Charting a New Course for Sex Ed

Illustrations by Sonia Roy

For Candice Lys, '06 BA(Hons), the memory of sex ed is singular, uncomfortable and all too familiar.

In Lys's first and only sex education class, her Grade 8 teacher put a female anatomy diagram on an overhead projector and had the class silently label the parts on worksheets. Next, he rolled out a VCR, turned on a video of a woman giving birth and walked out of the classroom.

Ten years passed and not much changed. Lys went back to the North to live in Yellowknife - 740 km from her hometown of Fort Smith, N.W.T. - while working on her master's degree in public health in 2009. She discovered that young women's sex education was still awkward and hardly relevant to their real lives. Behind closed doors, how many 15-year-olds are debating the positions of the labia minora and majora with their crushes, anyway?

In 2012, Lys founded FOXY, an arts-based sexual health and leadership program that grew out of her PhD research: a girls-only, one-day workshop that swaps labelling anatomy worksheets for drawing body maps of each girl's personality and replaces dry lectures with role-playing relationship problems. They get the facts about sex but it's through "myth versus truth" trivia games and candid conversations with peer leaders over pizza lunches. FOXY (which stands for Fostering Open eXpression among Youth) has reached more than 1,400 young women across the Northwest Territories, Yukon and Nunavut and recently started a similar program for boys called SMASH (Strength, Masculinities and Sexual Health). In 2014 FOXY received the $1-million Arctic Inspiration Prize.

As one teen wrote after taking part: "Talking about sexual education before, I was, like, super awkward about it, but now it's just like another thing to talk about."

Another wrote: "I looked back at all I learned and realized how much more educated I had become, and for that I am grateful. At school we did sex ed but nothing will compare to what I learned at FOXY."

FOXY does more than debunk myths about sex, says Lys. It also gives teens confidence to be themselves. It's built on the belief that sexuality isn't separate from the rest of who we are. "We approach sex ed as one core component of the whole person," Lys says. "You can't have really healthy sexuality if you don't have really healthy mental health and physical health."

What is Sexting Anyway?

Alberta's sexual health curriculum is 14 years old. In digital technology years, that's an eternity. When the curriculum was introduced in 2002, Facebook was still two years away, and teens couldn't have imagined Snapchat, since the guy who invented it was 12 at the time. While some teens would have had a cellphone, few would have heard of sexting, the now-widespread activity of sharing explicit photos and messages over smartphones.

Digital technology has changed all that. Kids today live in a world where perceptions of relationships, body image, identity and sexuality are fraught with the powerful - but often-misinformed - influences of social media, the Internet and digital communication.

"You can't have really healthy sexuality if you don't have really healthy mental health and physical health." - Candice Lys

Ninety-nine per cent of students in grades 4 to 11 have access to the Internet outside school through various devices, according to a 2014 survey of more than 5,400 Canadian students by MediaSmarts, a non-profit organization focusing on digital and media literacy. The survey also found that 24 per cent of Grade 4 students and 85 per cent of Grade 11 students owned cellphones, and about 40 per cent of teenage boys had looked for pornography online.

Yet if young people live in Alberta, Manitoba or New Brunswick, their teachers don't have to mention sexting during sex ed.

"Sexual health education in Canadian schools varies by province, it varies by school board, it varies by school, and it varies by classroom. It ranges from non-existent, to terrible, to - in some cases - excellent," says Alex McKay, executive director of the Sex Information and Education Council of Canada.

The underlying problem with sex ed, he says, is North American society's long-standing reluctance to accept that many teens are sexually active.

"If we want sex education to make a meaningful contribution to the health and well-being of young people, we have to understand that adolescents are sexual beings. Their needs are broader than those simplistic messages that were always delivered in a strictly heterosexual context."

The Cost of Failure

When Canada's sex education programs emerged in the early 20th century, the first goal was to lower rates of premarital pregnancy and venereal disease - back when they still called it venereal disease. More than a century later, only half that plan has been successful.

Canada's teen pregnancy rate fell by 20.3 per cent between 2001 and 2010, and the teen abortion rate in Ontario dropped by 40 per cent between 2007 and 2013, according to the Sex Information and Education Council of Canada. Yet a 2013 report by the Public Health Agency of Canada stated that rates of sexually transmitted infections (STIs) have been rising steadily since the late 1990s and that young Canadians have the highest reported rates of STIs.

Canadian studies have consistently found that more than 85% of parents agree with the statement: "Sexual health education should be provided in schools." (Source: Sex Information and Education Council of Canada)

And then there's the issue of sexual consent in a media world that makes the boundaries extremely murky. While almost all Canadians agree that you should have consent to have sex, a 2015 survey by the Canadian Women's Foundation found that only one in three Canadians actually knows what it means - that only yes means yes. (According to the Criminal Code, any kind of sexual contact without a voluntary "yes," whether with words or body language, is sexual assault. That means being married, saying yes the day before, or staying silent do not count as consent.)

Sexuality is entangled in our identities and cultures, our emotions and deepest insecurities. Making sense of sexuality has never been as simple as pointing to body parts, in the same way that travelling has never been as simple as looking up capital cities on a map. We wouldn't call our teens good drivers for being able to buckle a seatbelt, but today's sex education hardly expects anything more from them.

Making it Real

Carol Ann and her boyfriend's nervous laughter and heavy breathing escalate until Carol Ann springs out of bed. "Mac, wait! I have to go. I … left the stove on." She barrels out of bed, spilling the sheets on the ground, and walks to the front of the stage, baring her insecurities to an audience of 14-year-olds watching with wide-eyed, skeptical interest.

"That was close. Too close," Carol Ann says. "Suddenly it's happening and I'm thinking … we need a condom … I was so scared I just … ran out of there."

Carol Ann and Mac are fictional characters in Are We There Yet?, a participatory play intended to give young people the tools to make healthier choices surrounding sex and relationships. In each scene, characters are pushed to dilemmas and turn to the audience for advice.

"If these students get any sexual health education at all, it tends to focus on heterosexuals and not LGBTQ youth." - André Grace

"Now I don't know what to do. What should I tell him?" Carol Ann asks. Silence simmers across the audience for a few tense seconds, then a girl at the back pipes up.

"You could just tell him you need protection?" the student suggests. Carol Ann is still concerned. Will Mac think she's easy for bringing condoms? Other teens in the audience offer ways to soften the conversation. Later, Carol Ann meets Mac onstage and uses the words the audience gave her. It's full of awkward pauses and antsy giggles - just how the playwright intended it.

U of A drama professor Jane Heather, '75 BA, '93 MFA, wrote Are We There Yet? in partnership with Edmonton's Compass Centre for Sexual Wellness. It was produced by Edmonton-based Concrete Theatre from 1998 until 2013. Theatre companies across Canada also picked it up and performed it to thousands of teenagers in diverse communities, from Vancouver and Toronto to Indigenous communities in Saskatchewan to rural towns in Nova Scotia.

The play asks teen audiences to problem-solve real-life situations - from talking to a partner about using protection, to being in a relationship where each person has different sexual boundaries - and applies their suggestions, both good and bad. A professional sexual health educator sits in on each play to answer questions during and after the play and visits the school a week later to give a formal sex ed workshop.

A five-year research study, led by drama professor Jan Selman, '79 MFA, that measured how more than 1,000 students' attitudes toward sexual decision-making changed after seeing the play found that they preferred it to learning about sex in a classroom, says Heather. Most participants recorded a "significant" change in their sexual decision-making.

"For a lot of the teens, the play is a revelation that sex is a choice. That it isn't something that just happens to you because you're at a party," Heather says. "It's actually something that you would decide to do."

Beyond the Birds and Bees

"Quality sex education is so much more than learning about how babies are made and how to prevent babies from being made," says Brea Malacad, '06 BEd, '09 MEd, an Edmonton-area school psychologist whose graduate research focused on sexual health education.

She advocates for what experts call a comprehensive sex education - that is, one that goes beyond anatomical drawings and warnings against premarital sex. It would still talk about body parts and present abstinence as a legitimate decision for a teen to make but would also include many other aspects of sexuality - from gender expression, to sexual pleasure, to birth control.

"Comprehensive sex ed should also incorporate reflection on one's personal, cultural and religious values regarding sexuality," says Malacad. "It addresses all the emotions and behaviours surrounding sexuality and gets students to think about their own boundaries." And contrary to what some think, it doesn't cause young people to have sex. Research has consistently shown that it can actually reduce sexual activity among adolescents. They understand the implications and feel more comfortable with setting boundaries, she says.

McKay, of the Sex Information and Education Council of Canada, says that for many people, sexual health education is not at the top of the priority list. "But just as HIV in the 1980s woke us up to the implications of sex education for physical health, we're now beginning to understand that sex ed has important implications for mental and emotional health, as well."

So Much More at Stake

If you were a teen in Alberta when the province's sex ed curriculum was last updated in 2002, you could only daydream about marrying a same-sex partner. Until 2016, your school could still legally stop you from starting a gay-straight alliance club with your friends.

While things outside the classroom have changed for LGBTQ Canadians, curriculums still lag behind, says educational psychology professor André Grace. He says sexual- and gender-minority youth - people who don't identify as a man or woman or aren't straight - are consistently left out of talk in the sex ed classroom. "If these students get any sexual health education at all, it tends to focus on heterosexuals and not LGBTQ youth," says Grace, co-director of the Institute for Sexual Minority Studies and Services. When sex ed is done right, he believes, it can save lives.

The Comprehensive Health Education Workers project, CHEW, has taken a creative approach to troubling STI and suicide rates among gender- and sexual-minority youth.

The institute created the program in 2014 in response to Alberta's rising youth STI rates, especially among young men who have sex with men. Until its funding ran out last summer, the program hosted STI testing in the community and on campus, as well as self-care fairs, sex ed trivia nights, support groups and Art Jam workshops. CHEW still offers some of its services with piecemeal funding and the help of volunteers.

The program fills a key gap in mental and physical health systems, which often don't address the particular challenges facing LGBTQ youth. Suicide attempts among LGBTQ youth are two to seven times higher than among other youth, surveys in various countries have consistently found. In Canada, up to 40 per cent of homeless youth identify as LGBTQ, according to a 2012 study, "No Safe Place to Go."

"Everything's so intertwined," says CHEW facilitator Evan Westfal. "You have to deal with their other pertinent issues first before you can even touch on sex." A teen might be struggling with gender identity and turning to street drugs to cope. Another might be diagnosed with an STI and find the weight of dealing with the stigma too much to bear.

That's why CHEW's goal was to be not only a sex ed classroom but a community hub and health clinic, too. Westfal says the CHEW team performed at least 48 suicide interventions in the first half of 2016 alone.

Better Sex ed For All

As a former sex ed scholar, Malacad knows there's enough research to show what a good sex ed program looks like. For some young people, it means modelling tricky situations; for others, it's a place where they can finally learn to love themselves in a world that isn't always willing to.

There is some movement across Canada toward a more comprehensive approach to sex ed. In Alberta, for example, the Ministry of Education has launched a review of six subject areas, including the kindergarten to Grade 12 wellness curriculum, which encompasses sex education. The review will consider current research as well as input from an expert working group and feedback from schools and the public through an online survey launched this fall.

"We know there are some concerns about Alberta's sex education, and we think it could use some updating," says Jeremy Nolais, chief of staff for Alberta Education. The department has started work on resources that will help teachers teach sexual consent, he says. It is also taking steps to ensure greater inclusion of LGBTQ students and staff in schools and inclusive language throughout the curriculum.

Making changes to sex ed curriculum can be tricky, though. Just look at Ontario. In 2015, the province updated its 17-year-old sexual health curriculum to include teaching Grade 1 students the correct names of body parts, including genitalia, and mentioning sexual and gender orientation in Grade 3 in a discussion about how to show respect for people who might be different from you. Hundreds of parents pulled their children out of public school in protest. The protests show how emotional the topic of sex ed in schools can be. In one newspaper's photo, a little girl holds a sign reading: "I'm only 6. I like ponies, I like clay. Why do you want to take my innocence away?" Another protester's sign reads: "Don't Sexualize Our Children."

Another challenge in improving the sex ed curriculum, says McKay, is that while the best sex education programs tend to be tailored to the specific needs of a particular group of youth, that's very difficult to do in a provincial curriculum designed to meet everybody's needs.

At the classroom level, while most teachers want to improve sex ed, it's not easy to do, says Malacad, who taught a sex education course for future teachers in the U of A's Faculty of Education. It's an uncomfortable topic for parents and kids, let alone a teacher addressing a classroom of 30 young people. "So we often go back to how we were taught and what we're most comfortable with: worksheets, the anatomy, the overhead projected diagrams - teaching about the plumbing."

"Kids want to know the same thing they did 30 years ago - how to have good relationships." - Alex McKay

In Canada, there is no formal process for educators to become specialized in teaching sexual health. But as of September 2016, educators and health professionals from across the country can take an online graduate-level Certificate in Sexual Health through the U of A Faculty of Rehabilitation Medicine. Offered in collaboration with the Alberta Society for the Promotion of Sexual Health, the program is designed to teach skills in comprehensive sexual health education - and to fill a critical gap in training specialized sex ed practitioners, says Shaniff Esmail, '88 BSc(OT), '93 MScRS(OT), '05 PhD, professor and associate chair of the Department of Occupational Therapy. Esmail says once the program is fully underway, it will be promoted to school boards as a resource for teachers.

Making Healthy Choices

FOXY's founder Lys says the goal, at heart, is to help young people make healthy choices for themselves. Research and feedback from participants show an increase in sexual health and HIV knowledge, a greater capacity for safer sexual health behaviours and - perhaps most importantly - stronger leadership skills and the confidence to be the people they want to be.

"We can give young people all the information they want, but at the end of the day, they have to make their own decisions," Lys says.

"Kids want to know the same thing they did 30 years ago - how to have good relationships," says McKay. "Sex is more than pulling out a condom and saying we're going to use this; it's about sitting down and talking openly with your partners. It's about both people knowing that their needs, health and safety are being respected.

"Then the conversation about condoms becomes quite easy. And we won't need to rewrite the curriculum every time one of these topical issues comes up."

Good sex ed benefits not only a young person's long-term sex life, but their health and happiness and how they treat others. The way it's taught, then, argues Malacad, shouldn't be relegated to the end of a curriculum when a teacher can fit it in. Instead, it deserves the investment our society gives sexuality itself - something more colourful and complicated than a worksheet could ever be.