Written by Professor Maria Lohan, Professor of Social Sciences and Health, Queen’s University Belfast
If I were Jack is a new comprehensive sexuality education (CSE) program designed to attract boys and address masculinities. The program has proven successful in helping both adolescent boys and girls avoid an unintended pregnancy. If I were Jack it is based on a gender equality approach, also known as a “gender transformative” approach. It is specifically designed to attract men and transform masculinity to be more consistent with gender equality.
The World Health Organization (WHO)1 and the United Nations Educational, Scientific and Cultural Organization (UNESCO)2 among others, they have highlighted the need for greater engagement with boys through ‘gender transformative’ CSE that challenges gender inequalities to reduce unintended teenage pregnancy and improve sexual and reproductive health and rights (SRHR). However, there has been a lack of programming specifically designed to achieve this commitment – a deficit highlighted, for example, by the United Nations Population Fund (UNFPA) and by the latest systematic review of evaluations of sexuality education programs3. THE If I were Jack program is designed specifically to address this deficit.
Its effects If I were Jack program were studied in a randomized controlled trial and the results were published in Lancet Public Health. This was the first randomized trial of a CSE program to show a significant increase in contraceptive use for both adolescent boys and girls. The trial also showed that the program increased adolescent boys’ and girls’ sexual health and health care knowledge, improved gender equality attitudes, and increased intentions to prevent unintended pregnancy.
The UK-wide randomized trial involved 66 schools and more than 8,000 pupils, making it the largest trial of its kind. It is the first randomized trial of a gender-transformative CSE program aimed at engaging men to reduce unintended teenage pregnancy, the first CSE trial to be conducted in four UK nations and the first UK CSE trial involving faith-based schools based.
The assessment is timely as WHO has just launched a global research priority setting exercise Masculinities and Sexual and Reproductive Health and Rights. The aim of the WHO exercise is to shape, in collaboration with a wide range of global stakeholders, a common research agenda on transforming masculinity and engaging men and boys in SRHR. WHO practice is also informed by systematic reviews of research on men’s involvement in SRHR, specifically involving men in gender-transformative intervention studiesas well as evidence and gap maps of this sector. We invite you to participate in shaping this common research agenda here.
Our motivation for its design and evaluation If I were Jack The project is to examine the outcomes of effectively engaging adolescent boys early in discussions around sexual health and rights alongside adolescent girls. We are focused on reinforcing positive masculinity to help young men navigate their role in healthy, consensual sexual relationships. Boys have as much a role to play as girls in preventing unwanted pregnancies.
THE If I were Jack The program starts with an interactive video drama co-designed with young people and policy makers. The drama allows boys and girls around the age of 14 to step into the shoes of a boy, Jack, who has just been informed by his girlfriend that she is unwittingly pregnant. In subsequent classroom activities, young people can discuss and explore, on their own terms, what makes gender norms and practices changing and resistant to change.
Follow-up classroom activities also encourage communication and behavioral skills among adolescent boys and girls. This allows for greater confidence and competence in discussing contraception and consent. It also helps boys and girls know how to get safe contraception and how to seek help in the event of an unintended pregnancy. Classroom activities encourage students to consider how intimacy, sexual relationships, and future parenthood are not negative experiences, but rather pleasant things to look forward to when one is ready. To maximize the quality of the organization and delivery of these activities, relevant training is provided to teachers. The program also provides materials for parents to encourage discussion with their child.
At follow-up more than a year later, we were pleased to see that those who received the program in the schools were significantly more likely to use contraception than those who did not, an important step in reducing unintended pregnancies. There has been no increase in sexual initiation among young people at all – only that as young people become sexually active, they are more informed and more prepared.
Cost-effectiveness analysis included in the trial also showed the program was low-cost, around £5 per pupil to deliver, including teacher training, as well as cost-effective in reducing health and social care costs. Increases in contraceptive use when young people are sexually active means a reduction in unintended pregnancies as well as sexually transmitted infections, which in turn would reduce health care costs over a 20-year period. This is not only a saving in terms of health care costs, but also increases the chances of girls to finish school well.
If I were Jack is, however, a short intervention low dose that is not designed to cover all the needs of the CSE. Recognizing that access to ECEC is a human right under the United Nations Rights of the Child and is optimally provided as other subjects, throughout the school year across all year groups, in an age-appropriate manner, arguably the added value in advancing COPD practice in this trial is to demonstrate how and why men’s engagement and gender-transformative programming in CSE is important.
Based on its success in the UK, we are delighted that the program is now being adapted for use with young people, teachers and policy makers in South America, South Africa and Lesotho. We have also co-designed and evaluated a similar program using a rights-based and gender transformative approach for young people in prison.
You can access the Lancet Public Health publication here.
Participate in WHO’s global research priority setting exercise Masculinities and SRHR.
This study was funded by the National Institute for Health Research Public Health Research program (NIHR PHR 15/181/01). The views and opinions expressed herein are those of the author and do not necessarily reflect those of the Public Health Research Programme, the NIHR, the NHS or the Department of Health.
Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of SRHM as an organization.
