Association of Reproductive Health Professionals
Association of Reproductive Health Professionals
Reproductive Health Topics Publications & Resources Professional Education Newsroom Membership Policy & Advocacy About Us
Clinical Proceedings
Send To A Friend Send To A Friend Bookmark this Page Share this page
Breaking the Contraceptive Barrier: Techniques for Effective Contraceptive Consultations

(Published September 2008)

The Sexual Education Barrier

A “major chasm” lies between the barrage of sexual messages in the media and abstinence-only messages conveyed in school-based sex education programs.1 In the decade between 1996 and 2006, the United States spent more than $1.5 billion on abstinence-only education.2 These federally funded programs were prohibited from including any information that could be construed as promoting or advocating the use of contraceptives.3

A congressionally mandated report revealed that these programs were not effective in stopping or even delaying teen sex.3 These programs may even be deterring contraceptive use, and thus increasing the risk of pregnancy and the spread of sexually transmitted infections (STIs).3 The Special Investigations Division of the House of Representatives reviewed 13 abstinence-only curricula and found that 80 percent contained distorted and inaccurate scientific and medical information about reproductive health.1

Strategies for breaking barriers of media and sexual education
  • Direct patients to useful Web sites of organizations that provide accurate and realistic information, such as the Association of Reproductive Health Professionals (ARHP) at www.arhp.org; Planned Parenthood® Federation of America at www.plannedparenthood.org; the Sexuality Information and Education Council of the United States (SIECUS) at www.siecus.org; and other Web sites listed here.
  • Discuss what media influences are at work in patients’ lives. This will help illuminate specific points of misunderstanding in how each patient thinks about sex and her risk of pregnancy. Health care providers can then fill in the knowledge gaps with information about realistic and responsible attitudes toward contraception.7,8
  • Ensure that patients understand the real-life risks of having sex. Does each woman understand her menstrual cycle and how it affects her risk for getting pregnant? Can she recognize the signs of pregnancy?
  • Advocate for more comprehensive sex education. To learn more, visit SIECUS at www.siecus.org.
  • Encourage both partners to be active participants in contraception; this creates shared responsibility, joint decision making, effective contraception, and some protection from STIs.

A 2005–06 nationally representative survey of more than 1,000 people revealed that 82 percent of adults in the United States support a comprehensive approach to sexual education that includes abstinence and other methods for preventing pregnancy and STIs.4 A rigorous review of sex education programs found that comprehensive sex education can effectively delay sex among young people, even as it increases condom and overall contraceptive use among sexually active youth.3,5

The following case study illustrates how media messages can influence behavior and how health care professionals can help provide women with the information noticeably lacking in the media and federally funded sexual education programs.

Elaina. Elaina is 16 years old. She is a new patient who has come today for a human papillomavirus vaccine. You take this opportunity to ask her if she has contraceptive needs. She tells you that she had sex once, a few months ago. You ask if she used a contraceptive method, and she says that she hadn’t planned on having sex but that it just happened, so she didn’t have time to think about using contraception. “But everything’s OK,” she says brightly. “I’m obviously not pregnant.”

Was Elaina acting out the messages she’s seen in the media when she let herself get swept up in the moment without thinking about contraception? If so, health care providers can help counter those messages by talking to Elaina about her menstrual cycle and her risks for getting pregnant. This is also an opportunity to make sure that Elaina knows the signs of pregnancy and understands that she can come to the office or clinic at the first sign of pregnancy, while she has the most options (safe and healthy continuation of the pregnancy, medical or surgical abortion, or arranging for adoption). If she understands her risk for pregnancy, discuss effective contraceptive options and the value of choosing a method that is consistent with her desire to avoid pregnancy. Discuss STIs and the importance of condom use. This visit would also be a good opportunity to introduce the topic of emergency contraception if she does not already know about it. It may be appropriate to give her a prescription for EC to fill so that she has a supply on hand.

Perhaps there were other reasons for Elaina’s behavior, including alcohol or drug use. If you have reason to think these were involved, explore that issue. Almost one-quarter of sexually active high school teens report using alcohol or drugs during their most recent sexual encounter.6 If you think she may have been forced into having sex, explore that issue as well.

References

  1. Espey E, Cosgrove E, Ogburn T. Family planning American style: why it’s so hard to control birth in the US. Obstet Gynecol Clin N Am. 2007;34:1-17.
  2. SIECUS. A brief history of federal abstinence-only-until-marriage funding. Available from: www.siecus.org/policy/states/2006/explanation.html. Accessed February 26, 2008.
  3. 3. Boonstra H. The case for a new approach to sex education mounts; will policymakers heed the message? Guttmacher Policy Review. 2007;10(2).
  4. Bleakley A. Public opinion on sex education in US schools. Arch Pediatr Adolesc Med. 2006;160(11):1151-6.
  5. Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy; 2007.
  6. Centers for Disease Control and Prevention. Youth risk behavior surveillance survey, 2005.
  7. Strasburger VC. Adolescents, sex and the media: Ooooo, baby, baby. A Q&A. Adolesc Med Clin. 2005;16:269-88.
  8. Strasburger VC. Risky business: what primary care practitioners need to know about the influence of the media on adolescents. Prim Care Clin Office Pract. 2006;33:317-48.