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Integrating gender and rights into sexuality education: field reports on using It's All One.

Abstract: International policy agreements, along with emerging evidence about factors influencing programme effectiveness, have led to calls for a shift in sexuality education toward an approach that places gender norms and human rights at its heart. Little documentation exists, however, about the degree to which this shift is actually taking place on the ground or what it entails. Field experiences in using new curriculum tools, such as It's All One, offer one lens onto these questions. To gain a sense of practitioners' experience with this tool, a two-part exercise was conducted. First, responses from an on-line survey of It's All One users were synthesized. Additionally, five programmes were selected for documentation, including two school-based programmes (Nigeria, China), two reaching extremely vulnerable youth (Haiti, Guatemala), and one reaching adolescents from a polygamous Mormon community (United States). Findings suggest the shift to an empowerment approach is indeed taking place in diverse geographic and programmatic contexts, and that It's All One has strengthened the ways their programmes address gender, foster young people's critical thinking skills and use interactive teaching methods. A common challenge across many programmes is strengthening teacher capacity. Recommendations for further implementation and research are presented. [c] 2013 Reproductive Health Matters

Keywords: adolescents and young people, gender roles and issues, HIV prevention, sexuality education, China, Guatemala, Haiti, Nigeria, USA

Resume

Les accords politiques internationaux, parallelement aux donnees emergentes sur les facteurs influencant l'efficacite des programmes, ont abouti a des appels pour une reorientation de l'education sexuelle en faveur d'une approche axee sur les normes sexospecifiques et les droits de l'homme. On dispose cependant de peu de documentation sur le degre auquel cette reorientation se produit sur le terrain et quelles en sont les consequences. Les experiences pratiques de l'utilisation de nouveaux outils curriculaires, tels qo'Un seul programme, offrent une perspective sur ces questions. Un exercice en deux parties a ete realise pour connaitre l'experience des praticiens avec cet outil. Premierement, on a fait la synthese des reponses a une enquete en ligne aupres des usagers d'Un seul programme. De plus, cinq programmes ont ete selectionnes pour la documentation, notamment deux programmes scolaires (Nigeria, Chine), deux qui desservaient des jeunes extremement vulnerables (Haiti, Guatemala) et le dernier pour les adolescents d'une communaute mormone polygame (Etats-Unis). Les conclusions suggerent que le passage a une approche d'autonomisation se deroule effectivement dans divers contextes geographiques et programmatiques, et qu'Un seul programme a renforce les fagons dont leurs activites abordent la sexospecificite, favorisent les capacites a la pensee critique des jeunes et utilisent des methodes d'enseignement interactives. Un enjeu commun a beaucoup de programmes est le renforcement des capacites des enseignants. Des recommandations sont presentees sur la poursuite de la mise en oeuvre et de la recherche. Pour demander un exemplaire: www.unseulprogramme.org.

Resumen

Los acuerdos internacionales de polfticas, junto con la evidencia que esta surgiendo respecto a los factores que influyen en la eficacia de los programas, han suscitado un cambio en la educacion sexual hacia un enfoque basado en las normas de genero y los derechos humanos. No obstante, existe poca documentacion que indique hasta que punto esta ocurriendo este cambio en el terreno o que implica. Las experiencias de campo utilizando nuevas herramientas, como Un solo curriculo, ofrecen una mira a estas preguntas. Para adquirir familiaridad con la experiencia de los practicantes con esta herramienta, se llevo a cabo un ejercicio de dos partes. Primero, se sintetizaron las respuestas de una encuesta en Ifnea de los usuarios de Un solo curriculo. Ademas, se seleccionaron cinco programas para la documentacion: dos programas escolares (Nigeria, China), dos dirigidos a jovenes sumamente vulnerables (Haiti, Guatemala) y uno dirigido a adolescentes de una comunidad mormona polfgama (Estados Unidos). Los hallazgos indican que el cambio hacia el enfoque de empoderamiento esta ocurriendo en diversos contextos geograficos y programaticos y que Un solo curriculo ha fortalecido las maneras en que los programas tratan el tema de genero, fomentan las habilidades de pensamiento crftico de la juventud y utilizan metodos didacticos interactivos. Un reto comun en muchos programas es fortalecer la capacidad del profesorado. Se presentan recomendaciones para continuar la implementacion y las investigaciones. Para obtener una copia: www.unsolocurriculo.org.

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The past decade has witnessed a growing demand for a paradigm shift in sexuality education, toward an approach that places gender norms and human rights at its heart. The rationale for this call has been two-fold. First is the precedent in international policy agreements. In calling on governments to provide sexuality education to adolescents, for example, the 1994 International Conference on Population and Development Programme of Action specifies that such education should seek to ameliorate gender inequality, including by teaching young people about gender equality and violence. (1) Second, evidence demonstrates that curricula that foster reflection and critical thinking about gender norms and power in intimate relationships--here referred to as an empowerment approach to sexuality education--are more likely than conventional gender-blind curricula to achieve desired sexual health outcomes. (2)

A small number of organizations have long pioneered gender-focused, rights-based sexuality and HIV education programmes; in recent years, several international agencies and organizations have sought to promote and enable a shift toward this approach at the global level as well. These efforts have involved, for example, development of curricular resources, dissemination of evaluation research, and limited capacity-building.

Little documentation exists, however, about the degree to which a paradigm shift to "empowerment sexuality education" is actually taking place on the ground, whether it is feasible, or what that shift entails. There is a dearth of information on such questions as: Are programme goals remaining focused only on sexual health outcomes or are they encompassing gender equality and/or human rights objectives? What is the uptake of existing technical resources, and how adaptable are these resources proving across culture, programme type, and learner age? What challenges are programmes facing as they attempt to adopt this new approach and how are they addressing those challenges? Are non-governmental organizations (NGOs) partnering effectively with government to help advance the scale-up of empowerment approaches to sexuality education in public schools?

One lens onto these questions is to examine field experiences in using new resources such as It's All One Curriculum. (3) * It's All One is a practical tool created to help curriculum developers and educators integrate a gender perspective, a human rights focus, and critical-thinking teaching methods into sexuality and HIV education. (It is not a curriculum per se.) It was developed by a working group comprised of three international NGOs (Population Council, IPPF, and International Women's Health Coalition); one regional NGO (IPPF/Western Hemisphere Region); and three country-based NGOs (Girls Power Initiative/Nigeria, CREA/India, and Mexfam/Mexico).

The first volume in this two-book set includes flexible teaching content, along with an evidence-based policy introduction, learning objectives, critical-thinking questions, and fact sheets; Volume 2 includes guidance for interactive, learner-centred teaching approaches, 54 sample activities, and a list of free downloadable resources. It is available in English, Spanish, French, Bangla, and Chinese; an Arabic adaptation is under development. To date, the Population Council has sent 12,000 copies of It's All One around the world; in addition, thousands of copies have been downloaded from various sites where it is available. [dagger] While the Population Council receives frequent feedback from users, no effort to collect and synthesize practitioner experience with this resource had been conducted. The lack of such evidence has hindered efforts to build on successes, identify challenges, and refine priorities for further progress.

This paper reports on an effort to gather and analyse practitioners' experiences using It's All One in diverse contexts, as a way to explore the acceptability, feasibility, and challenges faced by programmes implementing empowerment sexuality education. It also explores whether programmes using this approach are seeking to affect non-health outcomes.

Methods

This exercise had two components. First, the results of an on-line user survey of a subset of individuals who had received It's All One were synthesized. The survey, sent by email with a link to a SurveyMonkey site, was sent to 2,597 individuals who had received a hard copy or CD-Rom of It's All One, generally in response to an online request, and optionally provided their email address. ** The survey asked a series of questions about whether, how and with what objectives respondents were using It's All One\ whether and how widely they had shared this resource; what aspects of it they found most and least useful; and whether they had additional needs for capacity-building or adaptations (e.g., in other languages or for specific populations). Most questions were multiple-choice; several included optional fields for further comments. In addition to generating knowledge about user experience, the survey aimed to help identify programmes for the second component of this exercise, a series of brief case studies.

The case study component involved documenting five programmes that are implementing innovative empowerment approaches to sexuality education. Programmes for possible documentation were initially identified through the survey, donor agencies, presentations at professional meetings, and informal networking. Data on these programme experiences were gathered by in-person interviews, review of written materials and presentations, email, and telephone interviews. Final programme selection placed some emphasis on: 1) partnerships between government and NGOs (or universities) to strengthen school-based sexuality education; 2) NGOs emerging as resources at the national level; and 3) community-based programmes serving hard-to-reach, highly vulnerable youth. Other criteria included geographic and cultural diversity, programme insights and expressed interest in collaborating on a case study. The leaders of five programmes were then invited to co-author brief field reports.

Several caveats are noted. First, this exercise was designed to be illustrative, rather than a representative study, and for those individuals who had volunteered an email (e.g. individuals from NGOs were more likely to provide an email than those from governments), responding was optional. Second, it was undertaken as a learning exercise by the organization that published It's All One, rather than by an external evaluator. Finally, while young people's perspectives were incorporated to different degrees in the case studies, the survey was aimed at the user audience for It's All One, that is, curriculum developers and educators. Nevertheless, the responses give a sense of new work taking place on the ground in diverse settings.

Survey findings

The survey generated 423 responses (response rate of 9.6%). Asked to identify the sectors in which they work (multiple responses permitted), the majority of respondents identified the education sector, followed by health, youth, women and girls, government, and international agency. Geographically, the largest proportions were from developed countries and sub-Saharan Africa, although responses were received from every region in the world.

Respondents reported that their main purpose for using It's All One is for developing or adapting a curriculum. Another question (with multiple responses permitted) asked how use of It's All One had strengthened respondents' curriculum or programme. The most common responses were: to address gender (107 respondents), to foster young people's critical thinking skills (97), and to use interactive teaching methods/activities (96). In a similar question, the three aspects users liked best about It's All One were, in order of frequency mentioned, that it: promotes dignity, respect and gender equality (300); is practical and user-friendly (241); and fosters young people's critical thinking skills (233). The responses to these last two questions suggest that programmes are targeting the achievement of gender equality, human rights and critical thinking skills as ends in themselves.

A key concern was to learn what users liked least about It's All One. To this end, the survey included an open-ended question, which generated 91 complaints and 66 other comments. By far the main concern related to the shipping of the books: fully 65 respondents, virtually all in developing countries, reported that the books had never arrived. Among those who did receive the set, the single main complaint (9 respondents) was that it was too heavy/bulky. Thirteen comments about the substance of It's All One were received; these addressed the need for adaptation for use in a specific setting, the desire for more (or less) detail, or an uneven response to one or more activities. Two respondents requested supplementary digital adaptations and new media components, and two indicated confusion about whether It's All One was a resource for curriculum development or a curriculum per se. In addition, two respondents expressed doubts about teachers' capacity to apply the content. The other 66 responses we received were praise and positive feedback (e.g. "Nothing we like least; it's very helpful!").

Asked about their ongoing needs, large numbers of respondents identified a need for further training (especially on interactive teaching methods that promote critical thinking and on teaching young people advocacy skills); a version of It's All One specifically adapted for teaching younger adolescents; an It's All One-based, ready-to-use curriculum of shorter length (the multiple choice option indicated "about 15 hours", falling into the range of many widely used curricula); and/or translations into additional languages.

Field reports

Of great interest was the finding, from both the survey and related correspondence, that many respondents are pioneering empowerment approaches to sexuality education in a wide range of programmatic and geographic contexts, using both It's All One and other resources. A very small sampling of these efforts includes:

* School-based HIV and sexuality education (Nigeria, China, USA)

** A large but unknown number of users thus did not receive the survey, including those who had downloaded It's All One from a website, or acquired a hard copy or CD Rom from partner organizations also disseminating copies, or who had not provided an email address.

* School-based gender and puberty education for pre-adolescents (Pakistan, USA)

* Design of national curriculum framework (Uganda, Turkmenistan)

* National curriculum assessment (multiple countries in East and Southern Africa)

* Education in large-scale/national community youth groups (Mexico, Nicaragua, Colombia, Guatemala)

* Community-based programmes for highly vulnerable youth (street children in Indonesia, internally-migrating Tibetans in China, HIVpositive youth in Haiti, Muslim orphans in Burma, runaways and juvenile offenders from a fundamentalist polygamous community in the USA)

* Research (intervention study for internally displaced women in Haiti; randomized trial among adolescents in Bangladesh).

Five case examples were selected by the authors, based on the criteria described above. The following reports describe the background, responses, challenges and future plans of two programmes that are school-based (Nigeria, China); two reaching extremely vulnerable youth and emerging as resources nationally (Haiti and Guatemala); and one serving adolescents from a polygamous Mormon community (United States).

Nigeria: strengthening the national curriculum during state-level implementation by Grace Osakue, Girls Power Initiative (GPI)

Background

Since 2000, the Nigerian government has been gradually scaling up a Family Life and HIV Education (FLHE) programme, with the content infused across four subjects - social studies, basic science, home economics, and physical/health education. State Ministries of Education (MOE) are charged with adapting the curriculum to fit local cultural circumstances and implementing it in every upper primary, junior, and senior secondary school. In most states, a local NGO has served as a technical partner to the State MOE, developing the curricular framework ("scheme of work"), training master trainers and teachers, and assisting with monitoring, as well as conducting community advocacy to build political support.

Response

In Edo State (and three other states), the key NGO partner was Girls Power Initiative (GPI). Our first step was to strengthen the national teacher-training curriculum specifically to:

* More effectively address the challenges specific to children in the state, such as forms of gender-based violence and societal tolerance of such violence;

* Increase teachers' understanding of the rationale for this wider approach and promote their commitment to implementing the FLHE curriculum;

* Improve teachers' ability to engage students' critical thinking and reasoning skills; and

* Address teachers' need for more substantive detail and sample activities.

To make these modifications, we drew primarily from GPI's Comprehensive Sexuality Education Curriculum and from It's All One Curriculum (which we had co-authored).

The Ministry of Education invited each public junior secondary school to nominate one social studies and one basic science teacher to be trained as master teachers. Between April 2009 and March 2012, we trained 508 master teachers, each of whom would have responsibility for training other teachers in their school.

The training was evaluated in several ways. Trainees completed pre-tests and post-tests of knowledge and attitudes. As part of the training, they also had to complete a school-based practicum under observation. In addition, teachers reflected verbally on their changing attitudes during the workshop. The findings suggest meaningful positive changes not only in teachers' knowledge, but also in their attitudes about their work, children, and gender norms. In addition, we conducted on-going monitoring, visiting the schools to conduct classroom observation one year after the training, and give feedback as needed.

In 2011, we conducted a more in-depth evaluation exercise involving 51 randomly selected schools. Sixty-one teachers instructing 4,337 students were observed and interviewed. The results indicated a wide range in the degree to which the teachers were integrating the FLHE content into their course. The main reasons given by those who were not teaching the FLHE content were; 1) that the FLHE content was not subject to examination; 2) a lack of textbooks from which to develop their lesson plans.

Successful advocacy remedied these problems. The FLHE topics are now part of the examinable content for the carrier subjects. In addition, teachers have received It's All One and are now relying on the supportive detail from this resource and weaving selected activities into their lesson plans. For example, students learn to critically analyse how unsafe sex is often the result of gender norms that lead boys to prove they are "macho" or girls to '"prove their love".

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GPI's partnership with the Ministry has led to other benefits as well. Teachers are also using It's All One and their new skills in their teaching of topics outside of FLHE, for example, in civic education. In addition, in modifying the curriculum, the State expanded the goals beyond reducing HIV/AIDS to also include prevention of child trafficking, as a result of which the Edo State Junior Secondary Schools Curriculum now includes modules on migration and human trafficking.

Challenges

Currently, key challenges include the shortage of materials for both teachers and students, difficulties using participatory teaching methods effectively in overcrowded classrooms, and attitudes that have been slow to change among some teachers--especially their discomfort about sexuality and failure to adopt values of gender equality. All of these factors impede the effective teaching of the FLHE content. Additional concerns include the absence of youth-friendly health services in many communities to respond to the increased demand generated by FLHE, a cut (mandated at the national level) in the duration of teacher training from ten to four days, and the unmet need for refresher training to improve teacher performance. However, the strong partnership between the State government and a feminist NGO (GPI) is making a difference for teachers and students, and empowering children across Edo State.

Haiti: rights, gender and hope for HIV-positive young people by Michelle Skaer, The Caris Foundation

Background

The Caris Foundation works to address paediatric HIV, in partnership with Haiti's Ministry of Public Health and Population and local hospitals. Although the original scope of this work was to identify, diagnose, and treat early infant HIV, Caris coordinators were encountering increasing numbers of adolescents living with HIV and AIDS at the hospital paediatric units. These coordinators saw that the adolescents were struggling with taking their medication and were not always returning to the hospital for their appointments. They also understood that these young people faced complex obstacles to medication adherence. For example, one boy explained that his family often could not afford food, and taking his medications on an empty stomach led to nausea. Others were struggling psychologically with living with HIV.

Response

The Caris Foundation decided to start clubs for adolescents. In contrast to traditional HIV support groups, which were narrowly focused on encouraging adherence to medication, Caris staff had a broader vision. In order to take care of themselves, these young people needed social support and solidarity, as well as a safe space to reflect on their hopes and worries, wrestle with practicalities of self-care, and explore notions of sexuality, fairness, equality, and basic human rights in their own lives. Hence, the goals of these clubs were for participants to improve their emotional and physical well-being, including their compliance with ARV treatment; increase their agency and sense of citizenship; adopt more egalitarian gender norms; and avoid high-risk sexual behaviour.

A conventional sex education and HIV curriculum would have missed the point. Instead, the Caris Foundation drew on It's All One, which was sensitive to these young people's health needs, while also addressing a range of topics affecting their well-being. For example, activities about human rights and gender--which were missing from other curricula--were included. Coordinators translated selected content into Creole, and added modules on positive everyday experiences and on the importance of taking medication regularly (including from My Living Positively Handbook). (7)

Six clubs have now been established at hospitals in Cap Haitian, Jeremie, and Port-au-Prince. The numbers currently served are tiny--approximately 90 participants--but they are among the most vulnerable youth in the country and also a critical population in terms of preventing the spread of HIV. The clubs meet every month for 2.5 hours at the hospital. The Caris Foundation supports transportation costs of participants to attend the clubs and provides meals; some hospitals also provide overnight housing for participants who come from three hours or more away.

Part of the facilitators' job is to be a caring role model. Often, young people arrive at the club having just learned their HIV status. Many participants did not know why they had been taking medicine all their lives until Caris advocated with the hospital staff and families for young people's right to be informed of their HIV status. It's All One helps facilitators respond to the daunting emotional needs of these vulnerable young people; for example, activities engage participants in writing stories exploring difficult feelings. Caris also pays for a part-time psychologist to help participants address their emotional burden.

In general, however, the coordinators focus on the positive and use various creative methods. For example, in one activity, the participants draw a picture explaining the importance of taking one's medicine. One child drew a chicken pecking for corn, explaining that that is what it feels like in his stomach when he takes his medicine; another drew a car saying that medicine is like gas for the car. The clubs also include trust-building activities, physical exercise and songs, as it takes new participants time before they are ready to share their experiences and struggles.

Challenges

An early difficulty was identifying good facilitators who were invested in the participants, motivated, and understood the topics we wanted to address. Indeed, Caris had to replace some of the initial facilitators. In general, those with a background in social work or psychology were better equipped than medical personnel to lead these groups. However, in a setting characterized by poverty and lack of infrastructure, finding the right facilitators was not easy.

Another complicated task is helping older adolescents think about their sexual lives. Like all adolescents, these participants are influenced by prevailing gender norms. Working with a group of boys, coordinators did the Word Web activity from It's All One. At first, they immediately characterized certain tasks as strictly male or female. Gradually, many of the boys acknowledged that they often perform what they had labelled girls' work, like making a beef broth. The discussion led them to realize that girls could also do the tasks they thought of as male, and that gender roles are taught, rather than innate.

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Applying a rights-based approach is also complex; different "inalienable rights" bump into each other. These adolescents have a right to be protected from the discrimination they would suffer if they disclose their HIV status. But as they become sexually active, questions arise about the rights of their partners to protect their health. Is it enough to say always plan to use condoms? Or does someone have a right to know if his or her sexual partner is HIV positive? These questions are posed in It's All One in thoughtful ways that can guide facilitators to honour the feelings and vulnerability of the participants while helping them to think about prevention.

Looking forward

Caris is taking steps to establish a partnership with--and contribute curricula to--a network of groups working with vulnerable adolescent girls across the country. In the meantime, the clubs are gradually scaling up. Caris hopes to reach every adolescent living with HIV in Haiti.

A gender-sensitive, critical thinking curriculum in China: testing outcomes by Zhihong Sa, Beijing Normal University

Background

In China, as elsewhere, prevailing gender stereotypes and sexual double standards affect adolescents' sexual attitudes and behaviour. Silence about sexuality and negative attitudes about homosexuality are also still dominant. However, sex education in the country neglects these issues.

Response

Researchers from the School of Social Development and Public Policy at Beijing Normal University piloted a gender-sensitive sex education intervention in six high and vocational schools in Beijing (both rural and urban) and urban Lanzhou in northwest China to address these gaps. The objectives were to:

* Increase students' gender-sensitivity and critical thinking skills, and change their sex-related knowledge, attitudes and behaviours;

* Change teachers' attitudes and improve their teaching skills;

* Provide evidence-based policy recommendations for the promotion of comprehensive sexuality education.

Major parts of It's All One Curriculum were translated and adapted into a 12-session training course for students, covering the following topics:

* Puberty, body image and respect for differences

* Gender (2 sessions)

* Love and relationships

* Sexuality

* Sexual double standard

* Communication and decision-making skills (3 sessions)

* Sexual and reproductive health (2 sessions)

* Life planning.

A key part of the project was sensitizing approximately 30 teachers in selected high and vocational schools in Beijing and Lanzhou about gender and sexual rights issues. A quasi-experimental school-based intervention was then carried out among about 1,500 high and vocational school students (average age 16) in various sites. Outcomes for students were assessed through surveys and focus group discussions. Survey results showed:

* Positive changes among both boys and girls in sex-related knowledge and attitudes about gender and sexual rights, including reduced tolerance of a double standard (regarding contraceptive use, pre-marital virginity, multiple partners), and of forced sex, compared to those in the control group;

* Fewer stereotypical attitudes towards gender roles among boys in the intervention group;

* Better self-efficacy for postponing sexual initiation and negotiating condoms among girls in the intervention group.

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The experience was assessed through classroom observation and through focus groups with teachers. Findings showed that through participating in the intervention, teachers developed greater gender sensitivity, increased ability for critical thinking, and improved skills in participatory and interactive teaching. Among their comments were the following:

"At first I didn't quite understand the linkage between gender and sexuality. After the training and two rounds of teaching, I now understand gender is an important part of sex education. I feel it should also be integrated into other school subjects."

"I became more aware of gender inequalities in society and in intimate relationships ... I've also learned to understand and interact with students in class on these issues."

Overall, the intervention was well received by students, teachers, and school administrators. Notably, after the close of the study, most intervention schools have turned the experimental curriculum into a regular class.

Challenges

Although many teachers reported positive changes about gender and sexuality norms, some continued to exhibit gender stereotypical and discriminatory attitudes. In one class, for example, an activity about the double standard of sexual activity turned out to promote pre marital virginity among girls. Some teachers also tended to reinforce stereotypes and stigma about homosexuality, as evidenced by the following comment:

"I told students that sexual identity is one's own choice, but I also told them that if one chooses to be homosexual s/he will face a lot of problems in future life."

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The key challenge, therefore, is selecting and training teachers, especially to develop training materials and teacher training programmes for disadvantaged rural and vocational schools.

Looking forward Current plans are to:

* Revise and expand our guidebook for high and vocational school teachers;

* Develop teacher training programmes based on the content of the revised guidebook;

* Develop and implement larger-scale intervention programmes that are tailored for the needs of students in rural areas and in vocational schools;

* Combine peer education with the current school-based intervention.

Guatemala: empowering rural indigenous girls by Angel Del Valle, Population Council

Background

By the age of 17, over 60% of rural indigenous girls in Guatemala are out of school and at risk of early marriage and adolescent pregnancy. (8) To get ahead of that curve, the Abriendo Oportunidades (Opening Opportunities) programme works with girls ages 8 to 17 to build their assets and skills. The programme locates safe spaces within communities and establishes girl-only clubs that meet weekly, for girls in school (aged 8-12) and out of school (aged 13-17). *

The format of the Abriendo programme involves four meetings each month. Weeks 1 and 2 focus on content, week 3 is recreational, and week 4 is skill-building. Mentors provide on-going training to local girl leaders who then mentor young girls, using a sexuality education and reproductive health curriculum. During the first five years, our curriculum guide was periodically revised. However, by 2010, we realized that our approach was not comprehensive enough to address the challenges girls faced at the community level, in particular, with courtship violence and unwanted sex.

Response

We used It's All One as a tool to feed new content into the curriculum guide, especially in the areas of sexuality, reproductive health, gender norms, and gender-based violence. With the help of an education consultant, girl leaders field-tested the material with both age groups. It took two years to complete and validate the new curriculum guide. Currently, the eight thematic areas of the programme are personal empowerment, community impact, health, sexual and reproductive health, finance education, violence prevention, and gender.

The process of revising and testing the curriculum guide was fascinating. For example, the previous guide assumed that girls knew what we were talking about when we said "human rights", but the validation process proved us wrong. We asked girls: "What are some of your basic rights?" While some basic rights--to participate, to speak up to local authorities, and to organize themselves--came up, other rights--to study, to health or to safety--were not mentioned at all.

So we tried an activity in It's All One that begins by asking a group to imagine what rights they would establish if they were settling a community on a new island. The girls identified the right to shoes. We thus realized that by being more concrete, this approach did not assume that the girls' priorities were necessarily the same things that facilitators and programme managers were thinking. By allowing the girls to start where they were, it opened a door for them to think critically and discuss their needs.

We also found ways to make pedagogical training more useful and comprehensible for

the girl leaders. For example, the curriculum guide includes learning objectives within the three formal domains of learning: cognitive (knowledge-based), affective (attitudes), and skills. To teach the girl leaders how to read the curriculum guide, we use more concrete signifiers for the domains of learning. Instead of cognitive, we refer to learning with the Mind; affective learning we call learning with the Heart; skill-based learning we refer to as learning with the Hands and Feet. This simple tool enables girl leaders to distinguish information from feelings and actions when interacting with girls. By adapting It's All One to the rural indigenous context and validating it with local girls, our girl leaders are now comfortable with the teaching process and the participating girls understand the sessions and activities.

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Challenges

Girl leaders from the Abriendo Oportunidades programme are adolescents between the ages of 14 and 17; they are not teachers and most of them have not participated in any kind of teaching or training before joining the programme. With the new design of the curricular guide, efforts to assess the quality of teaching need to be put in place to make sure that girls have no problems following the lessons. We also had a learning curve in terms of identifying the qualities needed for adult facilitators and hiring those staff.

Looking forward

Abriendo Oportunidades has already reached over 6,000 girls in more than 50 rural indigenous communities and trained over 100 girl leaders since 2004. Based on this experience, we are now in discussions about contributing comprehensive content that can add value to the national school-based curriculum in Guatemala.

Talking about coercion, gender, and sexuality with adolescents from fundamentalist, polygamous communities (United States) by Nicole Lee, Planned Parenthood of Utah

Background

When discussing polygamy within contemporary religious fundamentalism, few people picture the United States. Indeed, polygamy was outlawed in the US in 1862 and rejected 30 years later by its leading domestic practitioners, the Church of the Latter Day Saints (Mormons). Nevertheless, breakaway fundamentalist Mormon sects have continued the practice, which also often entails forced early marriage of girls to older men. Scholars have estimated the number of fundamentalist Mormons who continue to practice polygamy in North America as ranging from 8,000 to less than 30,000; (9) however, because the practice is generally surreptitious, estimates are not considered reliable.

Some individuals, particularly young people, exit the sect, either of their own volition or because of expulsion; a 2012 report estimated that between 2004-2012, some 750 young people left a particular sect along the border of the states of Utah and Arizona. (10) These young people face ostracism, isolation, and a lack of information and services, including about their sexuality and reproductive health.

Response

An agency providing social services to these youth asked Planned Parenthood Association of Utah (PPAU) to offer educational sessions. A facilitator from PPAU taught several sessions of a puberty education curriculum to children and younger adolescents. The agency subsequently requested additional workshops in a "Transition to Adulthood" series for boys and girls aged 15-18. These latter workshops lasted about two months.

PPAU approached this task with the perspective that reproductive health, sexuality, gender norms, and power are tied together in countless ways. There was also the understanding that these adolescents had gone through a lot, and were in varying stages of rejecting many of the teachings that had defined them. For example, boys talked about having learned that women are snakes and that childbirth should be painful. To open up reflection and discussion, the facilitator asked the participants about their views on sexuality, relationships, body image, and about having a happy and healthy adult life. To explore the notion of choice and coercion existing along a spectrum, PPAU adapted an activity from It's All One Curriculum, inserting examples that these adolescents were likely to have witnessed, given their background.

This activity proved liberating; It gave the participants a framework and skills to think and talk about how power and gender operate in the patriarchal religious context they grew up in. They explained that a man can reach the highest level of "celestial glory" on his own, but a woman can reach this state only if she is attached to a "worthy" man. Because challenging male authority could result in a woman losing her children and the attachment that is her only possible ticket to celestial glory, their mothers were afraid to cross their fathers. The adolescents themselves characterized this pattern as spiritual coercion, that is, as using spiritual life to reinforce power inequalities. PPAU's role was not to judge, only to follow carefully their lines of thought. As it happens, they developed their own analysis far more quickly than we had anticipated.

Using the participants' own language and ideas as a starting point, the group began to talk about spiritual coercion as a form of violence, and after that, about other forms of violence, including physical violence. The discussions further explored what the participants wanted in a relationship. Because there was a sense that some young people who had fled the sect were encountering difficulty living without strict rules, the discussion also covered how to develop boundaries for oneself, including to avoid sexually transmitted infections and unintended pregnancy.

PPAU learned that, like many young people, these youth had paradoxical experiences. They had no knowledge about sexual health, yet many of them had witnessed natural childbirth at home. They grew up in a culture steeped in gender inequality, yet they tended to feel more loyalty to their mothers than to their fathers (who, through their other wives, had numerous other children). For most of their lives, they had learned not to question, yet were actively engaging in critical thought and personal reflection about their life experiences.

Challenges

Given the particular circumstances, it was essential to adopt an approach outside of typical sexuality education. It was also essential for the PPAU facilitator first to develop her own awareness and sensitivity, so that she could work with these young people (whose own views were diverse and often evolving) in a way that was respectful, compassionate, and nonjudgmental. Another challenge is that while these adolescents are highly vulnerable, their numbers are small (typically, the groups included 12 or fewer young people), which has implications for staffing.

Looking forward

This experience taught PPAU a great deal about the possibilities that emerge from meshing a gender perspective on sexuality and power with a deep respect for every human being. PPAU is now better equipped to serve young people in this and similar conservative settings.

Conclusion

Recent evidence that empowerment approaches to sexuality education lead to better sexual health outcomes raised questions about whether a shift toward this approach is feasible, what is entailed in implementing this new approach and, about the acceptability of affordable tools to help effect such a paradigm shift. The results of our survey and reports from work on the ground suggest that many programmes are seeking to promote gender equality, human rights, and critical thinking skills, along with improving sexual health outcomes. Moreover, this shift is taking place in a highly diverse set of geographic and programmatic contexts.

Users report that global resources like It's All One can and do contribute in meaningful ways to this shift. However, users register the need for dissemination that is wider and more efficient. Additionally, while many curriculum developers and educators want hard copies, some users would like to see a wider range of convenient formats and platforms.

More broadly, documentation of programme examples indicates that a key remaining challenge across many programmes is teacher preparedness. In formal education settings, teachers may be arbitrarily assigned to teach sexuality education and often lack knowledge and attitudes needed for becoming effective sexuality educators. Despite the significant systemic challenges that teacher training poses, the investment in teacher training may have wider benefits for pedagogy and for gender equality in the learning environment.

There are some promising advances. Both UNFPA and UNESCO are investing in advancing a shift to gender-focused, rights-based sexuality education. A number of programmes are also exploring new media approaches to expand the reach of empowerment approaches. For example, Mexfam has been exploring the potential for a web-based teacher training programme based on It's All One. The Population Council is adapting It's All One for new media such as web-based games. Other agencies and organizations are also innovating along similar lines.

A number of recommendations emerge from this field assessment. First, policymakers and evaluation researchers may wish to incorporate gender equality and human rights outcomes more explicitly into programme goals and evaluation indicators. Second, further interventions to improve and assess teacher skill are needed to ensure that investments in curriculum content pay off for adolescent learners. Third, the potential benefits of such training for education overall--strengthening teachers'pedagogic skills with critical thinking pedagogic methods and fostering their belief in gender equality--need to be better understood. Fourth, research can document and analyze how partnerships between NGOs and governments can most effectively advance the quality and reach of sexuality education. Finally, materials like It's All One still need to be disseminated more widely, in local languages, to the extent possible.

DOI: 10.1016/S0968-8080(13)41699-3

Acknowledgements

The authors wish to acknowledge the International Women's Health Coalition for support in developing the China, Guatemala, and Nigeria case studies.

References

(1.) United Nations. Resolution adopted by the General Assembly. (ICPD+5). A/RES/S-21/2; Para 35(b). New York: UN; 8 November 1999.

(2.) Haberland N. What happens when programs emphasize gender? A review of the evaluation research. Presentation at Global Technical Consultation on Comprehensive Sexuality Education, Bogota, 30 November-2 December 2010.

(3.) International Sexuality and HIV Curriculum Working Group. It's All One Curriculum: Guidelines and Activities for a Unified Approach to Sexuality, Gender, HIV, and Human Rights Education. Haberland N, Rogow D, editors. New York: Population Council; 2009 and 2011. www.itsallone.org.

(4.) International Planned Parenthood Federation. IPPF Framework for Comprehensive Sexuality Education. London: IPPF; 2006 and 2010. http://ippf.org/resources/publications/ ippf-framework-comprehensive-sexuality-education.

(5.) United Nations Educational, Scientific and Cultural Organization. International Technical Guidance for Sexual Education. Vol.1 and 2. Paris: UNESCO; 2009.

(6.) WHO Regional Office for Europe and Federal Center for Health Education of Germany (BZgA). Standards for Sexuality Education in Europe: A framework for policy makers, educational and health authorities and specialists. Cologne: BZgA; 2010.

(7.) Children's Rights Centre. My Living Positively Handbook. Johannesburg: Jacana Media; 2006. http://childrensrights. org.za/index.php/resources/publications/by-crc.

(8.) United Nations Development Programme. Guatemala: ?Un pais de oportunidades para la juventud? Informe nacional de desarrollo humano 2011/2012. Guatemala. Programa de las Naciones Unidas para el Desarrollo; 2012.

(9.) Driggs K. Twentieth-century polygamy and fundamentalist Mormons in southern Utah. Dialogue: A Journal of Mormon Thought 1991; Winter:46-47.

(10.) Whitehurst L. First study of people who leave FLDS polygamous sect shows struggle. Salt Lake Tribune. 16 June 2012.

* This issue of RHM includes another paper, by Wehr and Turn, about the Abriendo Oportunidades programme, pp.136-42.

Deborah Rogow, (a) Nicole Haberland, (b) Angel Del Valle, (c) Nicole Lee, (d) Grace Osakue, (e) Zhihong Sa, (f) Michelle Skaer (g)

(a) Consultant, Santa Barbara, CA, USA. Correspondence: deborah.rogow@gmail.com

(b) Associate, Population Council, New York, NY, USA

(c) Monitoring and Evaluation Specialist, Population Council, Guatemala City, Guatemala

(d) Community Educator. Planned Parenthood Association of Utah, St. George, Utah USA

(e) Co-Director, Girls Power Initiative, Benin City, Edo State, Nigeria

(f) Associate Professor, School of Social Development & Public Policy, Beijing Normal University, Beijing, China

(g) Technical Coordinator, Caris Foundation International, Jeremie, Grand'Anse, Haiti

* Curricular guides have also been developed by International Planned Parenthood Federation (IPPF), (4) UNESCO, (5) and WFIO Regional Office for Europe. (6)

([dagger](It's All One is available for free (hard copy or download) at: www.itsallone.org. It was reviewed in RHM 2010:18(36) www.rhm-elsevier.com/article/S0968-8080(10)36522-0/pdf.
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Author:Rogow, Deborah; Haberland, Nicole; Del Valle, Angel; Lee, Nicole; Osakue, Grace; Sa, Zhihong; Skaer,
Publication:Reproductive Health Matters
Article Type:Report
Date:May 1, 2013
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