By Angela García Vargas and Rachel Strohm *
As young adults marry at older ages, they are more likely to have sex before marriage, increasing exposure to unwanted pregnancies and sexually transmitted infections (STIs).
In Colombia, 60% of young people are sexually active by age 18, and only 55% of young women used a condom during their first sexual encounter.
Sexual education courses are supposed to be provided in public schools, but in practice their extent is limited, and many Colombian adolescents never receive formal sex ed.
The need for a cost-effective, scalable course of instruction in sexual health is clear.
While most sex ed programs around the world rely on teachers and peer educators to provide instruction in schools, there has been growing interest in the use of information and communication technology (ICT) for sexual education. ICT programs may be an attractive option for three reasons.
First, scale-up may be easier than with school-based methods.
Second, online courses can compensate for teachers’ potential discomfort with or resistance to discussions of sexual health.
Third, the anonymity of ICT programs may facilitate learning better than the group setting of a classroom. Given these potential benefits, ICT programs may be an attractive option for policymakers – but rigorous evidence of their impact is still needed.
A new paper by Alberto Chong, Marco Gonzalez-Navarro, Dean Karlan and Martin Valdivia uses a randomized controlled trial to evaluate whether an internet-based sexual education course in Colombia improves sexual health knowledge, attitudes and behavior among adolescents in public schools.
The course was developed by Profamilia, an affiliate of Planned Parenthood International (EN ESPANOL)with many decades of experience working with adolescents on sexual health issues.
The interactive, semester-long course had five modules on sexual health and social relationships, and includes practice questions, tests, and personalized follow-up by a remote tutor available to answer questions and provide feedback.
What were the evaluation results?
Six months after the course concluded, participating students were more knowledgeable about sexual health, had more favorable attitudes towards condom use and more conservative attitudes towards sexual activity, and were better able to identify instances of sexual abuse.
Among the minority of students who were sexually active at baseline, the authors find a decrease in self-reported sexually transmitted infections.
Even if the effects of the course decay relatively quickly, at 25% per year, the value of the reduction in STIs is enough to cover the costs of the course ($14.60 per student per semester).
To go beyond self-reported measures of STI incidence, the authors also provided students with vouchers for condoms six months after the course ended, and found that being in a treated classroom led to a 10 percentage point increase in students’ likelihood to redeem the voucher (28% for treated students vs. 18% for the control group).
The authors also look at spillovers across classrooms and students’ social networks. They find that treating a single classroom in a school has no overall effect on other classrooms in the same school.
However, the effects of the course are magnified as the percentage of a student’s friendship network taking the course increases.
In fact, when entire networks of friends are treated, improvements in overall sexual behavior emerge compared to treated students whose friends were not treated (in particular with regard to frequency of sex and number of partners).
This suggests that in situations in which social norms play an important role, interventions that target whole peer groups are more likely to be successful than individual-focused programs.
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