Initiating the sexual health conversation in middle school, according to Joy Souza, chief academic officer for the Central Falls School District, has proven a pivotal strategy for tackling teen pregnancy rates head-on.

"We know that historically, the rate of teen pregnancies in Central Falls has been higher than the state average," Souza said. "Ensuring that students are informed about reproduction and contraception, and empowered to make important decisions about their bodies, is an important step in preventing unwanted pregnancies and increasing the health of students."

Building a distinct learning experience

Until recently, Rhode Island lacked statewide mandates for sex education, leaving it up to each school district to determine how to teach the subject. Sex Ed by Brown Med's structured program — eight lessons taught every other week in-person over five months during the school year — emphasizes abstinence as the most effective method for preventing pregnancy and sexually transmitted infections. It also covers reproductive anatomy, sexual decision-making, contraception, pregnancy, parenthood, healthy relationships and gender identity.

"The most crucial aspect of our curriculum is its foundation, which was vetted from existing sexual health programs but meticulously pieced together from various sources, drawing insights from literature on adolescent sexual behaviors and nationwide behavioral surveys," Magee said. "The medical students prioritized topics such as consent, fostering safe relationships and identifying abuse so that the program is centered around personal safety, self-esteem and comfort, both individually and within relationships."

While some critics argue that introducing the topic in middle school may encourage early sexual activity, Magee refutes that notion: "Some people may fear that providing this information will lead to an increase in sexual behavior, but that's simply not true," she said. "Research consistently shows that harm reduction strategies do not promote harmful behaviors." 

Parents and guardians are informed about the program, allowing them to opt their middle schoolers out of the lessons if they choose. Most elect to participate.

Souza said that as future doctors, the Brown medical students wield significant influence, adding a necessary weight to the subject. Their presence in classrooms — as many as 22 medical students visit the school each week, clad in crisp blue medical scrubs — creates a distinct learning atmosphere where teens feel more receptive, open and comfortable talking about anatomy, sex and relationships.

"Although our health and physical education teachers are qualified to teach sex education, the opportunity for our students to learn about anatomy, puberty and the psychology of relationships from doctors in training elevates the importance of these topics," Souza said. “The relationships that Brown students forge with our students create safe spaces for children to learn and share." 

Creating those kinds of spaces for seventh graders is all about building trust, said Miranda Lassar, a second-year Warren Alpert Medical School student and a member of the Sex Ed by Brown Med leadership team. Brown's volunteer teachers are trained to listen attentively, encourage questions — no matter the topic — and respond to queries directly with honesty, accuracy and age-appropriate answers. They also strive to create a classroom environment that allows for moments of lightheartedness and laughter. 

"We start the program by building trust — we introduce ourselves, explain what sex ed is and establish the classroom ground rules," Lassar said. "At first, the students are quiet, and there's little giggles or side conversations happening around the room, and we acknowledge that — we say, 'Listen, we understand sex ed is a difficult topic. You can laugh; it's OK as long as we remain respectful.' Their openness grows with each lesson because we build on that trust and those relationships."

Allowing anonymous questions is a cornerstone, which helps middle schoolers to inquire freely. Following each lesson, the kids receive two Post-it Notes to jot down unanswered questions about the day's material. The notes are then collected and addressed at the start of the next session. This weekly practice solidifies the core concepts taught in the lessons and empowers kids to openly address topics they may wonder about, free from judgment.

For Lassar and the other Sex Ed by Brown Med instructors, addressing the Post-it Notes ensures students receive credible information and resources, steering clear of peer-exchanged misinformation or the maze of misleading online content.

"We have a rule: We won't ignore any question they write, no matter how frivolous it may seem,” Lassar said. “If they ask something silly, I'll respond seriously because this information should be accessible beyond just what's on Google. Being able to address all their questions straightforwardly helps break the stigma surrounding these topics. They might otherwise turn to each other or the internet for answers. We're their resource when we are in their classroom, so I'll answer anything they ask."

Empowering teens beyond the classroom

Alexa MacKinnon, a second-year medical student and vice president of Sex Ed by Brown Med, said by presenting accurate information and reliable resources such as Day One Rhode Island, a 24/7 sexual assault helpline, and the school-based health center located in the city's high school, the program hopes to empower teens to make well-informed, healthy choices as they progress through high school. According to the state's Adolescent Sexual Health report, the percentage of sexually active teens jumps from 19% during the first year of high school to 57% by the final year.

"We like to emphasize, 'We're here for eight classes, but what comes next for you?'" MacKinnon said. “How will you navigate as a 13-year-old with lingering questions? You might not remember everything from this class, but hopefully you'll know where to find trusted sources, whether it's a teacher, family member or community resource."

Sex Ed by Brown Med can be an equally valuable learning opportunity for the future doctors.

"I see my role as a future physician as centered on empowering patients, equipping them with the tools to assert agency over their decisions and health care journey," said Alexa Steckler, president of Sex Ed by Brown Med. "We're in a seventh-grade classroom and not a clinical setting, but we are instilling that same sense of agency and empowerment in these students, hoping they can embrace and carry forward these principles as they mature and navigate their lives."

And what about teen pregnancy rates in Central Falls?

According to state data, teenage pregnancy in the city has declined 44%. From 2011 to 2015, Central Falls experienced 236 births to teens (ages 15-19), resulting in a birth rate of 64.7 per 1,000 young women. By contrast, from 2016 to 2020, the number dropped to 133 births, with a birth rate of 36.1 per 1,000 young women.

While it's tempting to connect those dots to Sex Ed by Brown Med, Magee said that the program has yet to gather the evidence needed to directly link the new curriculum to that precipitous decrease. She also credits the opening of the school-based health center, operated by the Blackstone Valley Community Health Center, which provides high schoolers free medical care, including confidential birth control, as one of many measures the state has led to reducing the number of teen pregnancies.

Student leaders have collected their own data demonstrating the program's contribution to nurturing a healthier, more knowledgeable generation of students. Recent findings from evaluations conducted before and after participation in Sex Ed by Brown Med demonstrate significant progress in understanding sexual health. Specifically, middle-schoolers showed improved understanding in critical areas, including communication and consent, sexual health decision-making, safe sex practices, puberty and reproductive health, and access to community resources, Magee said.

"We saw significant shifts in knowledge, particularly in lessons focusing on pregnancy and STIs," Magee said. "It's rewarding to see such tangible impacts on students' understanding, evident from the beginning to the end of the year."

Research published by Brown medical students in academic journals has helped to inspire similar sex education initiatives at other medical schools, including in Michigan and North Carolina. Magee and the Sex Ed by Brown Med student leaders also hope to bring the program to other school districts in Rhode Island’s urban core. To do that, they are recruiting volunteer instructors outside the medical school, including undergraduate and graduate students concentrating in public health.

In reflecting on the 10 years dedicated to teaching the program in Central Falls, Magee says her greatest source of pride stems from the deep impact the program has had on the school’s culture and community.

"Sex Ed by Brown Med isn't just a new health class offered to kids during the day — it's now part of the school culture, where eighth graders are sharing with seventh graders, telling them about the Post-It Notes, 'You can ask anything there, just jot it down, and you'll get an answer.' It's fantastic," Magee said. "It's a culture of care, of community involvement that is now seamlessly integrated into the fabric of the school, and we're proud of that."