Talk about itEducation on sexual reproductive health needs further attention and investment in Nepal
As Nepal continues to rapidly experience social and cultural changes, the avenues for young people to become involved in unsafe sexual practices have been further widened. Especially with the proliferation of social media, adolescents are continually exposed to messages that promote unsafe and non-consensual sexual practices.
According to the United Nations Population Fund Nepal, seventeen percent of women aged between 15 and 19 years have experienced childbirth—and these statistics have largely remained consistent over the past five years. The rising rates of adolescent marriages and the pressure to rear children shortly after marriage directly intersects with many of Nepal’s development challenges. This points to the urgent need for a robust and adequate sexual reproductive health (SRH) education system.
In order to address the SRH needs of young people, the Government of Nepal launched the National Adolescent Sexual and Reproductive Health Programme in 2011, to provide adolescent-friendly SRH services. A crux of the programme revolves around ‘comprehensive sex education in school’—which is incorporated in the national curriculum. The programme aims to support adolescents in developing life skills to tackle issues such as puberty, early marriage, and pregnancy. To address issues of adolescent sexual health, the Government of Nepal also developed a National Adolescent Health and Development strategy, which was implemented in 2000. Based on this strategy, sex education was introduced into the school curriculum in Nepal; however, evidence suggests that progress of implementation and pedagogical delivery has been slow. Another difficulty is that these programmes do not reach youth whose educational trajectories are curtailed due to early marriage, gender-based discrimination, among other issues. For example, only Sex education is largely taught at lower secondary and secondary levels under the Health, Population and Environment subject. However, despite the emphasis to incorporate sex education in the school curriculum, the student learning materials are inadequate. Moreover, the design and structure of the current sex education curriculum, which was updated in 2011, is considered to be inconsistent and ineffective in promoting sexual health as these approaches are surface-level. And national data speaks to this: According to a 2017 report by the World Health Organisation and the Government of Nepal, only 59.7 percent of married adolescents aged 15-19 had knowledge of sexually transmitted diseases and HIV/AIDS and only around 53 percent of those with school-leaving certificate SLC and above education had comprehensive knowledge of HIV and AIDS.
There is a lack of comprehensive information on sexual health, social issues, sexual behaviours, sexual attitudes, and life skills. Consequently, sex education appears in a disjointed manner across many subjects. Furthermore, many other issues, such as sexual harassment, gender inequality stigma, and discrimination are not considered in the curricula and classroom syllabi—even though they encompass a significant portion of SRH education.
A majority of young people who participated in a recent study that gauged sexual health education awareness at schools, especially female students, were not comfortable discussing sexual health-related matters with their teachers. If a culture of shame and embarrassment around these issues shrouds society—and spills over in the classroom—how can students engage in safe and open discussions about issues concerning SRH?
Many Nepali school teachers also appear to lack proper knowledge about sexual health themselves, and the teaching techniques they currently employ to address young people’s curiosity about sex and sexual health in the classroom seem limited. In terms of implications for pedagogy, it may be important for teachers to consider discussing broader issues of sexual health, such as feelings and relationships as a way of overcoming issues of embarrassment and the shyness students. For example, it may be possible to use leverage a variety of pedagogical participatory approaches to the delivery of sex education, including group discussions, role-plays and quizzes.
A majority of the participants also reported a glaring ‘communication gap’ in their households—especially between parents and their children. Parent-led communication about sex and sexuality is known to have profound effects on shaping children’s knowledge and understanding of sexual health. In Nepal, this may be of particular significance to female youth, as they are not always linked to other social institutions and may therefore not be reached by many educational and social programmes. By cultivating safe spaces to discuss these issues at home, parents play a large role in tackling the culture of shame and embarrassment about SRH. However, it is, of course, the case that parents will also require some education, as well as support and encouragement, to discuss sexual health issues with their children. Schools could serve as an effective facilitator in this process by instigating coordination with parents, community members, and children to develop trusting relationships.
Peer education, which is widely adopted in health promotion strategies, can also be used to engage youth groups in the country. Mentorship programs—in the form of debate groups, rotary initiatives, and programs—are already proliferating across the country. These established networks and existing relationships could be purposively untapped in this endeavour.
Improving school sex education may also usefully involve developing partnership between schools and external agencies, such as Non-Governmental Organisations (NGOs), Community-Based Organisations (CBOs) and private organisations. This could help to develop professional protocols to approach school-based sex education programmes and thereby ensure a pedagogical standard for all schools. These middle-group stakeholders could also provide sex education training to ensure that these approaches are culturally appropriate, robust and adequate.
There are implications for school, teacher training and curriculum development to promote sex education. For example, schools could involve young people in sex education programme and the teachers could use a more informal approach in delivering sex education. Nepalese schools could for example make use of outside experts, such as health facilitators, to help bring significant improvements in pupils’ sexual health knowledge and understanding .Additionally, more rigorous research and appropriate interventions are required in order to support change, with the aim of bringing about real improvement in young people’s sexual health.
Acharya is a lecturer at the School of Education, Aberystwyth University, United Kingdom