Strategy overview

  • Informing sexual behavior and well-being: Sexual health and education strategies seek to reduce STI transmission and unintended pregnancy by teaching and encouraging safer behavior and decision-making. Comprehensive programs are typically delivered in multiple modalities, including one-on-one, in groups, and community-wide.
  • Combining education and health services: Interventions often combine sexual health services (such as STI tests, pregnancy tests, or prescribing birth control) with education on contraception, STI prevention, and other evidence-based practices. In many cases, education and health services are delivered by a single person, who cultivates strong relationships with each client, schedules follow up sessions, and provides referrals to other services, such as mental health counseling.
  • Delivery from trained specialist: Given the sensitivity of some sexual health topics, program design and delivery is often shaped by culturally competent specialists; such specialists typically receive training on both skills (like motivational interviewing) and subject matter (such as the latest research on effective contraception). Many initiatives facilitate partnerships with colleges and other institutions to train specialists and provide ongoing professional development.
  • Removing barriers to access: To reach as many members of a target population as possible, sexual health and education programs are typically located in public spaces with significant foot traffic, such as high schools and easily accessible community clinics. Such locations may include private office space for individual visits and areas for public displays with educational materials.

Multiple independent systematic reviews of rigorous studies found that evidence-based reproductive health and education programming is associated with statistically significant decreases in risky sexual behavior, STI rates, and unintended pregnancy among adults and adolescents.

  • A 2017 research synthesis found that comprehensive risk reduction sexual education reduces risky sexual behaviors, including frequency of and engagement in sexual activity, number of partners, and unprotected sexual activity, and increase use of contraception. 

  • A 2019 research synthesis found that condom availability programs increase condom acquisition and use in adults and adolescents, particularly in high-risk populations.

  • A 2019 research synthesis found some evidence that increased access to long-acting reversible contraception through cost reduction (low-cost or no-cost) and counseling can increase use and decrease unintended pregnancy.

  • A 2019 research synthesis found that expedited partner therapy (in which a health care provider prescribes or provides medication for both the patient and their partner for STI treatment, without examination of the partner) increases the number of partners treated for STIs and reduces rates of reinfection.

Before making investments in this strategy, city and county leaders should ensure it addresses local needs.

The Urban Institute and Mathematica have developed indicator frameworks to help local leaders assess conditions related to upward mobility, identify barriers, and guide investments to address these challenges. These indicator frameworks can serve as a starting point for self-assessment, not as a comprehensive evaluation, and should be complemented by other forms of local knowledge.

The Urban Institute's Upward Mobility Framework identifies a set of key local conditions that shape communities’ ability to advance upward mobility and racial equity. Local leaders can use the Upward Mobility Framework to better understand the factors that improve upward mobility and prioritize areas of focus. Data reports for cities and counties can be created here.

Several indicators in the Upward Mobility Framework may be improved with investments in reproductive health and education. To measure these indicators and determine if investments in these interventions could help, examine the following:

Mathematica's Education-to-Workforce (E-W) Indicator Framework helps local leaders identify the data that matter most in helping students and young adults succeed. Local leaders can use the E-W framework to better understand education and workforce conditions in their communities and to identify strategies that can improve outcomes in these areas.

Several indicators in the E-W Framework may be improved with investments in this strategy. To measure these indicators and determine if investments in this strategy could help, examine the following:

  • Physical development and well-being: Percentage of students meeting benchmarks on self-rated surveys of physical health, such as the California Healthy Kids Survey Physical Health & Nutrition module.

  • Access to health, mental health, and social supports: Percentage of programs offering health, mental health, and social services, or staff or consultants providing infant and early childhood mental health consultation (IECMHC) services.

  • Invest in specialized staff: While sexual health education and services can be delivered by general clinic or medical staff, evidence-based models often employ highly trained specialists. These professionals are experienced in discussing sensitive topics with the groups that could most benefit from the intervention (i.e. teenage girls) and demonstrate a high degree of cultural competence. By hiring staff members committed to the subject matter, programs can increase the likelihood of cultivating strong relationships with clients, engaging in follow-up sessions, and delivering the model effectively.
  • Prioritize one-on-one visits, follow-ups: For those most at risk for unintended pregnancy or contracting an STI, visits with a trusted specialist are often the most impactful in shaping behavior. While requiring significant staff time and private office space, many crucial services, such as intensive sexual health counseling and discussions of highly sensitive topics, can only be delivered in a private setting.
  • Cultivate partnerships for program sites: Effective sexual health and education models are often delivered at a site offering a range of other services, such as a community health center or a school-based clinic. Identifying a strong host site for program delivery allows programs to reach a higher number of residents who could benefit from the services (i.e. high school students) and can produce significant ancillary benefits, such as increased use of other clinic services as a result of referrals. School-based clinics have demonstrated particularly promising results, given their high visibility among students. 
  • Address stigma through education: A major barrier to accessing sexual health and well-being services is stigmatization. Programs can address this through community-wide programming that includes a robust educational component on the benefits of such services. Staff at delivery sites (such as teachers) should receive training on how to discuss sensitive topics and when to refer individuals for one-on-one services.

Evidence-based examples

Individual-, group-, and community-level programming promoting healthy sexual behavior
Stable and healthy families

Evidence varies across specific models

Community- or school-based programming on protection against sexually transmitted infections (STIs)
Stable and healthy families

Evidence varies across specific models

Increasing access to long-term contraception for adults and teens at fully or partially subsidized rates
Stable and healthy families
Medically equipped vans staffed by clinicians offering reproductive health services
Supportive neighborhoods