Youth Sexuality Education in a Multicultural Europe
Country Papers on Youth Sexuality Education in Europe
These Country Papers on Youth Sexuality Education have been compiled to assess the national strategies and approaches to youth sexuality education of 16 countries participating in the international conference of the Federal Centre for Health Education (BZgA) / Regional Office for Europe of the World Health Organization (WHO) on “Youth sex education in a multicultural Europe“, to be held in Cologne, Germany, from 14th to 16th November 2006.
- Sexual and Reproductive Health and Rights: International definitions
- Sexual and reproductive health in Europe
- WHO Regional Strategy on Sexual and Reproductive Health: Strategies to meet the needs of adolescents
- WHO Collaborating Centres
- International reports regarding reproductive and young people‘s health in the region
- BZgA / WHO Conference “Youth Sex Education in a Multicultural Europe”: Scope and Purpose
- Assessment and editing of the Country Papers
Sexual and Reproductive Health and Rights: International definitionsAt the International Conference on Population and Development, held in Cairo in 1994, sexual and reproductive health was identified as an area of special concern for all national health services. This includes both prevention and care, and covers a range of issues, such as safe motherhood, reproductive choices and STI/HIV/AIDS control.
Following the recommendations of the WHO, sexual health is defi ned as “a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infi rmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.” (WHO 2004a)
Reproductive health, referring to the WHO‘s definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infi rmity, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability and the freedom of choice to reproduce. The areas of sexual health (responsible, satisfying and safe sex life), reproductive freedom (access to information, methods and services) and safe motherhood (safe pregnancy, childbirth and healthy children) are included in the internationally accepted definition of the declaration of the International Conference on Population and Development (ICPD), Cairo 1994. (WHO 2001)
The 1995 International Planned Parenthood Federation (IPPF) Charter on sexual and reproductive rights declares the “right to equality and to be free from all forms of discrimination (…) to protect the right of all people, regardless of race, colour, sex, sexual orientation, marital status, family position, age, language, religion, political or other opinion, national or social origin, property, birth or other status, to equal access to information, education and services related to development, and to sexual and reproductive health“. Sexual and reproductive rights as defi ned in the IPPF Charter comprise the right of reproductive choice on the basis of full, free and informed consent. In this context, the right of access to full information and the widest possible range of safe, effective and acceptable contraceptive methods, the right of choice regarding marriage, to found and plan a family, the right of access to the highest possible quality of health care, the women‘s right of safe motherhood and of protection from genital mutilation, as well as protection from forced pregnancy, forced sterilisation or abortion, and the right of women, men and children to be protected from all forms of sexual violence and exploitation, the right of privacy in services relating to sexual and reproductive health and the right of political participation in order to advocate sexual and reproductive health and rights are addressed. www.unfpa.org/swp/1997/box8.htm
Sexual and reproductive health in EuropeIn the WHO European Region, the contrast in health and health care status between the market economies of the West and the Eastern countries in transition is a major area of concern. Thus, international programmes focus on reducing regional gaps in health status and services. Inequalities are most signifi cant in the area of reproductive health, and adolescents constitute one of the specific target groups of global, regional and national reproductive health strategies. Regarding adolescents in the Eastern and Central European Region, the high number of induced abortions, the increase in sexually transmitted infections and HIV/AIDS, and the growing number of sex workers indicate the need to develop and implement programmes addressing the specifi c needs of young people. Inequalities in access to information, knowledge and services addressing the sexual and reproductive health of adolescents are also to be tackled in the Western Region, where young people with a migrant background, socially disadvantaged and poorly educated adolescents, and young girls are identifi ed as special vulnerable groups at high risk of reproductive morbidity. Indicators for lacking knowledge and options enabling people to lead a healthy sexual and reproductive life are, for example, the rates of unwanted and teenage pregnancy, and growing evidence of increasing sexual violence and sexual exploitation. (WHO 2001; CDC 2003)
Growing implementation of programmes in the area of sexual and reproductive health in the framework of national health strategies can be noted in the Central and Eastern countries of the WHO European Region. Most programmes consider young peoples‘ special needs in reproductive and sexual health. In some countries, programmes addressed to young people are implemented in the framework of strategies to prevent and combat HIV/AIDS and STIs.
In Ukraine, which adopted a national reproductive health strategy in 2006, the main objectives within the programme are to implement services addressed to young people, to promote safe behaviour and to develop curricula for youth sex education on a national level. Latvia implemented sexuality education as a statutory part of school health education in 2005. The Kyrgyz Republic only recently introduced a national strategy for protecting the reproductive health of mothers and children on a legal basis, one chapter referring to the promotion of adolescents‘ reproductive health. A meeting of parliamentarians of the Commonwealth of Independent States (CIS), held in the Kyrgyz Republic in August 2006 to exchange issues of reproductive and sexual health of young people in the region, also indicates growing awareness of the need to focus on adolescents in the framework of reproductive health policy and programmes.
The WHO European Regional Strategy on Sexual and Reproductive Health (WHO 2001) underlines the need for a comprehensive framework and solidarity among member states to reduce regional inequalities. Internationally funded programmes have played a vital part in initiating the development and implementation of programmes on a national level. Sexual and reproductive health issues have been set out as priorities in the collaborative agreements between the WHO Regional Offi ce for Europe and the member states. Programmes and projects have also received international funds, e.g. from UNDP, UNICEF, UNAIDS, the EU and USAID.
In Uzbekistan, the action plan to introduce Youth-Friendly Services throughout the country and to implement school sex and reproductive health education was funded by the UNESCO in its initial phase. Currently, it is solely fi nanced by government funds. Turkey‘s reproductive health programme is fi nancially assisted in the framework of a bilateral agreement between Turkey and the European Commission. Vital challenges are to meet the needs of special vulnerable groups, such as women, and to reduce the enormous regional gaps within the country as regards health and education status, as well as in access to services.
As for the Western European Region, there is growing awareness of the need to develop approaches that address the diverse needs, attitudes, cultural and social backgrounds of young people, in order to gather experience regarding how to promote the inclusion of diverse groups, particularly young migrants, in sexual and reproductive health programmes and services.
WHO Regional Strategy on Sexual and Reproductive Health: Strategies to meet the needs of adolescentsThe WHO Regional Office for Europe released its Regional Strategy in 2001 to provide strategic guidance for member states in the development of policies and the implementation of programmes for improving sexual and reproductive health. The overall goal of the Strategy “is to support member states in their efforts to ensure sexual and reproductive rights, to improve the SRH status of the people and to generate solidarity in Europe“, in order to reduce the wide regional gap in SRH status in Europe, as well as inequalities within European countries. (WHO 2001)
Guiding principles based on international documents (World Health Declaration 1998; Health21 - Copenhagen 1999, Cairo Conference 1994, UN Conference on Population and Development 1999) that are particularly relevant in the area of sexual and reproductive health are:
- To ensure, on the basis of gender equality, universal access to, and availability of, reproductive health care services, including family planning and sexual health,
- Implementation under the responsibility and sovereignty of each country, respecting religious, ethical and cultural values of its people, and in conformity with international human rights,
- The commitment to equity, solidarity and social justice, and gender equality, which includes solidarity between countries, between groups in countries and between the sexes,
- To ensure services of good quality, based on scientific evidence, within affordable limits and sustainable for the future,
- To facilitate the participation and accountability of individuals, groups and communities, and of institutions, organisations and sectors in health development.
- The Strategy has set objectives and targets for the period 2000 to 2010 for the areas of reproductive choice, safe motherhood, STI/HIV/AIDS control, sexual abuse and violence, trafficking of women, and breast cancer, and for the special groups adolescents, refugees and displaced persons, migrant population, and ageing people.
Regarding adolescents‘ sexual and reproductive health, the three objectives are:
- 1. To inform and educate adolescents on all aspects of sexuality and reproduction, and to assist them in developing the life skills necessary to deal with these issues in a satisfying and responsible manner,
- 2. To ensure easy access to youth-friendly SRH services,
- 3.To reduce the levels of unwanted pregnancies, induced abortions and STIs among young people.
In connection with these objectives, the proposed targets and outcomes are:
- To include education on sexuality and reproduction in all secondary school curricula,
- To implement educational programmes aiming at young people out of school,
- To provide confidential, affordable Youth-Friendly Services, accessible without parental consent (one service for every 100,000 young people),
- To actively involve young people in all educational and service activities,
- To increase the proportion of young people protecting themselves against unwanted pregnancy and STI transmission to at least 90%,
- To reduce teenage pregnancy by between 20% (countries with a fairly low rate) and 50% (countries with a high rate).
Within the Strategy‘s implementation framework, strategies and activities proposed to advance the sexual and reproductive health of young people are:
- To use interactive methods in sexuality education and to start it before young people become sexually active,
- To integrate SRH activities in comprehensive health and social programmes for young people,
- To focus sexuality education on knowledge, values and building behavioural skills,
- To include gender issues in IE&C activities, e.g. to focus programmes with girls on strengthening self-confi dence and negotiation skills, and programmes with boys on their SRH needs and responsibilities,
- To develop materials for different age groups,
- To provide services where large groups of young people meet,
- To train and sensitise health, education and other professionals for adolescents‘ SRH needs,
- To initiate education of parents on guiding young people‘s sexual development.
Youth sexuality education and the SRH of young people are also addressed in other programme areas, such as in the fi eld of reproductive choice, where proposed activities are, for example, to introduce or to extend reproductive rights and family planning education in schools, universities, military services, and to remove legal obstacles to access to family planning services for minors.
In the field of STI/HIV/AIDS control, the Strategy suggests raising awareness of risky sexual behaviour through IE&C activities, adapting young people‘s safer sexuality education to the needs of boys and girls, and implementing peer education in STI/HIV prevention.
Strategies are specified in relation to the Strategy‘s objective to decrease inequalities in SRH status between migrants and the resident population, such as involving migrants in the planning of programmes, respecting different values, paying special attention to the IE&C needs of adolescent migrants, addressing all types of gender discrimination among migrant populations, and training sex education teachers in dealing with diversities in sexual values.
Within the implementation framework, special attention is paid to the monitoring and evaluation of activities and programmes. Referring to adolescents‘ sexual and reproductive health, there are recommendations to initiate or improve national monitoring of adolescent pregnancy, abortion and STI incidence, and to implement qualitative research on sexual behaviour and perceptions of young people, in order to use the results for programme development.
The Strategy defines national and international responsibilities for its implementation. While national governments and other organisations or institutions, including NGOs, are identifi ed on the country level, “technical and fi nancial collaboration with a wide range of international governmental and non-governmental agencies and institutions” is seen as being essential on the international level, referring to collaborative programmes of the European Union, bilateral East-West collaborative programmes, internationally operating NGOs, networks of professional organisations, youth and women‘s organisations.
WHO Collaborating CentresWHO Collaborating Centres are part of an interinstitutional collaborative network, set up by the WHO in support of its programmes on a national, regional and global level. In support of national health development, WHO Collaborating Centres participate in the strengthening of country resources in terms of information, services, research and training.
At present, there are 19 WHO Collaborating Centres in the European Region assigned in the field of sexual and reproductive health http://whocc.who.int/
While some of the centres focus on medical research, such as perinatal medicine, the following centres are involved in sexuality education:
Sexual and Reproductive Health
Dr. Elisabeth Pott
Federal Centre for Health Education (BZgA)
Ostmerheimer Str. 220
Research on Sexual and Reproductive Health
Professor Marleen TEMMERMAN
International Centre for Reproductive Health
Faculty of Medicine
De Pintelaan 185, 3P3, B-9000 Ghent
Training and Projects in Reproductive Health
Dr Evert KETTING
Sexual and Reproductive Health Centre (SRH)
Netherlands School of Public and Occupational Health
Tafelbergweg 51, NL-1105 BD Amsterdam
Prof Ayse Akin
Dptm. of Public Health
Hacettepe University. Medical School
TR – 06100 Ankara
International reports regarding reproductive and young people‘s health in the regionThe European Health Report, published by the WHO Regional Offi ce for Europe, summarises the major public health issues and effective policy responses in the region. It provides a picture of the health status and health determinants, and identifi es areas for public health action for the member states and the European public health community. The 2005 report focuses on the health of children and adolescents, and refl ects the widening gaps according to gender, geographical location and socio-economic status, both within and between the 52 countries in the WHO European Region. (WHO 2005)
The WHO Regional Office for Europe report on Family Planning and Reproductive Health in Central and Eastern Europe and the Newly Independent States compiles data and basic background information for the sub-region. Country reports focus on policy development and recent trends regarding reproductive health and family planning, and compile information on contraception, abortion, antenatal care, breast and cervical cancer, child health and adolescent reproductive health. They furthermore identify areas for action and policy changes. The development and implementation of reproductive health services is viewed as a chance to improve women‘s health in the region. The report is the third update edition for the region since 1995. Country information and data were assessed through answering a questionnaire in 1998. (WHO 2000)
Two US agencies, the Centers for Disease Control and Prevention (CDC) and ORC Marco, conducted surveys to assess reproductive health trends in Eastern Europe and Eurasia from 1993 to 2001. The surveys are based on interviews with women from a representative sample of households in each country to gather information on fertility, family planning, maternal and infant health and other reproductive health topics. They provide an insight into women‘s reproductive health knowledge, attitudes and behaviours for the sub-region. (CDC 2003)
The Health Behaviour in School-aged Children (HBSC) study is a cross-national research project, conducted by an international network of research teams in collaboration with the WHO Regional Offi ce for Europe. Its aim is to gain an insight into young people‘s health, well-being and health behaviour. The study considers young people‘s health as physical, social and emotional wellbeing.
In a wider context of health, it investigates family, school and peer settings, and the socioeconomic environment in which young people grow up. HBSC surveys are carried out at fouryear intervals. The data are collected in all participating countries through school-based surveys, using a standard questionnaire developed by the international research network. The target population is young people attending school, aged 11, 13 and 15 years. One focus of the study is on sexual health, in the context of young people‘s health-related behaviour. (WHO 2004b)
BZgA / WHO Conference “Youth Sex Education in a Multicultural Europe”: Scope and PurposeSex education programmes, addressing the specific needs of young people, play a key role in the promotion of reproductive and sexual health. However, “the youth” do not constitute a homogenous group and reproductive health is closely associated with socio-cultural factors, such as gender roles and religious beliefs. Therefore, countries need to develop their own designs and strategies.
The conference will create a forum for technical experts from both governmental and nongovernmental organisations to assess different country level strategies and their implementation within the WHO European Region. The aim is to share experiences and best practices, learn from each other and create networks and partnerships where it seems to be fruitful. In addition, three aspects should be highlighted and results produced during the conference: one is the multicultural dimension, the other one the quality of sex education.
The aims of the conference are as follows:
- Assessing the present state of the art of sexuality education for youth in Europe. The efforts of both, the governmental and the non-governmental sector will be considered.
- Identifying the different approaches and communication strategies, including aims, messages and target groups of each of the participating countries.
- Analysing the issues and dimensions of a multicultural approach to sex education for youth in the European region.
- Sharing existing approaches and instruments of quality management in use and identifying challenges and needs for further developing and ensuring good quality in youth sex education.
- Exploring how far sex education programmes contribute to the development of integrated life skills. According to the WHO, such skills are needed to deal with all aspects of sexuality and reproduction in a satisfactory and responsible manner.
- Promoting future collaboration between technical experts in the fi eld of sex education in the region.
Expected outcomes are as follows:
- Production of a set of country papers on national sexuality education strategies, frameworks and activities.
- Recommendations on how to deal with multicultural dimensions in the fi eld of youth sexuality education.
- Identification of further research and capacity building needs for each of the main topics, namely ‘multicultural dimensions’, ‘quality management’ and ‘life skills approach’.
- Initiation and strengthening of partnerships and collaboration at the regional level; identifi cation of strategies on how to further promote these relationships.
Assessment and editing of the Country PapersWith regard to these aspects, the Country Papers have been compiled to gather background information on how youth sexuality education is implemented in 16 countries participating in the conference, representing the regional, cultural and methodological diversity of sexuality education in the European Region: Austria, Belgium, France, Germany, Hungary, Kyrgyz Republic, Latvia, Netherlands, Portugal, Russian Federation, Sweden, Switzerland, Turkey, United Kingdom, Ukraine and Uzbekistan.
The Country Papers aim to give an insight into different conditions and circumstances, the diversity of approaches and innovative projects, as well as into strategies of how to ensure the quality and sustainability of programmes and how to meet current challenges youth sex education has to face.
The Country Papers give details regarding the national framework, on governmental and non-governmental key actors in youth sexuality education, on how sexuality education is implemented in school, and on the role of the family as a setting of sexuality education. Furthermore, they summarise strategies of access to sexuality education, with a special focus on the life skills-based approach, of special approaches to address parents, and of programmes aiming to meet the needs of diverse groups. Special regard is also given to challenges of youth sexuality education and to activities and strategies of quality management.
The information presented in the Country Reports was collected by means of a questionnaire sent out to cooperative partners in governmental and non-governmental organisations and institutions (see Questionnaire). The questionnaire was also an important reference for the preparation of the conference. Furthermore, some additional information was researched while editing the Country Reports. However, the Country Reports do not aim to give a comprehensive and reviewed overview, as they basically rely on the information kindly provided by the partner organisations of the respective country. All resources are listed, so as to provide a reference guide for further materials and publications, in particular for information that is available online.
We would like to sincerely thank all partners for their kind cooperation, and for their support, patience and expertise in responding.
ReferencesCenters for Disease Control and Prevention; ORC MARCO DHS (2003). Reproductive, Maternal and Child Health in Eastern Europe and Eurasia: a Comparative Report.
Published online: www.measuredhs.com/pubs/pub_detailscfm?ID=410
WHO Regional Officce for Europe (2000). Family Planning and Reproductive Health in Central and Eastern Europe and the Newly Independent States.
WHO Regional Offi ce for Europe (2001). WHO Regional Strategy on Sexual and Reproductive Health.
Published online: www.euro.who.int/document/e74558.pdf
WHO (2004a). Progress in Reproductive Health Research, No. 67. Sexual Health - a New Focus for WHO.
Published online: www.who.int/reproductive-health/hrp/progress/67.pdf
WHO (2004b). Young people‘s health in context. Health Behaviour in School-aged Children (HBSC) study: international report from the 2001/2002 survey.
Published online: www.euro.who.int/Document/e82923.pdf
WHO Regional Offi ce for Europe (2005). The European Health Report 2005. Public health action for healthier children and populations.
Published online: www.euro.who.int/document/e87325.pdf