Bullet Point of The storyscapes of teenage pregnancy. On morality, embodiment, and narrative agency - Cense & Ganzevoort - 2019

• Pregnant teenagers tell different stories about their experience. Their stories are influenced by normative discourses.
• How the meaning of teenage pregnancy is constructed depends on stigma and social norms, but the embodiment of pregnancy also plays a significant role.
• American, European and Australian public health polices follow the neoliberal ideology, which sees an individual as rational and being capable of self-care and autonomy. Youngsters are encouraged to have sexual control and act responsible in order to prevent unplanned pregnancies. An unplanned pregnancy is considered the result of behaving careless
• The neoliberal ideology reinforces the belief that a teenage pregnancy is shameful. The negative portrayal of teenage pregnancies by sexual health policies worsens the stigmatization.
• Numerous scholars call for a re-examination of the normative discourses regarding teenage pregnancy and being a mother at an early age. The aim of this study is contributing to the re-examination by investigating how young Dutch women negotiate the meaning of abortion, motherhood and teenage pregnancy in the current normative landscape.
• Strategic negotiations: the process of understanding, reproducing and reworking existing narratives on teenage pregnancy. How do girls situate their families, themselves and their choices of reproduction in a broader social context? This involves recognizing how policies, relationships and social norms influence how individuals see their selves.
• When telling their stories, the girls develop and express narrative agency: the capacity to weave out of (fragments of) narratives to make sense of herself as an individual.
• Motherhood can heavily influence a young woman’s construction of responsibility and morality, and it gives them new life directions and a new identity. Research shows that adolescent mothers are capable of overcoming obstacles and their pregnancy provides them psychological benefits. Instead of social exclusion, teenage pregnancies can also lead to social inclusion.
• Teenage motherhood can also have negative consequences regarding education, poverty and stigmatization.
• When it comes to abortion, The Netherlands is considered a liberal country. Although abortion is easily accessed, safe and legal, many people and the media question the morality of it. Nearly half of the Dutch young women felt ashamed and even more kept it a secret.
• Abortion stigma: a negative attribute ascribed to females who decide to end their pregnancy that labels them as inferior to the ideals of being a woman. Their decisions go against social norms, which evokes stigmatization from their social environment. As a result, abortions are kept a secret, which causes suppressed emotions, loneliness and psychological distress.
• Pregnancy is also a bodily experience, better known as ‘embodiment’: the experience of perceiving, experiencing and living in the world from the material and physical place of the body. A study found that pregnant women have changed perceptions about their bodies and sexuality and obtained more social space.
• The social position of pregnant teenagers also restricts the possibilities of the embodiment of pregnancy. They are at the bottom of the ‘motherhood ladder’ and have to try harder to perform a socially accepted pregnancy.
• The strategic negotiations of girls to give meaning to their pregnancies, and thus to adolescent motherhood or an abortion, are considered a continuous process in interaction with discourses and social norms, moral judgments, opinions, their visions of the future, their sense of self and the embodiment of being pregnant.
• This study involves the stories of Dutch women. The Netherlands stands out as it has one of the lowest teenage pregnancy rates in the world. Their sexual health policies follow the neoliberal ideology. Investigating the narrative and embodied agency of teenage girls contributes to better youth-friendly counselling practices and support.
• The study used a life history approach to explore how young women construct the meaning of teenage pregnancy in the context of their lives. Life stories are useful for evoking details about subjective experiences.
• The concept of storyscape creates a multidimensional and meaningful landscape of meanings that invites people to envision themselves as inhabiting that landscape. How does someone construct a life narrative to respond to the narrative world that was presented? This results into the negotiation of possible meanings with someone’s narrative context.
• The negotiation involves two stages: referential negotiation and performative negotiation. In the ‘referential negotiation’, the material reality is turned into narrative. In the ‘performative negotiation’, the narrative is turned into behavioral reality and material. How pregnant women tell the story of their pregnancy within their life story and the normative discourses represents the referential negotiation. How girls navigate the interaction with their community is shown through performative negotiations.
• The women are embedded in several storyscapes defined by contrasting and different audiences. Their narratives are used to change, maintain or shape the relationships with their audiences (partners, friends, parents).
• Interviews are a form of storytelling. Participants were asked to create their ‘lifeline’: a graph with a happiness-axis and an age-axis. This narrative technique visualizes life events in a chronological order and helps understanding the meaning of experiences. Topics can be talked about as part of a broader story, which prevents the whole life being interpreted according to one specific theme.
• The interviews were coded according to the thematic narrative technique. Narratives of experiences are stories that create order, establish connections with other people, make sense of events and contain emotions.
• The researchers looked for normative discourses in the life stories and how the women navigated them, and the meaning they gave to their choices and pregnancy. They also analysed the storyscapes: how did the women negotiate discourses on falling pregnant and making the right decision, how did the embodiment of the pregnancy play a role in the negotiation and how did they develop narrative agency?
• One participant felt foolish and embarrassed about falling pregnant at 17, but proud after the birth. This story illustrates two opposite attitudes towards distinct discourses on teenage pregnancy: shame (for losing control) and pride (for gaining a new position in society).
• The majority of the life stories showed that the pregnancies were preceded by difficulties in their private situation (abuse, neglect). As a consequence, many girls were in (bad) relationships at an early age. The meaning of falling pregnant is influenced by the social context of teenage pregnancy.
• Three moral discourses stood out: destiny, individual responsibility and failure, and being young and ignorant. The last one is associated with the narrative about losing control and first love. The responsibility discourse is connected to the narratives about feeling guilty, ashamed an foolish. The destiny discourse relates to fate (“everything happens for a reason”).
• The three discourses form a storyscape in which the girl’s naivety indicates that she is unable to take full responsibility and thus unable to develop agency as it is a matter of fate. These can be considered counter-narratives.
• With regard to their decision to continue or terminate their pregnancy, the narratives again showed different moral normative discourses. One discourse is thinking of being pregnant and having kids as a gift. Some women could not go for abortion as they considered it immoral. Other narratives about this gift-discourse were continuing the pregnancy out of fear of never becoming pregnant again or because many others are unable to have children. The second moral discourse was the right of children to have a good upbringing. The women mentioned the need of having a home, an education and a job before having a child. Some feared their relationship would fail and the child would have no father around. Most of these worries come from the general worry of being too young. Thirdly, the women expressed not being able to look after themselves, and the consequences for their child’s and their own well-being.
• The three discourses together form a storyscape of responsibility, with the leading question: how can you responsibly deal with the situation? Some accept the gift of new life, others decide they are unable to care for the baby or themselves. All cases have responsibility in common.
• The embodiment of pregnancy evokes various experiences (discomfort, happiness etc.) that challenge the moral and rational agency of girls and influence their choices. The bodily experience of birth and abortion can also evoke memories of intrusive bodily experiences. One girl expressed that the bodily experience of being pregnant made it more difficult to terminate her pregnancy. The bodily experiences (feeling the baby grow and kick) made others rethink their decision: they continued their pregnancy. The opposite – the bodily experience made them want to terminate instead of continue the pregnancy – never happened. Some participants associated the bodily experience of the pregnancy, giving birth or undergoing an abortion with past experiences like sexual abuse.
• Teenage girls have to deal with the judgments of their boyfriends and parents regarding the right decision. Many girls mentioned conflicts. Some participants conformed to the expectations of others, while others considered the pregnancy a breakthrough that changed the relationships with their boyfriends and parents. The life stories revealed the struggles and patterns of negotiations. The different stages in their lives show several storyscapes.
• The concept of storyscapes demonstrates how girls are constrained by their embeddedness in various storyscapes, defined by usually contrasting audiences. Developing their own narrative agency is often impeded by the limitations of their boyfriends’ and parents’ storyscapes. Girls have to negotiate storyscapes of female vulnerability, dependency, subordination, individual agency and responsibility.
• Teenage pregnancy offers possibilities to girls, as it puts them in charge of making a decision. Girls who decide to continue their pregnancy can see it as a breakthrough: it provides them social status and a new start. The decision for abortion can also be a turning point, as it proves resistance to pressure from people and storyscapes, which is a sign of personal growth.   
• Scholars advocate for a change in health policies, in which the stigmatization of teenage pregnancy should be avoided. Sexual education should focus on various stories about teenage pregnancy, parenthood and abortion, instead of merely linking it to limited aspirations and social exclusion. This offers new storyscapes and helps negotiating narrative agency.

Bullet Points of A motivation model of sex addiction – Relevance to the controversy over the concept - Toates - 2022

• Sex addiction was first formulated in the 1980’s and is often compared with drug addiction. While the notion is widely accepted, not everyone is fully convinced by it. Sex addiction includes both addiction to pornography and sexual behavior.
• This study presents a model of sexual addiction, which involves a combination of models based upon the dual-control organisation of behavior and brain, and the incentive motivation theory.
• Two criteria suggest addiction: there is suffering and a desire to be free of the excessive behavior and there is a specific set of causal processes and learning mechanism involved.
• Two dichotomies are important. First, the control of behavior has a dual structure: goal based (goal-driven) and stimulus based (compulsive). Second, there are corresponding inhibition processes that are also based on a dual structure.
• Stimulus based control of behavior has two components. One: Kahneman’s concept of dual control is explained by an automatic and fast System 1 that can act unconsciously (stimulus based), and a goal-directed, slow and intentional System 2 that has conscious control (goal based). The distinction between these systems refers to the control thought and behavior, and therefore also applies to addiction. Two: the targets of behavior gain increased power to lure the addict. This aspect is characteristic of motivational processes, especially addiction.
• According to the incentive-motivation theory of Robinson and Berridge (1993), motivational triggers are: certain incentives in the external world, like drugs and possible sexual partners, cues linked to these incentives, for example the link between a pc keyboard and pornography and internal representations of the incentives in memory.
• The activation of a number of brain regions as a reaction to cues (seeing drugs or pornographic images) is known as ‘cue reactivity’.
• Addicts have a tendency to show an approach bias towards the target of the addiction. In case of sex and drugs, the stimulus-based control can act unconsciously until the on-going approach response reaches awareness.
• There is a difference between ‘wanting’ and ‘conscious wanting’. The magnitude of the approach bias towards sexual cues is higher in people  with a problematic use of pornography.
• There is a difference between liking and wanting. Despite being different processes, there is a strong interaction between liking and wanting. People usually want what they like and like what they want. However, studies show that a high value of sexual wanting does not necessarily mean a high liking. Sex addicts even mentioned experiencing less or no pleasure over time.
• Rewards like sex, money and food activate a brain network which involves the ventral striatum, anterior insula, ventromedial prefrontal cortex and amygdala. The pathway of dopaminergic neurons from the ventral tegmental area to the nucleus accumbens plays a key role in analyses of incentive motivation. Activity in that pathway merely underlies wanting. Liking is mostly a matter of opioids.
• Repeated activation of the pathway results into ‘incentive sensitization’: the capacity of sexual stimuli or drugs to trigger the pathway becomes sensitized. Studies have demonstrated that males with a problematic use of pornography show a higher reactivity to erotic cues in several brain regions. They expressed a strong wanting but not a stronger liking compared to a control group.
• When it comes to the goal-based control of behavior and addiction, the goal is based upon the ‘hedonic representation’ of the reward in the brain, which involves the ventromedial prefrontal cortex. This influences the wanting and inhibits the tendencies that are not compatible with the goal.
• There are processes of active inhibition on sexual behavior and desire. The loss of sexual desire is caused by a loss of excitation and by the opposite of excitation: inhibition. Both inhibition and excitation are represented by dual controls. A possible clash is the resistance of temptation (incentive versus goal).
• There are two types of inhibition regarding sexual behavior: due to fear of 1) performance consequences and 2) performance failure. In the context of the dual control concept, the fear of performance consequences corresponds with goal-driven inhibition (wanting to stay loyal) and the fear of performance corresponds with stimulus-driven inhibition (smell, sounds, erectile functioning).
• The neurotransmitters serotonin and dopamine are responsible for respectively inhibition and excitation.
• There is a strong interaction between the two control modes. How the controls are ‘weighted’ depends on the circumstances. When a temptation is resisted, it is assumed that System 2 inhibits the tendency to give in. Sometimes, ‘cognition distortion’ happens: the conscious system tells itself it’s alright to give in.
• Behavior becomes more impulsive and stimulus-based when the arousal is high, restraints from the conscious system are outweighed. This is also known as ‘heat-of-the-moment’. Repeated experience can lead to an automatic control of behavior, which relates to sexual addiction. Sexual behavior can get ‘out of control’ and after a while actions ‘just happen’.
• Fantasy plays an important role in sex addiction. The brain regions that are excited by seeing drugs show the same response by thinking of it. Fantasy might also excite incentive motivation processes that underlie sexual desire.
• It is assumed that a sex addiction offers a regulatory function, such as regulating the mood. The mood of non-addicts is maintained by social interactions. Many addicts struggle with attachment, their behavior tries to make up for the lack of social interactions. In the context of biology, regulating behavior is influenced by low opioid levels. The control actions are rooted in dopamine.
• The majority of sex addicts is male (80% in 1998). Males are more likely to engage in pornography, paraphilias and paid sex. Women are more likely to associate sex with love. The statistics are explained by supernormal stimuli (easily available pornography and sex) and sex differences (men have a stronger response to erotic stimuli).  
• The concept of sex addiction has been criticized by several authors. They argue that the elements of risk, escalation, difficulties in regulation, tolerance and withdrawal symptoms are not present in sexual behaviors.
• It has been proven that sexually-addicted people have difficulties in regulation their urges. Tolerance: needing to do more of something to achieve the same effect. Like an increased dose of drugs over time, sexual activity can also be increased. The same goes for the level of risk. Some sex addicts have reported withdrawal symptoms (anxiety, depression, sleep disorders, tension).
• The presence of comorbidity offers valuable insights into sexual addiction. Other conditions either have certain features in common or are addictive in combination with sex. Examples are drugs and alcohol abuse, ADHD, bipolar disorder, borderline personality disorder, Parkinson’s disease, stress and depression.
• Adolescence and early adulthood are vulnerable periods, in which many sex and drugs addictions start. It is assumed that addiction is often the result of failing to find secure attachment as an infant, as it triggers the need for compensation. Brain development also plays a role: the development of the relevant subcortical regions during adolescence increases the chances of activities becoming addictive. People who suffer from ‘early life adversity’ (sexual, psychological or physical abuse) are more likely to engage in risky sexual behavior.
• Out-of-control sexual behavior can be explained by the following alternative models: obsessive-compulsive disorder, a high drive, hypersexuality and impulsive disorder. Sometimes, these are more suitable terms for the phenomena than ‘addiction’, but they can also co-exist with addiction. Impulsivity, compulsivity and hypersexuality can co-exist with problematic sexual behavior.
• Sex addicts have an excess weight of excitation compared to inhibition. Therapists try to increase the relative weight of inhibition, by shifting the weight to goal-based control. Certain biological interventions have proved to be successful (selective serotonin reuptake inhibitors, opioid antagonist naltrexone or testosterone blockers, excitatory electrical stimulation of the prefrontal cortex). Psychotherapeutic interventions are acceptance and commitment therapy (ACT), goal-setting and mentalization-based therapy. An example of behavioral interventions is looking at pictures of loved ones at moments of temptation.

Bullet Points of Women’s sexual desire. Challenging narratives of ‘dysfunction’ - Graham et al. - 2017

• The altered classification of sexual dysfunction of women in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the approval by the FDA of the first drug to treat low sexual desire in females have led to a debate among researchers and clinicians.
• Psychosexual dysfunction was first mentioned in the DSM published in 1980. Previous versions did not cover sexual disorders. The DSM classification received a lot of criticism in the last decades. One complaint concerns the absence of defined duration and severity criteria. According to the criteria, nearly half of the American females have a sexual dysfunction.
• The classification of sexual disorders was heavily altered in the DSM edition published in 2013, especially regarding female sexual disorders. Defined severity and duration criteria to all sexual dysfunctions were presented. Disorders regarding arousal and desire (FSAD and HSDD) were deleted an a new disorder was introduced: Female Sexual Interest/Arousal Disorder (FSIAD).
• A lot of criticism is also targeted at the increased medicalization of sexuality. The pharmaceutical industry tried to create a female version of Viagra. The creation of a pharmaceutical market for women included the promotion of the notion that Female Sexual Dysfunction is a urgent public health concern that requires treatment.
• In 2004, trials of Viagra for females with arousal disorders were stopped due to men’s and women’s  fundamentally distinct relationship between desire and arousal. The focus was then moved to treating low sexual desire.
• Flibanserin is the first drug for treating HSDD in premenopausal women that received approval by the FDA in 2015, albeit it with a serious safety alert and after several applications. It has effect on dopaminergic and serotonergic transmitter systems. Research on the impact of the drug in women with HSDD indicate marginal benefits, especially given the significant incidence of adverse events.
• A difference from the previous (unsuccessful) applications was the advocacy campaign ‘Even the Score’ in 2014, which included health professionals, women’s health organizations and patients. They wanted to raise more awareness for HSDD and address gender inequality regarding sexual dysfunction treatments. They (falsely) claimed that 26 drugs for the male problem were approved and none for women.
• FSD-patients attended and testified at the FDA Patient-Focused Drug Development Public Meeting in 2014. 5 out of 8 panel members and 7 out of 12 non-panel members who testified received payments for their travel from a pharmaceutical company and Even The Score. With the exception of one, all women had sought treatment and some were still taking drugs for FSD.
• Two women declared being ‘devastated’ when the previous Flibanserin trails were discontinued and told about the dramatic consequences for their sexual desire. Others also described how it had affected their relationships, feelings, friendships, family and work life. They all described the lack of sexual desire in physiological terms. Feminist narratives focus on the ‘right’ of women to receive medication and having treatment choices.
• Trials funded by pharmaceutical companies consider women without sexual desire as having a health problem that requires a pharmaceutical salutation. They do not see sex (and sexual desire) as diverse and varied, and pay no attention to the several possible reasons for the lack of desire (aging, cancer, stress, hysterectomy, fatigue, medication use). Additional problems regard the media: press coverage lacks a critical look at essential terms, conflicts of interest, the efficacy/safety of drugs and issues of trial design.
• Research is limited due to the choice of participants. Studies focused on Western, heterosexual, middle aged women in long-term and monogamous relationships. Black, single, lesbian and women younger than 30 were not represented in trials. Drawing conclusions about the sex lives and sexual desires of ‘all women’ from these limited studies is therefore not appropriate.
• Recommendations for clinicians, journalists and researchers. Clinical work and research: better assessments and definitions that acknowledge that desire and sex have several meanings and interpretations. The variability of women’s sexual experiences also needs to be better acknowledged by researchers. Media: more critical and comprehensive coverage (conduct, outcomes and history of trials, including side effects and limitations). Why were earlier trials discontinued or treatments disapproved? Are there conflicts of interest? Lastly, women need to be offered a truly informed choice, by also being told that a reduced sexual desire does not always equal the presence of a dysfunction, and they need to be informed about non-pharmacological solutions.

Bullet Points of A bio-ecological theory of sexual harassment of girls: research synthesis and proposed model - Brown et al. - 2020

• Many American teenage girls have experienced sexual harassment and nearly a quarter of female college students have been the victim of sexual assault. Despite the negative and long-term consequences of these experiences on their emotional, physical and mental health, perpetrating sexual assault and harassment is usually seen as normative.
• Very few perpetrators receive punishment. Cases are rarely tried and merely 5% of them result in a conviction. In spite of much media attention on this topic (MeToo) and the Weinstein-trial, there is still significant cultural acceptance of sexual assault and harassment of women.
• The tolerance and prevalence of sexual assault and harassment against girls by boys is the expected developmental result of the present cultural context in which boys and girls are socialized. Previous research on this matter concentrated on adolescence and the ‘what, who, were’ question. Hardly any research was done on the normative school, family and cultural contexts – in which young kids develop - support acceptance and perpetration of sexual harassment. Policymakers and researcher need to understand how the social contexts of kids might facilitate later sexual harassment.  
• In order to review relevant literature and propose factors, the bio-ecological theoretical framework of Bronfenbrenner was used. The proximal contexts of peers, schools and parents and the distal contexts of media content play a crucial role in the prevalence of sexual harassment. The interactions and engagement of children with these contexts shape their development. As kids enter adolescence, these interactions have resulted into behaviors that accept the perpetration of assault and harassment against women.
• According to Bronfenbrenner’s bio-ecological systems theory, children interact with their distal and proximal context. These contexts show overlap and interact with one another. The characteristics of an individual child are shaped by their proximal environments (the microsystem): their peers, school and family. Kids are directly influenced by the interactions with their friends, siblings, parents, class mates etc. Kids are also heavily influenced by their (indirect) distal environments (the exosystem), like mass media. These contexts together form a broader culture (the macrosystem). Lastly, the theory argues that children’s developmental and biological processes moderate and inform the impact of the distal and proximal context (the chronosystem).
• Sexual harassment: unwelcome sexual behavior, either physical, nonverbal or verbal, that takes place electronically or in person. Examples are touching, joking, gesturing and displaying pictures. The most extreme version is ‘sexual assault’: sexual touching and penetration obtained by incapacitation or force. The prevalence of sexual assault and harassment is partly a consequence of the sexualization of females, which occurs when someone’s value is purely based on sexual appeal, being physical attractive is equated with being sexy, when someone is considered a sexual object or when sexuality is inappropriately imposed upon someone (like a child).
• Subjects of sexual objectification are usually females, whereas males are ought to embody ‘hegemonic masculinity’ (strong, aggressive, dominant, emotionless). This leads to opposite roles of women and men. Following the cultural stereotypes,  men are expected to be sexually promiscuous (the aggressors), while women should behave passively and prioritize the sexual needs of men (the objects). Boys sexually harassing girls is a direct behavioral result of these sexualized gender stereotypes. Therefore, it is important to understand how social contexts influence the development of sexualized gender stereotypes.
• Sexual harassment mostly occurs in adolescence. In a national survey among teenagers, almost half of the girls declared having experience with unwanted comments, gestures or jokes, compared with less than a quarter of the boys. They were also more likely to mention being sexually intimidated or forced into sexual things by boys. Boys mentioned being harassed (being called gay for example) by other boys more often than by girls.
• Sexual harassment usually occurs between peers, in the presence of a small group and in schools. Many students have witnessed sexual harassment. Sexual harassment is not only conducted in public, but also accepted by other students. Peer group norms heavily influence the degree of toleration. Most did it because so many others do it and they were encouraged by friends.
• Sexual harassment is often tolerated and seen as normative by both adults and children. Adolescents think there are hardly any consequences for perpetrators. Peer sexual harassment is considered as normal, because it is associated with milestones as dating, puberty and becoming sexually active. Girls also mentioned that the inaction by teachers that witnessed the harassment was equally upsetting. Even though harassment is considered damaging, perpetrators are hardly punished. On the contrary: victims are frequently the ones being (socially) punished for reporting the harassment, whereas popular perpetrators are still liked.  
• Three crucial microsystems of children contribute to the high incidence of sexual harassment: peers, schools and parents. Parents emphasize gender as a functional category and binary, which worsens the gender stereotypes. They teach daughters to be passive and put effort in their appearance, and sons to be aggressive. Peers exacerbate gender differences by segregating themselves by gender. Schools reinforce the differences between boys and girls, and do not intervene when sexual harassment starts.
• The exosystem also has a big influence on development. In particular toys and media targeted at kids focus on gender differences, promote girls’ sexualization and boys’ aggression, and offer easy access to violent and sexist pornography. Children have an active role in choosing, influencing and engaging these distal and proximal processes.
• Parents provide the most important and first context in shaping the early development of children. They are responsible for teaching and emphasizing on the gender differences and stereotypes straight from the birth. They shape their kids’ development by a functional use of gender, through the emotional and behavioral socialization of their children, sexualization and an appearance-focus.
• Parents are responsible for socializing their kids’ behavioral and emotional expressions. They promote passive and submissive behavior in daughters, and aggressive and angry behavior in sons. Parents tend to pay more attention to submissive emotions (anxiety, sadness) of girls and are more likely to tolerate aggressive behavior by boys. They also seem to use more psychical control with sons. These gender differences are maintained over time: boys in middle childhood display more physical aggression.
• The appearance-focus is expressed by dressing girls in pink clothes and accessories. Young girls ask if they look pretty or complain about their hair. The focus on appearance can lead to sexualization. Young girls want to look like their barbie doll or popular girls and starting wearing make-up and tight clothes. While appearance-focused behavior is mostly influenced by peers, the mother's behavior can also be the reason, and the parents of sexualized young girls allow and purchase their clothing, make-up and toys. Boys usually receive aggression-focused toys.
• By the end of early childhood, kids have been socialized according to their gender, understand what behavior is appropriate for boys and girls and have constructed gender stereotypes. Girls have been encouraged to look pretty and be submissive, while aggressive behavior by boys has been accepted. This early developments have implications for later bullying and eventually sexual harassment.
• The peer group directly shapes the development of children. Some argue that peers have more influence on preferences, activities and behaviors than parents. Most children and teenagers behave in accordance with the norms of their peers. As soon as children start school, gender differences become more exaggerated due to the pressure of being in peer groups.
• Children in early childhood tend to play with peers of the same sex. Girls and boys segregate themselves, partly due to early gender differences in play styles and interests. Segregation is also the result of the belief that girls are more similar to girls and vice versa, which makes them want to interact more with children of the same sex. As they spend so much time playing together, the gender socialization of themselves increases and the initial small differences exacerbate.
• Playing in peer groups influences kids by further enhancing their stereotypical preferences and skills. Gender segregation also limits the quality and amount of cross-gender interactions. Cross-group contact is an effective strategy for enhancing positive intergroup interactions and attitudes. It creates the feeling of familiarity with peers from another group and fosters friendships. Gender segregation maintains gender stereotypes and uncomfortable interactions.
• During middle childhood, it becomes more important for children to conform to peer norms. Girls and boys have a preference for behaviors and appearances that are typical for a gender. Peers that behave very gender-typical are seen as more popular and having a higher social status.
• Hegemonic masculinity puts more pressure on boys to conform to gender norms. Many boys feel pressured to be aggressive, athletic and dominant (macho). This pressure is still present during adolescence.
• Conformity to gender norms for girls means being sexualized. Children, especially girls, perceive sexualized girls to be more popular and having a high social status.
• Children – especially boys - that do not conform to gender norms are more likely to be bullied or harassed. Boys are more pressured by parents and peers to conform to gender norms and are treated worse when they don’t. Boys that show too little (sexual) attraction to girls are likely to face homophobic harassment.
• Gender segregation and limited cross-gender interactions during childhood might result into later sexual harassment. When puberty hits, adolescents start wanting to interact with peers of the other gender, but due to a lack a (romantic) skills, sexual harassment happens. Adolescent boys maintain or gain a high social status by engaging in sexual harassment, and adolescent girls by being sexually objectified.
• Boys see sexual harassment as a way of proving their popularity and heterosexuality. Having a central place in the group makes a boy more likely to perpetrate sexual harassment. The interaction within boy-groups is also relevant. Conversations with badly behaving peers and laughing at it is associated with bad behavior later on.
• Schools heavily influence the lives of children in early childhood. They indirectly foster the acceptance of sexual harassment by emphasizing the functional use of gender (just like parents) and categorizing kids based on gender, which reinforces the gender stereotypes. School and teachers directly foster the acceptance of sexual harassment through a lack of education and policies.
• Teachers often use gender labels verbally (“welcome boys and girls”) and in the organization of classrooms (separate activities and boards). Extracurricular activities and physical education are also often gender segregated. The functional use of gender and the segregation of kids further restricts cross-group interaction and the possibility to build cross-gender friendships. Lastly, the school structure can influence the salience of gender as category (mixed or single-gender schools).
• Sexual harassment increases when children start middle school. Despite this increase, teachers usually ignore it. This may partly be due to a misunderstanding of sexual harassment between peers, and a lack of training and education on recognizing and dealing with it. More than half of the girls reported not telling anyone, because it would make no difference. Paying no or not enough attention to sexual harassment also occurs at a structural level, as it is not covered in sexual education. Many children are not taught about consent. Even when school policies address sexual harassment, they are often not used.
• School structures and teachers foster a social context in which the gender stereotypes are exacerbated. Research indicates that supportive policies and interventions by teachers can make a difference.  
• The acceptance of sexual harassment is further reinforced by marketing and media. Media targeted at infants encourage the sexualization of girls and aggressive, sex-focused behavior by boys. Their influence fosters (sexualized) gender stereotypes, which leads to the acceptance and perpetration of sexual harassment. The easy access to violent and sexist pornography from a young age normalizes the acceptance even further.
• Television shows, magazines, movies, music videos and video games portray females as sexualized. Popular shows for kids involve the objectification of girls by boys and self-objectification by girls. Sports media sexualize female athletes. Toys for girls focus on beauty. Gay or feminine boys in television programs are usually joked about. A longitudinal study showed that watching mainstream television caused women to be seen as sex objects and men as sexually dominant.
• Media focus on aggressive behavior in boys: male characters in tv shows are often behaving badly. Popular sports programs reinforce violence and aggression. Toys as weapons and action figures are exclusively marketed for boys. In addition to the marketing of boys are parents more likely to buy gender-typical toys for their children.
• Research shows that boys who consumed more sexually explicit media perpetrated more sexual harassment later in life than their peers. Adolescent boys who played video games with sexualized female characters displayed more tolerance and acceptance of sexual misbehavior.
• The proposed theoretical model emphasized a number of important implications for parents, policymakers, researchers and teachers.
• Policymakers: easily obtained and enforced school policies should directly express intolerance of sexual harassment between peers. Sexual education needs to cover consent and sexual harassment. Policies and practices should be focused on elementary, middle and high school teachers. This includes reducing the use of gender as a functional category, segregation by gender and no longer considering gender exclusively as a binary.
• Teachers: same as for policymakers and they need training about the consequences of harassment and interventions.
• Parents: a reduced use of gender as a category, encouraging kids to join mixed gender peer groups, pay more attention to the toys they buy and the media they let their kids consume. Teach children to be critical, discuss media content and monitor their access to sexualized media.
• Researchers: future research should focus on the interaction between the contexts (peers, media, parents, schools) and with the child’s characteristics. It also needs to be investigated how individual differences in kids moderate their responses to school and parent effects, what the possible predictors of sexual harassment in early childhood are, how middle school norms of sexual harassment could predict perpetration of harassment in high school, what barriers teachers encounter regarding intervening and how interventions in early childhood should be targeted.

Bullet Points of The complexities of sexual consent among college students: a conceptual and empirical review - Muehlenhard et al. - 2016

• Media coverage regarding sexual assault among college students puts pressure on universities to improve their sexual consent policies. The headlines express the controversy that surrounds sexual assault in college. American and Canadian universities are pressured to investigate and address the complaints of students. Both the accused and complaining student usually acknowledge the occurrence of sexual contact, but disagree about it being consensual.
• While most awareness and educational campaigns emphasize how important getting sexual consent is, they do not clarify what is considered consent.
• The terms rape, sexual assault and battery have no globally accepted definitions. Legal definitions and that of researchers vary. In general, they refer to sexual acts that are obtained by (the threat of) force or without consent. Rape: sexual penetration that is obtained by (the threat of) force or the victim being incapacitated. Sexual battery is usually defined as unwanted sexual touching. Sexual assault includes unwanted sexual touching and sexual penetration. In this article, sexual assault refers to sexual touching or penetration without consent.
• Addressing sexual assault became a priority in the US during the Obama era. New guidelines regarding the prevention of and response to sexual assault by universities and colleges were introduced in 2011. They declared that sexual violence is a form of prohibited sex discrimination and that schools are obligated by law to investigate and address complaints of sexual violence between students.
• A number of states, including New York and California, signed legislation that obligate universities to adopt policies requiring ‘affirmative consent’. Every person involved in a sexual activity needs to have the affirmative consent of the other(s). The absence of resistance or protest does not equal consent. Affirmative consent can be revoked at any moment. The existence of a relationship alone does not indicate consent.
• One in five female university students in Canada and the VS have experienced (attempted) sexual assault. The prevalence rate varies across US campuses.
• Several factors affect the risk of sexual assault. Female and transgender students are at greater risk than male students. Students in their first year are at greatest risk, while graduate and senor students are at lowest risk. Drugs and especially alcohol are involved in most of the sexual assault. Sex with an incapacitated person due to drugs or alcohol qualifies as sexual assault or rape.
• The greatest risk of sexual assault for females occurs during adolescence and young adulthood. Many female students have already experiences sexual assault before starting college.
• Numerous aspects of college life put female first-year college students at risk of sexual assault. The conjunction of moving out of their family home - which offers a newfound freedom - and seeing college as an experimental phase, encourages them to behave differently. While this is a natural development, the combination with a limited sex knowledge, gendered sexual expectations, heavy alcohol consumption and party culture controlled by men makes them vulnerable.
• Researchers and theorists have provided various recommendations and opinions regarding the conceptualization of sexual concept.
• Consent can refer to a physical act (verbally or non-verbally expressing willingness) or a mental act (a feeling or a decision of willingness). There are three meanings of consent: an act of explicitly agreeing to something, behavior that is interpreted as willingness and an internal state of willingness.
• An internal state of willingness is explain by the question “How indicative is this behavior of consent?” This indicates that consent is not directly observable. This has limitations, as internal states of others are unknowable and private. Policies or laws could never by framed around the internal state alone: they need to be framed around behavior.
• An act of explicitly agreeing to sex would be giving permission, either in writing or verbally. Most people do not explicitly discuss sexual consent, but look for indirect signals and cues.
• Consent as behavior that another person interprets as willingness is similar to ‘implied consent’, which is indirectly given and normally indicated by an action, inaction, a sign or a silence. It could also be called ‘inferred consent’. This concept entails that someone observes and interprets the behavior of another person. This involves speculation and assumptions regarding willingness.
• Consenting to and wanting to have sex are seen as synonyms, but they are different concepts that sometimes do not correspond to each other. One might want to have sex but not be willing (because they do not want to cheat or fall pregnant), or one might not be wanting to have sex but be willing to have sex (not in the mood, want wanting to please their partner).
• Behaviors that indicate desire are sometimes interpreted as indicative of consent. This can be problematic.
• Should we assume consent until the opposite is expressed or should we assume non-consent until consent is expressed? Legislation in New York and California requires universities to adopt policies that require affirmative consent. One must assume non-consent until consent is provided. Many people assume consent until non-consent is expressed.
• According to the traditional ‘sexual script’: men initiate sexual activity with women, if women are not willing, they are responsible for refusing or resisting sexual advances. This is problematic for several reasons. One: the burden for stopping sexual behavior is put on women, they might be blamed for the occurrence of non-consensual sex. Two: women might not resist or refuse, despite being unwilling (due to being drunk, afraid, surprised). Three: even if women refuse, men continue their behavior in the hope they will be aroused eventually or are just playing hard to get).
• Slogans such as ‘No means No’ do not address settings in which women are unable to say no. The affirmative consent standard addresses this issue, as the initiator is responsible for getting consent and cannot interpret the other’s refusal as insincere. The affirmative consent standard seems a good idea, but also raises questions: what counts as giving consent? In which circumstances may consent be assumed? In which circumstances should an explicit ‘yes’ not be interpreted as consent?
• Some policies based on the affirmative consent standard require verbal consent. This means verbally asking and giving or refusing consent for all types of sexual behavior. When non-verbally expressed consent is allowed, it raises the question which behaviors count as consent. Wearing revealing clothes, flirting, going home with someone and getting drunk are considered indicative of sexual consent by some.
• In the US and Canada, it is generally accepted to touch someone briefly on the shoulder, upper back or arm without prior consent. With regard to patting a stranger’s or non-romantic acquaintance’s behind, kissing or caressing their face, non-consent must be assumed unless consent is communicated. When it comes to relationships and dating, consent may be assumed.
• “Yes” is normally an indicator of consent. In some situations the opposite is true: consent in the context of verbal pressure, threats and coercion is considered not valid. Insufficient knowledge about what someone is consenting to and the effects of drugs and alcohol are other examples.
• Research shows that most participants communicated consent to sexual activity both verbally and non-verbally, some gave consent non-verbally and a few gave consent only verbally. Non-verbally consent was given in the form of kissing, touching, not moving away, caressing, smiling. Differences between men and women showing consent: more women than men showed consent by caressing, hugging and not moving away. Consent for specific sexual behaviors was often given non-verbally. Women were more likely to give verbal consent for first-time experiences.
• Signs that were interpreted as most indicative of consent were verbal and nonverbal signals (just starting or verbally communicating consent). Also considered indicative were indirect verbal signals (mentioning protection). Lower rated were indirect nonverbal signal (caressing). Not responding was rated as least indicative of consent. Paradoxically, their interpretations and their own usage of these behaviors showed an inverse relationship: not responding was mentioned as the most used way of communicating consent but also as the least indicative of consent.
• The refusal of sex was also topic of research. Many female high school and college students declared finding it difficult to refuse directly. Some had unwanted sex to avoid refusing. A small number preferred a direct verbal no. Many refusals were softened by offering excuses or delayed acceptances (being sick or menstruating, not being ready yet), in order to avoid having to express the unwillingness to have sex.
• Direct verbal expressions of consent were interpreted as highly indicative of consent, although they were not the norm. Students regarded verbal consent usually as unnecessary, because they found it easy to recognize sexual interest.
• Students of both genders declared that females normally communicate consent non-verbally. Non-consent is often communicated verbally by women. Most mentioned the need for women to be clear and direct when refusing, in order to avoid miscommunication.
• The statements that verbal consent is not necessary because it is obvious and that miscommunication is likely contradict one another. They are, however, consistent with the traditional sexual script (sexual advances by men are assumed to be consensual until women resist, it is their responsibility to communicate non-consent).
• Many students associate sexual consent with a mutual understanding, willingness between people to engage in agreed upon sexual activity, and a clear state of mind, free from (too much) alcohol or drugs. Some students viewed consent direct and active, while others saw it as indirect and passive. There was a gender difference between the mentioned examples of passive consent (women: not resisting means consent), men: not pulling away means consent).
• Men and women both agreed about the importance of consent, although slightly more women endorsed explicitly expressing consent. Most men and women agreed that a verbal consent policy as adopted by Antioch College might promote communication between (sex) partners, but they also deemed it unrealistic.
• Nearly all participants were able to define consent. Their definitions appeared to be influenced by affirmative consent policies and legal definitions.
• Although the verbal communication of consent appears ideal, it is not often used. Most students consider it unnecessary and ruining the moment. Verbal consent is used more frequently in the context of certain sexual behaviors (anal or oral sex or PVI).
• The question what counts as verbal consent is difficult to answer. Verbal consent needs to be specific and stay clear of vague terms. However, specific referents to sexual acts can also come across as offensive to some. Other difficulties with verbal consent regard the continuous process of consent, which must rely on nonverbal signals. It is unrealistic to constantly ask for consent.
• The following five principles might be helpful for thinking about consent (creating guidelines, interpreting research findings, study designs): individuals often have multiple objectives, decisions about how to communicate nonconsent/consent are often contingent and sequential, behaviors are often done concurrently (instead of one at a time), the most used behaviors to express consent are not the behaviors most indicative of consent and consent cues are indicative of likelihood, not of agreements.

Bullet Points of He is a stud, she is a slut! A meta-analysis on the continued existence of sexual double standards - Endendijk et al. - 2022

• Men and women are usually held to distinct standards of appropriate (sexual) behavior. For example, men are socially punished for behaving passively or modestly and women for behaving dominantly or directly. Receiving backlash for breaching social standards can have a bad influence on society and individuals.
• Sexual double standards (SDS) refer to the different sexual behaviors that are valued for and expected of women and men. Traditionally, males are expected to be dominant, initiating sexual activity and sexually active. Females are expected to be passive, submissive and reactive. As men have more sexual freedom, they are often treated differently for the same sexual behaviors. Half of the girls have experienced slut-shaming, compared with one-fifth of the boys.
• There is an association between SDS and gender differences in sexual risk behavior (men: more partners, women: more reluctance to ask for or insist on using protection) and societal problems (gender inequality, sexism, homophobia).
• Biosocial and evolutionary theory assume the existence of SDS and provide predictions regarding moderators of the strength of SDS, particularly with regard to historical change, cultural differences and the behavioral specificity of SDS. The female and male control theory draws on premises of biosocial and evolutionary theory. The gender-intensification hypothesis is used to make predictions about age differences in SDS.
• Evolutionary theories provide rationales for the differences in the evaluations an expectations of women’s and men’s sexual behavior. Gender difference in parental investment are particularly relevant. Biologically, mothers invest more in their kids than fathers. Because of their lower parental investment, there is a lot of competition among men for females. As they are sexually assertive and dominant, it is likely they will be successful. Having sex often and with several partners is more beneficial for men, as it offers them more opportunities to pass their genes on. Women are more selective when it comes to choosing a partner. These evolutionary processes influence how we perceive the sexual behavior of ourselves and others.
• Biosocial theory assumes that the different behavorial norms are the result of the societal division in gender roles (men provide, women stay at home). These distinct roles derive from biological differences between women and men. We are expected to behave in accordance with our gender roles. Gender roles are socially constructed and therefore, socialization processes (rewarding, punishing, observing) are important for learning what makes sexual behavior appropriate for women and men.
• The female and male control theory integrates sociocultural and evolutionary perspectives to explain gender differences in SDS. According to the male control theory, SDS are considered a male privilege that men want to maintain, as it offers them many advantages. SDS are created by and beneficial for men and suppress women. The female control theory considers female sexuality to have more value, because gender differences in sexual desire result into a higher demand for female sexuality. SDS offer advantages for females, as they can trade sexual favors for parental investment or economic favors.
• Evolutionary theories assume that SDS do not differ between countries: they are considered universal. According to biosocial theory, gender roles are the result of culture, SDS could therefore differ between countries. Cross-cultural differences in gender equality can be quantified by the gender inequality index and the global gender gap score. Data obtained through these measures show that Western European and Scandinavian countries have the smallest gender gap and the North American countries have bigger gender gaps. Intermediate levels were observed in Asian and Latin-American countries. The largest gaps were found in North Africa and the Middle East. Biosocial theory assumes that a low level of gender equality relates to more traditional SDS.
• When it comes to changes over time, evolutionary theory assumes no changes in SDS over the last 6 decades, because changes happen slowly. Biosocial theory assumes that SDS are less traditional in recent research compared with older research. In the majority of Western societies, the division of gender roles has become less strict in the last decades, which would result into less differences in SDS.   
• Biosocial theory and evolutionary theory both make no (direct) assumptions regarding age differences in the existence of SDS. However, gender norm conformity becomes more important during childhood, with the pressure to conform to gender role being the highest in adolescence. This is a phase in which girls and boys become more different due to the convergence of cognitive, biological and social changes (gender-intensification hypothesis). Given the significant developments in the sexuality of adolescents, which is something they evaluate each other on, SDS are expected to be more prevalent in adolescents compared with adults.
• The first (systematic) study of SDS was conducted in 1960, implying that men have more sexual freedom than women. Later research is very inconsistent. Some of the studies found no clear evidence of SDS, while others clearly showed their existence.
• Inconsistencies in earlier SDS-research might be caused by differences in measurement, study design and conceptualization. SDS was mostly conceptualized in terms of attitudes: how people evaluate men’s and women’s sexual behaviors. In this meta-analysis, SDS was also assessed in terms of individuals’ attitudes and stereotypes (how they expect men and women to behave sexually).
• Self-report questionnaires were often used in studies. However, these differ in whether they assess the agreement with statements regarding SDS or the evaluation of sexual behavior. Another frequently used type of measurement is the experimental task in which people are asked to evaluate a scenario or vignette that describes the character’s sexual behavior. There are between-subjects designs (the sexual behavior of either a woman or a man is evaluated) and within-subjects designs (the sexual behavior of both genders is evaluated). Studies using within-subjects designs and Likert-type-scale questionnaires are less likely to yield evidence for SDS.
• This meta-analysis extends earlier studies by examining the presence and strength of SDS from 1960-2019 and by examining the effect of moderators related to sexual behavior type, publication year, sample, design and measurement and by following a theory-based meta analytic approach.
• In accordance with biosocial and evolutionary theory, the current meta-analysis shows clear evidence for traditional SDS in studies assessing differences in expectation or evaluation. High sexual activity was expected more from males and low sexual activity was expected more from females. Highly sexually active males were evaluated more positively than females, and low sexually active females were evaluated more positively than males. Studies in which Likert-type-scale questionnaires were used did not yield evidence of SDS.
• Several moderator effects were found. The existence of traditional SDS was behavior specific. Compared with attitudes about SDS, stereotypes about SDS were more traditional. Compared to studies in which the ‘double standard scale’ was used, studies in which the ‘sexual double standard scale’ was used reported more traditional SDS. An association was found between high levels of gender equality and less traditional SDS in countries. The moderators publication year, study design, age and gender of the participants were not significant.
• When it comes to sexual behavior types, the strongest evidence of sexual double standards was found for victims of sexual coercion, then casual sex and being sexually active from an early age. There was less evidence of SDS for sexual infidelity, premarital sex, level of sexual activity and perpetrators of sexual coercion. Sexual behavior within a power hierarchy was evaluated more negatively for female victims (more damaging to their reputation). This indicates that females might be blamed for being victims of sexual coercion.
• Regarding cross-cultural differences in SDS, it was found that in countries with higher levels of gender equality, SDS were less traditional. This is in accordance with biosocial theory.
• In accordance with evolutionary theory (and contrary to biosocial theory), it was found that SDS did not change over time. Traditional SDS have been around for decades and do still exist. This might indicate that stable gender differences in reproductive strategies underlie SDS. Although gender roles are now less strict in many Western countries, there was no prove of less differentiation in the norms for the sexual behavior of both gender. As sexuality is a highly private matter, this might take more time.
• Regarding gender and age of the participants, no differences were found.
• Conclusion: both biosocial and evolutionary theory provide testable and relevant predictions regarding the existence of SDS. Sexual double standards can be best explained by a hybrid model that includes evolutionary processes related to gender differences in sexual strategies and parental investments, as to the societal division in gender roles.

Bullet Points of Addressing Gender Socialization and Masculinity Norms among Adolescents Boys: Policy and Programmatic Implications - Amin et al. - 2018

• Global health and development policies focus mostly on teenage girls, as gender inequalities make them more disadvantaged and vulnerable. However, there are convincing reasons to take a closer look at adolescent boys. Their transition from childhood to adolescence is associated with several health problems and risk factors that influence their health during their whole life (injuries, violence, suicide, aids, alcohol, drugs, tobacco). Males are also less likely to seek help than females, and their behaviors have a significant impact on the well-being and health of females.
• A frequently ignored contributing factor to the health behaviors of teenage boys is gender: their gender socialization to adopt stereotypical or unequal attitudes related to masculinity. Early adolescence is a critical phase for the development of gender attitudes, especially because the start of puberty evokes and intensifies gender related expectations. A recent review on gender attitudes of young teenagers demonstrates that girls and boys experience significant different sources and pressures of gender socialization.
• Teenagers endorse masculinity norms linked to: autonomy (providing, protecting, independency), psychical toughness (fighting, competing, high pain tolerance), heterosexual prowess (having sex with lots of girls, having control over girlfriends) and emotional stoicism (avoiding acting girly or showing vulnerability, not reaching out to others for help). Teenage boys are also more likely to endorse unequal norms related to gender.
• There are three possible explanations. Norms that privilege males are considered ‘normal’, so boys are not tempted to challenge them. Teenage boys experience greater relative power and freedom than girls, so they might not feel the need to challenge their privileges. Boys that want to act more feminine or strive for equity face more social obstacles (stigmatization, labeling, ridicule) than girls.
• Various factors contribute to the gender socialization of teenagers, but peers and parents play a key role. The contribution of the parents involves indirect and indirect communication: different expectations, rules and sanctions for sons and daughters. During the transition into adolescence, (male) peers play a key role in the establishment of masculinity norms. They verbally and physically challenge each other, and encourage risky behavior (sex, alcohol). Not complying with these norms leads to ridicule, bullying or insults.
• Some studies indicate that schools also shape gender attitudes in early adolescence. The same goes for social media.
• Reviews that examined the results of interventions regarding gender attitudes and sexual behaviors among young boys and men indicated that participatory activities in a small group to provoke reflection about unequal gender attitudes might be successful. However, the reviews also show that improved gender attitudes do not equal changed behaviors.
• A review of programs that focus on the prevention of violence against women provides three lessons. One: changing masculinity norms and gender attitudes requires the involvement of both boys and girls. Two: it requires working with communities (like schools) and families (the broader societal setting). Three: next to challenging norms of male privilege, entitlement, power and control over females, it is also important to respond to males’ own trauma, marginalization, social exclusion and victimization.
• It is during early adolescence when gender attitudes are formed and equitable norms are built. Masculinity norms should be influenced by policies and programs during this phase. In order to change these norms, boys need to be motivated to challenge the privilege and power they have, and to address stigmatization and ridicule of the ones that don’t comply to the norms.
• Changing norms requires a socioecological approach, targeted at individual males, peers, schools, parents and communities.
• There is a number of gaps in the research regarding intervention programs that need to be addressed. Most of the research on gender socialization comes from high-income countries. More evidence from middle- and low-income countries is needed. Also, there is a need for valid and reliable measures of gender attitudes in adolescents that can be consistently used. Longer time frames are needed in evaluation designs. It needs to be more clear which parental aspects influence the development of gender attitudes. There is a need for more evidence regarding school approaches and sexual education. The bad influence and potential uses of (social) media needs to be better understood. Lastly, adolescent girls need to be empowered, by helping them build agency and self-esteem.