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By Anita Brakman, MS
Senior Director of Education, Research and Training
Physicians for Reproductive Health
New York City
Taylor Rose Ellsworth, MPH
Director, Education, Research and Training
Physicians for Reproductive Health
New York City
Melanie Gold, DO, DABMA, MQT, FAAP, FACOP
Medical Director, School-Based Health Centers
New York-Presbyterian Hospital
Columbia University Medical Center
New York City
The #MeToo movement and the disclosures of sexual harassment and assault by many brave individuals in recent years have opened the door for many survivors to come forward and share those experiences. The movement also has brought these topics to the forefront of conversation in many fields, including medicine. People are sharing their experiences at home and in classrooms, workplaces, and exam rooms.
Experiences of sexual harassment and assault are unfortunate realities for many adolescents and young adults, especially for young people of color and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth. A nationally representative survey of 1,965 students conducted in 2011 found that almost half of students in grades 7-12 reported experiencing sexual harassment in the previous year, and 87% described negative effects such as absenteeism and poor sleep as results of harassment. Sexual harassment by text, email, social media, or other electronic means affected nearly one-third (30%) of students.1
According to the 2017 Youth Risk Behavior Survey, 7.4% of high school students surveyed reported being forced to have sexual intercourse during their lifetime, including 11.3% of females and 3.5% of males. Nearly 7% of students reported experiencing sexual dating violence in the past year, defined as being forced to participate in sexual activities (including kissing, touching, or being physically forced to have sexual intercourse) they did not want to do by someone they were dating or going out with. The number, 9.7%, was higher for students reporting sexual violence from anyone (regardless of dating or relationship) in the year prior to the survey.2 With sexual harassment, violence, and abuse being chronically underreported, we can only consider these numbers as a window into what likely is an even more common experience among young people.
Many youth-serving health professionals have begun to ask how they can contribute to addressing or even preventing sexual harassment and assault in their patients’ lives. A natural place to integrate this work is in comprehensive sexuality education programs already in existence or under development. Sex education advocates and policy makers alike are promoting age-appropriate consent education to teach young people about the concepts of consent for physical contact and healthy relationships for students of all genders.
The Center for American Progress recently analyzed sexuality education policies and found that of the 24 states (plus the District of Columbia [DC]) that mandate public schools to provide sex education, only eight states and DC even mention the topic of consent or sexual assault in their curricula.3
This situation is likely to change as six states have introduced bills mandating consent education in schools since the beginning of 2018. In Maryland, which recently passed such a bill and began implementing consent education in grades K-12, these policy changes were initiated by local young people seeking to educate themselves and their peers.4 States vary in their definitions of what young people should learn, but Maryland takes a broad approach and defines consent as “the unambiguous and voluntary agreement between all participants in each physical act within the course of interpersonal relationships.”5 This approach is comprehensive enough to include discussions of consent within sexual activity but also in other contexts. Such an expansive definition of consent is especially useful when discussing the topic with younger children.
The medical community is already widely supportive of comprehensive sex education. The Society for Adolescent Health and Medicine, the American Academy of Pediatrics, the American Medical Association, and the American School Health Association all have position statements that support providing age-appropriate and medically accurate information in schools about sex, sexuality, and healthy relationships.6
In addition to supporting efforts to improve sex education in schools, healthcare professionals also have a role to play in talking with young patients and educating them about these topics.
Research focused on identifying and preventing adolescent relationship abuse provides evidence that universal education and routine anticipatory guidance during adolescent patient visits promotes healthy relationships among young people and facilitates better (and earlier) connections to victims’ services when needed.7 In family planning settings, this approach has been shown to increase patients’ awareness of intimate partner violence and ability to use harm reduction strategies.8
Unfortunately, this research has not examined interventions around sexual harassment or violence outside of dating or relationships. Research on the role of healthcare providers in identifying and supporting adolescents who experience sexual harassment is especially lacking. However, continuing discussions of this topic in policy, media, and education settings provide significant momentum necessary to initiate this work.
In November 2017, the Sexuality Information and Education Council of the United States (SIECUS) launched the #TeachThem campaign in partnership with Tamara Burke, founder of #MeToo. The campaign highlights the lack of education in schools surrounding sexual assault, harassment, and the concept of consent, and it provides resources for individuals to advocate for better sexuality education policies in their communities. Their toolkit, which is available at , includes resources for learning more about local sexuality education polices as well as guidance on how to organize for change with community partners.9
Financial Disclosure: Author Melanie Gold, DO, is a consultant for Bayer. Consulting Editor Robert A. Hatcher, MD, MPH, Nurse Planner Melanie Deal, MS, WHNP-BC, FNP-BC, Author Rebecca Bowers, Author Anita Brakman, Author Taylor Rose Ellsworth, Executive Editor Shelly Morrow Mark, Copy Editor Josh Scalzetti, and Editorial Group Manager Terrey L. Hatcher report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.