By Melissa Perri, Sarah Flicker, Adrian Guta, and Marilou Gagnon | May 10, 2021
Social and Behavioural Health Sciences, Dalla Lana School of Public Health at the University of Toronto
Sexual education (sex-ed) is a fundamental public health and health promotion-based intervention (Carstairs, Philpott & Wilmshurst, 2018). Traditionally, sex-ed programs in the United States and Canada have emphasized abstinence, pregnancy prevention, and reducing the risk of sexually transmitted infections. Programs, however, with an abstinence-only emphasis have not been particularly effective (Santelli et al., 2017; Carstairs, Philpott & Wilmshurst, 2018; Hoefer & Hoefer, 2017). Internationally, comprehensive sex-ed programs have garnered more promising results. Ontario, Canada’s largest province, recently implemented a new, responsive and controversial provincial sex-ed curriculum.
An interdisciplinary team of public health, sociology and education scholars collaborated to learn more about the implementation challenges faced by health and physical education teachers. We sought to gain feedback on how recent curricular changes have altered the ease and effectiveness of delivery and get educators’ opinions on recommendations for improving future sex-ed curricula changes. This blog post will focus specifically on recommendations that were made. Full details of the study findings can be found here: (Flicker et al., 2020).
According to Dickson and Lobo (2017, p78) comprehensive sex-ed programs “emphasize evidence-based, medically and scientifically accurate, age-appropriate content that includes human development, puberty and reproduction, relationships, decision-making, sexual violence prevention, body image, gender identity and sexual orientation, abstinence or delaying sexual activity, contraception, condom use, and disease prevention”. There have been numerous studies which show that comprehensive school-based sex-ed programs assist in reducing unwanted pregnancy, increase condom use, limit sexual partners, decrease rates of sexually transmitted infections, and delay initiation of intercourse (Leung et al., 2019; Hogben, Chesson & Aral, 2010).
The implementation of state/provincial sanctioned comprehensive sex-ed programs, however, have received significant push-back. Sex ed has been categorized as a contentious and highly politicized issue. Legislative policies significantly shape the dissemination and integration of sex-ed within schools, while also regulating included content and staff dissemination strategies (Grace, 2018). Parental misconceptions, held by a small but vocal minority that providing information surrounding sexual practices actually encourages sexual behaviour among young individuals, have made implementing comprehensive programs challenging (Starkman & Rajani, 2002).
The controversial nature of sex-ed programs has been particularly relevant in Ontario, Canada, following a change in the sex-ed curriculum in 2015 (Bialystok, 2019). The implementation of this new sex-ed curriculum was the first change the province had integrated in over a decade. Various updates were made in this implementation, including covering concepts such as sex and gender identity, consent and non-violent intimate relationships (Bialystok, 2019). The development of this new curriculum has been reported to be much more “comprehensive” and “progressive” compared to previous years (Bialystok, 2019). Discussions surrounding sex-ed program reform and perceptions have also been reported in other regions of Canada such as Alberta and British Columbia (News Staff, 2020; MacLeod, 2019). Often, sex-ed curriculum modifications cycle in and out of reforms as news and controversies develop across the country.
Data was collected from 34 experienced health education teachers through semi-structured interviews, which lasted between 30 minutes and 1 hour. All interviews were audio-recorded and transcribed verbatim. Teachers were recruited from six different sites across of Ontario through snowball sampling and methods such as advertising through email. Data analysis of the interview data was done in an inductive and collaborative manner.
Teachers from 17 different school boards – including public school boards, independent First Nations boards, catholic boards, and French boards - partook. Participants ranged in age from 31-55, with an average age of 40. Nearly half (43%) of the sample had been teaching between 5-10 years; 39% 10-19 years and 18% 20+. Across the sample, teachers had experience teaching all grades from Kindergarten to 12th grade. Most of our sample (70%) identified as female, 97% as heterosexual and 88% identified as White. We recognize that the lack of diversity in the sample is a limitation, however it is somewhat reflective of the physical and health education education community in Ontario.
Ensuring that there is consistent communication and trust between teachers, parents, administrators, and school boards is essential in creating a constructive learning environment. Relevant stakeholders should move away from fostering a punitive surveillance culture (as epitomized by the recent “snitch line”), which perpetuates fear and retribution among teachers, impacting knowledge dissemination, morale and overall health and well-being.
Teachers voiced the necessity of extensive training to ensure that they are adequately equipped to navigate changes in the sex-ed curriculum. Training should include the dissemination of pedagogical content and resources (especially audiovisual media), that reflects the diversity of the school student body (including in relevant languages).
Teachers highlighted the importance of scheduling regular revisions of the curriculum, which would prevent drastic changes (which may foster push-back from stakeholders). Revisions to the existing sex-ed curriculum were recommended to be released at least four months before being integrated, to allow for familiarization and planning of content dissemination. Some participants suggested staggering the rollout, which would include integrating adaptations in the early grades and then moving forward, year-by-year, with further updates to ensure all children gain the same set of information.
To ensure that the sex-ed curriculum meets the needs of heterogeneous communities, participants recommended integrating stakeholder consultations in the adaptation and implementation of the sex-ed curriculum. Relevant stakeholders can include diverse youth, parents and community stakeholders, teachers, school administration, experts in the fields of education, sexual and reproductive health, curriculum development and pedagogy, as well as representatives from the appropriate governmental bodies.
Teachers recommended publicly announcing and communicating adaptations to the sex-ed curriculum prior to its implementation. In association with this, they recommended that funding for town halls and other community outreach strategies would be provided by school boards, to ensure that parents are informed about what content their children will be engaging with.
Teachers explained that often the responsibility to create an alternative curriculum when students had been pulled out of sex-ed fell on them. As such, they recommended that education boards create a guide as to what information parents would be able to exclude their children from and to provide supports for such students to ensure they receive adequate sex-ed information.
Melissa Perri, MPH, (she/her/hers) is a doctoral student studying Social and Behavioural Health Sciences at the Dalla Lana School of Public Health at the University of Toronto. She also works as a researcher at the University of Toronto and St. Michael's Hospital, working on projects ranging from harm reduction to intimate partner violence. Melissa and her coauthors presented these findings at the 2020 American Public Health Association Annual Meeting, where ETR awarded her the Outstanding Student Abstract Award for the School Health Education and Services Section. Melissa and her co-authors are in the process of submitting these findings for publication. She can be contacted at firstname.lastname@example.org