Do you remember your first “very special” health class? Mine was taught by a middle-aged lady whose first priority was eliminating dirty fingernails. She stalked around our fifth-grade public school classroom, examining each girl’s hands, prepared to name and shame any offenders.
Besides the hygiene review, we also received a blurry diagram of the female reproductive system. The teacher unconvincingly strove to impress upon us that we each had inside ourselves a duplicate of this diagram, and that soon these organs would power on, like a self-aware computer. As far as I was concerned it may as well have been a map of the battle of Gettysburg, labeled entirely in French.
She explained that an egg would one day travel down one of our tubes like a marble, and if that egg wasn’t fertilized by sperm, “it” would happen. “It,” the teacher made clear, was an unstoppable part of life. The train was bearing down upon us and there was no way to unstrap ourselves from the track. Carnage—ahem, menstruation—was inevitable.
We also watched a sappy video produced under the mistaken assumption that all tween girls long with their whole hearts to get their periods, grow breasts, and most of all, be noticed by boys. I was in no hurry to grow up, and I experienced the same feeling of loneliness I got from reading Judy Blume novels. The girls in the video, like the characters in the Judy books, seemed anxious and very unhappy, so I was glad their problem was not my problem. Still, was there something wrong with me? Should I be worried that I wasn’t worried about eggs and tubes and bras?
Unless you were very lucky, you can probably tell a similar story about your first sex-ed experience. It was probably strange, awkward, and not what you needed. Can you imagine another way? What if the way kids learned the “facts of life” was positive, useful, and even feminist?
Fertility awareness has been grabbing headlines recently as women discover one of medicine’s best kept secrets—that they can plan their families without being chained to a pill bottle. But fertility awareness is not, at its core, about avoiding pregnancy. It proposes the radical notion that women are people with bodies that deserve to be studied, understood, and appreciated. I spoke with three women helping lead the fertility awareness charge to find out what that looks like with teenagers.
Sex ed that teen girls actually want to learn
Cassie Moriarty is a women’s health dynamo based in New York City—she’s a certified breastfeeding counselor, a trained DONA postpartum doula, and knows multiple methods of natural family planning. She’s also a certified teacher for FEMM, a comprehensive women’s program that helps women understand how their cycle intersects with their health.
“I got involved with TeenFEMM when I was training with FEMM,” Moriarty says. “I saw it as such an opportunity. I view sex ed as something that happens periodically throughout one’s life rather than a conversation that happens once; sex ed should happen even throughout your twenties. The idea of teaching teens about fertility awareness sets a great foundation for young girls with their bodies.”
Moriarty works with clients of all ages, usually in small groups or in one-on-one sessions, sometimes even with OB/GYNs alongside teens who are dealing with hormonal disorders. Regardless of the setting, the material hits home.
“Honestly teens are some of my best students!” says Moriarty. “For one, they are in the swing of learning. They are used to having homework and pop quizzes. Almost everyone I have taught has been bright, mature, curious, and excited . . . they are usually more intrigued than embarrassed. I joke that the couples I work with who are getting married sometimes act more squeamish than a 13-year-old girl.”
I asked Moriarty what young women can learn from fertility awareness that they may never discover otherwise.
“The biggest most obvious piece is cervical fluid. That is something virtually every teen girl experiences, and just about all of them aren’t taught about it in their public school sex ed. A lot of young girls, like myself at that age, experience shame about a totally normal bodily function,” she told me. She also says that students benefit from hearing “a different angle” than simply “Don't get pregnant!”
I remember as a 13-year-old feeling like pregnancy wasn’t even close on my radar . . . but I did want to know more about that strange bleeding I was experiencing. And headaches and cramps.
“Sex ed is usually built upon the message of ‘here’s how pregnancy happens, here’s how to avoid it’ rather than ‘here are these amazing (and sometimes annoying, strange, and intrusive) things your body is doing.’ I hardly even talk about pregnancy in the first few classes. I talk more about mental health, hormonal health, and cycle health.”
Your body is feminist
Leah Jacobson had been working with young people and moms for more than a decade by the time she founded the Guiding Star Project in 2011. She saw a deep, unmet need for an initiative to bring together whole-woman feminism and women’s health. Guiding Star Centers around the country offer a variety of location-specific health-related services like childbirth education, breastfeeding support, postpartum care, and family planning to help women achieve or avoid pregnancy. It also includes fertility awareness outreach to young girls.
“The core of these programs and our philosophy on fertility, is that there’s nothing wrong with our fertility. It’s a really beautiful part of who we are,” Jacobson says. “It’s our belief that by giving [young people] the tools and the education to understand their bodies, they’re going to make better decisions that are in line with avoiding risky behaviors. They’re going to care for their dignity and the dignity of their partner.”
In our culture, which regards a woman’s fertility as an obstacle or a potential threat to her success and happiness, Jacobson has seen first hand how women have lost touch with their bodies.
“It’s sad; we have had women come in for the first time to learn how to chart their cycle, and you explain to them more than once that they have to come off the Pill to chart,” Jacobson told me. “They don’t understand, because they somehow think that they have a natural cycle, when what they actually have is withdrawal bleeding [when they take the ‘inactive’ drugs in their pill pack]. That’s an incredibly shocking and alarming situation for women to be in. They feel empowered, they feel like they’re ‘doing something’ because they’re taking the Pill. But for them to not even know that they’re not ovulating and that they don’t have a cycle . . . that’s disturbing, because it means they don’t at all understand the function of these drugs that they are [taking].”
For so many of us, that confusion starts at the very beginning, with that first period. Almost as a rite of passage, many moms take their daughters to the doctor, who may perform a pap smear but who almost certainly will want to discuss medication to “treat” and control her new, risky state of natural fertility.
The result is that thousands of children are prescribed synthetic hormones. It’s clear many kids are never told how the Pill works, nor are they routinely screened and warned about the Pill’s links to depression and breast cancer. Some girls stay on the drug for decades, until they decide to have children—only to confront the reality that they know virtually nothing about what to expect from their bodies once the medication leaves their system.
This is even more so the case if girls complain of symptoms like cripplingly painful periods or irregularity. Few OB/GYNs make the effort to find out what is wrong when hearing of period symptoms.Take for example endometriosis, a painful condition that affects one in every ten women and can destroy a woman’s quality of life and fertility. Even though it is one of the most common diseases affecting women’s health, it takes a woman an average of seven years of suffering, begging, and doctor-shopping before she can get a diagnosis. Because hormonal contraception covers up the symptoms of diseases like endo, doctors often employ birth control as an easy fix for any potential reproductive problem—as if passing the buck to the next doctor to figure out whatever it may actually be. One study from the Guttmacher Institute found that more than 80 percent of teens on the Pill had been prescribed contraceptive meds for non-contraceptive reasons.
“What is our health-care system doing? This is a complete act of paternalism,” Jacobson says. “It’s dignifying to tell girls the truth about themselves. It should be the core of feminism. Feminism that fails to acknowledge the female body does not have women’s best interests at heart. All it is, is a facade for a male normative culture. Fertility is a liability to how success is currently defined in [that culture].”
Authentic feminism, according to Jacobson, will “redefine the worldview—not just accept the male normative world and say we have a right to fit ourselves into it. It’s confusing to tell our daughters, your breastfeeding is good, you should breastfeed, but your fertility is dangerous, you should suppress that. We have to have a consistent narrative. It’s all good.”
Each Guiding Star center has different programs, ranging from the Guiding Star Cycle Show—a five-hour, interactive, hands-on experience for young girls—to offerings that can be accessed online, particularly useful in the era of coronavirus. Jacobson specifically points out that the programs are science-based and secular. “Our presentations don’t have a religious aspect. . . . We want every girl regardless of any religious affiliation to understand this applies to her,” she says. They’re already used in public schools in Germany, China, and the United Kingdom.
Jacobson has a new book, Wholistic Feminism, coming out in the fall, and I for one will be reading.
Teens who understand their fertility are less sexually active
Dr. Hanna Klaus is a fellow of the American College of Obstetricians and Gynecologists. She’s also the founder of Teen STAR, a fertility awareness program that has spread to Europe, Africa, Asia, and North, South, and Central America since it began in 1980.
The program got momentum through a chance connection with Eunice Kennedy Shriver, who was President John F. Kennedy’s younger sister and at the time, the vice president of the Kennedy Foundation. Shriver had a special interest in helping people with intellectual disabilities, and one of the risk factors for intellectual disabilities is premature birth to a teenage mother. So, in the interest of seeing how fertility awareness training could affect teenage girls, the Kennedy Foundation provided Teen STAR with its first research grant.
The results of the research were profound. “What we found was that [learning fertility awareness] helped prevent girls from being sexually involved, and also half of those who had already started stopped. And that’s been characteristic of our program overall,” Dr. Klaus told me. Decades later, Teen STAR continues to be the subject of research worldwide.
There are programs for both boys and girls, and for different ages. “We invite the girls to understand their mucus discharge, what causes it, where it comes from, what hormones are responsible for which changes, what those hormones do to your emotions, thinking, and relationships. Ultimately these girls own their womanhood and make better decisions about adult relationships,” Dr. Klaus says. “We ask boys to monitor their emotions. They don’t have a cycle to track, but they can get in touch with the fact that they have emotions—a lot of them are supposed to have a ‘stiff upper lip’ or [believe that] ‘men don't cry.’
“They really love discovering about themselves. We don’t just tell them these things, we ask them questions and let them make their own discoveries. Generally it takes the girls three cycles before they get a handle on it and recognize, ‘this is ME.’ This is when they move away from peer pressure.”
Then Dr. Klaus told me about an element of the program that made my heart leap.
“One of the things the girls really like is assertiveness training,” she said. “That doesn’t just deal with sexual matters, but can have to do with anything in a relationship. It’s important whenever you’re being asked to do anything you don’t want to do. You have a right not to be bullied into anything.”
Can you imagine what the world would be like if every schoolgirl was trained in her right to be assertive and stand up for herself, not just when it comes to sex but in all her relationships?
“The biggest obstacles are the gatekeepers. On the one hand, that’s parents who are afraid that if you talk about this it will be an invitation to become sexually active—our statistics show the opposite,” Dr. Klaus told me. “And on the other hand . . . I belong to ACOG [American College of Obstetricians and Gynecologists], and I’m also a member of the Society for Adolescent Health and Medicine. They want to make sure that girls are protected against pregnancy and that they know about avoiding sexually transmitted infections. That particular bit hasn’t been helped very much—adolescents make up about a third of the population and have half the STIs,” she says. “Something isn’t working out.”
She particularly calls out efforts to promote long-acting contraception, IUDs, which don’t prevent the spread of diseases like HIV or HPV and can perforate a woman’s uterus. Women can still get pregnant with an IUD, but the device means that when such pregnancy occurs, often the embryo will implant in her Fallopian tube instead of her uterus—a medical emergency that the baby cannot survive and that threatens the life and fertility of the mother. Since this form of birth control is often presented as virtually failure-proof, women may not suspect their symptoms are coming from a pregnancy that has gone very wrong. “These are not sugar pills,” Dr. Klaus says.
Each of the women I spoke to was inspiring for her knowledge and her passion for girls and their health. Will every teenager one day have access to sex ed that is body positive and corny-video free? The future looks bright.