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Breaking the Awkward Silence Around Sex Education

Maternal disorders are the leading cause of death for young women. Experts say teaching children about sexual health and reproductive rights can help reverse that trend and contribute to gender equity.

Written by Christine Chung Published on Read time Approx. 5 minutes
Pakistani students from poor families attend a makeshift school set up by an NGO in Islamabad’s slums. Insufficient resources, low school attendance and untrained teachers all make it harder to get comprehensive sexuality education to more young people around the world.AP/B.K. Bangash

With more than 40 percent of the global population under the age of 25, the world now has the largest generation of young people ever.

There are lots of reasons to celebrate this youth explosion, including the promise it holds for the future of the workforce. It could also bode well for global health statistics a few decades from now, since we know that so many health outcomes later in life are determined by the choices that people make when they are young. “Adolescence is arguably the last best chance to build positive health habits and limit damaging ones,” the Population Reference Bureau notes.

But it’s impossible to make healthy choices without the right information, and the surge in young people exacerbates a challenge the health community is already wrestling with: the lack of comprehensive sexuality education. That means going beyond the fundamentals of sex and reproduction to teach young people about the issues surrounding sex, such as gender identity, relationships, personal rights and the emotional side of growing up.

According to a recent Lancet article, HIV/AIDS – along with road injuries and drowning – was among the leading causes of death in 2013 for young people aged 10–14 years, while for girls and young women, maternal disorders were the highest cause of death for those aged 20–24 years.

UNESCO reports that young people account for almost 50 percent of new HIV infections, and in sub-Saharan Africa, young women aged 15–24 are twice as likely as men in the same age range to be living with HIV. Globally, only 34 percent of young people can demonstrate accurate knowledge about HIV prevention and transmission.

Experts say there’s clear evidence that comprehensive sexuality education has a positive impact on sexual and reproductive health, for starters by reducing unintended pregnancy and sexually transmitted infections including HIV. And young people themselves have been instrumental in the movement for ensuring universal access to sexuality education – one reason why the issue features prominently in the United Nations’ Sustainable Development Goals for 2030.

So why are so many young people still not getting accurate, unbiased information about their sexual health?

“The reason for resistance is discomfort with adolescent sexuality,” says Dr. Venkatramen Chandra-Mouli, an expert in adolescent sexual and reproductive health at the World Health Organization (WHO). “Many people believe that adolescents shouldn’t be having sex before marriage. And they believe that sexuality education promotes sex before kids are ready. It cuts across all countries and all regions.”

Studies show that one of the main criticisms against sexuality education is unfounded: Providing young people with information about their bodies does not encourage them to have sex before they are ready. Instead, it helps them make more responsible choices whenever they do decide to engage in sexual behavior. Before the U.K. launched a nationally led sexuality education program in 1999, the country had the highest teen pregnancy rate in Western Europe. By 2013, its under-18 birth rate was down by 56 percent.

And the potentially damaging effects of denying young people information on sex and the issues around it, especially for girls and young women, are clear. About 16 million girls aged 15–19 give birth every year, and adolescent girls and young women make up 40 percent of all unsafe abortions worldwide, meaning many of them experience unplanned or unwanted pregnancies.

“Policymakers should be encouraged to start sexuality education at puberty for both girls and boys, so that they can understand the changes in their bodies and to learn about physically and emotionally respectful relationships,” says Chandra-Mouli.

There are already NGO programs working to deliver that education in some countries, like Grow and Know, which provides adolescents with age-appropriate books on puberty in Cambodia, Ethiopia, Ghana and Tanzania, but, “We need to move beyond small-scale boutique projects to big government-supported programs,” says Chandra-Mouli. “We need leadership.”

Even in culturally conservative countries, there are ways to get vital information about sexual health to young people. One example is Pakistan. The country has a high incidence of early marriage and pregnancy, low use of contraception and high prevalence of unsafe abortion. Young people in Pakistan have relatively little knowledge about sexual and reproductive health issues, a problem that cuts across class lines, with 44 percent of young women in middle-income families in Karachi reported to lack understanding about reproductive organs and normal physiology.

From 2004 to 2013, Rutgers WPF Pakistan, a Netherlands-based organization supporting sexual health and reproductive rights, collaborated with a number of local NGO and government partners to implement and scale up sexuality education in schools. The program, which was called Life Skills Based Education, reached a total of 312,807 students in 1,188 schools.

Throughout the program, the group modified the curriculum and modalities according to feedback from the community, including parents, teachers and school heads, and religious and community leaders. It turned out that Qur’anic references in the curriculum were important to the community, so the program was adjusted accordingly. And the organizers figured out that sexual and reproductive rights-related topics were more acceptable if healthcare professionals rather than teachers presented them. But at its core, the program maintained a focus on self-awareness, puberty, averting risks and peer pressure, decision-making and sexual and reproductive rights.

The program had a degree of success. Some girls were able to convince their parents to let them to stay in school and postpone marriage, while others were empowered enough to avoid or end sexual abuse. But in many parts of the world, a program taught in schools will reach only a portion of the young population. In Pakistan, for example, some 30 percent of children never attend school, while many children, particularly girls, drop out early.

Even within a school context, according to the UNFPA, the challenges to delivering sexuality education are the same as those for delivering education in general. These include low attendance rates, insufficiently trained or supported teachers, and large class sizes. At the same time, communities and schools don’t operate in a vacuum, so these places also have problems with gender-based violence and require policies and practices to address discrimination, bullying and behavioral problems.

And even if young people do get much-needed information on sexual health, many countries have laws and policies that make it hard for them to implement what they’ve learned. For example, some countries’ laws prohibit anyone under 18 from accessing services like HIV testing. Young people can also have trouble accessing health services, including sensitive counseling and affordable family planning methods. And in many places, all over the world, there are still powerful cultural and religious taboos against talking about sexuality and reproduction.

The importance of sexuality education isn’t just about tackling illness and preventing unwanted pregnancies in the largest generation of young people ever. It’s also about teaching those young people how to protect their sexual and reproductive rights, and how to respect those rights in others. “This is the time for equitable gender norms to be entrenched in the hearts and minds of young people,” says Chandra-Mouli. “Abusive patterns begin early.”

This version corrects an earlier version of the story.

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