The Sexual Health Cliff Effect

By Becca Bolden, Research and Evaluation Manager
February 25th, 2016

The “Cliff Effect”. What does it make you think of? Approaching a wall of rock that can’t be climbed? Being pushed towards the edge of a steep mountain? How about battling a system designed to only allow you so much progress before denying you the support needed to go further?

The concept of the Cliff Effect has gained popularity over the past few years, often in the context of child care, and specifically in Colorado, the Colorado Childcare Assistance Program (CCAP). CCAP provides financial support to parents living at 130% or less of the federal poverty guideline to put their child in high-quality childcare, and is designed to support families in achieving self-sufficiency. This is a fantastic program that supports parents and their children, often to the point where a parents’ income increases because they have positive supports for themselves and their family. Which is great – until the parent earns enough income to lose eligibility for CCAP, but not enough to keep covering the childcare they were receiving. There are similar trends and patterns of the Cliff Effect related to sex education and sexual health.

While sex education still has a long way to go, Colorado and the US have made huge strides in a relatively short time period in evaluating programs and building the list of evidence-based programs, creating laws that support comprehensive sex education, increasing access to low cost contraceptives and health care services, and providing funding to support this work. These are all very good initiatives that we want to maintain and build upon, in Colorado and nationwide. Teen birth rates, one of the primary ways we measure success in the sexual health field, have plummeted 41% in the past five years alone in Coloradoⁱ.

Everyone working in the sexual health field can think of many gaps that need to be addressed, but one often overlooked is what happens to young people when they lose their “eligibility” and reach the cliff effect - i.e. they age out of the traditional sex education services provided in high school. Of the 37 evidence-based programs identified by the Office of Adolescent Health (OAH), half are designed for older teens ages 18 and 19, and none are identified to serve young people out of high school or in their early twenties. Most often the laws and funding for comprehensive sex education are designated for these specific evidence-based programs. The programs can still be implemented with older youth, but they weren’t designed for or evaluated to assess effectiveness with older youth.

Additionally, the average age of sexual initiation is 17ⁱⁱ, so many young people may be having some of their first romantic and sexual relationships as they leave high school and their home, and enter college and/or the working world. There is a lot that may be new in that life transition, and it seems odd that the vital information and support provided in comprehensive sex education – about not only preventing sexually transmitted infections and pregnancy, but also learning about consent, how to have safe relationships and thinking about goal setting – is nowhere present for young people at this stage in life. It’s great that sex ed is provided earlier on (in some schools, if you’re lucky), but shouldn’t it continue as young people grow and change and enter new environments?

Research tells us yes. In Colorado, there were over 13,000 births to females ages 20-24 in 2014 – that’s 3.8 times higher than the birth rate among 15-19 year oldsⁱⁱⁱ. While many do want to start their families at this age, an unwanted pregnancy during this time can derail a woman’s college or career plans at a crucial transitional moment when starting her own life. Additionally, sexual assault, a topic that should be covered in comprehensive sex education, has the reputation of running rampant at college campuses. Young people may also receive a new healthcare provider, which can be a positive change and experience but nonetheless is an additional hurdle for young people to ensure they are receiving the healthcare services they need.

Just as child care advocates are actively working to expand eligibility and ensure the cliff effect doesn’t impact low-income families needing child care, organizations in the sexual health field should also advocate for expanded access for young adults to ensure they don’t lose access to important information and resources they need as they enter their twenties. This could be in the form of a comprehensive sex education class in college, open community sex ed classes, or at the very least, an effort to increase awareness of the many existing resources, like informational websites and apps.

Some great resources and websites have already begun to provide information for this age group – bedsider.org and beforeplay.org; check them out and share them with the twenty-somethings in your life. If you would like to discuss incorporating sex education for young (and the not-so-young) adults on a college campus or workplace, contact Colorado Youth Matter’s Training Manager, Ruthie Kolb.

ⁱColorado Department of Public Health and Environment (CDPHE) (2014). Teen birth data provided to Colorado Youth Matter, November 2015, from the Health Statistics Section.
ⁱⁱBolden, R. (2015). The State of Adolescent Sexual Health in Colorado. Colorado Youth Matter, September 2015. Denver, CO.
ⁱⁱⁱCDPHE (2014). Colorado health information dataset birth query. Queried February 2016.