Practical Aspects of Sexual Education S. Ozalp, T. Bombas, M.Joao Trindade, F. Branco Why are teenagers still getting pregnant? Adolescents: pregnancy, parenting, prevention 6th Seminar, ESC, 8 Oct. 2001, Coimbra

Prof. Dr. S. Sinan ÖZALP Osmangazi University Faculty of Medicine Department of Obstetrics and Gynecology Eskişehir TURKEY

Sexual Education for Adolescents is a Human Right Young people, as all human beings, have the right to experience and fully develop their sexuality, as well as the right to highest attainable standard of sexual education and reproductive health. A good and well planned school curriculum, which must include sexual education, will certainly bring more choices possibilities for the young people. The youth need to be equipped with the skills, tools and knowledge that will enable them to face the future with confidence, responsibility and hope.

Definition of Sexual Education Comprehensive sexuality education is a consciously planned, usually formal process for teaching about the biological, psychological, sociocultural, and spiritual aspects of human sexuality, and for developing the skills and attitudes necessary for a positive and healthy sexual life. Sexuality education approaches sexuality as a natural, positive, and healthy part of human life and addresses the pleasures and joys of human sexuality as well as its undesirable aspects, such as sexual violence or sexually transmitted infections (STIs).

Aims of Sexual Education Provide accurate information on all aspects of human sexuality, including gender Assist people to consciously explore, consider, question affirm, and develop their own feelings, attitudes, and values on the various dimensions of sexuality.

Aims of Sexual Education Enhance self-esteem and social skills for developing mutually satisfying, supportive, equitable, and loving intimate relationships, and for self determination in the experience of one’s sexuality, including the expression of one’s gender, and control of one’s reproduction Enable women and men to responsibly in the expression of their sexuality, in their reproductive behavior, and in their intimate and social relationships.

Sex Education: Reasons of Dissatisfaction In practice many claim they learn more from friends than from teachers They also complain that when do get sex education, it focuses on biology, issues such as feelings, relationships, homosexuality and sexual decision-making are often omitted For many young people most learning is still acquired through sexual experience rather than through sex education.

Sex Education I was uncomfortable and the teacher was uncomfortable The way it was, I would have preferred not to have even had it. It was embarrassing.

Constraints The question of morality. Teachers face a real dilemma as to how to approach the issues of sexual morality and family life. Not developing a climate in the classroom in which young people feel safe to discuss their feelings Sexless course about sexless behaviour in a sexless society

Effects of Cultural Values Religious Beliefs Community leaders Friends Family Members School teachers Cultural Values Religious Beliefs

Where Do Young People Learn About Sex? Debate: Whether schools should teach or leave that to families. Reality: They learn sex not from their schools or families but instead from their friends, other peers, and books, magazines, and the mass media. Reality: Much of the information young people learn from these sources is misleading, incomplete, or wrong. Reality: They learned too little, too late.

Sex Education From School Programs Education in the school curriculum. The quality, extent and content of courses vary wildly. Problem: Poor understanding of reproductive biology or contraception. Problem: Teach only the biology of sex and omit important information about sexuality and preventing pregnancy. Problem: Schoolbased programs, at the secondary-school level, can not reach those who begin sex earlier or who drop out or never attend school.

Sex Education From Parents and Other Family Members Policy- makers, program managers, and parents themselves often agree that parents are the preferred providers. Reality: In many societies few parents talk to their children about sex. Problem: May not receive accurate or complete information.

Parents’ Approach to Sex Education They must be well-informed. They must talk with their children about reproductive health and sexual responsibility and answer all their questions fully and accurately Listen to their children compassionately, without dismissing their concerns as childish or condemning their questions as improper

Sex Education From Peers and Friends For some young people, friends are the primary or only source of such information Because friends and peers are so influential, some health programs are training young people to work as peer educators

Sex Education From Mass Media Source: TV, radio, books, and popular magazines, “adult” movies. Problem: Entertainment media imply that sex is largely risk free, that everyone is doing it, and that planning for protection spoils romance. Solution: To counter common mass-media images of sex through appealing and entertaining programming that present more responsible and realistic models for healthy behavior.

The Mass Media Approach to Sex Education Stop glorifying irresponsible sex In entertainment, depict people who benefit form using contraceptives In news coverage and other informational formats, provide accurate information and healthy guidance about reproductive health and contraceptives Make the public aware of young people’s health needs

Political Leaders Approach to Sex Education Political leaders can enact and enforce laws and policies that improve young people’s access to reproductive health information and services Insist that the news and entertainment media provide more responsible coverage and treatment of sexual behavior

Community and Religious Leaders Approach to Sex Education Advocate and organize substantial reproductive health programs in schools Call for for responsible depiction of sexuality in the mass media

Ten Elements of Effective Sexuality Education 1.The program presents a positive, accurate, and comprehensive view of human sexuality. 2.The program respects and empowers students. 3.The program respects cultural and sexually pluralism and promotes universal values. 4.The program addresses a diversity of learning styles and abilities. 5.The program addresses all three learning domains: cognitive, affective, and behavioral.

Ten Elements of Effective Sexuality Education 6.The program is interdisciplinary and integrated across the curriculum. 7.The curriculum is comprehensive in scope, age-and experience- appropriate, and logically sequential. 8.The program is supported and reinforce by the family, peers, religious groups, reproductive health clinics, and local media. 9.The teachers are willing, comfortable, and well-trained. 10.The program promotes lifelong learning. Evonne Hedgepeth and Joan Helmich,Teaching about Sexuality and HIV:Principles and Methods for Effective Education, NewYork, New York University Press,1996,pp,14-38.

Request from the Adolescents Not only the improvement of the educational system, but also the inclusion of comprehensive, non-judgmental, reliable, youth friendly and responsive to the different needs of young people sexual education in school curricula. These programs should be developed, implemented and evaluated by young people. Such information and education should address gender relations and equality, responsibility for one self as well as for partners; sexuality and freedom of expression

Request from the Adolescents Young people, as all human beings, have the right to experience and fully develop their sexuality, as well as the right to highest attainable standard of sexual education and reproductive health. A good and well planned school curriculum, which must include sexual education, will certainly bring more choices possibilities for the young people. The youth need to be equipped with the skills, tools and knowledge that will enable them to face the future with confidence, responsibility and hope. A good and well-planned school curriculum, which must include sexual education, will certainly bring more choices for the young people.

Adolescents should be actively involved in the planning, implementation and evaluation of development activities that have a direct impact on their daily lives. This is especially important with respect to services concerning reproductive and sexual health.

Sex Education Programs Involving the Adolescents Discussions and activities work better than classroom-type lectures A workshop approach allows young people to explore their own attitudes and feelings and make discoveries for themselves, and gain the confidence to make their own decisions regarding sexual behaviour, including the confidence to delay a sexual relationship until they are ready Plays, songs, radio shows and other popular communication methods are also useful.

Speak to adolescents in their own language and through their own lines of communication such as TV shows they watch, etc. Whenever there were points raised about the specific needs and problems, it must be put forwarded by adolescents themselves.

Adolescents Approach Work with parents, community leaders, teachers, and health care providers to design mutually acceptable approaches to meeting their own reproductive health needs Act responsibly in sexual matters, for their own sake and that of others In sexual situations, respect the rights, wishes, and concerns of others, including use of contraceptives to avoid unwanted pregnancies and of condoms for STD protection.

What is Good Sex Education Building self-esteem and self- confidence Provide the opportunity to acquire accurate information Allowing to clarify attitudes and values and explore potential consequences of decisions they might make Encouraging young people to develop a sense of responsibility for their own sexual health and respect for the feelings, values and well-being of others Enabling young people to develop the communication and personal skills that are necessary for building and maintaining relationships as friend, partner, parent and family member.

Qualifications of Sexuality Educators Untrained sexuality educators often believe that they know more than they do,and do not realize the importance of specialized expertise. Not just adolescents, but educators,need to identify and work through their own attitudes and values, biases and prejudices. Developing expertise in sexuality education takes training,practice feedback, supervision, refresher training, and time.  Providing reference materials to educators on sexuality and sexuality education is a simple, essential step. Sexuality educators must be carefully selected. Not everyone is suitable!

Educators Approach to Sex Education Develop school curricula that give students age appropriate information about reproductive health Train and support teachers so that they can teach about reproductive health and contraception accurately and comfortably Facilitate better communication about sexuality and contraception between students and their parents.

Leaders of Reproductive Health Programs Approach to Sex Education Provide information and services at times and in ways that are acceptable and convenient Remove other unnecessary barriers to services, including limits on access to contraceptives for reasons of age or marital status; Help the mass media inform the public about sexuality and reproduction accurately and encourage the entertainment media to depict sexual behavior responsibly; and Know where to refer young people for more information and health services.  

Leaders of Reproductive Health Programs Approach to Sex Education Establish health care protocols that meet the needs of young adults Be sensitive to the concerns of the community while acting as advocates for meeting young adults’ needs Involve young people in program design, delivery, and evaluation; Train health care providers to offer high quality care to young adults in a nonjudgmental, confidential manner

Results of Sexual Education Increases in sexual knowledge and personal comfort with sexuality Increased tolerance toward the behaviors and personal values of others Delay in the onset of onset of sexual intercourse and increased likelihood of using contraception when individuals do begin having intercourse Increased communication with parents about sexual matters, which correlates with more responsible behavior Increased self-esteem and decision-making skills. Evonne Hedgepeth and Joan Helmich,Teaching about Sexuality and HIV; Principles and Methods for Effective Education, New York:New York University Press, 1996, p.3.

Results of Sexual Education Does not lead to increased sexual activity No evidence that sex education in schools leads to earlier or increased sexual activity in young people Sex education resulted in either delayed sexual activity or decreased overall sexual activity   Access to counseling and contraceptive services did not encourage earlier or increased sexual activity Sex education increased the adoption of safer sexual practices among sexually active youth   Sexuality Education Does Not Lead to Increased Sexual Activity.Press Release,26 November 1993. Geneva: WHO,1993

Sex Education is a Complex Process Gather information Observe the behavior of peers and other people Develop attitudes and values Experiment with behavior Rely on different sources for sex information during different stages of life.

What shall we do now?

IPPF Charter on Sexual and Reproductive Rights, 1996  All persons have the right to equal access to education and information to ensure their health and well-being, including access to information, advice and services relating to their sexual and reproductive health and rights. All persons have the right to access to education and correct information related to their sexual and reproductive health, rights and responsibilities IPPF Charter on Sexual and Reproductive Rights, 1996

IPPF Charter on Sexual and Reproductive Rights, 1996  All persons have the right to sufficient education and information to ensure that any decisions they make related to their sexual and reproductive life are made with full, free and informed consent.  All women have the right to information, education and services necessary for the protection of reproductive health safe motherhood and safe abortion and which are accessible, affordable, acceptable and convenient to all users. IPPF Charter on Sexual and Reproductive Rights, 1996

Family Planning Association of Turkey (FPAT) Runs four model clinics in different cities, and conducts four community-based health service projects for marginal groups and deprived urban communities where there is a high level of unmet need. These projects aim to assist local communities to mobilize their own resources to promote reproductive health care and contraceptive use, and include education programs for women and young girls especially.

FPAT Through its 23 branches, the Association conducts information, education and communication (IEC) activities in urban and rural areas, focusing especially on activities for young people and male involvement, for example, through programs for military conscripts. The FPA has organized young peoples' panels discussions in order to assess priorities in sex education. It runs two youth sexual health projects and has set up a Youth Group. The FPA broadcasts a weekly radio and TV programs `Healthy Family - Happy Society', with audience feedback.

There is a great difference in sexuality between boys and girls? norms and values are given to sexuality. Norms and values influence policy and programs, leading to more inequality and discrimination against women.

Maybe make it a serious class you need a grade in, in order to graduate, to make it really mean something. It may be opposed in some places, like by religious organization not letting this information come through, but then special programs could be establish by government to oversee the implementation of sex education, so that it's done right. Maybe a law was passed, but not enough is being done to make it happen. Keeping information from young people is very dangerous.