Sexual Health Matters A Policy Brief on the Sex and Sexuality Component of the Health & Family Life Education Curriculum December 2012 Jamaica Youth Advocacy Network (JYAN)
Sexual risk taking and other unhealthy behaviours present a social and public health problem that can have a negative impact on national development. Appropriate and evidence-based interventions must be supported to equip children and youth with the skills, tools and resources needed to confront transition into healthy adulthood.
provides an opinion on the importance of understanding sexual diversity as a means of appreciating diversity and human rights, addressing intolerance, discrimination, and homophobic violence and bullying among youth in schools.
Many children and youth are exploited, abused, misguided, and misinformed because of vulnerabilities attributed to poverty, low educational levels, poor parenting and lack of positive role models. As well, conservative sexual ideals coexist in Jamaica with tacit disapproval of sexual diversity. Therefore, it is imperative that young people are equipped with the life-skills promoting their own health and wellbeing. This policy brief provides the rationale for the delivery of the current sex and sexuality component of the Health and Family Life Education (HFLE) Curriculum. It
There is increasing evidence that Jamaica has high levels of adolescent sexual activity and young people both in and out of school are engaged in activities that make them susceptible to HIV and other sexually transmitted infections (STIs), teen pregnancy, transactional sex and human trafficking.
The HFLE curriculum is crucial given increased reports of high-risk behaviours among children and youth. High-risk behaviours generally include alcohol consumption, unsafe sexual practices, tobacco and marijuana smoking. These are reported to be prevalent even among adolescents. These behaviours have been associated with adverse outcomes including intentional and non-intentional injuries, teen pregnancy, bullying, suicide, homelessness, violence, aggression, sexually transmitted infections (STIs) and obesity. These can have significant impact on the development of young people and ultimately sustainable development.
sexual partners and females of the same age group three sexual partners. Additionally, behavioural studies indicate that one in every three gay, bisexual and other males who have sex with male (MSM) is HIV positive. A significant number of this cohort is between the ages of 15 and 24. However, despite the alarming realities, only 38% of young adults between 15-24% can correctly identify the modes of preventing HIV transmission.
INTRODUCTION â€“ MAGNITUDE OF THE PROBLEM
High-risk behaviours and unhealthy lifestyle practices remain a pervasive problem in Jamaica. The mean age of sexual initiation in Jamaica is 14 years old (12 for boys, 15 for girls). Seven percent of all reported AIDS cases in Jamaica have been adolescents and young adults between ages 15 and 24 (NHP 2011). The Knowledge Attitudes Perception Behaviour (KAPB) study of 2008 indicated there was a 100% increase in the rate of STIs among adolescent girls from 2004. Transactional sex and casual sex are also common among adolescent males and females. Over 170,000 sexually active young people are engaged in transactional sex (2012 KAPB). The KAPB study findings also revealed that males in the 15-24 age group reported having an average of six
High-risk behaviours such as having sex without a condom should not be surprising. Children in Jamaica are being exposed to wide range of sexual messages are often very explicit, far too violent, awash in male dominant-female submissive images, heterosexist, and sensational. They can come from print media, television, movies, videos, music, the Internet, the childâ€™s neighborhood and home life.
1 Figueroa JP, Ward E, Walters C, Ashley DE, Wilks RJ. High risk health behaviours among adult Jamaicans. West Indian Med.J. 2005; 54(1):70-6.Wilks, R., Younger N, McFarlane S, Francis D, and van den Broeck J. Jamaica Youth Risk and Resiliency Behaviour Survey 2006. Community-based Survey on Risks and Resiliency Behaviours of 15-19 year olds, 2007. (http://www.cpc.unc.edu/measure). 2007.
Sexual Health Matters: A Policy Brief on the Sex and Sexuality Component of the Health & Family Life Education Curriculum | PAGE 1
APPROACHES & RESULTS The ability to support the healthy sexual growth and development of children is an important and essential task for parents, teachers, and other professionals who work with them. Adults need to know when a child’s sexual expression is normative and developmentally appropriate, and when it has crossed this boundary into the realm of problematic behavior. Coming out of the study, was that a disparity existed between the importance teachers assigned to teaching particular sex topics and their own knowledge about and comfort teaching such. The researchers also found teachers to be more knowledgeable about, and comfortable with, teaching areas that were more compatible with their own experiences and gender roles. Cohen et al. recommended that teachers should be provided with training that increases both their knowledge about and comfort with teaching topics that have not been associated with their gender roles. In Jamaica, certain sections of the HFLE Curriculum have come under serious criticism from the public. Aspects of the sex and sexuality component are facilitated through one-onone discussion between teacher/student; and in which case the teacher is trained in the use of curriculum. The Personal Risk Assessment component is geared towards ascertaining the degree and extent of risky sexual behaviours among individuals and is for private use by students to help them calculate their personal risk. It must be noted that the information emanating from this individual risk assessment is not returned to the teacher. The purpose of the risk assessment exercise is to build the students’ critical thinking, decision-making and healthy self-management and refusal skills. Another activity, the guided imagery activity which asks students to imagine they are the only heterosexuals in a world of homosexuals is not intended to “make students homosexual or promote homosexuality” but to build empathy and self awareness skills. The aim of this activity is to address intolerance and its consequences including bullying and abuse of students because of sexual orientation. The curriculum also entails many other activities, which address marriage and family, abstinence, and delayed sexual activity. The Health and Family Life Education (HFLE) Curriculum is a life-skills programme that forms the basis of a cornerstone for behavior modification and transformation in providing a solid foundation of information and values regarding sexual behavior and attitudes. Building on learning and resources from past efforts in the region, the HFLE Curriculum, with specific interactive, life skills-based classroom lessons, was developed to reflect themes such as Self and Interpersonal Relationships, Sexuality and Sexual Health while taking into account Jamaica’s unique cultural context. These two themes
address priority health issues of violence and HIV and AIDS. Taken together, they aim to provide youth with knowledge and skills that promote healthy behaviours and contribute to school and future success. Children exposed to the lifeskills training will be better equipped for managing sex, sexuality and sexual health related issues and the constant stream of unsolicited content to which they are exposed from media and peers. HFLE is a comprehensive, holistic life skills-based programme, which incorporates topics such as (a) Self and Interpersonal Relationships; (b) Sexuality and Sexual Health; (c)Appropriate Eating (d) Fitness and (e) Managing the Environment. Within each topic, the life skills are broken down into major sub categories of social, cognitive and coping life skills, including decision-making; problem solving; effective communication; empathy; coping with stress; coping with emotions; healthy self management and conflict resolution. Importantly, the life-skills programme focuses on the development of the whole person in that it: • Enhances the potential of young persons to become productive and contributing adults/ citizens. • Promotes an understanding of the principles that underlie personal and social well-being. • Fosters the development of knowledge, skills and attitudes that make for healthy family life. • Provides opportunities to demonstrate sound healthrelated knowledge, attitudes and practices. • Increases the ability to practice responsible decisionmaking about social and sexual behaviour. • Increases the awareness of children and youth of the fact that the choices they make in everyday life profoundly influence their health and personal development into adulthood. The sex and sexuality component of the HFLE curriculum is grounded on research, evidence theories and models for comprehensive, accurate sexuality education in schools. In addition to being theoretically grounded, the extensive, collaborative development process helped assure that the Curriculum is culturally appropriate to the life experiences of adolescents in the Jamaica. Critical health issues are tackled through participatory activities that are both timely and relevant—for schools, families, and students. Care was also taken to assure that lessons address gender differences in both development and challenges faced. Teaching life skills in this way has been shown to delay the onset of drug use; prevent high risk sexual behaviour; facilitate anger management and conflict resolution; improve academic performance and promote positive social adjustment. Additionally, the curriculum already includes behaviour modification strategies to deal with anger management, which the Minister of Education proposed to introduce in schools. (Jamaica Gleaner, September 15, 2012).
Sexual Health Matters: A Policy Brief on the Sex and Sexuality Component of the Health & Family Life Education Curriculum | PAGE 2
IMPLICATIONS Psychologically, adolescence is such a vulnerable stage that boys or girls of this age are easily carried away by perceptions generated by: • Misleading and misguiding parents, teachers, friends, siblings. • Ignorance of elders. • Half-informed or ill-informed friends, brothers, sisters. • Wrongful messages depicted through TV serials, advertisements, films • Widely and easily accessible publications carrying partially or fully false information. The sexual attitudes and behavior of young adolescents in Jamaica have already been significantly shaped by the media, socio-cultural and gender norms that send mixed messages about sexuality and impose different standards of behavior and levels of tolerance for boys and girls. Age appropriate sex and family life education should be taught among younger children in Jamaica, not just those entering puberty. Young adolescents in this environment also need better access to life-skills education. Policymakers, government and other stakeholders must face the fact that our young people are sexually active, and they really do not understand their susceptibility to risks such as HIV and other sexually transmitted infections. Lack of life-skills, sex and family life education make young people more susceptible to self-destructive behaviours, risky sexual practices and exacerbate the social ills in our society. The social ills have a direct and indirect economic and social burden for Jamaica. The social consequences for the families of young people with poor social and life skills are profound. As a country, if we fail to implement and institutionalize the appropriate mechanisms to facilitate proper and accurate sex and family life education for our young people, our children’s friends or the television will be; resulting in disastrous effects on the future of our children and our country. Teen pregnancy has become a source of major concern in Jamaica as it a public health challenge that presents many socio-economic problems that include maternal mortality, delayed education because of school drop-out, increased dependency on welfare support from the state and lack of or limited employment opportunities. The rates of teenage pregnancy in Jamaica are among the highest in the Caribbean, with the birth rate for 15-19 year olds at 108 births per 1,000 women. Forty-five percent of all Jamaican women who are 15 to 24 years old have been pregnant by 19 years of age, and 41% have given birth. The 2008 Knowledge Attitude and Practices (KAP) Survey, Jamaica, points to a high level of sexual risk-taking among young girls aged 15-24 years. Just over 20 per cent (21.4 per cent) of females aged 15-24 years old reported having more than one sexual partner within a 12-month period. Lifetime incidence of STIs increased by more than 50 per cent among women aged 15 to 24 years old, moving from 8.2 per cent in 2004
to 14.4 per cent in 2008, (Jamaica Gleaner Newspaper, November 23, 2011). HFLE‟s thematic areas of “self” and “sexual health and sexuality” are designed to help children to deal with sexual threat. The curriculum is also designed to help children, who actively participate in it, to develop self-esteem, as well as skills of critical thinking, healthy selfmanagement and refusal skills that should enable them to employ health-enhancing behaviours consistent with their values. Cumulatively, these competencies can help to empower children to make choices and act appropriately to affect a healthy lifestyle. Issues of sexual promiscuity and sexual abuse among primary school children could also be averted if they are given the opportunity to interact constructively with the content of Health and Family Life Education. By implementing the curriculum in diverse school settings it is highly likely that it will have a positive impact on students’ health. Improved students’ health will, in turn, improve students’ school attendance and enhance their learning outcomes. The HFLE curriculum is successfully being implemented across the Caribbean. St Lucia and Barbados have reported major successes and accomplishments. The Curriculum is already having a positive impact in Jamaica as evidenced in an evaluation conducted in 2010. The evaluation of the programme done in 2010 found “much greater knowledge of HIV among sixth-grade students in schools that took part in the programme than among students whose schools did not participate.” By ninth grade, “students in the programme were less likely to engage in risky behaviours and more likely to refuse sex2. However, despite the positive impact of the HFLE in contributing to increased HIV knowledge and awareness, an additional level of complexity which relates to the distinct, only partly overlapping categories of sexual diversity, sexual behaviour, sexual identity and gender identification, which vary significantly across our youth and adolescent population must be sufficiently addressed in the HFLE curriculum if Jamaica is to achieve its Vision 2030 goal of “THE PLACE
OF CHOICE TO LIVE, WORK, RAISE FAMILIES AND DO BUSINESS.” Additionally, critical factors and issues of sexual diversity and vulnerability, casual partnerships and transactional sex among adolescents must be widely explored and addressed as evidence has demonstrated that these populations have
Sexual Health Matters: A Policy Brief on the Sex and Sexuality Component of the Health & Family Life Education Curriculum | PAGE 3
continued to be at heightened risk of HIV/STIs and their related consequences. Jamaica’s 2012 National KAPB Study findings have revealed that (a) risky behaviour of multiple partnerships among youth (15-24 years) significantly increased; (b) transactional sex also up significantly among youth; (c) multiple partnerships increased significantly among youth and (d) condom use is increasing but not consistent use. The continued exclusion of these challenging issues and sexually diverse adolescent populations from the HFLE Curriculum intensifies the burden of HIV and other public health risks and will remain problematic thus presenting further health and socio-economic malaise if not tackled. The HFLE Curriculum should be adapted to a changing context of increased sexual diverse adolescent populations in Jamaica and therefore the education ministry and its key stakeholders should utilize, implement and institute believable and creative approaches and strategies to sustaining healthy lifestyle practices in what is for many a truly different context of emerging sexual diverse populations. Finally, there is a need to develop and implement programmes and interventions to counter the social exclusion of sexual diverse adolescent populations in order to accomplish the highest attainable standard of sexual health, including access to sexual and reproductive healthcare services and sexuality education to include sexual diversity to move forward and safeguard the future for large numbers of adolescents and youth whose diverse sexual and reproductive health needs have long been neglected.
RECOMMENDATIONS The need to fuse traditional education systems with lifeskills application so that they militate against threats to children’s health and learning opportunities, is highlighted in the Convention on the Rights of the Child, the International Conference on Population and Development, and Education for All. The Health and Family Life Education Curriculum like all school subjects, entails information and skills that are ageappropriate, reflect best-practice, and which is built on evidence and experiences from around the region. It is has proven to be an effective sexuality education that: • uses behavioral goals, teaching methods, and resources that are age-appropriate, developmentally appropriate, and culturally competent
Teen pregnancy has become a source of major concern in Jamaica as it a public health challenge that presents many socioeconomic problems that include maternal mortality, delayed education because of school drop-out, increased dependency on welfare support from the state and lack of or limited employment opportunities.
• is based on theoretical approaches that have been proven to be effective • takes place over sufficient time to cover necessary topics and skills • employs a variety of teaching methodologies that present the content in ways that make it relevant to the student • provides basic, accurate information about the risks of unprotected sexual intercourse and how to avoid unprotected sexual intercourse • includes activities that address peer pressure and cultural pressure • practices decision making, communication, negotiation, and refusal skills • utilizes teachers who are well-trained, comfortable, and believe in the program
2 (http://www.unicef.org/publications/files/Opportunity_in_Crisis-Report_EN_052711.pdf). Sexual Health Matters: A Policy Brief on the Sex and Sexuality Component of the Health & Family Life Education Curriculum | PAGE 4
PRIORITY ACTION STEPS • Provide tuition and support for teachers to help them with the required teaching techniques • Comprehensive AIDS education should be incorporated into the national curricula and should be examinable to encourage full implementation. • The Ministry of Education should involve parents, school faculty, administration and staff, community leaders, civil society, youth organizations, international development agencies, donor organizations, and student leaders early in the process of dialogue and consultation to ensure successful delivery of the HFLE Program. • To improve and sustain parental support for the HFLE curriculum, the Parent Teachers’ Association (PTA) can be used as a forum for educating parents about the core aspects of the HFLE programme. • To initiate and sustain support for HFLE implementation in schools, the Ministry of Education should undertake workshop sessions as an orientation to the HFLE programme. This should include information and discussions about the core principles, the philosophical underpinnings of the programme and the relevance of the skills-based approach. We further recommend that the Ministry of Education undertake the following: • Facilitator/Teacher Preparation: establish partnerships with in-service training teachers and youth-serving professionals to deliver the curriculum to help ensure effectiveness and to add depth and breadth to thus sexuality education program and thus reducing the work demands of an already burdened and resourceconstrained educational system. The persons selected will require guidance in how to select the goals, the information, the activities, and the methodologies to effectively teach about sex and sexuality and therefore should be trained in the use of the HFLE Curriculum. • Time-tabling and scheduling: the success of HFLE relies on the ability of the Ministry to sustain support for the HFLE Program. The Ministry must establish a policy as a means of ensuring that the HFLE Program is timetabled into classroom schedules and that this schedule is adhered to. Competing priorities for classroom time must be balanced with the goals of HFLE and therefore the ministry should carve out adequate time within school hours to implement the lessons. Additionally, to eliminate concerns related to the physical environment, synchronized timetables should be established so that all classes are engaged in the activity simultaneously. Additionally, given the student population in different schools, the team-teaching technique should be considered as a possible means of teachers providing support for each other thus avoiding disruption to the other subject areas.
activities and in providing meaningful feedback to teachers. These are necessary to empower the principal with the competencies necessary to give substantial support to teachers. • Practice Delivery: Teachers may not be accustomed to modifying their teaching approaches, strategies and delivery to match the changes in child development (particularly mid-adolescence) in secondary school. They usually focus on curriculum content and therefore practice delivery is critical to the success of the HFLE program. Practice in leading participatory exercises is especially needed, since these methods are not seen in regular classrooms. • Ongoing Training: Trainings should be ongoing to accommodate the needs of both new and experienced teachers. Some schools might experience teacher turnover during the course of the year, resulting in several untrained teachers assuming HFLE classroom responsibilities. • Standards and Quality Assurance: Develop a strategy for creating a safe learning environment in the dissemination and delivery of the curriculum. Develop and practice a protocol for teachers and facilitators to answer difficult questions that may emanate from the sex and sexuality sessions. • Monitoring & Evaluation: Develop and implement an evaluation plan for the HFLE program to measure the results and document best practices and lessons learned to inform future strategic decision-making. Develop and implement a plan to get feedback from all stakeholders. • Impact Assessment: Conduct a baseline and end line study to measure the impact of this curriculum on student outcomes, along with the process of implementation in all schools across the country where the HFLE is being disseminated. Government should seek funding from international development partners to support this study.
References 2012 Knowledge Attitudes Behaviour and Perceptions Survey (KABP) http://jamaica-gleaner.com/gleaner/20111123/news/news4.html retrieved 22 December 2012 http://www.aboutourkids.org/articles/towards_better_understanding_ children039s_sexual_behavior: Retrieved 10 December 2012 Implementing Health and Family Life Education (HFLE) at a Primary School in the North Eastern District in Trinidad & Tobago. 2011Pdf. Retrieved 10 December 2012
• Sustainability: to sustain support for HFLE, the Ministry of Education should periodically conduct workshops for principals to prepare them adequately to initiate citebased workshops. Principals should, in these sessions, gain insights into effective monitoring of classroom Sexual Health Matters: A Policy Brief on the Sex and Sexuality Component of the Health & Family Life Education Curriculum | PAGE 5
JAMAICA YOUTH ADVOCACY NETWORK (JYAN) c/o Ministry of Health 2-4 King Street, Kingston, Jamaica W: www.j-yan.org | E: firstname.lastname@example.org
Sexual Health Matters: A Policy Brief on the Sex and Sexuality Component of the Health & Family Life Education Curriculum | PAGE 6
This policy brief provides the rationale for the delivery of the current sex and sexuality component of the Health and Family Life Educati...