Placing gender at the heart of sexuality education.

Our field now sits on an enormous body of literature documenting the ways that gender dynamics profoundly shape knowledge, attitudes, and behavior in the area of sexual and reproductive health. In recent years, clinical and community-based sexual/reproductive health programs around the world have increasingly reconfigured services to reflect an awareness of the power imbalances that exist between males and females. Some efforts have also been made to pay attention to gender issues in formal sexuality education, but these strides have, for the most part, been less thorough than they might be.

Substantial evidence illustrates the ways that gender roles shape sexual attitudes, behavior, experiences, and outcomes. For example, pressure on young men to "prove their manhood" may lead to attitudes that condone risk-taking and abusive behavior, while creating sexual performance pressure and anxiety related to sexual dysfunction. At the same time, in many settings, girls are taught to be submissive and not to associate sex with their own pleasure. Not surprisingly, studies also show that gender often shapes the reasons adolescents become sexually active: Boys typically cite such things as curiosity and pleasure as primary reasons for having sex, whereas girls' principal reason is for love or approval.

Adherence to traditional gender norms is an antecedent to poor sexual health outcomes, including those that sexuality education programs typically aim to influence--early sexual initiation, greater number of partners, and low rates of condom and contraceptive use.

NEW PROJECT AT POPULATION COUNCIL

The Population Council program in Gender, Family, and Development--coming out of parallel institutional streams of work in adolescence, sexuality, and sexual health--is hoping to foster a dialogue to address the question of how sexuality education might look different if we were to incorporate a gender perspective more fully into the design of curricula, materials, training, and evaluation.

Under the direction of Nicole Haberland and Debbie Rogow, the project is beginning with the assumption that for young people to have the promise of satisfying and healthy sexual and reproductive lives, they need not only information and communication skills, but also greater understanding of how traditional gender norms increase their risk of poor outcomes (particularly, but not only, for girls). This includes developing greater awareness of--and strategies for reducing--the enormous power differential girls suffer vis-a-vis male partners. The project is focusing on sexuality education in both US-based and developing country settings.

In cooperation with their colleagues, both within the Council and in sister organizations, Haberland and Rogow are undertaking several activities to foster this dialogue including developing a content analysis tool, reviewing curricula, examining evaluation approaches, and facilitating learning circles with colleagues in the field.

Content Analysis Tool

The project is currently completing revision and testing of a tool that programs can use to assess how thoroughly, and to some degree, how thoughtfully, their own curricula address gender issues. In its current form, the tool involves approximately 40 questions, some in a checklist manner, others more scaled, along with guidelines for use. The instrument helps a reviewer identify:

1. whether and how the promotion of gender equality is incorporated into the objectives of a curriculum;

2. how gender is addressed in the content of the curriculum, and what possible gaps may exist with regard to highlighting girls' and boys' social roles in intimate relationships, but also in the family, the community, the workplace, the larger society, and the law;

3. whether a curriculum seeks to promote critical thinking and reflection about how traditional gender roles inhibit equality and lead to poor sexual health outcomes, and practical and strategic avenues for addressing inequality;

4. the proportion of time that gender issues receive in a curriculum and how the relevant lessons are distributed throughout the curriculum; and

5. the difference and balance between gender-"blindness" and gender-sensitivity in a lesson.

The content analysis tool is expected to be completed and distributed in 2005.

Curricula Review

The project is also conducting a content analysis of selected curricula from both the US and developing countries. The goal is to gather a sense of the "state of the art" and to compile sample lessons and curricula that are particularly thoughtful or creative, even if they have not been rigorously evaluated. To date, we have reviewed 24 curricula, in large part using the tool described above. We have identified a number of very strong lessons (and curricula) that teach adolescents how to recognize, disentangle, and challenge the gender-based social scripts that so deeply influence their own sexual behavior and health outcomes. These examples more often tend to come from community-based rather than school-based programs, and more typically, from curricula designed for developing countries. However, a number of them are adaptable for various settings and can inspire and/or serve as useful resources for others.

Overall, however, this preliminary review indicates that curricula largely ignore gender or address it in a fairly superficial manner. Some tack a lesson on gender onto the end of a curriculum. Alternatively, some curricula make reference to gender issues in a number of places but never discuss the issue in any depth. Rarely do programs thread attention to gender--a basic underpinning of sexual attitudes, decisions, and behaviors--throughout a curriculum in a coherent and consistent way. Lessons that help students rethink traditional masculinity, that foster reflection on homophobia, and/or that address social power are particularly scarce.

Often, emphasis on the adolescent "couple" eclipses specific attention to gender. As Delia Barcelona and Laura Laski of UNFPA have written about traditional approaches, "By focusing on the generic adolescent or the adolescent 'couple,' such curricula, for the most part, have buried the critical issues. They have failed to take adequate account of boys' and girls' often distinct--and frequently competing--rationales, constraints, experiences, interests, expectations, feelings, and meaning in regard to sexuality and relationships." (1)

Evaluation Approaches

Currently, sexuality education programs are evaluated for their effectiveness in contributing to specific social, health, and demographic outcomes. Typically, these include delaying sexual debut, increasing contraceptive and condom use, reducing the number of sexual partners, and reducing rates of pregnancy. The Council is currently examining how program effectiveness varies by gender. Preliminary results suggest that the majority of rigorous evaluations find different outcomes for girls as compared to boys for one or more indicators. In other words, one program may delay sex among girls but not among boys, while another has the converse effect. A curriculum may be proven to increase condom use among participating girls but not among their male classmates, while a different curriculum has the opposite effect. Such findings suggest that boys and girls have different learning needs. This notion should not be that surprising, given the underlying issues facing boys and girls.

In addition, program evaluations--shaped by the original goals of programs and by some practical and political considerations--have rarely sought to learn whether sexuality education is influencing the quality or nature of young people's sexual experience. Which programs reduce the high levels of sexual coercion and violence? Which are most effectively promoting attitudes favoring mutuality, equality, and respect? Do some curricula result in girls attaining a greater measure of pleasure when they become sexually active? Do any curricula effectively provide a greater sense of safety and self-esteem among homosexual youth? Finally, how do such program-based outcomes vary by gender?

The project operates on the assumptions that in promoting a gender perspective in sexuality education, these outcomes matter in their own right, are amenable to change, and are worthy of investing in as wisely as we can. Current activities in this domain focus on promoting a dialogue on these issues in the field through various professional and collegial venues, including publication of a policy-oriented paper and sponsorship of the "learning circle" series at the Council (see next section).

Learning Circles

Haberland and Rogow are currently planning a series of small discussions focused on specific topics related to gender issues in sexuality education. The goal of these discussions is to work with colleagues in the field to bring to light recent research, consider programmatic implications, and explore ways to ensure that sexuality education is as effective as possible. Effectiveness would be measured as enabling young people to foster intimate relationships that are not only safe, but also mutual, respectful, and pleasurable; helping young people delay sexual debut until they are developmentally capable of engaging in such relationships; and laying the groundwork for a healthy and satisfying adult sexual life.

Reflecting the desire to learn from and with our colleagues, there are four "learning circles" planned. The precise direction of these groups is subject to change, based on the interest of participating colleagues. Tentatively, one will examine questions related to evaluating sexuality education with the hopes of considering the specific methodological challenges and opportunities that arise in addressing evaluation with a greater eye to gender. A second learning circle may focus on the question of whether young men around the world are facing a crisis in their traditional roles, and what that implies regarding teaching about masculinity within sexuality education. A third circle will review and consider research and curricular implications related to the issues of coercion/voluntarism/wantedness in sexual decision-making. A fourth circle may involve sharing resources from cutting edge programs around the world. The expectation is that out of this collaborative process will emerge a shared follow-up plan for widening the dialogue on effective ways to bring lessons about gender into sexuality education.

Authors Note: We welcome correspondence from colleagues interested in discussing these issues, receiving sample copies of interesting curricula or lessons, and learning of relevant studies currently underway. For more information, please contact Michelle Skaer at [e-mail].

Reference:

1. D. Barcelona and L. Laski. "Universal Sexuality Education in Mongolia: Educating Today to Protect Tomorrow." Introduction. Quality/Calidad/Qualite No. 12. (New York, NY: The Population Council, 2002), p. 2.

RELATED ARTICLE: ADDRESSING THE DISPROPORTIONATE BURDEN WOMEN FACE IN THE GLOBAL HIV/AIDS EPIDEMIC

In the international fight against HIV/AIDS, advocates have struggled to bring the needs of women and girls to center stage. In areas where the general population is--or is beginning to be--at high risk of HIV-infection, women and girls suffer disproportionate risk of infection. Advocates say that addressing the vulnerability of women and girls and providing them with appropriate services will not only alleviate the suffering of individual women but also curtail the pandemic at large.

Recognizing that gender inequalities are a linchpin in the HIV/AIDS pandemic, the United Nations Secretary-General's Task Force on Women, Girls and HIV/AIDS in Southern Africa, studied the role of gender in the AIDS crisis in nine countries severely affected: Botswana, Malawi, Mozambique, Swaziland, South Africa, Namibia, Zambia, Lesotho, and Zimbabwe. In its recently released report, Facing the Future Together, the Task Force writes, "Gender inequality fuels HIV infection because many women and girls cannot negotiate safer sex or turn down unwanted sex. The findings also demonstrate that HIV/AIDS deepens and exacerbates women's poverty and inequality because it requires them to do more domestic labour as they care for the sick, the dying, and the orphaned."

The Task Force sets out six areas requiring immediate action: HIV-prevention among girls and young women; girls' education; violence against women and girls; property and inheritance rights; women and girls as care-givers; and access to care and treatment for women and girls. For each area, the report describes the situation in the studied countries and proposes specific ways to address the problems.

For the complete Report of the United Nations Secretary-General's Task Force on Women, Girls and HIV/AIDS in Southern Africa: Facing the Future Together: http://womenandaids.unaids.org/regional/docs/Report%20of%20SG%27%20s%20Task%20Force.pdf.

Eleanor Timreck

Intern, Population Council

New York, NY

The author is an intern at the Population Council program in Gender, Family, and Development. The above article was adapted from a Population Council document by Nicole Haberland and Debbie Rogow.