Exploring comprehensive sexuality education experiences and barriers among students, teachers and principals in Nepal: a qualitative study.
Adolescents
Comprehensive sexuality education
Nepal
School
Sexual health
Journal
Reproductive health
ISSN: 1742-4755
Titre abrégé: Reprod Health
Pays: England
ID NLM: 101224380
Informations de publication
Date de publication:
11 Sep 2024
11 Sep 2024
Historique:
received:
08
07
2024
accepted:
03
09
2024
medline:
11
9
2024
pubmed:
11
9
2024
entrez:
10
9
2024
Statut:
epublish
Résumé
Comprehensive sexuality education (CSE) is essential in empowering adolescents with the knowledge and confidence to manage their sexual and reproductive health. Despite its recognized benefits, access to quality CSE remains limited, especially in low-income countries, where societal norms and structural barriers hinder effective delivery. The aim of this study is to investigate the experiences and perceptions among students, teachers, and principals in Nepal about comprehensive sexuality education. Qualitative methods were used. 13 Semi-structured interviews and 1 focus group discussion were carried out with 15 teachers and principals working at higher secondary schools and two focus group discussions were conducted with a total of 13 adolescents. Thematic analysis was used to analyze the data. Four themes were developed: Resistance to Teaching and Learning, Preparation and Engagement Strategies, Taboos and Silencing and Structural Barriers. Students, teachers, principals and students reported discomfort and embarrassment when discussing sensitive topics, with gender dynamics playing a significant role. Strategies like warm-up sessions and continuous interaction with students and parents were used to create a supportive learning environment. However, socio-cultural barriers and family attitudes continued to hinder open discussions about sexuality. Structural barriers, including the lack of formal training for teachers and inadequate instructional materials, further impeded effective CSE delivery. The experiences of CSE in Nepal among students, teachers and principals highlight significant barriers including cultural taboos, gender dynamics and insufficient resources. Addressing these barriers through comprehensive teacher training, curriculum reform, and societal engagement is critical to ensure access to CSE.
Sections du résumé
BACKGROUND
BACKGROUND
Comprehensive sexuality education (CSE) is essential in empowering adolescents with the knowledge and confidence to manage their sexual and reproductive health. Despite its recognized benefits, access to quality CSE remains limited, especially in low-income countries, where societal norms and structural barriers hinder effective delivery. The aim of this study is to investigate the experiences and perceptions among students, teachers, and principals in Nepal about comprehensive sexuality education.
METHODS
METHODS
Qualitative methods were used. 13 Semi-structured interviews and 1 focus group discussion were carried out with 15 teachers and principals working at higher secondary schools and two focus group discussions were conducted with a total of 13 adolescents. Thematic analysis was used to analyze the data.
RESULTS
RESULTS
Four themes were developed: Resistance to Teaching and Learning, Preparation and Engagement Strategies, Taboos and Silencing and Structural Barriers. Students, teachers, principals and students reported discomfort and embarrassment when discussing sensitive topics, with gender dynamics playing a significant role. Strategies like warm-up sessions and continuous interaction with students and parents were used to create a supportive learning environment. However, socio-cultural barriers and family attitudes continued to hinder open discussions about sexuality. Structural barriers, including the lack of formal training for teachers and inadequate instructional materials, further impeded effective CSE delivery.
CONCLUSION
CONCLUSIONS
The experiences of CSE in Nepal among students, teachers and principals highlight significant barriers including cultural taboos, gender dynamics and insufficient resources. Addressing these barriers through comprehensive teacher training, curriculum reform, and societal engagement is critical to ensure access to CSE.
Identifiants
pubmed: 39256840
doi: 10.1186/s12978-024-01876-0
pii: 10.1186/s12978-024-01876-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
131Informations de copyright
© 2024. The Author(s).
Références
Chandra-Mouli V, Ferguson BJ, Plesons M, Paul M, Chalasani S, Amin A, et al. The political, research, programmatic, and social responses to adolescent sexual and reproductive health and rights in the 25 years since the international conference on population and development. J Adolesc Health. 2019;65(6s):S16–40.
Organization WH. Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation. 2017.
Camilletti E, Banati P. Making strategic investments in adolescent well-being. In: Handbook of adolescent development research and its impact on global policy. 2018;299.
UNFPA. The power of 1.8 billion-adolescents, youth and the transformation of the future. 2014.
Anderson R, Panchaud C, Singh S, Watson K. Demystifying data: a guide to using evidence to improve young people's sexual health and rights. 2014.
UNESCO U, UNFPA, UNICEF, UNFWOMEN, WHO. International technical guidance on sexuality education: an evidence-informed approach: UNESCO Publishing; 2018.
Mkumba LS, Nassali M, Benner J, Ritchwood TD. Sexual and reproductive health needs of young people living with HIV in low- and middle-income countries: a scoping review. Reprod Health. 2021;18(1):219.
doi: 10.1186/s12978-021-01269-7
pmcid: 8570025
Nepal U. Population situation analysis of Nepal. Kathmandu: UNFPA Nepal; 2017.
Khatri R, Schildbach E, Schmitz K, Silwal P, van Teijlingen E. National adolescent sexual and reproductive health programme: mid-term evaluation report. 2013.
Demographic N. Health Survey 2011 Kathmandu. Nepal: Ministry of Health and Population. 2012.
Paudel YR, Acharya K. Fertility limiting intention and contraceptive use among currently married men in Nepal: evidence from Nepal demographic and health survey 2016. BioMed Research International. 2018.
Aguilar AM, Cortez R. Family planning: The hidden need of married adolescents in Nepal. 2015.
Puri M, Wagle K, Rios V, Dhungel Y. Early impacts of the expanded Global Gag Rule in Nepal. Center for Research on Environment Health and Population Activities. 2019.
Khanal GN, Khatri S, Pryor S, Yahner M. Adolescent and youth family planning and reproductive health. 2021.
Cardoso LF, Clark CJ, Rivers K, Ferguson G, Shrestha B, Gupta J. Menstrual restriction prevalence and association with intimate partner violence among Nepali women. BMJ Sex Reprod Health. 2019;45(1):38–43.
doi: 10.1136/bmjsrh-2017-101908
UNFPA C, UNICEF. Ministry of Health and Population Department of Health Services Family Health Division. The Qualitative Study on Assessing Supply Side Constraints Affecting the Quality of Adolescent Friendly Health Services and the Barriers for Service Utilization in Nepal [Internet]. 2015.
Thapa S, Bhattarai S, Aro AR. ‘Menstrual blood is bad and should be cleaned’: A qualitative case study on traditional menstrual practices and contextual factors in the rural communities of far-western Nepal. SAGE Open Med. 2019;7:2050312119850400.
doi: 10.1177/2050312119850400
pmcid: 6537045
Amatya P, Ghimire S, Callahan KE, Baral BK, Poudel KC. Practice and lived experience of menstrual exiles (Chhaupadi) among adolescent girls in far-western Nepal. PLoS ONE. 2018;13(12): e0208260.
doi: 10.1371/journal.pone.0208260
pmcid: 6287853
Khatri RB, Mishra SR. Female community health volunteers in community-based health programs of Nepal: future perspective. Front Public Health. 2017;5: 225406.
doi: 10.3389/fpubh.2017.00181
Pokharel S, Kulczycki A, Shakya S. School-based sex education in Western Nepal: uncomfortable for both teachers and students. Reprod Health Matters. 2006;14(28):156–61.
doi: 10.1016/S0968-8080(06)28255-7
Herat J, Plesons M, Castle C, Babb J, Chandra-Mouli V. The revised international technical guidance on sexuality education—a powerful tool at an important crossroads for sexuality education. Reprod Health. 2018;15(1):185.
doi: 10.1186/s12978-018-0629-x
pmcid: 6220458
UNFPA W. Sexual and reproductive health and rights infographic snapshot Nepal 2021. 2021.
Tiwari A, Wu W-J, Citrin D, Bhatta A, Bogati B, Halliday S, et al. “Our mothers do not tell us”: a qualitative study of adolescent girls’ perspectives on sexual and reproductive health in rural Nepal. Sex Reprod Health Matters. 2022;29(2):2068211.
doi: 10.1080/26410397.2022.2068211
pmcid: 9225746
Shrestha S, Wærdahl R. Girls’ access to adolescent friendly sexual and reproductive health services in Kaski, Nepal. Asia Pac Policy Stud. 2020;7(3):278–92.
doi: 10.1002/app5.305
Acharya D, Thomas M, Cann R. Nepalese school students’ views about sexual health knowledge and understanding. Educ Res. 2018;60(4):445–58.
doi: 10.1080/00131881.2018.1525304
Creswell JW, Poth CN. Qualitative inquiry and research design: choosing among five approaches. Sage Publications; 2016.
Pal KB, Basnet BB, Pant RR, Bishwakarma K, Kafle K, Dhami N, et al. Education system of Nepal: impacts and future perspectives of COVID-19 pandemic. Heliyon. 2021;7(9).
Ramberg J. Global Education Monitoring Report 2021–Central and Eastern Europe, the Caucasus and Central Asia–Inclusion and education: all means all. 2021.
Green J, Thorogood N. Qualitative methods for health research. 2018.
Jamshed S. Qualitative research method-interviewing and observation. J Basic Clin Pharm. 2014;5(4):87–8.
doi: 10.4103/0976-0105.141942
pmcid: 4194943
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
doi: 10.1191/1478088706qp063oa
Braun V, Clarke V. Toward good practice in thematic analysis: Avoiding common problems and be(com)ing a knowing researcher. International Journal of Transgender Health. 2022:1–6.
NVivo Q. NVivo qualitative data analysis software. 2012.
Chandra-Mouli V, Plesons M, Hadi S, Baig Q, Lang I. Building support for adolescent sexuality and reproductive health education and responding to resistance in conservative contexts: cases from Pakistan. Glob Health Sci Pract. 2018;6(1):128–36.
doi: 10.9745/GHSP-D-17-00285
pmcid: 5878066
Thin Zaw PP, McNeil E, Oo K, Liabsuetrakul T, Htay TT. Abstinence-only or comprehensive sex education at Myanmar schools: preferences and knowledge among students, teachers, parents and policy makers. Sex Educ. 2021;21(1):75–90.
doi: 10.1080/14681811.2020.1749043
Denford S, Abraham C, Campbell R, Busse H. A comprehensive review of reviews of school-based interventions to improve sexual-health. Health Psychol Rev. 2017;11(1):33–52.
doi: 10.1080/17437199.2016.1240625
Chavula MP, Svanemyr J, Zulu JM, Sandøy IF. Experiences of teachers and community health workers implementing sexuality and life skills education in youth clubs in Zambia. Glob Public Health. 2022;17(6):926–40.
doi: 10.1080/17441692.2021.1893371
Menger LM, Kaufman MR, Harman JJ, Tsang SW, Shrestha DK. Unveiling the silence: women’s sexual health and experiences in Nepal. Cult Health Sex. 2015;17(3):359–73.
doi: 10.1080/13691058.2014.937462
Rich-Zendel S. Taboo dynamics: the translation of sexual rights in Nepal. University of Toronto (Canada); 2020.
Zulu JM, Blystad A, Haaland MES, Michelo C, Haukanes H, Moland KM. Why teach sexuality education in school? Teacher discretion in implementing comprehensive sexuality education in rural Zambia. Int J Equity Health. 2019;18(1):116.
doi: 10.1186/s12939-019-1023-1
pmcid: 6764121
Panchaud C, Keogh SC, Stillman M, Awusabo-Asare K, Motta A, Sidze E, Monzón AS. Towards comprehensive sexuality education: a comparative analysis of the policy environment surrounding school-based sexuality education in Ghana, Peru, Kenya and Guatemala. Sex Educ. 2019;19(3):277–96.
doi: 10.1080/14681811.2018.1533460
Tabong PT, Maya ET, Adda-Balinia T, Kusi-Appouh D, Birungi H, Tabsoba P, Adongo PB. Acceptability and stakeholders perspectives on feasibility of using trained psychologists and health workers to deliver school-based sexual and reproductive health services to adolescents in urban Accra, Ghana. Reprod Health. 2018;15(1):122.
doi: 10.1186/s12978-018-0564-x
pmcid: 6034281
Ram S, Andajani S, Mohammadnezhad M. Parent’s perception regarding the delivery of sexual and reproductive health (SRH) education in secondary schools in Fiji: a qualitative study. J Environ Public Health. 2020;2020:3675684.
doi: 10.1155/2020/3675684
pmcid: 7201858
de Haas B, Hutter I. Teachers’ conflicting cultural schemas of teaching comprehensive school-based sexuality education in Kampala, Uganda. Cult Health Sex. 2019;21(2):233–47.
doi: 10.1080/13691058.2018.1463455
Le Mat MLJ, Miedema EAJ, Amentie SA, Kosar-Altinyelken H. Moulding the teacher: factors shaping teacher enactment of comprehensive sexuality education policy in Ethiopia. Comp J Comp Int Educ. 2021;51(6):862–80.
Kemigisha E, Ivanova O, Ruzaaza GN, Ninsiima AB, Kaziga R, Bruce K, et al. Process evaluation of a comprehensive sexuality education intervention in primary schools in South Western Uganda. Sex Reprod Healthc. 2019;21:51–9.
doi: 10.1016/j.srhc.2019.06.006
Gudyanga E, de Lange N, Khau M. Zimbabwean secondary school Guidance and Counseling teachers teaching sexuality education in the HIV and AIDS education curriculum(). Sahara j. 2019;16(1):35–50.
doi: 10.1080/17290376.2019.1610485
pmcid: 6493312
Kunnuji MON, Robinson RS, Shawar YR, Shiffman J. Variable implementation of sexuality education in three Nigerian States. Stud Fam Plann. 2017;48(4):359–76.
doi: 10.1111/sifp.12043
Vanwesenbeeck I, Westeneng J, de Boer T, Reinders J, van Zorge R. Lessons learned from a decade implementing comprehensive sexuality education in resource poor settings: the world starts with me. Sex Educ. 2016;16(5):471–86.
doi: 10.1080/14681811.2015.1111203
Ogolla MA, Ondia M. Assessment of the implementation of comprehensive sexuality education in Kenya. Afr J Reprod Health. 2019;23(2):110–20.
Ha TTT, Fisher JRW. The provision of sexual and reproductive health education to children in a remote mountainous commune in rural Vietnam: an exploratory study of parents’ views. Sex Educ. 2011;11(1):47–59.
doi: 10.1080/14681811.2011.538148
Chau K, Traoré Seck A, Chandra-Mouli V, Svanemyr J. Scaling up sexuality education in Senegal: integrating family life education into the national curriculum. Sex Educ. 2016;16(5):503–19.
doi: 10.1080/14681811.2015.1123148
Browes NC. Comprehensive sexuality education, culture and gender: the effect of the cultural setting on a sexuality education programme in Ethiopia. Sex Educ. 2015;15(6):655–70.
doi: 10.1080/14681811.2015.1065476
Keogh SC, Stillman M, Awusabo-Asare K, Sidze E, Monzón AS, Motta A, Leong E. Challenges to implementing national comprehensive sexuality education curricula in low- and middle-income countries: case studies of Ghana, Kenya, Peru and Guatemala. PLoS ONE. 2018;13(7): e0200513.
doi: 10.1371/journal.pone.0200513
pmcid: 6040779