Mexican psychologist Susan Pick, PhD, still remembers how stunned she was to discover that family planning was illegal in Mexico, her native country. The realization, made while she was an undergraduate, marked the beginning of what would become her life's work.
"It was a shock to me," says Pick. "I wanted to understand what people were doing to prevent having unwanted children and to develop work that would be of use in solving my country's problems."
Today Pick, who received her doctorate in 1978, is president of a nonprofit organization called the Instituto Mexicano de Investigacion de Familia y Poblacion in Mexico City. Founded in Pick's living room in 1985, the institute has since developed programs that have taught the basics of healthy sexuality to an estimated six million children and adolescents in several Latin American nations, the United States and Greece.
Other programs have targeted parents, physicians and pharmacists. Together they represent Pick's goal of revolutionizing attitudes toward sexuality.
Certain aspects of Mexican culture make achieving her goal a challenge for the institute's 42 full-time employees and an ever-shifting roster of consultants and interns. Although family planning has been legal for more than 20 years in the country, there are plenty of other problems.
Take machismo, says Pick.
"There's still this idea that men should make the decisions, that men should have many women in bed and that men have enormous, uncontrollable sexual urges," she explains. "People still believe that women should be submissive, that women should not have sexual pleasure and that if a man beats you, it's a sign that he loves you."
The concept of rights--women's rights, reproductive rights or human rights--is relatively new to many Mexicans. That's especially true when it comes to adolescents, she says, enabling a mind-set that can be deadly. Adolescents are one of the fastest-growing groups of Mexicans with HIV, says Pick, and 18 percent of live births in 1995 were to women under 19. And talking about sexuality is still taboo.
Pick and her colleagues are determined to change that.
"When we started doing the research, we found that providing people with knowledge about contraception wasn't enough," says Pick. "They were very good at repeating that knowledge, but couldn't transform it into behavior."
The result of their "research to action" methodology has been sexuality education programs that focus on empowerment, teaching communication, decision-making and assertiveness as well as providing information on sexuality, contraception and sexually transmitted disease. In keeping with this approach, one of the institute's first sexuality education programs was called "Planeando tu vida," or "Planning your life."
The institute continued this approach with a program for younger children called "Yo quiero, yo puedo," which Pick translates as "I want, I love, I can." In addition to communication and decision-making, the program covers such topics as sexuality, self-esteem, responsibility, nutrition and free time.
Designed for boys and girls from preschool to high school age, the program takes developmental differences into account by providing different information for students at each level. In the elementary school version, for instance, students learn about puberty; in high school they learn about contraception. The institute has developed a series of training manuals, videos and workbooks for each grade.
Instead of adding to adolescents' problems, as critics charge, the program has empowered young people to take charge of their lives.
The institute's research has confirmed that adolescents who take "Planeando tu vida" before they start having sex are more likely to practice safe sex than other adolescents, Pick reports. Those who take "Yo quiero, yo puedo" are able to talk more openly with their parents about contraceptive use and sexuality. They participate more in the classroom and score higher on self-esteem scales. Most important, they recognize their right to make their own decisions.
Now children around the world are receiving the program. An estimated 30,000 "replicators" are bringing the program to students in the United States, Europe and other Latin American countries, including Peru, Bolivia, Guatemala and Honduras. In Mexico, the "Yo quiero, yo puedo" program has become part of the national curriculum for seventh-, eighth- and ninth-graders as part of a civics and ethics course.
The institute doesn't just work with young people, however. A program called "Si yo estoy bien, mi familia también," or "If I'm OK, my family is, too," targets young mothers in Mexico's remote rural areas. The institute trains health workers who then train women; they in turn teach their children. Just as in the "Yo quiero, yo puedo" program, this program addresses basic life skills development and incorporates healthy sexuality, substance abuse prevention, nutrition and ecological protection.
Although healthy sexuality is a crucial component, the program's goal is to give women the basic life skills they need to thrive.
In the two years since it began, the program has reached more than 40,000 women and children. It's been so successful at empowering participants that it has broadened its mission to include community development.
At one site, for instance, the women asked for ideas about how they could sustain themselves economically. After persuading the Finnish Embassy to provide the funding, the women set up a bakery. Now 42 bakers are helping both their communities and themselves.
"It all started with giving them the elements they needed to improve their sexual health," explains Pick. "This is a process that teaches life skills and sexuality education is part of this broader integral framework."
The institute has also enlisted the help of other professionals. A program for physicians and nurses teaches them how to improve the quality of their services. Another program teaches pharmacists how to talk to customers about condom use and HIV/AIDS prevention. Still other programs focus on promoting gender equality, preventing cervical cancer and stopping domestic violence.
Pick has been pleasantly surprised by the reception the institute's programs have received. Gallup polls commissioned by the institute show that 80 to 90 percent of the population would like their children to receive "Yo quiero, yo puedo" from elementary school on up. Men in the rural areas reached by the "Si yo estoy bien" program have been so impressed by their wives' new-found skills that they have been asking the institute to develop programs for them as well.
Most surprising has been Mexicans' willingness to talk about a part of their lives that has long been off-limits, says Pick.
"The authorities kept saying, 'No one will talk to you,' and school directors kept saying, 'No one will talk to you,' and parents kept saying, 'No one will talk to you,'" Pick remembers. "But when we go out into the field to interview people, our problem is how to stop them from talking so much."
By helping Mexicans and others overcome the taboo against frank talk about sex, Pick has fulfilled the goal she set for herself as a student. Now she hopes other psychologists will follow in her footsteps.
Psychologists, she says, must become more "needs-oriented." That means helping policy-makers, public-health departments and others come up with strategies for changing people's behavior, doing a better job of disseminating research results and ensuring that everyone knows about psychology's ability to prevent, as well as cure, problems.
"For the general public, psychologists are still seen as clinicians who psychoanalyze you to understand why you behave the way you do," says Pick. "We have to make people understand that psychologists can help you develop healthy behaviors in your day-to-day life."
Rebecca A. Clay is a writer in Washington, D.C.