Empowering adulthood through sex education
- Part 1 -

Dr Ashwini Sirapanasetty Karache *

"Comprehensive sexuality education needs to be understood by different stakeholders, such as parents, community members, religious leaders & politicians, in order to promote comfort & understanding of what can be a sensitive topic."

What is Comprehensive Sexuality Education ?

Comprehensive Sexuality Education (CSE) is a curriculum based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. It aims to equip children and young people with knowledge, skills, attitude and values that empower them to realize their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; understand and ensure the protection of their rights throughout their lives.

CSE plays a pivotal role in the preparation of young people for a safe, productive accomplished life in a world where HIV & AIDS, sexually transmitted infections (STIs), unintended pregnancies, and gender based violence (GBV) & gender inequality still pose serious risks to their well-beings.

National policies and curricular may use different terms to refer to CSE. These includes: Prevention Education (refers to comprehensive education that is focused on addressing the root causes of interpersonal violence or sexual assault, relationship violence & stalking), Relationship & Sexuality education, Family life education, life-skills education, HIV education, life styles and basic life safety.

Regardless of the term used, comprehensive refers to the development of learner's KNOWLEDGE, SKILLS and ATTITUDES for positive sexuality and good sexual and reproductive health (SRH). Core elements of CSE programmes share certain similarities such as a firm grounding in Human Rights and recognition of broad concept of sexuality as a natural part of human development.

SRH (Sexual and Reproductive Health) Issues that affects Adulthood.

1. Puberty: For both boys and girls, the transition from childhood to adulthood may be presented as exciting, and marking a major change. However, for boys, the shift of puberty is much more explicitly linked to sexual feelings in a positive way, whereas for girls this moment often marks the beginning of conflicting messages about sexuality, virginity, fertility and womanhood.

For many girls, menstruation is seen as the start of puberty. In some settings, cultural taboos and stigma force girls to sleep or eat away from their families or to miss school while they are menstruating. In many countries, schools do not have toilets that facilitate privacy, cleanliness or proper disposal of menstruation-related products.

Puberty for boys is often considered as the onset of sexual desire, erections and wet dreams, while potentially embarrassing occu- rrences, are not usually approached from the same narrative of shame that girls experience. A discussion of masculinity has been absent from many sexuality education programmes because masculinity is generally not perceived as problematic, yet boys feel that their needs and questions about their sexuality are not being addressed (UNESCO).

2. Pregnancy : Early marriage is a key factor of births to teenage mothers in developing countries occur within marriage (IPPF, 2017). Early pregnancy and childbirth can have serious health and social consequences and is the second cause of death among girls under 19 years old. Complications during pregnancy or childbirth are one of the leading causes of death among adolescent girls (WHO).

Adolescent girls that are pregnant may be more likely than older women to delay seeking maternal health care because they do not have enough knowledge about pregnancy and its complications; or because they are constrained in making decisions about their access to and use of medical services (e.g. by in-laws, or through restrictive laws and policies related to age of consent to sexual intercourse and access to services) (WHO). Pregnant adolescent girls are more likely to drop out of school and discontinue education, which limits their future employment and other life opportunities.

3. Access to modern contraception : Both young men and women are responsible for using contracep- tives, however more is known about women's unmet needs for contraception. Unmarried women generally account for less than half of all women with unmet needs for contraception, although levels of unmet need in this population may be underestimated due to the reluctance of unmarried women in conservative societies to admit that they are sexually active.

Adolescent girls also report legal barriers and other access-related reasons, as well as health concerns and worries about side effects of contraceptives. Additionally, critical gaps in knowledge exist, especially in Africa and Asia, regarding where to obtain and how to use a range of modern contraceptive methods, including condoms and emergency contraception, and where to go for pregnancy or HIV testing services.

4. Unsafe abortion: Because of the legal restrictions on access to safe abortion that exist in many parts of the world, adolescents often resort to unsafe procedures administered by unskilled providers. Adolescent girls suffer a significant and disproportionate share of deaths and disability from unsafe abortion practice compared to women over 20 years of age (WHO, 2007; WHO, 2015).

Adolescents typically take longer than adult women to realize they are pregnant, and adolescents who want to end their pregnancy consequently have abortions later in the gestational period.

In some cases, because of stigma and discrimination or other factors, adolescent girls are also more likely than older women to self-induce an abortion or seek abortion services from untrained providers, and are generally less knowledgeable about their rights concerning abortion and post-abortion care.

Key Concepts, Topics & Learning Objectives of CSE:

There are eight key concepts which are important, mutually reinforcing and intended to be taught alongside one another.

1. Relationships:

Families-Parents/guardians and other family members help children acquire values and guide and support their children's decisions. Gender inequality is often reflected in the roles and responsibilities of family members. Families can promote gender equality through their roles and responsibilities. Health and illness can affect families in terms of their structure, capacities and responsibilities.

Conflict and misunderstandings between parents/guardians and children are common, especially during adolescence, and are usually resolvable. There are support systems that young people and family members can turn to when faced with challenges related to sharing or disclosure of information related to sexual relationships and health issues

Friendship, Love and Romantic Relationships-There are healthy and unhealthy relationships. Relationships involve different kinds of love (e.g. love between friends, love between parents, and love between romantic partners) and love can be expressed in many different ways. Friendship and love can be expressed differently as children become adolescents.

Romantic relationships can be strongly affected by inequality and differences in power (e.g. due to gender, age, economic, social or health status). There are healthy and unhealthy sexual relationships.

Tolerance, Inclusion and Respect-Stigma and discrimination are harmful. Stigma and discrimination on the grounds of differences (e.g. HIV, pregnancy or health status, economic status, ethnicity, race, origin, gender, sexual orientation, gender identity, or other differences) are disrespectful, harmful to well-being, and a violation of human rights.

It is disrespectful and hurtful to harass or bully anyone on the basis oftheir social, economic or health status, ethnicity, race, origin, sexual orientation, gender identity, or other differences. It is important to challenge stigma and discrimination and promote inclusion, non-discrimination and diversity.

Long-term Commitments and Parenting-Long-term commitments, marriage and parenting vary and are shaped by society, religion, culture and laws. There are many responsibilities that come with marriage and long-term commitments. People become parents in various ways and parenthood involves many different responsibilities. Children have a variety of needs that parents/guardians have a responsibility to fulfil.

to be continued...