Imagine a teacher who lets her 8th grade students say all the dirty, sex-related words they know, and writes them down on the chalkboard. That's how Malin Hammarström, science teacher for seventh- through ninth-graders at a school in Bålsta, Sweden, starts her first sex ed lesson. The point is to de-dramatize the subject and show her students that she won't be shocked and embarrassed, no matter how hard they try - and they will try, she tells me. That first lesson is followed by at least 12 more, which devote significant time to discussing the students' own questions about sexuality and relationships. She finds sexuality education the most rewarding subject to teach, because it relates so directly to her students' own lives. And she has never heard from any angry parents.
In the light of studies that show how abstinence-only programs are ineffective, a growing movement in the United States is pushing for accurate, comprehensive and reality-based sexuality education. Many U.S.-based sex ed advocates point to Sweden and the other Scandinavian countries as models for effective programs.
"It is time that the US looks to its northern European colleagues for lessons learned in adolescent sexual health promotion," says Debra Hauser, Vice-President at Advocates for Youth. "In these countries, young people's right to honest sexual health information and confidential services is respected and adolescent sexual development is recognized as normal and healthy. As a result the rates of teen pregnancy, birth and abortion are significantly lower than in the United States."
Studies show very small differences in levels of teenage sexual activity across developed countries. But when it comes to teen pregnancy, the US rates are much higher than those of comparable countries. A study from the Guttmacher Institute show that in the year 2000, the US had a teenage birthrate of 49 per 1,000 women aged 15-19, which was five times higher than the rate in Sweden. Teenagers in the US are also less likely to use contraception, and they have higher rates of STD infection. A 2001 Guttmacher Institute study show that the chlamydia rate among US teens aged 15-19 was 1,132 cases per 100,000, which is nearly twice that of Sweden.
Of course these differences cannot be attributed to different approaches to sex ed alone, but are also likely to depend on socioeconomic, political and cultural factors. In Sweden, teen sexuality is largely seen as normal and positive, but there is also an expectation that intercourse will take place within committed relationships (not only marriage) and that those involved will protect themselves and their partner. In the US, teen sexuality is often seen as problematic in itself, and abstinence-only programs underscore that view.
In Sweden, the debate over sex ed is far beyond whether or not the curriculum should emphasize abstinence-only. Sex ed is an uncontroversial subject, and isn't discussed much outside circles of educators and experts. The topic of debate is how to better educate teachers on the subject, and how to move away from curricula that perpetuates the gender norms and heteronormativity that still permeate our understanding of sexuality.
The history of sex ed in Sweden goes back more than a century. It became a mandatory school subject in 1955, but the first classes were held in the early 1900s at a girls' school in Stockholm. The Swedish Association for Sexuality Education, RFSU, was one of the main proponents of mandatory sex ed. RFSU was founded in 1933 by pioneer sex educator Elise (Ottar) Ottesen-Jensen, and a group of doctors.
Early sex ed was met with critique, not for addressing the subject, but for being out of touch with young people's lives. A national 1945 poll found that only 18% of Sweden's population thought that abstinence until marriage was important, so the moralizing tone of sex ed that portrayed girls as responsible for keeping their virginity and boys as only wanting sex, did not correspond with most people's perceptions about sexuality. From the 1970s, a more reality-based approach prevailed, related to broader political shifts in society. It was acknowledged that young people have a sexual life, often with a partner, and the focus was on helping them to be responsible.
Today, the curriculum emphasizes that sex ed belongs in various subjects, not only biology, but also history, social studies and psychology. It is often tied to other ethical discussions, such as drugs and alcohol, peer pressure, beauty standards and gender norms. In comparison with previous detailed guidelines that told teachers exactly what to say and not, the curriculum today is very open and general. There are no rules on how to carry out the course, or how many hours it should take, so this is up to the individual school to decide. This is both an opportunity and a challenge for teachers, and it means that the quality of education varies a lot from school to school. A study commissioned by the National Agency for Education in 1999 found that students who had received a rather conventional sexuality education thought that it had been enough or even unnecessary, as they "already knew everything from magazines." Students who had taken part in more interactive and varied forms of sex ed were satisfied or wanted more. Interviews with students suggest that the most valued part of sex ed is not the facts, but the chance to discuss those facts and relate them to their own lives. Despite differences in quality and in the students' own perceptions of sex ed, a yearly national youth poll show that the majority of young people aged 16-25 feel that they got the main and best information on sexuality, contraception and STDs from school.
"Our sex ed was good because you found out things you didn't knew before," says Viktor Svensson, 19 years old and due to graduate from the Swedish equivalent of high school this summer. Though he hasn't received any sex ed in high school, he still remembers the classes from earlier grades. The curriculum at his school was part discussion about ethics and morals, gender roles and views and sexuality, and part pure facts about things like reproduction, STDs and contraception.
"Both parts were equally important," he says. "The discussion part was held by a substitute teacher who normally taught P.E. and you could tell that she was a bit insecure and embarrassed. Then our biology teacher, a man in his 50s, came back for the facts part of the course. He wasn't embarrassed at all, and he made the students feel comfortable."
The quality of sex ed is also affected by the fact that it is not a mandatory part of teachers' education today. A study carried out by RFSU in 2004 showed that only 6% of recently graduated teachers had received any sex ed teachers' training. Hans Olsson, responsible for school issues at RFSU, says that when teachers don't have knowledge about how to handle the subject, they risk focusing too much on biology, and giving short shrift to broader issues related to sexuality. It's easy to talk about biological facts because those can be found in a book, but to discuss the role of sex in society, or emotionally charged issues such as abortion or pornography, in a meaningful way requires a deeper level of knowledge.
The relative openness about and acceptance of young people's sexuality is one of the big advantages of Swedish sex ed, according to Hans Olsson, RFSU. That the education is focused around the students' own questions, and that all students will receive sex ed, are other pros. Like teacher Malin Hammarström, he has never heard any negative reactions from parents. It is sometimes said that certain immigrant groups would have problems with the subject, but when RFSU have visited courses in Swedish for immigrants, they have only received positive reactions.
Despite over 50 years of mandatory sex ed in Sweden, there has been no systematic evaluations of the results. RFSU emphasizes that such research, together with mandatory training for teachers and clearer guidelines, are needed to improve the quality of sexuality education, and they call for a professionalization of the subject. As the example of Sweden shows, comprehensive sex ed is not without its problems, and for US sex ed advocates, ending abstinence-only is just the beginning. The real challenge may lie in developing an alternative.
