ippf-choices-2011 by IPPF

From choice, a world of possibilities December 2011

Sexual and reproductive health and rights in Europe

Sexuality Education in Europe and Central Asia

Developments in Western Europe IPPF and Comprehensive Sexuality Education Sexuality Education in Central and Eastern Europe

Contents

The International Planned Parenthood Federation is a global service provider and a leading advocate of sexual and reproductive health and rights for all. We are a worldwide movement of national organizations working with and for communities and individuals. We work towards a world where women, men and young people everywhere have control over their own bodies, and therefore their destinies. A world where they are free to choose parenthood or not; free to decide how many children they will have and when; free to pursue healthy sexual lives without fear of unwanted pregnancies and sexually transmitted infections, including HIV. A world where gender or sexuality are no longer a source of inequality or stigma. We will not retreat from doing everything we can to safeguard these important choices and rights for current and future generations. The IPPF European Network is one of IPPF’s six regions. IPPF EN includes 41 member associations in as many countries throughout Europe and Central Asia.

Cover photo: © IPPF EN/ Marie Lenoir/Republic of Macedonia 2010 Editor Published in December 2011 by IPPF European Network The articles in Choices do not necessarily reflect the opinions and policies of the IPPF European Network. Photo Disclaimer IPPF European Network is a signatory to the CONCORD European-wide NGO Code of Conduct on the use of photographs and images and is committed to upholding its principles. The photographs used in this publication are for illustrative purposes only; they do not imply any particular attitudes, behaviour or actions on the part of any person who appears in the photographs. © IPPF European Network Design www.inextremis.be

Editorial 3 Introduction Sexuality Education in Europe

Developments in Western Europe Developing Standards for Sexuality Education in the European Region

Sexuality education in Sweden – an experience of more than half a century

IPPF and Comprehensive Sexuality Education Sexuality Education in the radar again!

Let’s (not) talk about sex – Sexuality Education in Central and Eastern Europe

Is straightforward sexuality education possible in Poland?

Republic of Macedonia – the Minister said No to Sexuality Education and No to contraception 15 Health and sexuality education in Bulgaria – Things seem brighter after all!

Thoughts from a Teacher

Activities of Member Associations Belgium - Flag system, talking with children and young people about sex and unacceptable sex

Ukraine - Improving Sexuality Education in Ukraine

Resources

Editorial Dear readers, I vividly remember the days when sexuality education was limited to information on contraceptives. We would go to secondary schools with a little suitcase containing all types of modern contraceptives, or at least those that were on the market and this was defined by the pharmaceutical companies who made their decisions based on their possible market share. The contraceptive suitcase was the only thing we had and in most cases it was doctors or nurses working in the family planning clinics who did the explanation. Not really attractive for 16-18 year olds and, also in that time, most probably far too late for many of them. This approach was usually completed by the biology teacher who explained in a rather dry and scientific way what reproductive organs looked like and where you could find them. Like a roadmap to an alien country, definitely not something young people would connect to their own bodies and experiences. In the 80ties a lot of progress in our thinking occurred and sexuality education became, also due to HIV/AIDS, more explicitly related to sexual behaviour and the risks attached to it. The way sexuality education was provided became more interactive and participatory but still very much based on the experience of adults who developed the programmes. The whole set up was directed to the avoidance of unwanted pregnancies, sexually transmitted diseases and, most of all, HIV/AIDS. Having sex was something that was full of dangers and pitfalls and, in the end, young people did not listen anymore because to them sex as such was not the most important problem in their lives. We figured out that young people were most of all in need of guidance on how to start a relationship, what to expect, how to set boundaries, how to talk about the use of condoms or contraceptives. Much more intimate questions were in the centre of their needs. This recognition then led to developing what we call now comprehensive sexuality education. It is quite a complicated terminology but in fact it means that all aspects of life skills education are included: how boys and girls are constructed, how they are thinking about relations and sexuality, sexual identities including gay, lesbian, bi-sexual and transgender, defining what one wants and how to say no, gender based violence,

contraception, hygiene and prevention but also love and respect in relationships. I have always been convinced that sexuality education, even its simplest form, makes young people more prepared for life and with comprehensive sexuality education, this is certainly Vicky Claeys, the case. It increases self-esteem, the Regional Director ability to take the needs and desires of others into account, the respect of their partner’s boundaries and to strive for a fulfilling sexual life in a promising relationship. However, today sexuality education – whether comprehensive or not – is still not implemented as it should be. There is still a fierce opposition from conservative and religious groups but also from the side of parents who are still convinced that sexuality education is only leading to early sexual activity and promiscuous behaviour. There are a huge amount of scientific studies that are proving the contrary but many parents are afraid and do not recognize that their sons and daughters are sexual beings and will have sex whether their parents like it or not, and this has never been different throughout history. IPPF is committed to comprehensive sexuality education because we are convinced that all young people have the right to be fully prepared to step into real life with all it entails in finding a balance between their personal needs and ambitions and those of the people they will love and eventually start a family with. There is no free option here – if we want the world to be a better world with understanding and respect then comprehensive sexuality education is a good start. We would not like to see our children hitting the road in a fast car without a driving licence; well sexuality education is the driving licence to safe and respectful traffic in love and relations. I hope that this edition of the Choices magazine will provide a contribution to a better understanding of the contents and benefits of comprehensive sexuality education for the benefit of all our young people. Vicky Claeys, IPPF EN Regional Director

Sexuality Education in Europe

By Evert Ketting

International Sexual and Reproductive Health consultant, and former editor-in-chief of CHOICES and its predecessor, Planned Parenthood in Europe (1989-2001)

look at the international literature on sexuality education will immediately give the impression that the United States is the leading nation in this field. Most published programmes, and particularly most of the evaluation studies on the impact of sexuality education originate from there. In a recent overview of such impact studies, reviewed by UNESCO (2009), 47 studies originate from the US, and only 11 from European countries. Most of those 11 European studies are from the UK, and only a handful are from other European countries. Is Europe such a backward continent where sexuality education is concerned? The answer is: No! The reasons why this is hardly visible are, first, that sexuality education is much more accepted in Europe, and therefore there is not that strong need to “prove that it works”, and, second, most of the literature is in national languages and not published in international (English language) journals, and thus hardly visible. In the US, and also in most (other?) developing countries, on the other hand, the issue is very controversial, and dominated by a

heated discussion between advocates for “comprehensive” sexuality education and proponents of “abstinence only” education. That discussion generates a need to demonstrate that programmes don’t produce negative, and do produce positive outcomes in terms of sexual behaviour and sexual health. In Europe, there is hardly a discussion on “comprehensive” versus “abstinence only” education; the preferred term here is “holistic” sexuality education.

How Europe made progress In Europe, sexuality education as a school curriculum subject has a history of more than half a century, which is longer than in any other part of the world. It officially started in Sweden, when the subject was made mandatory in all schools in 1955. In practice, it took many years to integrate the subject in curricula because the development of guidelines, manuals and other educational materials, as well as the training of teachers, took several years. The “Safe Project” (2006) includes information on the development of

SAFE project – developing ways to advance sexuality education

to 14-18 years), of available standards (more than one third of countries do not have sexuality education standards) and professionals responsible for teaching.

Information about sexuality education in 26 European countries was collected and published as part of the SAFE Project: A European partnership to promote the SRH and rights of young people” (financed by the European Commission and conducted by the IPPF European Network, WHO Regional Office for Europe and Lund University). The analysed data confirmed that there is a wide variation in the age when school based sexuality education starts (from 5-6

As part of the SAFE project, IPPF EN published in 2006 “Sexuality Education in Europe: A Reference Guide to Policies and Practices”. This guide was created as a tool to assist policymakers and governments to develop better policies and practices related to sexuality education, as well as helping EU Member States to improve the exchange of information and best practices on adolescent sexual and reproductive health and rights and

sexuality education. In the 1970s and 1980s many other western European countries - besides Sweden - adopted sexuality education, first in other Scandinavian countries, but also elsewhere. For example, in Germany it was already introduced in 1968, and in Austria in 1970. In The Netherlands it also started in the 1970s, although, because of the high degree of independence of schools, it became mandatory only two decades later. The introduction of school sexuality education continued in the last decade of the 20th and the first one of the 21st century, first in France, the UK and some other western European countries, and later on gradually in southern European countries, notably Portugal and Spain. Even in Ireland, where the power of the Catholic Church has traditionally been a very strong opposing factor, sexuality education has become mandatory in primary and secondary schools in 2003. Only in a few ‘old’ EU countries, like Italy and Greece, has sexuality education not yet been introduced in schools.

sexuality education. The guide is the first to describe the situation in Europe in more quantative terms, and that can be used to give at a glance data and comparisons between countries. IPPF EN is planning an update of the publication as part of the SAFE II project which is a 3 year project (2009-2012) co-funded by the European Commission. The project deliverable will be a baseline youth SRHR policy assesment in 18 countries which provides an overview of youth SRHR policies in 18 Europe countries in relation to general government policies, comprehensive sexuality education, access to SRH services and access to safe abortion services.

a result, Central and Eastern European countries started with sexuality education, as is currently understood and practised in most countries, 20 or 30 years later than Western Europe, and only in some of them, most notable the Czech Republic and Estonia, a serious start has been made in developing these modern types of sexuality education, as being different from Family Life Education. In several other Central and Eastern European countries, this development recently slowed down because of new conservative tendencies, partly inspired by re-emerging religious influences in the public domain, and also by demographic concerns (Russia).

Sexuality Education in Europe: A Reference Guide to Policies and Practices. London: IPPF EN, 2006. http://www.ippfen.org/ en/Resources/Publications/Sexuality+Education+in+Europe.html

In 2009, the WHO Regional Office for Europe and the German Federal Centre for Health Education ( BZgA) started an important initiative by bringing together

sexuality education specialists from various European countries to develop a common framework for sexuality education in Europe. This Working Group has been the first European-level attempt to build on, and integrate the vast experience that is available in Europe. This resulted in a publication called “Standards for Sexuality Education in Europe” (2010), which provides a systematic overview of learning needs by age, for young people up to age 18. These “Standards” (further explained in the following article) make a strong case for “holistic” sexuality education, which means that sexuality should be approached as a positive human potential (and not in the first place as “a problem”) and that it should be firmly based on internationally accepted human rights, in particular the right to information.

Most western European countries now have national guidelines or minimum standards for sexuality education, and in several of them it has been made mandatory, but until very recently no attempts had been made to recommend standards at the European or EU level. In Central and Eastern Europe, the development of sexuality education basically started after the fall of communism. Before that, there have been some initiatives in a few countries, but, in retrospect, those can hardly be called “sexuality education” initiatives. These mostly were “preparation for marriage” or “preparation for the socialist family” initiatives, that denied the fact that young people gradually develop a strong interest in love relationships, and even more the fact that they could be sexually active before marriage. Preparation for sexuality was hardly ever discussed. Most of these curricula were called “Family Life Education” or “Preparation for Parenthood Education”, and, in some of these countries, this is still the case. As

Working Group on Standards for Sexuality Education in Europe/© E. Ketting

References: Federal Centre for Health Education and WHO Regional Office for Europe (2010): Standards for Sexuality Education in Europe. A framework for policy makers, educational and health authorities and specialists. Federal Centre for Health Education, Cologne. IPPF EN (2006): Sexuality Education in Europe: A reference guide to policies and practices. The SAFE Project. Brussels. UNESCO (2009): The rationale for sexuality education: International Technical Guidance on Sexuality Education, Vol. I. Paris.

Developing Standards for Sexuality Education in the European Region

By Dr. Christine Winkelmann, Federal Centre for Health Education (BZgA), Germany

n autumn 2010, the World Health Organization Regional Office for Europe and the Federal Centre for Health Education (BZgA) in Germany launched the "Standards for sexuality education in Europe – a framework for policy makers, educational and health authorities and specialists" (1). The Standards take an innovative approach to sexuality education and emphasize its holistic nature. The document is intended to contribute to improvements in sexuality education in the WHO European Region.

Sexuality education is a very important means of countering many of the challenges related to sexual health and rights. Adolescents and young people in Europe are affected by high or even rising rates of sexually transmitted infections (STI) including HIV, unintended teenage pregnancies, sexual violence and many other issues (2). But most importantly knowledge about sexuality is increasingly perceived as a human right. Young people have the right to know about sexuality in terms of both risks and enrichment, in order to develop a positive and responsible attitude towards it. In this way, they will be enabled to behave responsibly not only towards themselves, but also towards others in the society they live in. In 2008, the WHO Regional Office for Europe and the Federal Centre for Health Education (BZgA), a WHO Collaborating Centre for Sexual and Reproductive Health, brought together an international group of experts to develop standards for sexuality education. This group comprised 19 experts from nine western European countries, with various backgrounds, ranging from medicine to psychology

and social sciences. All of them had extensive experience in the field of sexuality education, in either a theoretical or a more practical way. Governmental and nongovernmental organizations, international organizations and academia were also represented in a process extending over one-and-a-half years.

such as the human body and its functions, emotions, relationships, fertility and reproduction, sexual health and sexual rights and sociocultural determinants of sexuality. This can replace the narrow approach to sexuality education, which deals with sexuality by concentrating on avoidance or control of sexual activity. • T his broad understanding of sexuality also makes it possible to insist that sexuality education must be a lifelong process, beginning at birth, remaining part of people’s lives and supporting them at all ages. Children are born as sexual beings, and their psychosexual development occurs in various stages which are closely linked with the child's general development and the associated developmental tasks.

Publication: WHO Regional Office for Europe/BZgA (2010): Standards for Sexuality Education in Europe – a framework for policy makers, educational and health authorities and specialists. Cologne: BZgA (PDF version: www.bzga-whocc.de).

Holistic approach The Standards introduce a holistic understanding of sexuality education firmly based on sexual and reproductive health and rights and recognising that sexuality is an essential part of being human. Core elements of the approach are: • Sexuality is understood in a comprehensive sense, including aspects

• T raditionally, sexuality education in many countries has focused particularly on the potential risks of sexuality. This approach was further encouraged by the HIV epidemic and the associated prevention campaigns. An approach based exclusively on risk minimization may inspire fear and rejection in children and adolescents, and often has absolutely no relevance to their daily lives. Moreover, it often leaves urgent questions and concerns unanswered, and does not pay due attention to the positive and fulfilling aspects of sexuality. •W hile in the past the emphasis has, all too often, been placed on the simple provision of information, the holistic approach described here stresses the acquisition of life skills and the development of values.

• Children and adolescents are enabled to decide for themselves about sexuality and relationships at the various stages of development. They are supported in living with their sexuality and relationships in a fulfilling and responsible manner. The capabilities and skills they learn as part of sexuality education will also help them to protect themselves from potential risks. Seen this way, sexuality education is an important element of general upbringing and formal education and influences the development of a child's personality. Not only can the negative consequences of sexuality be avoided, but the child's quality of life, health and well-being

can be improved. In this way, sexuality education contributes to overall health promotion. • S exuality education keeps pace with the child’s own development and is culturesensitive and gender-sensitive. It provides scientifically proven information about all aspects of human sexuality and about access to advice and assistance. Sexuality education based on human rights, gender equality, respect, responsibility and the acknowledgement of diversity conveys values and attitudes about sexuality, contraception and sustainable relationships.

Next steps To date, the Standards for Sexuality Education in Europe have been made available in Russian, Finnish, Dutch and German. Spanish, Turkish, Italian and Latvian translations are being prepared. To support countries in developing or upgrading sexuality education programmes WHO Regional Office for Europe, BZgA and the expert group are currently working on a second document giving guidance on how to implement the Standards for Sexuality Education.

Sexuality education in Sweden – an experience of more than half a century

By Hans Olsson Advisor Manager Sexuality Education, RFSU

he foundation of comprehensive sexuality education should be characterized by the following key terms: knowledge, dialogue, reflection as well as positive outlook, non-judgmental and realistic. By “realistic”, we mean that youth and young people are accepted and respected as having a sexuality — expressed through thoughts, questions, fantasies and actions. The actions can be anything from being in love with an idol, kissing or masturbating to being directly sexually active with a partner. Of course, one can have different opinions about what is thought to be appropriate for youth and young people to do and at what age. Yet no matter what one thinks, those who teach must take into consideration and accept that their students' experiences, backgrounds and life circumstances vary

and must adapt their teaching accordingly. Some young people become sexually active with a partner relatively early, others after their later teens and both need to feel that the information is relevant. In addition, the education needs to be inclusive regarding gender, sexual orientation, etc. However, it is also important not to make the mistake of interpreting a person solely on the basis of gender, ethnicity, class, functionality, or sexual orientation; unfortunately, this happens all too often in sexuality education. The most common is the generalizations about gender that complicate and limit people's access to choose, to be oneself, and to enjoy. In reality, to determine that “boys are like this” and “girls are like that” is not possible, no matter how much we are influenced by beliefs about gender.

But it's not just what youth should do at certain ages that people can have different opinions about. This also applies to the sex education: What to teach, when it is appropriate to do so, and what messages should be communicated. This is where we find the greatest battle over sex education. This, and, of course, the purpose of the education itself: should it be primarily for disease prevention, or should it also be about personal development, or to prevent discrimination? The purpose directs the content and timing for the education.

Historical context and development of sexuality education in Sweden The emergence of compulsory sexuality education in Sweden was preceded by a long period of discussions, debates and studies from the early 1900s to the

1 WHO Regional Office for Europe/BZgA (2010): Standards for Sexuality Education in Europe – a framework for policy makers, educational and health authorities and specialists. Cologne: BZgA (PDF version: www.bzga-whocc.de). 2 Ketting, E.;Winkelmann, C. (2011): Sexual health of adolescents and young people in the WHO European Region. In: Entre Nous 72, 2011, pp. 12-13.

late 1940s about sexuality education, prevention and other topics connected to sexuality. There were elements regarding youths’ development, the prevention of illness as well as proper moral education (the school historically has always had a role with this last element — moral education — which may also explain why the school sector has often been cautious and even conservative; the school and teachers had both the duty and the reputation of being the moral guardians of society.) The fact that we eventually had mandatory sex education is not merely due to the view of sexuality itself, but is linked to the rest of society’s development. With the modern society came the emergence of an increasing democratization and along with it even changes to the perception of sexuality. The fight for sex education was won in several stages. The first documented school lessons in what was then called sexual hygiene was given by Sweden's first female doctor, Karolina Widerström, in the late 1800's. She also taught future teachers in sex education. Her motive to teach came from experiences in her medical practice, where she met many people, particularly women, who lacked knowledge about their bodies, wondering why they had become pregnant unintentionally or how they had contracted a sexually transmitted infection. Along with several other doctors, she argued strongly for compulsory sex education. Politicians also drove issues relating to knowledge and the right to contraception, including by women’s organizations and labor parties. As Hinke Bergegren, a socialist leader put it: “Better love without children, than children without love”. Simultaneously, the turn of the 19th century marked the expansion of discussions about sexually transmitted disease — not least due to the period’s fairly extensive prostitution. Sexuality existed, so to say, on the political agenda. Additional activities also coincided with this period. In the early 1900s came the first tutorials on sex education and in 1908 the first bill was passed by Parliament

requiring compulsory sexuality education in teacher training. In the following years, some schools began to have sex education. An extensive study was conducted in 1918, which argued that the most appropriate age for sex education was 14-15 years old. The study also found that most "school deans believe that sex education is needed." Long before sex education became compulsory, there had been some schools that had already started teaching about sexuality. During the 1920s, sexual issues continued to be discussed quite heavily, and in principle, the different authorities agreed that the general knowledge needed to be improved and that the school should take part in this. The question, however, was to what degree. Although school authorities had not approved the general sex education programme, they did indeed consider that the teachers could provide information—and even warnings—to the students who had questions. In other words, there became reluctance, uncertainty, and openings in the resistance on the part of the school authorities about to what degree the subject could be breached. Between the 1920s and 1930s, more sex education books for youth and young people were published, including one with a title that pretty well sums up what the Swedish sex education has been characterized by: "Honest answers to hidden questions". When IPPF Member Association of Sweden, RFSU was formed in 1933, mandatory sex education in schools was at the top of the agenda and RFSU eventually became one of the main actors in the campaign for sex education in schools. In this way, a sexuality education movement developed on the part of both the teachers and schools, as well as from social movement organizations, unions and political groups. However, progress was slow at the decision-making level. Finally, many became weary of waiting and in 1940, fifteen women’s organizations, including two teachers' unions, together wrote to the Board of Education and demanded sex education. In 1942, the Board agreed, and the

government recommended sex education, and made sex education mandatory from the year 1955 onward. The consensus about sex education was wide once it was introduced. The protests and opposition came mainly from conservative Christians, some of them active in the parties, especially on the right wing. The teaching has never since been seriously questioned. Small-scale attempts have been made without success and all parties in the Swedish parliament, including the Christian Democratic Party, support sex education in school today. Soon after its initiation, the mandatory education was severely criticized, especially by the young, for being outdated and not adapted to reality. This included, for example, education advocating abstinence in one’s teens, which was inconsistent with how either youth or adults actually lived and thought. Sweden had already had a long tradition of cohabitation and sexuality outside of marriage, which was accepted by the majority. For example, the teachers´ union protested in the 1940s against a proposal by the Board of Education that the school should make clear the relationship between love, children and marriage. The union aimed to defend the women who had children outside of marriage, saying that they neither wanted nor could condemn their pupils' mothers who they knew as "respectable people". 56 years and still going strong … Sweden’s new curriculum for 2011 gives issues about sexuality even more prominence. The education has shifted, with more focus on social issues and identity, gender and sex. Gender, gender roles and sexual orientation, for example, are already included in the curriculum in the 4th grade. Discrimination issues are important, and include gender, sexual orientation and gender identity or expression. The school's mission is to "counteract traditional gender norms." Puberty, love and responsibility still play a clear role, but it is interesting to note that sexuality is mentioned 15 times in the curriculum, while the word love is mentioned four. The sex education

curriculum in Swedish schools is therefore about much more than simply preventing diseases; it is not new, but it is accentuated even more now. The education aims to support young people and get them to reflect on issues of sexuality, love, relationships and health. It is difficult to evaluate sex education – how to measure what children learn when they were eleven or fourteen, and what do we want to measure? But if you ask young people in Sweden, the vast majority say that they are satisfied with their sex life. The majority report that they wanted to have sex the first time that they did and describes their first time in a positive way. (About seven percent of girls and two percent of boys said they had sex for the first time even though they did not want to; however, this does not mean that it was the result of sexual assault). Most people had sex for the first time with someone that they were in a relationship with and the majority were sober at the time.

However, protests against the sex education’s content and teaching aims will continue and flare up from time to time. This was the case recently when RFSU and the Swedish Educational Broadcasting Company released the animated sex education film "Sex on the map" (see www.rfsu.se/eng). The film attracted attention for its openness and for the animated sex scene between two of the main characters. “Sex on the map” has been shown on Swedish television and was seen by half a million viewers. It has been widely used in school education. The reception has been overwhelmingly positive among students and teachers and media — but criticism has existed. Again, it came mostly from conservative Christians, who say that the film speaks too openly about sexual acts, and “legitimizes” young people as being sexually active. They have also criticized—rather cautiously—how same-sex relationships

are integrated into the film and equated with heterosexual relationships. There were also reactions from the extreme right that were racists in nature, in line with the patriotic and hostile Islamic wave over Europe. These reactions were severe, however they were organized by just a small group of people and were in principle visible only on the Internet. This blew over quickly and the activities disappeared after a couple of weeks. These views have little impact on the general public (which hardly were aware of it), but the situation shows how sexuality can be used, how one wants, to build a society and people's souls. Students have generally appreciated that the film shows that people are different (views, looks, sexual orientation, etc) and that you decide for yourself — when you want to have sex, with whom and how. Students understand, in other words, the film's message. A good sex education also sees youth and young people as competent individuals.

Illustration from ”Sex on the Map”/ © Eksjö Animation/RFSU/UR

Sexuality education is on the radar again! A

fter decades of strong emphasis on HIV prevention and behavioral change programmes, many International Non-Governmental Organizations and UN organizations, such as WHO Europe, UNFPA and UNESCO, are re-defining sexuality education. This article looks at current debates and developments and showcases IPPF’s contribution to the improvement of sexuality education.

Abstinence versus choice Recent reviews on the effectiveness of HIV and sexuality education programmes focus primarily on ‘narrow’ health outcomes; to reduce the probabilities of sexual risktaking. While abstinence-only approaches have been widely promoted, there now exists a substantial body of evidence showing that comprehensive sexuality education has a positive impact on young people. A review of 83 sexuality education programmes by Doug Kirby and others in developed and developing countries revealed that two-thirds of sexuality education programmes lead to individuals making positive, healthy choices about sex and contraception.1

New focus on gender and social justice Whilst recognizing the importance of evaluating the effectiveness of HIV and sexuality education, a host of researchers and educators are now taking a broader approach by asking new questions that lead to different findings. They claim that these reviews do not measure the effect or impact of sexuality education on gender equality, young people’s rights or civic participation. Research demonstrates that gender norms and power disparities negatively affect both girls’ and boys’ sexual attitudes, practices and health2 and gender and gender inequality has a

direct influence on so-called sexual risk behaviors3. To phrase it in a more positive way, egalitarian gender attitudes are associated with higher condom use and higher contraceptive use.4 Another view is that sexuality education should build the link between democratic practices and rights and between health and happiness. It aims to directly explore existing cultural and social power dynamics around health and sexuality by promoting the concept of ‘rights’ – in general and ‘sexual rights’ specifically - with an emphasis on equality, social inclusion and empowerment. It is an approach that seeks to empower young people to exercise these rights and support them to advocate for their rights within their communities. This approach to sexuality can also lead to improved health and empowerment outcomes for a larger proportion of young people, targeting those who are vulnerable and marginalized, and who are often excluded from more restricted sex education programmes. This includes populations at risk, such as out of school youth, injecting drug users and men having sex with men (MSM), who are often overlooked within conventional programmes. In addition, this approach to sexuality education recognizes that all individuals should be able to enjoy sexual and reproductive health and rights, including the mentally and physically disabled.

By Doortje Braeken Senior Adviser Adolescents IPPF, London

Doortje Braeken, Senior Adviser Adolescents IPPF, London

including comprehensive, gender-sensitive and rights-based sexuality education. IPPF recognizes CSE as an essential intervention to ensure that all young people are aware of their sexual and reproductive rights, are empowered to make informed choices and decisions and are able to act on these decisions.

IPPF and Sexuality Education Comprehensive Sexuality Education (CSE) is a central component of the International Planned Parenthood Federation’s (IPPF) work with adolescents and young people. IPPF’s Declaration of Sexual Rights clearly articulates that all young people have the right to education and information,

IPPF Framework for Comprehensive Sexuality Education

In 2005, IPPF decided to focus its work on CSE around elaborating and promoting the specific content that should be included in comprehensive, rights-based and gendersensitive CSE programmes. At the time, the global debates about the effectiveness of abstinence-only education programmes vs. comprehensive sexuality education programmes were in full swing. IPPF felt it was necessary to clearly articulate what is meant by ‘comprehensive, rightsbased and gender-sensitive’ sexuality education and to generate resources to support policy-makers, educators and programme implementers to integrate a comprehensive approach in their sexuality education programmes. As a result, IPPF developed the "IPPF Framework for Comprehensive Sexuality Education (CSE)" in collaboration with young volunteers, and with the support of the WHO, UNFPA and the Population Council. It’s all in one curriculum, 2009 The Population Council

WHO/Europe working group and IPPF’s Framework for CSE IPPF Central office, the European Network and the Rutgers WPF were members of WHO/Europe working group on sexuality education which produced the “Standards for Sexuality Education in Europe” together with BZgA (2010). This unique document provides guidelines from the age 0-18 and is now being implemented by WHO Europe in several countries in Western and Eastern Europe, Russia and Eurasia. IPPF was also closely involved in developing the "It's All One Curriculum" with the Population Council and other partners, which provides a more detailed overview of messaging, content and possible activities for developing a rightsbased, gender-sensitive, and participatory guidelines and activities. The IAOC is a tool to implement rights-based and gender-sensitive CSE programmes and includes two books: the first is the curriculum, which includes human rights, gender, sexuality, relationships, sexual and reproductive health and advocacy; the second book includes 54 activities that engage young people and foster critical

thinking skills. The IOAC is being rolled out through projects by more than 19 Member Associations worldwide.

CSE on-line learning tool, MYX City, 2010 - 2011 In collaboration with the Regional Offices and a reference group of young people, the Youth Team has recently produced an online CSE tool, MYX CITY, (www.myx.ippf.org), which is hosted on our new youth website MYX. The Internet is a fundamental source of information for young people around the world and so it is crucial that they have access to accurate and comprehensive sexuality information online. Several sex education websites already exist, but mainly focus on the biological and health aspects of sex, and lack a focus on gender, rights, sexuality and critical thinking. IPPF’s online CSE tool seeks to address these gaps.

The Future Now that the content of CSE is clearer, IPPF feels it is important to develop a more in-depth consensus about the methodology and approaches

for delivering CSE. As a sexual and reproductive health organization, IPPF is a long-standing leader in health promotion and Information, Education and Communication programmes. However, education is a relatively new area of work. As such, IPPF would like to explore how to better integrate educational principles and approaches into our work, moving beyond traditional models of health promotion and IEC. This process will also involve identifying improved ways to monitor and evaluate CSE programmes by identifying new indicators that capture outcomes related to educational objectives, empowerment, gender equity and rights.

Finally IPPF and its Member Associations are very well placed to advocate and promote sexuality education that includes gender equality, rights and a positive approach to sexuality. We believe these are crucial elements of sexuality education and will contribute to happy, healthy sexual and reproductive lives of young people now and in the future.

1 Kirby, D, Laris BA and L Rolleri (2005) Impact of sex and HIV programmes on sexual behaviours of youth in developing and developed countries. Youth Research Working Paper Series. New York: Family Health International. 2 http://www.unfpa.org/public/home/publications/pid/3346 3 Guttmacher Institute/IPPF (2010) Facts on the sexual and reproductive health of adolescents women in the developing world 4 (Karim et al, 2003; Zambrana et al 2004; Marsiglio, 1993; Pleck, Sonenstein & Ku, 1993),–(Stephenson et al, 2006; Kowaleski-Jones & Mott, 1998; Marsiglio, 1993)

Let’s (not) talk about sex – Sexuality Education in Central and Eastern Europe

by Marta Szostak, Poland ASTRA Youth Coordinator

Marta Szostak, Poland ASTRA Youth Coordinator

Sexuality education as a comprehensive, science-based and ideology free subject has not yet made it to the schools in Central and Eastern Europe (CEE). The region, which is now over 20 years after a major political transition from communism to democracy, still neglects young people’s right to knowledge on sexual and reproductive health.

he countries of the CEE region share a few common characteristics which lead to inadequate policies within the area of Sexual and Reproductive Health and Rights. Weak civil society, gender inequality and strong religious and conservative forces all influence the most intimate areas of human life, especially those of very young people. Most CEE states have a two- to four-times higher teenage pregnancy rate than their

Western counterparts (excluding the United Kingdom) and adolescent HIV infection rates are the fastest rising in Europe. Bulgaria is ranked third in Eastern Europe for the number of abortions, after Ukraine and Russia. One third of all pregnancies end with abortion, many of these are young Bulgarian women. Access to contraception is limited due to the high prices and lack of information.1 As the Western world has officially recognised sexuality education as means of preventing unwanted pregnancies, HIV/AIDS and sexually transmitted infections, it has also acknowledged it to be a tool of investing in the young people’s future and better standard of living. Despite these findings the reproductive health of the young people living in CEE region is vastly ignored and their SRHR needs remain unaddressed. Young people in the region do in fact receive some sort of education on their reproduction. These classes are often called “Health Basics/Skills” (Ukraine), “Health Education” (Croatia), or “Preparation for Family Life” (Poland) and are sometimes part of other classes in the curriculum like biology, home economics, ethics and even religious teaching. They include some information on sexual and reproductive health, but are very often biased, stigmatizing and insufficient. A young boy or girl will learn that abstinence is the best contraception method for young people but will never experience a practical lesson on proper condom usage or learn how to recognise sexually

transmitted infections. The Ministries do sometimes support abstinence based sexuality education programmes, as in the case of Croatia. “Young men and women who have reached physical and mental maturity become capable of a normal mutual (heterosexual) relationship”.2 The official discourse presents sex as something appropriate for married and heterosexual couples, as the Lesbian, Gay, Bisexual and Transgender (LGBT) issues are also very marginalized and left out from the curriculum. Sex should lead to becoming parents. Moreover, like in the case of Poland, the Catholic teachings influence the classes so strongly, that they are sometimes facilitated by nuns or priests. The knowledge provided during these classes is biased, insufficient and often leads to myths and misconceptions, such as this one: “Our religion teacher told the girls that they shouldn’t use tampons because they can grow into your vagina”.3 There are also countries were there is no mention of reproductive health what so ever. Cyprus, Georgia, Bulgaria, Kazakhstan, Macedonia all experience this great gap in the curriculum. The region of Central Asia is also experiencing the strong influence of Islam where sexual health and sex itself remain a taboo. The discrepancy between real life practice and the vision of sexuality brought to youngsters by schools is so vast that the adolescents do not even perceive school as the appropriate place to turn to when in need of advice. In fact, the teacher is one of the last people to be

1 „Sexual and reproductive health and rights of adolescents in Central and Eastern Europe and Balkan countries” ASTRA Youth 2011, http://www.astra.org.pl/SRHR_of_adolescents_in_CEE_and_Balkan_countries_AY_2011.pdf 2 Extract from Croatian biology textbook. „Sexual and reproductive health and rights of adolescents in Central and Eastern Europe and Balkan countries” ASTRA Youth 2011 3 „What does Sex Education really look like In Poland?” Report of the Ponton Group of Sex Educators 2009, www.ponton.org.pl/downloads/what_sex_education_poland_ponton_report_2009.pdf "Ponton" is a group of volunteer sex educators from Warsaw, Poland, who provide sex education in schools and counselling on the web, phone and through e-mail.

asked about such issues, as the Internet and friends are the main sources of information about sex. It seems like adolescents are perceived by the law makers as people of no sexuality. There is no question whether it is possible to teach young girls and boys how to make responsible and fully informed choices on their sexuality during classes where even the word “sex” is often avoided. In the current times of economic crisis and the declining birth rates, the Central and Eastern European governments push young women to bear children (preferably more than one) but are not creating enough institutions to help with child care. Political leaders choose another path which is harmful for women, also the very young ones. They advocate for a restriction of abortion and contraception, neglecting the need of introducing a reliable sexuality education to schools. Interventions which bolster anti-reproductive rights rhetoric are usually supported by right-wing forces. This year’s events in Hungary, Russia and Poland, where a bill proposing a total ban on abortion has made it to the Parliament,

are a clear sign that these political moves are becoming stronger. Growing fundamentalism and religious conservatism as well as the rise of new HIV infections all create a climate in which the young people are those who are usually forgotten. The counteractions of the non-governmental organisations can be observed as activities which slowly but surely bring change. A close cooperation between the NGOs and the government can be observed in Georgia, where the current work aims to include youth SRHR in the youth policy. Cyprus is also working on an implementation of sexuality education programme into the school curriculum. Another good sign is that the international agencies, such as UNFPA, become more and more involved in this process. Azerbaijan experienced a wide scope of training on sexuality education for students country-wide. But again, these were voluntary courses, similar to all the countries described above. None of the CEE countries have an obligatory and comprehensive programme on sexuality education in the school curriculum. Grassroots activism, peer education and

PONTON Group of Sex Educators, Valentine's Day street action, Poland/©Astra Youth

non-governmental initiatives are doing the wide-spread and much needed job of awareness raising, consultation and support. However, this is still a drop in the ocean.

ASTRA Youth (www.astra.org.pl) is an informal group of young advocates for sexual and reproductive health and rights from the Central and Eastern Europe region and Balkan countries. It was launched in 2004 as a youth wing of the ASTRA Network. ASTRA Youth is especially dedicated to advocacy for the implementation of comprehensive and reliable sex education in the school curriculum, access to science-based, free of indoctrination information on sex, HIV/ AIDS prevention and youth friendly services among adolescents as well as the participation of young people in the policy development and decision making processes regarding SRHR.

Is straightforward (comprehensive) sex education possible in Poland? By Joanna Dec, Ph.D., President of IPPF EN, volunteer with Towarzystwo Rozwoju Rodziny (IPPF Member Association of Poland) and lecturer at the University of Zielona Gora, Poland

Schools of all levels are obliged to run the sexuality education classes but the students' attendance to the class is voluntary. It is the headmaster of the school who is responsible for such classes. In 2009, the Minister of Education issued a new Ordinance. The previous

regulations had required that parents or legal guardians of a student should submit a written declaration authorizing their child's attendance in the classes previously. Students who were adults had submitted such written statements independently. Now, students' parents or legal guardians who do not agree to their child's

Joanna Dec, Ph.D.

he issues related to sexuality education have always aroused a lot of emotions and controversies in Poland, which impedes any constructive and reliable implementation of the subject in Polish schools. Dilemmas refer not only to the issue of the students' age but also to the scope of the lesson curriculum, handbook selection and appropriate contents taught during lessons. Professional skills of those who teach it and parents' consent to their children's attendance are also key debates. The discussion pertaining to sexuality education in Polish schools is of a political and catholic world view nature (context). This is proved by the fact that even the name of the subject has changed throughout the years from 'Socialist Family Roles' to 'Family Roles' and ‘Knowledge of Human Sexual Life'. The subject is now called 'Education to Family Life' and the course starts in the last grades of primary school. In Poland, sexuality education in schools is implemented under Section 4, Item 3 of the Act of January 7th, 1993 on Family Planning, Protection of Human Fetus and Conditions for Termination of Pregnancy.

Facts and figures

contraceptive pills. Thermal or symptombased methods are used by approximately The issues discussed during classes 4% of the respondents and 15% of them usually stray from expectations of the choose the calendar-based method. The youth. Although the curriculum of the intrauterine loop is used by more than subject includes matters related to sexual 5% of the respondents and 21% of initiation, STI's, contraception or planned them believe that coitus interruptus is a parenthood, teachers generally choose the contraceptive method. Similar data were issues pertaining to the roles of the male acquired by the Central Statistical Office and female, functions of family, marriage in 2009. and friendship while they do not introduce subjects which the youth would like to The statistics concerning teen discuss in course of the lessons. pregnancies are also alarming. There were 419,337 births in 2009 of which This situation may affect the decisions 20,606 births were given by teenagers made by Poles with reference to their under 19. This is 4.9% of all the births. choice of the appropriate methods of The number of girls who were under 17 birth control. The UNDP Report "Health when they became mothers (4,870 cases) of Women at Procreation Age of 15-49, was increased significantly. The number Poland 2006" presents the findings of of births given by girls under 15 is still the research of a national sample of growing. In 2004, there were 288 of such 3,200 people aged 15-49, including births as compared to as many as 406 1,585 women. The research shows that cases in 2009. more than 50% of sexually active women (58%) use methods of contraception The lack of straightforward and reliable whereas nearly 28% of the women do sex education based upon scientific not use any methods. Condoms are the knowledge, taught by properly trained most popular contraceptive methods teachers will definitely cause a spread of among Poles (54%) and 30% use such phenomena.

References: 1 Kopański S., Edukacja seksualna w polityce władz centralnych po transformacji ustrojowej, www.racjonalista.pl/kk.php/s,6168 (as of 10.11.11) 2 Report of Gazeta Wyborcza Daily on sex education, http://edukacja.gazeta.pl/edukacja/0,112291.html (as of 10.11.11) 3 Raport: Zdrowie kobiet w wieku prokreacyjnym 15-49 lat, Polska 2006, UNDP 2007 4 Stan zdrowia ludności Polski w 2009 r., GUS 2011 5 Szczepańska J., O wychowaniu seksualnym młodzieży, Komunikat z badań, CBOS 2007 6 Act on Family Planning, Protection of Human Fetus and Conditions for Termination of Pregnancy (Journals of Laws No. 17, Item 78; of 1995 r., No. 66, Item 334, of 1996 r., No. 139, Item 646, of 1997 r. No. 141, Item 943, No. 157, Item 1040 and of 1999 r. No. 5, Item 32, No. 5, Item 32 of 2001 r. No. 154, Item 1792)

attendance in sexuality education lessons can remove their child from them. The contents of the subject are described in the curriculum for each type of school. However, the strong influence of the Catholic Church exerts significant pressure on the contents and the manner of teaching the subject. The same situation applies to written handbooks on sexuality education. The vast majority of the handbooks registered by the Ministry of National Education should not be used as teaching materials primarily as their contents do

not treat sexual and reproductive health as defined by the World Health Organization. The handbooks often provide false information inconsistent with the recent research findings, they spread myths and stereotypes related to human sexuality and other issues such as contraception methods. Another difficulty pertains to the professional preparation of the teachers to teach the subject. Both the contents and the quality of such preparation of teachers arouse doubts. In most cases, the contents have an unambiguously catholic

world view context, inconsistent with the approved scientific knowledge. Candidates for sex education teachers usually complete qualification courses organized by Centres for Additional Education of Teachers or Regional Centres for Methods of Teaching, or they may attend postgraduate studies in a few academic centres in Poland. Sexuality education classes are also offered by some universities (e.g. the University of Zielona Góra). The subject is a part of pedagogy courses and students are obligated to attend.

The Republic of Macedonia – The Minister says NO to sexuality education and NO to contraception 1

By Marija Matovska and Velimir Saveski, Youth volunteers within H.E.R.A.(IPPF Member Association of the Republic of Macedonia)

These are the views of Marija Matovska and Velimir Saveski, both youth volunteers within H.E.R.A. and members of YSAFE (IPPF EN Youth Network). Marija Matovska is 23 years old and has recently graduated from the Faculty of Economics in Skopje. Marija has been volunteering for H.E.R.A. for over six years. Velimir Saveski, aged 22, is a medical student. He has recently been granted a scholarship from the Foundation “Trajche Mukaetov” for his dedication to Health in the Republic of Macedonia. He is also currently an executive board member of H.E.R.A.

he Republic of Macedonia is a small country in the South-East of Europe. It is located in the Balkan Peninsula. It is also a relatively ‘new country’. The Republic of Macedonia became independent in 1991 and was granted candidate status for EU membership in 2005. The country counts approximately 2 million inhabitants and is far behind the average European standards in terms of education, social and economical development. The situation is the same in the field of sexual and reproductive health and rights (SRHR) and young people. With no comprehensive sexuality education nor the Government’s will to recognize youth’s needs, young people face many challenges which is why non-governmental organisations (NGOs)

have an important role to play. However, this is not enough, due to NGOs' limited funding. Furthermore, NGOs cannot cover the entire country, in order to ensure basic knowledge of all youngsters in terms of sexuality.

Ministry of Health has made it clear that they do not plan to include oral hormonal contraceptives on the list of drugs that are covered by the Health Insurance Fund because they feel there are other drugs that are of more priority.

Despite the current situation, the Government does not seem to support comprehensive sexuality education in country. In fact, the Minister of Health, on the occasion of World Contraception Day 2011, said to one of the journalists who raised a question regarding sexuality education and contraception, that “It is not necessary to introduce sexuality education as a separate class, life skills classes are enough for this purpose.” In addition, the

“Life Skills” classes, as referred to by the Minister of Health, is a programme designed in cooperation with UNICEF and intended to give all young people (in primary and secondary schools) general life skills. Information regarding SRHR is included. However, the sections on this particular subject is not sufficient. Barely 10% of the programme is dedicated to SRHR. Teachers also tend to choose which areas they care to cover. Bearing

1. UN technical referencee "The Former Yugoslav Republic of Macedonia"

an existing framework for comprehensive sexuality education in the Republic of Macedonia. The first draft was prepared by representatives of the state institutions, academia, international organisations and non-governmental organisations.

Youth volunteers of H.E.R.A., Skopje, Republic of Macedonia

in mind that a lot of these issues remain taboo, we can just imagine what they will speak about! In addition, the information contained is either not relevant or often erroneous. For example, the programme stipulates: “Contraception is not recommended for use because it can cause unwanted and permanent consequences”. Overall, young people, on the ground, offer a completely different story: Dragana, 17 years old, says: “Within the framework of our school programme, we do not have any information on SRHR, and most of the time, people from nongovernmental organisations come to our school in order to provide us with the needed information. I share the same opinion with other young people of my age, that comprehensive sexuality education should be introduced in schools because I’ve heard quite a lot of nonsense, coming from my peers, for example, such as “if you use contraceptives, you may end up growing a beard!” In 2010, in order to assess the country’s situation, H.E.R.A. (Health Education and Research Association) conducted a research survey within primary and secondary school called “Love only after classes”. The results of the research shows the attitudes and needs of teachers, parents and young people regarding comprehensive sexuality education: Very encouraging is the fact that 90% of teachers are in favour of introducing sexuality education in elementary school, starting from seventh grade. Parents believe that sexuality education should be based on sexual rights, without neglecting family values however. They are not against the inclusion of topics such as sexual diversity and sexual orientation.

On the other hand, students do not see the school as an institution that can answer all their questions. Overall, students have a positive attitude towards sexuality but they are easily influenced by existing prejudices and stereotypes. In 2011, H.E.R.A. conducted further research among 100 000 students in Skopje (57,65% of the population surveyed were male and 42,35% were female). The survey results show that only 4% of the population has had an HIV-test and coitus interruptus also known as the withdrawal method accounts for 25% of contraceptive methods. In addition, the figures regarding the use of modern contraception are devastating. Merely 1.6% of the girls, aged 15 to 19, reported having used oral contraception. Only 34.8% of the youth say they used a condom during their last sexual intercourse. The rate of teenage pregnancy and abortion within this age group is several times higher than in EU countries. There also appears to be an increasing number of people affected by sexual transmitted infections (STIs) in the country, especially chlamydia and HPV (Human Papilloma Virus). As a consequence, there is an increasingly lower age limit for cervical cancer as a result of HPV infection. Another fact is that more and more young married couples face infertility that is caused by untreated STIs. Because of such a hostile environment, violence and intolerance among young people is increasingly preoccupying. Other worrying indicators are gender stereotypes and gender inequality all over the country. In order to persuade governmental officials, many steps have been made in the previous years. Besides the research “Love only after classes”, there is now

The Macedonian Framework for Comprehensive Sexuality Education was presented at the public hearing at the Parliament earlier this year together with the youth declaration for comprehensive sexuality education: “Sexuality Education in Macedonia: Now Make it Happen”. The conclusions of the hearing were as follows: -The Parliament supports the framework for comprehensive sexuality education; -The Bureau for the Development of Education should revise the level of implementation of the life skills classes in the area of SRHR; -The Bureau should prepare a separate programme, under the framework for comprehensive sexuality education. On World Contraception Day 2011, our young people sent the following petition to all MPs, entitled: “You have the right to information on contraception, ask for sexuality education.” The reality is young people in the Republic of Macedonia still lack credible information regarding all aspects of their SRHR and they are insufficiently taken into account in the existing curriculum.

Therefore, it is important, we ask ourselves whether we need comprehensive sexuality education within our schools or whether the existing information is enough ? Bearing in mind the situation, H.E.R.A. is prepared more than ever to remain on track; to continue to advocate for comprehensive sexuality education for all young people in country. Next year, we will continue to build stronger public support for this issue. In addition, we will work together with the Bureau to amend the existing Life Skills’ programme in order to overcome all existing gaps that are still present in the current programme, because all young people have the right to credible information on SRHR.

Health and sexuality education in Bulgaria – things looking brighter after all!

Message from Dr. Radosveta Stamenkova, Executive Director, Bulgarian Family Planning and Sexual Health Association (BFPA)

n the last two decades various efforts have been made in Bulgaria for the introduction of modern interactive and youth friendly health and sexuality education in the school curriculum. The series of initiatives and different campaigns have evolved and ended without particular success, even if planned strategically and following the advocacy campaigns rules. The process started initially with NGO efforts in which the IPPF Member Association of Bulgaria, BFPA, was one of the main catalysts. Later on, NGOs were supported by UN agencies and other international bodies in country and in the last decade, the Ministry of Health added its voice to the chorus of advocates and supporters trying to persuade the Ministry of Education about the importance of the step to be taken. Indeed, the needs for this introduction was proven by fact of life in various ways throughout those long years – in comparison with other EU and European states, Bulgaria is one of the countries with highest teenage pregnancy, high abortion versus low contraceptive prevalence rate among the young generation. Many other examples can be given, many pilot initiatives were taken in selected schools, cities, municipalities, regions. Youth friendly training materials were produced, peer education networks were created and sustained, methodology and a curriculum was designed, tested and pilot implemented, but still the political will was lacking. In 2010 with the guidance of BFPA and the support of the United Nations Population Fund (UNFPA) and the National Center for Public Health Protection and Analysis, a new campaign with a new strategic

approach was launched. The ministry of education started the elaboration of a new law – the Law for School Education. This attracted all ‘old’ and many new supporters, position papers and general recommendations were written and submitted, a referendum in 4 schools in different locations in the country were held, asking students, teachers, school authorities about their position: FOR or AGAINST the introduction of health and sexuality education in the school curriculum. More than 80% were FOR and a major part of the rest wanted Health and sexuality education, but not in schools, because they did not believe schools can provide modern sexuality education. In parallel, young people started collecting signatures for the inclusion of sexuality education in school curriculum in more than 10 big cities in the country. These are just part of the massive initiatives taken. In 2011, BFPA and UNFPA organized a hearing in parliament with the support of the heads of the Parliamentarian Commissions on Health and on Education. The Deputy Minister of Education, responsible for school education and the elaboration of a new law was invited. The meeting in which many NGOs and young people took part came up with such strong messages and examples that after 3 hours of discussion, the Deputy Minister changed opinion and one of the

future educational standards – “Civic and intercultural education” was redesigned as “Civic, intercultural and HEALTH education” and the Executive Director of BFPA and two other representatives of the initiative were included in the working group. Later on, BFPA succeeded to promote as members of the group two teachers – one was a volunteer of BFPA for years and the other is a member of BFPA’s management board. So, things look more promising than ever! Of course, there are pessimistic voices that say that the law may not be designed on time and may not be voted. However, we as NGO advocates are now working with the Ministry of Education and our efforts seem to be welcomed. This means, if we are successful, Health and Sexuality Education will be institutionalized, teachers will be prepared to teach it at universities based upon special curriculums and all young people will have in long term perspective access to modern, interactive, youthfriendly Health and Sexuality Education.

Thoughts from a Teacher By Marie-Anne Ramuz Evensen

Marie-Anne Ramuz Evensen

n 2006, the government removed all optional topics from Upper secondary education. Since 2011, sexuality education is no longer an obligatory subject. Sexuality education should only be taught in primary and lower level secondary education (10-15). “A great political mistake” says Ramuz Evensen: “Twenty years of hard work thrown out of the window! Most young people start having sex with others than themselves at that age. The authorities are not in line with the needs and interests of the pupils aged 16-19. Young politicians rightly accuse their older colleagues for allowing “health threatening attitudes” (Sverre, et al., 2011). When people ask me why I am so interested in sexuality education, I always answer “because it is so much fun!” Being together with teenagers is such a pleasure and their longing for knowledge and skills in the field of sex and relationships is so inspiring for a teacher. Colleagues often say that there is no time to teach sexuality and relations in upper secondary education anymore, as preparing for exams take too much time. Others say that they simply can’t think of not teaching sexuality (Evensen, 1992).

Most of my pupils think sexuality education is what school nurses teach: pregnancy, contraception and diseases. The boring medical things, they often say. Every 16 year old knows about contraception and condom use, but information is not enough. They insist on open dialogue with their teacher and discussions about behavior, norms and values, reflecting their own lives and experiences. They want to talk about love and friendship, and the brighter sides of sexuality. They want to study and learn about the complexity of gender and sexuality: body and mind, the ambiguous feelings, the difficult choices, identity and sexual diversity and how to have fun and enjoy sex without confusion and anxiety – the things that take time (Evensen,1996). It is true that Norway has a liberal social and moral climate and was one of the first countries to pass a law criminalizing discrimination on sexual grounds. The government fully supports family planning. General public attitudes towards the sexuality of young people are positive, but people are often worried by the enormous pressure from the media and the internet (IPPF EN, 2006, p 69). However, reality may be tougher for young people than most teachers and parents may think. I hear pupils tell me that they are confused and stressed. ‘Sex is everywhere’, they say, and they don’t know how to deal with what is considered to be ‘natural’ and ‘normal’ sex in newspapers and on television. Apparently, they can freely express sexual autonomy, but girls may be stigmatized for having sex with boys, while heterosexual boys may have the privilege to impose their own needs and attitudes on others. Young lesbian, gay, bisexual and transgender people are mostly ‘invisible’ in schools, and may fear homophobic harassment and ridicule.

Marie-Anne Ramuz Evensen has been teaching comprehensive sexuality education since 1978 in lower and upper secondary schools (pupils aged 16-19) in Norway. She has been Executive Director of the Norwegian Aids Association (LMA) 1994-96, board member of the Norwegian Society for Clinical Sexology, board member of the Norwegian MA Sex og Politikk and a member of the Regional Executive Committee of IPPF European Network. In 2009, the Nordic Association for Clinical Sexology entitled her ‘Authorized Sexuality Educator and Sexual Health Promoter’ (NACS). She is also a teacher in upper secondary school. Because sexuality education was very poor in upper secondary education in the 80s, she initiated “Sexuality and relations” in 1986 as an optional two-hours a week topic. The authorities wanted schools to implement the topic in their programmes, and for five years she was responsible for sexuality education teacher training, financed by the Ministry of Health (Evensen & Melås 1989). The topic soon became very popular among teachers. In 1996, she became head of the curriculum planning group for “Sexuality and Relations” as a National Optional Topic for the Ministry of Education (KUF, 1996). In 1997, Marie-Anne wrote the textbook “Samlivogseksualitet” with sexological theory, discussion topics and class room activities.

More and more time is spent online. They have easy access to pornography and violence, and blogs offer advice on how to become skinny or sexy. The ‘MySpace generation’ is more open about inner feelings in front of the computer than their parents. Therefore, the internet may be dangerous (Bjørkeng, 2011). Many fear the consequences of exposure on Facebook and YouTube . Discrimination, sexual harassment and rumors put forward by other youths on Facebook are a constant threat. On the other hand, social media may be used in the classroom, in a positive way, to establish contact between youth all over the world. They may learn how to communicate without being harmful to others. Communication skills on the internet should become part of sexuality education.

The need for education, training and support Youngsters are impatient and easily bored. It is a challenge for a teacher that some pupils are outspoken, while others are silent. They may be shy or afraid of revealing personal experiences, or the lack of knowledge and skills. Some may fear discrimination and harassment by the other pupils. Sexuality education touches personal and intimate parts of their lives, therefore teachers should be careful not to let pupils expose themselves in the classroom. Collaboration with the school health professionals is crucial, as a support for the teacher, and in order to meet pupils’ need for individual consultation. Both young and old often refer to the embarrassed ‘blushing fool’, when they

recall their own sexuality education experience. No wonder some teachers feel uncomfortable in front of young people with a large appetite for sexuality education. They may lack security and experience in teaching so-called emotional subjects. They have no control over the school curriculum and structure. Sexology and sexual pedagogy is not offered in colleges and universities. But most teachers do their best, and they think it is unfair that they may be judged incompetent. However, public expectation of improved sexuality education indicates that what is taught in schools may have an impact on the pupil’s attitudes and behavior (Røtting & Svendsen, 2009).

(Evensen, 1993). Teachers may need protection from parents who disagree with the pro-choice approach. Lesbian and gay teachers may be accused of advocating homosexuality, and male teachers may fear suspicion of sexual abuse. Head teachers should be offered courses to implement anti-discriminatory sexuality education in their schools, and they should allow their teachers to attend seminars and conferences. The whole school community should be involved to ensure the quality of life of dedicated teachers (Røtting & Svendsen, 2009). Pupils, parents and the local community should be informed that comprehensive sexuality education and sexual health promotion has priority in their schools.

To ensure high standard educational competence among teachers, the colleges and universities should offer studies in SRHR issues, sexology and didactics by professional sexuality educators. Participatory and interactive methods are recommended, and the pupils should be involved in planning and organizing the sessions. One way, top down communication may create opposition or indifference (Evensen & Melås, 1989). Students should be trained to become confident with both theory and teaching, but they should also work on their own sexual emotions and attitudes.The teacher is a role model. Comprehensive sexuality education should be anti-discriminatory, sex positive and youth friendly. Hundreds of colleagues have attended my seminars. Being a teacher with classroom experience is useful, because I can recognize their excitement, but also the structural challenges and personal stress.The lack of support by the head teacher can make their work very difficult

References: Bjørkeng, P. K. (2011). Nettkidsa. Barnas digitale hverdag. CappelenDamm. Evensen, M.-a. R. (1993). Opprettelse av Samlivslære valgfag ved landets videregående skoler. Evalueringsrapport. Delrapport II: Barrierer for gjennomføring. Tiltak. Evensen, M.-A. R. (1996). Et fag om følelser - Samlivslære valgfag i videregående skole. Nordisk Sexologi nr 2. Evensen, M.-A. R. (1997). Samliv og seksualitet. Bekkestua: NKI Forlaget. Evensen, M.-A. R., & Melås, P. S. (1989). Opprettelse av Samlivslære valgfag ved landets videregående skoler. Prosjektdesign. IPPFEN. (2006). Sexuality Education in Europe. A reference guide to polilcies and practices.Brussel: IPPF EN. KUF. (1996). Samliv og seksualitet. Najonalt valgfag. R94. Kirke, utdannings- og forskningsdepartementet.

Activities of IPPF Member Associations Belgium

Flagsystem. Talking with Children and Young People about Sex and Unacceptable Sexual Behaviour By Frans Erika & Franck Thierry, Sensoa, IPPF Member Association of Belgium (Flanders)

n different professional settings people are confronted with the sexual behaviour of children and young people, and are in the position to judge, react to, and evaluate this behaviour. Also as a parent you need to give advice and guidance, and you often feel uncertain. This insecurity and fear to deal with sexuality and children makes sexuality problematic, so that people often overreact or do not react at all.

Example 1 An adult caresses a girl's (10) breasts, wich she doesn't like.

Example 1 A boy shows his penis on a webcam

Example 2 T wo girls (13) massage one another between and over their tights and find it nice

Example 4 A girl (5) intentionally exposes her private parts in the playground.

What does the method intend to do? The flagsystem is intended to give some guidance. This method helps educators and parents to deal with sexual behavior during development. It makes conversation on (observed) sexual behavior more rational and less emotional. The system hopes to have a positive effect on the prevalence of sexually abusive behavior. Professionals evaluate the method as useful and clear; it helps distinguish between healthy and abusive sexual behavior, makes conversations less emotional, and invites teams to discuss current policy and professional behavior. It stimulates resilience in children by explicitly educating them on values and norms.

How has is been developed? Example 1 corresponds to BLACK BEHAVIOUR

Consent

Voluntary

Equality

Age/ developmental appropriateness

Context approrpriateness

Self-respect

The method is shaped and constructed in collaboration with teams of institutions (schools, youth centers, child care) who participated in workshops, feedback sessions and discussion groups for 3 years. Additionally, important input was delivered by juvenile sex offender therapists, and experts on child development and sexuality. MOVISIE translated the method for the Dutch reality, and in the implementation and further development both MOVISIE and Rutgers WPF are involved.

Purpose:

An overview:

The Flagsystem is a method - that helps to judge a situation in a correct way - that stimulates communication about sexual behavior - that promotes sexual resilience and assertiveness in children

Flags

Content: To support this method, an extensive normative list has been developed to describe sexual behaviour in children and youth of different ages. This list is based on literature, and will be updated in time. (www.seksuelevorming.be/download) The list makes a distinction between 4 flags (green, yellow, red, black) , according to the level of acceptability of the sexual behaviour. To make this categorisation, a list of 6 criteria are used namely: 1. Mutual consent: we both want it 2. Voluntary: no coersion or pressure 3. Equality: equal in development, power, strength 4. A ge - and developmentally appropriate: what do children “normally” do at a certain age 5. A ppropriate within the context: not disturbing to others 6. Self-respect: not self-harming  A negative answer, as in example 1 (see previous page), to one of these criteria indicates possible unwanted or unacceptable sexual behaviour. The green flag indicates that the behaviour is OK for all of the criteria.  Example 2: green flag: OK for all criteria  Example 3: red/  yellow flag, depending on who is at the other side of the webcam; could be not ok for consent, voluntariness and equality, and slightly not ok for contextappropiateness.  Example 4: yellow flag: slightly not ok for context appropriateness Sexual abuse = situations where there is clearly no consent, no voluntarity and not enough equality (dark grey) Sexual unappropriate behaviour is all behaviour where one of the criteria is slightly not ok (light grey).

Green

yellow

red

black

Consent

+ - OK

- OK

Voluntariness

+ - OK

- OK

Equality

+ - OK

- OK

Development appropriate

+ - OK

- OK

Context appropiate

+ - OK

- OK

Self respect

+ - OK

- OK

How to work with the method?

Further development and evaluation

In training sessions, professionals are trained in identifying the colour of the flag, and in formulating an appropriate and motivated response. Each color of the flag corresponds with an appropriate pedagogical response from the people responsible.

The Flag System has been a popular tool and training subject in the last 2 years, and will probably be used more in the future. Youth work, sport, people with a disability - we are working on more situations and tools.

 A green flag corresponds with no intervention or positive feedback  Yellow flag: limiting, explaining, giving alternative behaviour suggestions  Red flag: prohibiting and explaining why, suggesting alternative behaviour, saying sorry, explaining consequences and further steps  Black flag: prohibiting and explaining why, interfering with punishment, referral, time-out,…  Example 1: Black flag: adult is reported to responsible  Example 2: green flag: no reaction is needed.  Example 3: yellow flag: warning about risks; Red flag: prohibiting and explaining why this is not ok for other person in the interaction, limiting use of webcam can be proposed when the boy does it again.  Example 4: yellow flag: explaining why exposing private body parts is not ok in that public place. In this way children and young people are helped to display correct and acceptable sexual behavior, and are given an explanation about the criteria that society expects from them and others. Next step is the development of materials for children and youngsters to help them recognize situations where criteria are violated, and to stimulate communication about sexual abusive behavior to others.

The implementation has proceeded faster than imagined. Evaluations show that the method can be of immediate use and helps on different levels: in working with the children, in working as a team, in correcting the policy on sexuality, in communicating with external partners. A training of 1 day minimum is necessary to be able to use the method.

‘Absolutely positive: the flags are doing the work they promise. They are instruments to divide behavior into normal or problematic sexual behaviour. Also they make it easier to discuss and confer over with collegues, parents, educators, etc,… Congratulations!’ Els Vandecasteele ‘The norms used are logic and practical. They give the possibility to explain why certain limits are necessary and when these limits are crossed. For educators and young people for who these personal limits as not so evident, this is a tool which help. It provides a normative matrix without being judgemental’. Director of a juvenile institution

Supporting materials • Manual Flag system • Normative list extended • Powerpoint flagsystem • Article: Making the Sexual Behaviour of Children a Talking Matter on www.sensoa.be/download - Flagsystem

Ukraine

Improving Sexual Education in Ukraine: An NGO Perspective By Iryna Skorbun, Raising the Standards for Sexuality Education in Ukraine Project Coordinator, Charity Foundation “Women Health and Family Planning” (Ukraine)

n 2001, the Ministry of Education introduced a course on “Health Basics”. It is aimed at young people from 1st grade up to the 9th grade (13-14 years of age) and covers topics such as the physical and psychological aspects of growing up. However, no obligatory health education lessons including sexual education are offered to teens at the age of 16-17 (the two last grades of secondary school).

ince 2010 the IPPF Member Association of Ukraine, Charity Foundation Women Health and Family Planning has been implementing a project called: “Raising the Standards for Sexuality Education in Ukraine Project (RAISE project)” in partnership with SENSOA (Belgium) and with the support of the Flemish Department of Foreign Affairs. The main goal of this 3-year project is to assist in improving the quality of school sexual education programmes which in the long term perspective should have an impact on the HIV epidemic and improve teen’s reproductive health. Working at the grassroots level, the RAISE Project has given way to a series of events with schools’ administrations, teachers, local authorities and health care providers to alert them on the status of teens’ RH and importance of schoolbased sexuality education. Such dialogue has helped to involve the most interested partners in the project and offer several trainings with carefully selected topics and

exercises that meet the needs and priorities formulated by sexuality education teachers themselves. These trainings have given an opportunity to teachers, class tutors, school psychologists and social workers to deepen their knowledge on Reproductive Health and Rights, modern methods of contraception and family planning, as well as on the impact advertising, media images and new media have on sexual behavior and health of adolescents. School professionals were presented with a variety of interactive methods, developed and widely used by their Belgian colleagues from SENSOA. As appeared it was also a great opportunity to share experiences, ideas and views on improving sexuality education, to assess the acceptability of the use of new methods in school, and most importantly – to get an example, that sexual education lessons can be exciting and yet effective. Regular meetings have helped to create a network of associates at the community level, which has the support of local authorities and school administrations. The next stage of the project is a broader parents’ involvement in sexuality

According to a recent study on parents' views which was conducted under the RAISE project, most parents welcome the coverage of sexuality education topics in school curriculum. A lot of parents do not feel comfortable discussing sex issues with their children as sex has always been seen as taboo. Family planning, and contraception have rarely been discussed openly. Some parents prefer to leave the “sex talk” to schools and teachers.

education. The model of communitybased cooperation, as well as a package of interactive teaching materials precisely tailored for current school-based sexuality education programme, will be offered to the Ministry of Education and Science of Ukraine as a positive example of practice. RAISE project initiated the discussion of the "Standards for Sexual Education in Europe" (WHO/BZgA), as well as UNESCO’s International Guidelines on Sexual Education, among leading Ukrainian state education and medical structures representatives, as well as NGOs and international organizations working in the field of preventive education. These documents were highly marked as a good example of a comprehensive approach to sexuality education by both national experts and grassroots practitioners, but are now rather seen as a platform for policy dialogue than specific examples to follow. We hope that the RAISE Project will not only emphasize the importance of sexual education standards’ improvement in Ukraine, but will also inspire the development of the SE document reflecting common vision, cultural traditions, modern realities and needs of the Ukrainian society.

Others would appreciate additional information/training to become more competent and confident in sexuality education issues. It is also noted, that religious parents’ opposition towards sexuality education is becoming more frequent. The survey helped to identify the most interesting topics for parents and the most convenient ways to view this information.

Resources: Publications: - Sexuality Education in Europe, a reference guide to policies and practices, The SAFE Project, 2006 IPPF European Network, http://www.ippfen.org/en/Resources/Publications/Sexuality+Education+in+Europe.htm - A guide for developing policies on the sexual and reproductive health and rights of young people in Europe, The SAFE Project, 2007 IPPF European Network, http://www.ippfen.org/en/Resources/Publications/Guide+for+developing+policies+on+Sexual+and +Reproductive+Health+and+Rights+of+Young+People+in+Europe.htm - International technical guidance on SE, Volume I, the rationale for sexuality education, UNESCO, 2009, http://www.out.ac.tz/announcements/general/Unesco/documents/Guidance_Sexuality_Education_Vol_1_En.pdf - International technical guidance on SE, Volume II, Topics and Learning, UNESCO, 2009, http://www.out.ac.tz/announcements/general/Unesco/documents/Guidance_Sexuality_Education_Vol_2_En.pdf - Standards for SE in Europe, WHO Regional Office for Europe and BZgA, 2010, http://www.bzga-whocc.de/?uid=6728fd600d7c47d0b1b58749179671e5&id=Seite4486 - “It’s all one curriculum vitae”, guidelines and activities for a unified approach to sexuality, gender, HIV, and human rights education, 2009 The Population Council, http://www.ippfwhr.org/en/allonecurriculum_en - Framework for comprehensive sexuality education, IPPF, 2010, http://www.ippf.org/NR/rdonlyres/CE7711F7-C0F0-4AF5-A2D5-1E1876C24928/0/Sexuality.pdf

Outside back cover photos (from left to right): 1. Boy in market, Skopje, Macedonia, 2010 / © IPPF EN 2. Youth volunteers, H.E.R.A., Macedonia / © IPPF EN 3. I llustration "Sex on the Map"/ © Eksjö Animation/RFSU/UR 4. PONTON Group of Sex Educators, Poland/ © Astra Youth

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