A Conversation with Population Council’s Nicole Haberland
IWHC’s Susan Wood spoke with Nicole Haberland, Senior Associate in the Poverty, Gender, and Youth Program at the Population Council, about her research on sexuality education and what it tells us about essential components of truly comprehensive and effective programs.
SW: Your review of sexuality education programs found that curricula focused on gender issues and power dynamics are nearly five times more effective at reducing rates of sexually transmitted infections and unintended pregnancy than conventional curricula that ignore gender. Did this surprise you?
NH: A little, but not really! I was not surprised by the general direction of the results, but I hadn’t anticipated that the magnitude of the effect would be as strong as it was. Sex is about human interaction, interactions that exist in a social context. Indeed, studies have found that gender norms and power dynamics are key drivers of sexual behavior, experiences, and health outcomes.
We can think about it in terms of young people’s lives and how these dynamics play out. For example, “Jacob” sexually harasses a girl at a party in order to stop his friends from calling him gay. “Grace” has unwanted sex because she’s afraid her boyfriend will become violent again if she refuses. “Liz” is afraid to refuse the advances of a supervisor at work. “Dhara,” age 15, is about to be married to someone 20 years older than she is and whom she has never met. Multiply these stories by millions…
What is surprising is that decades of earlier reviews of the effectiveness of sexuality education programs rarely looked at gender and power. Of course, if you don’t ask about something, you don’t find the answer. So the field was stuck for decades with lists of “key characteristics” for effective sex education programs that entirely missed this profound element.
SW: Why did your research focus on sexually transmitted infections and unintended pregnancy?
NH: For this review, the aim was to set a high, objective bar for success. Most studies on sexuality education assess changes in behavior, such as condom use. This is due to a variety of reasons, including the resources, timeframes, and sample sizes that studies with biological outcomes, such as HIV incidence, often require. However, the problem with people’s reports about their sexual behavior is the likelihood of bias. Self-reports of sexual behavior change are not as reliable or valid — or convincing, for that matter — as more objective indicators such as an STI diagnosis. For this reason, I looked only at evaluations that measured the impact of the program on rates of STIs, HIV, and/or pregnancy. That said, I do believe it is important to measure behavioral change because it does lead to better health. And for a program that wants to learn from its own experiences, measuring reported behavior is a practical approach.
In addition, in the sexuality education field, the aim of most programs is to reduce HIV, STIs, and/or unintended pregnancy. So those are the outcomes researchers have measured. If we take a different approach, one that aims to be more holistic and to empower young people and improve critical thinking skills, then we can—and should—look at other outcomes.
SW: Could you elaborate on these other outcomes that comprehensive sexuality education researchers could explore?
NH: Evidence is emerging that suggests that an “empowerment approach” to sexuality education—programs that foster critical thinking about gender and power—may have a range of positive outcomes, including decreased reports of intimate partner violence, greater female control over the terms of sex, and more equitable gender norms.
We have also hypothesized that programs that address gender and power, especially utilizing critical thinking pedagogies, may yield broader benefits, such as better education outcomes, expanded social support networks, and safer schools and communities. For example, if a program engages students with content on gender and power that is meaningful to their lives, fosters their sense of agency, and builds skills they can also use in other disciplines, it can, hypothetically, improve education overall. Changes may operate through increases in students’ school connectedness, confidence, and learning skills, and a more equitable and supportive learning environment.
There is a lot to explore in this area. We know almost nothing about the influence of empowerment-focused education on girls’ ability to stay in school, delay marriage, avoid FGM, or assert themselves in their families and communities. Happily, some organizations—UNFPA for example—have embraced this more ambitious agenda for comprehensive sexuality education. But we need greater investment in research on whether and how programs that have gender and rights at their core can contribute to achieving this broader range of outcomes. And there is plenty that can be done in addition to rigorous evaluations of impact. Nongovernmental organizations can carry out their own assessments, through classroom observations and teacher interviews, for example, to both document what is happening in a program and to make improvements. They can share innovative solutions and continue to advocate for implementing an approach to sexuality education that empowers young people.