Impact and cost-effectiveness analysis of the national school-based sexuality education programme in Estonia

Policy-makers making decisions on the implementation of school-based sexuality education (SE) programmes face two important questions: (1) what are the costs of implementing and scaling up SE programmes, and (2) what are the impacts? This paper responds to these questions by retrospectively assessing costs, impact and cost-effectiveness of the national school-based SE programme in Estonia 1997–2009. The three-year curriculum had been taught to 190,000 students at the end of 2009. The cost of reaching one student was USD 32.90 and the total costs were USD 5.6 million. There has been a remarkable improvement in sexual health indicators in the age groups 15–19 and 20–24 years in Estonia between 2001 and 2009. During this period, annual abortions, STIs and diagnosed HIV infections in the age groups were reduced by 37%, 55% and 89%, respectively. It is difficult to assess to what extent the improvements in these sexual health indicators are attributable to the SE programme. Nevertheless, our conservative threshold analysis indicates that the Estonian SE programme could be considered cost-saving if only 4% of the observed reductions in HIV infections are attributable to the programme. There is strong evidence, therefore, to support that the Estonian school-based sexuality programme has been cost-effective.     

Advocacy for school-based sexuality education: lessons from India and Nigeria

Drawing on evidence from a wider study on the cost and cost-effectiveness of sexuality education programmes in six countries, and focusing on the examples of India and Nigeria, this paper argues that advocacy is a key, yet often neglected component of school-based sexuality education programmes, especially where sex and sexuality are politically or culturally sensitive issues. It also suggests that advocacy is not a one-off activity but needs to be carried out continuously and adapted as contexts and needs change. Overall, this piece recommends that advocacy should be a key component of sexuality education work, and needs to be planned and budgeted for. Without such investment, country-level sexuality education programmes are likely to fail.     

Renewed commitments in a time of vigilance: sexuality education in the USA*

Over the past 20 years, the USA has seen more than its fair share of controversy with respect to education about sexuality, sex and intimate relationships. Attention has focused on content (abstinence-only vs. comprehensive instruction), delivery (by teachers, parents, health professionals or community educators) and context (within school and beyond). In recognition of this fact, Sex Education invited the development of a virtual special issue comprising a sample of its most impactful papers on these and related topics. The 2016 Presidential election results and recent legislative action in the USA point to the importance of thinking broadly about teaching and learning about sexuality inside and outside of schools and of considering sexuality as it intersects with categories of difference, privilege and penalty, including ability, age, immigration, race, gender and class. This paper, developed as an introduction to the virtual special issue, opens with a discussion of the journal’s contributions to the ongoing discussion of pleasure and desire in sexuality education. From there, we turn to the question of what is possible given the material and ideological conditions of schooling and then to opportunities for teachers and learners outside the conventional classroom. We follow with a discussion of the place of intersectional analyses in sexuality education research, and conclude with some thoughts on sexuality education research at this political moment.     

Towards comprehensive sexuality education: a comparative analysis of the policy environment surrounding school-based sexuality education in Ghana,Peru, Kenya and Guatemala

The successful implementation of comprehensive sexuality education (CSE) programmes in schools depends on the development and implementation of strong policy in support of CSE. This paper offers a comparative analysis of the policy environment governing school-based CSE in four low- and middle-income countries at different stages of programme implementation: Ghana, Peru, Kenya and Guatemala. Based on an analysis of current policy and legal frameworks, key informant interviews and recent regional reviews, the analysis focuses on seven policy-related levers that contribute to successful school-based sexuality education programmes. The levers cover policy development trends; current policy and legal frameworks for sexuality education; international commitments affecting CSE policies; the various actors involved in shaping CSE; and the partnerships and coalitions of actors that influence CSE policy. Our analysis shows that all four countries benefit from a policy environment that, if properly leveraged, could lead to a stronger implementation of CSE in schools. However, each faces several key challenges that must be addressed to ensure the health and wellbeing of their young people. Latin American and African countries show notable differences in the development and evolution of their CSE policy environments, providing valuable insights for programme development and implementation.     

Safety,celebration, and risk: educator responses to LGBTQ professional development

Research has explored multicultural teacher education from multiple, sometimes divergent perspectives; yet, these studies agree that what passes for multicultural education fails to address issues of educational inequity. This paper is part of a larger evaluation study of Reduction of Stigma in Schools (RSIS) – a professional development program aiming to empower educators to create affirming environments for Lesbian, Gay, Bisexual, Transgender, Queer and Questioning (LGBTQ) youth. Interview data indicate that though workshops utilized a critical approach, what teachers embraced was a call to understand and “protect” LGBTQ students through the “safety” discourse – a form of understanding and valuing the “cultural other” – and investment in one time “visibility” or “celebration” events as symbols of improved school climate. Further, educators framed LGBTQ issues as “risk” issues rather than as equity issues, which continue to mark LGBTQ students as “victims” or “problems” in need of saving or solving. We posit that responses to RSIS content reflect educators’ understanding of their obligation to “diversity” as presented during their teacher preparation programs and that workshop content which resonated with them was that which they could easily fit into these familiar frameworks.     

Our voices count: the lived experiences of LGBTQ educators and its impact on teacher education preparation programs

LGBTQ issues are often marginalized in teacher preparation programs. This marginalization perpetuates heternormative practices in schools. Utilizing the lens of narrative inquiry, this study examined the lives of 10 LGBTQ teachers residing in various geographical regions in the United States. Based on the theoretical framework of Queer Theory, this paper examines discursive powers that marginalize LGBTQ teachers and offers recommendations to eliminate repressive, heteronormative practices in teacher educator preparation programs.     

Trauma-informed sexuality education: recognising the rights and resilience of youth

Experiences of maltreatment during childhood and the emergence of sexuality during adolescence are both critical developmental issues that intersect in meaningful ways, yet the two are often isolated from each other in practice. Despite the prevalence of childhood maltreatment, sexuality education does not accommodate young people with trauma histories. This results in curricula and content that ignore the particular needs and experiences of a proportion of students in sexuality education classrooms. Trauma interventions commit a similar oversight by neglecting the prospects for positive, growth-promoting sexual experiences and relationships among young people who have been abused. The failure to account for young people's resilience in the sexual domain results in treatment approaches that emphasise sexual risks (e.g. revictimisation) and problem behaviours to the exclusion of guidance in cultivating positive sexualities. Consequently, many forms of sexuality education and maltreatment interventions may be of limited effectiveness and relevance in promoting the future sexual well-being of young people with histories of trauma. To redress this gap, we advocate for trauma-informed sexuality education, an approach that acknowledges past experiences of abuse, the promise of resilience, and young people's right to positive sexualities.     

An implementation and outcome evaluation of a multicomponent sexuality education programme for high school students

Numerous classroom-based interventions have aimed to improve sexual health outcomes for young people, yet few have shown strong, lasting effects. Ecological approaches that address multiple levels of a young person’s environment offer largely untapped potential to positively change sexual behaviour. This paper presents results of a cluster-randomised trial of a multicomponent sexuality education intervention that integrated a classroom curriculum, parent education workshops and materials, peer advocate programme, and sexual health services at 10 urban high schools. An implementation evaluation, employing quantitative and qualitative instruments, was conducted to examine whether the individual components of the intervention were delivered as planned and how they were received by the target populations. Multilevel modelling was used to evaluate the effect of the multicomponent intervention on outcomes at one-year follow-up. Results showed that the intervention components were successfully implemented with and well received by target populations. Students receiving the multicomponent intervention reported greater increases in the use of sexual health services (odds ratio [OR] = 1.73, 95% CI = 1.09–2.75) and the likelihood of carrying a condom (OR = 2.71, 95% CI = 1.44–5.09) relative to those receiving a control condition. No effects were found for other behaviours, possibly due to low prevalence of sexual activity in the sample and the small number of schools randomised.     

Effects of a life skills-based sexuality education programme on the life-skills,sexuality knowledge,self-management skills for sexual health,and programme satisfaction of adolescents

This study aimed to develop and establish the efficacy of a life skills-based sexuality education programme for junior high school students that focused on prevention. A non-equivalent control-group pretest-posttest design was employed with 105 students in the first-year of junior high school participating. The experimental group received 10 sessions of a life skills-based sexuality education programme, and the control group received 10 sessions of the standard sexuality education, both provided during a home economics class. A comparison of the two groups’ post-test scores showed that the experimental group scored significantly higher than the control group on sexual and reproductive health related knowledge (F = 58.50, p < .001) and life-skills (F = 11.52, p = .007). In addition, the experimental group showed a larger improvement in self-management skills for sexual health than did the control group (F = 9.32, p = .003). A life skills-based sexuality education programme increased life skills levels, knowledge about sexuality and sexual and reproductive health, and helped participants identify appropriate behaviours when facing a sexually risky situation. Results highlight the value of including an evidence-based and practice-oriented life skills-based sexuality education programme in the formal curriculum of junior high schools in Korea.     

Stepping out of our comfort zones: pre-service teachers' responses to a critical analysis of gender/power relations in sexuality education

This paper discusses pre-service teachers' responses to a critical analysis of gender/power relations using examples from a final assessment for an intensive elective unit called Teaching Sexuality in the Middle Years. This unit critically examines gender/ power relations, the production of difference, heteronormativity and pleasure and desire, employing a feminist post-structural framework. Despite the focus on critical thinking, reflection and interrogating structural inequalities in this unit some students were resistant or unable to engage with this approach in their assessments, although appearing to do so in workshops. We consider the broad range of sexuality education discourses mobilised by this unit to try to make sense of what looks like resistance but may be something more complex and difficult to negotiate. The paper ends with a consideration of some of the implications of this approach for practice.     

论中小学教师教育中的校本培训

校本培训是最经济有效的教师教育方式。为积极发挥这种培训方式的作用,我们必须做到以下几点:端正认识,明确目标;建立和完善校本培训管理体系,使之系统化;框定校本培训内容和范围,使之明确化;创新和总结校本培训途径和方法,使之可操作化。     

Bringing our communities to the research table: the liberatory potential of collaborative methodological practices alongside LGBTQ participants

Research on and about queer people and topics in higher education continues to evolve, expand, and push boundaries on identity, policy, and programming, increasingly informed by our narratives and experiences. Thus far, this work has done little to dismantle the imposed binary of researcher and subject(s), relegating queer research and practice as something that is done ‘on,’ ‘to,’ or ‘for’ queer people, rather than ‘with’ them. Collaborative ethnographic methodologies and communities of practice (CoP) provide alternative modes of scholarship and practice that build queer people’s agency through active involvement in research and social change processes. Situated in two of our own examples, our purpose is to explore big questions and raise even more. This article calls for a further queering of LGBTQ research in higher education by utilizing collaborative methodologies such as CoP and collaborative ethnography to improve the strategies, practices, and knowledge of campus queer communities and imagining new democratic and liberatory realities together.     

Culture and sexuality in Finnish health education textbooks

In Finland, Young people’s sexuality education has not been examined from a multicultural perspective, with the exception of a few policy-oriented papers. This paper examines how cultural diversity is addressed in chapters on sexuality and sexuality education in Finnish health education textbooks. The analysis is based on material contained in textbooks used in grades 7–9 and upper secondary schools. Findings suggest that cultural diversity is included in textbooks in one of two ways: either to demonstrate the uniqueness of liberal, emancipated and progressive ‘Finnish’ sexuality; or as a way of distancing Finland and Finnish values from the rest of the world. In these textbooks, culture is understood as belonging to non-Finnish ‘others’ and a culture that itself as not being Finnish. This somewhat tendentious treatment of cultural diversity leaves teachers with limited tools with which to promote anti-discriminatory education. The textbooks also overlook the diverse backgrounds of young people growing up in Finland today.     

Comprehensive sexuality education,culture and gender: the effect of the cultural setting on a sexuality education programme in Ethiopia

Comprehensive sexuality education (CSE) is recognised as an effective method of sexual health education, with the school identified as a fitting site of implementation. Its holistic and participatory nature endeavours to develop the knowledge, attitudes and life-skills of students to help them secure their sexual and reproductive health and rights (SRHR). This qualitative study aimed to better understand aspects of CSE implementation in one context. Specifically, it focuses on the effects of the cultural setting, considering how gender and sexuality norms influence teacher and student implementation strategies. The research was carried out in one secondary school in Ethiopia, which delivered a Dutch-developed programme throughout 2013. Over 50 in-depth interviews were conducted with teachers and students, influential community members and experts in SRHR. Data were also gathered through focus group discussions and classroom observations. Results show that CSE teachers and students, both male and female, were able to discuss issues of sexuality. However, the cultural context was seen to affect interpretation of programme information, influencing the nature of this discussion. For an impactful implementation, it is recommended that sexuality education aims to engage with and involve the wider community, to reduce contradictory messages and increase programme support. Furthermore, teachers should undergo extensive and comprehensive pre-programme training that addresses their attitudes and values, not just their knowledge.     

Primary school puberty/sexuality education: student-teachers' past learning,present professional education,and intention to teach these subjects

Primary school teachers are often tasked with puberty/sexuality education for students who are undergoing sexual maturation at ever-earlier ages. This study explores the changing trajectories of the pre-service learning and teaching of primary school puberty/sexuality education at an urban university, including student-teachers' childhood learning, professional pre-service studies, and technological educational future. Biographical narratives and a theoretically based conceptual and diagnostic framework are used to analyse the views of fourth-year Bachelor of Education student-teachers about their own primary school puberty/sexuality education, their present university professional education for teaching these subjects, and their intentionality to teach them to future Grade 6 school students. Results show that these student-teachers intend to replicate their own primary school learning experiences. Pre-service professional education appears to have failed to operationalise the contemporary learning and teaching of puberty/sexuality education that would allow a new generation of more effective knowledge and pedagogies to be implemented.     

Teaching gender and sexuality diversity in foundations of education courses in the US

This article is a summary of comprehensive units on gender and sexuality diversity that the authors have used in teacher education courses in undergraduate and graduate social foundations of education classes over several years. The course lesson plan includes a five‐part analysis of the following categories: biological sex; gender identity/sexual identity; gender roles; sexual behavior; and sexual orientation. The authors have experienced much success and positive student evaluation by using this approach. This is true even in religiously and politically conservative universities. The authors introduce the complexity of biology, gender roles, and gender identity, before addressing human sexuality. This helps to diffuse many stereotypes and misconceptions in the initial lessons.     

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.     

Scaling up comprehensive sexuality education in Nigeria: from national policy to nationwide application

Nigeria is one of few countries that reports having translated national policies on school-based comprehensive sexuality education (CSE) into near-nationwide implementation. We analysed data using the World Health Organization-ExpandNet framework, which provides a systematic structure for planning and managing the scaling up of health innovations. We examined how Nigeria's nationwide programme was designed and executed. Since 2002, Nigeria has developed a well thought through strategy to scale up CSE. Crucial attributes that facilitated the scaling up included technical consensus about the innovation and clarity about its components, dissection of a complex intervention into manageable components for implementation by organisations with complementary expertise, strong political leadership and championship in concert with advocacy and technical support from non-governmental organisations, proactive and energetic involvement of community stakeholders, effective programme management, and improvements to the information management system to ensure on-track implementation and mid-course corrections to keep stakeholders, including funders, informed and engaged. Challenges included programmatic values, competing priorities for available human resources and a lack of predictable funding for sustaining a rapid scale-up effort. Despite some weaknesses, implementation has largely proceeded according to plan. The lessons learned from Nigeria's experience can and should be used in other settings to achieve wide-scale coverage.     

Primary schools and the delivery of relationships and sexuality education: the experience of Queensland teachers

Primary school provides an appropriate opportunity for children to commence comprehensive relationships and sexuality education (RSE), yet many primary school teachers avoid teaching this subject area. In the absence of teacher confidence and competence, schools have often relied on health promotion professionals, external agencies and/or one-off issue-related presentations rather than cohesive, systematic and meaningful health education. This study examines the implementation of a 10-lesson pilot RSE unit of work and an accompanying assessment task in two primary schools in South-East Queensland, Australia. Drawing predominantly from qualitative data, the research explores the experiences of primary school teachers as they engage with RSE curriculum resources and content delivery. The results show the provision of a high-quality RSE curriculum resource grounded in contemporary educational principles and practices enables teachers to feel more confident to deliver RSE and minimises potential barriers such as parental objections and fear of mishandling sensitive content.     

Enacting whole-school relationships and sexuality education in England: Context matters

Evidence from intervention evaluations suggests that achieving meaningful and lasting social, behavioural and attitudinal change from relationships, sex and health education (RSHE) in schools requires more than just a curriculum. Whole-school approaches appear particularly promising since they work at multiple levels. For instance, they may: engage with carers, communities and local services; address iniquitous cultures and norms; change school policies and practices; and actively involve young people themselves. They have also been advocated to tackle sexual harassment and abuse in schools. Currently, however, such approaches have not been rigorously evaluated in the UK. This article focuses on the whole-school elements of two recent RSHE pilot studies conducted in English secondary schools. We describe how these elements were variably enacted in different settings. We analyse contextual factors that help account for these differences, including: teacher and departmental professional identity and autonomy; broader education policy including high-stakes testing and school inspection judgements; the significance of support staff; and staff–student relationships and partnerships. We argue that the likely impact of whole-school approaches and RSHE in schools more generally will depend on attending to all of these factors. The paper contributes firstly to debates about the theory and practice of RSHE by highlighting the significance of processes and cultures beyond the classroom in enabling or constraining positive change. Secondly it contributes to scholarship that elucidates the role of contexts, broadly defined, in understanding the enactment of policy and practice.