When I got off the airplane at the Edinburgh airport in September 2016, the first thing I saw was a wall full of Scottish whiskey advertisements. What else could properly welcome you to Scotland’s capital city? With expectations of bagpipes, kilts, and castles, I knew my decision to move from Texas to Edinburgh for my undergraduate degree was going to be full of new experiences. Although this was true, I found the differences between the United Kingdom and the United States to be more subtle than I had originally thought – things like my native English language being spoken with a different accent, drinking alcohol I was able to buy legally at age 18, and even spellings like “colour” instead of “color” and saying “chips” instead of “fries.” It was like my reality had just been ever so slightly shifted, and yet it was completely disorienting. But perhaps what struck me the most were the different perspectives and discussions I would encounter relating to sex and the body.
As the first semester went by, I became involved in my first sexual relationship. I assume any first sexual encounter may involve fears and unknowns. As I found myself in various sexual situations, however, it became shockingly clear how little I was aware of my own body. It felt strange that my 20-year-old boyfriend had more knowledge of the way my body worked than I did, had more knowledge of available contraceptive options and condom use than I did, and even had more knowledge of non-sexually transmitted infections than I did. I felt helplessly uneducated about how to practice safe sex, and, I admit, I was a bit terrified. Clearly, sexual education is not something that should be left to trial and error.
Thankfully, the United Kingdom has a public healthcare system available to everyone living in the country. I booked an appointment and in less than a week visited with a general practitioner. I told the doctor I had recently become sexually active and wanted a prescription for birth control pills. She gave me a link to a guide about additional contraceptive options available in the UK, including the implant and the coil, and after the short appointment was over I walked out of the building armed with new knowledge and a sense of control over my own body.
When I traveled home to the United States during summer break, I wanted to be certain of my health care choices, so I visited my doctor’s female health clinic. This time, however, I did not experience the same warmth and reassurance from the physician as I did in the UK. In fact, I was reprimanded for having sex with my boyfriend of almost a year without using a condom, even though I was taking birth control. While the concern for condom-less sex is warranted for the sake of protection against STDs and STIs, the doctor insinuated that it is only acceptable to forgo a condom once engaged or married. The condescending tone in which the doctor discussed this issue with me only served to reinforce the stigma that sex and intimacy outside of a marital bond carries.
Although I would like to believe this was a one-off negative experience, it was my only sexually related discussion with a doctor in the United States – and the attitude expressed at the clinic that day seems to coincide with current debates in the country. This condemnation of sexual relations is prevalent throughout US politics, from the push to defund Planned Parenthood to the promotion of abstinence-based sexual education in high school.
It wasn’t until I experienced the health system in the UK that I became aware of these international differences. Because 41% of the students at my British university are from other countries, I realized I probably wasn’t alone – that others were probably also experiencing differences in attitudes on sexuality. To explore these international differences – in contraceptive knowledge, doctor-patient experiences, and attitudes about sex and the body – I decided to interview four female peers: two from the UK, one from France, and one from Russia.
Based on my small sample survey, sex education in high school stands out as an area where experiences diverge considerably across cultures. My friends from the UK and France recall experiencing a much more comprehensive and open sex education program than I did growing up in Texas. Jessica, a second-year French language student from the UK, remembers the attitude being “pretty much, this is going to happen at some point, so let’s just get on with making sure you do it safely.” Lila, a second year English Literature and History of Art student from France, describes a similar experience: “Except for consent, they never said we shouldn’t do anything,” she says. “The attitude was more ‘if you’re going to do it, do it safely.’”
Lily, a second year Chemistry student from the UK, says she even remembers her sex education course providing information on masturbation. She says, “they just kind of explained what it was, and that it was normal for girls and boys and it wasn’t seen as a sin.” This contrasts with my experience as well as that of Victoria, a second year International Relations student from Russia. In Texas, I remember the teacher speeding through sex ed. And stressing abstinence as the only true form of birth control. However, even this was more informative than Victoria’s experience. “I was in Russian school whilst we were supposed to be educated on it,” she says, “but I never [was].”
These differences in sexual education seem to follow quite closely with general attitudes towards sex from a medical standpoint, specifically with regard to contraception. All four girls noted that birth control pills are obtainable. “In France you go and you get your pills for free, under 18 at least…but you have to go to at least two meetings with the gynecologist before they give it to you,” Lila says. “The emergency pill, you get it for free if you’re under 18 and for about three Euros if you’re older, but either way you can just get it over the counter in five minutes.” This freedom in contraceptive access contrasts with the experience in Russia. Victoria shares, “I think in Russia it’s […] more acceptable when you’re in a long term relationship to be on a contraceptive pill. But if it’s short term or anything, it’s suspicious.” Although this is not the case in the US, where over 99% of women under aged 44 have used a contraceptive method (according to the Guttmacher Institute), the provision of birth control costs more than in the UK or France. Because the US healthcare system is almost entirely private, available contraceptive options and out-of-pocket costs may vary depending on health insurance and state legislation.
Although contraception is free and easily accessible in the UK, problems still arise when it comes to discussing sexual issues. Jessica recalls a negative experience she had in the UK when trying to obtain emergency contraception from a health clinic. Rather than being given the morning after pill at request, the doctor questioned Jessica about her sexual experience incessantly, to the point where she became so uncomfortable she regretted having come to the clinic in the first place. The doctor’s questions were more humiliating than reassuring, Jessica recalled. “If you’ve got someone vulnerable, who’s worried, you [should] just give them the pill to sort it out,” Jessica says. “It was very, very embarrassing.”
Jessica’s experience raises questions about doctors’ ability to deal compassionately with highly sensitive subjects such as sex and contraception. Lila’s experience in France was the only example of doctors prioritizing compassion towards patient’s fears. “I had lots of pregnant-a-phobe moments,” Lila shares, “in France, they were very nice about it.”
Because of the controversies surrounding sex, even in countries like the UK and France where contraception and sexual education are more out in the open, young women are ultimately left with a lack of proper awareness of the most vital element to our lives: our bodies. Instead, we must entrust ourselves to our doctors, so when it comes to such intimate issues as our sexual health, the need for support and understanding from doctors is of the utmost importance. We need safe places where we can become educated about our bodies, and where others will listen to our concerns and give us advice without bias.
In the United States such resources are available, but are often viewed as controversial. Perhaps this is because of a lack of understanding about what these organizations do. Planned Parenthood, for example, places emphasis on improving knowledge of sexual health in a caring manner, in order to help women make educated decisions about their bodies and futures. Likewise, the American Sexual Health Association is working towards improving knowledge of sexual health and reducing the stigma about sex by providing education resources. The Guttmacher Institute makes available current research into sexual health and rights.
As for college students in the US, there are options for contraceptive access and sexual education. Examining universities in my home state of Texas, there appear to be contraceptive resources available at university health clinics. The University of Texas health service website states that it can provide prescriptions for birth control, and Texas A&M’s health service website maintains that it can address “contraceptive issues.”
It is reassuring to learn that there are a myriad of sexual health options available in Texas and elsewhere in the United States. However, I count myself lucky to have become sexually active in the UK, where obtaining contraceptive information and prescriptions is guaranteed to be free of cost and relatively free of complications. I am confident about my sexual health options for my next two years of study in Scotland, and under the normal stress of university life it is easy to forget the prevalence of debates and controversy about sexuality in the US. However, it is clear that new legislation will be aiming to change accessibility of contraception and sexual information. I am anxious to see how the atmosphere around sexual health will have changed by the time I graduate and return to the United States.
Caili is a second year English Literature student at the University of Edinburgh in Scotland, where she is still struggling to understand everyone’s accent. At University she is active in various musical theatre and dance societies, and hopes to continue performing throughout her life. In addition to reading and writing, her passions include being a children’s storyteller as the character of Princess Caili Skye. She is happy to finally be living in a city with an actual castle.