Let's talk about sex

Let's talk about sex

More open and comprehensive approach to sex education in conservative Asian societies could lead to healthier outcomes in many dimensions

Ask anyone what sex means and you will get any number of different responses. After all, it's a highly personal matter and can mean different things to different people. It is such a delicate and intimate topic that most people prefer to avoid the conversation altogether.

This is especially true in Asia, where conservative cultural norms often discourage the provision of sex education in schools. At home, many parents also find it difficult or inappropriate to discuss sex-related matters openly with their children.

"When I was young, the missing link in information about sexuality education was parenting education. It starts from home. I never learned about sexuality education from home while I learned only a little bit in school," says Abeeram Tata.

Comprehensive sexuality education needs to “reach every child”, says Toun Thavrak, secretary of state of the Ministry of Planning in Cambodia.

His story is far from unique, and it's one he shared as a youth delegate from the Pacific Island republic of Kiribati at a recent forum held in Bangkok by the United Nations Population Fund (UNFPA).

"In Kiribati, it's very difficult to talk about sexuality education because people have the perception that it would encourage students to have premature sex," Abeeram said.

The paucity of sex education in many Asian societies results in children receiving confusing and conflicting information about relationships and sex. This often leads them to turn to their peers, the internet, or to seek out premature sexual experiences. It's an unhealthy situation that can have disastrous consequences for some.

Healthy habits, and the understanding of how to maintain good sexual and reproductive health and lifestyles, should begin in early childhood and adolescence, participants in the forum agreed.

The lack of appropriate comprehensive sexuality education (CSE), as the UN likes to call it, can have consequences in many areas, among them puberty transition, pregnancy, access to modern contraception, unsafe abortions, gender-based violence, child marriage, Aids/HIV and sexually transmitted infections (STIs).

Premature and uninformed sexual initiation is a global problem that occurs in high-, middle- and low-income countries. It is mainly driven by poverty, lack of education, lack of opportunities and unemployment. This places adolescents at elevated risk of acquiring STIs, leading to poor social and psychological outcomes and unintended pregnancies.

According to the World Health Organization (WHO), approximately 16 million girls aged 15 to 19 years and 2.5 million girls under 16 years give birth each year in developing regions. Some 3.9 million girls aged 15 to 19 undergo unsafe abortions, while adolescent mothers aged 10 to 19 years face higher risks of eclampsia, puerperal endometritis and systemic infections.

Unicef reports that there are more than one billion 10- to 19-year-olds in the world today who are growing up in circumstances in which they are making uninformed decisions about their sexual and reproductive health.

But when it comes to dealing with children and adolescents, many adults still believe that sex education would induce them to participate in premature sexual experiences and therefore, should not be integrated into school teachings.

Participants discuss attitudes toward sex education at a recent forum held in Bangkok by the United Nations Population Fund.

However, significant evidence suggests that CSE, which extends beyond mere teaching of reproduction, risks and STIs, can help create a foundation for young people to establish healthy interpersonal relationships, develop social and emotional skills, improve decision-making and promote respect and gender equality.

"Comprehensive sexuality education is about preparing young people for the future. It builds social and emotional skills and gender-equitable attitudes," Laura Londén, deputy executive director of management and assistant secretary-general of UNFPA, told the forum.

The forum, hosted by the government of Cambodia, highlighted the regional commitment to CSE and reviewed progress updates in Asia Pacific countries.

"Every parent in every culture wants their child to enter adolescence and adulthood with the skills to make the right decisions -- to live healthy lives, to be safe and to have happy relationships," Ms Londén said.

"The foundation for these decisions on life and love need to be developed in early childhood, building social and emotional skills in communication, negotiation and decision-making, with underlying respect and gender equality."

When CSE is properly carried out, she said, it will not only reduce adolescent pregnancy, HIV and gender-based violence, but also lead to potential reductions in school bullying, drug and alcohol dependence, depression and other mental health issues.

STARTING YOUNG

Experts suggested that one of the best ways to prepare children for adulthood in matters of sexual health is through CSE programmes that are consistent and age appropriate, while recognising the role and responsibilities of parents.

Unesco describes CSE as "a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality.

"It aims to equip children and young people with knowledge, skills, attitudes and values that will empower them to realise their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and understand and ensure the protection of their rights throughout their lives."

CSE is education delivered in formal and non-formal settings that is scientifically accurate, incremental, age- and developmentally appropriate, curriculum-based, comprehensive, based on human rights and a gender equality approach, culturally appropriate and has the ability to help children develop life skills needed to support healthy choices.

"CSE is a continuing educational process that should start at age 5, and where new information builds upon previous learning. It is age- and developmentally appropriate, with the content responsive to the changing needs and capabilities of the child and the young person as they grow," said Kabir Singh, regional adviser for HIV and Health at Unesco in Bangkok.

"CSE aims to empower individuals and communities with the knowledge, attitudes and skills that are needed to support young people to make informed decisions, communicate effectively and enjoy healthy and respectful relationships."

Mr Singh suggested that there is significant evidence on the positive impact of sexuality education on sexual behaviour and health. Evidence has shown that CSE does not increase sexual activity, but is effective in delaying sexual debuts. In addition, it has the potential to reinforce gender-equitable norms and prevent and reduce gender-based violence.

Ms Londén suggested that the region move toward a commitment to CSE through teacher training, with leadership from school principals and supportive supervision from the education system.

"We must work toward CSE programmes in schools, having a strong gender component and beginning during the early years of primary school when children are learning about gender roles, communication and relationship skills," she said.

Cambodia is among the countries that have already made progress to integrate age-appropriate CSE in the school curriculum.

CSE is intended to be incorporated in a curriculum with other competency-based learning and teaching processes for primary and secondary schools, said Yung Kunthearith, deputy director of the School Health Department at the Ministry of Education, Youth and Sports.

"We hope that in the next few years, all the young people in Cambodia learn CSE from primary, secondary and high school. We want all children to understand themselves and people around them to make the right decisions," he said.

EFFECTIVE IMPLEMENTATION

While some progress has been made in terms of supportive policies for CSE, the challenge is to ensure that every child, whether in school or not, receives quality information. This would require all stakeholders -- governments, civil society and communities, parents and young people themselves -- to make a commitment to CSE.

"Advancing CSE means the need to provide an opportunity for the whole community to work in partnership to generate support for prioritising investment in CSE," said Toun Thavrak, secretary of state of the Ministry of Planning in Cambodia.

"It is not just the Ministry of Education's responsibility. All ministries and civil society including young people need to work together to ensure that comprehensive sexuality education reaches every child."

As youth is a common concern of humankind, sex education is necessary to support the right to health and development, as well as gender equality and the empowerment of women and girls and young people, he said.

In Thailand, the government has taken steps to deal with teenage pregnancies in a holistic manner, said Saipan Sripongpankul, senior education officer with the Office of the Basic Education Commission at the Ministry of Education.

The Prevention and Solution of the Adolescent Pregnancy Problem Act, BE 2559 (2016) focuses on adolescents' rights and an integrated approach to prevent and alleviate adolescent pregnancy.

The Act identifies five main ministries as being responsible for promoting the rights of adolescents: Public Health, Labour, Social Development and Human Security, Interior and Education, said Ms Saipan.

"It is in everyone's interest -- governments, civil society and communities, parents and young people themselves -- to work to support teachers to ensure every child receives the foundation skills that they need for their future life and love," Ms Londén added.

"One of the most common challenges faced when we try to incorporate CSE in school is that teachers do not have the capacity to talk about the topic as they lack the appropriate vocabulary," said Sana Tajuddin, manager of Life Skills Based Education (LSBE) at Aahung, a Karachi-based non-governmental organisation dedicated to improving sexual and reproductive health and rights in Pakistan.

"Some of the teachers come to us and said they want to talk about child sexual abuse but they don't know how to address it to the younger people," she said. "Promoting culturally relevant language, vocabulary and developing content around it can help ease this problem."

The other challenge, she says, is the general perception of society, communities and families when they are told that their children will be exposed to sex education.

At Aahung, Ms Tajuddin said that to take any school on board, the programme first starts with orientation of school management so they understand the importance of CSE.

This way, they will be confident enough to take it further in their school and understand which teachers would have the counselling skills with appropriate rapport with the children to impart the subject, she said.

In addition, Aahung has an orientation session with parents to ensure mutual understanding and that a consistent message is being sent to the children.

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