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Sexuality Education: lessons learned and future developments in the WHO European Region

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hosted by the Federal Centre for Health Education (BZgA)
WHO Collaborating Centre for Sexual and Reproductive Health
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Group picture of the participants
Group picture of the participants
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Over 180 experts on sexual and reproductive health and sexuality education from more than 30 countries throughout the WHO European Region attended, including representatives of:

• government ministries (health, youth, education) and other government institutions working in related areas;

• international and national nongovernmental organizations (NGOs), including education associations;
 
• research institutions; and

• international and multilateral organizations.
Group picture of the participants
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The conference heard opening speeches from Dr Heidrun Thaiss, the director of the German Federal Centre for Health Education (BZgA), Dr Gunta Lazdane on behalf of the WHO Regional Director for Europe, from the head of unit for the pregnancy conflicts law, sexuality education and women with disabilities in the German Federal Ministry of Family Affairs, Senior Citizens, Women and Youth, and the head of unit for human immunodeficiency virus (HIV) and sexually transmitted infections (STI) prevention at the German Federal Ministry of Health.

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Julia Krieger, Federal Ministry of Family Affairs, Senior Citizens, Women and Youth, Germany

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"We are very pleased to be able to contribute with this conference to the implementation of the goals shared by WHO and the BZgA in the field of sexual and reproductive health at national and international levels.“




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Ines Perea, Federal Ministry of Health, Germany

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“Work in the field of sexual and reproductive health and rights is firmly grounded on certain principles, most importantly the acknowledgment of human rights, gender equality, a positive understanding of sexuality, acceptance of diversity and the right to self-determination.”


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Presentation of research results and discussion

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Angelika Hessling, BZgA

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In 2003, when BZgA became a WHO collaborating centre, it was a newcomer to the field of sexuality education. BZgA organized an international networking conference on sexuality education for young people in a multicultural Europe in 2006. In the run-up to the conference, BZgA performed a study on sexuality education in the WHO European Region, which identified best practices and new approaches in 16 countries. The current research project has been conducted in close collaboration with IPPF EN.

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Lena Luyckfasseel, IPPF EN

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Countries of eastern Europe and central Asia were not included in the European Commission-funded SAFE project on improving the sexual and reproductive rights of young people across Europe in 2006. The project had three components: researching young people’s sexual and reproductive health behaviour; identifying new and innovative ways of providing information; and developing tools to support policy work. Since then, much progress has been made, building and consolidating the work.

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Laura Brockschmidt, BZgA

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Joint working between BZgA and IPPF EN and cooperation has been very successful, emphasising the importance of intersectoral collaboration in pooling sources and resources. For the current research, the partner organizations adapted the questionnaires used in the 2006 surveys.

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Ilona Renner, BZgA

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The research project was subject to a number of challenges. Both partners had many new ideas for questions in the questionnaire, which, while welcome, created challenges in creating a coherent and manageable instrument. Choosing countries was also difficult – 25 of 53 were chosen with the aim of representing all parts of the Region. Language problems were addressed by consultants who were fluent in English and Russian.

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Irene Donadio, IPPF EN

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The full report of the research will be issued later this year. Participants should use the results to maximum effect, particularly with their contacts in governments and journalists, but also in all communities interested in the topic. A comprehensive scientific paper will be published, and young people who have been involved will take the messages forward in their communication and advocacy work. IPPF EN will also be taking forward strong advocacy efforts.

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Background

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The SAFE report, published in 2006 by IPPF EN, WHO and Lund University, covered 26 countries in western, northern and central Europe. The same year, BZgA published country papers on sexuality education for young people, which looked at 14 countries in Europe and two in central Asia: six of the countries covered had not been involved in the SAFE report. More recently, the United Nations Educational, Scientific and Cultural Organization (UNESCO) produced a global review of comprehensive sexuality education (in 2015) that included nine countries in eastern Europe and central Asia, and various country reports have been published through the international literature.

Methodology

The questionnaire for the research was sent to IPPF member associations and ministries of education or health. It covered laws, policies and strategies, school sexuality education in practice, sexuality education outside schools, youth-friendly sexual and reproductive health service delivery, and relevant survey results at country level that provide insights into other areas of sexuality education. Responses were received from 24 countries from all parts of the WHO European Region.


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Dr Evert Ketting, Consultant, the Netherlands

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Sexuality education is becoming a normal, integrated teaching subject in schools in Europe

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Dr Evert Ketting, Consultant, the Netherlands

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Sexuality education is becoming a normal, integrated teaching subject in schools in Europe

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Dr Evert Ketting, Consultant, the Netherlands

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Ten countries (mostly in northwest Europe, but also Albania and Bosnia and Herzegovina (Sarajevo canton))were found to have fully comprehensive sexuality education, but four had no sexuality education at all. Comprehensiveness was partial in four countries and minimal in six.

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Four countries involved in the research – Sweden, Albania, Estonia and Tajikistan – not only represent disparate parts of the WHO European Region, but also provide different examples and stages of development and implementation of sexuality education.
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Results for Tajikistan

Results for Estonia

Results for Albania

Results for Sweden

More findings

The findings for all 25 countries who took part in the research are available as pdf or as print version. Click here to get more informations.

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Conclusion and recommendations

Olena Ivanova, Ludwig-Maximilians-University, Munich, Germany and Dr Evert Ketting, Consultant, the Netherlands
Olena Ivanova, Ludwig-Maximilians-University, Munich, Germany and Dr Evert Ketting, Consultant, the Netherlands
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Since 2000, rapid progress has been made in developing and institutionalizing school sexuality education in countries of Europe and central Asia. Most surveyed countries have basic elements of sexuality education in schools, although curriculum development, implementation, monitoring and evaluation processes differ across the WHO European Region and within countries.

Moving forward, the research recommends that:

• European and central Asian countries that do not yet have a legal basis for sexuality education should be supported in creating such a basis, using examples from comparable countries;

• in the vast majority of countries, there is a very clear need to train teachers in sexuality education and develop educational materials for that purpose;

• in addition to being the main beneficiaries, young people should be more involved in developing, implementing and evaluating sexuality education programmes;

• monitoring and evaluation systems for sexuality education should be strengthened, focusing not only on the quality of the programme, but also the quality of its implementation;

• as there is still widespread misunderstanding of the impact and benefits of sexuality education, there is a strong need to demonstrate the results of scientific research in this field to decision-makers, the education sector and the public at large; and

• sharing of knowledge and experience and collaboration in the field of sexuality education should be strengthened.
Olena Ivanova, Ludwig-Maximilians-University, Munich, Germany and Dr Evert Ketting, Consultant, the Netherlands
Olena Ivanova, Ludwig-Maximilians-University, Munich, Germany and Dr Evert Ketting, Consultant, the Netherlands
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Future developments - new practice from across the Region

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UNESCO has been working on sexual and reproductive health for over 20 years, recognizing that sexual and reproductive health has a huge influence on the education and future prospects of young people. In December 2016 UNESCO IITE in cooperation with a Popular Science YouTube channel «NauchPok» developed a series of “edutainment” videos. Since then the programme has reached over 3.5 million Russian-speaking Internet users with important messages about sexual and reproductive health through online videos, using very simple drawn images.

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The IFMA launched an online project in 2016 on sexuality and gender identity and expression. The objective was to engage patients, medical students, faculties, medical professionals and key stakeholders in developing sustainable relationships and actions to advocate for the inclusion of LGBTQI health and wellness in medical education across the world. A working group was formed from participants of the webinars who created a booklet advocating for LGBTQI rights in medical education. This is currently being used in medical faculties all over the world.

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SEX vs the STORK is a Romanian feminist sexuality education video web series for teenagers and young adults, formed in 2012. Its YouTube channel has over 16 000 subscribers and around 2 million viewers, and its Facebook page has over 9000 friends.

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The hub is a social media platform, which corresponds what young people requested. It provides a safe place for young people and experts in the field. Sections include “Conversational circles”, where young people can create or take part in conversations with fellow members, “Advocacy stories” from different countries and regions, an overview of comprehensive sexuality education with regular updates, and resources. A youth advisory panel with representatives from youth organizations has been created to participate in future developments.

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Joint commitment

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The world café methodology is a flexible and effective way of moderating large group dialogues. Groups of people discuss aspects of a topic at several tables, with individuals switching tables periodically and getting introduced to the previous discussion at their new table by a "table host". Participants are encouraged to write comments or make drawings on tablecloths at each station being supported by the table host. The questions discussed at each table were as follows.

1. Who are the main drivers of resistance to sexuality education in your country or region, and what are their main arguments?

2. What kind of effective strategies, actions and networks have you or others in your country or region implemented to meet resistance?

3. What kind of concrete actions should be taken in future to address resistance at national and international levels?

Some results of the discussion can be summarized as follows:
 
Who and what are driving resistance?

Churches and religious groups, conservative and right-wing politicians and parties, as well as anti-choice activists were identified as the main drivers of active opposition to sexuality education, this being exacerbated in societies with strong patriarchal traditions. However, passive resistance by schools was also highlighted, along with faith-based parents’ groups. Teachers who feel uncomfortable with sexuality education issues, lack understanding about their roles or fear external interventions into their teaching can be a hindrance to the implementation of sexuality education.


Effective anti-resistance strategies

National and international coalition-building, including NGOs, minorities and other stakeholders who may not be primarily focused on sexuality but who nevertheless share areas of common interest (such as those interested in harassment, sexual and reproductive health and gender-based violence), was identified as important, as was continuous building of alliances with governmental representatives and parliamentarians.

An interesting example of a successful advocacy initiative was recounted from Belgium, where well-known journalists and TV personalities were invited to ‘hijack’ a school class and talk about sexuality education – this was filmed and broadcast through YouTube and other portals and proved very successful in raising awareness about sexuality education. Another successful example is encouraging people who have previously been resistant to sexuality education but who have, for whatever reason, changed their minds to speak publicly about their experiences and the reasons for their conversion.


Taking concrete action to reduce resistance

Policy coherence is important – sexuality education should not be seen as a stand alone issue, but should influence and be influenced by political activity at country level on issues such as inequalities, teenage pregnancy prevention, mental health, anti-bullying and sexual health: the language used in relation to sexuality-education needs to mirror that used for other policy areas. A more cohesive policy landscape would enable practitioners to implement sexuality education programmes in a more effective manner. Similar approaches might be taken in some countries in ensuring coherence with the SDGs, especially targets 3, 4 and 5.
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Looking back and moving forward

Youth delegation
Youth delegation
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The closing session delivered take-home messages from the delegation of young people and representatives of the European Expert Group on Sexuality Education.

Based on their participation in the conference and lessons learnt, the youth delegation recommends that:

• CSE should reflect a positive approach to sexuality: when peer educators talk about sexuality, it should provide a strong frame to influence how young people think and talk about sex in the future;

• CSE should also focus on pleasure, not only the risks of having sex: this is important for issues such as consent and sexual violence;

• policies and programmes should be developed to ensure that all young people have access to CSE and services in formal and informal settings;

• CSE should adopt a holistic approach and extend beyond biology to include social and human-rights aspects related to sexual orientation and gender identity;

• professional and political support for CSE should be increased at national level, with appropriate indicators to measure success;

• standards should be set for CSE in informal settings;

• young people from minority backgrounds should be active participants in, and beneficiaries of, sexuality education programmes;

• multisectoral and culturally sensitive approaches that involve more than the health sector should be deployed; and

• programmes need to be relevant to local realities in more traditional societies and should involve all relevant local players, including teachers and religious and community leaders.

The young people’s delegation called on all partners to work together to make CSE a reality for all young people.

Youth delegation
Youth delegation
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Sharafdzhon Boborakhimov, Y-PEER regional network, Tajikistan

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Meaningful and effective comprehensive sexuality education can provide young people with accurate and relevant information with which they can explore attitudes and values and develop the skills they need to make informed and positive life decisions. Young people’s participation is crucial, and they should be engaged from the design of programmes right through to evaluation.

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Simone Reuter, Sherwood Forest Hospitals NHS Foundation Trust, United Kingdom

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The inclusion of young people, not just as observers but as participants, is central to everything we do. They are the parents, politicians and people of tomorrow. That will take us one step closer to tackling public opinion, because young people are public opinion.

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Helene Reemann, BZgA

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We have all worked hard to take sexuality education as far as it has come, but we need to work equally hard in future – many challenges remain, such as how to deliver sexuality education to families who have recently arrived from other countries. In the face of multiple forms of discrimination and abuse, the starting point for sexuality education has to be the law, including the Universal Declaration of Human Rights. Media and online platforms must be a major part of the work taken forward from here.

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Lena Luyckfasseel, IPPF EN

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This conference has changed the whole concept of what “expert” means. Among all the academics, teachers and international organizations represented, the experts are young people, who are the greatest advocates for, and leaders of, sexuality education. The conference also shows the potential that comes from going forward together, and the fact that we need to celebrate the successes of the last 10 years. Shortcomings were identified, but so were potential opportunities and solutions. People are committed, as is IPPF EN, which will continue to put resources into supporting the agenda going forward.

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Joanna Herat, UNESCO

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The combination of governmental and NGOs, international organisations, teachers and other professionals and young people who came together to organise and deliver this conference shows the strength of collaboration in this area. Europe is the driving force behind sexuality education globally. So much learnt from programmes in Europe has been taken to inform programmes elsewhere in the world: as an example, the definition of sexuality education in the United Nations international technical guidance on sexuality education currently being revised includes reference to positive sexuality and well-being. The aim is to move from disease-prevention to well-being, with young people at the centre, and much of this is being driven from initiatives in Europe.

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Rune Brandrup, UNFPA Regional Office for Eastern Europe and Central Asia

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The energy, commitment and fun seen at the conference is inspiring. If participants can have such a good time together, they can certainly work together going forward. The young people’s participation augurs really well for the future – they are the ones who will bring innovations to this field. They see the world differently and are tomorrow’s leaders, but they also have ideas today on how to solve problems right now.

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The links between comprehensive sexuality education and health services are important. Health services are ready to respond to the demand. The SDGs offer great opportunities: 50 of the 53 Member States of the WHO European Region have approved the strategy for sexual and reproductive health, which is in line with the SDGs and the Agenda 2030. We must use this strength to promote sexuality education further, identifying key action plan recommendations that can be discussed with ministries to promote progress. Countries and institutions should work together as we move forward, creating expert pools – indeed, participants should think about which countries are not included in the conference and make links.

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Further information

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Over 180 experts on sexual and reproductive health and sexuality education from more than 30 countries throughout the WHO European Region attended in May 2017 in Berlin.

The overall aim of the conference was to promote sexuality education as an integral part of health promotion and as a crucial element in supporting the healthy development of children and young people. The conference also provided a platform for the facilitation of:
• scientific and technical exchange on latest research results and examples of good practice; and
• networking opportunities among international experts working in the field of sexuality education.

Specific objectives of the conference were to:
• provide an overview on trends and the current state of sexuality education in the WHO European Region; and
• identify current challenges related to the implementation and improvement of sexuality education, as well as future strategies and approaches to address them.

Order number: 60596075
The printed version of the conference report also will be available for download soon.
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Comprehensive report on Sexuality Education in Europe and Central Asia

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This report presents the results of a new assessment of the status of sexuality education in the European Region of the WHO which includes 53 countries from Western Europe, Eastern Europe and Central Asia. It is largely based on answers to a detailed questionnaire sent out to respondents in 25 countries in this region who, it was felt, are well informed about sexuality education in their respective countries. The research project was initiated and implemented by the German Federal Centre for Health Education, BZgA, and the European Network of the International Planned Parenthood Federation, IPPF EN.

This research constitutes an updated assessment of the situation in selected countries of western and eastern Europe and central Asia which were only partly covered by two previous studies conducted a decade ago by IPPF EN (the Sexuality Awareness for Europe (SAFE) project) and BZgA (Country Papers on Youth Sex Education in a Multicultural Europe).

Order number: 60596046
The country report is also available for download:
Comprehensive report on Sexuality Education in Europe and Central Asia (12,4 MB)

The Russian translation of the report will be released in late 2018.
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Sexuality Education in the WHO European Region - fact sheets

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The fact sheets are based upon a joint research project of the International Planned Parenthood Federation European Network (IPPF EN) and the Federal Centre for Health Education (BZgA), a WHO Collaborating Centre for Sexual and Reproductive Health. The data of this research were collected between October 2016 and July 2017 by means of written expert interviews with representatives of governmental and non-governmental organisations in 25 countries and collection of available data from international information sources.



The fact sheets are available for download:
Country factsheets of 25 countries of the WHO European Region

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www.bzga-whocc.de/en

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The website https://www.bzga-whocc.de/en/home/ offers informations on the work of BZgA as WHO Collaborating Centre for Sexual and Reproductive Health.
 

BZgA has been a WHO Collaborating Centre for Sexual and Reproductive Health since 2003. The thematic focus lies on sexuality education in the WHO European region, a theme in which BZgA has many years of experience on the national as well as on the international level. As WHO Collaborating Centre it engages in the development of frameworks and materials for different target groups in the field of sexuality education, in the development of standards, in research and in the organisation of seminars and conferences for knowledge transfer and networking.
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BZgA team
BZgA team
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The Federal Centre for Health Education (BZgA) would like to express their sincere gratitude and appreciation to the many individuals and organisations that contributed to the international conference on the state of Sexuality Education in Europe and Central Asia.

BZgA team
BZgA team
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