Sexuality Education: What does research tell us?

1. Sexuality Education: What does research tell us? Dan Apter, dan.apter@vaestoliitto.fi Chief Physician & Director The Sexual Health Clinic Väestöliitto, Family Federation of Finland

2. SEXUAL HEALTH FOR ADOLESCENTS TODAY 1. Recognizing sexual rights 2. Sexuality education and counseling 3. Confidential high quality services

3. Sexuality education • Counseling, in direct interpersonal relationship based on recognizing individual needs. Counseling might include very sensitive areas. 2. Sexuality education is typically given in schools, where a group of 20-30 young persons of similar age listen to lectures, see educational material and can discuss. 3. A third approach is information campaigns about sexual health through e.g. mass media.

4. Sexuality education in school improves knowledge and support informed and responsible choices

5. Sexuality Education – what it is The learning about the cognitive, emotional, social, interactive and physical aspects of sexuality. Sexuality education starts early in childhood and progresses through adolescence and adulthood. For children and young people it aims at the support and the protection of sexual development.

6. Sexuality Education II It gradually equips and empowers children and young people with information, skills and positive values to understand and enjoy their sexuality, have safe fulfilling relationships, and take responsibility for their own and other’s sexual health and well-being. It enables them to make choices which enhance the quality of their lives and contributes to a compassionate and just society. All children and young people have the right to have access to age appropriate sexuality education.

7. Research and Documentation Sexuality Education Reference Guide • Information on policies & practices in sexuality education • Allows for comparisons between 26 countries http://www.ippfen.org/en/Resources/ IPPF EN, SAFE Conference, Brussels 2007

8. Sense, emotion, biology Sexuality = essential part of human wellbeing Sexuality education should take into consideration love, mutual respect and self-confidence.

9. How good is the evidence for effect of sexuality education on different outcomes? Judith Stephenson Margaret Pyke Professor of Sexual Health, UK

10. Do we have information about the right indicators? Available data about sexual and reproductive health (SRH) of adolescents: abortion and delivery rates, STI, contraceptive use, sexual behavior, sexual abuse, other health aspects, gender equality, happiness, and quality of life? ?  Present ways SRH services of adolescents are provided Education of professionals in relation to SRH of adolescents and children

11. Sex and HIV Education Programs: Their Impact on Sexual Behaviorsof Young People Throughout the World Douglas B. Kirby, B.A. Laris, Lori A. Rolleri Journal of Adolescent Health 2007, 40: 206–217 reviews 83 studies that measure the impact of curriculum-based sexuality education programs on sexual behavior and mediating factors < 25 years anywhere in the world.

12. Identification of evaluation studies The program had to: ● Be a curriculum- and group-based sex or HIV education program The research methods had to: ● Include a reasonably strong experimental or quasi-experimental design with both intervention and comparison groups and both pretest and posttest data collection. ● Measure program impact upon one or more of the following sexual behaviors: initiation of sex, frequency of sex, or number of sexual partners; use of condoms or contraception more generally; composite measures of sexual risk

13. Sexuality education works ! • Two thirds of the programs significantly improved one or more sexual behaviors. • The evidence is strong that programs do not hasten or increase sexual behavior but, instead, some programs delay or decrease sexual behaviors. Effective curricula incorporated 17 characteristics that describe the curricula development; the goals, teaching strategies; and their implementation. • Programs were effective across a variety of countries, cultures, and groups of youth. Replications of studies indicate that programs remain effective when implemented by others in different communities, provided all the activities are implemented as intended in similar settings.

14. Impact on contraceptive use Condom use • Of the 54 studies measuring program impact on condom use, almost half (48%) showed increased condom use; none found decreased condom use. Contraceptive use in general • Of the 15 studies measuring impact, 6 showed increased contraceptive use, 8 showed no impact, and 1 showed decreased contraceptive use

15. Sexual abstinence only programmes to prevent HIV infection in high income countries: systemic reviewUnderhill et al BMJ 2007 • 13 trials enrolling 16 000 US youths identified, all outcomes were self reported • No program affected incidence of unprotected sex, number of partners, condom use, or sexual initiation

16. How to cope with disappointment

17. 1994:”The Evolution of Sexual Health in Finland: How we did it” 2001: ”The Evolution of Sexual Health in Finland: How we spoiled it” 2009: How we did it again? VÄESTÖLIITTO Dan Apter

18. Abortions and deliveries (per 1000) in 15-19 yr old girls in Finland 1975 - 2010 Sex.edu and health services were reduced Sex.edu and health services developed Sexuality education developed again 8,5

19. National Core Curriculum for Basic Education the objectives and core contents of health education are issued in accordance with lesson allocation as follows: • Grades 1–6: health education integrated into environmental and natural studies • Grades 7–9: a total of three units (= 114 lessons over 3 years) as an independent health education subject. • Sexuality education is a part of health teaching. Sexual health core contents consist of: human relations, sexuality, behavior, values and norms.

20. Sexuality education as part of health teaching • Sexual health: human relations, sexuality, behavior, values and norms • The student should learn basics of sexual health, the importance of contraception and methods for it, and be able to consider and justify responsible sexual behavior • The student should be able to name, recognize and reveal different feelings, and describe their development and reasons, and provide examples how behavior and interactions can be regulated according to the situation Ministry of education, guidelines for teaching 2004, but my translation

21. % girls who have had intercourse, Finland 1996-2007 STAKES school health survey D Apter, EntreNous p12-13, 2009

22. %-girls who did not use contraception at last intercourse, Finland 1998-2007. STAKES school health survey D Apter, EntreNous p12-13, 2009

23. Abortions and deliveries per 1000 girls 15-19 year old in Finland 1975 to - 2008 %-girls who did not use contraception at last intercourse

24. Aim and structure of the sexualhealthknowledgestudy • Produce a representative picture of sexuality education of school grade 7-9 in 2006, and the changes from 1996, particularly related to the introduction of a new subject, health, as described by teachers • Evaluate the sexual health knowledge of 8 grade students by a national quiz, and changes between 2000 and 2006 • Combine the information provided by the teachers with knowledge of the students in the same schools, to evaluate the impact of sexuality education Väestöliitto 2007

25. Number of hours Health knowledge is obligatory with 3 courses during grades 7-9, total 114 h. Sexuality education hours:

26. Teachers • Still various backgrounds • Greater variety of methods is used • Only 4% thought it was difficult to talk about sexual matters, 80% considerded it easy

27. A study of students’ sexual health knowledge • In 2006, 462 schools returned the questionnaires of 33 819 students (30241 in 2000) at grade 8. • 75 questions in common in 2000 and 2006 • In 2000, meannumber of correctanswerswas 49,6 and 51,5 in 2006 • The number of correctanswersincreased for girlsfrom 53,9 to 55,1, and for boysfrom 45,4 to 48,3

28. Boys lack adequate knowledge

29. Distribution of sum of knowledge for girls and boys in 2006, %

30. Extent of sexualityeducation in Health, schoolgrades, and the number of correctanswers. Boys Extent of sexuality education

31. Q41. Emerencycontraceptionshouldbeused: • in a weekfromunprotectedintercource • in twoweeksfrom the absence of periods • as soon as possible, but at the latest 72 hoursfromunprotectedintercource • at the latestsixhoursfromunprotectedintercource

32. Q28. Who is responsible for preventing adolescent pregnancies and STDs?

33. Letter by the Archbishop of Finland 1998 • I give my support to your work in order to ensure sexual rights for children and adolescents throughout the world, especially in developing countries. • Accurate, age- and culture-appropriate information about sexuality is a foundation for nurturing of healthy adolescents, adults and relationships. • I am pleased to hear about your efforts to address such problems as access to family planning and proper use of contraception methods, safe parenthood and STD/HIV prevention programs

34. Conclusions • When adolescent sexuality is not condemned but sexuality education and sexual health services are provided, it is possible to profoundly improve adolescent sexual health with comparatively small costs. • But each year new groups of young people mature, requiring new efforts. Education, counseling and services are all needed. If the resources are cut too much or not given, negative effects are soon evident.