Sex education



Sex education is a broad term used to describe education about human sexual anatomy, sexual reproduction, sexual intercourse, and other aspects of human sexual behavior. Common avenues for sex education are parents or caregivers, school programs, and public health campaigns.

Overview
Education about reproduction typically describes the creation and development of a new human being, from conception and the development of the embryo and fetus, through to childbirth. It often includes topics such as sexually transmitted infections (STIs) and how to avoid them, as well as birth control methods.

Although some form of sex education is part of the curriculum at many schools, it remains a controversial issue in several countries, particularly with regard to the age at which children should start receiving such education, the amount of detail that is revealed, and topics dealing with human sexuality and behavior (eg. safe sex practices, masturbation and sexual ethics).

In 1936, Wilhelm Reich commented that sex education of his time was a work of deception, focusing on biology while concealing excitement-arousal, which is what a pubescent individual is mostly interested in. Reich added that this emphasis obscures what he believed to be a basic psychological principle: that all worries and difficulties originate from unsatisfied sexual impulses.

In many countries, sexual education raises much contentious debate. Chief among the controversial points is whether covering child sexuality is valuable or detrimental; the use of birth control such as condoms and hormonal contraception; and the impact of such use on pregnancy outside marriage, teenage pregnancy, and the transmission of STIs. Increasing support for abstinence-only sex education by conservative groups has been one of the primary causes of this controversy. Countries with conservative attitudes towards sex education (including the UK and the U.S.) have a higher incidence of STIs and teenage pregnancy.

The existence of AIDS has given a new sense of urgency to the topic of sex education. In many African nations, where AIDS is at epidemic levels (see HIV/AIDS in Africa), sex education is seen by most scientists as a vital public health strategy. Some international organizations such as Planned Parenthood consider that broad sex education programs have global benefits, such as controlling the risk of overpopulation and the advancement of women's rights (see also reproductive rights).

United States
Almost all U.S. students receive some form of sex education at least once between grades 7 and 12; many schools begin addressing some topics as early as grades 5 or 6. However, what students learn varies widely, because curriculum decisions are so decentralized. Many states have laws governing what is taught in sex education classes or allowing parents to opt out. Some state laws leave curriculum decisions to individual school districts.

For example, a 1999 study by the Guttmacher Institute found that most U.S. sex education courses in grades 7 through 12 cover puberty, HIV, STIs, abstinence, implications of teenage pregnancy, and how to resist peer pressure. Other studied topics, such as methods of birth control and infection prevention, sexual orientation, sexual abuse, and factual and ethical information about abortion, varied more widely.

Two main forms of sex education are taught in American schools: comprehensive and abstinence-only. Comprehensive sex education covers abstinence as a positive choice, but also teaches about contraception and avoidance of STIs when sexually active. A 2002 study conducted by the Kaiser Family Foundation found that 58% of secondary school principals describe their sex education curriculum as comprehensive.

Abstinence-only sex education tells teenagers that they should be sexually abstinent until marriage and does not provide information about contraception. In the Kaiser study, 34% of high-school principals said their school's main message was abstinence-only.

The difference between these two approaches, and their impact on teen behavior, remains a controversial subject in the U.S. Since 1991, U.S. rates of teenage pregnancy have declined significantly, and a slightly higher percentage of teens say they are abstinent. However, the U.S. still has the highest teen birth rate and one of the highest rates of STIs among teens in the industrialized world. Public opinion polls conducted over the years have found that the vast majority of Americans favor broader sex education programs over those that teach only abstinence, although abstinence educators recently published poll data with the totally opposite conclusion. Proponents of comprehensive sex education argue that sexual behavior after puberty is a given, and it is therefore crucial to provide information about the risks and how they can be minimized; they also claim that denying teens such factual information leads to unwanted pregnancies and STIs.

On the other hand, proponents of abstinence-only sex education object to curricula that fail to teach moral behavior; they maintain that a morality based on sex only within the bounds of marriage is "healthy and constructive" and that value-free knowledge of the body may lead to immoral, unhealthy, and harmful practices. Within the last decade, the federal government has encouraged abstinence-only education by steering over a billion dollars to such programs. Some states, such as California, decline the funding so that they can continue to teach comprehensive sex education; several other states have recently joined California. Funding for one of the federal government's two main abstinency-only funding programs, Title V, was extended only until September 30, 2007; Congress is debating whether to continue it past that date.

The impact of the rise in abstinence-only education remains a question. To date, no published studies of abstinence-only programs have found consistent and significant program effects on delaying the onset of intercourse. In 2007, a study ordered by the U.S. Congress found that middle school students who took part in abstinence-only sex education programs were just as likely to have sex (and use contraception) in their teenage years as those who did not. Abstinence-only advocates claimed that the study was flawed because it was too narrow and began when abstinence-only curricula were in their infancy, and that other studies have demonstrated positive effects.

Europe
In England and Wales, sex education is not compulsory in schools as parents can refuse to let their children take part in the lessons. The curriculum focuses on the reproductive system, fetal development, and the physical and emotional changes of adolescence, while information about contraception and safe sex is discretionary. Britain has one of the highest teenage pregnancy rates in Europe and sex education is a heated issue in government and media reports. In a 2000 study by the University of Brighton, many 14 to 15 year olds reported disappointment with the content of sex education lessons and felt that lack of confidentiality prevents teenagers from asking teachers about contraception.

In Scotland, the main sex education program is Healthy Respect, which focuses not only on the biological aspects of reproduction but also on relationships and emotions. Education about contraception and sexually transmitted diseases are included in the program as a way of encouraging good sexual health. In response to a refusal by Catholic schools to commit to the program, however, a separate sex education program has been developed for use in those schools. Funded by the Scottish Executive, the program Call to Love focuses on encouraging children to delay sex until marriage, and does not cover contraception, and as such is a form of abstinence-only sex education.

In France, sex education has been part of school curricula since 1973. Schools are expected to provide 30 to 40 hours of sex education, and pass out condoms, to students in grades eight and nine. In January 2000, the French government launched an information campaign on contraception with TV and radio spots and the distribution of five million leaflets on contraception to high school students.

In Germany, sex education has been part of school curricula since 1970. It normally covers all subjects concerning the growing-up process, the changing of the body, emotions, the biological process of reproduction, sexual activity, partnership, homosexuality, unwanted pregnancies and the complications of abortion, the dangers of sexual violence, child abuse, and sex-transmitted diseases, but sometimes also things like sex positions. Most schools offer courses on the correct usage of contraception. There are also other media of sex education, in first place the youth magazine "Bravo", which always contains a topic where teenagers pose questions about partnership and sexuality.

Subsidized by the Dutch government, the “Lang leve de liefde” (“Long Live Love”) package, developed in the late 1980s, aims to give teenagers the skills to take their own decisions regarding health and sexuality. Nearly all secondary schools provide sex education as part of biology classes and over half of primary schools discuss sexuality and contraception. The curriculum focuses on biological aspects of reproduction as well as on values, attitudes, communication and negotiation skills. The media has encouraged open dialogue and the health-care system guarantees confidentiality and a non-judgmental approach. The Netherlands has one of the lowest teenage pregnancy rates in the world, and the Dutch approach is often seen as a model for other countries.

In Sweden, sex education has been a mandatory part of school education since 1956. The subject is usually started at grades 4–6, and continues up through the grades, incorporated into different subjects such as biology and history. In Finland, the Population and Family Welfare Federation provides to all 15-year-olds an introductory sexual package that includes an information brochure, a condom and a cartoon love story.

Asia
The state of sex education programs in Asia is at various stages of development. Indonesia, Mongolia, South Korea and Sri Lanka have a systematic policy framework for teaching about sex within schools. Malaysia, the Philippines and Thailand have assessed adolescent reproductive health needs with a view to developing adolescent-specific training, messages and materials. India has programs that specifically aims at school children at the age group of nine to sixteen years. These are included as subjects in the curriculum and generally involves open and frank interaction with the teachers. In India, there is a huge debate on the curriculum of sex education and when should it be increased. Bangladesh, Myanmar, Nepal and Pakistan have no coordinated sex education programs.

In Japan, sex education is mandatory from age 10 or 11, mainly covering biological topics such as menstruation and ejaculation.

In China, sex education traditionally consists in reading the reproduction section of biology textbooks. However, in 2000 a new five-year project was introduced by the China Family Planning Association to "promote reproductive health education among Chinese teenagers and unmarried youth" in twelve urban districts and three counties. This includes discussion about sex within human relationships as well as pregnancy and HIV prevention.

The International Planned Parenthood Federation and the BBC World Service ran a 12-part series known as Sexwise, which discussed sex education, family life education, contraception and parenting. It was first launched in South Asia and then extended worldwide.

Africa


Sex education in Africa has focused on stemming the growing AIDS epidemic. Most governments in the region have established AIDS education programs in partnership with the World Health Organization and international NGOs. These programs commonly teach the 'ABC' of HIV prevention, which has been frequently backed by the Bush Administration: a combination of abstinence (A), fidelity to your partner (Be faithful) and condom use (C). (See Abstinence, be faithful, use a condom.) The efforts of these educational campaigns appear now to be bearing fruit. In Uganda, condom use has increased, youths are delaying the age at which sexual intercourse first occurs, and overall rates of HIV infection have been going down.

Egypt teaches knowledge about male and female reproductive systems, sexual organs, contraception and STDs in public schools at the second and third years of the middle-preparatory phase (when students are aged 12–14). There is currently a coordinated program between UNDP, UNICEF, and the ministries of health and education to promote sexual education at a larger scale in rural areas and spread awareness of dangers of female circumcision.

Morality of sex education
One approach to sex education is to view it as necessary to reduce risk behaviours such as unprotected sex, and equip individuals to make informed decisions about their personal sexual activity. Additionally, some proponents of comprehensive sex education contend that education about homosexuality encourages tolerance and understanding that homosexuality isn't something that is wrong.

Another viewpoint on sex education, historically inspired by sexologists like Wilhelm Reich and psychologists like Sigmund Freud and James W. Prescott, holds that what is at stake in sex education is control over the body and liberation from social control. Proponents of this view tend to see the political question as whether society or the individual should teach sexual mores. Sexual education may thus be seen as providing individuals with the knowledge necessary to liberate themselves from socially organized sexual oppression and to make up their own minds. In addition, sexual oppression may be viewed as socially harmful.

To another group in the sex education debate, the question is whether the state or the family should teach sexual mores. They believe that sexual mores should be left to the family, and sex-education represents state interference. They claim that some sex education curricula break down pre-existing notions of modesty and encourage acceptance of practices that those advocating this viewpoint deem immoral, such as homosexuality and premarital sex. They cite web sites such as that of the Coalition for Positive Sexuality as examples. Naturally, those that believe that homosexuality and premarital sex are a normal part of the range of human sexuality disagree with them.

Many religions teach that sexual behavior outside of marriage is immoral, so their adherents feel that this morality should be taught as part of sex education. Other religious conservatives believe that sexual knowledge is unavoidable, hence their preference for a curricula based on abstinence.

Lesbian, gay, bisexual, and transgender youth


Lesbian, gay, bisexual, and transgender (LGBT) youth are often ignored in sex education classes, including a frequent lack of discussion about safer sex practices for manual, oral, and anal sex, despite these activities' different risk levels for sexually transmitted diseases.

Some people do not agree with comprehensive sexual education that references or discusses such practices, believing that including this additional information might be seen as encouraging homosexual behavior. Proponents of such comprehensive curricula hold that by excluding discussion of these issues or the issues of homosexuality, bisexuality, or transgenderedness, feelings of isolation, loneliness, guilt and shame as well as depression are made much worse for students who belong or believe they may belong to one of these categories, or are unsure of their sexual identity. Supporters of including LGBT issues as an integral part of comprehensive sexuality education argue that this information is still useful and relevant and reduces the likelihood of suicide, sexually transmitted disease, 'acting out' and maladaptive behavior in these students. In the absence of such discussion, these youths are said to be de facto forced to remain in the closet, while youths are left without guidance on dealing with their own possible same-gender attractions and with their LGBT classmates.

Supporters of comprehensive sex education programs argue that abstinence-only curricula (that advocate that youth should abstain from sex until marriage) ignore and marginalize lesbian, gay, bisexual, and transgender youth, who are often unable to marry a partner due to legal restrictions. Proponents of abstinence-only education often have a more conservative view of homosexuality and bisexuality and are against them being taught as normal, acceptable orientations, or placed in equal footing to heterosexual acts/relations, and so they generally do not see this as a problem. While supporters of comprehensive programs feel that this is a major problem as it could lead GLBT youth to feel even more alienated and shameful of their sexual orientation.

Scientific study of sex education
The debate over teenage pregnancy and STDs has spurred some research into the effectiveness of different approaches to sex education. In a meta-analysis, DiCenso et al. have compared comprehensive sex education programs with abstinence-only programs. Their review of several studies shows that abstinence-only programs did not reduce the likelihood of pregnancy of women who participated in the programs, but rather increased it. Four abstinence programs and one school program were associated with a pooled increase of 54% in the partners of men and 46% in women (confidence interval 95% 0.95 to 2.25 and 0.98 to 2.26 respectively). The researchers conclude:


 * "There is some evidence that prevention programs may need to begin much earlier than they do. In a recent systematic review of eight trials of day care for disadvantaged children under 5 years of age, long term follow up showed lower pregnancy rates among adolescents. We need to investigate the social determinants of unintended pregnancy in adolescents through large longitudinal studies beginning early in life and use the results of the multivariate analyses to guide the design of prevention interventions. We should carefully examine countries with low pregnancy rates among adolescents. For example, the Netherlands has one of the lowest rates in the world (8.1 per 1000 young women aged 15 to 19 years), and Ketting & Visser'' have published an analysis of associated factors. In contrast, the rates are:
 * 93.0 per 1000 in the United States (85.8/1000 in 1996)
 * 62.6 per 1000 in England and Wales, and
 * 42.7 per 1000 in Canada
 * 15.1 per 1000 in Belgium (1996)


 * We should examine effective programs designed to prevent other high risk behaviors in adolescents. For example, Botvin et al.'' found that school based programs to prevent drug abuse during junior high school (ages 12–14 years) resulted in important and durable reductions in use of tobacco, alcohol, and cannabis if they taught a combination of social resistance skills and general life skills, were properly implemented, and included at least two years of booster sessions.


 * ''Few sexual health interventions are designed with input from adolescents. Adolescents have suggested that sex education should be more positive with less emphasis on anatomy and scare tactics; it should focus on negotiation skills in sexual relationships and communication; and details of sexual health clinics should be advertised in areas that adolescents frequent (for example, school toilets, shopping centres)."

Also, a US review, "Emerging Answers", by the National Campaign To Prevent Teenage Pregnancy examined 250 studies of sex education programs. The conclusion of this review was that "the overwhelming weight of evidence shows that sex education that discusses contraception does not increase sexual activity".