Motherhood in Childhood

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The right to age-appropriate, comprehensive sexuality education Curriculum-based comprehensive sexuality education provides young people with ageappropriate, culturally relevant and scientifically accurate information. It also provides young people with structured opportunities to explore attitudes and values and to practise skills they will need to be able to make informed decisions about their sexual lives. Adolescents and young people have a right to comprehensive and non-discriminatory sexuality education through several human rights agreements and documents, including the Convention on the Rights of the Child, the International Covenant on Economic, Social and Cultural Rights; the International Covenant on Civil and Political Rights; the Convention on the Elimination of All Forms of Discrimination against Women; and the Convention on the Rights of Persons with Disabilities. Comprehensive sexuality education is essential for the realization of other human rights (UNFPA, 2010). In a review of 87 comprehensive sexuality education programmes including 29 from developing countries, UNESCO (2009) found that nearly all of the programmes increased knowledge, and two-thirds had a positive impact on behaviour: Many adolescents delayed sexual debut, reduced the frequency of sex and number of sexual partners, increased condom or contraceptive use, or reduced sexual risktaking. More than one-quarter of programmes improved two or more of these behaviours. Another study concluded: “There is now clear evidence that sexuality education programmes can help young people to delay sexual activity and improve their contraceptive use when they begin to have sex. Moreover, studies to date provide an evidence base for programmes that go beyond just reducing sexual activity—namely, unintended pregnancy and sexually transmitted infections—to instead address young peoples’ sexual health and well-being more holistically” (Boonstra, 2011). There are two main approaches to sexuality education: advocating abstinence only or providing age-appropriate, comprehensive programmes. Two large reviews (Oxford, 2007; Kirby, 2008) found that abstinence-only programmes are not effective at stopping or delaying sex. Comprehensive sexuality education “teaches about abstinence as the best method for avoiding sexually transmitted diseases and unintended pregnancy but also teaches about condoms and contraception to reduce the risk of unintended pregnancy and of infection with sexually transmitted diseases, including HIV. It also teaches interpersonal and communication skills and helps young people explore their own values, goals and options” (Advocates for Youth, 2001). Looking at comprehensive programmes, UNESCO found that “nearly all of the programmes increased knowledge, and two-thirds had a positive impact on behaviour…” including delaying sexual debut. In the United States, the highest rates of adolescent pregnancy tend to be in states where abstinence-only education predominates. The lowest rates occur in states where information about sexuality and contraception is provided in a non-judgmental manner (Szalavitz, 2013). In reviewing the progress and achievements of comprehensive sexuality education since the 1994 International Conference on Population and Development, the international community 66 CHAPTER 4: TAKING ACTION
has learned a number of lessons about comprehensive sexuality education. One is that even in the face of the HIV/AIDS pandemic, governments have been slow to implement comprehensive sexuality education, and even slower to reach the most vulnerable young people (Haberland and Rogow, 2013). A second lesson is that comprehensive sexuality education can be effective beyond the prevention of high-risk behaviours. Research shows that programmes that tend to have the greatest impact on adolescent pregnancy and sexually transmitted infections are those that emphasize critical thinking about gender and power in relationships (Haberland and Rogow, 2013). These findings offer promise for a new generation of programmes that can have a concrete, positive impact on the well-being of young people. New research shows that comprehensive sexuality education programmes are more likely to have an impact on reducing adolescent pregnancy and sexually transmitted infections when they address gender and power issues. Studies from both developing and developed countries confirm that young people who believe in gender equality have better sexual health outcomes than their peers. In contrast, those young people who hold less egalitarian attitudes tend to have worse sexual health outcomes (International Sexuality and HIV Curriculum Working Group, 2011). Gender equality and human rights are key to preventing the spread of HIV and to enabling young people to grow up to enjoy good health. For example, young people who, compared to their peers, adopt egalitarian attitudes about gender roles are more likely to delay sexual debut, use condoms, and practice contraception; they also have lower rates of sexually transmitted infections and unintended pregnancy and are less likely to be in relationships characterized by violence. Another study found that a targeted programme to increase girls’ understanding of the risks of intergenerational sex reduced pregnancy by 28 per cent (Dupas, 2011). Most comprehensive sexuality education is delivered through school-based curricula. However, not all adolescents attend school and not all remain in school until they initiate sex. Married girls between the ages of 10 and 14 and who are not in school thus have virtually no access to sexuality education. It is therefore important to make additional efforts to meet the needs of adolescents who are out of school. Curriculum- and group-based sexuality and HIV education programmes can reach those who are not in school if they are implemented by providers of health and other services for youth, community centres, or other local institutions accessible to adolescents (Kirby et al., 2006). According to UNESCO (2013), 57 million children of primary school age and 69 million children of lower-secondary school age do not attend school. Most of them live in developing countries, and slightly more than half are girls. Two approaches with potential for reaching large numbers of out-of-school adolescents—although not necessarily as stand-alone programmes for preventing pregnancy—involve the use of the mass media and interactive radio instruction. Recent reviews of mass media campaigns that promoted adolescent sexual health, mostly in developing countries, found that they commonly increased knowledge, and the majority THE STATE OF WORLD POPULATION 2013 67
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Motherhood in Childhood Facing the
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state of world population 2013 Moth
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to health. Conversely, a girl who i
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“I was 14… My mom and her siste
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access to sexual and reproductive h
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Research shows that addressing unin
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Additional efforts must be made to
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1 A global challenge Every year in
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ights, or where access to health ca
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According to DHS and MICS surveys,
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“Efforts—and resources—to pre
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adolescents with no education and i
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A UNFPA review of four countries fo
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Developed countries face challenges
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Delivering a world where every preg
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