Let’s Talk About Sex

By: Ditte Lystbæk Andreasen and Sophie Lauridsen

Why Talk About Sex ?

As mentioned in the first article of this blog, Millennium Development Goal (MDG) 5  has made less progress then the other health related MDG’s. Within MDG 5, goal 5B is universal access to reproductive health, which is why we would like to stress the importance of sexual and reproductive health education in this Blog edition.

By educating people on SRH there are a number of benefits including reducing the spread of sexual transmitted diseases (STD), and preventing unwanted pregnancies. In addition to this the WHO estimates that if the need for and use of effective contraception methods, were met worldwide the number of maternal deaths could be cut by almost a third. It therefore seems important that there is universal access to SRH, of which, in our opinion, the education component is an essential part.

Diagram 1

Personal perspectives from Tanzania, Uganda and Denmark 

We are two persons writing this post; one of us has experience from SRH education in Tanzania and Uganda and the other in Denmark. While discussing these experiences we found that the problems within SRH education seemed remarkably similar in the countries.

Young people are especially at risk of problems related to SRH (UNAIDS). Forth global report on the global AIDS epidemic: Focus on HIV and Young People: The Threat For Todays Youth), which is why it is important that the youth has the adequate knowledge on SHR.

Within the last decade there has been an increase in the amount of STD´s in Denmark. In Tanzania and Uganda there are also problems regarding STD’s, early sexual debut, high prevalence of teenage pregnancy and illegal abortions (Skolnik, 2012). Teenage pregnancy can lead to school dropout which greatly impacts the girls’ future life. Therefore, from our experience we see it as important that there is a greater focus on SHR education in all three countries.

So why don’t we talk more about safe sex? 

The experience from Tanzania is based on fieldwork in a project organised by IMCC Danzania. This is a group under the NGO; International Medical Cooperation Committee (IMCC). The project concerns SRH education in rural secondary schools in Tanzania. The SRH education is provided by Tanzanian medical students and is delivered in two-hour sessions five times in the school classes. We found there was lack of knowledge on SRH and in some cases a wrong perception. As an example one of the students thought that masturbation would make you blind, another that shaking hands with a person who had HIV would transfer the disease. The level of knowledge seemed to be different from rural to urban areas, with the youth in urban areas having a wider understanding of SRH.

So why can’t we reach the whole population?

We cannot ignore the fact that lack of resources and resource allocation for health in low income countries has an effect on the quality and quantity of SRH related education. There is a lack of health care professionals in the health care system in Tanzania (Skolnik, 2012), which gives them less chance to provide SRH education. There are also religious barriers, and resistance on SRH-education from the school, the family, and the general opinion in the population. This comes from a fear that SRH-education will lead to promiscuity, a fear that is not only specific for Tanzania, but other countries as well.

Diagram 2

In Denmark the experience is from working with “Sexekspressen” which is also a group under IMCC. Sexekspressen offers a service where two health students visit a class (7th-10th grade) or a youth organization, and teach about STD’s, contraception and relationships for 6-8 hours over one day per class. From our own experience the level of knowledge seemed to vary a lot even within the same school, with questions from the students varying from; ‘can you become pregnant by swimming in the same pool as a boy?’ To, ‘what is the normal amount of porn to see per day?’

We see a big problem in the level of knowledge there seems to be between different classes. Denmark is a country where SRH-education is mandatory, but it is unknown if it is really implemented in the curriculum. Clearly from our experiences the quality and quantity of SRH education is insufficient. In addition to this we only know of the classes where the school is willing to pay for our service. So what about all the other schools in the country?

Diagram 3

It is equally not only in the youth that there seems to be a need for more SRH-education and more adequate education. On a fieldtrip to Uganda the experience was that knowledge on SRH was also insufficient. An organisation called Dialogos was teaching a group of women about family planning. They demonstrated how to put on a condom, illustrating this with the use of a broomstick. The women then went home and put the condom on the broomstick and about eight month later, when they gathered again, some of them where pregnant. In this case we see a barrier in communication between the care professionals and the women. This barrier arises when the health care professional expects a basic knowledge in SRH that is actually lacking.

From the above examples it is our experience that there is a need for NGO´s to educate the population in SRH in all three countries due to a lack of knowledge on SHR, but of course this is not a sustainable solution, it needs to be implemented in each countries policies.

The bottom line

In spite of difference in barriers in the three countries compared in this blog, there are also similarities, such as the lack of knowledge, probably resulting from lack of SRH education. If this was given in an adequate way in these countries, and in all other countries as well, it might help bring down the disease burden related to SHR, and bring us one step closer to achieve the MDG5. We hope our organisations, and other NGOs around the world have an impact on the problems we have stressed in this article.

So let’s talk about sex.

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