For young people sex is a thrilling subject. They romanticise it, seeing it as a source of joy, but at the same time they can be very afraid of it. By the age of 16 half of the young folk in the world have had sexual intercourse.
For young people sex is a thrilling subject. They romanticise it, seeing it as a source of joy, but at the same time they can be very afraid of it. By the age of 16 half of the young folk in the world have had sexual intercourse (l). Acknowledging this, parents, educators and health professionals should want to support young people at the beginning of their sexual careers, but instead they often deliver them all kinds of messages, ranging from "do not do it", through "wait until you are married," to "sex is fun as long as you do it in a safe and honest way."
Many young people find their parents, teachers or any other adults for that matter, not very well equipped to talk to them about sexual health. Young people do not want to be subjected to the moralising of adults. To a large extent youngsters share the values of their parents in their attitudes to abortion, sexual intercourse or fidelity, but at the same time their actions are governed by other, external, factors. To begin with they take risks, proceeding through life by trial and error at the same time as they may have to face psychological, family and social problems which can delay their maturity.
Adults often talk about the rebellious, irresponsible behaviour of young people, but this often results from their own ignorance of the conditions inflicted upon youngsters by society, such as a lack of information, poor education or no access to contraceptive services.
Education is an important tool to support and help young people. However clear this may be, there is no agreement on the messages, content and methods of education when applied to sexuality.
Who are these young people?
Before considering educational approaches that teach sexuality to young people, it is important to understand what I mean by "youth". Although internationally the term "adolescent" is frequently used, I believe it might be more appropriate to think in terms of "youth" or "young people". The word "adolescent" only refers to those who fall within the age range that spans puberty. Yet, to support young people effectively in their sexual development, action must be undertaken both before and after the child reaches puberty. Some young people are already involved in sexual activities before they reach puberty while others wait until their mid twenties. I would therefore like to refer to the age group between 10-24 years old. Obviously children of 10, adolescents of 16 and youngsters of 22 do not face the same problems, nor do they possess the same degree of understanding and self-expression. There are also big differences in the standard of education and socio-economic environments between young people. Maybe even more important is the influence of gender. There are big differences between what young boys and girls believe is to be gained from a sexual relationship, when expressed among themselves, as well as those differences perceived for them by adults. In the context of sexuality, gender is obviously a powerful force and it should be harnessed to form the basis of sound education in sexual health and safer sexual practices.
We know that in most Western industrialised countries young people start their sexual life around 16-17 years (2). Studies from Africa and Latin America have reported increased percentages of "unmarried" young adults who are sexually active (3).
Reports also show that, in Western industrialised countries, the level of knowledge about contraceptive methods, STD's and AIDS is rising. There are many signs indicating that young people are intending to improve their preventive behaviour. But it is also clear that knowledge and awareness are not always translated into safe behaviour (4). Additional factors determining behaviour are peer pressure and the individual's perception of the meaning of sexuality.
The reasons why young people do not use contraceptives or practice safer sex have been identified as:
Studies from the Netherlands show that there are four important factors that control the use of contraceptives by young girls. Firstly, teenagers need to be educated concerning sexuality, sexual relationships, fertility and contraception. Secondly, they should be motivated to prevent pregnancy and not to take risks. Thirdly, they require communicative skills and self confidence to discuss the need for prevention with their medical advisor and with their partner. Finally, they should have easy access to contraceptive services.
These studies show that the quality of their relationship with their partner, the level of their feeling of self esteem and the control they have over the relationship, determine whether young people will engage in safer sexual techniques or use preventive measures (5). Education should therefore focus on the development of self empowerment and the ability to cope with social norms and pressures. After the transfer of knowledge, education should place emphasis on a discussion of attitudes to social norms and values, as well as upon an understanding of the importance of communication skills. In this way young people can be guided to set realistic goals and make the right decisions in life.
There are still many obstacles that prevent the teaching of sexual health issues to young people. There is a shortage of trained and skilled professionals. There is a great dearth of suitable teaching materials. In some countries there are still legal constraints to providing educational materials and contraceptives.
Sex education in schools
In Europe, public opinion is generally in favour of sex education but in reality sex education in schools often falls short of expectation. Only in a few countries, like Denmark, Portugal and Sweden is sex education well integrated into the school curriculum (6).
School-based programmes are delivered either through formal curricula or as part of extra curricular activities. Formalised sex education is developed through the introduction of guidelines and curricula. Some countries have extended their programme beyond the school setting to include parents and out-of-school projects in their activities. Most education on sexual and reproductive health starts in secondary schools but there is a move towards introducing these subjects at an earlier age, in primary schools or even in the pre-school years.
Recently Kirby (7), reviewed several school based sex education programmes. His study showed a variety of approaches, ranging from the promotion of sexual abstinence to the dispensing of contraceptives. It was found that most programmes are inadequately evaluated. Only a few of the programmes produced promising outcomes. According to this overview five groups of sex education programmes have emerged:
The advantage of school-based sex education programmes is that large numbers of young people can be included. There are, however, also disadvantages to this approach. For many schools it is difficult to reach a consensus on the attitude and content of the programmes, so many are restricted to the transfer of biological and medical information.
Examining the content of the various programmes, one can see that many of them are confined to the medical aspects of sexuality and reproductive health. The programmes often concentrate on technical information rather than addressing the sexual behaviour of the young, their aspirations and how to handle learning experiences. There are also programmes which try to integrate all these aspects into the larger context of life styles and health education. Some recent initiatives concentrate on one particular issue like AIDS, the prevention of sexual abuse or self empowerment.
The following topics are covered in most programmes:
The topics that are rarely covered are:
Effective sex education in schools should be based on a student centred approach. It requires a clear and sensitive insight into behaviour, and the use of teaching techniques such as participatory and experiential learning, which are often quite new for the teachers. School based programmes should be part of the school programme in general and should not be delegated to only one teacher or to an outsider. Correctly used they seem to be an effective way to deliver sex education, however, it is equally clear that a lot of time and effort must be deployed to train and support the teaching staff.
Sex education outside schools
The out of school strategies range from mass media activities to community based programmes.
Young people love mass media entertainment, all of it - radio, television, music, film, comic books, the lot! The entertainment media love young people. Love, romance and sex are the stuff of entertainment. Many young people say that it is from these sources that they learn about sex, although what the young see and hear about sex in this type of entertainment is often misleading, incomplete and distorted (8).
Only in the Nordic countries are there specialised television and radio programmes on sexuality designed for young people, to help them to protect themselves by the adoption of safer sexual practices.
Community based programmes
The advantage of community-based sex education programmes is that they can reach young people who do not attend school regularly. They can also address certain matters more openly and explicitly. They can be directed to the specific needs of different target groups.
In addition to giving information these programmes aim to encourage discussion on emotions, and attitudes towards safer sexual practices and to develop decision making and communication skills. They also help young people to adopt safer sexual practices.
Young people are not a homogeneous group. They have differing needs concerning sex education which must be recognised. Recently some new issues have arisen and new groups have developed in community-based programmes for young people. One new issue is gender. Although it is not acknowledged by all educators, gender plays an important role in the sexual behaviour of young people as young men and young women have different views, attitudes and aspirations towards sex. In the past, priority was given to girls in many programmes, sometimes unconsciously, especially in regard to self-empowerment and self-esteem. Now it is becoming clear that self-esteem is equally important for young men. Both young men and young women need to explore their attitudes and feelings towards sexuality and towards one another in order to enable them to define sexuality on their own terms, while at the same time developing a proper regard and respect for the feelings of their partner.
Sexual orientation is still neglected in many programmes. The Nordic and Western European countries show a more positive attitude towards young people who engage in homosexual contacts, but despite this only a few programmes show an integrated or lifestyle approach.
Sexual abuse has also been a recent inclusion into sex education. Although in the more traditional programmes this problem is not given prominence nor seen as an important subject in adolescent education, we now know that much more sexual abuse occurs to young people than is reported. Sexual abuse can profoundly affect self-image. Those programmes which are now emerging to tackle this problem are mainly to help girls. Young men are left out again. In the Netherlands an educational programme for young sex offenders has proved to be very effective(10).
There are still many young people in society who are at risk and have special needs, for example young people who are drug abusers or juvenile delinquents. Very few programmes address the requirements of these youngsters. All young people whose rights of sexual self expression are denied deserve our sympathy, understanding and help, including those with mental or physical disabilities, who should have the same rights to sex education as their normal peers. Some countries like Sweden, England and the Netherlands have started to include these persons in suitable programmes.
The role of young people
A recent advance in the sex education programmes is the development of peer-led programmes, especially in the area of HIV/AIDS.
It is still not clear what the impact of peer education programmes will be. Evaluation of them must be a priority. The importance of involving young people as educators and counsellors is self evident, but in many countries in Europe this approach is used only because the actual cultural and social setting is not understood by professional educators and health service providers. This is especially so when it concerns sexual health and AIDS education. Some professionals like to believe that young people are a "hard to reach" group. Hard to reach by whom: by well educated, middle class, often elderly and staid professionals?
It is important to define the degree to which young people are involved in planning, implementing and evaluating these programmes and activities. There is more to participation than simply involving young people in education and counselling programmes, as is so often seen in "youth to youth" projects. Participation must have empowerment as its objective. In 1969 Arnstein developed a so called "participation ladder" (9) starting with "unreal participation" - activities in which young people play a role but have no influence. Most youth activities include this form of participation. Then the rungs progressed through manipulation, decoration, and tokenism. The more attention that is given to the freedom to choose and the taking up of self-constructed initiatives, the higher one goes up this ladder of participation. The highest step of the ladder is reached when the initiative is taken by the young people themselves. At this point they assume ownership, designing the content and objectives of the programme on an equal footing with participating adults and professionals.
Considering the programmes with their different approaches, settings and strategies we can draw some conclusions:
Finally, education is just one of the ways to support young people in their fascinating journey of discovery. It is most important that we help them to make this journey safely by taking their needs, their feelings and their sexuality seriously: we must give them the stability and confidence they crave.
1. Trends in Adolescent Fertility and Contraceptive Use in the Developing World. U.S. Bureau of the Census Report IPC/95-1 U.S. Government Printing Office, Washington, DC, 1996.
2. Meeting the Needs of Young Adults; Population Reports. Population Information Programme. The John Hopkins School of Public Health Baltimore, USA, 1995.
3. Sexual Behaviour of Young Adults in Latin America. Advances in Population, 1994.
4. Contraception in Western Europe, A current appraisal, Pantheon, Lancs, 1990.
5. Anticonceptie en interactie. J. Rademakers. ICD, Utrecht 1991.
6. School Sex Education: Still a priority in Europe. D. Villar, Planned Parenthood Europe, Nov. 1994.
7. School-based Programmes to reduce sexual risk-taking behaviours. Journal of School Health, 62, 1992.
8. Reaching Young Adults through Entertainment. Population Reports Supplement, Meeting the Needs of Young Adults. John Hopkins Centre for Communication Programmes, 1995.
9. Children's Participation, from Tokenism to Citizenship. Innocenti Essays No 4. UNICEF.
10. Educational Programmes for Young Sex Offenders; D. Braeken, Rutgers Stichting, The Netherlands, 1994.