Studies find teenagers need better reproductive health education to tackle parenthood fears

Nearly half of teenagers are worried about having children and many lack knowledge about their reproductive health, find two new studies by University College London researchers.

The studies, published in Human Fertility and Health Education Journal, used survey results from 931 students in England aged 16 to 18, collected between May 2021 and July 2022.

The Human Fertility paper found that a majority of students (64%) still wanted to have children in the future—with nearly half (49%) desiring to have two children.

However, 45% of all participants said that they had concerns about future parenthood—expressing their fears about their ability to have healthy offspring and the lives their children might lead.

When asked what their concerns were, the teenagers responded that fear, self-doubt, health and well-being, financial burdens, hindrance to personal aspirations and non-inclusive LGBTQ+ education all played a part in their anxieties.

For example, some students' desire to have children was influenced by climate change, while others who identified within the LGBTQ+ community felt that the Relationships and Sex Education (RSE) they received at school lacked inclusivity.

Meanwhile, the students who did not want children in the future (36%) cited reasons including negative associations with pregnancy and childbirth; parenthood apprehension; raising a child in a world with an uncertain future; considering alternative routes to parenthood; and finding children a nuisance.

One female participant said, "The state of the world is in a shambles. Governments are corrupt. The environment is deteriorating … it would be cruel to put a child through any of our problems, especially since they are not getting better."

Senior author, Professor Joyce Harper (UCL EGA Institute for Women's Health), said, "Sadly, a number of female students expressed a lack of interest in future parenthood due to their fears about pregnancy and childbirth.

"Shortcomings in fertility education in schools also meant that students were left feeling both ill-informed and negative towards their own fertility and ability to have children."

Until recently, sex education in the UK focused on puberty, menstruation, sexually transmitted infections including HIV/AIDS, contraception and abortion.

Guidance in England about sex education remained unchanged for almost 20 years until in September 2020 a new Relationships Education curriculum became compulsory for all primary schools (5 to 11-year-olds) in England.

Additionally, a compulsory RSE curriculum was brought in for secondary schools (11 to 18-year-olds) and included the need to teach reproductive health.

However, the second paper, published in Health Education Journal, found there were still significant gaps in young people's education—and that teenagers are not being taught about key reproductive issues such as endometriosis, infertility and the impact of lifestyle on fertility.

Over half (65%) of the students rated the sex education they'd received as adequate or below and half (49%) said they did not know when a woman was most fertile.

When asked how their education could be improved, students suggested making the curriculum more inclusive and relevant, alongside providing honest, transparent and non-judgmental teaching and boosting sex positivity.

One female participant responded, "All we've done in school is go over and over having safe sex and talked about periods which while is important is barely scratching the surface of things people need to know about. If miscarriage and infertility were better taught, then that could reduce the guilt and embarrassment people who struggle with it would feel."

While a male teen added, "Make the education a bit more 'real world' in the sense that [currently] it can be difficult to apply current knowledge to what is needed in life."

Professor Harper added, "It is not surprising that we take so long to diagnose conditions such as endometriosis and polycystic ovary syndrome (PCOS) when pupils are not taught about these conditions. It seems we are afraid to talk about a 'normal' and 'abnormal' menstrual cycle.

"With regards to fertility education, most teenagers told us they want children in the future but at school we concentrate on teaching them how not to get pregnant, not how to have a healthy pregnancy.

"The menopause is now included in the Department for Education curriculum and it needs to be taught.

"This is why the International Reproductive Health Education Collaboration that I co-founded has developed a number of educational resources, including a teacher's guide which will be available, for free, very soon."

The research team hopes that the study will contribute to the improvement of sex and reproductive health education for students in England.