Let's talk about sex

Peer education, involving formal and informal talks by young people to their contemporaries, has been used to spread awareness of sexual and reproductive health

Changing sexual behaviour across Southeast Asia is raising an interesting challenge: How do you teach young people about sexual and reproductive health in countries with strict moral taboos?

(Article taken from our customer magazine, Momentum)

Across Southeast Asia young people’s lives are changing. More and more are staying on at school, going to university, finding work away from home and marrying later. While the majority still begin their sexual lives within marriage, the number of young men and women engaging in sex before marriage is increasing.

These rapid lifestyle changes have not been matched by changes in attitudes. Despite issues such as unwanted pregnancy and increases in HIV and sexually transmitted infections, in many Southeast Asian countries sex remains a taboo subject. To tackle these issues a programme was set up by the European Union and the United Nations Population Fund to improve the sexual and reproductive health (SRH) of young people across Asia. The three year Reproductive Health Initiative for Youth in Asia (RHIYA) programme reached 2.5 million young people across Bangladesh, Cambodia, Laos, Nepal, Pakistan, Sri Lanka and Vietnam. It focused on increasing awareness of young people’s sexual and reproductive health issues, provision of youth friendly services and helping organisations provide the services that young people needed.

Towards the end of the programme Catharine Taylor, maternal and newborn health specialist at HLSP, Mott MacDonald’s health consultancy, was asked to evaluate components of the programme and particularly how a peer education approach, which helped bring the topic of SRH out into the open, could help with future initiatives. “With young people making up between one third and a half of the population in Southeast Asia, the sexual and reproductive health risks now facing a growing number of young people have implications for both the future health of the population and the economic growth and social development of their countries,” Taylor comments.

"The risks facing young people have implications for the population's future health and their countries' economic and social development." Catharine

“Peer education involves equals – peers – talking among themselves. Typically it involves an educator or counsellor who has a background similar or the same to those of the people you are trying to reach.” It is a strategy that has been used in health related fields before and has been widely used in HIV prevention programmes, she adds. Peer education takes many forms – formal and informal group talks that are open to whoever from a community wishes to attend, handing out leaflets, plays and chats between individuals all figure in the strategy. Health education centres are often set up to provide support and counselling for young people who wish to discuss their own sexual health or sex in general.

The kind of information exchanged starts with the fundamentals: “Our mothers did not inform us about any puberty related issues,” reveals Safi a, a 19 year old woman from Bheen, Pakistan. “I did not even know about menstruation and was frightened out of my wits when my period started.

“Now, girls who learn from reproductive health sessions are passing on information to their sisters and cousins.” She adds that being able to discuss her own sexual and health concerns with counsellors without feeling judged has been a huge relief.

But the education programme encountered resistance when it kicked off. “Conservative socio-cultural traditions stipulate very strong codes of behaviour for young people, especially girls,” Taylor notes. “Across all seven countries there was initially a strong anxiety that learning about sexual and reproductive health would lead young people to experiment sexually. Parents were worried that sexual knowledge would ‘ripen’ their girls too early.” Peer educators had to tread carefully and acted as brokers between parents and other ‘gatekeepers’ and youth.

“But parents started to view it as a positive thing. A couple of parents said that, as the project went on, they realised it was a protective exercise.”

In communities where peer education has been carried out monitoring of sexual health suggests that it has, indeed, not resulted in increased sexual activity, but in the wider use of condoms and other contraceptives among those who are sexually active. Taylor concedes that a great deal more work is needed to allay parents’ and other ‘gatekeepers’ fears about the effects of sexual and reproductive health education. Time and effort must be spent establishing local ownership and ensuring an enabling environment. Emphasis needs to be placed on gaining the support of tribal leaders and other ‘gatekeepers’ from the outset.

She points out that SRH remains a taboo subject in many countries and resistance to peer education programmes continues. “Until adolescent and youth SRH is fully integrated into health and education services, initiatives such as the RHIYA programme need to be supported. Only then will adolescents and youth achieve their right to SRH information and care.”

Key sustainability facts

• Peer education can be used to promote the use of condoms and other contraceptives
• Is an effective way of reaching young people
• Helps overcome taboos between adults and young people