Comprehensive Sexuality Education - Rutgers
Arthur van Schendelstraat 6963511 MJ UtrechtP.O. Box 90223506 GA UtrechtThe Netherlands 31(0)30 231 34 tgers.nlUtrecht, December 2018Authors: Maeva Bonjour & Ineke van der VlugtProject number: AA3047SE Rutgers 2018Comprehensive SexualityEducationKnowledge fileBIC ABNA NL 2AIBAN NL18 ABNA 0496 3238 22
Index2Comprehensive Sexuality EducationRutgers 201811.11.21.2.11.2.21.31.41.5IntroductionWhat is meant by sexuality education?Several approaches to sexuality educationComprehensive sexuality educationOther approaches to sexuality educationSettings for CSESexuality education in a historical viewPolicy on CSE3333456622.12.22.32.4Principles and goals of CSEPrinciples of CSEMain objectives, goals or outcomes of CSERelevant topics in CSERights based 53.4Quality implementation of CSELegal basis and level of implementationStudies on impact of CSEEvidence-based conditions for quality of CSEProgramme fidelityThe content and approachThe educatorThe learnerThe learning environmentGuidance for CSE programming131313141516171819214Conclusions and challenges for the future255References27
1IntroductionIn this white paper we give an overview of the current state of sexuality education with a focus onEurope and developing countries. We start in chapter 1 with a short introduction on the definition ofsexuality and sexuality education and will address several views on and approaches to sexualityeducation worldwide and the current international policy. We mainly focus on comprehensivesexuality education (CSE) in schools, although we realise that the scope of sexuality education isbroader (for example community based interventions, online information, education by youthworkers, etc.). In chapter 2 we start with a short history of CSE. Subsequently we present the coreobjectives, the main content and will describe the main settings, and working within multicomponentapproaches. In chapter 3 we focus on the quality, evaluation and implementation process of CSE andeffectiveness. Finally in chapter 4, we end with some conclusions and challenges for the future.1.13What is meant by sexuality education?During the process of growing up, children and adolescents gradually acquire knowledge, values,attitudes and skills related to the human body, intimate relationships and sexuality, often referred toas sexual development. Sexuality education aims to support and protect children and young peoplein their sexual development, for them to benefit from global innovations while being critical towardsuntrue, misleading (online) information and capable of handling contradicting messages on sexualityand relationships.Ideas on the age at which sexuality education should start are also very different. Most of thecountries start with sexuality education from 12-14 year of age or older. In some Western Europeancountries like the Netherlands, Denmark, Norway, Germany and Belgium, they start at a younger age:from 4 or 5 years of age onwards. In some countries, the term ‘relationships and sexuality education’is preferred.Rutgers interpretation of ‘sexuality education’ is based on, among others, the definitions by the WHOand UNESCO. Rutgers sees sexuality education as a lifelong learning process about the cognitive,emotional, social, interactive and physical aspects of sexuality. It gradually equips and empowerschildren and young people by acquiring information and forming positive beliefs, values and attitudesabout identity, relationships and intimacy, and by supporting them with skills to be able tocommunicate and make their own decisions in the area of sexuality, sexual health and wellbeing.Sexuality education helps young people to understand and enjoy their sexuality, have safe, mutual,caring and fulfilling relationships and take responsibility for their own and other people’s sexualhealth and wellbeing.1.2Several approaches to sexuality education1.2.1Comprehensive sexuality educationRutgers’ sexuality education programmes, and many others around the world, choose acomprehensive 1 approach in which sexuality is put in a wider perspective of personal growth,development and building up mutually consensual (sexual) contacts and relationships.1 Insteadof comprehensive the term holistic has been used also.Comprehensive Sexuality EducationRutgers 2018What is understood as sexuality education differs across countries and programmes. Very often,sexuality education is interpreted through a narrow understanding and strongly focussed on sexualcontacts. In some programmes they use the term ‘sex education’, which focuses primarily on thebiological characteristics and subjects such as sexual anatomy, reproduction, birth control anddisease prevention. WHO regional Office for Europe/BZgA and UNESCO both have formulatedbroader definitions for sexuality education (WHO & BZGA, 2010; UNESCO, 2018).
4Comprehensive Sexuality Education (CSE) is characterised by a positive approach to sexuality 2 thataccepts sexual feelings, desire and pleasure as essential components of young people’s sexuality(IPPF, 2017; WHO & BZgA, 2010). CSE is strongly linked with empowerment, gender equality and arights based approach, and with putting children and young people at the centre of the education.CSE is aimed at enhancing well-being, and therefore strives to achieve ideal experiences, rather thansolely working to prevent negative experiences. CSE acknowledges and tackles the various concernsand risks associated with sexuality, but without reinforcing fear, shame or taboo of young people’ssexuality and gender inequality (IPPF, 2011).CSE addresses not only physical, emotional, social and cultural aspects, but it also includes aspectslike friendship, feelings of safety, intimacy, gender, security, pleasure and attraction. Comprehensivesexuality education is not value free; it promotes values such as gender equality, dignity, respect forothers, awareness of sexual and reproductive rights and freedom from discrimination, exclusion andsexual violence (IPPF, 2017; WHO & BZgA, 2010).CSE is grounded in young people’s right to be informed. Based on the United Nations Convention onthe Rights of the Child (UN, 1989; IPPF, 2016a), sexual rights have to be seen as human rights relatedto sexuality, which encompasses the right for everybody to be informed and to have universal accessto comprehensive sexuality education (IPPF, 2008). All people are born as sexual beings 3 and haveto develop their own sexual potential and identity. Comprehensive Sexuality Education helps toprepare children and young people for building and maintaining satisfactory and consensual (sexual)relationships, now and in the future. CSE should therefore start long before young people becomesexually active. CSE starts often at a young age taking in account the needs and developmentalphases in a live time approach. In this document we will only focus on CSE during childhood andadolescence.Comprehensive Sexuality EducationRutgers 20181.2.2Other approaches to sexuality educationIn many societies, expression of sexual feelings or sexual activities are not allowed or even forbiddenbefore marriage, due to religious and cultural reasons. Therefore comprehensive sexuality educationfor unmarried young people is seen as not necessary or is forbidden even. In those societies,sexuality education is often based on an ‘abstinence only approach’ that aims primarily or exclusivelyat abstaining from sexual intercourse before marriage. The focus in these programs is particularly onself-discipline and restraint to abstain from all sexual activities. This is a strongly normativeapproach in which sexuality among youth/adolescents is not accepted or tolerated and should berepressed. Rutgers is very critical of these approaches. First, they neglect the realities of adolescentlives. Secondly, abstinence only programs are shown to not be effective, and even harmful to youngpeople who are already sexually active, who are LGBTQ, or have experienced sexual abuse. (Kirby,2007; Underhill et al., 2007; UNESCO, 2009; Fonner et al., 2014; Santelli et al., 2017; SAHM, 2017).Another category of sexuality education programmes uses a ‘risk prevention approach’, aimedparticularly at problem solving or disease prevention. These programmes strongly focus onpromoting contraception use and safe sex practices in order to prevent sti/hiv and unintendedpregnancies. This approach uses a strong negative approach to sexuality, emphasising only therisks. They find their roots in the fact that sexuality has long been perceived as a threat to people’shealth. In the 1980’s, after the sexual revolution, countries were confronted with a high rate of STIsand unintended pregnancies. Therefore sexuality education fulfilled the highly needed function ofsexual health promotion and was primarily aimed at preventing sexual diseases.Since Rutgers adheres to the comprehensive approach, the rest of this paper focusses on CSE.2A ‘sex-positive’ approach in CSE recognizes that all people are sexual beings with sexual rights regardless of their age,gender, religion, sexual orientation, HIV-status or (dis)ability. ‘Sex positivity is an attitude that celebrates sexuality as anenhancing part of life that brings happiness, energy and celebration.’ (IPPF, 2011).3 ‘Being born a sexual being’ refers to the perception that sexual development starts from birth (or even conception) andthat every individual has its sexuality right from the starts. ‘Being a sexual being’ does not equal ‘being sexually active’:also individuals who have never been sexually active, are sexual beings.
1.3Settings for CSEComprehensive Sexuality Education is defined as a structured, curriculum based education. It can beprovided in formal settings and non-formal settings (IPPF, 2017). Formal CSE occurs in an educationor training institution, and provides structure in terms of learning objectives, learning time/supportand delivery which can, but doesn’t have to, lead to a recognized qualification. In school, this can beimplemented as part of school curriculum or other activities within the school timetable. Out-ofschool examples are courses provided by institutions, health services, social service agencies, NGOs,juvenile detention agencies, work preparedness programmes, employers, etc. Formalized in-schoolCSE is well placed to reach a majority of the target group (WHO 2010; UNFPA, 2015; UNESCO, 2018).There is a growing emphasis that young people need formal sexuality education to complement theinformal sexuality education at home or informal learning from peers. By learning about ageappropriate topics related to sexuality together with their peers in a structured and safe environment,children and young people gain specific knowledge, attitudes and skills they most often not gain athome.By definition, CSE rules out most education provided in family setting or individual learning throughbooks, magazines or online media, such as discussion platforms, education games and websites.These forms of information gathering and learning opportunities are dependent on individual actions.It is therefore more difficult to structure and thus not included in the CSE definition. However, onecannot overestimate the importance of the individual supportive role by parents/caretakers. Theycan show trust and maintain a mutually respectful dialogue with their children in a safe environment.A warm and supportive parenting climate at home can contribute to healthy choices at a later stage(De Graaf, 2012). That is why it is important that parents gain the necessary knowledge and skills toadequately accompany their children during their (sexual) development into adulthood, and why CSEprogrammes should always involve parents/caretakers. During life time young people interact alsowith partners, peers and media in an online world. Young people learn from and intersect withdifferent sources. They explore and experiment with relationships and sexualised contacts, and learnfrom these experiences. They are actor themselves in shaping the process of meaning and will actand reflect on it in an interactive and dynamic way. The online world provides another increasinglyimportant channel for young people for their development of knowledge, attitudes and skillsregarding sexuality, that can form a very relevant complement to CSE. In 2017, the IDS Bulletindedicated an issue to digital and online sexuality education, providing a range of articles from aroundthe globe on this topic. In the introduction, the editors argue that there is both need and opportunityto create new types of digital sex education environments that are realistic, emotionally attuned, nonjudgemental and open to the messages young people themselves create, which are accessible andyouth-friendly (e.g. in local language). The editor stress the urgency of developing digital literacyskills for academics and practitioners: Sex educators cannot help build such environments until theyunderstand how they work. They face the immense power of new supranational commercial digitalgatekeepers such as Facebook and Google and must respond to digitally mediated sexual andgender-based violence. Online sex educators thus find it hard to gather the information they need inorder to design outreach strategies to provide target groups with realistic, healthy and supportive sexeducation environments. More and better collaboration with online gatekeepers would be helpful(Oosterhoff et al, 2017).Comprehensive Sexuality EducationRutgers 2018Non-formal CSE is an extra-curricular educational group activity implemented in a voluntary learningenvironment. It is structured in terms of learning objectives and time/support. In school, this canoccur in school clubs, during special class periods, or after school-time, etc. In the out-of-schoolsettings, these forms of CSE occur through community-based clubs, sport clubs, NGO youth groups,churches or religious settings, community meeting points, hairdressing salons and taxi drivers, etc.Non-formal CSE programmes should not be underestimated, as they can complement an existing inschool curriculum and reach the out-of-school children and youth, who are particularly vulnerable toexclusion, misinformation, coercion and exploitation (UNESCO, 2018). However, to narrow the scopeof this white paper, we mainly focus on CSE in formal, in-school settings.5
1.46Sexuality education in a historical viewSexuality education has a long history in most of the Western European countries, US and the globalSouth. Sexuality education has been developed by responding to emerging issues in the society. Theattention to sexuality education is constantly being influenced by norms and values on sexuality andyoung people and the current political climate in a country.Globally, in the 20th century, sexuality education started as “Education, Information andCommunication” with names such as Family Life Education, Population Education, Life SkillsEducation. Stimulated by institutions such as the UNFPA, (inter)national NGOs developedinterventions, mostly based on temporary mass media campaigns on specific topics, but sometimesalso developing courses for schools as well. These interventions were mostly aimed at behaviourchange regarding reproduction. With the increased attention for adolescent health and the rise ofHIV/AIDS in the ’80, educational programmes in school focussing on health related behaviourchange increase rapidly in number. In the ’90, a broader vision on SRHR and thus sexuality educationemerged and the attention for adolescents and young women in particular increased further. Thisresulted in the formulation of more progressive and comprehensive international declarations aroundsexuality, reproduction and gender, at events like the International Conference on Population andDevelopment in Cairo in 1994. This was picked up by (inter)national NGOs and donors, and morecomprehensive and rights-based sexuality education programmes started to be developed. However,it was only in 2009 that UNESCO published its Technical Guidance on Sexuality Education, providinga first elaborate international standard for sexuality education.Comprehensive Sexuality EducationRutgers 2018In Europe and the US, sexuality education as a school curriculum subject, has a history of more thanhalf a century. It officially started in Sweden in 1955 followed by many more Western Europeancountries in the 1970s (like the Netherlands) and 1980s and Eastern European ones in the 1990s and2000s.During the 1970s and 1980s formal Sexuality education in schools in Western Europe largelycoincided with the introduction of the contraception pill and the legalisation of abortion. Theemergence of HIV/AIDs in the early 80s emphasises the need of sexuality education on safe sex andusing condoms. In the 1980s, more and more women and girls reported experiences with sexualcoercion and sexual violence. It took at least a long time before prevention of sexual violence wasintegrated into sexuality education programmes. In general, most of the CSE programs focussed onprevention of STI and teenage pregnancy. In the last decades in particular in the North Westerncountries, responding to a more liberal climate and the changing online world, sexual pleasure, onlinesexual behaviour like sexting, grooming and pornography is more and more embedded in sexualityeducation programs.In the United States in the late 1990s and early 2000s, during a more conservative climate, fundingfor abstinence until marriage programs began to increase: 1.5 billion of dollars was spent in the USfor promoting abstinence only programs. Recently again (during Trump period) funding by the US forNGO’s, abortion services and sexuality education programs in the US and worldwide went downconsiderably.In many countries around the world, amongst others Pakistan, Indonesia, Hungary, Burundi, Ugandaand Brazil, the space for civil society is shrinking and opposition to CSE growing. This calls forreflection on how the language and imagery used in public debate shape people’s stances on CSEand how the values and objectives of CSE can be explained in ways that engage people and mobilizesupport for progressive long-term social change.1.5Policy on CSEGovernments have committed to ensure adolescents’ and young people’s access to sexual andreproductive health information and education, including comprehensive sexuality education in alarge number of international and regional resolutions. The formulations are diverse but captureoverlapping aspects of CSE. Relevant paragraphs from international agreements, instruments and
standards that are of relevance to comprehensive sexuality education are quoted in appendix 1 ofthe UNESCO International Guidance on Sexuality education (UNESCO, 2018). The most importantones are:4 http://www.unfpa.org/sdgand sustainable-development.5 On the Fast Track to Accelerating the Fight against HIV and to Ending the AIDS Epidemic by 016/2016-political-declaration-HIV-AIDS6 ?NewsID 17168&LangID E7Comprehensive Sexuality EducationRutgers 20181. The Programme of Action of the International Conference on Population and Development andthe Commission on Population and Development (CPD) : PoA para 7.41: “the response of societies to the reproductive health needs of adolescentsshould be based on information that helps them attain a level of maturity required to makeresponsible decisions” and “information and services should be made available to adolescentsto help them understand their sexuality and protect them from unwanted pregnancies, sexuallytransmitted diseases”. CPD resolution 2013/1 OP11: “ensuring the access of adolescents and youth to full andaccurate information and education on se
During the process of growing up, children and adolescents gradually acquire knowledge, values, attitudes and skills related to the human body, intimate relationships and sexuality, often referred to as sexual development. Sexuality education aims to support and protect children and young people
historical overview of sexuality education in the modern world. This also includes a brief account of single-sex education in America. The second chapter deals with the Islamic philosophy of sexuality education. It gives some indications about sexuality education during the contemporary as well as the early periods of Islamic history.
Comprehensive sexuality education: same as abstinence-based education. Statement of the Problem The purpose of this study was to examine the difference between comprehensive sexuality abstinence-based education and abstinence
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National Sexuality Education Standards Introduction and Background The goal of the National Sexuality Education Standards: Core Content and Skills, K–12 is to provide clear, consistent and straightforward guidance on the essential minimum, core content for sexuality education that is developmen-
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It is a three stage model in which each state consists of specific skills that the therapist uses to help the client move forwards. By mastering the process of using these basic skills in an appropriate manner (often in a cyclical process of stage 1 - 2 - 3 evaluate 1 - 2 - 3 evaluate) the talking therapist may be able to increase their efficiency and structure their work in a more logical way .
