This article was written by Peter Aggleton, Director of the Thomas Coram Research Unit, Institute of Education at the University of London, and Cathy Campbell, Associate Director of the Gender Institute and Social Psychology Lecturer at the London School of Economics. The authors discuss sexual health within English and Scottish culture. However, many of their insights can be applied to adolescent pregnancy prevention work here in the U.S. This research summary will highlight the work the authors have done to:

1. define the term "sexual health"
   
   
2. explore the barriers encountered in promoting sexual health positively among youth, and
   
   
3. develop a framework for policy and program development on the subject.

In the early 90s, England's Health Education Authority conducted a phone survey with various health agencies working with youth. One of the goals of the survey was to elicit a definition of sexual health. Definitions often included such elements as possessing knowledge about reproductive health, making informed choices, and feeling comfortable with one's sexuality. Sexual pleasure was only mentioned by one organization, which emphasized attainment of sexual enjoyment with a simultaneous avoidance of sexually transmitted infections (STIs) and unplanned pregnancy.

What appears pertinent in a comprehensive definition of sexual health, according to Aggleton and Campbell, is that it is:

"…an affirmative concept, a state of well-being imbued with positive qualities, not merely the absence of those which are undesired."

 

…more than reproductive health; being concerned with the procreative relationships and modes of sexual expression."

"…inextricably linked to the expression of individual and collective needs as well as to broader human rights and responsibilities."

 

"…concerned with the attainment and expression of sexual pleasure, not with the repression of sexual energies and desires, still less with their denial."

Dominant contemporary policy is at odds with the tenets of the United Nations Convention on the Rights of the Child, which holds that youth deserve to have their opinions and needs considered in the decision-making process on matters concerning their health.

Often seen as a homogenous group, adolescents are portrayed as problems for society, troubled by stresses related to biological and hormonal changes, and victims of others' actions. Such assumptions hinder our ability to see adolescents as individuals with their own unique needs, aspirations and desires. These assumptions create a difficult barrier for those who wish to work with youth in a more inclusive manner.

These views, dominant as they are in society, have greatly impacted the debate about the role of schools in sex education. The agenda of school-based sexuality programs is cluttered by:

1. feelings of inadequacy in discussing sexuality by educators,
2. confusion about laws defining appropriate content,
3. fear of offending parents or religious groups,
4. myths that sex education in schools encourages sexual activity, and
5. myths that sex education is opposed by most parents.

Fortunately, research has debunked these last two myths, indicating that comprehensive sexuality programs do not cause heightened sexual activity, and that most parents approve of such programs in the schools.

Effective sexuality and reproductive health programs emphasize the acquisition of knowledge and skills as well as an attitude shift necessary to encourage action upon those knowledge and skills. However, effective sexuality programs aren't enough. Larger challenges, such as socio-economic status, access to services, and familial and community support, also impact the promotion of good health.

"Both individual persuasion and societal enablement are necessary" if we wish to positively impact our youths' sexual health. Perhaps the greatest challenge is the promotion of environments which enable healthy behaviors to flourish. The authors suggest the following priorities:

• Information and misinformation — even in high-income countries, many youth are ill-informed. Youth are confused by mixed messages and often report that the information they do receive is inadequate and ill-timed. In countries such as the Netherlands and Sweden, where openness and communication characterize the society's approach to sex, sexual activity rates are among the lowest in the world. Teens from these countries often cite "love and commitment" as the main motivators for becoming sexually active with a partner. (U.S., Canadian, and English boys usually claim "physical attraction" and "peer pressure" as their top reasons.)
  
  
• Accessible, youth-friendly, integrated services — youths' perceptions of services greatly impact their decision to use them. Common concerns of youth include: 1) confidentiality, 2) the convenience of clinic hours and locations, and 3) providers' attitudes toward teen sexuality and homosexuality. Services provided in non-traditional settings such as parks, shelters and drop-in centers may increase use by adolescents. The inclusion of teens in the planning and delivery of services may ensure that such services really are youth-centered. Finally, the integration of health services with other agencies serving young people has been shown effective in countries such as Greece, Norway, France, Switzerland and the Netherlands.
  
  
• Improving young peoples' confidence and aspirations — evidence from the developed world indicates that unintended teen pregnancy occurs most frequently among those who are socio-economically disadvantaged and who have poor prospects for the future. Programs which increase self-esteem and confidence often include life skills and community involvement elements. Programs should start with young children and be delivered to both boys and girls.
  
  
• Family environment — poor parental communication is a strong indicator of poor adolescent sexual health. Beyond communication, parental attitudes also have an impact: among youth in the US, parents' egalitarian attitudes and youths' perceptions of parental concern for their well-being are predictors of safer sex behaviors. Support is needed to assist parents in developing effective parent-child communication skills.
  
  
• Community environment — a positive correlation between good health and social support has been established for children, adolescents and adults alike. Efforts to include youth in their community should go beyond involving them in activities which are health-related. In order to effectively bring youth into broader social contexts, we must encourage their input on various levels of community development.
  

Appropriate policy should be guided by a concern for the factors described above. While all but two countries worldwide are signatory to the UN Convention on the Rights of the Child, few have successfully implemented the tenets of the document into the framework of their sexuality education programs. Efforts such as the Joint United Nations Programme on HIV/AIDS, the Ottawa Charter for Health Promotion, and the Adelaide Declaration and the Jakarta Principles are exemplary in their intentions to link sound public policy with the aforementioned factors.

The key is to develop a rights-based approach to sexuality and reproductive education as well as an integrated network of services which are youth-centered. This challenge should not be taken lightly.

1. Does your current curriculum or program address all aspects of sexual health, including pleasure, enjoyment and self-expression?
   
   
2. What are your fears or limitations as an educator? What could be done to better support you in your role?
   
   
3. How can organizations in your community collaborate more effectively to better serve the health needs of its youth? What is being done in neighboring communities, states, countries?
   
   
4. Have you or your colleagues researched programs from countries such as the Netherlands and Sweden, where teen pregnancy rates are low and open dialogue is the norm?
   
   
5. How can you, as an educator or service provider, make your program or intervention more interactive and inclusive of the youth you serve?
   
   
6. What can be done immediately in your community to involve youth in program development?
   

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