The National Adolescent Health and Development Strategy (2000) of Nepal considers adolescents a key target group for information and services. The extent to which sex education is being provided in schools has received little attention, however. At higher secondary level, students are supposed to be taught basic sex education using a chapter in a textbook called Health, Population and Environment. Little is known about how or how well this material is covered. In a study in 2002 among adolescents in eight schools in the Nawalparasi District in the Western Region of Nepal, we interviewed eight teachers responsible for teaching this subject. We also collected survey data from 451 students and held four focus group discussions with 26 of them. We found that adolescents in these schools did not appear to be getting the information they needed. Most of the teachers did not want to deal with sensitive topics and feared censure by their colleagues and society. Some lacked the skills to give such instruction. Many students also felt uncomfortable with the topics. The challenge is to strengthen sex education, make it more appropriate for the students and ensure that teachers are more comfortable and able to give instruction on the topic.
Résumé
Au Népal, la Stratégie nationale de santé et de développement de l’adolescent (2000) considère les adolescents comme un groupe cible essentiel pour les informations et les services. Néanmoins, l’éducation sexuelle dispensée dans les écoles n’a guère reçu d’attention. Dans l’enseignement secondaire du deuxième cycle, les élèves sont censés étudier les notions d’éducation sexuelle avec un chapitre d’un manuel intitulé « Santé, population et environnement ». On sait peu de choses sur la manière dont cet enseignement est réalisé. Dans une étude de 2002 auprès d’adolescents dans huit écoles du district du Nawalparasi, dans la région occidentale du Népal, nous avons interrogé huit professeurs chargés d’enseigner cette discipline. Nous avons aussi recueilli des données auprès de 451 élèves et organisé quatre discussions par groupes d’intérêt avec 26 d’entre eux. Nous avons constaté que, dans ces écoles, les adolescents ne semblaient pas recevoir les informations dont ils avaient besoin. La plupart des enseignants ne voulaient pas aborder des questions sensibles et craignaient les critiques de leurs collègues et de la société. Certains n’avaient pas les compétences requises pour assurer cet enseignement. Beaucoup d’élèves étaient également gênés par les thèmes traités. L’enjeu consiste à renforcer l’éducation sexuelle, l’adapter aux élèves et veiller à ce que les enseignants soient plus à l’aise et plus aptes à l’assurer.
Resumen
La Estrategia Nacional de Salud y Desarrollo de la Adolescencia (2000) de Nepal considera a los adolescentes un grupo objetivo clave para recibir información y servicios. No obstante, no se conoce mucho acerca de la enseñanza de educación sexual en los colegios. En el nivel secundario superior, se supone que los estudiantes reciban educación sexual básica, usando un capítulo del libro de texto titulado La salud, la población y el ambiente. Poco se conoce en cuanto a cómo o cuán bien es abarcado este material. En un estudio realizado en 2002 entre adolescentes en ocho colegios en el Distrito Nawalparasi de la Región Occidental de Nepal, nos entrevistamos con ocho profesores responsables de enseñar esta materia. Además, recolectamos datos de la encuesta entre 451 estudiantes y llevamos a cabo cuatro discusiones en grupos focales con 26 de ellos. Encontramos que los adolescentes en estos colegios no parecían estar recibiendo la información que necesitaban. La mayoría de los profesores no querían tratar temas delicados y temían la censura de sus colegas y la sociedad. Algunos carecían de las habilidades para impartir tal enseñanza. Muchos estudiantes también se sentían incómodos con los temas. El reto es fortalecer la educación sexual, adaptarla al contexto de los estudiantes y asegurar que los profesores se sientan más cómodos y capacitados para enseñar esta materia.
Key Words: sex education, adolescents, secondary school teachers, Nepal
Nepal adopted its first National Reproductive Health Strategy in 1998 and a National Adolescent Health and Development Strategy in 2000.1 BB Campbell, LH Reerink, F Jenniskens. A framework for developing reproductive health policies and programmes in Nepal. Reproductive Health Matters. 11(21): 2003; 171–182.
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Both envisaged adolescents as a key target group for integrated reproductive health services, with interventions planned to increase knowledge about reproductive health issues and service availability. School adolescents attending the eighth and ninth grades, who are typically about 15 years old, would for the first time receive sex education. This paper provides a preliminary assessment of the content and quality of the provision of sex education, both from the perspective of teachers and students.
Existing studies of adolescent and reproductive health in Nepal are limited in number and scope.2 A Pradhan, M Strachan. Adolescent Reproductive Health in Nepal: Status, Policies, Programs, and Issues. 2003; Policy Project: Washington, DC.
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What is known is that by age 20, over half (52%) of all adolescent girls were already mothers and only 12% of deliveries among them were in a health facility. Moreover, among married girls aged 15–19, only 12% practised contraception, with barely 9% using a modern method.7 Nepal Demographic and Health Survey 2001. 2002; Family Health Division, Ministry of Health; New ERA; ORC Macro: Calverton MD.
In 2001, fewer than one-third of Nepali adolescents (31%) who should have been attending secondary school were in school at that level, more of whom were boys (35%) than girls (27%).7 Nepal Demographic and Health Survey 2001. 2002; Family Health Division, Ministry of Health; New ERA; ORC Macro: Calverton MD.
Girls typically stop attending school if they marry early. The school learning environment has been overlooked in existing studies, though that is the only place where adolescents can get sex and reproductive health education at the present time. The authors of one study reported having trained teachers as part of a youth reproductive health intervention,5 Mathur S, Mehta M, Malhotra A. Youth Reproductive Health in Nepal: Is Participation the Answer? New York: EngenderHealth and Washington, DC: International Center for Research on Women, 2004.
but not on how they incorporated training into the intervention, or the outcome.
In the higher secondary class (ages 14–16), students are now taught basic sex education using a chapter on reproductive health contained within the textbook Health, Population and Environment.8 Health, Population and Environment. 1999; Ministry of Education and Sports, Government of Nepal: Kathmandu.
This covers basic reproductive health facts concerning safe motherhood, family planning, reproductive physiology, STIs/HIV, infertility, adolescent health, reproductive health problems of post-menopausal women and reproductive rights. The material was endorsed by the Ministry of Education and Sports in 1998–99. However, very little is known about the extent to which this material is covered in classes in private or government schools in urban or rural areas.
Data and methods
The study formed part of a broader investigation of sex education and reproductive health among in-school adolescents, with fieldwork conducted in 2002. The overall study was designed to be representative of Nawalparasi District in the Western region of Nepal. Stratified random sampling was used to select eight schools from the district’s four electoral constituencies, including two governmental and two private schools drawn from the urban area and two governmental and two private schools from rural areas. Survey data were collected by a self-administered and pre-tested questionnaire completed by 451 eighth and ninth grade students (174 female, 277 male) aged 12–19. Up to 60 students (half male, half female) were selected from each of the eight schools using systematic random sampling. If there were fewer than 30 female students in a particular school, we still sampled 60 students in the school by selecting additional boys from the same classes to make up the desired sample size. Questionnaire items included socio-demographic characteristics; knowledge of reproductive biology; knowledge of and attitudes towards STDs, HIV/AIDS, abortion, family planning, and service use; menstrual practices (asked of girls only); and contraceptive use. This paper reports only those results with direct bearing on sex education.
We found that although adolescents in schools are said to receive the new sex education course, they may not get the information they need. To examine this situation further, we conducted in-depth interviews with eight teachers, each responsible for implementing sex education in the selected schools. We asked the teachers what they actually taught, whether they felt comfortable teaching this material and how their classes responded to the information they gave. In addition, four focus group discussions were held with 26 of the 451 students from the same schools who had answered our questionnaire, in two same-sex groups each and with same sex facilitators. These focus groups allowed participants to discuss the sex education class in more detail and comfort than the questionnaire allowed, as well as other issues relevant to their reproductive health. Focus group participants were recruited with the help of teachers and students who recommended those they considered representative of their class in both private and government schools.