Sex education in India

Adolescent girls engaged in sex education

Sex education in India refers to the organized delivery by Indian governments and non-profits of material regarding sex, sexuality, and pregnancy. The three categories of sex education in India are (1) the sex education courses targeted at adolescents in school, (2) family planning for adults, and (3) HIV/AIDS Prevention Education. This article outlines the current state of, efficacy of, and opposition to these types of sex education in India. For history regarding family planning in India, see Family Planning in India.

Current State of Sexual Health

Sex and Pregnancy

The sex ratio in India is skewed towards males, with 962 girls born per 1000 males in 2001. This is propagated by several factors, including lower caloric intake by mothers, female infanticide, and cultural preference for boys. However, the most plausible explanation for fewer female than male births is attributed to prenatal sex determination, followed by induced abortion of female fetuses (Jha et al).[1] This suggests that potential mothers are socialized to believe that having a female child is detrimental to their family, either economically or socially.

In some areas of India, many young men and women are delaying their marriage to pursue their careers, a result of rising education levels. However, most Indian households are conservative and prohibit discussions about sex. In rural areas and urban slums, girls are often married early and they don't go into marriage equipped with any knowledge of sex. This manifests itself on a larger scale. According to UNICEF, about 240 million women alive in India today were married before the age of 18[2] even though the average age of women at first marriage has increased to 20.6.[3] (see also India States ranking by fertility rate)

Adolescent fertility usually occurs within marriage because girls are encouraged to reproduce as early as they can after they are married. Therefore, 36% of children (aged 13–16) and 64% of adolescents (aged 17–19) are pregnant or already mothers (Jejeebhoy et al).[4] On the flip side, pregnancy outside of wedlock carries severe social stigma in India. Medical termination of pregnancy available to few and the attitude of the providers towards such women is not amicable. As a result, they may attempt unsafe abortions or abandon the child. Such stigmatized women may also commit suicide (Watsa et al).[5]

Contraception is rarely used within or outside of marriage. Based on a National Family Health Survey conducted in 1992-1993, only 7.1% of married women (aged 15–19) use contraception, compared to 21% among women (aged 20–24).[4] Additionally, adolescents lack access to contraceptive methods like oral contraceptives and diaphragms. Lack of contraception use is coupled with lack of availability of safe abortions. While five million abortions occur annually in India, only 10% of those are performed within the structures of a high quality hospital.[4]

HIV/AIDS and other STIs

More than four million people are estimated to be infected with HIV in India - the highest proportion of any country in the world. Slightly more than one half are men, and almost one half, women.[6]

Premarital sex has risen in India, and a large proportion of it is unprotected. Additionally, married men often engage in risky behavior by having unprotected sex with multiple partners, which can include commercial sex workers. Finally, the cultural patriarchal structure in India makes it unlikely that women will be able to ensure that their husbands are monogamous (South et al).[7] This makes young Indians vulnerable to teenage pregnancy and sexually transmitted diseases (STDs) (Parwej et al).[8] Studies have found that lower educated groups such as truck drivers are especially vulnerable to STDs due to lack of knowledge and prevalence of misconceptions.[9]

Types of Sex Education

Sex Education for Adolescents

There are about 190 million adolescents in India - a demographic in which over 30% of people are illiterate. Disparities in gender at this age can often be explained by relatively poor access to reproductive health care and the fact that girls often have less access to food, which adversely affects their growth patterns. Additionally, adolescent girls often work long hours in the home with no opportunity for employment (Selvan et al).[10]

Adolescents, both males and females, tend to not be informed about sexuality. This is often caused by lack of education in general (but sex education in particular) and conservative attitudes towards sex.[10]

Efficacy

Parents are often reluctant to teach accurate and relevant information about sex to adolescents because of the stigma associated with the topic. More than taboo, mothers especially feel like talking about sex is embarrassing and dirty (Tripathi et al).[11]

This same attitude is held by teachers. First, when the National Council of Educational Research and Training initiated sex education, they structured it as a part of existing studies, rather than a separate subject. However, teachers tried to avoid teaching the topic. Second, a school in Gujarat implemented a system where students could anonymously drop letters into a box for trained counselors to read. The nature of these questions tended to split by sex. Girls' questions tended to focus on menstruation, physical appearance, and 'normal' sexual behavior while boys' questions tended to focus on nocturnal emission, masturbation and body size (Abraham et al).[12] Though these programs exist, they are unable to reach girls who are not school, a significant section of the population. Other than the specific initiatives outlined above, there are very few services that cater specifically to adolescents. Though NGOs and local schools are trying to push for more, teachers rarely cover issues like sexuality and reproductive health. Additionally, NGO reach is limited even though they can reach out-of-school adolescents (Tripathi et al).[11]

In a 2005 study in Chandigarh, a reproductive health education package was prepared after consulting parents and teachers to address cultural sensitivities. The package had a guidebook for the instructor and a book for the students for self-study. The students (aged 15–20; mean age was 16.47) were grouped and subjected to two types of education methods. In the first method, education was directly provided to them in a classroom setting by an instructor. In the second method, some students were selected and educated by instructors. Following which, they were encouraged to engage in peer education. A third group was reserved as a control. The first group showed the most improvement in their knowledge after the nine month program. The peer-education group showed knowledge levels similar to the first group after a three month course. The increase in knowledge level was consider significant after comparison to the control group.[8]

Surveys have shown that adolescents learn a significant amount about sex from the media, including books and movies. However, exposure is not equivalent to accuracy. Though teens interacted with media that talked about sex, they did not glean accurate information regarding the reproductive process. Additionally, exposure to media didn't teach adolescents about healthy emotional growth or responsible adulthood.[11]

Finally, the level of awareness and knowledge regarding sex education among adolescents is higher among those living urban areas compared to those living in rural areas. This is caused by higher quality education and more exposure to globalized points of view (Abraham).[12]

Opposition

There has been significant opposition to sex education, specifically for adolescents. In 2007, when sex education curriculum was promoted by India's Ministry of Human Resource Development, controversy developed. Many opponents believed that sex education would corrupt youth and be anathema to traditional Indian values. Additionally, they believed it would lead to promiscuity and irresponsible behavior. Finally, they argued that sex education was a western construct that was being forced upon India. These arguments cause states like Gujarat, Madhya Pradesh, Maharashtra, Karnataka, Kerala, Rajasthan, Chhattisgarh and Goa to ban sex education programming.[11]

In March 2007, the Maharashtra state government banned sex education in schools.[13] The ban came after the ruling and opposition Members of the Legislative Assembly claimed that western countries had forced the Central government to implement the program.[14] In April 2007 Basavaraj Horatti, the Karnataka Minister for Primary and Secondary Education, said that the program has been put on hold after complaints from teachers. The teachers had complained that the books were oriented towards increasing the sales of condoms and that they were sexually provocative.[15] A women's organization, Akhila Bharatha Mahila Samskruthika Sanghatane, also protested the course in the state.[16]

On May 15, 2007, the Chief Minister of Madhya Pradesh Shivraj Singh Chouhan removed sex education from the state curriculum on the grounds that it offended Indian values, acting on the advice of Rashtriya Swayamsevak Sangh (RSS) ideologue Dinanath Batra. Batra suggested that yoga be added to the curriculum instead.[17] This view was criticized by S. Anandhi, a scholar of gender issues, who wrote that sex-education was vital for combatting child sexual abuse and the spread of HIV/AIDS. Later that year, Batra wrote a letter on behalf of the Shiksha Bachao Andolan Samiti, which stated that teachers who followed the sex-education curriculum could be jailed for two years on the charge of "outraging the modesty of a woman."[18]

In May 2007, Rajasthan Chief Minister Vasundhara Raje wrote a letter to Arjun Singh, the Union Minister of Human Resource Development. In the letter, she stated that children in Class IX and XI did not require sex education because they were in the early stages of puberty. The state Education Minister Ghansyam Tiwari stated that they already had a life skills course called Jeevan Shaili which was sufficient.[19]

In June 2009, Orissa Education Minister Bishnu Charan Das stated that they were delaying introduction of sex education by a year as a result of protests by teachers' organizations and students' political groups. Rajendra Burma of All India Democratic Students' Organization (AIDSO) claimed that it would cause innocent students to become too curious about sex.[20][21]

In July 2009, a teachers' association protested the introduction of sex education in Uttar Pradesh. Om Prakash Sharma, the chief of the association, said that it would result in embarrassing questions from students. He threatened to burn the books on a bonfire if they were not withdrawn.[22]

Ram Madhav of Rashtriya Swayamsevak Sangh (RSS) called sex education unfit for Indian society. He instead proposed that workshops be held for adults only to warn them against a promiscuous lifestyle. Prakash Javadekar of the Bharatiya Janata Party (BJP) proposed that sex education should consist of abstinence-only education. Another BJP leader Murli Manohar Joshi stated that the course would disturb the mental development of children and claimed that multinational companies were behind this to boost the sales of condoms.[23]

Opponents of sex education for adolescents are swayed if sex education is deemed to be culturally sensitive and in line with Indian values. This can be achieved if the government and NGOs work in tandem to create curriculum that is acceptable to schools and the community. This trend may change as years progress because adolescents tend to have a more liberal view towards sex than adults.[11]

Family Planning for Adults

Family planning in India has had a varied history. During India's Emergency period in the 1970's, the government implemented a population-control policy which targeted lower-caste individuals.[24] Because the United States used food aid as leverage, India was incentivized to create a program that would influence lower-caste individuals to not have children. This program was eventually disbanded because of the lack of hygiene associated with the procedures and the nearly coercive techniques that were used (Connelly).[24] (see Family planning in India)

Currently, India's family planning programs are mainly run by the government in conjunction with NGOs. Because these programs are often quota-based, they take two forms: sterilization programs or contraceptive programs (Gray et al).[25] Both use an incentive-based approach, where families are often given kitchen items or cash to undergo procedures (Bhatnagar et al).[26]

Efficacy

The efficacy of India's family planning programs is dependent on the paradigm that is being used. Programs like Accredited Social Health Activist (ASHA) encourage women to register pregnancies and visit local health centers, and also encourage family planning through sterilization. ASHA also holds information meetings and raise awareness on such issues as women’s health, disease, social determinants of health, nutrition and sanitation. Additionally, they serve as counsellors on adolescent and female sexual and reproductive health (Scott).[27] Past hospital care, ASHA also gives out free birth control pills and condoms which remove the stigma associated with couples buying contraceptives at drug stores (Scott).[28]

Opposition

First, the most significant criticisms of India's Family Planning program are those that advocate that it should be education-based rather than quota-based. They argue that India's program isn't sustainable because it does not stop women from marrying early or from spacing their pregnancies. Second, critics state that India's program does not consider the psyche of women who often undergo irreversible procedures like sterilization because it doesn't provide the infrastructure for regular follow-ups. Finally, critics state that the program is inherently gendered because most sterilizations are performed on women even though the procedure is less invasive for men (Vicziany).[29]

HIV/AIDS and STD Prevention Education

HIV/AIDS Prevention Sign

Because HIV/AIDS has been deemed a health crisis in India, prevention techniques have been set as a priority by the government which have been pushing NGOs to implement programming that focuses on training, support, and outreach.[30] HIV/AIDS prevention education in India has been focused on educational materials like newspapers and pamphlets as well as conversations with educated professionals.[30]

Efficacy

In a study conducted in Tamil Nadu, 29% of women and 58% of men attending an outpatient clinic were aware of AIDS/STDs, however only 12% of women and 26% of men attending an STD clinic were aware of AIDS. The conclusion from this study was that mass media had been more effective at disseminating information about HIV/AIDS than the radio. However, this study also showed that mothers were not knowledgable about Mother-to-Infant transmission because the information hadn't filtered down to them.[30]

Additionally, a 2008 survey conducted among 11 and 12 class girls (aged 14 to 19; mean age was 16.38) in South Delhi found that 71% had no knowledge about the effects of genital herpes. 43% did not know the effects of syphilis and 28% did not know gonorrhoea was an STD. 46% thought the all STDs, except AIDS, could be cured. The major sources of information about STDs and safe sex among the girls were their friends (76%), media (72%), books and magazines (65%) or the internet (52%). 48% felt that they could not talk to their parents about sex.[31]

Opposition

Opposition to HIV/AIDS prevention education in India has been scarce because of the recognition of the importance of stopping this disease. However, there has been a hesitance to acknowledge and interact with men who have sex with men (MSM). This has decreased the efficacy of programming because of the stigma associated with this population.[32]

Advocacy organizations and movements

The Family Planning Association of India (FPAI) was established in 1949. It was formed with the aim to safeguard the health of women by preventing too many and too closely spaced pregnancies.[33] In 1952, it established its first clinic where it provide advice to family planning, infertility, and family counseling.[34]

The Society for Nutrition, Education & Health Action (SNEHA) was established in the 1990s and is located in Mumbai, India. From children's health all the way to sexual assault prevention, it works to promote awareness of women's autonomy, health, and sexuality.[35]

Talking About Reproductive and Sexual Health Issues (TARSHI) was established in 1996 and is located in New Delhi, India. TARSHI works to expand sexual and reproductive choices by operating from an affirmative and rights based perspective - a perspective that is often antithetical to common cultural beliefs.[36]

Nirantar Trust promotes gender equality, especially for girls from marginalized communities, and was started in 1993. By considering factors like caste, sexuality, religion, class, and ethnicity, Nirantar works to develop feminist leadership.[37]

The Sonagachi Project is a peer education project which was started in 1992. It encourages sex-workers in West Bengal to insist on condoms. The project has successfully increased condom usage and reduced STD levels among sex-workers in West Bengal.[38]

See also

References

  1. ↑ Jha, Prabhat, Rajesh Kumar, Priya Vasa, Neeraj Dhingra, Deva Thiruchelvam, and Rahim Moineddin. "Low male-to-female sex ratio of children born in India: national survey of 1· 1 million households." The Lancet 367, no. 9506 (2006): 211-218.
  2. ↑ "At 240 million, India has a third of child marriages in the world". Hindustan Times. 12 August 2014. Retrieved 7 March 2016.
  3. ↑ "Indian women push back marriage age". DNA India`. 20 February 2010. Retrieved 7 March 2016.
  4. 1 2 3 Jejeebhoy, Shireen J. "Adolescent sexual and reproductive behavior: a review of the evidence from India." Social Science & Medicine 46, no. 10 (1998): 1275-1290.
  5. ↑ Watsa, M. C. (2005). "Sexual Health Services for Young People" (PDF). Journal of Family Welfare. Family Planning Association of India. 50 (I): 36.
  6. ↑ Newmann, S., P. Sarin, N. Kumarasamy, E. Amalraj, M. Rogers, P. Madhivanan, T. Flanigan et al. "Marriage, monogamy and HIV: a profile of HIV-infected women in south India." International journal of STD & AIDS 11, no. 4 (2000): 250-253.
  7. ↑ South, S. J., Trent, K., & Bose, S. (2012). INDIA’S “MISSING WOMEN” AND MEN’S SEXUAL RISK BEHAVIOR. Population Research and Policy Review,31(6), 777–795. http://doi.org/10.1007/s11113-012-9248-3
  8. 1 2 Saroj Parwej; Rajesh Kumar; Indarjeet Walia; Arun K. Aggarwal (2005). "Reproductive health education intervention trial" (PDF). The Indian Journal of Pediatrics. 72 (4): 287–291. doi:10.1007/bf02724005. Retrieved 27 January 2016.
  9. ↑ Deborah H Cornman; Sarah J Schmiege; T. Joseph Benziger (2007). "An Information-Motivation-Behavioral model-based HIV prevention intervention for truck drivers in India". Social Science & Medicine. 64 (8): 1572–1584. doi:10.1016/j.socscimed.2006.11.011. PMC 4675654Freely accessible. PMID 17257724.
  10. 1 2 Selvan, M. S., M. W. Ross, A. S. Kapadia, R. Mathai, and S. Hira. "Study of perceived norms, beliefs and intended sexual behaviour among higher secondary school students in India." AIDS care 13, no. 6 (2001): 779-788.
  11. 1 2 3 4 5 Tripathi, Niharika, and T. V. Sekher. "Youth in India ready for sex education? Emerging evidence from national surveys." PloS one 8, no. 8 (2013): e71584.
  12. 1 2 Abraham, Leena, and K. Anil Kumar. "Sexual experiences and their correlates among college students in Mumbai City, India." International Family Planning Perspectives (1999): 139-152.
  13. ↑ "Maharashtra resorts to another ban". The Hindu. 2 April 2007. Retrieved 6 January 2015.
  14. ↑ "No sex education please, it corrupts, and this is Maharashtra". The Indian Express. 31 March 2007. Retrieved 6 January 2015.
  15. ↑ "No sex education in Karnataka schools now: Minister". One India. 18 April 2007. Retrieved 6 January 2015.
  16. ↑ "Women's organisation opposes decision to introduce sex education in schools". The Hindu. 8 March 2007. Retrieved 14 March 2016.
  17. ↑ "Madhya Pradesh bans sex education". The Indian Express. 16 March 2007. Retrieved 23 May 2014.
  18. ↑ "Former HRD minister feels sex education corrupts kids". Hindustan Times. 15 July 2007. Retrieved 23 May 2014.
  19. ↑ "Sex education course too hot for VHP". The Indian Express. 3 May 2007. Retrieved 6 January 2015.
  20. ↑ "Orissa govt against sex education in schools". The Times of India. 11 June 2007. Retrieved 13 March 2016.
  21. ↑ "Orissa debates sex education in schools". The Times of India. 29 April 2007. Retrieved 13 March 2016.
  22. ↑ "No sex education, say Uttar Pradesh teachers". Hindustan Times. 9 July 2007. Retrieved 13 March 2016.
  23. ↑ "Sex education runs into trouble". BBC News. 22 August 2007. Retrieved 14 March 2016.
  24. 1 2 Connelly, Matthew. "Population control in India: Prologue to the emergency period." Population and Development Review 32, no. 4 (2006): 629-667.
  25. ↑ Gray, Ronald H., Xianbin Li, Godfrey Kigozi, David Serwadda, Fred Nalugoda, Stephen Watya, Steven J. Reynolds, and Maria Wawer. "The impact of male circumcision on HIV incidence and cost per infection prevented: a stochastic simulation model from Rakai, Uganda." Aids 21, no. 7 (2007): 845-850.
  26. ↑ Bhatnagar, R., K. Singh, T. Bir, U. Datta, S. Raj, and D. Nandan. "An assessment of performance based incentive system for ASHA Sahyogini in Udaipur, Rajasthan." Indian journal of public health 53, no. 3 (2008): 166-170.
  27. ↑ Scott, K., & Shanker, S. (2010). Tying their hands? Institutional obstacles to the success of the ASHA community health worker programme in rural north India. AIDS Care, 22(sup2), 1606-1612. doi:10.1080/09540121.2010.507751
  28. ↑ Scott, Kerry, and Shobhit Shanker. "Tying their hands? Institutional obstacles to the success of the ASHA community health worker programme in rural north India." AIDS care 22, no. sup2 (2010): 1606-1612. Harvard
  29. ↑ Vicziany, M. (1982). Coercion in a Soft State: The Family-Planning Program of India: Part 2: The Sources of Coercion. Pacific Affairs, 55(4), 557-592. doi:1. Retrieved from http://www.jstor.org/stable/2756842 doi:1
  30. 1 2 3 Shrotri, A., A. V. Shankar, S. Sutar, A. Joshi, N. Suryawanshi, H. Pisal, K. E. Bharucha, M. A. Phadke, R. C. Bollinger, and J. Sastry. "Awareness of HIV/AIDS and household environment of pregnant women in Pune, India." International journal of STD & AIDS 14, no. 12 (2003): 835-839.
  31. ↑ Alexandra McManus; Lipi Dhar (2008). "Study of knowledge, perception and attitude of adolescent girls towards STIs/HIV, safer sex and sex education: (A cross sectional survey of urban adolescent school girls in South Delhi, India)". BMC Women's Health. 8 (1): 12. doi:10.1186/1472-6874-8-12.
  32. ↑ Dandona, Lalit, Rakhi Dandona, Juan Pablo Gutierrez, G. Anil Kumar, Sam McPherson, Stefano M. Bertozzi, and Asci FPP Study Team. "Sex behaviour of men who have sex with men and risk of HIV in Andhra Pradesh, India." Aids 19, no. 6 (2005): 611-619.
  33. ↑ Leela Visaria; Rajani R. Ved (29 January 2016). India’s Family Planning Programme: Policies, Practices and Challenges. Routledge. p. 59. ISBN 978-1-317-31324-3. Retrieved 16 March 2016.
  34. ↑ R.L. Kleinman; P. Senanayake (15 November 1993). Family Planning: Meeting Challenges, Promoting Choices. CRC Press. p. 607. ISBN 978-1-85070-514-7. Retrieved 16 March 2016.
  35. ↑ More, Neena Shah, Ujwala Bapat, Sushmita Das, Glyn Alcock, Sarita Patil, Maya Porel, Leena Vaidya, Armida Fernandez, Wasundhara Joshi, and David Osrin. "Community mobilization in Mumbai slums to improve perinatal care and outcomes: a cluster randomized controlled trial." PLoS Med 9, no. 7 (2012): e1001257.
  36. ↑ Dhingra, Nishu, and Yogesh C. Rotliwala. "THE ROLE OF NGOs IN REALIZING AND PROMOTING REPRODUCTIVE RIGHTS IN INDIA."
  37. ↑ Sharma, J., A. Dwivedi, P. Gupta, R. Borah, S. Arora, A. Mittra, A. Bose et al. "Assessing national action on protection from child marriage."
  38. ↑ Flora Cornish; Catherine Campbell (2009). "The social conditions for successful peer education: a comparison of two HIV prevention programs run by sex workers in India and South Africa" (PDF). LSE Research Online. 44 (1-2): 123–135. doi:10.1007/s10464-009-9254-8. Retrieved 15 January 2016.

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