The pandemic within the pandemic: Comprehensive sexuality education as the path forward to addressing intimate partner violence

Elizabeth Wilkinson & Rebekah Rollston

COVID-19 and Intimate Partner Violence

The COVID-19 pandemic has necessitated physical distancing and isolation, driven up stress and uncertainty, and exacerbated inequities and violence, especially intimate partner violence. Intimate partner violence (IPV) is defined as physical or sexual violence, stalking, or psychological harm by a current or former partner or spouse. ¹ This type of violence can occur amongst couples of any gender, though women in heterosexual relationships report higher rates of IPV. Approximately 30% of women worldwide have experienced physical or sexual violence by a current or former intimate partner, and some national studies show that up to 70% of women in the United States (U.S.) have experienced physical or sexual violence by a current or former intimate partner in their lifetime. ^2,3 Beyond the harm directly inflicted upon its victims, IPV is associated with a myriad of health conditions, such as acute trauma, mental illness, chronic pain, substance use disorders, and more. ⁴ Before the COVID-19 pandemic in the U.S., 20 people were abused by an intimate partner every minute, and in a typical day, more than 20,000 calls were placed to domestic violence hotlines nationwide. ⁵ Intimate partner violence has significantly increased worldwide during the COVID-19 pandemic, with shelter in-place ordinances and other stressors contributing to this upsurge. ^6-8 Shutdowns of businesses and unemployment increased financial insecurity and economic stress, which in turn are risk factors for perpetration of IPV. ⁹ Additionally, preventative measures against the spread of COVID-19 increased isolation and inability to separate from violent partners while simultaneously decreasing access to third-party intervention and shelter. ¹⁰

Comprehensive Sexuality Education as a Tool Against Intimate Partner Violence

As vaccines, treatments, and public health measures are improving to extinguish the current COVID-19 pandemic, similar efforts should also be adopted to curtail the IPV pandemic. Comprehensive sexuality education (CSE) is an effective tool to prevent against IPV: it comprises age-appropriate, developmentally and culturally relevant, science-based, and medically accurate information on a wide range of topics, including gender identity, relationships, sexual behaviors and health, and mutual respect. ^11,12 Contrary to popular thought, CSE is not just about sex—instead, it also teaches critical life skills. When CSE is delivered following international technical standards, it equips youth and adolescents with the necessary tools to develop a healthy self-identity, challenge societal norms, promote gender equality, prevent gender-based violence, and ultimately, lead healthier and more fulfilling lives. ¹²

The United Nations Educational, Scientific, and Cultural Organization (UNESCO), United Nations Population Fund, and United Nations Entity for Gender Equality and the Empowerment of Women (UN Women) support comprehensive sexuality education for all people. ¹² Together, these organizations have authored the International Technical Guidance on Sexuality Education, which provides guidance on the core content that is recommended for all students throughout primary and secondary education. ¹³

Healthy relationships are a primary focus of the international sexuality education standards. Trust, mutual respect, open communication, and personal boundaries are essential components of all healthy relationships, whether intimate or amicable. ¹⁴ According to the National Sexuality Education Standards in the United States, CSE emphasizes the characteristics of healthy and unhealthy romantic and sexual relationships and demonstrates effective ways to communicate personal boundaries, whether that is by defining sexual consent and its implications, or establishing strategies to avoid or end an unhealthy relationship. ¹⁵ These vital skills and concepts, introduced beginning in kindergarten and successively built upon in an age-appropriate manner, equip individuals with the tools needed to decrease the number of persons at risk for IPV.

Comprehensive sexuality education also plays a key role in addressing gender inequality, which has a complex relationship with gender-based violence. ^16,17 Gender inequality inevitably increases the risk for gender-based violence, which is largely perpetrated by men against women. Core tenets of CSE are that all genders are equal, and as such gender-based violence is a violation of human rights. ¹² Both internationally and U.S.-approved CSE curricula address gender equality by teaching students to generate tolerance and respect for people with diverse gender identities, analyze societal gender roles and challenge harmful gender norms, and encourage mutually respectful and equitable relationships based on empathy and open communication. ^13,15

Furthermore, low self-esteem is a key characteristic of people who perpetrate IPV. ^18,19 The self-identities of perpetrators are often tied to their intimate partners, and consequently, perpetrators seek to increase their own self-worth through control of their partners. The International Technical Guidance on Sexuality Education teaches students how to develop healthy self-esteem from a young age, thereby empowering them to develop their own positive self-worth, cultivate ways to serve as a healthy partner in a relationship, and prevent interpersonal violence. ¹³ Complementing this, the core concepts in the National Sexuality Education Standards in the United States tackle identity development, body confidence, and bullying and harassment, all of which influence one’s sense of self. ¹⁵

Barriers to Comprehensive Sexuality Education in the United States

As pointed out by Phumzile Mlambo-Ngcuka, Executive Director of UN Women, in her remarks during the plenary session of the Five Days of Violence Prevention in Johannesburg, South Africa, “We have [not yet] developed interventions proportionate to the size of the challenge [to] address [intimate partner] violence.” ²⁰ Now that COVID-19 has increased the visibility of the IPV pandemic, the need for policymakers to heed this call and implement broad comprehensive sexuality education has only grown. If we are to adequately address IPV, the United States must urgently invest in comprehensive sexuality education. Just as we emphasize math, language, and humanities education, we must also develop an educational platform for teaching the crucial life skills that CSE encompasses.

While IPV is a multi-faceted issue, the failure to implement CSE in the United States undoubtedly puts all people at increased risk for violence. Because the U.S. lacks a national mandate, CSE is not standardized across states, counties, or even school systems, and a large proportion of sexuality education programs are not evidence-based or medically accurate. ¹⁹

These gaps are striking. Only nine states require students be taught about consent; meanwhile, an average of 400,000 cases of sexual assault are reported annually. Furthermore, despite 1 in 10 high school students having experienced physical dating violence in 2020, only nine states require comprehensive instruction on healthy relationships. ²¹

Given the decentralized nature of education in the United States, increasing the uptake of CSE faces several barriers. First, data on the delivery of CSE at the local school district level is scarce. This makes it difficult for researchers to conduct rigorous evaluations on the effects of CSE beyond observational studies and subsequently suggest targeted improvements. ²² Moreover, the absence of state or national mandates, combined with variable forms of social, normative, religious, and political resistance, results in variable implementation of CSE at the local level. Compounding these issues, a trained educator workforce, necessary for evidence-based and accurate CSE delivery, is sorely lacking. ²² Nearly one in three teachers responsible for delivering sexuality education reported having received no pre-service or in-service training in the area. ²³

Avenues for Advancement of Comprehensive Sexuality Education

Ultimately, overcoming the barriers to implementing CSE in the United States requires commitment from educators, politicians, medical experts, and community leaders. Concerted efforts from advocates at the local and state level are needed to improve CSE standards and implementation. Advocates for CSE should engage religious leaders in affirming the shared values between sexual and reproductive health and religious belief to bolster collective support for CSE at all education levels; similar approaches to other CSE-resistant interest groups could also prove fruitful. ²⁴ Leaders and educators of the teacher workforce should prepare their graduates to bring science-based, medically accurate, and inclusive CSE into the classroom using national guidelines. ²³ Importantly, political leaders and legislators must become informed about CSE, recognize its importance, and increase funding commitments for data collection and research on the delivery, implementation, and impact of CSE at the local, state, and national levels.

The COVID-19 pandemic has exposed the deep socioeconomic, racial, and gender inequities in the United States. The recovery process must include those who were, and still are, harmed by IPV. We must not only ensure their safety and healing in the short term, but also invest in tools like CSE that have the powerful potential to reduce future suffering in the long term.

About the Authors

Elizabeth Wilkinson, BA

Analyst, Robert Graham Center for Policy Studies in Family Medicine and Primary Care

Elizabeth Wilkinson, BA, is an Analyst at the Robert Graham Center for Policy Studies in Family Medicine & Primary Care in Washington, D.C. Her research covers the delivery of primary care, primary care physician workforce issues, and women’s health.

Email: dibetw@gmail.com

Rebekah Rollston, MD, MPH

Instructor in Medicine, Harvard Medical School; Family Medicine Physician, Cambridge Health Alliance

Rebekah L. Rollston, MD, MPH, is a Family Medicine Physician at Cambridge Health Alliance, Instructor in Medicine at Harvard Medical School, Faculty of the Massachusetts General Hospital Rural Health Leadership Fellowship (in partnership with the Indian Health Service Rosebud Hospital), Editor-in-Chief of the Harvard Medical School Primary Care Review, and Head of Research at Bicycle Health, a digital health startup that provides biopsychosocial treatment of opioid use disorder via telehealth. Her professional interests focus on social determinants of health & health equity, gender-based violence, sexual & reproductive health, addiction medicine, rural health, homelessness & supportive housing, and immigrant health.

Email: rrollston@cha.harvard.edu

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