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Parents' and Teachers' Perspectives on Children's Sexual Health Education Health Prospect: Journal of Public Health Research Article Open Access: Full Text Article Parents’ and teachers’ perspectives on children’s sexual health education: a qualitative study in Makwanpur Nepal Dev R Acharya1,2, Malcolm Thomas1, Rosemary Cann1, Pramod Regmi3,4 1School of Education, Aberystwyth University, UK 2Visitng Fellow, Shree Medical College, Tribhuvan University, Chitwan, Nepal 3Visiting Fellow, Datta Meghe Institute of Medical Sciences, India 4Faculty of Health and Social Sciences, Bournemouth University, UK Abstract Received: Sex education is taught to secondary school students in Nepal. Nevertheless, there are concerns that the 28 June 2018 school-based sexual health education is not effective and adequate to address young people’s necessities. We carried out a qualitative study comprising key informant interviews with teachers (n=8) and parents Revised: (n=6) in Makwanpur district in Nepal. Interviews were recorded, transcribed and translated into 5 February 2019 English. Thematic analysis was performed to identify patterns or themes within the qualitative data. Most participants (both teachers and parents) had a thought of delivering sex education preferably from Accepted: grade seven to avoid the effects of globalised mass-media and internet. The practical aspects of school 26 July 2019 sex education programme and the importance of parent-child communication were of major concerns. Comprehensive training to health teachers, an informal approach to teaching sex education and seeking outside health professionals, such as health facilitators were the frequently reported issues. There is a need *Corresponding author to offer sexual health services along with sex education to protect young people from potential dangers of [email protected] STIs including HIV infection. Particularly, health teachers should be trained properly to mitigate the social School of Education, and cultural impacts, and to allow a smooth sex education discussion in the classroom. The curriculum for Aberystwyth University, sex education should be relevant, engaging and developmentally suitable with clear progressive avenues UK for learning experience. Keywords: parents, school teachers, sex education, adolescent, Nepal Tweetable Abstract: Sexual and reproductive health issues of school children in Nepal-parental and school teachers suggestion for further improvement. Introduction that sexual health educators who maintain a clear rapport with the School-based sex education can offer an age-appropriate education students should deliver school-based sex education [4]. Thus, sex about sexuality and relationships that offers scientifically accurate education is a special subject and young people’s engagement in the information to the pupils [1]. Delivering sex education appropri- classroom is a crucial factor in potentially improving their sexual ately can have a positive impact on individuals’ Sexual and Repro- health and well-being. ductive Health (SRH) and help avoid unintended pregnancy and reduce Sexually Transmitted Infections (STIs) including Human School-based sex education in Nepal Immunodeficiency Virus (HIV). A systematic review showed that A significant proportion of Nepal’s population (about 22% of 28.5 the use of school-based sex education programmes in low-and million) are adolescents aged 10-19. Teenage pregnancy is relative- middle-income countries (LMICs) have contributed to increased ly common in Nepal with about 17% of women aged 15-19 have HIV knowledge, increased self-efficacy, increased contraception begun childbearing and contraceptive prevalence is relatively low and condom use and reduction in the number of sexual partners (15 percent) among them [5]. Poor SRH status is considered to [2]. Similarly, findings from a Cochrane review of 41 randomised be the main causes for health problems among the adolescents in controlled trials (RCTs) suggested that sex education is capable of Nepal [6, 7]. Currently, SRH education in Nepal is focused at sec- helping to prevent unintended adolescent pregnancies [3]. It also ondary level (grades 9-10) students aged 14-15 under the Health, empowers young people to reflect critically on their environment Population and Environment (HPE) subject. However, mass-me- and behaviours and promotes gender equality and equitable social dia often report that many Nepali adolescents hesitate to talk and norms. ask questions about SRH issues in the classroom. As these issues Sex education programmes along with youth-friendly services are not openly discussed, adolescents may not get support to ob- can have a considerable impact in increasing the knowledge and tain SRH information at home either. understanding of adolescents around SRH issues [1]. However, ef- In an attempt to address the SRH issues of adolescent, Gov- fectiveness of sex education such as how this is delivered or who ernment of Nepal implemented a five-year national programme in does the delivery can play a significant role for effective school sex 2010, known as Nepal Health Sector Programme (NHSP), to pro- education. For example, Pound and colleagues [4] recommend vide adolescent-friendly sexual and reproductive health (ASRH) This is an open access article distributed on the terms ofCreative Commons Attribution3.0 license. This work may be freely reproduced, distributed, transmitted, modified, or otherwise used provided that the original work is properly cited. Author emails are available at the end of the article. Acharya et al. (2019) Research Article services [8]. The programme was propelled in the period of the central Nepal, namely Makwanpur district. A total of 14 interviews Millennium Development Goals; however, it is in the essence of (six with parents and eight with health subject teacher) were car- the Sustainable Development Goals (SDGs) 2030 to emphasise the ried out at four government secondary schools. Most of the partici- universal access to health care to everyone[9]. The Nepal Health pants were male (n=11). The inclusion criteria for parents (with no Sector Programme (NHSP) is accompanied by a comprehensive age limit) were that they should have at least one child studying in sexuality education programme in schools as part of the national the participating school. The school teachers were the head teach- curriculum which was initiated amid 2002 and 2006. A mid-term ers who were familiar with the sex education curricula or health evaluation of National Adolescent Sexual and Reproductive Health subject teachers who had been teaching sex education for at least however suggests that there should be more coordination between two years from those participating schools. We coordinated with the ASRH programme and school sex education programme to school and district education authority prior inviting participants. meet the demand for ASRH services among adolescents [10]. Considering the research question, we used a topic guide to fa- The design and structure of the current school sex education cilitate the interviews with teachers and parents [20].The interview curriculum, which was updated in 2011, is considered to be in- guidelines were pretested to check for appropriateness and com- consistent and ineffective in promoting sexual health at the ado- prehensibility of language used and coherence of information (e.g. lescent age [11]. The curriculum approach is the delivery of sex training to school teachers, parental involvement, issues about sex education as biological facts which are still embedded within a di- education programmes, attitude towards sex education, school pol- dactic context. There is a lack of comprehensive information on icy, partnership etc.) All the interviews were conducted in Nepali SRH including sexual behaviours, relationships, social issues, and by the main researcher in a comfortable environment, i.e. peaceful life skills [12]. Consequently, sex education appears in a disjointed and closed room to assure clarity and confidentiality. manner across many subjects e.g. lack of quality, not implemented All the interviews were audio recorded with participants’ per- uniformly, minimal teacher training, lack of effective implementa- mission [21] and lasted for about 1.5 hours in average. Non-ver- tion etc. Many other important issues, such as sexual harassment, bal communications were also note taken. We collected the data gender inequality, and stigma and discrimination are not given a up to the saturation point. We transcribed the recording [22]and proper place in the curricula in the practical term as highlighted by translated them into English. Each transcript had a covering note a previous report [13]. describing the setting, how the session was developed, any errors Limited studies in Nepal have shown that the prevalence of mul- or differences to other interviews, particular incidents, the envi- tiple sexual partners and high-risk sexual behaviours among ado- ronment and the issues recognised in the interview [23]. A care- lescents is high along with the number of STIs and unwanted preg- ful consideration was taken to ensure the consistency of coding nancies [14, 15]. However, in South Asia, it is common for parents such as reading through the initial notes, reading data repeated- to perceive that adolescents and unmarried individuals are hardly ly, reviewing codes, and making sure that it was as inventive and involved in sexual relationships [16]. The proportion of unmarried imaginative as possible [24]. We performed a thematic analysis to young women and men has increased over the past
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