Our purpose at the Chicago Department of Public Health is to work with communities and partners to create an equitable, safe, resilient, and Healthy Chicago. Sexual health is a crucial component of the physical, mental, emotional, and spiritual development of an individual. It is much more than the presence or absence of disease.
As children grow, it is important to empower their decision-making skills and reinforce that their voice matters. In early childhood, the conversations are focused on teaching students about personal autonomy through the concept of consent.
As they age, sexual health education and awareness allows for youth and adults alike to comfortably grow in their bodies, develop their personal identities, and navigate interpersonal relationships free of violence or coercion.
Title X (ten) Family Planning clinics are funded to provide a broad range of family planning services and related preventive health services. These include STI and HIV testing, HIV counseling, cervical and breast cancer screening, and HPV vaccines. Services are confidential and provided regardless of patients’ ability to pay and clinics charge for services on a sliding fee scale.
Personal Health and Safety in Early Childhood
Consent is a fundamental component of comprehensive sexual education. The National Sex Education Standards (NSES) was originally published in 2012 by the Future of Sex Education Initiative and later revised in 2020. NSES was written to deliver a trauma-informed, age-appropriate curriculum to students to learn to navigate their changing bodies, relationships, and environment. Students are encouraged to acquire knowledge and practice healthy behaviors such as decision-making, goal-setting, advocacy, and analyzing external influences on their own behavior. Chicago Public Schools (CPS), along with many other school districts in the United States, has adopted the NSES as their standard for the CPS sexual education curriculum
Sexual health education is not limited to discussions of sexual activity, it also includes building healthy interpersonal relationship building from a young age. According to the NSES, by the end of second grade, students should be able to:
Define interpersonal consent, such as:
Not touching someone when they don’t want to be touched
Communicating when they don’t want to be touched
Asking to share instead of taking items like toys or snacks
Describe the characteristics of a friend
Communicate their personal boundaries
Show respect for others’ boundaries
Identify healthy ways for friends to verbally or physically express feelings
Discussions of consent with young children should allow them to reflect on personal spaces, touch, and boundary setting. Conversation starters include:
Discuss what personal space means. Everyone has a “bubble” around them that makes them feel safe. Some are small, while others may be very large. How large is their bubble? Do they notice other people with different sized bubbles? What would they do if someone popped their bubble (i.e. invade their personal space)? Have they ever popped someone else’s bubble before and what did they do?
Reflect on different types of touch. Ask the children you work with what kinds of touch they do or do not like. Who gives the best hugs and why? Do they like giving hugs at all? How do they feel when playtime gets a bit rough with friends? When are some touches, like kissing or wrestling, okay?
What to do when boundaries are crossed. It can be difficult for people, especially children, to process emotions when boundaries are crossed, or feelings are hurt. Practicing clear communication early on is crucial. Remind them that No and Stop are complete sentences regardless of age. Tell them that it is okay to step away if someone is making them uncomfortable.
How to find help. Children should have a trusted adult they can talk to about uncomfortable feelings, whether it be a parent, teacher, family friend, or community leader. Talk to children about trusted adults in their lives. Who is an adult in their life that you trust, and why? Do they know anyone at school they could talk to about uncomfortable situations? Remind them that going to an adult for help is not tattling
Asking for physical touch, such as hugs and kisses – “Can I give you a hug?”
Reminding them it is okay to not want physical touch from someone – “It’s okay if you don’t feel like hugging right now.”
Allowing them to make decisions on their own – “Do you want help with what you’re doing?”
Encouraging them to model consent with friends and peers – “Remember to ask first before taking a toy from someone.”
Teaching consent to young children is no easy feat. Children are learning about their environment, social expectations, and other rules on top of learning about how to listen to their minds and bodies. Different families have different definitions and cultural expectations that dictate ‘proper’ behavior for children of certain ages, so it is important to have nuanced discussions about politeness. Begin with strategies such as:
No wrong options. Baby steps! Encourage structured decision making with young children by providing opportunities for decision making where there is no wrong option.
“It’s cold out today. Do you want to wear your red or blue jacket?”
“After homework is done, do you want to go outside or do a puzzle?”
Scaffolded decision-making. Once children are comfortable making choices on their own, slowly introduce them to nuanced decisions. Sometimes some choices are better than others and other times we need to compromise. Encourage children to gather information and think about points such as:
What decisions do I need to make?
What are all my options?
How will my choice impact others?
How does my decision make me feel?
What does my gut tell me?
How does this relate to consent? Scaffolded decision-making empowers children to make decisions that are best for themselves while considering the needs of others and familial or cultural expectations. This is not to encourage children to forego their boundaries for the sake of others. Let’s explore scaffolded decision-making with an example.
Grandma loves hugs. Jeremy, however, doesn’t like long or tight embraces. It’s time to go home, though, and Grandma is excited to send Jeremy off with love.
What decision does Jeremy need to make? Jeremy needs to choose if he will hug Grandma, not hug Grandma, or find another option to say goodbye.
What are all of Jeremy’s options? Jeremy can give Grandma a hug. Maybe he can yell “No!” and hide in the car. Yelling is always an option. Or maybe he can offer another way to acknowledge her and say goodbye.
How will his choice impact others? Hugs make Jeremy extremely uncomfortable. Yelling, screaming, or storming off will seem rude and can hurt her feelings, too.
How does Jeremy’s decision make him feel? Jeremy is nervous. He wants to say goodbye and show Grandma affection, but he can’t force himself to be comfortable with hugging either.
What does his gut tell him? He knows he doesn’t want to hug. Maybe Jeremy can give Grandma some no wrong options, like a high five or wave, that acknowledges both his grandma’s wants and his boundaries.
Backing up young children’s decisions. Children can make well thought out decisions and sometimes adults still won’t support them – but you can. Try to preface expectations with other adults beforehand and back your child up if the child refuses something like a hug and the adult expresses disappointment. Remind other adults that children refusing hugs or other affection is usually a power struggle rather than a genuine expression of dislike. Young children don’t have control over so many things in their lives. Sometimes they reflexively defy a request just because they can.
“Grandma, I need you to hear that Johnny is telling you he’s not feeling like a hug today. Johnny, how would you like to say goodbye to Grandma- how about a high five or a wave?”
Some decisions aren’t for children. All that’s to say, kids don’t get to make certain decisions regarding their health and safety. Caregivers of all types – parents, teachers, nurses, and so on – will need to make decisions in the best interest of the child. This is a unique challenge in teaching consent to young kids. Remind them that it’s your responsibility as their caregiver to keep them safe. It’s okay to have to try a variety of approaches to convey this to them.
“I hear you telling me that you don’t want to get in your car seat. It’s my job to keep you safe. I can’t let you be in a car without being buckled in. Can you do your chest buckle, or would you like me to do it?”
Teaching consent is an ongoing, complex conversation. It’s okay to take a breath and try another approach. You know what is best for the child you’re working with. If you need additional guidance and examples, more resources are listed below.
Sexual Health Education in k-12 Schools
Young adults who take ownership of their sexual health and development with the support of trusted adults will grow into healthy decision-making adults. Most teenagers report that parents have the biggest influence on their behaviors regarding sex. However, parents and healthcare providers are not their only source of sexual health information. Anyone speaking to a child or teen about sexual health should be mindful of what is said, how it is being said, and ensure that they are employing active listening without imposing judgment.
Questions about sex, sexual health, and relationships can be difficult to navigate. Here are some tips and prompts for creating an open dialogue with youth about sensitive topics:
Don’t make assumptions about why they came to you with questions. Instead, ask:
“Can you tell me what you already know about that?”
“What have you heard about that?”
Keep the conversation going. They might be too nervous to ask the real questions they want answered.
“What other questions about stuff like this do you have?”
“You can talk to me about anything. I know it’s awkward and you might not know the right words for things, but it’s ok.”
Use gender neutral language whenever possible. For example, try using terms such as “people with vaginas”, “people with penises”, or “birthing parent”.
Sexual encounters are not strictly heterosexual. Avoid labeling penis in vagina sexual intercourse as “real sex”, “actual sex”, or “normal sex”, as there are many different ways to have sex.
Always check for understanding. Complex answers are hard to digest – keep it simple!
“Does that answer your question?”
“What do you think of that?”
It’s okay to not know. Research challenging questions with teens. It’s a good opportunity to practice media literacy with them.
“I’m not sure how to explain that / I’m not sure what the answer to that is. Let’s look it up!”
It’s ok if they don’t want to talk to you about this but support them to find someone to talk with them.
“It’s ok if you don’t want to talk with me about this stuff, but it is really important that you go to a trustworthy adult with any questions you have. You have a checkup with Dr. Smith next week, do you want me to make sure to tell her that you’d like some time alone to ask her any questions?”
Sexual Health Education in Higher Education
Primary care providers (PCPs) are often patients’ first contact with medical services and can vary in a wide range of practices. PCPs are an important tool for reducing the prevalence of sexually transmitted infections in higher education students. Currently, young adults and teenagers have the highest rates of sexually transmitted infections. Young people aged between 13 and 24 years old make up 54.7% of chlamydia cases and 42.6% of gonorrhea cases reported in Chicago. By encouraging long-term relationships between patients and PCPs, young adults will feel more comfortable asking questions about their sexual wellbeing and actively seek out any necessary referrals for treatment or counseling.
When To Get Tested?
Regular visits to their PCP will ensure that patients are current on the recommended STI screening schedule. The CDC outlines when and how often certain groups of people should be tested for various STIs, including HIV. Most sexually active people should get tested on a yearly basis or with each new partner, as many of these infections have no symptoms. This should be a conversation between patient and provider to make a plan that suits their individual and lifestyle needs. It is important that patients are open and honest with providers about sexual history in order to make a plan that reflects each person’s unique risk.
If someone thinks they might have an STI, they should get tested as soon as possible. It is critical to complete treatment and get any sexual partners tested and treated as well.