Wake up and smell the condoms: An Analysis of Sex Education Programs in the United States, the Netherlands, Sweden, Australia, France, and Germany

France supplements its sex education programs with public policies that provide teens with access to condoms and contraception. National health insurance in France covers all reproductive health services and condoms are provided free and confidentially to anyone under age 18 (Berne & Huberman, 1999). Abortion is free and legal through the tenth week of pregnancy (Berne & Huberman, 1999). One unique aspect of French sexual health policy is “Free Wednesdays”. All students have Wednesday afternoons off from classes, and family planning clinics cater to teens during these times (Berne & Huberman, 1999) .

The final country I will examine is Germany. Germany has an teen abortion rate of only 3.6 per 1000 and a teen birth rate of only 12.5 per 1000 (US rates are 29.2 per 1000 and 54.4 per 1000, respectively) (Singh & Darroch, 1999) . Germany’s gonorrhea rate is also 25 times less than that of the US (Berne & Huberman, 1999). There is no national curriculum for sex education in Germany. The German government allocates responsibility to schools, community-based organizations, and health authorities to develop appropriate sex education programs, with the requirement that the programs be comprehensive and address a wide range of ages and target groups (Berne & Huberman, 1999). The Federal Center for Health Education is specifically responsible for developing sex education concepts geared toward individual age and social groups and providing uniform educational materials to school, vocational training counselors, and counseling centers (Berne & Huberman, 1999).

German sex education is approached in a positive, non-repressive context and led by dialogue that gradually introduces sexuality to students and presents sex as a positive expression of emotion or tenderness in a relationship (Berne & Huberman, 1999). German sex education strives to provide students with information about physical aspects of sexuality, an understanding of individual sexual development, personal identity, gender roles, and relationships, information on how to develop a healthy sexual life, educational information on pregnancy and prenatal life, awareness of other lifestyles, and a comprehensive understanding of sexually transmitted diseases and how to reduce risk. German sex education is designed to motivate students to use protection from pregnancy and STDs, make conscious responsible decisions about sexuality and relationships, and accept and tolerate different lifestyles. German sex education helps students become competent in communication regarding relationships, family planning, and STD protection and teaches students to take an active role in intimacy and sexual encounters (Berne & Huberman, 1999) .

German sexual health is not only a result of their sex education, but of public policies that support the sexual health of all citizens. Ninety percent of German households have compulsory health insurance, while 10% of households with the highest incomes have access to private insurance (Berne & Huberman, 1999) .  Oral contraceptives, IUDs, barrier methods, and sterilization are covered by insurance and offered free to women under age 20. National health insurance also covers abortion, which is legal during the first trimester, but parental consent is required for women under age 18 (Berne & Huberman, 1999). Condoms are easily accessible and can be found in pharmacies, grocery stores, restaurants, clubs, and vending machines in public restrooms (Berne & Huberman, 1999) . The German people view sexual expression as a basic need and a normal, healthy part of human development, and their public policies support this view.

Clearly, the US is failing at providing adequate sexual education and health services to our youth. The Netherlands, Sweden, Australia, France and Germany outperform the US dramatically in measures of teen sexual health. Each of these countries offers comprehensive, non-judgmental sex education in their schools and supplementary social programs to provide sexual health services to youth. The US should look to these countries for inspiration. However, it is important to note that concepts of sexuality vary vastly among cultures. Effective sex education programs must be culturally appropriate (Labauve & Mabray, 2002) . Simply adapting the policies of another country would not solve United States’ sexual health problems. In fact, due to the incredible cultural variations between states and regions in the United States, I would suggest that the implementation of a single, national sex education curriculum would also be ineffective.  Comprehensive sex education, starting in elementary school and continuing throughout high school, should be mandatory in schools across the country, but it should be up to individual states to develop a curriculum that meets the specific needs of its population.

Comprehensive sex education programs in the US should be based in theory and research and target at-risk populations. As stated by Schaalma et. all (2004): “Health promotion planners need to identify theory- and evidence-based methods that have proven, or are likely to, be effective in changing behavior, and they need to translate these methods into educational strategies and materials that fit target populations” (Schaalma, Abraham, Gilmore, & Kook, 2004) . Health promotion planners should look to the countries reviewed earlier in this paper for examples of methods that have proven to be effective and translate them to meet the needs of different US populations. All teachers should be trained in sex education while pursuing their teaching degrees. Teachers who already have their degrees and are currently teaching should be required to attend sex education seminars to provide them with skills for addressing sex education topics in the classroom.

While each state should be free to establish a program that most meets the needs of its population, there should be some principles common to all programs. First, the programs should provide comprehensive information about sexuality, relationships, sexual identities and diversity, setting boundaries and respecting the boundaries of others, developing effective communication skills, preventing STDs, successfully using contraception. Sex should be regarded in a positive way; programs should not induce fear or deny the pleasurable aspects of sex. Sexual development should be viewed as a normal part of growing up, and sex within relationships should be presented as an ideal, without condoning other sexual relationships. Students should be encouraged to explore their own sexuality through masturbation before engaging in sex with a partner.

For sex education programs to be effective they must do more than just provide information. Effective sex education programs must influence psychological processes of decision-making and pursuing goals. These programs should be informed by cognitive theories that have been used successfully to address other health behaviors, like drug abuse prevention programs (Schaalma et al., 2004) . Sex education programs need to provide students with decision-making, communication and negotiation skills and an ability to resist social pressure (Schaalma et al., 2004) . One of the most effective means of teaching these concepts is through social rehearsal or role playing activities. These activities provide students with skills to deal with many situations and are especially useful to students who don’t yet have actual experience with these situations (Schaalma et al., 2004). Because sexuality is a sensitive topic for many students, a safe classroom atmosphere must be maintained. Students must comfortable participating in activities and asking questions in order to truly benefit from sex education courses. A safe atmosphere can be established by setting confidentiality rules and engaging the class in “feelings-and-values” exercises before introducing the sex education topics. “Feelings-and-values” exercises encourage students to discuss feelings of embarrassment and what they mean, as well as set limits about what information is appropriate to disclose in a classroom (Schaalma et al., 2004).

Media literacy, defined as the ability to access, analyze, evaluate, and communicate messages in a wide variety of forms (Pendleton, Austin, Cohen, Chen, & Fitzgerald, 2008), should be an important component of sexuality education in the United States, where adolescents report that they view television as an important source of information on birth control, contraception, how to talk to a boyfriend or girlfriend about sexual issues, and norms for sexual behavior (Eye, Kunkel, Bialy, & Finery, 2007). Media literacy has proven to be an effective component of sex education in the past and research has shown that individuals who understand media production recognize that messages in the media are carefully constructed and are better able to identify motives, purposes, and points in the media they are exposed to (Pendleton et al., 2008). Images of sexuality dominate media in the United States and students need to be equipped with skills to analyze and deconstruct the messages they receive.

The United States should also initiate social health programs that support the values being taught in sex education and allow teens access to sexual health services. A national health insurance program should be developed to cover every citizen under age eighteen. This insurance program should fund all reproductive health services. Condoms should be cheap and easily accessible; putting vending machines in school restrooms and other public restrooms would be a good way to spare teens any embarrassment about buying them at a pharmacy. Sexual health clinics should be established in locations that are easily accessible to youth and be open during after-school hours and on weekends. These clinics should follow the same guidelines as those in the Netherlands: accept teen sexuality and sexual behavior, guarantee anonymity, waive Pap smear and pelvic exams for initial contraceptives, provide nonjudgmental service, and require minimal paperwork and no parental consent (Lottes, 2002). Abortion should be free and legal and minors should not be required to have parental consent. I do support requiring pre- and post-procedure counseling to women of any age who seek abortions, but this counseling should be supportive and nonjudgmental.  Finally, national mass media campaigns should encourage safe sex and responsible decision making and make youth aware of the resources available to them in their community.