Contraception

CHAPTER ONE

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INTRODUCTION

1.1 Background to Study

Sexuality and contraception among students can be seen to be a public health problem of immediate concern in developed and underdeveloped countries. While the knowledge of HIV/AIDS as an inevitable disease is high among Nigerians in general, HIV/AIDS transmission in reduction measures is inconsistently taken by sexually active individuals. The youths and adolescents are those that have high risk of being affected with STDS, if contraceptives are not used correctly or avoided, because the youths are vulnerable to indiscriminate sexual intercourse, with multiple sex partners.

Heterosexual transmission accounts for as high as 90% of HIV/AUIDS in Sub-Saharan African where about 14 million people were estimated to be infected with HIV. The federal ministry of Health and Human Services (FMH & HS 1992) in Nigeria suggested that about one million HIV infected people exist. This prevalence is increasing due to high risk of sexual behaviours. These STDS diseases are mostly common among individuals younger than 25 years world-wide. Several educators have shown that young people lack knowledge about prevention and the use of contraception and often have little or no idea about reproduction. Pregnancy and sexually transmitted disease among students is very rampant among undergraduate. Most of these pregnancies are unplanned and unwanted. They are often terminated illegally by quark doctors in the dark. About 600,000 clandestine abortions took place in Nigeria in the 1980s some of which had disasters consequences for the abortion seekers (African Journal of Reproductive Health, 2002). In most parts of Nigeria, sexual abstinence before marriage is expected from unmarried youths. However, studies show that premarital activity is high among adolescents. Parents, government and NGOS have expressed serious concerns about adolescents. Sexual activity based on the board information that adolescent who engaged in sexual activity whether orally or otherwise often fail to use contraceptives thus, exposing themselves to the risk of unwanted pregnancy and sexually transmitted infections and diseases.Contraception And Sexuality Among Students Of College of Education Essay

Timely provision of accurate and comprehensive information and life skills training regarding sexual and reproductive health and rights (SRHR) is essential for adolescents to achieve sexual health and rights and avoid negative health outcomes.1–3 While sexuality education is just one component in a multifaceted approach to address, and ultimately improve, the sexual and reproductive lives of young people, it provides a structured opportunity for adolescents to gain knowledge and skills, to explore their attitudes and values, and to practice the decision making and other life skills necessary for making healthy informed choices about their sexual lives.2–7 Abstinence-only education programs have shown little evidence of improving sexual and reproductive health (SRH) outcomes.8,9 In contrast, comprehensive sexuality education programs that recognize sexual activity during adolescence as normative behavior, that seek to ensure the safety of such behavior, and that focus on human rights, gender equality and empowerment have demonstrated impact in several areas: improving knowledge, self-confidence and self-esteem; positively changing attitudes and gender and social norms; strengthening decision-making and communication skills and building self-efficacy; and increasing the use of condoms and other contraceptives. Contraception And Sexuality Among Students Of College of Education Essay

Adolescents’ sexual and reproductive health
Addressing the high levels of unprotected sexual activity, STIs (including HIV infection), early pregnancy and abortion among adolescents is a priority for program planners and policymakers in Kenya.16–18 Despite efforts targeting these reproductive health issues, recent studies indicate a persistently high need for SRH information and services, further emphasizing the need for high-quality sexuality education.19–21

Sexual activity

Nationally, more than a third of adolescents (those aged 15–19), whether married or not, have had sexual intercourse (37% of females and 41% of males), and about one-fifth are currently sexually active (Table 1.1). The median age at first intercourse is 18 for females and 17 for males, yet among 15–19-year-olds, 11% and 20% of each gender, respectively, initiated sex before age 15. In the three geographic areas included in the current study, adolescents living in Homa Bay county were more likely to initiate sex at an early age (24% of females and 39% of males) than were those living in Mombasa (6% and 26%, respectively) or Nairobi county (10% and 17%, respectively).Contraception And Sexuality Among Students Of College of Education Essay

Contraception, unplanned births and abortion

Contraceptive use is relatively low among adolescents in Kenya. Although 96% of all adolescent females have heard of at least one modern method, only 41% of sexually active 15–19-year-olds are currently using any contraceptive method, and 37% are using a modern one.20 The vast majority (93%) of sexually active adolescent females who are unmarried want to avoid pregnancy within the next two years, but 52% have an unmet need for family planning, meaning they either want to postpone their next birth by at least two years or do not want any (additional) children, but are not using a contraceptive method. Among the 12% of adolescent females who are married or in a union, 61% want to avoid a pregnancy, and 23% have an unmet need for family planning. About one-fifth of all adolescents in Kenya have begun childbearing (i.e., have had a live birth or are currently pregnant), and 59% of their births in the past five years were reported as unplanned. There is also evidence that adolescents are particularly vulnerable to severe complications from clandestine unsafe abortions.19 A 2013 study on the incidence of and complications from unsafe abortion in Kenya indicated that 10–19-year-olds accounted for 17% of all women who sought postabortion care in public facilities, and that 74% of the moderate or severe complication cases were among this group, partly because of their use of less-skilled providers.Contraception And Sexuality Among Students Of College of Education Essay

HIV prevalence and knowledge

HIV infection among adolescents remains a concern in Kenya, despite multiple efforts to reduce its prevalence.22 Nationally, 62% of females and 81% of males aged 15–19 know where to get condoms, but only 49% and 58%, respectively, have comprehensive knowledge of HIV and AIDS.*20 HIV disproportionately affects young women: HIV prevalence among 15–24-year-olds is 4%, compared with 2% among their male counterparts,23,24 and the number of new infections among females aged 10–19 in 2015 was more than double that among males in the same age-group (13,000 vs. 5,100).23

Sexual violence and harmful traditional practices

Among 15–19-year-olds, 7% of females and 3% of males in Kenya have experienced sexual violence, and 4% and 1%, respectively, had the experience by age 15.20 Six percent of adolescents who have ever been pregnant have experienced some form of physical violence during pregnancy. Female genital cutting persists as a traditional practice, despite being outlawed since 2011;25 nationally, 11% of adolescents have undergone this procedure.20

The need for sexuality education in Kenya
As these indicators demonstrate, the contexts in which adolescents in Kenya must navigate their sexual and reproductive lives are complex and, in some cases, vary by region and gender. In recognizing that improving adolescents’ access to high-quality information and services is essential for ameliorating negative health outcomes, key stakeholders in Kenya have proposed policies and programs regarding adolescent SRH, including those related to sexuality education.18 Implementation of new policies, however, has been difficult in the absence of official legislation to enforce them. A major challenge in this effort has been to reconcile rights-based approaches that emphasize adolescents’ right to comprehensive SRH information and services with deeply rooted conservative approaches that stigmatize or denounce certain aspects of SRH education and services, such as improving access to condoms.26,27 The legal and policy environments are discussed in Chapter 3.Contraception And Sexuality Among Students Of College of Education Essay

Scope of this report
Reviews of policies and curricula pertaining to sexuality education have shown that while many countries have established curricula, little is known about their use in schools—the degree of implementation, the mode and quality of the instruction, the existence of program monitoring and evaluation tools, the adequacy and quality of teacher training, the level of support for or opposition to the subject, and the effectiveness of existing programs in achieving desired knowledge and behavioral outcomes among students.28–33 Small-scale reviews of school-based programs run by nongovernmental organizations (NGOs) have been conducted in Kenya, but there has not been a review of the government’s sexuality education program in schools.34,35

This report provides a snapshot of how sexuality education policies in Kenya are translated into practice in secondary schools, and what students, teachers and principals think about them. Data from official documents, key informant interviews and school-based surveys were used to examine how sexuality education programs in three counties were developed, implemented and experienced. This report presents findings on the development of policies and curricula, including the actors involved and challenges faced; how sexuality education is taught in classrooms; students’ experiences and preferences; support for implementation, including teacher training and school environment factors; sexuality education outside of the classroom; and general opinions about sexuality education among key stakeholders. The information presented is intended to provide the Kenyan government and other stakeholders with a better understanding of sexuality education in its schools, and ultimately to improve the quality and effectiveness of such education for both teachers and students.Contraception And Sexuality Among Students Of College of Education Essay

Chapter 2: Study Methodology
The study on which this report is based was conducted as part of a multicountry study to assess the implementation of sexuality education in four countries from two regions (Latin America and Africa): Peru, Guatemala, Ghana and Kenya.† In each region, one country was chosen that is at a relatively more advanced implementation stage with its sexuality education program (Peru and Ghana), and another was chosen that is at an earlier stage (Guatemala and Kenya); these selections were based on reviews of policy documents and curricula, program evaluations and other regional reports,30,31,36,37 as well as consultation with stakeholders and research partners. While a major aim of the overall study is to compare all four countries, this report presents findings only for Kenya.

Study objectives
The goal of this study was to provide a robust, comprehensive analysis of policies and curricula regarding sexuality education in Kenya and their implementation in secondary schools, with a focus on three geographically and ethnically diverse counties: Homa Bay, Mombasa and Nairobi. Specific objectives included documenting policies and curricula on sexuality education, describing the implementation of these, assessing the comprehensiveness of the content, examining the opinions and attitudes of students and teachers regarding sexuality education, and providing recommendations to inform the design and implementation of such programs in schools in Kenya and beyond.Contraception And Sexuality Among Students Of College of Education Essay

Defining comprehensive sexuality education
While different definitions of comprehensive sexuality education (CSE) have been developed over time,4–7,38,39 this study used the United Nations Population Fund (UNFPA) definition (Box 2.1). On the basis of the UNFPA definition, this study explored sexuality education according to three dimensions: information and topics covered, values and attitudes nurtured, and life skills developed.

Abstract Sex education is a controversial topic. Some parents oppose sex education based on the belief that it will lead to sexual activity. However, research indicates that the opposite is true. Sex education that contains a comprehensive topic agenda helps to prevent teen pregnancy and sexually transmitted diseases in youth. This research explores this topic and supports that thesis that schools should provide comprehensive sex education classes, including abstinence practices.
The topic of sex education is a controversial one. Many parents have opted to have their children withdrawn from the classes for fear that teaching the use of condoms and other forms of birth control will send the message that having sex before you are an adult is acceptable. In addition, some claim that this practice violates their religious beliefs. Teen pregnancy is a pervasive problem. The goal of sex education classes is not only to help to prevent teen pregnancy, but to teach about the prevention of sexually transmitted diseases. Nearly four million teens contract a sexually transmitted disease every year (Friedman, 2005). This research will support the thesis that schools should teach their students comprehensive sex education that includes the practice of abstinence.
In the past, it was the place of the parents to talk to their children about sex education. There are several problems with this assumption. Sex is a difficult topic to talk about and many parents fail to talk to their children about it. Further, they will often talk to them about it when it is too late. Children are having sexual relations at younger ages than in the past. The timing of talking to children has changed over the decades. Many times, students do not feel comfortable talking to their parents about sex. They often resort to asking their friends. Either way, parents and friends can provide misinformation to the students. For instance, some students may feel that they are practicing abstinence by having oral sex instead of sexual intercourse. Providing standardized sex education classes assures that students have access to complete, credible information about sexual relations and pregnancy prevention.Contraception And Sexuality Among Students Of College of Education Essay
Teaching abstinence is the most popular message that it sent by the school system. Abstinence is taught as the preferred method of preventing sexually transmitted diseases and pregnancy. However, it is also recognized, that even though abstinence is preferred, not all students will adhere to this advice. For this reason, information about condoms and safe sex must be presented. The schools are not giving students a license to go out and have sex. This teaching philosophy is based on reality, rather than idealistic personal preferences. The reality is that teens are having sex, regardless of whether their parents agree or disagree with it.
It is not the place of the schools to replace the moral teachings of the parents. It is the intention of the school system to address a real problem that could jeopardize the education of the student and limit their future choices in life. Comprehensive sex education classes will help to not only protect girls from becoming pregnant, they will protect their partners from being exposed to sexually transmitted diseases.
Some of the most controversial topics in sex education classes are masturbation, condom rolling, and issues involving homosexuality and transgender issues. This draws religious beliefs into the issue of sex education. Regardless of whether one is tolerant of these practices, or believes them to be immoral, they are a part of the society of which the children are a part. One only needs to listen to the mass media or look at the Internet to be exposed to these topics. The students will be exposed to these topics whether their parents want them to or not. It is better for them to have correct information than to have rumors and myths as their only source of information.
Just because the student is informed about controversial topics such as masturbation, condom rolling, homosexuality, and transgender issues does not mean that they will automatically participate in them. The parents still have the ability to teach their children their own set of religious and moral philosophy. These morals and philosophies can serve as an addition to the factual information presented at school. Providing the students with factual information does not undermine the ability of the parents to teach their children about controversial issues in a way that reflects personal and family values that they wish to instill. Children are taught about the dangers of drugs and alcohol in schools with the hopes of preventing them from participating in these activities. Similarly, they can be informed about sex education in a way that promotes abstinence, but that does not impose any religious or personal biases on it. The intention of the school is not to pose as a moral compass, but to eliminate or reduce a real threat to the student’s wellbeing and the wellbeing of others. Sexually transmitted diseases such as HIV/AIDS are life threatening. They are just as dangerous as drugs or alcohol abuse. The goal of school sex education classes is to attempt to help reduce a potential source of harm to the students.
One of the most difficult choices for lawmakers is how to adopt a policy on sex education that addresses both the concerns of the schools and the concerns of the parents. In a recent study in the United States, it was found that 46% of those surveyed believed that both abstinence and contraception should be taught in schools. It was found that those surveyed believed that the classes should focus on providing medically accurate information on both abstinence and contraception, sexual health information that is age and culturally appropriate, a focus on preventing teen pregnancy and sexually transmitted diseases.Contraception And Sexuality Among Students Of College of Education Essay  It is also suggested that the classes include a clarification of values within the individual, discuss the clarification of family and community values, and communication skills involving refusal and negotiation about sexual actions (Chen, 2014). Chen also suggests that parents be encouraged to participate in open forums regarding the selection of curriculum for the classes.
Recent polls have indicated that most families now support the teaching of sex education in schools to a certain extent (Reuters, 2014). However some a parents still adamantly reject the idea that the schools should teach their children anything about sex at all. Schools now have the option to teach abstinence only classes, which has helped to calm some of these parents on the subject (Reuters, 2014). However, abstinence only classes were found to increase sexually transmitted diseases in one study (Carter, 2012). This study concluded that abstinence only classes had the effect of increasing sexual activity, where full sex education classes had an effect on reducing teen pregnancy and sexually transmitted disease among teens aged 15 to 19 (Carter, 2012).
The primary reasons for not wanting sex education that includes abstinence along with other topics is religious and personal. While schools do not intend to undermine the teachings of the parents, they also have an obligation to provide students with the information that they need to navigate life. Research based practices in the area of sex education found that abstinence only classes did not have the desired effect on curbing teen pregnancy and sexually transmitted diseases. Claims that having open communication with children about sex will initiate sex are unfounded in academic research (McClung & Perfect, 2000). Instead, research supports that a curriculum based on comprehensive information is the best way to obtain results in terms of dropping teen pregnancy rates and sexually transmitted diseases (McClung & Prefect, 2000).Contraception And Sexuality Among Students Of College of Education Essay
While the wishes of parents must be respected when it comes to sex education, the outcomes for the youth must be the primary concern. Schools must provide information that is based on research and that has demonstrated the ability to achieve the desired results. There are certain to be some parents whom are upset by this, but research shows that public attitudes largely support sex education with a comprehensive list of topics. The focus of sex education must remain focused on providing students with the information that they need to remain safe in today’s world. This includes sex education, abstinence, and how to enforce their rights.Contraception And Sexuality Among Students Of College of Education Essay

  NOW

The purpose of this clinical report is to provide pediatricians updated research on evidence-based sexual and reproductive health education conducted since the original clinical report on the subject was published by the American Academy of Pediatrics in 2001. Sexuality education is defined as teaching about human sexuality, including intimate relationships, human sexual anatomy, sexual reproduction, sexually transmitted infections, sexual activity, sexual orientation, gender identity, abstinence, contraception, and reproductive rights and responsibilities. Developmentally appropriate and evidence-based education about human sexuality and sexual reproduction over time provided by pediatricians, schools, other professionals, and parents is important to help children and adolescents make informed, positive, and safe choices about healthy relationships, responsible sexual activity, and their reproductive health. Sexuality education has been shown to help to prevent and reduce the risks of adolescent pregnancy, HIV, and sexually transmitted infections for children and adolescents with and without chronic health conditions and disabilities in the United States.Contraception And Sexuality Among Students Of College of Education Essay

Abbreviations:
AAP — American Academy of Pediatrics
FoSE — Future of Sex Education Initiative
HPV — human papillomavirus
STI — sexually transmitted infection
Introduction
The purpose of this clinical report is to provide pediatricians with an update on the research regarding evidence-based sexual and reproductive health education that has been conducted since the original clinical report on the subject was published by the American Academy of Pediatrics (AAP) in 2001.1 Education about sexuality that is provided by pediatricians can complement the education children obtain at school or at home,2,3 but many pediatricians do not address it. In a review of health maintenance visits, 1 of 3 adolescent patients did not receive any information on sexuality from their pediatrician, and if they did, the conversation lasted less than 40 seconds.4

Background
Children and adolescents with and without chronic health conditions and disabilities will benefit when they are provided with accurate and developmentally appropriate information about the biological, sociocultural, psychological, relational, and spiritual dimensions of sexuality. Information about sexuality can be taught and shared in schools, communities, homes, and medical offices using evidence-based interventions. Children and adolescents should be shown how to develop a safe and positive view of sexuality through age-appropriate education about their sexual health. Sexuality education can be disseminated through the 3 learning domains: cognitive (information), affective (feelings, values, and attitudes), and behavioral (communication, decision-making, and other skills).Contraception And Sexuality Among Students Of College of Education Essay

Sexuality education is more than the instruction of children and adolescents on anatomy and the physiology of biological sex and reproduction. It covers healthy sexual development, gender identity, interpersonal relationships, affection, sexual development, intimacy, and body image for all adolescents, including adolescents with disabilities, chronic health conditions, and other special needs.6 Developing a healthy sexuality is a key developmental milestone for all children and adolescents that depends on acquiring information and forming attitudes, beliefs, and values about consent, sexual orientation, gender identity, relationships, and intimacy.7 Healthy sexuality is influenced by ethnic, racial, cultural, personal, religious, and moral concerns. Healthy sexuality includes the capacity to promote and preserve significant interpersonal relationships; value one’s body and personal health; interact with both sexes in respectful and appropriate ways; and express affection, love, and intimacy in ways consistent with one’s own values, sexual preferences, and abilities. The various dimensions of healthy sexuality comprise the anatomy, physiology, and biochemistry of the sexual response system; identity, orientation, roles, and personality; and thoughts, feelings, and relationships.6 Ideally, children and adolescents receive accurate information on sexual health from multiple professional resources.Contraception And Sexuality Among Students Of College of Education Essay

All children and adolescents need to receive accurate education about sexuality to understand ultimately how to practice healthy sexual behavior. Unhealthy, exploitive, or risky sexual activity may lead to health and social problems, such as unintended pregnancy and sexually transmitted infections (STIs), including gonorrhea, Chlamydia, syphilis, hepatitis, herpes, human papilloma virus (HPV); HIV infection; and AIDS.10 From a 2012 informative report by the National Campaign to Prevent Teen and Unplanned Pregnancy that surveyed 1200 high school seniors, many senior girls and boys reported having mixed feelings about the first time they had sex, with more than three-quarters responding that they would change the way their first sexual experience occurred. Interestingly, seniors in this study wanted their younger peers to know it was “fine to be a virgin” when they graduated from high school.11

It has been demonstrated that sexuality education interventions can prevent or reduce the risk of adolescent pregnancy HIV, and STIs for children and adolescents with and without chronic health conditions and disabilities in the United States.12 Adolescent sexual activity and teen births and pregnancies have been decreasing since 1991, with the exception of 2005 to 2007, when there was a 5% increase in birth rates. The decrease in adolescent birth rates in the United States reflects an increased use of contraception at first intercourse and in the use of dual methods of condoms and hormonal contraception in already sexually active teenagers.13 Nevertheless, the United States continues to lead industrialized countries with the highest rates of adolescent pregnancy.14  Importantly, 88% of births to adolescents 15 to 17 years of age in the United States continued to be unintended (unwanted or mistimed).Contraception And Sexuality Among Students Of College of Education Essay

Sexual health information messages are received by children and adolescents multiple times throughout the day from the media, religious organizations, schools, and family peers, parents/caregivers, and partners, although the quality of the information varies.16,17 In an article published in 2013 on how sexually experienced adolescents in the United States receive sexual health information, parents and teachers were the source of information for 55% of girls and 43% of boys about birth control and for 59% of girls and 66% of boys about STIs/HIV.18 Only 10% of sexually experienced adolescents reported health care providers as a source of birth control/STI/HIV information. More than 80% of adolescents 15 to 19 years of age received formal instruction about STIs, HIV, or how to say “no” to sex between 2011-2013, yet only 55% of males and 60% of females received instruction about birth control.19 Strong support of multilevel expanded and integrative sex education is warranted now more than ever.20

Delivery of Sexuality Education
Pediatricians/Health Care Providers
Pediatricians are in an excellent position to provide and support longitudinal sexuality education to all children, adolescents, and young adults with and without chronic health conditions and disabilities as part of preventive health care. Over the past decade, increasing numbers of adolescents contend with sexuality in the context of their own chronic physical or mental health condition and/or developmental disability.21,22 When sexuality is discussed routinely and openly during well-child visits for all children and adolescents in the pediatrician’s office, conversations are easier to initiate, more comfortable to continue, and more effective and informative for all participants. Pediatricians and other primary care clinicians can explore the expectations of parents for their child’s sexual development while providing general, factual information about sexuality and can monitor adolescent use of guidance and resources offered over time.

Pediatricians can introduce issues of physical, cognitive, and psychosexual development to parents and their children in early childhood and continue discussions at ongoing health maintenance visits throughout school age, adolescence, and young adulthood. Sharing this information can help overcome barriers to discussing the sexual development of all children and adolescents and to improve screening rates for STIs, pregnancy, and partner violence. It is also important to provide access to current accurate sexuality education and to provide access to confidential relevant information, services, and support over the course of a lifetime.18,21 These conversations can begin with questions the family might have about the child and his or her body as well as about self-stimulation and “safe touch.”Contraception And Sexuality Among Students Of College of Education Essay  With insights into the typical stages of child and adolescent sexual development, parents can better understand their own child’s behaviors. For example, by recognizing that masturbation is typical toddler behavior, parents can better understand and discuss self-stimulatory behaviors of their teenager. The problem is often the inability to distinguish between behaviors that are publicly and privately appropriate as children grow older.23

Often, the pediatrician can take the lead from the parent or caregiver and then ask a few gentle leading questions about how much information the family would like to receive with the child and parent together in the room. The dynamics of the sexuality education conversation can then change as the child becomes a young adolescent by asking the parent or caregiver to leave the room after the initial introductions and history taking has occurred with the parent in the room. Parents and adolescents benefit from being prepared for these changes in adolescent interactions when there will be time alone for the adolescent to engage with the pediatrician to discuss sexuality, as well as personal and mental health, drug and tobacco use, and other psychosocial issues. The importance of confidentiality and its role in adolescent health care autonomy should be discussed with both adolescents and their parents. Unlike school-based instruction, a conversation about sexuality with pediatricians can provide an opportunity for personalized information, for confidential screening of risks, and for addressing risks and enhancing existing strengths through health promotion and counseling. Children and adolescents may ask questions, discuss potentially embarrassing experiences, or reveal highly personal information to their pediatricians. Families and children may obtain education together or in a separate but coordinated manner. Prevention and counseling can be targeted to the needs of youth who are and those who are not yet sexually active and to groups at high risk of early or unsafe sexual activity, which includes children with and without chronic health conditions and disabilities.Contraception And Sexuality Among Students Of College of Education Essay

Use of a psychosocial behavior screening tool or the Bright Futures Previsit Questionnaire (available at https://brightfutures.aap.org/Bright%20Futures%20Documents/CoreTools11-14YearOCVisit.pdf) is a good way to address all of these topics, in addition to physical activity, nutrition, school, and relationships. The AAP policy statement on providing care for lesbian, gay, bisexual, transgender, and questioning youth, as well as other resources, offer suggestions on how to incorporate important conversations about sexual and gender identity in the health supervision visit.24–26

In the office setting, children and adolescents have been shown to prefer a pediatrician who is open and nonjudgmental and comfortable with discussions to address knowledge, questions, worries, or misunderstandings among children, adolescents with and without chronic health conditions and disabilities, and their parents/caregivers related to a wide range of topics. These topics include, but are not limited to, anatomy, masturbation, menstruation, erections, nocturnal emissions (“wet dreams”), sexual fantasies, sexual orientation, and orgasms. Information regarding availability and access to confidential sexual and reproductive health services and emergency contraception is important to discuss with adolescents and with parents. During these discussions, pediatricians also can address homosexual or bisexual experiences or orientation, including topics related to gender identity. It is also important to acknowledge the influence of media imagery on sexuality as it is portrayed in music and music videos, movies, pornography, and television, print, and Internet content and to address the effects of social media and sexting. According to the US Preventive Services Task Force, intensive behavioral counseling is important for all sexually active adolescents and for adults who are at increased risk of STIs.27 Although there may not be time to address all of these topics in a brief office visit, the longitudinal relationship and annual well visit present several opportunities for discussion. In addition, more information and resources can be shared with adolescents, many of which are easily accessible and listed at the end of this report.Contraception And Sexuality Among Students Of College of Education Essay

Most adolescents have the opportunity to explore intimacy and sexuality in a safe context, but some others experience coercion, abuse, and violence. In fact, unwanted first sexual encounters were reported in the National Survey of Family Growth among 11% of female and male subjects 18 to 24 years of age who had first intercourse before age 20 years.28 Teenagers who report first sex at 14 years of age and younger are more likely to report that it was nonvoluntary, compared with those who were 17 to 19 years of age at sexual debut.29 Unwanted encounters may include dating violence, stranger assaults, and intrafamilial sexual abuse/incest. Screening for sexual violence and nonconsensual sexual encounters is important when evaluating all sexually active adolescents, especially for adolescents with chronic health conditions and disabilities, because they may be more likely to be victims of sexual abuse.5,30

In the Schools
Formal sexuality education in schools that includes instruction about healthy sexual decision-making and STI/HIV prevention can improve the health and well-being of adolescents and young adults.31 If comprehensive sexuality education programs are offered in the schools, positive outcomes can occur, including delay in the initiation and reduction in the frequency of sexual intercourse, a reduction in the number of sexual partners, and an increase in condom use.12,32 Some studies also have shown less truancy and an improvement in academic performance in those who have taken sexuality education courses.Contraception And Sexuality Among Students Of College of Education Essay

A student’s experience in school with sexuality education can vary a great deal. The Sexuality Information and Education Council of the United States and the Future of Sex Education (FoSE) promote evidence-informed comprehensive school-based sexuality education appropriate to students’ age, developmental abilities, and cultural background as an important part of the school curriculum at every grade.34 A comprehensive sexuality program provides medically accurate information, recognizes the diversity of values and beliefs represented in the community, and complements and augments the sexuality education children receive from their families, religious and community groups, and health care professionals. Adolescents and most parents agree that school-based programs need to be an important source of formal education for adolescent sexual health.35–37

The protective influence of sexuality education is not limited to the questions about if or when to have sex, but extends to issues of partner selection, contraceptive use, and reproductive health outcomes.38 Creating access to medically accurate comprehensive sexuality education by using an evidence-based curriculum and reducing sociodemographic disparities in its receipt remain a primary goal for improving the well-being of teenagers and young adults. Ideally, this education happens conjointly in the home and in the school.Contraception And Sexuality Among Students Of College of Education Essay

Factors that shape the content and delivery of sexuality education include state and school district policies, state education standards, funding from state and federal sources, and individual teacher comfort, knowledge, and skills. Fewer than half of states require public schools to teach sexuality education, and even fewer states require that, if offered, sexuality education must be medically, factually, or technically accurate. State definitions of “medically accurate” vary, from requiring that the department of health review curriculum for accuracy to mandating that curriculum be based on published medical information.40

Two-thirds of states and the District of Columbia allow parents to remove their children from participation or opt out from sexuality education. Fewer than half of states and the District of Columbia require parents to be notified that sexuality education will be provided. Other states have specific content requirements, including “stressing abstinence” or precluding discussion of homosexuality or abortion.41 The status of sexuality education in private schools is less well known. There is little to no information available from parochial or private scholastic institutions on the provisions of sexuality education.Contraception And Sexuality Among Students Of College of Education Essay

Although policies exist requiring sexuality education, it may not be occurring in an unbiased and systematic manner. From the 2012 School Health Policies and Practices Survey, only 71% of US high school districts have adopted a policy specifying that human sexuality is taught. In a separate study comparing high schools, middle schools, and elementary schools, sexuality education taught in middle schools across states was more likely to be focused on “how to say no to sex” rather than other topics, with approximately 1 in 5 teenagers reporting that they first received instruction on “how to say no to sex” while in the first through fifth grade. Adolescent boys were slightly more likely than girls to be instructed on how to say no to sex or were using birth control while in middle school (52% of male teenagers, compared with 46% of female teenagers). Male teenagers were less likely than female teenagers to report first receiving instruction on methods of birth control while in high school (38% of male teenagers, compared with 47% of female teenagers).Contraception And Sexuality Among Students Of College of Education Essay

Teacher training in the United States is quite variable from district to district and school to school especially in sexuality education. The FoSE Initiative has released the National Teacher Preparation Standards for Sexuality Education to provide guidance to institutions of higher education to better prepare future teachers.9 The FoSE teacher standards include professional disposition, diversity and equity, content knowledge, legal and professional ethics, planning, implementation, and assessment. According to these standards, teachers may benefit from receiving specialized training on human sexuality, which includes accurate and current knowledge about biological, social, and emotional stages of child and adolescent sexual development (including sexual orientation) and legal aspects of sexuality (ie, age of consent).

Professionals responsible for sexuality education may benefit from receiving training in several learning and behavior theories and how to provide age- and developmentally appropriate instruction as part of sexuality education lesson planning. Ideally, teachers would be familiar with relevant and current state and/or district laws, policies, and standards to help them choose and adapt an evidence-based and scientifically accurate curriculum that is appropriate and permissible within a school district. Ongoing professional development and participation in continuing education classes or intensive seminars is advised. Teachers can benefit from access to updated and current sexuality information, curricula, policies, laws, standards, and other materials. The FoSE standards advise that teachers are aware of and take into account their own biases about sexuality, understand guidelines for discussion of sensitive subjects in the classroom and addressing confidentiality, and know how to address disclosure by students of sexual abuse, incest, dating violence, pregnancy, and other associated sexual health issues. The goal is for teachers to feel comfortable and committed to discussing human sexuality and to know how to conduct themselves appropriately with students as professionals both inside and outside of the classroom and school. It is important for teachers to have an appreciation for how students’ diverse backgrounds and experience may affect students’ personal beliefs, values, and knowledge about sexuality. In the United States, 35.5% of districts have adopted a policy stating that there is a requirement that those who teach health education must earn continuing education credits on strategies or on health-related topics. It is important for teachers to develop skills in creating a safe, respectful, and inclusive classroom Contraception And Sexuality Among Students Of College of Education Essay

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