It took Sweden 50 years to do it. In India, it might take even longer to include sexuality education in the school curricula, if the ongoing debate is any indication. Indian parliamentarians have just recommended that sex education for the young be banned, and indeed several states in the country have already done so. But, as a new Indo-Swedish collaborative study points out, the longer there is resistance to equipping adolescents with information associated with puberty and sexual and reproductive health (SRH), the greater are the chances of an increase in premarital sexual curiosity and its associated health risks.
The study found growing evidence from across the country that a significant proportion of young boys and girls had become sexually active before marriage. According to research conducted by MAMTA, a Delhi-based NGO working on SRH, and the Swedish Association for Sexuality Education (RFSU), there has been an increase in the percentage of unmarried young Indians becoming sexually active in the past five years. The study, which focused on urban and rural areas of Haryana, Uttar Pradesh and Karnataka over a five year period beginning 2003, found that in 2004, 5.8 per cent unmarried young people had sexual intercourse. This figure increased to 7.4 per cent in 2006 and 7.5 per cent in 2008. More unmarried males (9.3 per cent in 2004 and 10.2 per cent in 2008) reported having a sexual experience compared to unmarried females (0.5 per cent in 2004 and 3.2 per cent in 2008).
What is worrying was that very often they did not use protection, either because of lack of information or lack of access to the means to gain it. "Considering the sensitivity of the subject and the taboos associated with it, it was important to adopt an approach that would be culturally acceptable. On the other hand, we also needed to measure their knowledge, attitude and practice on sexual health to be able to design strategies to address their needs. This is why we sought the support of RFSU, as it has expertise on SRH and sexuality education," said Dr Sunil Mehra, Executive Director, MAMTA.
According to Maria Andersson, International Director, RFSU, even though people as young as 16 years were sexually active in Sweden and premarital sex was not considered taboo there, it is a proven fact that increased sexual knowledge had prevented unwanted pregnancies and sexually transmitted infections (STIs) there. She believed that even though the two countries had different cultural beliefs, with Sweden being a more open society than India, there was no reason to think that the same approach would not work in India. "Good sexuality education enabled people to find joy in their sexuality and gave each individual an opportunity to make decisions about his or her own body. Our strategy is to support and encourage young people to make their own decisions and not let anyone else, including friends, group pressure or expectations, influence them. Providing relevant facts was important, but it was not enough. We also support responsible behavior that includes using contraceptives and allowing them to discuss and reflect on the importance of this knowledge that contraceptive use should not be the responsibility of women alone, a strategy easily adaptable to Indian conditions," she contended.
Building on RFSU's experience that investing adequate and quality time in understanding the gaps was critical before implementing any strategy, 32 villages in Bawal Block of Rewari district in Haryana, 31 villages in Pindra Block of Varanasi district in Uttar Pradesh and four urban slums in Kormangala in Bangalore, Karnataka, were chosen to identify the key areas of health needs associated with puberty. They included menstruation, personal hygiene and contraception, a less talked about issue.
At the same time, it was decided to study the impact of imparting adolescent education to 5,000 school children in four schools - two of girls and two of boys, in urban Rewari and rural Bawal - to assess whether this changed their perceptions on premarital sex, unwanted pregnancies, STIs, HIV-AIDS, sexual abuse and equity in decision making powers of girls and boys.
"Unlike in India, in Sweden sexuality education is compulsory in schools and has been since 1955. The right to sexual and reproductive health services and sexuality education is the key to ensuring gender equality. RFSU sees openness on sexuality as the point of entry of health promotion and the prevention of sexually transmitted infections and HIV/AIDS. This is why the strategy for India was also to break the culture of silence and let young people open up on these sensitive subjects," pointed out Andersson.
After spending time with young people, their parents, teachers and community leaders, MAMTA found that in addition to interventions like training peer educators, it would be more useful to adapt RFSU's concept of youth clinics where information on SRH could be accessed without fear or embarrassment. Thus was born youth information centres (YIC).
Since young people, particularly girls, were more vulnerable to STIs, YICs facilitated information sharing; and also worked closely with community and religious leaders and sensitized Panchayati Raj Institution (PRI) members on issues of education and school retention. The most important outcome of this strategy were attitudinal changes.
In all the intervention areas, age at marriage was delayed among young people. The percentage of girls that married below the legal age of marriage fell from 61.2 per cent in 2004 to 45.2 per cent in 2008. For boys, the corresponding figures were 79.5 per cent and 76.2 per cent, respectively.
By 2008, the perception that education was important for girls led to 38.5 per cent young men whose sisters had dropped out of school, to argue that they could share some household chores with their sisters and help them get more time for studies. Nearly 26.9 per cent young men felt that they could convince their parents to allow their sisters to continue studies as external candidates.
Using RFSU's technical expertise in gender sensitization, the sexuality education curriculum under the adolescent education programme (AEP) was developed for students of Classes VIII, IX and X based on an assessment of their knowledge and needs. At the end of three years, a comparison was made between students of Class 10 who had been through the sexuality education curriculum and Class 11 students of the same school who had not experienced it. Irrespective of the location of the school, boys and girls who had been through the programme were able to identify and reject common misconceptions about nocturnal emissions, masturbation and myths related to HIV transmission. Girls in Class X were able to understand that the oral pill did not protect them from STIs and HIV, while a significant number of urban and rural girls said they would decline to have sex without a condom and oppose sexual abuse.
The evidence clearly is that increased sexuality knowledge decreases risky behavior and boosts gender equality. MAMTA is now hoping that its research findings will influence policy makers in India to formulate a more rational and relevant national policy on sexuality education.