Sexuality education: the silent revolution in Europe

It needs no explanation: if you want to have a happy, healthy and satisfactory sexual life you need information and education on how it all works, what risks are involved and how to prevent potential accidents. It is self-evident; it is nothing new; it is just like any other subject that is important for people, also for young people. And therefore all the leading organisations in the field of sexual and reproductive health and rights, such as the World Health Organisation (WHO), International Planned Parenthood Federation (IPPF) and the United Nations Population Fund (UNFPA), are unanimous in their opinion that sexuality education is a must. To promote and preserve sexual and reproductive health, young people must be educated about it and have access to services that are able and willing to respond to their questions and problems. It is as simple as that.

But it has not worked that way for most of human history and it still does not in many parts of the world. The reason is because sexuality is a totally different subject from all others. Fred Sai, president of the IPPF in the 1990s, used to say, ‘there is only one subject in the world where people say “if you give them the right knowledge, they’re going to do the wrong things”: sexuality!’ But that has changed in recent decades, or is changing right now, at least in large parts of Europe. Interestingly, this important and quite revolutionary change has happened largely in silence, mainly unnoticed and mostly undocumented.

It is no exaggeration to say that until 10 years ago, at a global level sexuality education was a completely taboo subject. Hardly any attention was paid to it; UN agencies did not touch on this sensitive subject; only IPPF, a non-governmental organisation, was just starting to address it [1]. Then, in 2009, everything suddenly seemed to begin to change. In that year the United Nations Educational, Scientific and Cultural Organization (UNESCO) produced its International technical guidance on sexuality education [2]. In the same year a consortium of organisations, including the Population Council and IPPF, released an extensive publication on sexuality education called It’s all one curriculum [3]. A year later, the German Federal Centre for Health Education (BZgA), a WHO collaborating centre, published its Standards for sexuality education in Europe [4]. Finally, in 2014, UNFPA published its Operational guidance for comprehensive sexuality education [5]. All these publications were attempts to demand much more attention for sexuality education, particularly in schools; to promote the development and implementation of sexuality education programmes; and to advise on the contents and methodology of such programmes. But there was no reasonably comprehensive study on the realities of sexuality education in schools.

There had been two early attempts to make an inventory of the status of sexuality education in WHO European Region countries (including five in Central Asia). The results of both attempts were published in 2006 [6,7]. The first resulted from the SAFE project, implemented by IPPF’s European Network (IPPF EN) in 26 countries in Western, Northern and Central Europe but not in Eastern Europe and Central Asia [6]. The second, produced by BZgA, presented data from 14 countries in Europe and two in Central Asia (six countries in this overview were not included in the SAFE report) [7]. Given the rapid developments in this field after 2008, these two early attempts were soon outdated. For that reason, in 2016, BZgA and IPPF EN began a new systematic inventory on the status and recent developments in sexuality education in the WHO European Region. For this purpose half of the countries in the region (i.e., 25 countries, excluding mini-states) were selected for inclusion. The selection is geographically fairly representative of the entire region. Data were collected using both governmental and non-governmental sources of information. The results of this study, which were finally published in May 2018, were interesting [8]. They showed that an almost silent revolution had taken place in most European countries, whereby sexuality education in schools had become the norm in just two decades. Other remarkable outcomes of the same study are:

• In the majority of countries (21 out of 25) there is now a clear legal framework for sexuality education in schools, or at least political support for it. In only four countries is sexuality education still virtually absent.

• In North-Western and Central Europe sexuality education in schools is almost always comprehensive, i.e., it provides all relevant information. In some other countries (notably Portugal and Albania) this is also the case. Elsewhere it is either partly, or not, comprehensive.

• In countries with fully comprehensive school programmes, sexuality education is (by far) the most important source of information for young people on sexuality-related issues.

• School sexuality education programmes in Europe are almost always fully integrated into broader teaching subjects, such as citizenship, life skills or health education studies. As such, sexuality education is mostly a mandatory and not an optional subject. It is rarely a stand-alone subject (only in Spain and Tajikistan).

• In about half of European countries sexuality education starts in primary school and continues in secondary school. It is usually spread out over several years of education so as to guarantee that it is age- and developmentally appropriate, as recommended in the Standards for sexuality education in Europe [4].

• There still is opposition to sexuality education in several European countries, but the arguments used by opponents ignore existing evidence of the impact of sexuality education on young people. This means there is still a need for public education on the benefits of sexuality education.

• Availability of (comprehensive) sexuality education in schools is closely associated with (very) low teenage birth rates and high levels of oral contraceptive use in those countries.

• The European experience clearly demonstrates that comprehensive school sexuality education does not hasten initiation of sexual intercourse at ever younger ages. There is no difference in this regard between countries with and without comprehensive sexuality education.

This last point is very relevant because a fear of ‘spoiling the innocence of young people’ is the main reason why many parents and decision makers remain opposed to school sexuality education. Although most young people nowadays learn about sexuality from pornographic websites – a fact that is widely known – this idea of young people’s innocence persists. It is also one of the main reasons why sexuality education is still barely accepted and implemented in the USA. The impression one may easily get from the scientific literature is that sexuality education is rather advanced in the USA, because most evaluation studies on the benefits of sexuality education originate from that country. But that is a false impression. There are so many evaluation studies in the USA on the benefits of sexuality education precisely because sexuality education is barely accepted. This very fact creates a pressing need to show that sexuality education has many benefits and hardly any disadvantages. But unfortunately, scientific evidence seems to be becoming less and less convincing in the USA when it comes to sensitive issues like the sexuality of young people. Intuition and common sense seem to become more important starting points for decision making in this field, which is also illustrated by the fact that ‘abstinence-only’ sexuality education programmes continue in the USA, in spite of the fact that there is clear scientific evidence that such programmes are totally ineffective.

For this very reason, European countries should be proud of what has been accomplished in the pursuit of improving young people’s sexual and reproductive health. European experience in this field is very valuable, especially because belief in the value of scientific evidence remains strong. Unfortunately, we cannot learn much from the US experience.

Evert Ketting

International Consultant in Sexual and Reproductive Health and Rights, Zeist, The Netherlands

Part-time Senior Fellow of the Guttmacher Institute, New York

Co-author with Olena Ivanova, of ‘Sexuality education in Europe and Central Asia’ (BZgA and IPPF EN, 2018)

[email protected]

不需要解释：如果你想拥有快乐、健康和满意的性生活, 你需要了解有关它如何运作的信息和教育, 涉及哪些风险以及如何预防潜在的事故。这是不言而喻的；这不是什么新鲜事；它就像其他任何对人们重要的主题, 也适用于年轻人。因此, 世界卫生组织（WHO）, 国际计划生育联合会（IPPF）和联合国人口基金（UNFPA）等性健康和生殖健康与权利领域的所有主要组织都一致认为, 性教育是必须的。为了促进和保护性健康和生殖健康, 必须对年轻人进行有关教育, 并有权获得能够并愿意回答他们问题的服务, 就是这么简单。

但在人类历史的大部分时间里并没有这样做, 而且在世界许多地方仍然没有, 原因是因为性与其他所有主题完全不同。20世纪90年代, IPPF主席Fred Sai曾经说过, “世界上只有一个主题, 人们会说, 如果你给他们正确的知识, 他们就会做错事, 那就是性！”但是近几十年来这种情况发生了变化, 或者正在发生变化, 至少欧洲大部分地区是如此。有趣的是, 这种重要且相当革命性的变化主要是在沉默中发生, 主要是未被注意到, 而且大部分是无记录的。

毫不夸张地说, 直到10年前, 在全球范围内, 性教育是一个完全禁忌的话题。几乎没有人注意它；联合国机构没有提及这一敏感话题；只有非政府组织IPPF刚刚开始解决它 ^[1]。然后, 在2009年, 一切似乎突然开始发生变化。在那一年, 联合国教育、科学及文化组织（UNESCO）制定了关于性教育的国际技术指导 ^[2]。同年, 包括人口理事会和IPPF在内的一个联盟组织发布了一份关于性教育的广泛出版物, 名为“所有课程” ^[3]。一年后, 世界卫生组织合作中心的德国联邦健康教育中心（BZgA）发布了其欧洲性教育标准 ^[4]。最后, 2014年, UNFPA公布了全面性教育操作指南 ^[5]。所有这些出版物都试图要求更多地关注性教育, 特别是在学校, 促进性教育计划的发展与推行, 并对这些计划的内容和方法提出建议。但是, 对学校性教育的现实没有进行合理全面的研究。

早期曾两次尝试对WHO欧洲区域的国家（包括中亚的五个国家）的性教育状况进行盘点。两次努力的结果均发表于2006年 ^[6,7]。第一个来自于SAFE项目, 由IPPF的欧洲网络（IPPF EN）西欧、北欧和中欧的26个国家实施, 但不在东欧和中亚 ^[6]。第二个由BZgA制作, 提供了来自欧洲14个国家和中亚2个国家的数据（本概述中的6个国家未包括在SAFE的报告中） ^[7]。鉴于2008年后该领域的快速发展, 这两个早期的尝试很快就过时了。因此, 2016年, BZgA和IPPF EN开始对WHO欧洲地区性教育的现状和最新发展进行新的系统清点。为此目的, 纳入了该地区一半的国家（即25个国家, 不包括小国）, 选择的国家在地理上相当代表整个地区, 采用政府和非政府信息来源收集数据。这项研究结果最终于2018年5月发表, 很有意思 ^[8]。他们表明, 大多数欧洲国家都发生了一场几乎无声的革命, 学校里的性教育在短短二十年内已成为常态。同一研究的其他显著成果是：

• 在大多数国家（21/25）, 现在有一个明确的学校性教育法律框架, 或者至少是对它的政治支持, 只有4个国家的性教育仍然几乎不存在。

• 在西北欧和中欧, 学校的性教育几乎总是全面的, 即它提供所有相关信息。在一些其他国家（特别是葡萄牙和阿尔巴尼亚）也是如此。在其他地方, 要么是部分全面要么是不全面的。

• 在有非常全面学校课程的国家, 性教育（到目前为止）是年轻人在性问题上最重要的信息来源。

• 欧洲的学校性教育课程几乎总是完全融入到更广泛的教学科目, 如公民身份、生活技能或健康教育研究。因此, 性教育主要是强制性的, 而不是一个选修课。它很少是一个独立的主题（仅在西班牙和塔吉克斯坦）。

• 在欧洲大约一半的国家, 性教育从小学开始, 并在中学继续。它通常分布在几年的教育中, 以保证其符合年龄和发育, 如欧洲性教育标准 ^[4]推荐的那样。

• 几个欧洲国家仍然反对性教育, 但反对者使用的论据忽视了现有的性教育对年轻人影响的证据。这意味着仍然需要对性教育的益处进行公共教育。

• 学校（全面）性教育的实用性与这些国家（非常）低的青少年出生率和高水平的应用口服避孕药密切相关。

• 欧洲的经验清楚地说明, 全面的学校性教育并没有加速在更年轻时开始性交。在有和没有全面性教育的国家之间, 这方面没有区别。

最后一点是非常重要的, 因为害怕“破坏年轻人的天真”是许多父母和决策者仍然反对学校性教育的主要原因。虽然现在大多数年轻人从色情网站上了解性行为-这一事实众所周知-年轻人天真的想法仍然存在。这也是美国尚未接受和实施性教育的主要原因之一。从科学文献中可以很容易地得到的印象是, 在美国性教育相当先进, 因为大多数关于性教育益处的评估研究都来自该国, 但这是一种错误的印象。

美国有很多关于性教育益处的评估研究正是因为性教育几乎不被接受。这一事实迫切需要表明性教育有许多好处, 几乎没有任何缺点。但遗憾的是, 在涉及年轻人性行为等敏感问题时, 美国的科学证据似乎越来越不具说服力。直觉和常识似乎成为这一领域决策制定更重要的起点, “禁欲”性教育计划在美国继续存在这一事实也说明了这一点, 尽管有明确的科学证据证明这些计划完全无效。

出于这个原因, 欧洲国家应该为改善年轻人的性健康和生殖健康所取得的成就感到自豪。欧洲在这一领域的经验非常有价值, 特别是因为对科学证据价值的信念仍然很强。不幸的是, 我们无法从美国的经验中学到很多东西。

声明

作者声称没有任何潜在的利益冲突。

Discourse statement

No potential conflict of interest was reported by the authors.