Sex education for teens has long emphasized contraception over conception. However, a growing movement is sparking an international debate over whether to broaden the school-age curriculum to include the subject of fertility.
Champions of the notion argue that countless young people grow up misinformed about fertility and infertility. According to a survey by the Fertility Centers of Illinois, out of 1,208 women between the ages of 25 and 45, 79 percent say they support adding fertility education to school sex ed curricula. Additionally, 52 percent of respondents over age 35 say they might have made different life choices had they been educated about fertility and infertility earlier in life.
Others contend that adding a fertility element would water down sex education at a time when preventing sexually transmitted infections (STIs) and teen pregnancy is of paramount importance. The Centers for Disease Control and Prevention reports that young adults between the ages of 15 and 24 account for half of all new STIs in the United States. Pregnant teens face a high risk of pre-eclampsia, infection and other complications. Complications from pregnancy and childbirth are the leading cause of death for young women between the ages of 15 and 19 globally, according to the World Health Organization (WHO).
Given these risks, many critics suggest we need to improve existing sex education before adding new lessons into the mix. So, what's the right decision?
The Global State of Sex Education for Teens
Sex education should be medically accurate, evidence-based and age-appropriate, advises the American College of Obstetricians and Gynecologists (ACOG). Instruction should cover the advantages of delaying sex until adulthood while teaching teens about healthy reproductive development and contraception. Research shows sexual education helps to curb risky sexual behaviors, STI contraction and teen pregnancies.
In reality, sex education often tends to become a mishmash of standards reflecting local attitudes about sexuality. Almost half of all U.S. states require sex education, but only 13 insist that the information given in these classes be medically accurate, according to the Guttmacher Institute. Nearly 40 states mandate some form of abstinence training. The Guttmacher Insitute reports that in Nigeria, another country with abstinence-based sexual education, only around 30 percent of young women between the ages of 15 and 19 say they know where and how to access basic birth control.
Globally, sex education is also wrapped up in views about promiscuity. Even so, a pilot program in India, a country with high teen pregnancy rates, is now teaching young people about gender equality and consent to promote a healthy attitude toward sex and curb sexual abuse. In Romania, curriculum developed by the International Planned Parenthood Federation uses dolls to teach teens with learning difficulties about consent.
Why Add a Lesson on Fertility?
Given the current patchwork approach to sex education, some favor shoring up existing standards rather than adding a fertility element to student instruction. Still, backers of fertility education point to the sharp decline in fertility rates coupled with more people choosing to postpone parenthood — often with the misplaced belief that unassisted conception is possible well into their 40s.
The average age of first-time parents has been increasing worldwide. Older patients can benefit from assisted reproductive technology (ART) procedures such as in vitro fertilization (IVF), but these methods don't eliminate the risks of advanced maternal or paternal age, such as low birth weight or increased incidence of birth defects. ART is also far from foolproof. Even with IVF, a 41-year-old woman has less than a 10 percent chance of conceiving in one cycle, according to national statistics from the Society for Assisted Reproductive Technology.
Beyond Pregnancy Prevention
Some countries are embracing fertility education for teens. The U.K. now mandates "facts about reproductive health, including fertility and the potential impact of lifestyle on fertility for men and women" in sexual education for young people, according to a report by the country's Department for Education.
Although Japan is not yet adding fertility to its national curriculum, a cross-sectional study in the journal Reproductive Health recommended doing so after discovering 65 percent of participants had learned about age-related fertility decline from mass media or online sources rather than from an educator. Other studies have echoed the recommendation to teach young people about fertility, mostly with the aim of combating the country's declining birth rate and aging population.
Meanwhile, U.S. supporters of fertility education suggest starting by teaching adolescents about the effects of STIs, smoking, alcohol, drug use and normal age-related changes on their fertility. Teenagers with a uterus and ovaries may be surprised to learn their age bracket has the highest risk for pelvic inflammatory disease (PID), a common condition causing infertility in one in 10 cases.They also may not realize they will lose nearly their entire ovarian reserve by their late 30s, which makes natural conception later in life more challenging.
Addressing Fertility Education for Teens in Your Practice
As the debate plays out over whether to include the topic of fertility in sex education for teens, OB/GYNs and other practitioners may wish to raise the issue during routine checkups with their young patients. They may also want to screen for conditions such as polycystic ovary syndrome (PCOS), one of the most common — and treatable — causes of infertility.
Given the prevalence of social media and inaccurate online content, consider asking your young patients where they are getting their information about sexual health. If they are leaning on the advice of friends, or are curious but don't know where to begin, recommend reputable age-appropriate sources such as Scarleteen or Go Ask Alice.
"OB/GYNs are in a great position to educate adolescent patients and their parents or guardians about everything from dangerous online behavior to the benefits of long-acting reversible contraception," explains Joanna H. Stacey, M.D., in an ACOG committee opinion on sexual education for teens.
Bring parents and guardians into the conversation to foster a healthy environment for young people to talk about all aspects of sex education, from their current challenges to their future plans.
