Sex education

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

Overview
Sex education may also be described as "sexuality education", which means that it encompasses education about all aspects of sexuality, including information about family planning, reproduction (fertilization, conception and development of the embryo and fetus, through to childbirth), plus information about all aspects of one's sexuality including: body image, sexual orientation, sexual pleasure, values, decision making, communication, dating, relationships, sexually transmitted infections (STIs) and how to avoid them, and birth control methods.

Sex education may be taught informally, such as when someone receives information from a conversation with a parent, friend, religious leader, or through the media. It may also be delivered through sex self-help authors, magazine advice columnists, sex columnists, or through sex education web sites. Formal sex education occurs when schools or health care providers offer sex education.

Sometimes formal sex education is taught as a full course as part of the curriculum in junior high school or high school. Other times it is only one unit within a more broad biology class, health class, home economics class, or physical education class. Some schools offer no sex education, since it remains a controversial issue in several countries, particularly the United States (especially 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 sexual behavior, e.g. safe sex practices, masturbation, premarital sex, 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.

When sex education is contentiously debated, the chief controversial points are 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). The use of mass media campaigns, however, has sometimes resulted in high levels of "awareness" coupled with essentially superficial knowledge of HIV transmission.

According to SIECUS, the Sexuality Information and Education Council of the United States, 93% of adults they surveyed support sexuality education in high school and 84% support it in junior high school. In fact, 88% of parents of junior high school students and 80% of parents of high school students believe that sex education in school makes it easier for them to talk to their adolescents about sex. Also, 92% of adolescents report that they want both to talk to their parents about sex and to have comprehensive in-school sex education. Furthermore, a "...study, conducted by Mathematica Policy Research Inc. on behalf of the U.S. Department of Health and Human Services, found that abstinence-only-until-marriage programs are ineffective."

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 were undercut significantly by the Global Gag Rule, an initiative put in place by President Ronald Reagan, suspended by President Bill Clinton, and re-instated by President George W. Bush. The Global Gag Rule "...required nongovernmental organizations to agree as a condition of their receipt of Federal funds that such organizations would neither perform nor actively promote abortion as a method of family planning in other nations...." The Global Gag Rule was again suspended as one of the first official acts by United States President Barack Obama. The incidences of new HIV transmissions in Uganda decreased dramatically when Clinton supported a comprehensive sex education approach (including information about contraception and abortion). According to Ugandan AIDS activists, the Global Gag Rule undermined community efforts to reduce HIV prevalence and HIV transmission.

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). A coordinated program between UNDP, UNICEF, and the ministries of health and education promotes sexual education at a larger scale in rural areas and spreads awareness of the dangers of female genital cutting.

Asia
The state of sex education programs in Asia is at various stages of development. Indonesia, Mongolia, South Korea have a systematic policy framework for teaching about sex within schools. Malaysia and Thailand have assessed adolescent reproductive health needs with a view to developing adolescent-specific training, messages and materials. India has programs aimed at children aged nine to sixteen years. In India, there is a huge debate on the curriculum of sex education and whether it should be increased. Attempts by state governments to introduce sex education as a compulsory part of the curriculum have often been met with harsh criticism by political parties, who claim that sex education "is against Indian culture" and would mislead children. (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 and Sri Lanka, sex education traditionally consists of reading the reproduction section of biology textbooks. In Sri Lanka they teach the children when they are 17–18 years. 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 included 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.

Finland
In Finland, sexual education is usually incorporated into various obligatory courses, mainly as part of biology lessons (in lower grades) and later in a course related to general health issues. The Population and Family Welfare Federation provides all 15-year-olds an introductory sexual package that includes an information brochure, a condom and a cartoon love story.

England and Wales
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 and discussion about relationships is often neglected. 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 a 2008 study conducted by YouGov for Channel 4 it was revealed that almost three in ten teenagers say they need more sex and relationships education.

France
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.

Germany
In Germany, sex education has been part of school curricula since 1970. Since 1992 sex education is by law a governmental duty.

It normally covers all subjects concerning the growing-up process, body changes during puberty, 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.

A sex survey by the World Health Organization concerning the habits of European teenagers in 2006 revealed that German teenagers care about contraception. The birth rate among 15- to 19-year-olds was very low - only 11.7 per 1000 population, compared to the UK's 27.8 births per 1,000 population, and—in first place—Bulgaria's 39.0 births per 1,000. but it is considered high by Asian standards.

Poland
In the Western point of view, sex education in Poland has never actually developed. At the time of the People's Republic of Poland, since 1973, it was one of the school subjects, however, it was relatively poor and did not achieve any actual success. After 1989, it practically vanished from the school life - it is currently an exclusive subject (called wychowanie do życia w rodzinie/family life education rather than edukacja seksualna/sex education) in several schools their parents must give consent to the headmasters so their children may attend. It has much due to the strong objection against sex education of the Catholic Church; the most influential institution in Poland.

It has, however, been changed and since September 2009 sex education will become an obligatory subject in the number of 14 per school year - unless parents do not want their children to be taught. Objecting parents will have to write special disagreements.

The Netherlands
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 make their own decisions regarding health and sexuality. Professor Brett van den Andrews, a medical research scientist who graduated from ISHSS (International School for Humanities and Social Sciences), has suggested that exposing children aged 4–7 to sex education will greatly reduce the risk of future pregnancies and health issues. His theories have been the subject of much scrutiny under the NIGS (Netherlands Institute of Geooracular Sciences). Nonetheless, he is widely appreciated in the medical society and has been featured in many medical journals. 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.

Scotland
The main sex education programme in Scotland 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 programme 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 Government, the programme Called 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.

Sweden
In Sweden, sex education has been a mandatory part of school education since 1956. The subject is usually started between ages 7 and 10, and continues up through the grades, incorporated into different subjects such as biology and history.

Switzerland
In Switzerland, the content and amount of sex education is decided at the cantonal level. In Geneva, courses have been given at the secondary level since the 1950s. Interventions in primary schools were started more recently, with the objective of making children conscious of what is and isn't allowed, and able to say "No". In secondary schools (age 13-14), condoms are shown to all pupils, and are demonstrated by unfolding over the teacher's fingers. For this, classes are usually separated into girl-only and boy-only subgroups. Condoms are not distributed, however, except among older adolescents engaged in state-run non-compulsory education (age 16-17).

Slovak Republic
In Slovak republic / Slovakia the content of Sex education varies from school to school, mostly being led by a teacher for a subject which translated to English would be Nature science (The subject covers biology and petrology). The quality of explanation also varies from teacher to teacher and it is not uncommon that the teacher relies on students asking questions. Classes are usually divided into boys/girls, where girls are usually explained the necessary facts about menstruation and pregnancy. Boys are shown a picture of genitalia anatomy with description and may ask questions. Generally is the sex ed level in Slovakia quite poor, though the level actually varies from school to school and reason lies as mentioned above somewhere in the issues of the school or the teacher.

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 in 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., teenage birth rates had been dropping since 1991, but a 2007 report showed a 3% increase from 2005 to 2006. From 1991 to 2005, the percentage of teens reporting that they had ever had sex or were currently sexually active showed small declines. 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 opposite conclusion.

Proponents of comprehensive sex education, which include the American Psychological Association, the American Medical Association, the National Association of School Psychologists, the American Academy of Pediatrics, the American Public Health Association, the Society for Adolescent Medicine and the American College Health Association, 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 their standard of 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 25 states now decline the funding so that they can continue to teach comprehensive sex education. Funding for one of the federal government's two main abstinency-only funding programs, Title V, was extended only until December 31, 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.

According to a 2007 report, Teen pregnancies in the United States showed 3% increase in the teen birth rate from 2005 to 2006, to nearly 42 births per 1,000.

Virginia


Virginia uses the sex education program called, The National Campaign to prevent teen and unplanned pregnancy. The National Campaign was created in 1996. The program focuses on preventing teen and unplanned pregnancies of young adults. The National campaign set a goal to reduce teen pregnancy rate by 1/3 in 10 years. The Virginia Department of Health ranked Virginia 19th in teen pregnancy birth rates in 1996. Virginia was also rated 35.2 teen births per 1000 girls aged 15–19 in 2006. The Healthy people 2010 goal is a teen pregnancy rate at or below 43 pregnancies per 1000 females age 15-17.

Morality
One approach to sex education is to view it as necessary to reduce risk behaviors such as unprotected sex, and equip individuals to make informed decisions about their personal sexual activity.

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 curricula based on abstinence.

Lesbian, gay, bisexual, and transgender youth
In many countries, homosexual, bisexual, transgender (LGBT) youth, and those with other sexual orientations or practices, are often ignored in sex education classes, including a frequent lack of discussion about safer sex practices for manual, oral, and anal sex with regards to the different risk levels for contracting sexually transmitted diseases.

Scientific studies
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
 * 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 U.S. 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".