Awareness and attitude towards sex health education and sexual health services among youngsters

Objectives: To assess attitudes and awareness regarding sexual health education and services among young individuals in Pakistan.
Methods: A cross-sectional survey was conducted in urban and semi-urban districts of Sindh, Pakistan, in
2010. A self-administered questionnaire was distributed in-hand among 200 young people aged 16-25 years; who were selected on the basis of convenience sampling. Of the questionnaires distributed, 165 (82%) were returned. After checking for quality and consistency, 150 (75%) forms were found good enough to be used for categorical analysis, using PASW Statistics 18 for Mac 2008 version.

Results: Of the 150 participants, 94 (63%) were males and 56 (37%) were females. A quarter of them (n=38; 25.3%) said sexual health services were available too far away from their area. Besides, they also found the staff to be \'not competent.\' Almost one-third (n=49; 32.7%) reported of not having matching gender choice (male or female) of professionals with whom they could feel comfortable sharing their sexual health concerns. Majority of the participants (n=101; 67.3%) considered trained health professionals as the primary source of sexual health education, whereas, 90 (60%), 75 (50%), and 59 (39.3%) also reported to have secondary sources, including internet, parents and telephone helpline respectively.
Conclusion: Sexual health education and services for the young are barely enough or satisfactory in terms of quantity and quality in Pakistan, suggesting a case for having curriculum-based sex education implemented in academic institutions.
Keywords: Sex health education; Sexual health services; Perceptions towards Sexual Health Education. (JPMA 62:708; 2012).

Introduction

The proportion of young persons is growing faster in the world.¹ Risky sexual behaviours, such as early sexual debut, premarital sex, multiple partners and bisexual orientation, are also increasingly becoming common among young people.^2,3 Sex education for the young has remained a limited and controversial issue in many countries across the world.¹ According to the World Health Organisation bulletin 2007, many nations worldwide pledged that by 2007, more than 90% of young people in their countries would be able to correctly recognise the modes of HIV transmission and its prevention. However, available evidence shows that only 40% of young males and 36% of females have appropriate knowledge of HIV/AIDS.⁴ Health education is a basic right of young people. It improves their knowledge about their bodies, gives them the opportunity to understand their responsibility in society, and helps them develop negotiating skills.⁵ However, sexual and reproductive health is entangled in complex societal stigmas, fears, misconceptions and misinformation.¹
Limited access to information and services for young people decreases their self-confidence and the ability to make informed choices.⁶ For example, a study in Sri Lanka revealed lack of knowledge among youngsters aged 17-19 years to result in low self-confidence and psychological distress, especially with regard to masturbation practices and menstruation periods.⁷
Demographically high proportion of youth, low literacy rate, low knowledge about Sexually Transmitted Infections (STIs), delayed marriages, and poor health indicators are few major risk factors in raising the susceptibility of young people contacting sexually transmitted infections in Pakistan.⁸
Literature about sexual and reproductive health for young people is scarce in Pakistan.⁹ Young people in Pakistan have very limited knowledge about sexual and reproductive health, and majority of them have different misconceptions.¹⁰ For example, a study conducted on young boys and girls aged 10-19 years in Karachi found that 54% participants had no information on any STI.¹¹ A qualitative study on adolescents reported that girls perceived menstruation as the ability to give birth; and that having a shower during menstruation periods is harmful for their health.¹² Another study representing young men aged 18-21 years reported having fears of detrimental effects as a result of masturbation, varying from erectile dysfunction (30.4%) to physical (76.4%) and sexual weakness (10.9%). Feelings of guilt associated with masturbation were also reported by 76% of the participants. Young people experience many negative psychological effects due to their lack of knowledge about sexuality.¹⁰ They want to learn about their bodies^9,11 as 88% participants, in a study, maintained that sexual health should be included in school curriculum.¹³
Young persons\' perceptions about need of sex education, satisfaction with sexual health services, and knowledge about STIs has attracted very little space from research point of view in Pakistan.¹¹ Therefore, this study was aimed to assess youngsters\' awareness and attitude towards the availability of sexual health education and sexual health services in the country.

Subjects and Methods

A cross-sectional survey was conducted, using a self-administered questionnaire. In order to have representation from both urban and rural populations, two distinct study sites (district Hyderabad, which is predominantly urban, and village Sakrand in district Nawabshah) in the Sindh province of Pakistan were selected.
The study participants were recruited from both public and private academic institutions, using the convenient sampling method. The eligibility criterion was restricted to age between 16-25 years, regardless of gender and particular subject of study at the institution. In total, 200 questionnaires were distributed in-hand along with an information sheet explaining their participation in the research. Study participants were facilitated by a trained research assistant at each study site. They were given options to either complete-and-return the questionnaire on-spot; or take it home and return it later by a set date in a sealed envelope which was provided with the questionnaire. Majority of the participants (n=158; 79%) opted to return the questionnaire later, and the envelopes were subsequently collected by the research assistant. Altogether, 165 filled questionnaires were received. The quality and consistency of the forms were checked and the responses from 150 questionnaires were found suitable for entry and further analysis.
The data-collection tool was a quantitative-structured questionnaire, which was translated into three languages: English, Urdu and Sindhi. The translated questionnaire was piloted on 05% of the total sample size, randomly selected in similar settings before the study. Statistical analysis of the data was undertaken using PASW Statistics 18 for Mac 2008 version. The data was analysed to produce descriptive statistics.
As the study did not involve any physical or emotional harm to the participants, participation was made purely on voluntary basis for which verbal consent was obtained from all the participants. Confidentiality of the participant was ensured by coding individual responses on unique participant identification codes. The study received ethical approval from the Ethical Review Committee of the School of Health and Related Research (ScHARR), University of Sheffield, England.

Results

Of the 150 participants, 94 (63%) were male and 56 (37%) were female. Only 42 (28%) were married (Table-1).


Regarding sexual health service, 47 (31.1%) of the young people admitted to having a fear that a friend might find out that they had asked for an advice about sexual health, and this stopped them from seeking any medical help (Table-2).

There were 38 (25.3%) who said sexual health services were far away for them to make use.
Of the participants 37 (24.7%) commented about the attitude of staff at such health facilities as "unwelcoming" about sexual health concerns. It was observed that 41 (27.3%) of the participants perceived health facility staff as "not competent", whereas, 49 (32.7%) reported of not having gender choice (male and female) in terms of professionals with whom they could feel comfortable sharing their sexual health concerns. Besides, 51 (34%) young people acknowledged that very often they feared discussing sexual matters with anyone, while 41 (27.3%) would rather not know if they had an STI, including HIV/AIDS.


In terms of sexual health education, a majority of respondents favoured the concept of initiating the subject at some level of the academic process: primary (n-30; 20%); secondary (n=51; 39.3%); or college/university (n=95; 63.3%). However, 80 (53.3%) disagreed with the basic concept. With regard to the primary source of sexual health education, 101 (67.3%) participants favoured trained health professionals, while 90 (60%), 75 (50%), and 59 (39.3%) thought of secondary sources like the internet, parents, and telephone helplines, respectively. These observations were compared with global trends (Figure).

Discussion

The study underscored increased level of dissatisfaction among the young with the available sexual health services in Pakistan and highlighted the need to have curriculum-based sexual education in academic institutions.
The study also showed that existing sexual health services are inaccessible, that many staff are incompetent and unwelcoming, and that the services are not young-people-friendly. It is well known that stigmas associated with STIs deter many people from seeking sexual health services, the attitude and knowledge of staff play a vital role in building confidence and trust among healthcare seekers.^14,15 The review of the literature showed that unfavourable attitude results into under-reporting of unwanted pregnancies, and abortions in Pakistan.¹⁶ This study showed that one-third of the young people feared discussing their sexual health problems with anyone. This indicates that they have less trust and more fear of breaking confidentiality about their sexual health. It is well discussed that if the confidentiality is compromised, young people will be less likely to use the services or will be less than honest about their sexual health conditions.¹⁵
The findings of this study implied that the government should re-evaluate the existing sexual health services and should make them more young-people-friendly.
The findings of the study are consistent with many other studies, in suggesting that young people want to learn about their sexual health.^9,11,13 Throughout the world, schools have been recognised as an important place for sex and STI/HIV education.¹⁷ Strategies based on a written curriculum in school on HIV/STI education are promising interventions in terms of a reduction of unsafe sexual risk behaviours among the young.¹⁸ Several studies and reviews have concluded that school-based sexual health education for young people improves their understanding on sexually transmitted infections, including HIV/AIDS, reduces risky behaviour like unsafe and unprotected sexual intercourse, and develops skills to communicate effectively and make healthy relationships.^18,19
This study adds to the literature that suggests that young people want sexual health education to be taught in academic institutions of Pakistan. Young people said that the content of sex education should include family values such as responsibility of parenting; physical and emotional changes at puberty; biology of sex; human reproduction; contraception; and information about STIs including HIV/AIDS.
The study had many methodological limitations that may have influenced its results. Since the participants were recruited from academic institutions and the majority had higher secondary education level, therefore, it is difficult to generalise the findings on common young people in the local context. The quantitative nature of the questionnaire might have prevented participants from sharing their views that might have been different from the statements and options available in the questionnaire. Besides, because of the standardised nature of the questionnaire, participants who misunderstood any point might not have had an explanation of the questions concerned. Moreover, there is always doubt about the honesty of the participants\' responses when self-administered questionnaires are used. Inclination of socially acceptable responses might be possible due to the sensitive nature of the topic.

Conclusion

Low level of knowledge among youngsters and their dissatisfaction with the available sexual health services are the impeding factors undermining the scope of current reproductive health services in Pakistan. Nevertheless, the knowledge sources were largely perceived to exist either in the form of media and internet, and making them formal through academia was largely recommended.

References

1. Shaw D. Access to sexual and reproductive health for young people: Bridging the disconnect between rights and reality. Int J Gynecol Obstet 2009; 106: 132-6.
2. UNAIDS. Impact of HIV and sexual health education on the sexual behaviour of young people. A review update by UNAIDS 2007. (Online) (Cited 2010 April). Available from URL: http://data.unaids.org/publications/IRC-pub01/jc010-impactyoungpeople_en.pdf.
3. Braverman PK, Strasburger VC. Sexually transmitted diseases. Clin Paediat (Phila) 1994; 33: 26-37.
4. World Health Organization. Toward universal access: Scaling up priority HIV/AIDS interventions in the health sector. Geneva: WHO 2007.
5. FPA for Northern Ireland. Sex education in schools. Family planning association for northern Ireland. (Online) (Cited 2011 April) Available from URL: http://www.hpani.org/Resources/sexual/pdfs/sexedinschools.pdf.
6. UNAIDS. Young people and HIV/AIDS, Opportunity in crisis. UNAIDS 2002. (Online) (Cited 2010 April) Available from URL: http://data.unaids.org/topics/young-people/youngpeoplehivaids_en.pdf.
7. Agampodi SB, Agampodi TC, Ukd P. Adolescents perception of reproductive health services in Sri Lanka. BMC Health Serv Res 2008; 8: 98.
8. Siddiqui MH, Siddiqui JA, Ahmed I. Demographic profile and clinical features of admitting HIV patients in a tertiary care teaching hospital of Karachi Pakistan. Pak J Med Sci 2009; 25: 861-4.
9. Qazi Y. Adolescent reproductive health in Pakistan. In:Bott S, Jejeebhoy S, Shah I, Puri C. (eds). Towards adulthood: exploring the sexual and reproductive health of adolescents in South Asia. Geneva: World Health Organization, 2003; 78-80.
10. Khan A, Pine P. Adolescents and reproductive health in Pakistan: a literature review. Population council final report 2000.
11. Ali TS, Ali PA, Waheed H, Memon AA. Understanding of puberty and related health problems among female adolescents in Karachi, Pakistan. J Pak Med Assoc 2006; 56: 68-72.
12. Mohamed S. Addressing gender inequality in adolescent life skills education: Aahung\'s experience in Pakistan. International women health 2004.
13. Majid S. Reproductive health awareness in adolescent girls: report of a survey. J Coll Physcians Surg Pak 1995; 5: 214.
14. Leili S, Elham S, Farkhondeh S. A population based survey of HIV/AIDS knowledge and attitude in general public, Bandar-Abbas, Iran. Pak J Med Sci 2008; 6: 838-44.
15. Thomas N, Murray E, Rogstad K. Confidentiality is essential if young people are to access sexual health services. Int J STD & AIDS 2006; 17: 525-9.
16. Rehan N. Attitude of health care providers to induced abortion in Pakistan. J Pak Med Assoc 2003; 53: 7.
17. Mukoma W, Kagee A, Flisher AJ, Mathews C. School-based interventions to postpone sexual intercourse and promote condom use among adolescents. The Cochrane Collaboration. Published online first; 21 Jan 2009. doi: 10.1002/14651858. CD0064-17.
18. Kirby DB, Laris BA, Rolleri LA. Sex and HIV education programs: their impact on sexual behaviours of young people throughout the world. J Adolesc Health 2007; 40: 206-17.
19. Wellings K, Wadsworth J, Johnson AM, Field J, Whitaker L, Field B. Provision of sex education and early sexual experience: the relation examined. BMJ 1995; 311: 417-20.

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Sexual intercourse

Animals that reproduce sexually use sexual intercourse to have offspring. Sometimes sexual intercourse is called coitus or copulation and is more casually known as having sex or sleeping together. In sexual
intercourse, the male reproductive organ enters the female reproductive tract.[1][2] The two animals may be of opposite sexes or they may be hermaphroditic, as is the case with snails.[3]

Sexual intercourse between animals other than humans is often called mating. Most animals only mate when the female is at the point of estrus, which is the most fertile period of time in its reproductive cycle.[4][5]

In certain animals, sexual intercourse is not only used for reproduction, but has taken other functions as well. These animals include bonobos,[6] dolphins,[7] and chimpanzees which also have sexual intercourse even when the female is not in estrus, and to engage in sex acts with same-sex partners.[8] In most instances, humans have sex primarily for pleasure.[9] This behavior in the above mentioned animals is also presumed to be for pleasure,[10] which in turn strengthens social bonds.

Humans sometimes engage in behaviours that do not include the penetration of sexual organs, such as oral intercourse or anal intercourse or by non-sexual organs (fingering, fisting). These behaviours are sometimes included in the definition of sexual intercourse.[2]

Sexual intercourse with a partner of the same sex is called homosexual sex.

Forcing someone to have sex who does not want to, called rape, is a serious crime in many countries.
Contents

    1 Reproduction
    2 Behaviours unrelated to reproduction
    3 How humans prevent pregnancy
    4 Sexual orientation
    5 Sexually transmitted infections
    6 Sexual reproduction vs Asexual reproduction
    7 Other kinds of sex
        7.1 Oral sex
        7.2 Anal sex
        7.3 Painful sexual act
    8 Other pages
    9 Other websites
    10 References

Reproduction

    Main article: Sexual reproduction

Sexual intercourse is the natural and most common way to make a baby. It involves a man and woman having sex without birth control until the man ejaculates, or releases, semen from his penis into the woman's vagina. The semen, containing sperm (which is made in his testicles), moves to the Fallopian tubes, and if it finds an ovum on its way, it will try to fertilize it. If this works, the now fertilized ovum sticks to the side of the uterus and the woman becomes pregnant. The fertilized ovum then develops into a human. Medically, it is called a pregnancy until birth.
Behaviours unrelated to reproduction

Certain species of animals also have sex for other purposes than to bear offspring. These include Humans, bonobos,[6] chimpanzees and dolphins[7]. These species also are among those known to engage in homosexual behaviors.[8] In both humans and bonobos, the female has a relatively concealed ovulation. Neither male or female partners commonly know whether she is fertile at any given moment. One reason for this may be that sex partners of these species form strong emotional bonds. The partners come together for more than just sexual intercourse. In the case of humans, long-term partnership is more important than immediate sexual reproduction.[9]

Humans, bonobos and dolphins show cooperative behaviour. In many cases, this behaviour has shown better results than what an individual can achieve alone. In these animals, the use of sex has evolved beyond reproduction and has taken additional social functions. Sex reinforces intimate social bonds between individuals. Overall, such cooperation also benefits each member of the group in that they are better able to survive.

In humans, sexual intercourse seems to serve three types of purposes,which do not exclude one another:

    Reproduction
    Forming and keeping relationships
    Recreational[9][11]

How humans prevent pregnancy
Main page: Non-penetrative sex

In the late 20th century, very effective forms of contraception (birth control) were developed allowing a man and women to help prevent a baby from being made. One type of contraception is a condom. This is a piece of rubber that covers the penis that a man can wear during intercourse, which stops the man's semen from going into the woman's vagina. This does not always work though because the condom will rip or tear. Another well-known type of contraception is called the Pill, which a woman takes every day. When a woman is "on the Pill," she and her partner may have sex any time they wish with very little chance of making a baby. Contraception allows people to keep "sex for fun" separate from "sex to make children". For example, a fertile couple may use contraception to experience sexual pleasure (recreational). At the same time, this experience may strengthen their relationship, and a stronger relationship may mean that they will better be able to raise children in the future.
Sexual orientation

Who people like to have sex with depends on their sexuality. Men who like to have sex with women, and women who like to have sex with men are heterosexual or "straight". Men who only like to have sex with other men, and women who only like to have sex with other women are homosexual or "gay". A different word to describe a woman who only likes to have sex with other women is "lesbian". Some people like both men and women, which is called being bisexual. Approximately 1.5% of the Uk's population in 2010 was bisexual, gay or lesbian.
Sexually transmitted infections

    Main article: Sexually transmitted disease

Some diseases can be caught by having sex. These diseases are called sexually-transmitted infections (STIs).[12]

Some examples of STIs include chlamydia, syphilis and gonorrhoea. A virus called HIV causes AIDS, which cannot be cured and can lead to death.

Using Latex condoms or oral dams reduce the chance that a few types of diseases will be passed on, but it not entirely effective for all STIs. Birth control (like "the Pill") can prevent pregnancy, but won't prevent sexual infections.

Some STIs can also be spread in ways other than having sex. For example, herpes simplex and hepatitis B could be caught by a virgin without having sex, but can also be caught through sex. Some types of STIs can spread from contact between the genitals, mouth, anus, skin, eyes, and (rarely) infected surfaces; this depends a lot on the type of STI and how it spreads. Some common diseases like HPV can cause warts and cancer in the genitals or anus or throat.

There exists an HPV vaccine that prevents some sexually-transmitted strains of HPV; however, the vaccine only works if you get vaccinated before becoming infected. The vaccine is approved of for both men and women, but is often not required in the U.S. due to politics.
Sexual reproduction vs Asexual reproduction
Type     Advantages     Disadvantages
Asexual reproduction     No gestation period. No mate needed.     No variation in the species. No contact between the male and the female
Sexual reproduction     Variation of the species. Contact between male and female     Sometimes offspring are abnormal. Gestation period
Other kinds of sex

There are many other kinds of sex. Two of them are oral sex and anal sex.
Oral sex

Oral sex is when one partner uses the tongue, mouth, or throat to excite the other partner's sex organs.

Slang for oral sex is common in Western cultures, for example: "going down on", "giving a blowjob", or "giving head". The technical term for oral sex is fellatio if performed on a male and cunnilingus if performed on a female. When a man performs fellatio on himself, it is called autofellatio.

People can get sexually transmitted infections from oral sex, such as herpes (which can be passed between the mouth and groin), HIV and even oral cancer.
Anal sex

Anal sex is when an erect penis or other device made for sexual pleasure is inserted into the sexual partner's anus. Anal sex with a female does not lead to pregnancy by itself, however, semen can leak out of the anus and enter into the vagina, and pregnancy may rarely occur. Anal sex can still pass sexually transmitted diseases from one partner to another. It can also be very unhealthy for the body because the skin around the anus can tear, bleed and get infected with bacteria.[13] For safety and pleasure partners often use condoms, female condoms and/or lubrication.
Painful sexual act
Main page: Painful sexual act

A painful sexual act is a condition of repeated or persistent genital pain before, during, or after sexual intercourse due to physical, psychogenic and emotional causes. Doctors call the condition as "dyspareunia". It occurs in women and men. The condition affects up to one-fifth of women at some point in their lives.[14]

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زمین‌لرزه قائن (۱۳۷۶)

این زمین‌لرزه در منطقه‌ای به وسعت ۵۰۰٬۰۰۰ کیلومتر مربع از جمله در شهرهای مشهد، کرمان، و یزد احساس شد.[۲۶][۲۷] روزنامهٔ نیویورک تایمز در گزارش اولیهٔ خود دربارهٔ زمین‌لرزه از ایسنا نقل کرد که بیش از ۲٬۰۰۰ نفر در روستاهای اطراف قائن، ۳۹۴ نفر در بیرجند، و ۲ نفر در شهر کوچک خواف جان خود را از دست داده‌اند. میزان تلفات این زمین‌لرزه در افغانستان ۵ نفر اعلام شد.[۲۸]
با ادامهٔ عملیات امدادرسانی این ارقام مورد تجدیدنظر قرار گرفت؛ سازمان زمین‌شناسی آمریکا اعلام کرد که بر اثر این زمین‌لرزه ۱٬۵۷۲ نفر شامل ۱٬۵۶۷ نفر در ایران و ۵ نفر در هرات افغانستان کشته و بیش از ۲٬۳۰۰ نفر مجروح شده‌اند.[۲۹] همچنین این سازمان، زمین‌لرزهٔ قائن را مرگ‌بارترین زمین‌لرزهٔ سال ۱۹۹۷ توصیف کرد.[۳۰] روستای کوچک آبیز در ۹۰ کیلومتری شرق قائن شدیداً آسیب دید به گونه‌ای که یک سوم ساکنین این روستا بر اثر زمین‌لرزه کشته شدند.[۳۱] در روستای اردکول، ۱۱۰ دانش‌آموز دختر بر اثر فرو ریختن سقف دبستانشان جان باختند.[۳۲]

اجساد جان‌باختگان حادثه همزمان با عملیات جستجو و امداد و نجات، در گورهای دسته‌جمعی به خاک سپرده می‌شد. مقامات نگران بودند که نوسانات دمای هوا—از ۵ تا °۲۹ سانتی‌گراد در روز وقوع زمین‌لرزه—روند فاسد شدن اجساد را سرعت بخشد و باعث شیوع بیماری‌های عفونی در منطقه شود.[۳۳] بر اثر زمین‌لرزه آب و برق بسیاری از روستاهای منطقه قطع شد. فاصلهٔ نزدیک‌ترین بیمارستان تا اکثر مجروحین حادثه در حدود ۱۴۰ کیلومتر بود. یک پزشک، ضمن تأکید بر نیاز مبرم به پزشکان بیشتر برای درمان مجروحان، گفت: «نمی‌دانم امروز چه تعداد گچ‌گرفتگی را انجام داده‌ام، اما به نظرم صدها مورد باشد.»[۳۴] پس‌لرزهای شدید بازماندگان را وادار کرد حومهٔ محل سکونتشان را ترک کنند و در چادرها پناه گیرند.[۳۵]

شدیدترین ویرانی‌ها در نواری به طول ۹۰ کیلومتر میان بیرجند و قائن رخ داد.[۳۶] بنا بر گزارش رادیو تهران، ۲۰۰ روستا متحمل خسارات سنگین شده و یا به‌کلی ویران گشته‌اند.[۳۷] سازمان زمین‌شناسی آمریکا تخمین زده‌است که بر اثر این حادثه ۱۰٬۵۳۳ خانه ویران و ۵٬۴۷۴ خانهٔ دیگر نیز متحمل درجات مختلفی از خسارت شده‌اند و پنجاه هزار نفر بی‌خانمان گشته‌اند.[۳۸] مقامات محلی در ابتدا میزان خسارات وارده را معادل ۶۷ میلیون دلار آمریکا (به ارزش سال ۱۹۹۷) تخمین زدند.[۳۹] اما این برآورد بعدها به ۱۰۰ میلیون دلار معادل ۳۰۰ میلیارد ریال افزایش یافت.[۴۰]
کار بر روی مزارع زعفران جان بسیاری از روستاییان را نجات داد.

زمین‌لرزهٔ قائن باعث سنگ‌لغزش، سنگ‌ریزش، زمین‌لغزش، نشست‌های دینامیکی، روانگرایی در بستر رودخانهٔ کالشور، تغییر در سطح آب‌های زیرزمینی، ترک خوردن بدنه و هستهٔ رسی سد خاکی نیمه‌تمام داشگران، نشست موضعی سد سنگریزه‌ای رحیم‌آباد، و وارد آمدن آسیب‌های جدی به قنات‌های ۶۰ روستا شد.[۴۱][۴۲]

زندگی ساکنان فقرزدهٔ منطقه بر پایهٔ کشاورزی دیم، دامپروری، و پرورش محصولاتی نظیر گندم و زعفران می‌چرخد.[۴۳] به هنگام وقوع زمین‌لرزه، اکثر جمعیت منطقه در حال کار بر روی زمین‌های کشاورزی بودند؛ در نتیجه بر اثر ریزش ساختمان‌ها مجروح نشدند و جان سالم به در بردند. به همین دلیل میزان تلفات زمین‌لرزه بسیار کمتر از آنی‌است که از چنین زمین‌لرزه‌ای با این حجم وسیع خرابی‌ها انتظار می‌رفته‌است. اگر زمین‌لرزه به‌جای ظهر در شب به وقوع می‌پیوست، میزان تلفات آن می‌توانست تا ۱۰ برابر افزایش پیدا کند.[۴۴] همچنین تراکم پایین جمعیت در منطقهٔ بیابانی و دورافتادهٔ قائنات و وقوع پیش‌لرزه‌ای حدوداً ۱۰ ثانیه پیش از لرزهٔ اصلی در پایین بودن میزان تلفات مؤثر بوده‌است.[۴۵]

با وجود آنکه در اغلب مناطق روستایی ایران سبک ساخت‌وساز متأثر از عواملی چون مصالح محلی در دسترس، تکنولوژی ساخت سنتی–تجربی، و آب‌وهوای منطقه‌است و اغلب واحدهای ساختمانی از نوع چینه‌ای و خشت سنتی‌است، در منطقهٔ زلزله‌زدهٔ قائنات سبک ساخت‌وساز چهرهٔ کاملاً متفاوتی با دیگر روستاهای ایران دارد. در این روستاها علاوه بر واحدهای ساختمانی سنتی که با گل، خشت یا سنگ ساخته شده‌اند، ساختمان‌های آجری بدون کلاف و یا با کلاف‌های بتنی و یا تک میل‌گردی و حتی ساختمان‌های مسلح‌شده با قاب بتن مسلح و اسکلت فلزی دیده می‌شود. علت این تفاوت، لرزه‌خیز بودن این مناطق است که موجب شده مسئولین نسبت به ساخت محله‌های جدید در روستاهای منطقه پس از زمین‌لرزه‌های ۱۹۷۹ کریزان و کولی، اعطای وام مسکن، و انبوه‌سازی اقدام کنند.[۴۶]

عمده‌ترین نقص مصالح مصرفی در روستاهای منطقه استفاده از مواد اولیهٔ نامرغوب و نیز عدم آشنایی روستاییان با اصول و دانش فنی لازم برای ساخت مصالح مصرفی است؛ به گونه‌ای که آجرهای مصرفی که نسبت به سایر مصالح بیشترین استفاده را داشته‌است، همگی از نوع توکار بوده‌اند که فاقد مقاومت خمشی، کششی، و برشی لازم می‌باشند. در اغلب ساختمان‌هایی که برای ساختشان از بتن استفاده شده‌است، کیفیت بتن مورد استفاده در سطح پایینی می‌باشد که موجب شده‌است بتن مصرفی مقاومت و چسبندگی لازم را نداشته باشد. پروفیل‌های فولادی نیز اگرچه در کارخانه تولید شده‌اند و عموماً از کیفیت مناسبی برخوردارند، اما استفاده از جوش نامناسب و ضعیف در اتصال آن‌ها به یکدیگر موجب شده‌است که کارآیی بهینه نداشته باشند.[۴۷]
امدادرسانی
سازمان/کشور     مبلغ اهدایی به دلار آمریکا[۴۸]
سازمان‌های بین‌المللی صلیب سرخ و هلال احمر     ۱۰٬۵۹۳٬۲۱۰
نروژ     ۱٬۰۸۴٬۵۰۰
آژانس‌های وابسته به سازمان ملل متحد     ۹۵۰٬۶۵۰
کمیسیون اروپا     ۹۰۹٬۰۹۰
ژاپن     ۵۹۶٬۴۹۱
آلمان     ۳۴۶٬۳۰۰
بریتانیا     ۳۴۲٬۶۴۸
دانمارک     ۳۳۸٬۹۵۱
اوپک     ۳۰۰٬۰۰۰
روسیه     ۲۷۰٬۰۰۰
فرانسه     ۲۶۰٬۰۰۰
آمریکا     ۱۰۰٬۰۰۰

مقامات ایران برای امدادرسانی به ده‌ها هزار تن از آوارگان حادثه، از مردم ایران و کشورهای خارجی درخواست کمک کردند. اکثر کمک‌های کشورهای غربی، سه تا چهار روز طول کشید تا به منطقه برسد؛ حال آنکه ۲۴ ساعت نخست پس از وقوع زمین‌لرزه که اغلب توأم با قطع آب و برق است، حیاتی‌ترین و حساس‌ترین بازهٔ زمانی‌است که زلزله‌زدگان نیازمند کمک می‌باشند. اکثر کمک‌رسانی‌ها توسط خود روستاییان منطقه صورت گرفت و بسیاری از روستاییان، آوارگان و بی‌خانمان‌ها را در خانهٔ خود پناه دادند.[۴۹]

چندین هزار داوطلب برای پیوستن به عملیات جستجوی بازماندگانی که زیر توده‌های آجر و سیمان، مدفون شده بودند رهسپار منطقه شدند. بسیاری از داوطلبان بدون داشتن هیچ‌گونه تجهیزات و تنها با دستان خالی خود به جستجوی بازماندگان می‌پرداختند. سازمان‌های محلی، از جمله هلال احمر ایران ۹٬۰۰۰ چادر، بیش از ۱۸٬۰۰۰ تخته پتو، مواد غذایی کنسروشده، برنج، و خرما را به منطقه فرستادند. دولت وقت ایران نیز بیش از ۸۰ تن مایحتاج را به مشهد که مرکز هماهنگی اقدامات امدادی بود ارسال کرد.[۵۰]

کوفی عنان دبیر کل وقت سازمان ملل متحد از جامعهٔ جهانی خواست نسبت به این حادثه «فوراً و سخاوتمندانه واکنش نشان دهند». فرانسه یک هواپیمای باری محتوی پتو، چادر، لباس، و غذا به ایران فرستاد و مقامات سوئیس نیز یک تیم نجات به همراه سگ‌های آموزش‌دیده برای جستجو و نجات به منطقه اعزام کردند. نمایندهٔ ارشد ایالات متحدهٔ آمریکا در سازمان ملل این فاجعه را «موضوعی انسانی» قلمداد کرد. یکی از سخنگویان دولت وقت بیل کلینتون اظهار داشت که علی‌رغم وجود اختلافات شدید با ایران، ایالات متحده حاضر است در صورت تقاضای کمک، نسبت به اهدا و ارسال مایحتاج و سایر کمک‌های امدادی از طریق یک واسطه اقدام نماید.[۵۱] کمیتهٔ مرکزی منونایت، یک آژانس امدادی مستقر در آکرون پنسیلوانیا، ۴۰۰ تن روغن خوراکی و عدسی را که برای پناهندگان مهاجر به ایران، جمع‌آوری کرده بود، به زلزله‌زدگان ایرانی اختصاص داد.[۵۲] یک سازمان بریتانیایی متخصص در زمینهٔ نجات و مقابله با بلایای طبیعی موسوم به سپاه بین‌المللی امداد و نجات برای اعزام یک تیم ۱۵ نفرهٔ نجات اعلام آمادگی کرد که ایران به دلیل «کافی بودن تعداد نیروهای امدادرسان در محل فاجعه» از صدور ویزا برای اعضای این تیم سر بار زد. همچنین پیشنهاد سوئیس برای اعطای کمک‌های بیشتر از جانب ایران رد شد. چندین کشور حاشیه خلیج فارس با ارسال پیام، همدردی خود را با خانواده‌های قربانیان حادثه و دولت ایران اعلام داشتند.[۵۳]

دورافتادگی بسیار زیاد مناطق زلزله‌زده، موجب شده بود توزیع کمک‌های امدادی به‌دشواری صورت پذیرد. برای دسترسی به برخی از روستاهای محل حادثه گاهی لازم بود بیش از ۵ ساعت در جاده‌های خاکی رانندگی کرد. برخی از این مسیرها نیز سقوط کرده و یا بر اثر رانش زمین با ریزش حاشیهٔ جاده کاملاً پوشیده شده بودند. در برخی مناطق غیر قابل دسترس منطقه نیز، از بالگرد برای تأمین مایحتاج زلزله‌زدگان استفاده شد.[۵۴]

اگرچه عملیات امدادرسانی تا مدت‍ی ادامه یافت، اما دولت ایران عملیات نجات را در تاریخ ۱۴ مه متوقف کرد؛ زیرا با گذشت پنج روز از وقوع زمین‌لرزه، دیگر انتظار نمی‌رفت بتوان فرد زنده‌ای را از زیر آوارها و مخروبه‌ها بیرون کشید.[۵۵]
خطرات آتی

در گزارشی که در سال ۲۰۰۴ دربارهٔ کشورهایی با مهندسی زلزلهٔ بی‌کیفیت در وبگاه خبری ساینس‌دیلی منتشر شد ایران «متخلف‌ترین» کشورِ در حال توسعه با احتمال بالای وقوع زلزله‌های مرگ‌بار معرفی شد.[۵۶] از ابتدای قرن بیستم تاکنون از هر ۳٬۰۰۰ مرگ ثبت‌شده در ایران یک مورد بر اثر زمین‌لرزه رخ داده‌است. پروفسور راجر بیلهام، ژئوفیزیکدانی از دانشگاه کلرادو در بولدر شیوه‌های ناصحیح ساخت‌وساز را عامل اصلی این امر می‌داند. بیلهام که در زمینهٔ خطرات و تغییرشکل‌های ناشی از زمین‌لرزه تخصص دارد، عقیده دارد که «بیشتر ایران نیاز به بازسازی دارد».[۵۷] در ارزیابی عمومی کشوری سازمان ملل متحد برای ایران، به طرز مشابهی بیان شده‌است که «در حالی که مقررات ساخت‌وساز کافی برای شهرهای بزرگ وجود دارد، باور عمومی بر این است که با دقت و به شکل جدی به کار گرفته نشده‌اند . . . اغلب افرادی که از زلزله‌های شدید اخیر صدمه دیده‌اند در شهرهای کوچک و روستاها زندگی می‌کردند. ساخت‌وساز مطابق با استانداردهای زلزله در آن مناطق بسیار اندک است و مقررات لازم برای ساخت هنوز به خوبی جا نیفتاده‌است.»[۵۸] تحلیل عملکرد ساختمان‌های سنتی به هنگام وقوع زلزله نشان می‌دهد که عوامل متعددی از جمله هزینه‌های بالای ساخت‌وساز، مصالح نامرغوب، کمبود مهارت در نواحی روستایی، و نبود مقررات ساختمانی حاکم بر شگردهای سنتی ساخت‌وساز، موجب شده‌است که کیفیت ساخت چنین ساختمان‌هایی تنزل یابد. این پژوهش مقرراتی را جهت اعمال بر ساخت تاق‌های قوسی و گنبدهای سنتی پیشنهاد کرده‌است.[۵۹]

زمین‌لرزه‌های به وقوع پیوسته در ایران نگرانی‌های زیادی را در میان مردم این کشور ایجاد کرده و مانعی برای رشد اقتصادی ایران بوده‌است. دوازده زمین‌لرزه که هر یک شدتی بیش از ۷ ریشتر داشته‌اند در قرن گذشته در ایران رخ داده‌اند. سه‌چهارم از شهرهای بزرگ ایران در مناطق مستعد وقوع زلزله‌های مهیب واقع شده‌اند. زلزلهٔ مهیب منجیل و رودبار که تلفاتی بیش از ۴۲٬۰۰۰ نفر بر جای گذاشت، ۷ درصد از تولید ناخالص ملی ایران را در آن سال از بین برد و معادل دو سال رشد اقتصادی ایران را در عرض چند ثانیه نابود کرد.[۶۰]

در سال ۲۰۰۷ در واکنشی به وقوع زمین‌لرزه‌های متعدد در جنوب، جنوب غرب، و مرکز آسیا، «مرکز کاهش مخاطرات لرزه‌ای آسیا» بنیان گذاشته شد. هدف از تشکیل این سازمان «ترغیب همکاری و همفکری منطقه‌ای و بین‌منطقه‌ای برای کاهش مخاطرات لرزه‌ای» اعلام شد. زمین‌لرزه‌ها عامل ۷۳ درصد از مرگ‌های ناشی از بلایای طبیعی در این مناطق به حساب می‌آیند.[۶۱]

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Sex education

Sex education is instruction on issues relating to human sexuality, including human sexual anatomy, sexual reproduction, sexual intercourse, reproductive health, emotional relations, reproductive rights and responsibilities, abstinence, birth control, and other aspects of human sexual behavior.
Common avenues for sex education are parents or caregivers, formal school programs, and public health campaigns.
Contents

    1 Overview
    2 Scientific studies
    3 Public opinion studies
    4 Sex education around the world
        4.1 Africa
        4.2 Asia
            4.2.1 Thailand
            4.2.2 India
            4.2.3 Other countries
        4.3 Europe
            4.3.1 Finland
            4.3.2 France
            4.3.3 Germany
            4.3.4 Poland
            4.3.5 The Netherlands
            4.3.6 Sweden
            4.3.7 Switzerland
            4.3.8 Slovak Republic
            4.3.9 United Kingdom
                4.3.9.1 England and Wales
                4.3.9.2 Scotland
        4.4 North America
            4.4.1 United States
                4.4.1.1 Virginia
                4.4.1.2 Texas
    5 Morality
    6 Lesbian, gay, bisexual, and transgender youth
    7 See also
    8 References
    9 External links
Human sexuality has biological, emotional/physical and spiritual aspects. The biological aspect of sexuality refers to the reproductive mechanism as well as the basic biological drive, Libido, that exists in all species, which is hormonally controlled. The emotional or physical aspect of sexuality refers to the bond that exists between individuals, and is expressed through profound feelings or physical manifestations of emotions of love, trust, and caring. There is also a spiritual aspect of sexuality of an individual or as a connection with others. Experience has shown that adolescents are curious about some or all the aspects of their sexuality as well as the nature of sexuality in general, and that many will wish to experience their sexuality.

Traditionally, adolescents were not given any information on sexual matters, with discussion of these issues being considered taboo. Such instruction as was given was traditionally left to a child's parents, and often this was put off until just before a child's marriage. Most of the information on sexual matters were obtained informally from friends and the media, and much of this information was of doubtful value. Much of such information was usually known to be deficient, especially during the period following puberty when curiosity of sexual matters was the most acute. This deficiency became increasingly evident by the increasing incidence of teenage pregnancies, especially in Western countries after the 1960s. As part of each country's efforts to reduce such pregnancies, programs of sex education were instituted, initially over strong opposition from parent and religious groups.

Burt defined sex education as the study of the characteristics of beings; a male and female.[1] Such characteristics make up the person's sexuality. Sexuality is an important aspect of the life of a human being and almost all the people including children want to know about it.[citation needed] Sex education includes all the educational measures which in any way may of life[clarification needed] that have their center on sex. He further said that sex education stands for protection, presentation extension, improvement and development of the family based on accepted ethical ideas. Leepson sees sex education as instruction in various physiological, psychological and sociological aspects of sexual response and reproduction.[2] Kearney also defined sex education as “involving a comprehensive course of action by the school, calculated to bring about the socially desirable attitudes, practices and personal conduct on the part of children and adults, that will best protect the individual as a human and the family as a social institution. Thus, sex education may also be described as "sexuality education", which means that it encompasses education about all aspects of sexuality, including information about family planning, reproduction (fertilization, conception and development of the embryo and fetus, through to childbirth), plus information about all aspects of one's sexuality including: body image, sexual orientation, sexual pleasure, values, decision making, communication, dating, relationships, sexually transmitted infections (STIs) and how to avoid them, and birth control methods.[3] Various aspect of sex education are to right[clarification needed] in school depending on the age of the students or what the children are able to comprehend at a particular point in time. Rubin and Kindendall expressed that sex education is not merely a unit in reproduction and teaching how babies are conceived and born. It has a far richer scope and goal of helping the youngster incorporate sex most meaningfully into his present and future life, to provide him with some basic understanding on virtually every aspect of sex by the time he reaches full maturity.[4]

Sex education may be taught informally, such as when someone receives information from a conversation with a parent, friend, religious leader, or through the media. It may also be delivered through sex self-help authors, magazine advice columnists, sex columnists, or sex education web sites. Formal sex education occurs when schools or health care providers offer sex education. Slyer stated that sex education teaches the young person what he or she should know for his or her personal conduct and relationship with others.[5] Gruenberg also stated that sex education is necessary to prepare the young for the task ahead. According to him, officials generally agree that some kind of planned sex education is necessary.[6]

Sometimes formal sex education is taught as a full course as part of the curriculum in junior high school or high school. Other times it is only one unit within a more broad biology class, health class, home economics class, or physical education class. Some schools offer no sex education, since it remains a controversial issue in several countries, particularly the United States (especially with regard to the age at which children should start receiving such education, the amount of detail that is revealed, and topics dealing with human sexual behavior, e.g. safe sex practices, masturbation, premarital sex, and sexual ethics).

Wilhelm Reich commented that sex education of his time was a work of deception, focusing on biology while concealing excitement-arousal, which is what a pubescent individual is mostly interested in. Reich added that this emphasis obscures what he believed to be a basic psychological principle: that all worries and difficulties originate from unsatisfied sexual impulses.[7] Leepson asserted that the majority of people favors some sort of sex instruction in public schools, and this has become an intensely controversial issue because unlike most subjects, sex education is concerned with an especially sensitive and highly personal part of human life. He suggested that sex education should be taught in the classroom.[2] The problem of pregnancy in adolescents is delicate and difficult to assess using sex education.[8] But Calderone[who?] believed otherwise, stating that the answer to adolescents' sexual woes and pregnancy can not lie primarily in school programmes which at best can only be remedial; what is needed is prevention education and as such parents should be involved.

When sex education is contentiously debated, the chief controversial points are whether covering child sexuality is valuable or detrimental; the use of birth control such as condoms and hormonal contraception; and the impact of such use on pregnancy outside marriage, teenage pregnancy, and the transmission of STIs. Increasing support for abstinence-only sex education by conservative groups has been one of the primary causes of this controversy. Countries with conservative attitudes towards sex education (including the UK and the U.S.) have a higher incidence of STIs and teenage pregnancy.[9]

The existence of AIDS has given a new sense of urgency to the topic of sex education. In many African nations, where AIDS is at epidemic levels (see HIV/AIDS in Africa), sex education is seen by most scientists as a vital public health strategy.[citation needed] Some international organizations such as Planned Parenthood consider that broad sex education programs have global benefits, such as controlling the risk of overpopulation and the advancement of women's rights (see also reproductive rights). The use of mass media campaigns, however, has sometimes resulted in high levels of "awareness" coupled with essentially superficial knowledge of HIV transmission.[10]

According to SIECUS, the Sexuality Information and Education Council of the United States, 93% of adults they surveyed support sexuality education in high school and 84% support it in junior high school.[11] In fact, 88% of parents of junior high school students and 80% of parents of high school students believe that sex education in school makes it easier for them to talk to their adolescents about sex.[12] Also, 92% of adolescents report that they want both to talk to their parents about sex and to have comprehensive in-school sex education.[13] Furthermore, a "...study, conducted by Mathematica Policy Research Inc. on behalf of the U.S. Department of Health and Human Services, found that abstinence-only-until-marriage programs are ineffective."[14]
Scientific studies

The debate over teenage pregnancy and STDs has spurred some research into the effectiveness of different approaches to sex education. In a meta-analysis, DiCenso et al. have compared comprehensive sex education programs with abstinence-only programs.[15] Their review of several studies shows that abstinence-only programs did not reduce the likelihood of pregnancy of women who participated in the programs, but rather increased it. Four abstinence programs and one school program were associated with a pooled increase of 54% in the partners of men and 46% in women (confidence interval 95% 0.95 to 2.25 and 0.98 to 2.26 respectively). The researchers conclude:

    There is some evidence that prevention programs may need to begin much earlier than they do. In a recent systematic review of eight trials of day care for disadvantaged children under 5 years of age, long term follow up showed lower pregnancy rates among adolescents. We need to investigate the social determinants of unintended pregnancy in adolescents through large longitudinal studies beginning early in life and use the results of the multivariate analyses to guide the design of prevention interventions. We should carefully examine countries with low pregnancy rates among adolescents. For example, the Netherlands has one of the lowest rates in the world (8.1 per 1000 young women aged 15 to 19 years), and Ketting & Visser have published an analysis of associated factors.[16]

    In contrast, the rates are:

            93.0 per 1000 in the United States (85.8/1000 in 1996)
            62.6 per 1000 in England and Wales
            42.7 per 1000 in Canada
            15.1 per 1000 in Belgium (1996)[17]

    We should examine effective programs designed to prevent other high risk behaviors in adolescents. For example, Botvin et al. found that school based programs to prevent drug abuse during junior high school (ages 12–15 years) resulted in important and durable reductions in use of tobacco, alcohol, and cannabis if they taught a combination of social resistance skills and general life skills, were properly implemented, and included at least two years of booster sessions.

    Few sexual health interventions are designed with input from adolescents. Adolescents have suggested that sex education should be more positive with less emphasis on anatomy and scare tactics; it should focus on negotiation skills in sexual relationships and communication; and details of sexual health clinics should be advertised in areas that adolescents frequent (for example, school toilets, shopping centres)."[15]

Also, a U.S. review, "Emerging Answers", by the National Campaign To Prevent Teenage Pregnancy examined 250 studies of sex education programs.[18] The conclusion of this review was that "the overwhelming weight of evidence shows that sex education that discusses contraception does not increase sexual activity". The National Campaign published a follow up study in 2007 titled, "Emerging Answers 2007", reviewing fewer studies but confirming the original findings.[19] The 2007 study found that, "No comprehensive program hastened the initiation of sex or increased the frequency of sex, results that many people fear." Further, the report showed "Comprehensive programs worked for both genders, for all major ethnic groups, for sexually inexperienced and experienced teens, in different settings, and in different communities."
Public opinion studies

A survey conducted in Britain, Canada and the United States by Angus Reid Public Opinion in November 2011 asked adult respondents to look back to the time when they were teenagers, and describe how useful several sources were in enabling them to learn more about sex. By far, the largest proportion of respondents in the three countries (74% in Canada, 67% in Britain and 63% in the United States) said that conversations with friends were “very useful” or “moderately useful.” The next reputable source was the media (television, books, movies, magazines), mentioned by three-in-five Britons (65%) and Canadians (62%) and more than half of Americans (54%) as useful.

There are some striking differences on two other sources. While half of Canadians (54%) and Americans (52%) found their sex education courses at school to be useful, only 43% of Britons share the same view. And while more than half of Americans (57%) say conversations with family were useful, only 49% of Canadians and 35 per cent of Britons had the same experience.[20]
Sex education around the world
Africa
AIDS posters in the Ivory Coast (Côte d'Ivoire)

Sex education in Africa has focused on stemming the growing AIDS epidemic. Most governments in the region have established AIDS education programs in partnership with the World Health Organization and international NGOs. These programs were undercut significantly by the Global Gag Rule, an initiative put in place by President Ronald Reagan, suspended by President Bill Clinton, and re-instated by President George W. Bush. The Global Gag Rule "...required nongovernmental organizations to agree as a condition of their receipt of Federal funds that such organizations would neither perform nor actively promote abortion as a method of family planning in other nations...."[21] The Global Gag Rule was again suspended as one of the first official acts by United States President Barack Obama.[22] The incidences of new HIV transmissions in Uganda decreased dramatically when Clinton supported a comprehensive sex education approach (including information about contraception and abortion).[23] According to Ugandan AIDS activists, the Global Gag Rule undermined community efforts to reduce HIV prevalence and HIV transmission.[24]

Egypt teaches knowledge about male and female reproductive systems, sexual organs, contraception and STDs in public schools at the second and third years of the middle-preparatory phase (when students are aged 12–14).[citation needed] A coordinated program between UNDP, UNICEF, and the ministries of health and education promotes sexual education at a larger scale in rural areas and spreads awareness of the dangers of female genital cutting.
Asia

The state of sex education programs in Asia is at various stages of development.
Thailand

Only in Thailand has there been progress on sex education, with the boundaries being pushed forward with each revision of the curriculum. Thailand has already introduced sexuality education. The first national policy on sexuality education in schools was announced in 1938, but sex education was not taught in schools until 1978. Then it was called “Life and Family Studies,” and its content consisted of issues related to the reproductive system and personal hygiene. The education curriculum has been revised several times, involving efforts from both government and non-government sectors and sex education has been accepted as a problem solving tool for adolescent SRH issues. This has been a consequence of educational reform following the National Education Act B.E. 2542, increasing awareness of problems related to adolescents’ sexual practices, and the emergence of women’s sexuality, and queer movements. The most remarkable new approach in sexuality education curricula in Thailand has been the Teenpath Project developed by PATH, Thailand. PATH has also succeeded in institutionalizing sexuality education curricula in schools since 2003.
India
Know Aids - No Aids road sign in Spiti Valley, Himachel Pradesh, India, 2010
AIDS Clinic, McLeod Ganj, Himachel Pradesh, India, 2010

In India, there are many programs promoting sex education including information on AIDS in schools as well public education and advertising. AIDS clinics providing information and assistance are to be found in most cities and many small villages.[25][26]

    “India has a strong prevention programme which goes hand in hand with care, support and treatment. We have been able to contain the epidemic with a prevalence of just 0.31 %. We have also brought about a decline of 50% in new infections annually.” Shri Gulam Nabi Azad, Hon’ble Minister of Health and Family Welfare, 2011.[27]

Other countries

Indonesia, Mongolia, South Korea have a systematic policy framework for teaching about sex within schools. Malaysia and Thailand have assessed adolescent reproductive health needs with a view to developing adolescent-specific training, messages and materials.

(Bangladesh, Myanmar, Nepal and Pakistan have no coordinated sex education programs.[28])

In Japan, sex education is mandatory from age 10 or 11, mainly covering biological topics such as menstruation and ejaculation.[29]

In China and Sri Lanka, sex education traditionally consists of reading the reproduction section of biology textbooks. In Sri Lanka they teach the children when they are 17–18 years. However, in 2000 a new five-year project was introduced by the China Family Planning Association to "promote reproductive health education among Chinese teenagers and unmarried youth" in twelve urban districts and three counties. This included discussion about sex within human relationships as well as pregnancy and HIV prevention.[30]

The International Planned Parenthood Federation and the BBC World Service ran a 12-part series known as Sexwise, which discussed sex education, family life education, contraception and parenting. It was first launched in South Asia and then extended worldwide.[31]
Europe
Sex Education redirects here. For other uses see Sex Education Curriculum.
Finland

In Finland, sexual education is usually incorporated into various obligatory courses, mainly as part of biology lessons (in lower grades) and later in a course related to general health issues.[citation needed] The Population and Family Welfare Federation provides all 15-year-olds an introductory sexual package that includes an information brochure, a condom and a cartoon love story.[citation needed]
France

In France, sex education has been part of school curricula since 1973. Schools are expected to provide 30 to 40 hours of sex education, and pass out condoms, to students in grades eight and nine. In January 2000, the French government launched an information campaign on contraception with TV and radio spots and the distribution of five million leaflets on contraception to high school students.[32]
Germany

In Germany, sex education has been part of school curricula since 1970. Since 1992 sex education is by law a governmental duty.[33]

It normally covers all subjects concerning the growing-up process, body changes during puberty, emotions, the biological process of reproduction, sexual activity, partnership, homosexuality, unwanted pregnancies and the complications of abortion, the dangers of sexual violence, child abuse, and sex-transmitted diseases, but sometimes also things like sex positions. Most schools offer courses on the correct usage of contraception.[34]

A sex survey by the World Health Organization concerning the habits of European teenagers in 2006 revealed that German teenagers care about contraception. The birth rate among 15- to 19-year-olds was very low - only 11.7 per 1000 population, compared to the UK's 27.8 births per 1,000 population, and—in first place—Bulgaria's 39.0 births per 1,000.[35] but it is considered high by Asian standards.

German Constitutional Court and, in 2011, the European Court of Human Rights rejected complaints from several Baptists against Germany concerning mandatory sex education.[36]
Poland

In the Western point of view, sex education in Poland has never actually developed. At the time of the People's Republic of Poland, since 1973, it was one of the school subjects, however, it was relatively poor and did not achieve any actual success. After 1989, it practically vanished from the school life - it is currently an exclusive subject (called wychowanie do życia w rodzinie/family life education rather than edukacja seksualna/sex education) in several schools their parents must give consent to the headmasters so their children may attend. It has much due to the strong objection against sex education of the Catholic Church; the most influential institution in Poland.[37]

It has, however, been changed and since September 2009 sex education will become an obligatory subject in the number of 14 per school year - unless parents do not want their children to be taught. Objecting parents will have to write special disagreements.[38]
The Netherlands

Subsidized by the Dutch government, the “Lang leve de liefde” (“Long Live Love”) package, developed in the late 1980s, aims to give teenagers the skills to make their own decisions regarding health and sexuality. Nearly all secondary schools provide sex education, as part of biology classes and over half of primary schools discuss sexuality and contraception. Starting the 2012 school year, age-appropriate sex education -including education about sexual diversity- will be compulsory in all secondary and primary schools. The curriculum focuses on biological aspects of reproduction as well as on values, attitudes, communication and negotiation skills. The media has encouraged open dialogue and the health-care system guarantees confidentiality and a non-judgmental approach. The Netherlands has one of the lowest teenage pregnancy rates in the world, and the Dutch approach is often seen as a model for other countries.[39]
Sweden

In Sweden, sex education has been a mandatory part of school education since 1956. The subject is usually started between ages 7 and 10, and continues up through the grades, incorporated into different subjects such as biology and history.[29]
Switzerland

In Switzerland, the content and amount of sex education is decided at the cantonal level. In Geneva, courses have been given at the secondary level since the 1950s. Interventions in primary schools were started more recently, with the objective of making children conscious of what is and isn't allowed, and able to say "No". In secondary schools (age 13-14), condoms are shown to all pupils, and are demonstrated by unfolding over the teacher's fingers. For this, classes are usually separated into girl-only and boy-only subgroups. Condoms are not distributed, however, except among older adolescents engaged in state-run non-compulsory education (age 16-17).[citation needed]
Slovak Republic

In Slovak republic / Slovakia the content of Sex education varies from school to school, mostly being led by a teacher for a subject which translated to English would be Nature science (The subject covers biology and petrology). The quality of explanation also varies from teacher to teacher and it is not uncommon that the teacher relies on students asking questions. Classes are usually divided into boys/girls, where girls are usually explained the necessary facts about menstruation and pregnancy. Boys are shown a picture of genitalia anatomy with description and may ask questions. Generally is the sex ed level in Slovakia quite poor, though the level actually varies from school to school and reason lies as mentioned above somewhere in the issues of the school or the teacher.[citation needed]
United Kingdom
England and Wales

In England and Wales, sex education is not compulsory in schools as parents can refuse to let their children take part in the lessons. The curriculum focuses on the reproductive system, fetal development, and the physical and emotional changes of adolescence, while information about contraception and safe sex is discretionary[40] and discussion about relationships is often neglected[citation needed]. Britain has one of the highest teenage pregnancy rates in Europe[41] and sex education is a heated issue in government and media reports. In a 2000 study by the University of Brighton, many 14 to 15 year olds reported disappointment with the content of sex education lessons and felt that lack of confidentiality prevents teenagers from asking teachers about contraception.[32] In a 2008 study conducted by YouGov for Channel 4 it was revealed that almost three in ten teenagers say they need more sex and relationships education.[42]
Scotland

The main sex education programme in Scotland is Healthy Respect, which focuses not only on the biological aspects of reproduction but also on relationships and emotions. Education about contraception and sexually transmitted diseases are included in the programme as a way of encouraging good sexual health. In response to a refusal by Catholic schools to commit to the programme, however, a separate sex education programme has been developed for use in those schools. Funded by the Scottish Government, the programme Called to Love focuses on encouraging children to delay sex until marriage, and does not cover contraception, and as such is a form of abstinence-only sex education.[43]
North America
United States
See also: Sex education in the United States

Almost all U.S. students receive some form of sex education at least once between grades 7 and 12; many schools begin addressing some topics in grades 5 or 6.[44] However, what students learn varies widely, because curriculum decisions are so decentralized. Many states have laws governing what is taught in sex education classes or allowing parents to opt out. Some state laws leave curriculum decisions to individual school districts.[45]

For example, a 1999 study by the Guttmacher Institute found that most U.S. sex education courses in grades 7 through 12 cover puberty, HIV, STIs, abstinence, implications of teenage pregnancy, and how to resist peer pressure. Other studied topics, such as methods of birth control and infection prevention, sexual orientation, sexual abuse, and factual and ethical information about abortion, varied more widely.[46]

Only two forms of sex education are taught in American schools: "abstinence plus" and abstinence-only.[citation needed] Comprehensive or "abstinence plus" sex education covers abstinence as a positive choice, but also teaches about contraception and avoidance of STIs when sexually active. A 2002 study conducted by the Kaiser Family Foundation found that 58% of secondary school principals describe their sex education curriculum as "abstinence plus".[45]

Abstinence-only sex education tells teenagers that they should be sexually abstinent until marriage and does not provide information about contraception. In the Kaiser study, 34% of high-school principals said their school's main message was abstinence-only.

The difference between these two approaches, and their impact on teen behavior, remains a controversial subject. In the U.S., teenage birth rates had been dropping since 1991, but a 2007 report showed a 3% increase from 2005 to 2006.[47] From 1991 to 2005, the percentage of teens reporting that they had ever had sex or were currently sexually active showed small declines.[48] However, the U.S. still has the highest teen birth rate and one of the highest rates of STIs among teens in the industrialized world.[49] Public opinion polls conducted over the years have found that the vast majority of Americans favor broader sex education programs over those that teach only abstinence, although abstinence educators recently published poll data with the opposite conclusion.[50][51][52]

Proponents of comprehensive sex education, which include the American Psychological Association,[53] the American Medical Association,[54] the National Association of School Psychologists,[55] the American Academy of Pediatrics,[56] the American Public Health Association,[57] the Society for Adolescent Medicine[58] and the American College Health Association,[58] argue that sexual behavior after puberty is a given, and it is therefore crucial to provide information about the risks and how they can be minimized; they also claim that denying teens such factual information leads to unwanted pregnancies and STIs.

On the other hand, proponents of abstinence-only sex education object to curricula that fail to teach their standard of moral behavior; they maintain that a morality based on sex only within the bounds of marriage is "healthy and constructive" and that value-free knowledge of the body may lead to immoral, unhealthy, and harmful practices. Within the last decade, the federal government has encouraged abstinence-only education by steering over a billion dollars to such programs.[59] Some 25 states now decline the funding so that they can continue to teach comprehensive sex education.[60][61][62][63] Funding for one of the federal government's two main abstinency-only funding programs, Title V, was extended only until December 31, 2007; Congress is debating whether to continue it past that date.[64]

The impact of the rise in abstinence-only education remains a question. To date, no published studies of abstinence-only programs have found consistent and significant program effects on delaying the onset of intercourse.[49] In 2007, a study ordered by the U.S. Congress found that middle school students who took part in abstinence-only sex education programs were just as likely to have sex (and use contraception) in their teenage years as those who did not.[65] Abstinence-only advocates claimed that the study was flawed because it was too narrow and began when abstinence-only curricula were in their infancy, and that other studies have demonstrated positive effects.[66]

According to a 2007 report, Teen pregnancies in the United States showed 3% increase in the teen birth rate from 2005 to 2006, to nearly 42 births per 1,000.[67]

According to Anna Mulrine at U.S. News & World Report, records show that professionals still do not know what method of sex education works best to keep teens from engaging in sexual activity but they are still working to find out.[68]
Virginia

Virginia uses the sex education program called The National Campaign to prevent teen and unplanned pregnancy. The National Campaign was created in 1996. The program focuses on preventing teen and unplanned pregnancies of young adults. The National campaign set a goal to reduce teen pregnancy rate by 1/3 in 10 years. The Virginia Department of Health ranked Virginia 19th in teen pregnancy birth rates in 1996. Virginia was also rated 35.2 teen births per 1000 girls aged 15–19 in 2006. The Healthy people 2010 goal is a teen pregnancy rate at or below 43 pregnancies per 1000 females age 15-17.
Texas

Sex Education in Texas has recently become a policy of much focus in the state. With the rise of recent protests and proposed bills in the Texas House, the current policy has been the focus of much scrutiny. As of 1997, when Senate Bill 1 was enacted, Texas has left the decision on whether or not a school has sex education classes up to the individual districts. The school board members are entitled to approve all curriculums that are taught; however the bill has certain criteria that a school must abide by when choosing to teach Sex Ed. These include:

    present abstinence from sexual activity as the preferred choice of behavior in relationship to all sexual activity for unmarried persons of school age;
    devote more attention to abstinence from sexual activity than to any other behavior;
    emphasize that abstinence from sexual activity, if used consistently and correctly, is the only method that is 100 percent effective in preventing pregnancy, sexually transmitted diseases, infection with human immunodeficiency virus or acquired immune deficiency syndrome, and the emotional trauma associated with adolescent sexual activity;
    direct adolescents to a standard of behavior in which abstinence from sexual activity before marriage is the most effective way to prevent pregnancy, sexually transmitted diseases, and infection with human immunodeficiency virus or acquired immune deficiency syndrome; and
    teach contraception and condom use in terms of human use reality rates instead of theoretical laboratory rates, if instruction on contraception and condoms is included in curriculum content.

Additionally, school district may not distribute condoms in connection with instruction relating to human sexuality.[69]

Since the enactment of this policy several research studies have been done to evaluate the Sex Ed Policy namely the abstinence only aspect of the teaching. Drs. David Wiley and Kelly Wilson published the Just Say Don’t Know: Sexuality Education in Texas Public Schools[70] report where they found that:

    Shaming and fear-based instruction are commonly used for teaching Sex Ed
    Gender stereotypes are promoted
    A majority of students receive no information about human sexuality except abstinence
    The materials used regularly contain factual errors and distort the truth about condoms and STDs

According to Texas State Representative Mike Villarreal, "We have a responsibility to ensure that our children receive accurate information in the classroom, particularly when students' health is at stake," Villarreal said. "We're dealing with a myriad of problems in Texas as a result of our sky high teen pregnancy rates. We cannot allow our schools to provide erroneous information - the stakes are far too high."[71] With this in mind, many state legislators have proposed bills to improve the sexual education in Texas Schools.

    SB 852/HB 1624[72] – In Feb 2011, Senator Ellis proposed The Education Works bill. This bill would require schools that teach sex education to provide evidence-based, age-appropriate information that emphasizes the importance of abstinence as the only 100% effective method of avoiding sexually transmitted infections (STIs) and pregnancy, while also teaching about contraceptive methods to avoid STIs and pregnancy.

    HB 741/SB 515[73] – In 2011, Representatives Joaquin Castro and Mike Villarreal introduced a bill calling for abstinence-plus sexual health education bill. The bill would have medically accurate information, including: abstinence, contraception, and what it really takes to be a parent. The bill received a hearing but was left in committee.

    HB 1567/ SB 1076[74] – Introduced in 2009 by Villarreal, this bill would have required instruction on contraceptive use to be scientifically accurate when it is taught as part of a school's sexual health curriculum. It did not receive a hearing.

Catholic schools in Texas follow Catholic Church teachings in regard to Sex Education. Some opponents of sex education in Catholic schools believe sex ed programs are doing more harm to the young than good. Opponents of sex education contend that children are not mentally and emotionally ready for this type of instruction, and believe that exposing the young to sex ed programs may foster the students with the preoccupation of sex.

The Catholic Church believes that parents are the first educators and should rightfully fight for their duty as so in regard to sex education.[75] [76]

    Human Vitae teaches the faithful to use their 'conscience' as a guide to Christ-like decision making in regard to sex education.[77]
    the young should not engage in premarital sex, adultery, fornication or other acts of impurity or scandals to others
    Pope John Paul II says that sex education is "a basic right and duty of parents."

Morality

One approach to sex education is to view it as necessary to reduce risk behaviors such as unprotected sex, and equip individuals to make informed decisions about their personal sexual activity.

Another viewpoint on sex education, historically inspired by sexologists like Wilhelm Reich and psychologists like Sigmund Freud and James W. Prescott, holds that what is at stake in sex education is control over the body and liberation from social control. Proponents of this view tend to see the political question as whether society or the individual should teach sexual mores. Sexual education may thus be seen as providing individuals with the knowledge necessary to liberate themselves from socially organized sexual oppression and to make up their own minds. In addition, sexual oppression may be viewed as socially harmful. Sex and relationship experts like Reid Mihalko of Reid About Sex suggests that open dialogue about physical intimacy and health education can generate more self-esteem, self-confidence, humor, and general health.[78]

To another group in the sex education debate, the question is whether the state or the family should teach sexual mores. They believe that sexual mores should be left to the family, and sex-education represents state interference. They claim that some sex education curricula break down pre-existing notions of modesty and encourage acceptance of practices that those advocating this viewpoint deem immoral, such as homosexuality and premarital sex. They cite web sites such as that of the Coalition for Positive Sexuality as examples. Naturally, those that believe that homosexuality and premarital sex are a normal part of the range of human sexuality disagree with them.[citation needed]

Many religions teach that sexual behavior outside of marriage is immoral, so their adherents feel that this morality should be taught as part of sex education. Other religious conservatives believe that sexual knowledge is unavoidable, hence their preference for curricula based on abstinence

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