by Hanna Klaus, MMS, MD
This past summer I attended a meeting on Adolescent Reproductive Health: the Challenge and Benefits of Delaying Sex, convened by the US Agency for International Development (USAID). The speakers reviewed the many internationally funded programs that seek to focus youth on long-term goals, teach abstinence, skills toward self efficacy, or just “safe sex” or some combination of the above.
One speaker, Gene Roehlkepartain, of Search Institute, presented an analysis of factors that support delaying sexual activity, the weightiest being these: living in a stable two-parent family, positive peer influence, and religious practice. While all of these external and internal assets are laudable, one important factor is absent from their asset lists: understanding and valuing one’s sexuality and fertility.
In offering the body as a powerful and heretofore unmentioned asset, I pointed out that our culture has separated sex not only from procreation, but from relationship, and that the resultant “hook-up” culture has not led to healthy individuals but to very damaged ones.
Most prevention programs use the World Health Organization’s definition of healthy sexuality: engaging in voluntary and “protected” sex. Our own program, TeenSTAR (Sexuality Teaching in the context of Adult Responsibility), by contrast, places a high value on possessing fertility rather than either acknowledging it abstractly or isolating fertility from one’s self concept and from the body by the use of drugs or devices. The TeenSTAR program, which exists on five continents and is funded by USAID’s President’s Emergency Program for AIDS Relief (PEPFAR) program in Uganda and Ethiopia for the prevention of HIV/AIDS transmission, has led to increased self confidence among teen participants, enhanced their ability to resist pressure to engage in unwanted activities, especially sexual intercourse, and has led them to make their own decisions.
Our data, I went on to say, supports both primary and secondary abstinence. (Primary abstinence indicates no prior sexual involvement, secondary abstinence is a discontinuation of intercourse.) The speakers at the meeting did not react, but several members of the audience thanked me for speaking out, and encouraged me to continue.
What is TeenSTAR and why and how did it begin?
“When God gives a girl a sign she has a right to know what it means,” said Phyllis White, a veteran Natural Family Planning (NFP) teacher in Kansas City, Missouri, when she was first trained to offer the Billings Ovulation Method. At that time NFP was not offered to teens, but by 1980 the positive reactions of young women to learning to understand their fertility patterns encouraged us to extend this knowledge and to research the outcome.
We obtained a research grant in 1980. As it is necessary to obtain one parent’s permission when working with minors, we met with the parents to tell them that we planned to teach their daughters to understand their bodies’ fertility patterns, and also to work with them to explore the emotional, social, intellectual, spiritual, and behavioral aspects of possessing fertility. We invited the parents’ cooperation and consent before we approached the girls to invite them to join the program.
The curriculum and how it began.
We were blessed to have a wonderful educator, Mary Lou Bryant-Reid, on our team. Instead of following my theoretical, medical outline, she asked the girls if they wanted to “talk woman talk.” The sequence of their questions going from what they could see to what caused it and what it meant became the Young Women’s TeenSTAR curriculum.
They learned to identify bodily signs that indicate impending ovulation and to identify the day closest to ovulation by its characteristics. They discovered that the time from ovulation until the next period was the same in each cycle. Not only could they predict when their next period would come but they could be prepared for it.
Their body was telling them things, and they were in control. They learned that the hormone estrogen is the dominant hormone before ovulation, and that it releases endorphins, which usually lead to feeling extroverted and upbeat. After ovulation progesterone is dominant. One of its breakdown products is allopregnanolone, which relieves anxiety. Women often feel introspective and “arty” in the time of progesterone dominance.
Two to three days before the period is due both estrogen and progesterone levels drop, allowing the small amount of male hormone that women possess to become prominent. Testosterone is the hormone of aggression. If that aggression is turned outward, the woman has a short fuse, if turned inward, it is depression not pathological, but the normal cyclic variation. Understanding these hormonal influences makes it possible to adjust one’s responses, and gives one a greater sense of self control.
Once the girls took possession of their fertility cycle they began to move away from peer pressure. Both they and their parents, with whom we met during the program, reported concrete instances where the girls began to make their own decisions and had no difficulty resisting pressures from peers or boyfriends.
During one of our meetings one mother told us that the program was wonderful for her daughter, but what about her son? We found a gifted teacher, Father Donald Heet, O.S.F.S., who was the founding principal of a local high school and had excellent rapport with boys. He wrote up his procedures, which are still in use in the curriculum for boys. While men, obviously, don’t have monthly cycles, young men need accurate information about their pubertal development, as well as a chance to raise and discuss their questions about this with a man. The man will do more than answer factual questions he must also model self-possession.
Later curricula were developed and updated for younger students still in early adolescence, for young adults, and for teenage mothers. While the original curricula were in secular settings, objectives of Pope John Paul II’s Theology of the Body were added when the program was offered in religious schools or parishes. TeenSTAR is approved by all bishops in whose diocese it is offered, and by the Pontifical Council for the Family.
Who can teach the program?
Teachers need to be trained to offer the program and need to live its values, which are essentially those of Humanae Vitae. Teenagers have exquisitely sensitive antennae for inauthenticity, which they call hypocrisy. Any teacher who does not live the values of the program is not credible. We train teachers to deliver the curricula in a five-day training workshop and support them especially in their first year of teaching. As part of evaluation at the end of the program, students are asked to complete anonymous questionnaires that include questions on behavior.
Parents are included
We offer three parents’ meetings: before, during, and at the end of the program. The first meeting gives parents a chance to learn what we hope to teach, to ask questions, and make comments. The two later meetings are to learn how the parents perceive the program and discuss any changes they have seen in their offspring, and the challenges most parents of teenagers have to tackle.
At the first parent meeting someone nearly always asks if teaching teens when pregnancy is possible and when it is not might be an invitation to promiscuous behavior. The question is understandable. Would teens take advantage of their knowledge of their times of fertility and infertility?
As we monitor behavioral outcomes we can supply the answer. Very few male and female participants in the program initiated sexual behavior, while between one- and two-thirds of sexually experienced students discontinued the practice, using the Centers for Disease Control and Prevention (CDC, US Department of Health and Human Services) definition of no contact within the last three months. TeenSTAR is now in many countries, yet the behavioral outcomes are similar whether in France, USA, Chile, Korea, or Uganda. And they are similar for boys as well as girls. Once teens take ownership of their fertility they behave responsibly, and are able to turn their energies to their primary task of completing their education.
Premarital abstinence is a two-fer
When we began TeenSTAR we hoped to prevent abortion by preventing crisis pregnancies. That is still one of our goals, but as our data show, when sexual activity is delayed until adulthood, not only pregnancy but also transmission of sexual diseases is avoided. On that basis we were awarded a grant from the PEPFAR agency (mentioned above), administered by the USAID. The funded programs are in Uganda and Ethiopia, and have taught more than 55,000 young people, in addition to their families and communities. This program is in its last year and cannot continue under USAID funding because the current administration is not funding any prevention programs that do not include condoms. Nevertheless, the program is in great demand and communities have opted to continue and expand the programs.
Why don’t we embrace experiential learning?
It is curious that no other sexuality education program utilizes the experience of the body and its fertility patterns to help young people understand and value their sexuality as well as their fertility.
When God’s chosen people kept falling away despite the many signs of God’s love and mercy, He came in a body so that we could not only finally understand, but also touch Him and speak with Him, and be redeemed and healed by Him. In so doing, Christ not only gave the body a value equal to the soul’s, but established its intrinsic goodness.
Why are people hesitant to use the understanding of the body as the powerful teaching tool that it is, to teach their children how to love properly in marriage? Why are people afraid to make use of this powerful tool that links the two aspects of the marital act mutual love and openness to the transmission of life? Our culture is not only separating sex from procreation and relationship but is well on the road to denying the immutability of biological sex. TeenSTAR, and its adult progenitor, Natural Family Planning, are precisely the remedy. God not only created us, but knows how to reach us; He did that through the body, which Catholics receive when they receive the Eucharist. Our bodies are not mere tools for the expression of desires, they are us! Blessed John Paul II called it the “sacrament of the person.” Let us use this powerful means of teaching our youth to respect and value themselves and all others.
Hanna Klaus (Sister Miriam Paul) is Medical Mission Sister and a physician who has taught obstetrics-gynecology at medical schools (St. Louis University, Washington University, George Washington University). She has researched and taught the Billings Ovulation Method of natural family planning for many years. Since 1980, she has been executive director of the Natural Family Planning Center of Washington, DC in Bethesda, Maryland; and that same year, Dr. Klaus and her colleagues developed the TeenSTAR program, for teaching adolescents and their parents about sexual health. The TeenSTAR program is now available in 27 countries on 5 continents. For more information about TeenSTAR: teenstarprogram.org.
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