denying them the ability to make informed, responsible decisions about sex.

Sex education programs are also most effective when supplemented with public health programs that provide easily accessible sexual health services to youth, which the US does not have. Unlike teens in other countries, teens in the US face many barriers to attaining sexual health services. There is no universal healthcare system in the US and only approximately 85% of US residents have health insurance (Berne & Huberman, 1999) .

While condoms are sometimes provided free of charge by health centers and family planning clinics, only 33% of private health insurance plans cover oral contraceptives (Berne & Huberman, 1999) . Teens seeking sexual health services rely mainly on private organizations or school-based services, but private organizations tend to target older teens and young adults, and only 22% of school-based health services provide access to condoms or contraception (Berne & Huberman, 1999) . Abortion is legal in the United States during the first trimester, but high costs, lack of information, and parental consent requirements discourage teens who seek abortions (Berne & Huberman, 1999) .

The US is clearly not providing its youth with necessary measures to achieve sexual health, and should look to other industrialized countries for insight on how to improve. All of the countries under examination in this paper outperform the United States on measures of teenage sexual health. I will start by examining the Netherlands because they have the highest sexual health ratings of any industrialized country. The Netherlands have the lowest rate of unplanned pregnancy, abortion, and teen pregnancy in the western world (Lottes, 2002). The birth rate for teens ages 15-19 in the Netherlands is only 8.2 per 1000, compared to 54.4 per 1000 in the US (Singh & Darroch, 1999). Abortion rate for teens 15-19 in the Netherlands is only 4.2 per 1000, compared to 29.2 per 1000 in the US (Singh & Darroch, 1999). Rate of contraception used at first intercourse is 85% in the Netherlands but only 65-75% in the US (Weaver et al., 2005). Teens in the Netherlands also have fewer sex partners and postpone sexual intercourse longer than teens in the US (Lottes, 2002).

Teen sexuality is normalized in the Netherlands, rather than dramatized as it is in the US. Dutch parents anticipate teens will develop emotional involvement with another person and regard it as non-threatening; a healthy part of human development (Labauve & Mabray, 2002). Sex education was officially made mandatory for all Dutch students in 1993 (Weaver et al., 2005). Schools in the Netherlands are required to provide education about pregnancy, sexually transmitted infections, sexual orientation and homophobia, sexual values, respect for different attitudes regarding sex and sexuality, and skills for developing a healthy sexuality (Weaver et al., 2005).

Teachers’ pre-service education includes training on sex education topics, and additional funding for sex education training is provided by the Netherlands Institute for Health Promotion and Disease Prevention (Weaver et al., 2005). Dutch sex education emphasizes the importance of open discussions about sexuality in the classroom. Discussions are often led by student questions and teachers are allowed to cover any topic in which students express interest (Lottes, 2002). The major themes of Dutch sex education are:

1. Physical and emotional sexual development: This topic includes information about puberty of each sex for both sexes and covers physical and emotional changes that occur during puberty. Students are reassured that while they may have worries or concerns about their bodies, these concerns are a natural part of growing up and everything will be ok.
2. Reproduction: This topic includes simple, accurate language and illustrations explaining sexual intercourse and reproduction.
3. Weerbarheid: Translated as ‘interactional competence’, this topic addresses assertiveness, communication techniques, personal values, asking for help, and decision making. Weerbarheid encourages students to think about what they are comfortable with sexually and develop skills to maintain boundaries.
4. Relationships: This topic covers heterosexual and homosexual relationships and is often used to transition from discussions of puberty to discussions of sexuality.
5. Sexuality: Dutch sex education presents sexuality in a positive light, including information on the positive and pleasurable aspects of sex and relationships. Masturbation is encouraged as a safe, enjoyable way for students to discover their sexual preferences.
6. Safe sex: Safe sex is a very important topic in Dutch sex education. The “Double Dutch” method is encouraged- using oral contraceptives to prevent pregnancy and a condom to prevent STIs. The safe sex topic includes information on where to get contraception, how to use it, and what to do if you are nervous about asking for it. (Ferguson, Vanwesenbeeck, & Knijn, 2008)

The ultimate goal of Dutch sex education is to instill a sense of responsibility in youth regarding sexual activity and empower them to make good decisions and set their own sexual boundaries (Ferguson et al., 2008).

The Dutch back-up their school based sex education with mass media campaigns and youth-accessible sexual health clinics (Lottes, 2002). Educational sex-related materials concurrent with the concepts taught in schools are provided to parents, clinics, family doctors, and the media (Lottes, 2002).Continued on Next Page »