Design,implementation and evaluation of school-based sexual health education in sub-Saharan Africa: a qualitative study of researchers’ perspectives

This study investigated facilitators and challenges to designing, implementing and evaluating school-based sexual health education in sub-Saharan Africa, using interviews with intervention designers and researchers. At the pre-planning and planning stages, participants reported that facilitating factors included addressing the reproductive health needs of participants, contextual (culture, religion, economic and social) considerations and the adoption of holistic approach to sexuality education. Lack of open communication about sexual health matters between young people and adults; concerns that sexual health education could encourage sexual activity; and inadequate funding, were key barriers. Implementation was facilitated by the involvement of relevant stakeholders, the training of facilitators and adopting strategies to overcome resistance to sexual health education. The provision of structured, detailed lessons plans and monitoring with supportive supervision optimised fidelity of delivery. Barriers to implementation included facilitators’ resistance to teaching safe sex promotion and logistical challenges in school environments. Participants also reported that the validity of self-reported adolescent sexual behaviour (as part of evaluation) may be improved by complementing well-designed self-report surveys with computerised audio devices for data collection, qualitative interviews and participant observation. Study findings generate recommendations to improve future forms of school-based sexual health education in sub-Saharan Africa.     

Giving adolescent reproductive health and population issues a world view. Sri Lanka

This article reports on the production of 52 video programs addressing reproductive and sexual health and reproductive rights issues by the Colombo-based Worldview International Foundation. The UN Population Fund (UNFPA) and relevant NGOs and institutions chose the themes. Following the production, the video programs will be broadcast through Young Asia Television, which covers 18 countries in Asia and reaches over 385 million viewers, and other channels. This advocacy program is under the Television Advocacy Program for Adolescent Reproductive Health and Population Issues project, which complements special strategies under the European Commission/UNFPA Initiative for Reproductive Health in Asia. By promoting the global dissemination of information and education, the Worldview project aims to 1) strengthen young people's participation; 2) advance TV media advocacy; 3) advocate the inclusion of population, gender, sexual and reproductive health issues; 4) provide extended knowledge of adolescent reproductive health to all concerned groups; 5) encourage positive attitudes towards preventive methods among the target groups; 6) promote the importance of incorporating gender perspectives and child abuse issues; and 7) establish close cooperation among organizations at the national, regional and international levels.     

What Tanzanian parents want (and do not want) covered in school-based sex and relationships education

Despite evidence that demonstrates the benefits of school-based sex and relationships education (SRE) in promoting and protecting young people's sexual health, there are still controversies regarding what should be covered in the SRE curriculum among different stakeholders, including parents. This study assessed Tanzanian parents' attitudes towards the provision of SRE in schools in order to ascertain their level of support and what they wanted covered in school-based SRE. Two hundred and eighty-seven parents, recruited from one urban district and one rural district, completed a questionnaire assessing their attitudes towards school-based SRE. Results show that, in both districts, more than 75% supported the provision of SRE in schools as well as the inclusion of a wide range of topics in school-based SRE curriculum. However, the results also show that parents do not equally welcome the inclusion of some topics – especially those in the domain of attitudes and values, such as homosexuality and masturbation. The study concludes that, although parents may object to the inclusion of some topics, they generally support the provision of SRE in schools. It is hoped that the results of this study will help to overcome some of the resistance to a more widespread introduction of SRE in Tanzanian schools that rests on fears of parental reaction.     

Men engaging boys in healthy masculinity through school-based sexual health education

Young people’s sexual health is a significant concern to parents, educators, health professionals and policy makers in Canada. However, challenges exist with respect to the nature of school-based sexual health education content and mode of delivery. These include the lack of attention paid to the impact of gender ideologies on the development and expression of youth sexuality, and the tendency to exclude boys and young men by focusing primarily on the sexual and reproductive needs of girls and young women. This article discusses findings from a participant observation and focus group study conducted with the facilitators of WiseGuyz, a school-based sexual health and healthy relationship programme, which involves boys aged 13–15 years in Calgary, Alberta. Findings suggest that the process of facilitation is as important as curriculum content in securing positive outcomes for young men. Implications for school-based sexual health education and further research in this area are discussed.     

Democratic reform paves the way for new reproductive health strategy and advocacy. Mongolia

Ms. Munkhuu, senior adviser to the Reproductive Health Advocacy Project in Mongolia, reports the implementation as well as the impact of its National Adolescent Health Program. She relates the program's beginnings with the adoption of the National Program in Reproductive Health in 1997, which made adolescent reproductive health issues a public concern. Through the program, formal health education was incorporated in the secondary school curriculum. Other developments of the program were the training of trainers, publication of a quarterly newspaper called the Uerkhel--Love for adolescents, creation of educational radio and television programs on adolescent sexuality, and the establishment of a hot line service. In conclusion, Ms. Munkhuu emphasizes the need to make the program more effective and responsive by improving the country's information system and by increasing reproductive health awareness among policy-makers and the general public. Advocacy training should also be actively pursued.     

National news. India. First things first: a general framework for adolescence education. The urban educated Indian youth

A paper prepared by the National Council of Educational Research and Training in New Delhi, India, stressed the importance of culturally sensitive school-based reproductive health education. A survey of 4709 adolescents and young adults from 15 areas of India revealed substantial knowledge differences between males and females and urban and rural youth. Overall, however, respondents lacked access to reliable sources of information on sexual health matters and tended to rely on peers and the mass media. Collaboration among curriculum developers, policy makers, teachers, and parents is urged to promote appreciation of the desirability of school-based programs. Such programs should seek to influence the attitudes, behaviors, and value orientation of young people in India as well as impart knowledge.     

Sri Lanka: a holistic approach to reproductive health

In response to the request of Sri Lankan adolescents in the provision of family planning knowledge prior to marriage, a holistic approach to reproductive health education program supported by the UN Population Fund/Dutch multi-bilateral assistance was adopted. This program is jointly coordinated by the Social Science Department of the National Institute of Education and the Department of Science and Health. It conducts counseling by peers and teachers and educating parents concerning adolescent health. In addition, the Government invited nongovernmental organizations and private sectors to assist in the development of a national policy concerning reproductive and adolescent health. Policy statements were recognized by the public and programs at the community level were implemented by a task force. The government initiated preventive strategies through the counseling center network of the National Youth Services Council and the vocational training centers of the Vocational Training Authority. Reactions of Sri Lankan adolescents to these initiatives have been positive. They have demonstrated favorable attitude towards reproductive health and are receptive to family planning concerns. However, there is still a need to provide an organized service delivery program to ensure the availability and provision of contraception to adolescents.     

India: nationwide reproductive and child health programme

This article presents an outline of India's Reproductive and Child Health (RCH) Programme. This program provides special interventions for the country's adolescent population. One of its main objectives is to help stabilize population numbers, including adolescents, at a level consistent with the needs and goals of national development. A committee of experts constituted in the Department of Family Welfare developed an appropriate package for adolescents, focusing on counseling and the provision of reproductive health services through the existing health care delivery system. In addition, special projects for people living in urban slums and tribal areas have been incorporated in the RCH Programme. Its view has been to improve the delivery of family health care services. The success of the Programme has depended on the development of a strong partnership between the Government and non-Governmental organizations, and in overcoming age-old values and prejudice against adolescent girls. Moreover, India's reconceptualized population education, which brings the education of adolescents into focus, includes elements of adolescent reproductive health.     

Programme guidelines. How effective are sex education programmes? Findings

Adolescent reproductive health program promotion in Asia and Oceania has been hindered by a lack of appreciation on the part of parents, educators, policy makers, and development planners of the benefits of sex education. Concerns persist that sex education encourages adolescent promiscuity. However, a World Health Organization review of 1050 studies on sex education failed to provide any support for this position. In fact, the research shows that sex education can actually help to delay first intercourse among teens who are not already sexually active and promotes consistent contraceptive use among those who are sexually active. A comprehensive literature review commissioned by the US Agency for International Development as well as a US Centers for Disease Control study corroborated this finding. Cross-national comparisons have indicated adolescent pregnancy rates are lower in countries with liberal policies in terms of sex education programs and the provision of adolescent sexual health services.     

Sexual and reproductive health education attitudes and experience in India: how much support is there for comprehensive sex education? Findings from an Internet survey

This study assessed the extent to which an Internet-recruited sample of residents of India was supportive of the provision of comprehensive sexual education in school in a country where youth sexual health is poor. We sought to determine whether attitudes differed for those of varying demographic backgrounds (age, sex, education level, religion), the extent of support for comprehensive coverage, the school or age levels deemed appropriate for delivery, and whether own sex education history influenced support. We conducted an anonymous online survey with 1140 Indian adults using crowdsourcing methods. We found widespread support for the provision of sex education to youth in India among members of our largely well educated, middle-class sample. However, most participants believed sex education should be provided relatively late (i.e., in mid- to late-adolescence). Few opposed sex education altogether and attitudes were not predicted by background, own school-based sex education, or parent-child communication about sex. Less than one-third of participants endorsed the coverage of all topics, indicating that support for truly comprehensive coverage was not strong. However, the findings counter politicised efforts to ban sex education by state leaders despite the availability of a progressive, comprehensive curriculum offered by the Central government.     

‘Sex education should be taught,fine…but we make sure they control themselves’: teachers' beliefs and attitudes towards young people's sexual and reproductive health in a Ugandan secondary school

Although schools have been identified as important settings in which young people's sexual and reproductive health (SRH) can be promoted, there has been limited research into the role of teachers in delivering sex education programmes. This paper describes findings from a qualitative study of teachers' beliefs and attitudes towards young people's SRH in a Ugandan secondary school, and discusses the ways in which conservative attitudes to young people's sexual activity and an adherence to gender stereotypes can limit students' access to SRH information and services. Teachers' attitudes, beliefs and often superstitions relating to young people's sexual activity inevitably affect the content and nature of school-based sex education. Findings from this preliminary study suggest that, rather than assuming teachers act as neutral delivery mechanisms in schools, these attitudes and beliefs must be taken into consideration and addressed in the development of school-based sex education programmes.     

Next time somebody asks: "Is it good for young people to watch TV?" say YA TV,the Young Asia Television: the eyes and ears of young Asians

This article presents a profile of the Young Asia Television (YATV) initiative by the WorldView International Foundation. The YATV channel brings news and analysis of Asia-focussed environmental concerns, current affairs, population and reproductive health issues, social problems including poverty and illiteracy, arts and culture, and other topics. In addition, it broadcasts programs produced by different countries on reproductive and sexual health, including AIDS and sexually transmitted disease prevention, and youth/adolescent awareness of sexual health. It was launched by the Foundation with a thrust stating that "television must encourage dialogue and debate; advance the creativity of people, especially the younger generation who will be the leaders of the future." In order to reach many more millions of viewers, YATV programs are networked with the Asian Broadcasting Union and 1000 other organizations through the Foundation's own NGOs network. This network provides the medium for value-based broadcasts in an entertaining fashion. The International Office of Worldview International Foundation in Colombo monitors the program activities on a continuing basis and uses the information gathered for impact assessment and long-term planning.     

Preparing teachers to deliver gender-focused sexuality/HIV education: a case study from Nigeria

Evidence shows that a focus on gender and power in sexuality/HIV education increases the likelihood of achieving positive sexual health outcomes, and international agencies have called for a shift to a gender-focused approach. However, questions remain about the implementation of such programmes, including how best to prepare teachers to deliver such curricula. In the development of the national school-based HIV prevention curriculum in Nigeria, several state governments partnered with feminist (or like-minded) non-governmental organisations to collaborate on teacher training. This case study, drawing on teacher interviews and classroom observations, explores the effects of that experience. Teachers reported that the 10-day training developed their competence, confidence, and commitment to foster students' critical thinking about gender issues. Specifically, they reported changes in their own gender attitudes, pedagogic skills and connectedness with students, particularly girls. The findings suggest that high-quality training can prepare teachers – including those in large, resource-poor school systems – to deliver the kind of gender-focused sexuality/HIV education that is proving most effective at advancing sexual health outcomes. Non-governmental organisations can be important partners for providing such training. Further research is needed to assess what additional social and educational outcomes may result from gender-focused sexuality/HIV education.     

The provision of sexual health education in Australia: primary school teachers' perspectives in rural Victoria

In Australian schools, one significant component of whole-school learning in sexuality education is to provide students with developmentally appropriate curriculum and learning opportunities, with the intention of influencing positive health and well-being. In the situation where the usual classroom teacher is under-prepared or unwilling to teach sexuality education to their students, the use of external providers who are experts in puberty and sexual health is crucial. While the provider is a key influential factor in any sexual health programme, reliance on external providers for the provision of sexuality education in regional Australian cities is not well documented. This mixed-method study aims to address this gap in the literature with a specific focus on Ballarat, where the provision of sexuality education, particularly in primary schools, is heavily reliant on several external providers. Participant schools highlight the need for further positive synergies between the classroom teachers, external agencies and the accessibility of a rigorous curriculum to sustain the delivery of an effective programme to young people in schools.     

The Pacific region

Population education in the Pacific region is summarized in terms of awareness and commitment, curriculum and instructional materials development, integration into the school curricula, training programs, and evaluation research. Several population education issues of current concern relate to the increase in chronic diseases such as diabetes and hypertension that are associated with life styles and diet, and the rising incidence of AIDS and teenage pregnancy. In the Pacific region, many countries have advanced population programs and policies, while some still do not even have a population policy. The issue of balancing population and resources is a topic that has not been sufficiently addressed in resource-poor countries. There is wide variance in awareness and commitment to population education in the Pacific region. Commitment and continuous support are crucial to population education projects. Lack of support is sometimes due to changing government personnel and lack of awareness of policy makers. Population education is not the same as family planning or sex education, and traditionally is spread through seminars and workshops by part time project personnel unconnected to the entire educational apparatus. Presently, only 8 population projects are functioning in the region, with 2-3 in the planning stages. Materials development in the Pacific region has been devoted to the secondary school level, yet awareness is increasing that sexuality, family health, and the environment should be introduced at the primary level. A popular strategy is to integrate population issues into the existing curriculum, such as in Fiji, the Marshall Islands, and Kiribati, which also have teacher training curriculum. In most countries sex education is still a controversial topic, and materials are developed by teacher committees working after school rather in a curriculum development unit. AIDS has pushed this topic into the public sector. A chart is provided for each country and curriculum with population education and the level of schooling for formal and informal education. Training programs tend to be orientation workshops, materials development workshops, or teacher training workshops. Evaluation research in population education has been weak, due to an emphasis on program implementation, curriculum development, and limited resources and expertise.     

Assisting Parents of Bilingual Students to Achieve Equity in Public Schools

This article provides school-based consultants with an overview of the English language learner (ELL) student population and common programs available to ELL students (such as English-only programs, pull-out English as a second language [ESL], content-based ESL, transitional bilingual programs, maintenance bilingual programs, and two-way or dual language bilingual education programs). Past and current research examining bilingual education programs and guidelines and recommendations for the application of bilingual education knowledge to consultative practice with school personnel and culturally and linguistically diverse parents are discussed. Because of the paucity of research regarding school-based consultation related to bilingual education issues, guidelines and recommendations are presented within the larger framework of multicultural and cross-cultural consultation. Recommendations for future research regarding school-based consultation related to bilingual education issues are provided.     

Sexual and reproductive health among young people in Egypt: the role and contribution of youth-friendly services

Young people aged 15–24 constitute about one quarter of the population in Egypt. Recent survey findings provide evidence to advocate for the improvement of the number and quality of services targeting young people's needs. This study focused on the role of youth-friendly clinics in addressing young people's sexual and reproductive health. The study methodology included desk review, in-depth interviews with physicians and peer educators, and focus group discussions with young people of both sexes, including clinic beneficiaries and non-beneficiaries. The overall environment for sex education and service provision has improved in recent years. Pilot government and non-government youth-friendly clinics have been established but their coverage and use remain limited, with the majority of service users being married women rather than single men and women. The role of youth-friendly clinics in addressing youth sexual and reproductive health needs remains restricted due to societal reluctance to address these issues and cultural and religious sensitivities. Government commitment is required to scale up pilot clinics into a national programme to improve the welfare of all young people.     

The Institutionalization of Gender and its Impact on Educational Policy

To incorporate gender issues into public policy, most nations have established women in development (WID) units in their governmental bureaucracies at some point in the last 20 years. An examination of 48 WID units in developing countries indicates that in most cases these multisectoral organizations consider education among their activities. Within education the focus is more on non-formal education for adult women than on formal education. By concentrating on literacy programs combined with income generation, health and nutrition activities or on vocational education, WID units implicitly subscribe to a definition of gender issues as those concerning mostly poor women. It is argued that limited contestation by these units of the ideological function of schooling, revealed in the scarce attention given to teacher training and curriculum/textbook revision-added to their limited funding and infrequent contact with feminist non-governmental organizations (NGOs)-makes these WID units relatively ineffectual in altering the reproductive functions of the formal educational system.     

School programs to prevent intrafamilial child sexual abuse

The incidence of child sexual abuse would argue for the schools assuming a larger role in the development of preventive and educational programs. Because of the public school system's consistent and longitudinal contact with children and families it is perhaps the most promising institution for the delivery of preventive efforts. This article presents specific suggestions for school-based programs directed toward the prevention of intrafamilial child sexual abuse. Further, it is argued that for maximum effectiveness, the support of local parent-teacher organizations be elicited; that educational programs be presented separately for parents and children; and that a variety of programs in concert with the development level of participants be presented on topics related to child sexual abuse. Topics regarded as important for prevention efforts are factual information on sexual abuse, appropriate and inappropriate touch, the respective role responsibilities and rights of parents and children, and a sex education approach that stresses the values of nonexploitation and discrimination in the choice of whether to engage in sexual behavior and the choice of partners.     

Scaling up sexuality education in Senegal: integrating family life education into the national curriculum

In Senegal, school-based sexuality education has evolved over 20 years from family life education (FLE) pilot projects into cross-curricular subjects located within the national curriculum of primary and secondary schools. We conducted a literature review and semi-structured interviews to gather information regarding the scale and nature of FLE scale-up. Data were analysed using the ExpandNet/WHO framework, conceptualising scale-up from a systems perspective as composed of interrelated elements and strategic choices. Key enabling factors that facilitated the scale-up of FLE included (1) programme clarity, relevance and credibility; (2) programme adaptability to young people’s evolving sexual and reproductive health priorities; (3) the engagement of a strong and credible resource team comprising government and civil society agencies; (4) a favourable policy environment; and (5) deliberate strategic choices for horizontal and vertical scale-up. Barriers included sociocultural conservatism that creates resistance to content areas deemed to be culturally sensitive, resulting in partial scale-up in terms of content and coverage, as well as structural barriers that make it difficult to find space in the curriculum to deliver the full programme. Lessons learned from Senegal’s experience can strengthen efforts to scale-up school-based sexuality education programmes in other culturally conservative low- and middle-income countries.