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A whole new meaning to 'sexting'… » Women's Courage

A whole new meaning to 'sexting'…

February 24th, 2011 by anna Leave a reply »

This week I came across an interesting article in the New York Times about using SMS text messages to provide teens with free, anonymous, and frank information about their sexual and reproductive health (Hoffman, 2009).  The program, called “The Birds and the Bees Text Line”, was started just two years ago by the Adolescent Pregnancy Prevention Campaign of North Carolina.  The group offers information that kids cannot get in school: in NC, abstinence only education is mandated by state law. A staff member responds to each text message individually.  9 staffers rotate these response duties.  Each have graduate training in public health or social work, or years of experience working with teenagers.

The questions, as you might expect, range from myth-busting (If you take a shower before you have sex, are you less likely to get pregnant?) to requests for help with behavior change (How can I stop myself to giving into sexual temptations?) to innocent (Why don’t girls like short guys?).  Of the examples discussing in the article and a sister article published the same day (”Text Ed”, NYT), many pointed to disturbing gaps in teens’ knowledge (“If ur partner has aids and u have sex without a condom do u get aids the first time or not?” or questions about whether anal sex can pass STIsor cause pregnancy).  The responses are short, straightforward, non-judgmental, and often caring.  For example, a texter might respond to the question above about showering before sex, “Nope, doesn’t make a difference.”  Often, the article says, the service offers referrals to local clinics or other providers where the adolescent can get more comprehensive care.

This type of program is becoming more common in our digitally-oriented world.  California has an initiative called “Hook Up 365247″ that sends weekly  text messages with sex education/information and life advice (Teen Source, 2011).  Subscribers can also receive referrals to clinics in their area.  For example, Everyone gets the same messages, which are scripted rather than responses to specific questions.  You might learn from these text messages: “Meds cure chlamydia, gonorrhea + syph. herpes + HIV stay w/u 4ever. Txt CLINIC + ur zipcode 4 clincs.”

Trolling the web, I also found an initiative called “Sex Ed Text” (SET, 2011) which offers something similar to Birds and Bees in the Phillipines, but with a  decidedly adolescent style.  Rather than answering personal questions, SET uses computer program to respond to text messages containing specific keywords, including “preg” “stds” “hivaids” “condom” “pill” and “tubestyed.”  Users then select from a number listed of frequently asked questions within each key word.  For example, texting about “pill”, one would need to specify their inquiry from this list:

1-how 2 use
2-misd pill
3-can i stil have kids
7-can I tak d pill
9-gud or bad

The questions and answers themselves are also written in this slangy, informal style, while still providing useful information.  If I texted the service with a question about how to use a condom, I would receive this repsonse:

How 2 use-condom wil only work if used proprly. Put d roled up condom over stif penis, pinch tip of condom 2 leave space 4 sperm,  roll condom down d penis. D man shud hold d condom when he puls out his penis frm partnr 2 prevent sperm frm leakin out. A condom shud only b used once.

A program recently launched in Indonesia allows teenagers and anyone with access to a mobile phone to send questions to a panel of Indonesian doctors via text message (Jakarta, 2007). The program was started by a condom manufacturer ‘Fiesta Condoms’, who report that they felt Indonesian teens lacked access to sex education information (according to a study in four major cities that many teens were getting the knowledge primarily from pornographic videos online).  Like the other programs mentioned, the service works anonymously, allowing youth to access information without fear of breaking social taboos.

What should we think of all this?

The programs clearly fill a gap,  In North Carolina, texting the Birds & Bees hotline might be the only time a teen gets information about contraception, since they won’t ever learn about it in school.  Cell phones may be more difficult for parents to regulate (compared to the internet, which allows parents to block certain sites), meaning adolescents might have more privacy than other digital sources allow.  While it certainly cannot replace comprehensive, face to face sex ed programs, it doesn’t claim to.  It’s meant to give teens a forum to ask questions, and ask they do.  On the whole, I can get behind this type of program, but I do have some qualms.

What worries me about the Birds & Bees hotline in NC and the Indonesian doctor hotline is the idiosyncraticity and brevity of the responses.  The “Hookup” program in California circumvents this issue by sending weekly tips rather than answering specific questions.  The “SET” initiative in the Philippines answers pre-determined FAQs with pre-determined responses.  But when staff answer individual, personal questions, they must think carefully about how to respond to the specific individual’s needs, provide full information, encourage the adolescent’s safety and health, all while not presenting a judgmental or patronizing tone.  These challenges are present in any human interaction around difficult to answer questions, but they intensified here by the medium of texting.  You get 140 characters, little means of communicating tone, and no information about or rapport with your audience.

Take for example, the question about whether you can avoid pregnancy by taking a shower before sex.  “Nope, doesn’t make a difference” is a non-judgmental, accurate answer.  It meets the teen where they are, doesn’t shame them for asking questions, and gives them the information they need quickly.   But are there still important gaps in this answer?   The question itself demonstrates that the teen doesn’t have good knowledge of how pregnancy works or how to avoid it – would it be useful to refer him/her to a clinic or internet resource that could educate them about pregnancy and contraception? To address other common myths about pregnancy?  To probe to see if they have other questions? You can’t necessarily assess what the teen knows (or doesn’t know) beyond their question’s content, so even after an appropriate response, important gaps might remain in the teen’s knowledge.

According to an article by momlogic.com, part of this difficulty is dealt with by not answering every question at face value. “We will refine what they’re asking, clarifying questions,” says Sally Swanson, one of the responders in the program (as quoted here: http://www.momlogic.com/2009/05/sex_educaton_text.php).  But what about questions like these (from the Hoffman, 2009 article):

“If I was raped when I was little and just had sex was it technically my first time when I was raped or when I recently had sex?”


“I like boys but I also like girls. What should I do?”

Clearly, text message programs are not equipped to respond comprehensively to issues of domestic violence & sexual abuse, sexuality and sexual identity, or morality.  In these cases, referrals are paramount.  An important question to assess might be, how often do teens seek more intensive information/care after using a text message service?  Other evaluation questions will surely be studied as well, to judge such programs effectiveness at increasing knowledge, changing attitudes, promoting safer behaviors, and accessing community services.  For now, I think it’s safe to say that while clearly not a substitute for comprehensive education, these anonymous, youth friendly programs are an important way to increasing teen’s access to knowledge about their sexual and reproductive health.  And given the prevalence of cell phones world wide, even in developing nations, using SMS as a means to communicate information could represent an important movement in public health education.

What do you think?


Hoffman, J. “When the Cell Phone Teaches Sex Education.” New York Times, May 1, 2009. Accessed online at: http://www.nytimes.com/2009/05/03/fashion/03sexed.html?_r=1&pagewanted=all

“Text Ed.” New York Times, May 1, 2009.  Accessed online at: http://www.nytimes.com/2009/05/03/fashion/03sexbox.html?ref=fashion

Teen Source: “The Hookup.”  California Family Health Council, 2011.  Accessed online at: http://www.teensource.org/pages/hookup

“SMS Sex Education Line Launched.” Jakarta Post, July 19, 2007.  Accessed online at: http://www.thejakartapost.com/news/2007/07/19/sms-sex-education-line-launched.html

“Teen Sex Ed: Just a Text Message Away.” GNH Productions, 2011.  Accessed online at: http://www.momlogic.com/2009/05/sex_educaton_text.php



  1. ntahir says:

    This is a really innovative solution to increase aware about sex education. I think it’s necessary to have new technological solutions to current problems faced by women globally. The increasing awareness of social media websites, mobile applications, and research and development of new technological products, it is obvious that people respond to these mediums and are impacted by them. I was recently talking to a girl from the Bay Area who was telling me about a recently launched start-up that aims to mobilize healthcare by means of text messaging. The system would have villagers reporting their medical problems/symptoms to the text messaging center in the village, which in turn would forward these messages to the central system. Doctors would read messages on this system and prescribe medications/recommendations back via text messaging. This makes me think if other critical issues in global women’s health can also be tackled in the same way by developing innovative techniques that are more effective and expansive in their outreach.

  2. klstaves says:

    This sounds like a really interesting program. When I initially read about this program, I also questioned whether or not 140 character responses could effectively convey all the needed information. It made me think back to some of the issues brought up in the TeachAids presentation about the missunderstandings that can arise from oversimplified statements about sex. Still, I would tend to think that a program like this would on balance contribute to a better understanding of sex among the youth population. I would be very interested to learn more about what is being done to evaluate the impact of programs like these.

    The point you bring up about difficult questions (about sexuality, etc.) is an interesting one. I worry that referrals offered by text message would have little effect. For youth who are unable to discuss difficult issues such as questions about their sexuality with their parents, the barriers to independently accessing referral services seem considerable. I wonder if, in areas with conservative sex education programs, effective medical counseling services are available to youth who come in without their parents. If there are, do youth who receive referrals to these clinics/centers actually go?

  3. Bisi says:


    First of all I LOVED this post! I think that adopting technology use into sexual education has been a long time coming and in fact should have happened much sooner. Now with the general pleasantries out of the way, I agree wholeheartedly with your assessment that these programs are only equipped to a point.

    I don’t think that that is a critique of the programs as much as it is a critique of our inability to educate our healthcare professionals along all spectra. It is shameful that most, if not all, healthcare professionals say they have had “little” to “no” academic experience with domestic violence, sexual violence, or abuse.

    On the other hand, I think these programs serve to be brief bursts of information and help teens without them running the risk of being questioned or having their privacy interfered with.

    In the end, I think several questions need to be asked here to make sure that these programs run successfully–the two most important ones in my opinion are: will a teen be turned off to use the program if we pursue any relevant avenues of discussion?; and when can the program become legally responsible for what happens after a teen has used their information (with the consequence being a negative one)?

  4. kheflin says:

    Dear Anna,

    I love this idea, and we’re really been hoping for a while to adopt a similar idea at the SHPRC. I am so excited about involving popular technologies like text into areas where people are so socially uncomfortable (in all cultures, but especially those with strong concepts of female modesty).

    When you use something that adolescents already feel strongly attached to, and add a layer of anonymity guarantee, it’s such a great way to close that gap. So many mistakes get made around sexuality that are easily avoilable with more transparent inforamtion…and this is a great way to bridge to that transparency! GoGoTheBirdsAndTheBeesTextLine!


  5. vcarcia says:

    I would have to agree that while this text messaging service does fill in certain gaps, and can be extremely helpful in lieu of no contraceptive knowledge or sex education. However, it seems that the service itself does have various faults and I’m especially worried by how the brevity of the responses will not correspond to questions regarding domestic and sexual violence. The complexities regarding these issues as well as sex in general might not at times work with the 140 characters and that’s always something to keep in mind. Problems such as these could be alleviated by framing the service as basic and not meant to substitute substantial education or research on topics concerning sexual violence and health. In addition, it would be good for the service to provide links to actual resources regarding both sex education and sexual/domestic violence. doing this would ensure that these teens are able to have accurate information and can have access to resources that can counsel and help them come to terms with abuse or give them actual help (like condoms, information about contraception).

  6. taniat says:

    I think this a very innovative idea and could potentially be a very effective means of spreading information! Teenagers are always using their cell phones for texting anyway so this program is using possibly one of the quickest way to get information to this age group. It is great that through these programs, teens can gain access to critical information about health and sex at all times and at the tips of their fingers. I think this is really exciting!

    To address the more complicated questions that are texted in, I feel that there should also be some sort of hotline. These phone operators would be anonymous and trained to give advice/counseling. Do you know of any that are targeted at teens?

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