LONDON — The United Nations has come out with updated guidance to encourage education ministers, especially in developing countries, to invest further in comprehensive sexuality education for young people, offering advice on when and how it can most effectively be delivered.
The voluntary guidelines offer a more progressive approach than previous iterations, promoting a “positive” and broad understanding of what can be included in comprehensive sexuality education — or CSE — with a focus on gender, avoiding early pregnancy, and rights.
The revised international technical guidance on sexuality education, released by UNESCO earlier this month, is the long-awaited update to initial guidelines published in 2009. It is aimed at education policymakers to help them design and deliver more accurate, comprehensive, and judgement-free education programs about sex and relationships to young people.
Effective CSE can play a major role in achieving the sustainable development agenda, research shows. Reducing unintended pregnancies improves health outcomes and helps keep girls in school. CSE can also help reduce transmission rates for sexually transmitted infections; while research from the Population Council suggests that well-designed programs can reduce gender-based violence within relationships and promote gender equality.
However, sex education in many countries has been held back by conservative political agendas and cultural and religious concerns, advocates say. While the 2009 manual was initially met with controversy, according to Christopher Castle, head of UNESCO’s Health and Education section, it “quickly became a critical reference” and “standard” for CSE.
But the document needed a refresh, he said, due at least in part to the emergence of new evidence about what makes CSE effective. The organization wanted to promote a more “positive” and broader approach, Castle said, by emphasizing issues such as respect, responsibility, and reciprocity within sexual relationships as opposed to talking about “risks and scare tactics.”
Advocates welcomed the revised guidance, which they described as more “inclusive,” covering gender and LGBTQI issues in more detail than the 2009 version. But some also expressed fears that the U.N. guidelines would fall on deaf ears in some countries unless accompanied by additional financing to support advocacy around the importance of CSE.
“Inclusion is very good and important, but the question is what happens when this is being challenged,” said Maria Sjödin, deputy executive director of OutRight Action International, which campaigns for LGBTQI rights and was involved in putting the guidelines together.
“It's a really touchy subject and people still get panicked about the idea of young people and sex being discussed in the same sentence.”— Lori Adelman, director of youth engagement at Women Deliver
CSE gains at risk of backsliding
Momentum around the CSE agenda has been growing among world leaders in recent years, Castle said, with the revised guidance part of an effort to make sexuality education as effective as possible for young people.
“We are seeing a big upswing in interest and seriousness in addressing young people’s sexual and reproductive health and rights,” Castle said. This is linked to a realization that the status quo — including abstinence-only sexual education — is proving ineffective, he suggested.
“More and more countries are taking this up because they are worried about early and unintended pregnancy, they are worried about continuing high rates of HIV amongst young people in their countries, and they know that whatever they were doing wasn’t working,” Castle said.
However, despite growing political commitments around CSE in recent years, major gaps in provision remain. The Guttmacher Institute reports that nine out of 10 teachers surveyed in Ghana were teaching students that condoms do not prevent pregnancy, for example.
Furthermore, according to the U.N., in some countries up to two-thirds of girls said they had no idea what was happening to them when they began menstruating. And the latest data from UNAIDS shows that in 2016 only one in three young women had comprehensive and correct knowledge of how to prevent HIV, according to Luisa Cabal, special adviser on human rights and gender at UNAIDS.
“It’s a really touchy subject and people still get panicked about the idea of young people and sex being discussed in the same sentence,” said Lori Adelman, director of youth engagement at Women Deliver, an NGO campaigning for women’s rights.
As a result, some countries are also at risk of falling further behind or backsliding, experts warned, especially due to major funding cuts to global family planning budgets under U.S. President Donald Trump and the rise of a populist agenda in some regions. In 2016, the Ugandan government banned the teaching of comprehensive sexuality education in all schools, a move driven by conservative and religious groups who claimed that sex education encourages promiscuity and homosexuality. The ban is currently being challenged in a legal bid by civil society groups.
The trend is especially worrying, considering that developing countries are experiencing the largest youth population surge ever recorded, making CSE more necessary than ever, advocates warn.
“We have to remember what the stakes are here,” said Adelman. “We have the largest generation of young people ever … and they are relegated to receiving scientifically incorrect and confusing messages and it has very large consequences for their lives.”
A more evidence-based approach to CSE
A key reason for updating the guidelines was new research about what does and doesn't work when it comes to CSE interventions, Castle said.
As well as further evidence about the ineffectiveness of abstinence-based programs, researchers such as Nicole Haberland, senior associate at Population Council, have demonstrated that CSE programs that include modules on gender and power dynamics are more effective than traditional programs.
“The new guidance document places a far greater emphasis on gender and rights, which reflects robust and growing evidence about how harmful gender norms and power inequalities damage young people’s relationships and sexual and reproductive health,” Haberland said in an email to Devex.
“In fact, research shows that when we address gender norms and power disparities, it dramatically increases the likelihood that the sexuality education program will be effective,” she added.
Robin Gorna, co-lead at She Decides, which works to mobilize funding for family planning, said it was important for the technical guidelines to be “evidence based” as this will make it easier for politicians struggling with opposition to CSE in their countries to promote the agenda.
“The evidence shows that CSE saves lives and doesn’t lead to [young people having] more sex but actually delays sexual debut,” Gorna said.
A number of SRHR experts praised the new guidelines as offering comprehensive practical guidance that can be used by politicians, teachers, and advocates.
Humphrey Nabimanya, who founded Reach A Hand Uganda, an organization that focuses on youth empowerment and HIV/AIDS prevention, told Devex the revised guidelines would boost CSE efforts in his country.
“[In Uganda], one of the biggest challenges we face [in gaining access to CSE] is a lack of clear guidelines,” he said. The UNESCO guidelines can help by outlining the “steps and standards to be enacted toward the effective delivery of CSE at classroom level and teacher training levels,” but they can also help by providing “a solid basis on which to advocate for more investment and action on key aspects of CSE,” he said.
A more inclusive approach
The social and cultural landscape has also shifted considerably since the original guidelines were published, experts said. They welcome the fact these changes are reflected in the revised document.
“A lot has changed since the first guidelines came out,” Gorna said. “For example, transgender issues were not on the radar.” The use of the internet and social media has also grown exponentially, which means guidance is needed about things like “sexting,” she added.
Sjödin, of OutRight Action International, praised the document for using “more current language” in relation to sexual diversity and LGBTQI rights, and for including “intersex aspects” for the first time.
However, this move toward more inclusiveness is likely to result in push back from some countries, she warned, saying “these issues are so controversial in some countries [that] there will be attempts to discredit the whole guidance.” In this case, the question will be whether and how the U.N. partners “speak up for” the guidance, she said.
Insiders said the revised guidelines had proved divisive even between the U.N. agencies working on them — which included UNESCO, UNAIDS, UNFPA, and UN Women, among others — with some calling for the document to be “watered down” to avoid alienating certain member countries.
Even the report’s title was subject to heated debate, Castle said, with some groups lobbying for the word “comprehensive” to be cut, on the basis it would be too divisive among U.N. member countries. Ultimately the word was taken out of the title but kept in the text of the report. While Castle acknowledged that some countries that have anti-homosexuality laws, for example, are likely to ignore certain aspects of the guidelines, the fact the U.N. has taken a position on issues of inclusivity is positive and shows leadership, he said.
Women Deliver’s Adelman added that the broadened focus of the guidelines could help catalyze new funding for CSE — something advocates stressed is essential to overcome the influence of groups opposed to it. “These guidelines have a powerful symbolic value by connecting CSE to gender equality more broadly, which can help put CSE on the agenda of the SDGs,” she said.