The limits of school-based sex education: Lessons from rigorous evaluations in the UK
The UK has among the highest teenage pregnancy and STI rates in Western Europe and strategies to reduce these outcomes have a high priority. This paper seeks to draw lessons from the rigorous evaluations of three sexual health initiatives: SHARE (a cluster randomised trial (CRT) of teacher-delivered sex education), RIPPLE (CRT of peer-delivered school sex education) and Healthy Respect Phase 2 (a quasi-experimental study of a multi-component Scottish national sexual health demonstration project encompassing youth friendly sexual health drop-ins, social marketing, branding, a parenting component and SHARE).
Compared with conventional sex education all three interventions improved practical sexual health knowledge, had modest (mostly positive) impact on attitudes and quality of relationships, and the pupils and teachers preferred the new interventions. However, all three studies had disappointing self-reported sexual behaviour outcomes (sexual experience, number of partners, contraceptive use, pregnancy and terminations). None had an impact on objective NHS recorded pregnancies or terminations.
Meanwhile, there is a growing body of evidence that generic parenting interventions in the early years (e.g. the Family Nurse Partnership) and generic interventions that aim to change both parenting and school culture (e.g. SEATTLE project) can have a positive impact on sexual risk behaviours. We appear to have reached the limits of what can be achieved by specific school-based sex education in terms of changing sexual risk behaviours. However, there seems to be scope to develop and evaluate more generic programmes aimed at changing parenting and school culture to improve sexual health.
