Sex Education As Intervention Against Teenage Pregnancy Social Work Essay
Promotion of sexual health, and all Adolescence, the second decade of life, is increasingly recognized as a critical phase in the life course, especially from the health and social perspectives. The most challenging aspect of adolescence is sexual and reproductive health, as it is aspect of adolescence is sexual and reproductive health, the area that poses the greatest difficulty in maintaining adolescents’ health and implementing appropriate and effective interventions. For a start, there is a paucity of information and, if there is information, it is often uncoordinated and fragmented and not very useful for policy-making and programme interventions (WHO, 2005)
Understanding human sexuality is a prerequisite to the promotion of sexual health, and all over the world sexuality remains one of the most problematic and dangerous aspects of person-hood (Wilson and Mcandrew, S, 2000). Professor Catherine Ingram of the school of Nursing at the University of North Carolina at Chapel Hill has defined sexuality perhaps more succinctly than most authors in this field. She describes sexuality as ‘an important dimension of the human personality’ and sees it as being ‘inextricably woven into the fabric of human existence (Catherine Ingram, 1990)
The belief prevalent in the early part of the twentieth century, that sexual education of the intelligent adolescent was best served by one short, sharp talk- in the fifth if the school was enlightened, in the sixth if it was felt to be an unpleasant but unavoidable duty-was perhaps typical of attitudes to education in many other disciplines. Facts were enough, and sex was put over in a way similar to that used when dealing with the maps of the coalfields. The only difference was the special atmosphere which surrounded the short, sharp talk. It must often convey to its victim that these matters were unspeakable and no well-bred pupil would either need or investigate them further. This method had at least one advantage- it did not attract unfavourable critic from parents or education committees large because all concerned were much too embarrassed to mention it.
After the first World- war, pragmatic objectives in sex education become more apparent and by early 1930’s several of our national agencies with the prevention the prevention of illegitimacy, the spread of knowledge about contraceptives and marriages guidance had begun. There was a small but interesting upsurge of intellectuals who nobly hid their embarrassments they discussed sexual matters with their children and solemnly left the bathroom door unlocked so that nudity could be rationally displayed. There were, however, even in those days, teachers in schools effectively relieving adolescent anxiety and ignorance about sex often under the name of human biology, wit equivocally worded syllabuses, and without a word to the head. Such strategies are still in use today.
The ironic evidence from research on the effects of fear-arousing information in connection with types of preventive health behaviour is that people tend to reject the information rather than change their behaviour (Radelfinger, 1965; Young, 1967)
In 1936, 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 impulse (Reich W, 1936)
The existence of Acquired Immunodeficiency Syndrome (AIDS) has given a new sense of urgency to the topic of sex education. In many African nations, where AIDS is at epidemic level, sex education is seen by most scientists as a vital public health strategy. Some international organizations such as Planned Parenthood consider that broad sex education has global benefits, such as controlling the risk of overpopulation and the advancement of women’s rights.
According to the Sexuality Information and Education Council of the United States (SIECUS), 93% of adults they surveyed support sexuality education in high school and 845 support it in junior high school (SIECUS,1984). In fact, 885 of parents of junior high school students and 80% of parents of high students believe that sex education in school makes it easier for them to talk to their adolescents about sex. Also, 92% of adolescents report that they want both to talk to their parents about sex and to have comprehensive in-school examination.
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 sexually transmitted diseases (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 United Kingdom and the United states ) have a higher incidence of STIs and teenage pregnancy (Monbiot, 2004)
The proportion of women aged 20-24, who had a child before age 20 is a useful summary indicator that reflects the differences in teenage birth rates by country. This proportion is lowest in Sweden (4%), slightly higher in France (6%), much greater in Canada and Great Britain (11% and 15%, respectively) and highest in the United States (22%). Differences in the proportion giving birth by age 15 and by age 18 are also much higher in the United States than in the other four countries (Jacqueline et al, 2001)
Teenage pregnancy is times is a factor of early sexual exposure. Immaturity, inexperience or risky sexual experience often results in the unplanned pregnancy. In the study carried, between 1980 and 1998, among men and women to determine the age of first sexual experience, women were found to be exposed earlier than men (figure 1).
Figure 1. Proportion of participants younger than 16 years at first intercourse, by year of first intercourse.
Teenage pregnancy in Europe :
The incidence of teenage pregnancy across Europe varies considerably. The United Kingdom has the highest rate in Western Europe and is lower only than Bulgaria , Russia , and Ukraine in Europe as a whole. Throughout most of Western Europe, teenage birth rates fell during the 1970s, ’80s, and ’90s, but in the United Kingdom , rates have remained high-at or above the level of the early ’80s.
http://www.bmj.com/content/330/7491/590.full
Figure 2: showing teenage pregnancy in 6 European countries over a 25 year period.
The graph shows the trend over a twenty-five year period (1973-1995)
There is a sharp decline in the United Kingdom figures and then a near steady value in the late 70s and early 80s, before gradually reaching a crescendo in 1991 and then a sharp drop towards the end of the survey. The Netherland has the least and was fairly constant throughout the study period. Germany , France , Ireland ad Italy had fluctuating values, but generally, there was a decline towards the end of the study.
UNITED KINGDOM: In England and Wales , sex education is not compulsory in schools as parents can refuse their children take parting the lessons. The curriculum focuses on the reproductive system, foetal development and the physical and emotional changes of adolescence, while information about contraception and safe sex is discretionary and discussion about relationships is often neglected. Britain has one of the highest teenage pregnancy rate s in Europe and sex education is a heated issues I government and media reports. In 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 confidentiality prevents teenagers from asking teachers about contraception. In a 2008 study conducted by YouGov for channel 4 it was revealed that almost three in ten teenagers said they need more sex and relationships education.
In Scotland , the main sex education programme 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 bythe catholic school 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 encourage children to delay sex until marriage and does not cover contraception and as such is a form of Abstinence-only sex education.
It is important to recognise that for some young women, particularly from certain ethnic or social groups, teenage pregnancy can be a positive life choice. Rates of teenage pregnancy within marriage are high, for example, in some South Asian ethnic groups in the United Kingdom . However, for many other young women, the costs of teenage pregnancy can be very high, particularly when linked with poverty. These risks include poorer outcomes for the children of teenage mothers as well as for the mothers themselves.
http://www.bmj.com/content/330/7491/590.full
Figure 3: showing the rate of teenage pregnancy in 17 European countries.
A sex survey by the World Health Organization concerning the habits of European teenagers in 2006 revealed that the birth rate among 15-19-year-olds in the UK was 27.8 births per 1,000 populations. The graph shows, the United States with the highest rate of teenage pregnancy and Switzerland with the least. The United Kingdom has the highest rate in Europe, which is clearly above the average value in Europe
FRANCE: In France , sex education has been part of school curricula since 1973. Schools are expected to provide 30 to 40 hours of sexual 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 television and radio spots and the distribution of five million leaflets on contraception to high school students
GERMANY: In Germany , sex education has been part of school curricula since 1970. Since 1992 sex education is by law a government duty. It normally covers all subjects concerning the growing-up process, body change during puberty, emotions the biological process of reproduction, sexual activity, partnership, homosexuality, unwanted pregnancies and 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.
A survey by the World Health Organization concerning the habits of European teenagers in 2006 revealed German teenagers about contraception. The birth rate among under 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 per 1,000.
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. The Population and Family Welfare Federation provide all 15-year-olds on introductory sexual package that includes an information brochure, a condom and to be most effective when a multifaceted approach is used, as the problem is multiple determined and multidimensional. The interventions
cartoon love story should not only focus on sexual factors and related on sequences, rather Interventions that are designed to reduce teen pregnancy appears they should include non sexual factors such as skills training, and personal development as well. Further, stakeholders including pregnant teens, parents, health sector, schools and churches should work together to devise programs that are practical, evidence based, culturally appropriated and acceptable to the target population.
Boostma writing on Sex Education: Preparing Instead of Prevention, surmise that the teenage pregnancy rates has been (one of) the Netherlands for years now. Asking the question if Netherlands are hardly sexual active or if the Dutch promote abstinence from sexual intercourse? He asserts that in the Netherlands , there is not one specific governmental programme for teenage sex education or contraception. There is however, a lot of information about sexuality and contraception that is coming from all directions.
Boostma believes that the Dutch approach attitude towards sexuality is one of tolerance, open mindedness and pragmatism and that studies from many countries that giving the message to young people ‘not to have sex’ are having the opposite effects. The same account for countries where the subject sex is more or less a taboo to talk about. The Dutch concluded that many young people will have sex anyway, so they should be prepared for sexuality than to be prevented from it. This preparing attitude is coming from different levels of the society:
The government through the National Health insurance pay for the contraception. Parents talk about sexuality and its consequence.
The Mass-media (Television, newspaper, magazines, radio) addresses sexuality and sexual health. Schools give sexuality talk/sex education. There many accessible services for sexuality and contraception. These and other factors result in a tolerant and pragmatic attitude towards sex make information and contraception accessible and explains the low rate teenage abortion or pregnancy.
Sexual heath in the Netherlands means preparation instead of prevention. This preparation means that young people are stimulated to become sexually autonomous and can make their own sensible discussions. Up till now, ‘the Dutch method’ has proven its effectiveness over and over again. Ian Sutherland, who was director in the Health department of Britain in the early 80’s co-authored a book, Health Education, perspective and Choices which dwells on the several choices available to people and the choices they make based on the information they have. The book analyses the different areas where choice is inevitable and the ideological basis for which certain choices should be made. Various authors contributed various topics on the theme Health education. The book first published in 1979 is invaluable as it coincide with the transition period of balancing health needs in Britain . The increased rate in teenage pregnancies and the consequence rise in abortion rates. It was also a period Britain was trying to establish formal curriculum on sex education. In an effort to include as much as possible, the authors referred extensively to a literature which begins with Plato. The authors tried to draw the readers’ attention to as many authorities as possible, and so made attempt at bringing together in one book the extensive libraries of ‘health’, ‘education’, and health education.
Crosby et al (2008) in a study titled, The Protective Value of Parental Sex Education: A clinical-based exploratory study of adolescent females compared the impact of sex education provided by parents to female adolescents against the same education provided by formal settings to female adolescent.
They sampled females aged 16-24 years, attending an adolescent medical clinic in urban area of the south were recruited prior to examination. Each patient completed an anonymous self administered questionnaire. Data from 110 respondents were analysed to compare those who indicating they had learned about each of 4 topics from parents to those not indicating learning about all 4 topics from a parent. The same process was repeated relative to learning about all 4 topics in a formal education setting.
The result showed that in controlled, multivariate analyses, adolescent not communicating with parent on all 4 topics were nearly 5 times more likely to report having sex partners in the past 3 months. Further, adolescents were 3.5 times more likely to have low self efficacy for condom use, 2.7 times more likely to ever using alcohol or drugs or sex and about 70% less likely to have ever talked about HIV prevention with a partner before engaging in sex. Differences relative to learning about all 4 topics in formal settings were not found out.
Looking at works done recently in the United Kingdom, (SHARE: Sexual Health And Relationships; Safe, Happy and Responsible) included 8400 pupils aged 13-15years in 25 secondary schools in east of Scotland (Wight et al,2002) Questionnaires was completed at base line and follow up done 2 years later. The intervention was a new 5-day teacher training programme plus a 20-session pack: 10sessions were delivered in the third year (at 13-14 years) of secondary school and 10 in the fourth year (at 14-15years). The primary outcome for the study was use of condoms at first intercourse. Similar proportions of both intervention and control groups used condom at first intercourse with less than 105 of pupils reporting first intercourse without condom. For all other behavioural outcomes (condom use after first intercourse, oral contraceptive use and unplanned pregnancy) there were no differences with the groups. However, as with Martiniuk’s study in Belize, published in this issue of the international journal of epidemiology, pupils in the intervention group were more knowledgeable than those in the control group.(Martiniuk,2003).
The Belize study was well designed in allowing for the clustered nature of samples both when calculating and the sample size and analyzing the data. Publishing the intra-cluster correlation will be good for planning future research.
However, there are a number of weaknesses with the randomized procedures discussed by the authors in their paper. The imbalance between groups in the number of classrooms could have been overcome by a block method rather than the simple coin toss employed here. (Schulz and Grimmes, 2002) There were considerable differences between groups at baseline in terms of gender and sexual experience. These data were not available to the researchers prior to the study starting. It may have been appropriate to allocate classes to intervention and control groups when the results from pre-test questionnaires were available. At this time an alternative randomization procedure such as stratification or minimization may have reduced the chances of imbalance between groups in the study (Pocock, 1984)
Anna Graham noted that the factor with the strongest influence preventing teenage pregnancy is educational opportunity. It is well-educated women who tend to delay childbearing. For women aged 20-24 years the longer a woman remains in school the less likely she is to have a child before the age of 20. Adolescents with little schooling are often twice as likely as those with more education to have baby before their 20th birthday. For example, 46% of young Columbian women with less than 7 years schooling have their first child by the age of 20, compared with 19% of those with more education. The contrast is even greater in Egyptian, where 51% of less educated women have their first birth before the age of 20 compared with 9% of better educated women. She noted that the link between lack of education and early childbearing is also strong among adolescents in the US . Some 58% of young American women who receive less than a high school education give birth by their 20th birthday, compared with 13% of young women who complete at least 12 years of schooling. The report from the Alan Guttmacher Institute, from which these data came, suggested that low level of education is not necessary a direct cause of early child bearing, however, the two characteristic of living in impoverished and rural environments. She further argued that when school is the main source of information about sexual matters, like the cross-sectional surveys in the UK , early and unprotected sexual intercourse is less likely, compared with when other sources such as friends and the media dominate.
She surmised that, the greatest impact to be made in reducing unwanted pregnancies and sexually transmitted infections is to increase the time spent in education by young women worldwide. She believes this form of intervention is likely to change the role of women in society empowering them to avoid the adverse consequences of sexual activity.
The author in her work tried to justify the need for a comprehensive education over and above the micro aspect of education-sex education. Believing that with increased time spent acquiring education, a women is more likely to avoid the bad aspect of sexual activity. She had looked into certain aspects of form of sex education and did not really weigh each on its own merit. She probably relied on her experience to draw a far reaching conclusion.
Boostma writing on Sex Education: Preparing Instead of Prevention, surmise that the teenage pregnancy rates has been (one of) the Netherlands for years now. Asking the question if Netherlands are hardly sexual active or if the Dutch promote abstinence from sexual intercourse? He asserts that in the Netherlands , there is not one specific governmental programme for teenage sex education or contraception. There is however, a lot of information about sexuality and contraception that is coming from all directions.
He believes that the Dutch approach attitude towards sexuality is one of tolerance, open mindedness and pragmatism and that studies from many countries that giving the message to young people ‘not to have sex’ are having the opposite effects. The same account for countries where the subject sex is more or less a taboo to talk about. The Dutch concluded that many young people will have sex anyway, so they should be prepared for sexuality than to be prevented from it. This preparing attitude is coming from different levels of the society. He noted that the government through the National Health insurance pay for the contraception. Also parents talk about sexuality and its consequence. The Mass-media (Television, newspaper, magazines, radio) addresses sexuality and sexual health. Schools give sexuality talk/sex education.There many accessible services for sexuality and contraception. These and other factors result in a tolerant and pragmatic attitude towards sex make information and contraception accessible and explain the low rate teenage abortion or pregnancy.
Sexual heath in the Netherlands means preparation instead of prevention. This preparation means that young people are stimulated to become sexually autonomous and can make their own sensible discussions. Up till now, ‘the Dutch method’ has proven its effectiveness over and over again. Perspective and choices which dwells on the several choices available to people and the choices they make based on the information they have is important in tackling the issue of teenage pregnancy. The different areas where choice is inevitable and the ideological basis for which certain choices should be made should essentially be based on informed choices.
Health authorities have proposed several methods of addressing Health education. This was very significant, particularly during the transition period of balancing health needs in Britain . The increased rate in teenage pregnancies and the consequence rise in abortion rates is significant, particularly going back to the period Britain was trying to establish formal curriculum on sex education.
Abortion seems to be on the increase in the United Kingdom , according to the office of national statistics in the United Kingdom , the proportion of conceptions terminated by abortion among under 20-year-olds increased slightly from 36 per cent in 1990 to 39 per cent in 2000. Over half (51 per cent) of all conceptions among under 16-year-olds resulted in a termination in 1990 and this increased slightly to 54 per cent in 2000. Legal abortion rates were highest in London and the West Midlands in 2000 and 2001?. Similarly, the data collected by the agency noted a corresponding decrease in conception rate, it noted that, “In 2000, the conception rate among females under 20 years was 63 per 1,000 females aged 15 to 19 years. This marks a decrease in conception rates over the last decade that mirrors a general decrease among females of all ages. The exception however has been among females aged 13 to 15 years. Rates of conceptions in this group have remained consistent at between 8 to 10 per 1,000 females from 1990 to 2000”. A likely consequence of abortion is decreased fertility and sexual infections, the agency equally noted a rise in sexual related infection within this time period, “Genital infection with chlamydia trachomatis if untreated, is associated with pelvic inflammatory disease (PID) in women and infertility. The diagnostic rate of genital chlamydia infection in females aged under 20 years old has increased since the mid-1990s. In 2001, the highest rates of diagnosed chlamydia seen in GUM clinics, were among 16- to 19-year-olds (1,035 per 100,000 females). Genital warts are the most commonly diagnosed viral STI. In 2001, 29 per cent of females diagnosed with genital warts were under 20 years of age, compared with only 10 per cent of males in the same age group. Rates of diagnosis among females aged 16 to 19 years increased by more than 15 per cent during the last decade and reached 680 per 100,000 females in 2001”.
Intervention in teenage pregnancy, need to among other things focus on improving contraceptive use, and initiate attitudinal changes and life style likely to prevent pregnancy and sexual transmission infection transmission. This should involve long-term services and interventions, which are tailored to addressing the major causes of teenage pregnancy. This should be spelt in information, which are clear and unambiguous and may involve ideas which the youths relate with. It should also be home grown, in that it should relate with the culture or practices inherent in the society.
This will start with identifying the risk group. There are certain categories among this age, which appear to be vulnerable. Vulnerability may be by choice or imposed due to social economic reasons or accessibility to health care, such as contraception use. Interpersonal skills development is vital in achieving this objective. Programmes and other educational facilities, which allow interpersonal development, should be explored, this will allow productive engagement. Clinic service for education and information, will also serve a vital role in checkmating the trend. As teenage will not only benefit, but the society will be better for it as well. Information dissemination is vital and there is the possibility of teenagers accessing this on their own, if encouraged to talk to health personnel or attend clinics for advice and education. Education in this sense should be all encompassing and structured to the need at hand. Constructive engagement and participation of all and sundry are vital.
Periodic review of methods is important in our ever changing world. Therefore, interventions should not just be in theory, but clear goals which are practicable should be outlined to follow the strategies mapped out. Outcomes envisaged, need to be weighed in relation to the input.
The delicate age, adolescence confers on teenage, makes it imperative, to address peer pressure and to make leaders of peer groups participatory in addressing the problems identified. All this need be done in an atmosphere of trust and confidentiality. It is often difficult to identify sexually active individuals, therefore, the scope of the intervention need be broad-based to cater for all and sundry. This can be achieved by recruiting experts or people trained in working with youths, who have enough experience to deal with the challenges teenage present.
Catherine et al 2003, working on reviews which looked at teenage pregnancy and interventional means of check in the scourge, surmised the intervention on socio-demographics, which addressed the various health, education and psycho-social needs of teenagers and their environment in tackling the problem.
They found out that, there is mixed evidence for the effectiveness of school-based and/or teacher-delivered sex education. They are of the opinion that, the best chance of interventions being successful in this setting is when they are multifactor and address a broad range of issues, including self esteem, vocational development, and access to services.
In the area of Clinic/primary care as an interventional means, they equally believe that, there is mixed evidence for the effectiveness of interventions that take place in a clinic/primary care setting alone, and that it will be beat, based on the literature search, that they are linked widely to other community and school services, and evaluated as part of a broader programme. They are of the view that, confidentiality is of utmost importance considering the age group. They also surmised that in the UK context, particularly on UK-specific services and settings, such as doctors who may be the first to see these individuals.
On Education and information dissemination, there is mixed evidence for the effectiveness of educational approaches. It was found out that, the more positive outcomes, have been found for education based approaches which link directly to services offered. This also includes a broad range of skills to help improve confidence and relationships among teenagers Vocational development may also be useful. It is said that, programmes should be long term, sustained across school years, and be in place before teenagers become sexually active.
It is also suggested that, there is the need to support young parents to continue their education to enhance educational and employment opportunity for parents, mother/child interaction, and social outcomes for children. Early educational interventions for disadvantaged children can improve long-term. The family is foremost in checking the trend and this is dependent on teenagers getting support from parents and families. Neglect has always been attributed as a cause of teenage pregnancy. This could be deliberate or due to pressure from social responsibilities from parents to support the family, often leading to children not getting enough or desired attention from their parents.
They further found out that, ‘community interventions should be developed with regard to local needs and existing services. There is some evidence that multi-factor interventions involving a degree of community activity or service may be effective at improving contraceptive use.’
On school-based clinics., it is noted that, although, more research is needed on these as the evidence covered by reviews here was methodologically weak, They may be effective as part of multi-factor programmes, but clinic-based healthcare programmes for teenage mothers and their children can improve their health outcomes, if taken as a priority at all stages. The media and the Internet are often seen as social agents which are often not properly utilised, either as a child educator and form of entertainment, but also as a means of redeeming the problem. The study noted that much work has not been done in the United Kingdom , but again, further work is needed here for the UK . Skills, meant to give self-esteem are vital. There is encouraging result for approaches that focus on these factors, particularly when they are part of a broad-ranging intervention. Peer education, is also important in addressing the core issues right from the onset.
Abstinence, as an interventional means has actually, not been fully found to be effective, as there are little or no evidence for the e
