Normalizing sex to promote effective reproductive life planning

Background: Despite numerous entities devoted to improving reproductive health outcomes, sexual education still provokes “drama” stemming from the traditional paradigm that sexual activity is something to be dreaded and discouraged. It's not surprising that reproductive illiteracy is high and much sexual education is ineffective.

Purpose: To present an alternative approach to reproductive health education – one that focuses on normalizing sex. Normalizing sex opens the door to reproductive life planning and responsible intentional sexual behavior.

Methods: Healthy Start, a federally funded program to reduce poor pregnancy outcomes, encourages programs to address interconceptual health, especially adequate birth spacing. Three Healthy Start programs prepared their paraprofessional home-visiting staff to be reproductive health “warriors” by: a) identifying Reproductive Health Team Leaders (RHTLs) among staff; b) having a nurse practitioner mentor these RHTLs over 12 to 24 months; c) increasing their knowledge and skills for normalizing sex through client-centered, nonjudgmental and easy-to-understand communication (using concrete messages and learning tools). RHTLs then conducted training sessions with their peers and various audiences.

Results: Program evaluation revealed the RHTLs underwent profound changes in outlook and comfort level with reproductive health concepts. They became skilled resources for working with clients on reproductive life planning and contraception.

Discussion: The RHTL model adopted by three Healthy Start programs demonstrated how to work with practitioners to normalize sexual education to reduce reproductive illiteracy and improve pregnancy outcomes. This model can be applied by other programs seeking to promote adequate birth spacing, positive pregnancy outcomes and reproductive justice.