“Comprehensive sex education” is a vague term.  It’s often used in opposition with “abstinence-only,” but that only means that, at a baseline, it includes information about contraception and sexually transmitted diseases. What would it mean to be truly “comprehensive?” Well, in the beginning, there were single-celled organisms …

The Sexuality Information and Education Council of the United States says “Comprehensive sex education includes age-appropriate, medically accurate information on a broad set of topics related to sexuality including human development, relationships, decision-making, abstinence, contraception, and disease prevention.”

In a new study, Nicole Haberland, a senior associate at the Population Council, makes the case that “comprehensive” should include gender and power dynamics. The study, published in International Perspectives on Sexual and Reproductive Health, reviewed evaluations of 22 sex-education programs for adolescents and young adults, comparing how effective they were in reducing pregnancy and STIs.

Ten of the programs had at least one lesson on gender and power, and 80 percent of them saw significant decreases in pregnancy or STIs compared with a control group. Of the 12 programs that did not address these issues, 17 percent led to those positive outcomes. Teaching about power and gender roles was a consistent predictor of better health outcomes, even when Haberland accounted for other variables like sample size and whether the studies were longitudinal.

“The nearly opposite outcomes of programs that address gender and power and programs that do not is striking,” the study reads. “It echoes the increasingly frequent call to address the multiple contextual factors that shape adolescent sexual behavior … This review provides strong evidence that content on gender and power in intimate relationships should be considered a key characteristic of effective sexuality and HIV education.”

Other studies back up the need for this kind of education. Women who report having less power in their relationships than their male partners have higher rates of HIV infection and other STIs, and young men who adhere to traditional concepts of masculinity are less likely to use condoms. There’s a not-at-all fuzzy link between gender inequality and poor sexual health being shown by this kind of research.

Some of the curriculums in Haberland’s study challenged young people’s thinking on gender roles by having them discuss the advantages and disadvantages of being male or female, or by analyzing media portrayals of men and women. They asked things like, “What is this ad saying to you about what a woman is supposed to look like and act like?” Haberland says. “What are guys supposed to feel and act like?”

“Another thing people might do is use case studies,” she says, “working with a class to critically analyze what is really going on between these two characters. Why is it that Jane isn’t able to use a condom? It’s not because she doesn’t want to, it’s because she can’t say it. He has the car, the money, and he doesn’t want to, and she’s afraid he’s going to leave her. Helping kids identify the inequality in those power dynamics and how it affects all of us in our relationships.”

This is a cutting of the vacuum seal sex education sometimes places around sexual health and behavior, as though young people’s choices can be separated from their surroundings and upbringing, as though they won’t be swayed by anything but knowledge of the facts. Including a discussion of the effects of traditional gender roles and the consequences of unequal power in relationships better reflects the reality that young people’s choices about sex will take place in. And according to this study at least, that seems to lead to safer sex and better outcomes.

Which is not to say it’s easy. According to the Guttmacher Institute, only 13 states have laws requiring that sex education be medically accurate, while 19 “require that instruction on the importance of engaging in sexual activity only within marriage be provided.” Twenty-six states (and the District of Columbia) require “information about skills for healthy sexuality (including avoiding coerced sex),” which could include a discussion of gender and power, but I wasn’t able to find any data on how many schools and other sex ed programs are actually teaching these kinds of lessons.

“It’s such an achievement to already be able to get that health information to kids,” Haberland says. “The thing is, there’s room for improvement with what we’re doing.”

While none of the programs included in this study addressed LGBT relationships, Haberland says that incorporating gender and power into sex ed curriculums also creates a natural opportunity to talk about LGBT issues.

“Schools are trying to deal with issues like bullying, and part of that is adherence to gender norms,” she says. “It’s the same stuff that we haven’t been dealing with. I believe they absolutely are related.”

As it is with all issues in public health, context is everything when it comes to sex. Empowering as it may be to be knowledgeable about birth control and STIs, young people likely aren’t just running statistics through their minds when making choices in the real world. There are emotions and social pressures at play, and it seems that when teachers address them, sex ed gets a little closer to being truly comprehensive.