Baltimore gets a new sex-education program

Depending on who is asked, the money is:

a) just being used to enhance an already comprehensive sex-ed program that is taught in every city secondary school, as mandated by the state (Baltimore City Public Schools officials)

b) an effort to get a strong, evidence-based, uniform sex-ed curriculum in all the middle and high schools because less than 50 percent of middle schools are actually teaching comprehensive sex ed at the moment (Baltimore City Health Department officials)

c) a hail-Mary pass that will arrive—maybe, if the adults can get over their bickering and discomfort and reluctance and weirdness—too late for most current high schoolers to benefit from, and they could have used the information, thank you very much (disgruntled Baltimore City students, see page 10).

There are a few things most parties agree on—but not many. All three groups said teaching abstinence as the surefire way to avoid pregnancy and sexually transmitted infections (STIs) was in the existing curriculum, along with different methods of birth control. And in Baltimore, everyone concurred that students went home with a form allowing parents to sign if they wished their kids to opt out of sex ed. If schools didn't hear back from parents, they assumed the students had permission for the class.

Other than that, all bets were off. Baltimore City Public Schools (BCPS) officials said they were in compliance with state code requiring comprehensive sex ed in middle and high schools, but some teachers and students said sex ed wasn't offered at all or was offered too late or was inadequate. "The curriculum and guidelines are shared with our principals and teachers," said BCPS's Janise Lane, executive director of Teaching and Learning, when asked about gaps in implementation. "We at the central office can't monitor what happens every day," she said, adding that the district provided ongoing professional development to ensure the state-mandated sex-ed standards were being met and programs were being properly implemented.

"Less than 50 percent [of city schools] actually have reproductive health ed or sex ed being taught," said Rebecca Dineen, assistant commissioner for the Bureau of Maternal and Child Health at Baltimore City Health Department. "They have not been using one curriculum. There is known to be a big gap. . . . In many, many schools there was nothing at all." With that in mind, she says, "We've been working really hard to develop partnerships to get something in place that makes sense for everyone, that reaches everyone."

The $8.5 million federal grant went to the Health Department and the U Choose Coalition, a group that includes the Baltimore City Schools, Planned Parenthood of Maryland, Johns Hopkins University Center for Adolescent Health, Healthy Teen Network, Family League of Baltimore, Gay, Lesbian and Straight Education Network, Behavioral Health System Baltimore, and a network of seven Title X clinics. Awarded in July 2015, the grant is being used to implement a new, district-wide curriculum. It is being piloted in eight middle and high schools this year and will be in all city schools before the grant expires in five years, said Dineen.

"The idea is that every school should be using the same curriculum so if kids transfer they're on track with learning the same things," said Dineen. In the middle schools, they are trying three different curriculums. For high school, they're using a program called "Making Proud Choices." All of them are evidence-based curriculums approved by the U.S. Department of Health and Human Services' Office of Adolescent Health, said Dineen.

The new curriculum is designed to help young people "understand reproductive health and good decision making, making them feel good about their bodies," said Dineen. "This is a really important part of growing up."

In middle school, the focus is on body image, abstinence, and delay of sexual activity, she explained. For high school students, there is a comprehensive overview of contraceptives, in addition to basic information about biology, genitalia, hormones, pregnancy, and birth. If the curriculum is implemented as designed, students will have plenty of chance to think through their options and practice negotiating what they want. "It's all about healthy decision-making," said Dineen.

Interestingly, the coalition, which is part of a larger group looking to improve the general health of youth in the city, emphasizes a "trauma-informed" approach.  Given the exposure to violence of so many of the city's young people, the new health standards are designed to be sensitive to the trauma students may have experienced--to help them process it or get the resources they need to cope and grow. "So many things happen in the city where we're reacting to effects of violence," said Dineen, "and this is really about building a better future without having to react, making good decisions ahead of time, so we don't have to react to a terrible crisis."

Tackling these far-ranging and broad-based issues requires a coordinated effort and partnerships across the various departments, agencies, clinics, schools, and nonprofits--no mean feat inBaltimore. The plans are mapped out in a "Youth Health and Wellness" strategy document the group released in December 2015. Dineen is optimistic: "This is the direction we should be going in the city and people should understand that."

How does this look in concrete terms, in a sex-ed curriculum like the newly adopted "Making Proud Choices"? One chapter on condoms is instructive. (Students at City College, for example, said information on condoms and demonstration of how to use them is currently spotty. They complain that they would never ask for free condoms from the school nurse because she notifies parents. City College principal Cindy Harcum said parents are not called. But student perceptions may prevent them from seeking condoms. See page 10.) The section on condoms begins with a video demonstration of condom use and a series of exercises and teacher-led discussions. Specifically—and this is rare in sex-ed curriculums (see "Sex in the States" on the previous page)—questions are designed to "stimulate positive attitudes toward condom use."

"What steps in this process can involve the female?" the teacher is directed to ask. Answers: "Sexual arousal, rolling condom on, intercourse, orgasm, holding onto rim, removing condom, and relaxation. She can also buy condoms and have them ready." The lesson goes on. "If a male loses his erection after putting on a condom and before intercourse, what could the couple do?" Answer: "This will happen to most males at some point in their lives. Have partner take off condom, continue playing and stimulating one another, relax, and enjoy the fun. After awhile, put a new condom on as part of the play." Another lesson focuses on "how to make condoms fun and pleasurable" and gives students a list of eight things ranging from "You can use condoms as a method of foreplay" and "You can act sexy-sensual when putting condoms on" to "You can hide one on your body and ask your partner to find it" and "You can have fun putting one on your partner while pretending you are different people or in different situations."

The section ends by suggesting teachers share this summary: "Once you and your partner both agree to use condoms, do something positive and fun. Go to the store together. Buy lots of different brands and colors. Plan a special day when you can experiment. Just talking about how you'll use all of those condoms can be a turn on. Remember, the proud and responsible thing to do is to always use latex condoms if you have sex."

The lessons in "Making Proud Choices" are straightforward and give students a chance to talk about how they feel—and this is something students complained was lacking in existing sex-ed programs.

Dineen says the new curriculum will dovetail nicely with other citywide health efforts, such as making sure local city clinics and school nurses are providing "youth friendly" information. Teens must feel comfortable knowing that "any question is OK to ask," said Dineen. "A condom is given to them on asking, and that is seen as a positive thing" because they are being responsible.

"There is no reason that kids in Baltimore now should be afraid nurses aren't going to give them what they need," said Dineen. "We always encourage discussion with parents and you hope that it is a healthy relationship, but there are laws around [minors] and you can get contraceptives without parental consent in Maryland. Everybody would like families to be open enough to talk but we know that all families aren't."

When it comes to introducing this frank, comprehensive sex-ed program in city schools, Dineen said they haven't met with much resistance. "People seem inclined toward helping teens make better decisions and we anticipated more push-back than we've gotten."

And if they get it?

Dineen responded with the mantra that dates all the way back to Margaret Sanger, the Planned Parenthood founder who began campaigning for reproductive education way back in 1912 with her newspaper column "What Every Girl Should Know": "There is no evidence anywhere that suggests having reproductive health education increases sexual activity."