By: Marissa Billowitz
What would be different if we took sex-positive approaches to sexuality and comprehensive sexuality education (CSE)? People often assume that sex-positive approaches are naive. They believe advocates for sex positivity only talk about the positive aspects of sex without recognizing that the reality for many, especially women and adolescent girls, includes negative experiences of sexuality, in particular sexual violence and other forms of gender-based violence.
A sex-positive approach suggests that we reflect on how we would want others to experience their sexuality, as opposed to what we want to prevent. This approach recognizes that sexuality can be spoken of, it does not need to be a taboo or cause fear. It recognizes that, as the World Health Organization has, sexual pleasure is an important aspect of sexual health, and aspires to a world in which all people can experience sexuality not just without negative consequences, but in a positive, pleasureful way.
Comprehensive sexuality education is one of the best opportunities to change social norms around sexuality. In practical terms, CSE content can take a positive approach by including discussion of consent to sexual activity, equality and respect, open communication, seeking sexuality information, safety, and bodily autonomy.
Despite a plethora of guidance on the “comprehensiveness” of CSE, programs and curricula continue to convey the message that sexuality education is primarily aimed at prevention and risk reduction. Programs aim to avoid unplanned pregnancies and sexually transmitted infections in adolescents, and more recently, child marriage and other forms of gender-based violence.
What is holding back CSE programs around the world from employing this approach? Frankly, there are people, including decision makers, who believe that if sexuality causes some embarrassment, that’s a good thing. They believe that the discomfort surrounding sexuality will help young people avoid risks; that talking about sexuality in positive terms encourages early sexual activity.
Other approaches recognize that adolescents are engaging in sex, but focus completely on avoiding pregnancy and STIs/HIV; sometimes with fear-based messages, following theories of behavior change. As if having sex were the equivalent of smoking cigarettes. These messages were present when I was receiving sex education in the 1990s when preventing HIV was the major focus. Implicitly or explicitly, I heard “if you have sex you’ll die or you’ll get pregnant” at worst, and at best, “if you use a condom the wrong way, you’ll die or you’ll get pregnant”.
There is no evidence to support this fear-based messaging. In fact, young people who receive sexuality education focused on virginity and abstinence only -- which tends to increase fear and shame around sexuality -- are more likely to experience an STI or an unplanned pregnancy. They are also more likely to experience contraceptive method failure, compared to their peers who received no sexuality education.
One of the side effects of basing programs on fear and shame is that when young people decide to become sexually active, they continue to feel shame around sexuality. This limits their communication with sexual partners, their ability to enjoy sexual activity, and to protect themselves. This approach also stigmatizes young people who are sexually active to an extent that they may not seek sexual health services. Adolescent girls who become pregnant, and young people with HIV are equally stigmatized because the message has been that if they had sex, they did something wrong, and this consequence is their fault and cross to bear.
If we flip the switch to talk about sexuality from a more positive perspective, what do we gain? Fear and shame around sexuality is reduced, facilitating health service and information seeking. Communication between sexual partners is improved. There is evidence that promoting sexual pleasure as part of using a condom can increase condom uptake.
Think for a moment how we would want people’s first sexual experiences to be. Consensual, safe, protected? What about pleasurable, fun, caring? To make positive approaches a reality, here are some recommendations for decision makers and practitioners:
Explore available resources, such as those at the Pleasure Project, which include guidance and documents research on positive approaches
Review CSE curricula using the UNESCO SERAT tool, which covers CSE objectives by age and will pinpoint where positive messages are missing, and eliminate fear-and shame based content, according to the UN CSE Standards
Invest in preservice and ongoing teacher training and sensitization. It’s likely that teachers also need and want to deconstruct taboos
Involve parents to listen to their fears and discuss the importance of a positive approach to sexuality and find common ground
Create safe spaces for adolescents and young people in and out of school that encourage critical thinking and allow their leadership in what they want to know about sex and sexuality
While CSE is one in a host of strategies to improve some public health population-level measures, confusing the desired outcome with the approach can replicate fear and shame related to sexuality, and sabotage the desired effect. In other words, telling children and adolescents that sexuality only has negative consequences is unlikely to improve their health and lives.