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.

What evidence supports this strategy?

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.

Is this strategy right for my community?

Providing reproductive health and education services has been shown to improve outcomes predictive of upward mobility. These outcomes, identified by the Urban Institute, are access to health services and neonatal health.

City and county leaders can assess local conditions for each of these outcomes using the metrics below, identified by the Urban Institute. This assessment can be used to determine whether this strategy is appropriate for their community. (Note: these metrics are a starting point for self-assessment and are not intended to be comprehensive.)

All cities and counties with populations over 75,000 can receive a customized data sheet here.

  • Measuring access to health services in your community: Examine the ratio of residents to primary care physicians. These data are available from the U.S. Department of Health and Human Services’ Area Health Resource File.

Best practices in implementation

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