The Need For Sexuality Education In Bangladesh

THE NEED FOR SEXUALITY EDUCATION IN BANGLADESH Ekram Kabir

INTRODUCTION Switching through FM radio channels in the car the other day in Islamabad, looking for a good song, Masooda Bano - an analyst currently doing a PhD at Oxford - was amused by the repeated and casual use of a term that is considered bold and crass even by western standards on a Pakistani radio channel. Listening to the host, probably in his early twenties, liberally using the expression "pre-marital sex" she wondered what he was hoping to achieve by hosting a show on this topic, advising parents to be open about such issues and drug addiction with their children. The few minutes she listened to him raised many questions and dilemmas around the tension between tradition and modernity that confront the society - a society in transition not only economically but also in terms of the value structures that bind it. There is an argument in favour of such openness, according to which in an age when globalisation of media is exposing us to all kind of values and behaviour, it’s perhaps wiser to be open about such issues rather than sweeping them under the carpet. According to this line of thinking, restrictions increase frustration and push people into using the wrong means to attain what they want, while openness enables people to make betterinformed decisions and wiser choices. So, is it not a healthy sign that the younger generation are now openly talking about such issues? The answer is not as cut and dry as it would seem. Opening up social spaces is good, but not when it is done in blind pursuit of the west, without limits and with insensitivity to local needs. The young radio-show host clearly did not realise the full significance of the words he was using. And his casual use of these words indicated that he thinks this is common behaviour. Yet the term he was using is loaded not just because of its explicit sexual connotations but also because it refers to a social structure where gender roles, families, and parent-child relations are entirely different. Not always in a positive way. In such societies, children out of wedlock are common, teenage pregnancies are a constant worry, divorces are a norm rather than an exception, and children often grow up in families in which their parents have children from prior relations. Is this the model we want to follow? So why do we feel we need to accept this behaviour at the societal level? The argument that it is better to talk about such issues instead of suppressing them as they do happen is supplemented by the reasoning that being informed about the negative consequences of such actions might stop people from engaging in these activities. This argument is also advanced in case of policies like introducing sex education in secondary schools, or where some NGOs in South Asian countries have undertaken sex education programmes within communities due to availability of donor funding for such awareness work. Consider this that sex education is an integral part of secondary education in western societies but western youngsters do not always act more prudently. In fact the open discussion brings a certain acceptance of this behaviour as being normal. Many South

Asians in favour of open discourse on such matters claim that promiscuous behaviour is secretly happening all around us. It is difficult to substantiate such claims. But, even there it is important to remember the difference. Young college boys and girls in our society do date, but their relations are often quite innocent. The radio show, the host of which probably had noble intentions, is significant only for its indication of the general conflict we face in society today, with the opposing forces of tradition and modernity. The west faced this conflict in the last century and made certain choices about gender roles, social structures, and family values. Societies like Bangladesh, Pakistan etc., have to make these decisions today. In some ways we face more severe challenges because globalisation has made the processes of transition more rapid and extreme. But we also have a big advantage: the experience of western countries to learn from. To take another example, no one can use religion or morality to argue for repression of women. But western feminism and changing gender roles, along with the liberation of women and their full time involvement in economic activity, has meant that in age-old institutions and nurseries there is no one left at home to care for the elders or the young ones. Today the young woman of the west is revolting against the pressure for economic success, and is asking to be allowed to spend more time with her children, something the current socio-economic structure does not allow her to do. Therefore, we need to strike a balance between tradition and modernity, and take up the positive aspects of the west, discarding its negative influences. This is not easy and may even be impossible. But the first step is to realise that not everything western is positive. We can learn a lot from the west, true. But there are many advantages in our own traditional values and structures. In pursuing one let us not entirely forget the merits of the other. For example, Lysley Tullin was 15 when she became pregnant. The only contraception she and her boyfriend had used was wishful thinking: "I didn't think it would happen to me," she said. Tullin, who lives in Oldham in northern England, decided to keep the baby, now aged 4, although as a consequence her father has disowned her. Tullin is not alone. In the UK nearly 3 per cent of females aged 15 to 19 became mothers in 2002, many of them unintentionally. And unplanned pregnancies are not the only consequence of teenage sex - rates of sexually transmitted diseases (STDs) are also rocketing in British adolescents, both male and female. The numerous and complex societal trends behind these statistics have been endlessly debated without any easy solutions emerging. Policy makers tend to focus on the direct approach, targeting young adolescents in the classroom. In many western schools teenagers get sex education classes giving explicit information about sex and contraception. But recently there has been a resurgence of some old-fashioned advice: just say no. The so-called abstinence movement urges teens to take virginity pledges and cites condoms only to stress their failure rate. It is sweeping the US, and is now being exported to countries such as the UK and Australia. Confusingly, both sides claim their strategy is the one that leads to fewest pregnancies and STD cases. But a close look at the research evidence should give both sides pause for thought. It is a morally charged debate in which each camp holds entrenched views, and opinions seem to be based less on facts than on ideology. "It's a field fraught with subjective views," says Douglas Kirby, a sex education researcher for the public-health consultancy ETR Associates in Scotts Valley, California. For most of history, pregnancy in adolescence has been regarded not as a problem but as something that is normal, so

long as it happens within marriage. Today some may still feel there is nothing unnatural about older adolescents in particular becoming parents. But in industrialised countries where extended education and careers for women are becoming the norm, parenthood can be a distinct disadvantage. Teenage mums are more likely to drop out of education, to be unemployed and to have depression. Their children run a bigger risk of being neglected or abused, growing up without a father, failing at school and abusing drugs. The US has by far the highest number of teenage pregnancies and births in the west; 4.3 per cent of females aged between 15 and 19 gave birth there in 2002. This is significantly higher than the rate in the UK (2.8 per cent), which itself has the highest rate in western Europe. Another alarming statistic is the number of teenagers catching STDs. In the UK the incidences of chlamydia, syphilis and gonorrhoea in under-20s have all more than doubled since 1995. The biggest rise has been in chlamydia infections in females under 20; cases have more than tripled, up to 18,674 in 2003. Chlamydia often causes no symptoms for many years but it can lead to infertility in women and painful inflammation of the testicles in men. No surprise, then, that teenage sex and pregnancy has become a political issue. The UK government has set a target to halve the country's teen pregnancy rate by 2010, and the US government has set similar goals. But achieving these targets will not be easy. In an age when adolescence has never been so sexualised, in most western countries people often begin to have sex in their mid to late teens; by the age of 17, between 50 and 60 per cent are no longer virgins. The sex education strategy gained further support in the early 1990s when policy makers looked to the Netherlands. There, teenage birth rates have plummeted since the 1970s and are now among the lowest in Europe, with about 0.8 per cent of females aged between 15 and 19 giving birth in 2002. No one knows why for sure, as Dutch culture differs from that of the UK and America in several ways. But it is generally attributed to frank sex education in schools and open attitudes to sex. Dutch teenagers, says Roger Ingham, director of the Centre for Sexual Health Research at the University of Southampton,"have less casual sex and are older when they first have sex compared with the UK". Abstinence-based education got US government backing in 1981, when Congress passed a law to fund sex education that promoted self-restraint. More money was allocated through welfare laws passed in 1996, which provided $50 million a year. If contraception is mentioned at all, it is to highlight its failings - often using inaccurate or distorted data. A report for the US House of Representatives published last December [2004] found that 11 out of the 13 federally funded abstinence programmes studied contained false or misleading information. Examples of inaccurate statements included: "Pregnancy occurs one out of every seven times that couples use condoms," and: "Condoms fail to prevent HIV 31 per cent of the time." They also use some questionable logic regarding the success rate of abstinence. Studies have consistently found that youth lack basic knowledge about sexuality and contraception. In a survey of nearly 3,000 youth in Senegal, only one-third of those 15to 19- years-old could correctly identify the fertile time in the menstrual cycle, and 80 per cent incorrectly thought that oral contraceptives could cause sterility. Those youth who had participated in a family life education programme had more knowledge about

contraception and used contraception more often. A study of sex education programs in South Africa found that youth want more information, including help with decisionmaking and coping skills, and the opportunity for individual counselling with someone they trust. In focus groups with 60 students, youth said their parents ought to be the main source of information on sex education but were not giving them what they needed. In a survey among 2,460 students 14- to 19-years-old in Nigeria, just one in three could correctly identify when conception was most likely to occur. In focus groups, "students expressed a strong desire for better education about contraception and the consequences of sexual intercourse, and recommended that both schools and parents participate in educating young people about reproductive health.” In nearby Guinea, a survey of more than 3,600 unmarried men and women 15- to 24years-old found that one of four women had been pregnant and 22 per cent of these pregnancies ended in an abortion. The average age at first intercourse was 16.3 years for girls and 15.6 years for boys, but more than half of those who were sexually active had never used contraception. "School-based sexuality education could benefit even out-ofschool youths because their partners often are students," the study concluded.

DEFINITION In 1975, World Health Organization defined sexual health as "the integration of physical, intellectual, and social aspects of sexual being in ways that are positively enriching and that enhance personality, communication, and love...every person has a right to receive sexual information and to consider accepting sexual relationships for pleasure as well as procreation." Sex education is education about sexual reproduction in human beings, sexual intercourse and other aspects of human sexual behaviour. Education encompasses teaching and learning specific skills, and also something less tangible but more profound: the imparting of knowledge, good judgement and wisdom. Education has as one of its fundamental goals the imparting of culture from generation to generation. Reproduction is perhaps most commonly used in the context of biological reproduction and sex: •

Sexual reproduction is a biological process by which organisms create descendants through the combination of genetic material. These organisms have two different adult sexes, male and female.

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Asexual reproduction is a biological process by which an organism creates a genetically similar copy of itself without the combination of genetic material with another individual. For example, the Hydra (invertebrates of the order Hydroidea) and yeast are able to reproduce by budding. These organisms do not have different sexes, and they are capable of "splitting" themselves into two or more parts and regrow their body parts. Some 'asexual' species, like hydra and jellyfish, may also sexually reproduce. Most plants are capable of vegetative reproduction. Other ways of asexual reproduction are binary fission, fragmentation and spore formation.

There are a wide range of reproductive strategies employed by different species. Some animals, like the human (sexually mature after adolescence) and Northern Gannet (5-6 years), produce few offspring. Others reproduce quickly, but unless raised in an artificial environment, most offspring do not survive to adults. A rabbit (mature after 8 months) produces 10 - 30 offspring per year, a Nile Crocodile (15 years) produces 50, and a fruit fly (10-14 days) produces up to 900. Both strategies can be favoured by evolution: animals with few offspring can spend time nurturing and protecting them, hence greatly decreasing the need to reproduce; on the other hand, animals with many offspring do not need to spend parental energy on nurturing, allowing more energy to be devoted to survival and more breeding. These two strategies are known as K-selection (few offspring) and r-selection (many offspring). Which strategy is favoured depends on a wide range of circumstances. Sexual intercourse is the act of inserting the erect penis of the male into the vagina of the female for reproduction and also for sexual enjoyment. The terms "sexual intercourse" and "coitus" are used in reference to people. The term for the higher vertebrates and some other animals is "copulation". Many higher vertebrates animals (reptiles, birds. dogfish) reproduce internally, but their fertilization is cloacal. Other animals, such as catfish and most amphibians reproduce sexually but rely on external fertilisation rather than copulation. In a wider context, the term "sexual intercourse" may refer to a wider range of sexual activities than the act of coitus alone. In 1999, the World Association of Sexology, meeting in Hong Kong, adopted a Declaration of Sexual Rights.7 "In order to assure that human beings and societies develop healthy sexuality," the Declaration stated, "the following sexual rights must be recognized, promoted, respected, and defended": •

The right to sexual freedom, excluding all forms of sexual coercion, exploitation and abuse;

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The right to sexual autonomy and safety of the sexual body;

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The right to sexual pleasure, which is a source of physical, psychological, intellectual and spiritual well-being;

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The right to sexual information...generated through unencumbered yet scientifically ethical inquiry;

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The right to comprehensive sexuality education;

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The right to sexual health care, which should be available for prevention and treatment of all sexual concerns, problems, and disorders.

Comprehensive sex education provides explicit information about contraception, sexuality and sexual health. Abstinence-only approach teaches that the only place for sex is within marriage, and the only certain way to avoid pregnancy and STDs is abstinence. It does not teach about contraception. Abstinence-plus promotes abstinence as the best choice, but provides varying degrees of information on contraception in case teens do become sexually active.

RATIONALITY SEXUALITY EDUCATION Children need the right information to help protect themselves. The US has more than double the teenage pregnancy rate of any western industrialised country, with more than a million teenagers becoming pregnant each year. Teenagers have the highest rates of sexually transmitted diseases (STDs) of any age group, with one in four young people contracting an STD by the age of 21. STDs, including HIV, can damage teenagers' health and reproductive ability. And there is still no cure for AIDS. HIV infection is increasing most rapidly among young people. One in four new infections in the US occurs in people younger than 22. Sex education can result in young adults delaying first intercourse or, if they are already sexually active, in using contraception. Virtually all studies conclude that sex education does not lead to earlier or increased sexual activity. "Youth are interested in sex because of biological reasons, hormones," says Dr. Cynthia Waszak, an FHI [Family Health International] senior scientist who focuses on adolescent health. "Suggestions about sex in music, radio, advertisements, films and television reinforce that interest. Kids talk about sex and have questions about it. We should find ways to give youth the right information so they can make better, informed decisions about their sexual behaviour." Learning about reproductive health is part of the larger developmental process as children become adults. Developing self-esteem, a sense of hope and goals for the future, and respect for others are also part of the process. Aspects of education on sexuality are incorporated into various types of programs, sometimes called family life skills or family life education in many developing countries. Married as well as unmarried adolescents need education, on contraception in particular, especially in countries such as Bangladesh and India where 50 to 75 per cent of women under age 18 are married. Sex education programmes have been successful in various settings, including schools, community centres, youth groups and the workplace, explained Judith Senderowitz, a US-based consultant who has written extensively on adolescence. The programmes often include peer-based approaches and media activities to reach more people. A characteristic of programmes that appears critical to success is "an interactive and experiential learning environment where young people can comfortably and safely explore issues and concerns and develop skills to practice safer sexual behaviour," reported Senderowitz in one analysis. Successful sex education programmes have common elements that can be adapted to various cultural situations. These common elements include certain features in curriculum and adequate teacher training. Dr. Douglas Kirby, an analyst for ETR Associates, a USbased educational research company, reviewed sex education programmes and found 10 common elements of the most effective programmes. Giving a clear, consistent message is critical. "The programmes that give the pros and cons to having sex or using condoms and then implicitly say, 'Choose what is best for you,' were not as effective at changing behaviours as the ones that consistently made a specific case. A common effective message was 'always avoid unprotected sex.' Abstinence is the best way - if you have sex, always use a condom." Making the message appropriate to the age and sexual experience of the participants is also essential. "If few of the participants are having sex, focusing

almost entirely on abstinence may be appropriate," he said. The most effective programmes concentrated on reducing one or more sexual behaviors that lead to unintended pregnancy or HIV/STD infection. Another important component, he said, is to identify what should change. "The successful programmes," Dr. Kirby said, "all look at the factors that affect sexual behaviour - beliefs, attitudes, norms and skills - and design a curriculum to address those factors." Effective programmes also provided opportunities for students to practice communication and negotiation skills, and had them personalise the information. Traditionally, sex education messages are targeted to one of two groups: those who are sexually active or those who are not. A study suggests that messages could be tailored to address four groups instead: those who do not anticipate having sex in the next year (delayers), those who anticipate initiating sex in the next year (anticipators), those who have had one sexual partner (singles) and those who have had two or more partners (multiples). As a group, the anticipators showed riskier behaviours and looser ties to family, school and church when compared with the delayers. Youth with multiple sex partners also reported more risks, compared with those who have had only one partner. Health educators should "address the social and psychological context in which sexual experiences occur," recommended researchers from the US Centres for Disease Control and Prevention, which studied 900 students ages 15 to 18 in the United States and Puerto Rico. The US-based Sexuality Information and Education Council (SIECUS) has developed sex education guidelines. They emphasise beginning early, when children are in primary school, and continuing through adolescence. Teachers need to be trained, and programs should involve the community, parents, administrators and religious leaders. The curriculum should include information on human development, reproductive anatomy, relationships, personal skills, sexual behaviour and health, and gender roles. As countries begin to implement sex education programmes, they are drawing to some extent on international guidelines and acknowledged common elements for success. Brazil, for example, has mandated that sex education begin with primary school children. In Mexico, a course developed by the Instituto Mexicano de Investigación de Familia y Población (IMIFAP) called "Planning Your Life" incorporates sex in the larger context of life development. A study by IMIFAP and the New York-based Population Council showed that the course can increase students' knowledge and, among sexually active students, increase contraceptive use. In Nigeria, a new curriculum emphasises the development of skills, teacher training and community involvement. A national task force has developed guidelines for comprehensive sex education, working with the SIECUS model. Using the Nigerian guide, the Association for Reproductive and Family Health (ARFH), a Nigerian nongovernmental organisation working with the Oyo state government, has developed a curriculum being implemented in 26 schools for 10- to 18year-olds. Little research on sex education among newlyweds exists, and what is available focuses on contraceptive use. China and Bangladesh have used family planning field workers successfully among married adolescents. In Bangladesh, when family planning field workers targeted newlyweds with letters of congratulations and motivational talks, contraception use among newlyweds increased from 19 per cent in 1993 to 42 per cent in 1997. In Indonesia, counsellors use marriage registries to contact newlyweds. Attending talks on family planning is a prerequisite to a civil marriage in

several states in Mexico. And in Bangladesh and Taiwan, media campaigns have focused on reaching newlyweds. In the most comprehensive analysis of sex education, the Joint United Nations Programme on HIV/AIDS (UNAIDS) examined 68 evaluations of sex education projects, 53 of which evaluated specific interventions. Of these 53 interventions, 22 "delayed the onset of sexual activity, reduced the number of sexual partners or reduced unplanned pregnancy and STD rates," the UNAIDS analysis concluded. There were neither increases nor decreases in sexual activity and attendant rates of pregnancy and STDs in nearly all of the other interventions evaluated. In one of the few exceptions, a program that included only abstinence in the curriculum resulted in an increase in noncoital sexual activity such as breast touching. Most of the successful programmes have included strong community involvement and clear messages about avoiding pregnancy or STDs. A study in Senegal found that family life education programs needed to put more emphasis on skill development. The study used focus groups and surveys with 225 boys and girls 14to 18-years-old who participated in the programs at schools, youth clubs and sports associations. "This [education] allows us to be more mature and to be able to face some of life's problems," said one boy. The youth also brought up issues involving respect and responsibility. "Discussions about what boys and girls want from each other in relationships suggest a lack of respect between the sexes," the study found. Boys thought that girls were primarily interested in money and other material things from boys, while boys and girls mentioned "the possibility of beatings or rape if a woman refuses to have sexual relations. Values that instil respect for women while teaching that violence is never acceptable need to be emphasized." The Institut de Sciences et l'Environment Université Cheikh Anta Diop de Dakar and FHI conducted the study, working with several ministry offices and nongovernmental organizations. Simply providing educational materials without other key elements, such as community involvement, can be counterproductive. A study in Nicaragua found that placing health education materials in motel rooms used by commercial sex workers actually lowered the frequency of condom use. Other factors critical for good sex education programmes include adequate teacher training and resources for implementing the programme. The teachers do not get trained, so they ignore the curriculum or do not know how to deal with it. The training has to desensitise the discomfort the teachers feel in talking about subjects that were taboo when they grew up. And, once one starts talking about sexual health with youth, one has to listen to them. You have to deal with their questions, and often, that is not comfortable for teachers. A recent evaluation of the Peru sex education programme suggests the potential limitations of training and resources. "There is still resistance by some teachers asked to implement the programme, which undercuts its effectiveness," said Dr. Robert Magnani of Tulane University, who works with FOCUS on Young Adults, a US-based research programme. In South Africa, life-skills training is mandated in all schools by 2005. Good training requires creative approaches. In Jamaica, FHI has worked with the Ministry of Education to train guidance counsellors to teach family life skills using a manual called Preparing for the VIBES in the World of Sexuality. It teaches counsellors how to guide youth in developing skits, dances, songs and other theatrical expressions of their questions, concerns, fears and scenarios for sexual situations, working with the Ashe

Performing Arts Academy and Ensemble. An evaluation of the program is under way, following for two years youth who participated in the family life skills course at age 12. The need for good training goes beyond school-based curricula. Involving parents and community leaders is also important. Working in Jamaica with the National Family Planning Board and Ashe, FHI is developing an adolescent reproductive health program for parents. It includes a training manual and video to help parents communicate better with their teenagers. Using the manual, a group of parents will be trained to work with other parents. In an initial needs assessment, about 90 parents expressed concerns about STDs, rape, pregnancy and homosexuality. Reflecting on their own adolescent experiences and concerns for their children, they identified what they thought should go into the manual.

PRACTICES IN THE WEST United Kingdom The UK has the highest rates of teenage pregnancy in Europe and the incidence of sexually transmitted diseases among the young is also on the increase. Britain's soaring rates of STDs means that sex education should be made compulsory for all pupils, according to one of the most influential reports on the issue of the nation's sexual health. Too many children are taught the basics of biology but not the emotional and social skills to help them handle sexual relationships, according to the Commons committee report. Fear of a backlash from religious schools and traditionalist parents have so far led ministers to resist pleas to make so-called Personal, Social and Health Education (PSHE) - covering concepts such as self-esteem, resisting peer pressure, negotiating over contraception and protecting against disease, alongside sexual mechanics - a statutory part of the timetable. They argue that heads and governors should be free to choose what it is taught. But the report from the all-party Health Select Committee warns that amid alarming rises in sexually transmitted disease, 'the cost and consequences of this illconsidered decision are considerable'. David Hinchliffe, chair of the committee, said a set curriculum of compulsory PSHE from primary school upwards was 'absolutely crucial' to controlling the spread of STD. 'Unless you address very early on the issues of proper compulsory sex education, then frankly you will continue to have very serious problems,' he said. 'It's a sensitive, difficult issue. But the continuing problem we have identified [with sexually transmitted infections], the fact is it's not getting better: we have got to look at the root cause, and that's ignorance about our sexual health.' By law, schools must teach the facts of reproduction to children aged between 11 and 14: between 14 and 16, they should also learn about how hormonal contraception such as the Pill works, and how viruses spread. But they are not obliged to teach PSHE, and the content of such lessons is left to heads and governors to decide. But the report argues there is little point in learning 'isolated biological facts' without the full emotional context, reflecting experts' arguments that it is pointless telling teenage girls that a condom prevents pregnancy, for example, without teaching them how to persuade a boyfriend to wear one. Yet children interviewed by the committee recounted tales of embarrassed form tutors with no specialist knowledge stumbling through lessons. Faith school organisations insist that the law should be sensitive to parents' wishes. 'Different faiths have different attitudes towards sexual education,' said Sarah Lane of

Churches Together in England. 'We need to be sensitive to that and approach the subject as part of a dialogue involving parents and community leaders.' Children's rights to sex education will be discussed in a green paper on youth, but the Department for Education and Skills has signalled it will not make PSHE compulsory. 'You can't set a curriculum which will be as acceptable in a faith school as it would be to a non-faith one, which is why we have said we have got to decide this locally between governors, teachers and parents,' said one government official. The majority of secondary school teachers believe pupils should be told where to obtain an abortion, according to a survey published today. More than two thirds (69%) of staff who teach 11 to 18-year-olds said pupils should be taught how to arrange termination of an unplanned pregnancy. Some 59% of all the 700 teachers polled by the Times Education Supplement supported practical advice on abortion being included in sex education lessons. Support was higher among headteachers and deputies, and more men (65%) than women (56%) were found to be in favour. The survey also showed that most teachers (74%) would be happy to tell children it was acceptable to be gay. And more than three-quarters thought parents had a right to be told if their underage daughter became pregnant and opted for an abortion. Almost all - 98% - favoured teaching about contraception in class. More than eight out of 10 said pupils should learn about the morning-after pill. The positive message of abstinence is being lost in sex education classes because of negative associations with US-style programmes, according to an educational charity. Oasis Esteem, which trains volunteers to teach personal, social and health education (PSHE) in UK schools, believes fears surrounding programmes like the Silver Ring Thing, a Christian movement that encourages teenagers to pledge to abstain from sex until marriage, has caused some sexual health tutors to shy away from teaching abstinence. "The Silver Ring Thing is a religious and cultural model for the US, but people associate the message of abstinence with that movement," said an Oasis spokesman. "So the positive message, which is young people don't have to have sex, is being lost." Oasis Esteem, part of the Christian social care charity the Oasis Trust, teaches sex education classes in secondary schools based on the World Health Organisation's ABC model - A, abstinence, B, be faithful to one partner, C, condom use for those sexually active. Lessons are delivered by "associated educators" - volunteers from churches or youth workers - who are trained to government standards. Ben Wing, Oasis Esteem operations manager, said some sexual health teachers take a "damage limitation" approach to sex and relationship education (SRE). Assuming that most, if not all, teenagers are sexually active, classes focus primarily on teaching the benefits of safe sex without exploring other options. Mr Wing believes teenagers need all the facts about contraception and abstinence in order to make an informed choice about whether or not to have sex. "While Oasis Esteem does not view abstinence-only programmes as the best way to teach young people about sex and relationships, failing to teach the benefits of abstinence, like failing to teach the advantages of contraceptive use, only serves to limit young people's choices," he said. Guidance on teaching sex education from the Department for Education and Skills does not specifically refer to the teaching of abstinence, although it does say that pupils should

learn the significance of marriage and stable relationships and understand the reasons for delaying sexual activity, and the benefits of doing so. Britain has the highest teenage pregnancy rates in Europe and sexually transmitted diseases diagnosed among this age group have almost doubled in the past 10 years. The Silver Ring Thing believes its abstinence-only programme will help reduce these figures. Organisers from the US bring their message to Britain today, and over the next week will hold meetings at venues in London, Birmingham, Manchester, Glasgow and Belfast. Using sketches, music and video presentations to get its message across, the organisation hopes some two million young people will sign chastity pledges by 2010. Those who do, wear a silver ring on one of their fingers, as a sign of their commitment. So far, more than 17,000 young people in the US have taken the pledge. Compulsory sex education for five-year-olds will be demanded today by government advisers on teenage pregnancy, as an essential step towards halving the under-18 conception rate by 2010. The teaching of sex and relationships in primary schools is not progressing fast enough to prepare children for the earlier onset of puberty, the Independent Advisory Group on Teenage Pregnancy will warn ministers in its annual report. The advisers have been encouraged by a 10% reduction in the teenage conception rate since 1998, and they attribute part of this improvement to more confident teaching of personal, social and health education (PSHE) in secondary schools. But the governmentappointed group is expected to say: "We are disappointed this new confidence is not reflected in primary schools." It will call for PSHE to be made part of the statutory curriculum at all key stages of education from five to 16, with regular checks by Ofsted, the schools inspectorate, on the competence of teaching. Under the current rules, most state schools provide PSHE, but only the study of citizenship in secondary schools is compulsory. Ofsted reports on the emotional, spiritual and moral development of pupils, but there has been no thorough study of sex and relationship education. Gill Frances, deputy chairwoman of the advisory group, said: "We know this is not properly assessed across all schools." But it was important to start education about sex and relationships in the early years at primary school. Encouraging children to start talking about feelings and relationships developed emotional skills that helped them to avoid teenage pregnancy, sexually transmitted infection and drug taking, she said. The advisory group will ask ministers to give statutory force to sex education guidelines prepared by Ofsted. They say pupils by the age of seven should be able to compare the external parts of the human body, share their feelings and use simple rules for resisting pressure from strangers. By 11 they should be able to express opinions about relationships and bullying, recognise their changing emotions, discuss moral questions and know how to resist unwanted physical contact. They should understand the physical changes that take place in puberty, the need for love in stable relationships and the safe routines needed to avoid the spread of viruses including HIV. Ms Frances said the report would advise ministers to leave schools some discretion over the pace of the sex curriculum: "There is no point in pushing schools to do more than parents and the local community can stand." The advisory group is expected to call on the government to do more to change the behaviour of hard-to-reach groups. Proposals include a national information campaign targeted at boys and young men, particularly from black and ethnic minorities, and an advert to ensure under-16s know they have the same rights to

confidentiality as adults when they seek advice. Sex education in schools should be more "hands-on", with children given more instruction on how to be considerate lovers, according to a retired Oxford University lecturer. In the latest edition of the journal Sex Education, John Wilson argues children should be given more instruction during "erotic education" on how to be a lover, and advocates the use of videos to offer practical guidance. In his article, Can sex education be practical?, he says it was "remarkable" that art, literature and videos of people having sex are not used to "promote learning". Teachers in schools should pretext any such materials with the advice that the images show "desirable sexual encounters", he said. But he is clear the videos used should not be designed to titillate. He asks: "Why should educators leave this gap to be filled by the authors of erotic literature or pornographic videos, whose interests are not, primarily, educational?" And he argues sex education lessons should include how to negotiate sexual relations and how to say no to sex. He said receiving practical advice would not increase the likelihood of young people having sex, but instead encourage them to make a more balanced and thought-through decision. However, John Dunford, general secretary of the Secondary Heads Association, said he did not think many teachers would find the suggestions helpful. "Taking sex education lessons is never easy, and it has to be done in a sensitive way to classes of children who are at very different stages of maturity and sexual experience. It would potentially create some very difficult situations in class. Some teachers might be horrified." John Bangs, head of education at the National Union of Teachers, said the repeated use of the words "erotic education" undermined the balance of sex and relationships education. Simon Blake, from the National Children's Bureau and former head of the Sex Education Forum, said Mr Wilson had used some unfortunate "old-fashioned" language, such as the term "erotic education", but added: "I'm not sure that he's really saying anything that goes against best practices. It's just slightly different language. "What I think he's trying to say is that we should think sex education through more. If we do it in a biological way we deny that sex and relationships are harder to manage than whether you have a bar of chocolate or not. He's trying to say that in using role play and distancing techniques what you enable people to do is work through scenarios which can help prepare them for sexual relationships." He added that rows over sex education in the media "frighten educators" into self censoring and undermined their confidence in teaching young people about sex and relationships.

Scotland More than a quarter of 14-year-old Scottish girls have had sex and almost half of them regret it, according to a new survey. A nationwide poll by girls’ magazine Bliss discovered 26 per cent of 14-year-olds in Scotland had had sex, compared with 22 per cent nationwide. Of the teenage girls surveyed, 60 per said they were drunk the first time they had sex, a quarter said they were "forced into it" and 6 per cent said they were assaulted. Two-thirds of sexually active 14-year-olds surveyed admitted they had had unprotected sex and half had taken the morning-after pill or had a pregnancy test. Those having sex had an average of three partners and almost half had had a one-night stand. Seventy per cent said they wished they had more information about love and sex to help

them make the right choices in life. And 49 per cent said they have had a sexual experience they regret, with 29 per cent saying they "didn’t even like" their sexual partner. Alice McLeod, from Glasgow University Urban Studies department, who has carried out studies on teenage pregnancy in Scotland, said the results showed girls were having sex when they were not ready. "Improved sex education isn’t just about knowing what contraceptives to use but knowing you can not have sex and you can wait until a later date. "But there will always be a certain group of teenagers who will want to have sex at an early age and these need proper access to education and contraception." The editor of Bliss, Lisa Smosarski said the results were shocking and showed that teenage girls needed sex and health education with more emphasis on relationships and selfconfidence. Despite the high per centage having sex, the vast majority of 14-year-old girls hold traditional values, with 94 per cent dreaming of getting married by the age of 25 and 89 per cent saying they wanted to tie the knot before having children. An overwhelming 94 per cent said that love, affection and romance were more important to them than sex. Ms Smosarski added: "This survey shows that teenagers really are new traditionalists - they want to get married and have children first, yet they are having sex earlier and often under the influence of alcohol. "The figures are extremely worrying particularly the number of partners girls have had. Peer pressure from their friends plays a great role in this - they are desperate not to be the last virgin in school, but often they are not emotionally mature enough to deal with the situation. "A lot of these incidents were spur-of-the-moment things, which the girls often regret later." According to the survey, girls are most likely to lose their virginity at their boyfriend’s house, with around a quarter having sex for the first time in their own home. A fifth had their first sexual experience at a party, while 4 per cent had had sex on a bus. Six out of ten teenage girls said their parents never talked to them about sex and only 7 per cent said they got enough information at school. Seventy per cent said they wished they had been given more guidance. Tina Radziszewicz, a leading psychotherapist and Bliss magazine’s agony aunt, said answering thousands of letters from teenagers had convinced her that sex education was failing in schools. Ms Radziszewicz said that mentor schemes, where older girls guided younger ones, or classes taught by a psychotherapist rather than a teacher, were among the possible alternatives. "They all say, ‘Yes, we have all seen somebody at the front of the class with a red face, putting condoms on bananas, but what we really want is to know about the emotional side of things’," she added. "Girls say they want love, affection and romance, so many of those having sex must be doing it to hang on to their boyfriend. But a high proportion of sexually active teenage girls would not be having sex if they were taught how to negotiate what they want from a relationship." The survey questioned 2,000 girls with an average age of 14 and a half, across the UK. United States of America Sexuality education has always taken place. Long ago, it took place in the home, church, synagogue, mosque, or through peer interaction. As culture changed, the responsibilities of education and educators changed. Sex education was viewed as an aspect of the solution to many problems affecting society. Controversy began as soon as the government and the schools became involved in the process of sex education. The what, when, where, and how of sex education tended to polarize communities an individuals. Sexuality education began in the early 1900s as an effort to reinforce traditional values.

These traditional values emphasised restraint and the procreative nature of sex. Early education was aimed at preventing a new moral code. In 1919, White House Conference on Child Welfare supported sexuality education in US Public Schools. In 1920, US Public Health Service published the Manual on Sex Education in High School. In 1940s, major organisations, such as American Association of School Administrators, began to call for better, more progressive sexuality education in American schools. Restrictive messages, however, were still the norm. Focus was moralistic. Curriculum included promotion of healthy sexuality, reproductive issues, "normal" sexuality and "venereal diseases." In the 50s, American School Health Association developed a programme in family life education, Growing Patterns and Sex Education. American Medical Association and National Education Association jointly published sexuality curriculum. In the 1960s, significant advances shifted education focus to emphasise factual understanding, nonjudgmental decision-making, and values clarification. Sex Information and Education Council of the United States (SIECUS) was chartered. Purpose was the promotion of healthy sex attitudes and the spread of factual information. Opposition groups made efforts to stop progress. Groups such as John Birch Society, Parents Opposed to Sex and Sensitivity Education (POSSE), and Mothers Organised for Moral Stability (MOMS) fought fierce battles at the state and local levels against implementation of sexuality education curricula. In the 1980s, the emergence of HIV has spurred interest and debate. Surgeon General C. Everett Koop stated, "there is no doubt that we need sex education in schools and that it must include information on heterosexual and homosexual relationships." Surgeon General Jocelyn Elders dismissed, in part, after suggesting current polices were limiting the success true sex education could produce. Currently groups such as American Family Association, Focus on the Family (opposing perspective), and Eagle Forum have begun major, proactive campaigns aimed to discredit comprehensive sex education and promote abstinence-only curricula.

Interview of DR. ABUL HASNAT MILTON Senior Lecturer, Centre for Clinical Epidemiology and Biostatistics (CCEB), University of Newcastle, Australia

What is the definition of sex education? Is the term ‘sex education’ misnomer? Shouldn’t it be ‘sexuality education’? Sex education may be defined as the education about sexual reproduction in human beings, sexual intercourse and other aspects of human sexual behaviour. I don’t think ‘sex education’ is a misnomer. To me, ‘sexuality’ is a concept which indicates something more in abstract form than ‘sex education’ which is better defined nowadays. However, in many literatures, sex education has been described as ‘sexuality education’. How would you describe the sexual behaviour of your students at the university in Australia? I teach at the post-graduate level in a university who are mostly married or I reckon they are matured enough to practice safe sex. I don’t have any information with me on their sexual behaviours. In Australia, sex education is provided in the primary and junior

schools. Parents also provide their children with sex education. Do you think there is a necessity of sexuality education in Bangladesh? Why? I strongly believe that sex education is necessary in Bangladesh. The youth of Bangladesh need the right information to help protect themselves. Studies from different countries of the world reported increased sexually transmitted diseases (STDs) including HIV/AIDS and unintended pregnancy among the teenagers. All these risks potentially exist for Bangladeshi youth too. In the current context, there should not be any question whether the youth will receive sex education, the only question is: how? An informal sex education from peers, poor publications and media is riddled with confusion and misinformation. Most of our parents and adults in Bangladesh are reluctant to give young people accurate sexual information. They fear that knowledge about sex leads to early sexual activity – or that talking openly about sex stimulates casual sexual relationships. But the reality is whether or not sexual information is given, a certain proportion of teenagers will always be sexually active. Studies suggest that adults who try to protect their children from the information that they need to make responsible sexual decisions simply push sexually active adolescents toward irresponsible sex. Do you think we should introduce ‘sexuality education’ in the national curriculum? Yes, I do. It is better if we could include this earlier, such as from class five or six. Sex education curricula often begins in later classes of high schools in many countries, after many students have already began experimenting sex, at least in the form of masturbation. Studies from different countries have shown that sex education begun before youth are sexually active helps young people stay abstinent and use protection when they do become sexually active. What do you think would be the impacts of ‘sexuality education’ both in positive and negative terms? Do you think ‘sexuality education’ would mislead young people? I think, with effective sexual education from home and school, adolescents can be provided with factual information to make wise decisions about their behaviour. It would also promote safer sex, reduce the risk of STDs including HIV/AIDS and unintended pregnancy. Sex education is unlikely to have any negative effects. We consider ourselves very conservative, especially in terms of religion. Our religion and social norms also restrict us from pre or extramarital sex. But the reality and studies indicate the existence of many risky sexual behaviours including pre or extra marital sexual relations among our youth population. Sex is a natural human instinct. Hypocrisy being one of our almost national characteristics also prevails when the issue relating to sex education comes. It is the high time to consider this issue of sex education with special priority. I firmly believe that it is wise to make informed decision about sexual behaviour than suppressing it. Logical approaches succeed than many emotional

arguments arising from our ignorance. Will ‘sexuality education’ work for Bangladesh? This is a question of research. Once we develop ‘sex education programmes’, we would need to evaluate whether these programmes are effective, and if not, how can we make them better. But with adequate and appropriate efforts, it should work. During developing a sex education programme, one should always keep in mind that knowledge alone is not enough to change behaviours. Programmes that rely mainly on conveying information about sex or moral percepts – how the body’s sexual system functions, what teens should-do and should-not-do have failed. However, programmes those focus on helping youths to change their behaviour using role playing, games, and exercise that strengthen social skills have shown signs of success.

PRACTICES IN ISLAMIC COUNTRIES In a region where sex is largely a taboo subject in public, Qatar is battling pornographic websites and permissive satellite channels by its own Islamic-style sex education. Debates aimed at educating the public in sexual matters while upholding the tenets of Islam were organised in March 2005 by Qatar Welfare Association and the Family Counseling Centre, attracting mostly female audiences. The debates targeted mainly "teenagers who strayed from the (right) path, tasted the bitterness of sin and lost the pleasure of the halal (permissible)," the welfare association says on a special website (www.lovebeaches.com). "Love is not a soap opera with a happy ending," the association says, adding that its drive aims at countering "depraved satellite channels and satanic (pornographic) websites." The sex education drive also aims at initiating people in "the art of successful love which withstands storms," and teaching youth how to "seek the warmth of love" and "deal with their instinct and lust." "The family in the Gulf region is appealing for help. That's why we sought to stand up to the culture of the video clip... by starting with shielding the family from such sources of information on the basis of our Islamic identity," the association's executive director Abdullah Hussein Nehmeh said. Subjects which are usually not aired in public in Gulf Arab states were on the agenda of the debates, where women made up 80 per cent of participants, said the association's information chief Ali Abul Nasr. These included homosexuality, sexual harassment, sexual desires, sexual deviation and transsexuality, he said. The Family Counseling Centre invited speakers from several countries in the region and beyond to the debates, including Kuwaiti preacher Jassem al-Mutawa and Jordanian AIDS expert Abdul Hamid al-Qudhat. There have been calls in Qatar recently for introducing sex education in school curricula, though some believe this is premature. On the other hand, a lack of sex education is dooming Iranian girls to "unnatural" puberty and a lifetime of insecurity and resentment, a Tehran university professor said in newspapers in Tehran. "Our girls do not go through puberty naturally, and they don't

receive a realistic explanation of gender and its related issues," said Ahmad Akuchakiyan, cited in the Ham-Mihan daily. "If teachers and parents don't give young girls an openminded explanation during this period, many of their questions and expectations will turn into a deep-rooted knot that can never be untangled," he said. He said they would suffer from "insecurities, dependencies and resentments," and decried the traditional custom of marrying off young girls when they hit puberty. There is no sex education on the official curriculum of schools in this Islamic republic, but couples are separately informed about birth control when they take pre-nuptial blood tests before being granted a license to marry.

RELIGION AND SEXUALITY EDUCATION In Islam, sexuality is considered part of people’s identity as human beings. In His creation of humankind, Allah distinguished humans from other animals by giving them reason and will such that they can control behaviour that, in other species, is governed solely by instinct. So, although sexual relations ultimately can result in the reproduction and survival of the human race, an instinctual concept, our capacity for self-control allows humans to regulate this behaviour. Also, the mere fact that human beings are the only creatures who engage in sexual relations once they are beyond the physical capacity for reproduction, sets them apart from all other species which engage in sex for the sole purpose of reproduction. For Muslims, based on an understanding of Qur'an and hadith, sexual relations are confined to marriage between a wife and husband. Within this context, the role of a healthy sexual relationship is extremely important. Having and raising children are encouraged among Muslims. Once a child is born, the parents are expected to care for, nurture and prepare the child for adulthood, with a goal of imparting Islam so that the individual is equipped with knowledge and willingness to accept and practice Islam and thus become a productive member of society. Beyond childbearing, sexual relations assume a prominent role in the overall well-being of the marriage. In reading hadith, one is impressed with the Prophet's ability to discuss all issues including those dealing with human sexuality. The topics range from questions about menstruation to orgasm. He apparently was not embarrassed by such inquiries, but strove to adequately guide and inform the Muslims who asked. Both Qur'an and hadith allude to the nature of sexual relations as a means of attaining mutual satisfaction, closeness and compassion between a wife and husband. "Permitted to you on the night of the Fasts is the approach to your wives. They are your garments and you are their garments."(2:187) Also, Muslims are advised to avoid sexual intercourse during menses so as not to cause discomfort to the woman (2:222). The goal of marriage is to create tenderness between two individuals and satisfy the very basic human need for companionship. "And among His signs is this, that He created for you mates from among yourselves, that you may dwell in tranquillity with them, and He has put love and mercy between you; in this are signs for those who think."(30:21) The hadith which address this issue are numerous. The Prophet himself, while not divulging all aspects of his own sexual life, was known for his nature as a loving husband who was sensitive and physically demonstrative. In several hadith, he speaks about the importance

of foreplay and speaking in loving terms during sexual relations. Again, the concept of mutual satisfaction is elucidated in a hadith which advises husbands to engage in acts that enable a woman to achieve orgasm first. [see Ihya ulum-id-din (Revival of Religious Learning) by Imam Ghazzali, chapter on Marriage]. Sexual dissatisfaction is considered legitimate grounds for divorce on the part of either wife or husband. Naturally, attraction between individuals is necessary to initiate a relationship that leads to marriage. But sexual relations can obviously take place between any couple, consenting or not. Because of the far-reaching ramifications of sexual relations outside of marriage, Muslims are prohibited by Allah from such behaviour. And because the process that leads to physical attraction and ultimately intimacy is part of human nature, Muslims are advised to behave in a way and avoid circumstances that could potentially result in extra- or pre-marital sex. Modesty in dress and behaviour between women and men figures prominently as a means of exhibiting self-control. Similarly, unmarried couples are admonished against spending time alone in isolated places where they would be more likely to act on their feelings and thus be less inhibited. Some of the negative results of sex outside of marriage include the potential for unwanted pregnancies, transmission of STDs, disruption of the family and marriage (in cases of adultery), and emotional and psychological difficulties resulting from the lack of commitment associated with most relationships outside of marriage. As in other religions, extra- and pre-marital sex are considered major sins. Muslims believe that Allah does not simply forbid or allow behaviour whimsically, but does so with our best interest at heart, guiding us away from potentially destructive behaviour and towards behaviour that allows people to achieve their most fulfilling potentials as human beings. Although Muslims are encouraged to have children, contraception is not prohibited. The method used during the time of the Prophet was coitus interruptus (known as 'azl) about which several hadith exist. His basic response when asked if such a practice was lawful was that individuals can do as they will, but if Allah intends for a child to be born, she/he will be born. Some interpreted this to mean that preventing pregnancy is not recommended because child-bearing is preferred; yet the act is not specifically prohibited. Also, other hadith stipulate that 'azl’ could not be practiced without the wife's consent as it might interfere with her sexual satisfaction or desire to bear children. By analogy, the methods that exist today as contraceptives are lawful for Muslims to use at their discretion. Basically, it is our position that any method that does not involve pregnancy termination is permissible. Imam al-Ghazzali lists a number of legitimate reasons for practicing contraception, including financial difficulty, emotional or psychological hardship of having many children, and even the preservation of beauty and health. Abortion is viewed in the same context as having relevance only regarding pregnancies occurring in marriage, again, not as a response to conception as a result of extra- or premarital relationships. Early Muslim jurists considered abortion lawful for a variety of reasons until 40-120 days after conception (first trimester). This was based on interpretation of Qur'an (22:4 and 23:12-14) and hadith that implied that ensoulment or 'life' did not exist until after that time [Sex and Society in Islam, B.F. Musallam, Cambridge University Press, 1983]. Contemporary thinkers, considering available technology that allows visualisation of the embryonic heartbeat at four weeks of

gestation, are of the position that life begins much earlier than previously thought, and therefore to terminate would be to take a life illegally. The majority of Muslims today believe that abortion is allowed only if the mother's life is significantly endangered by the pregnancy. Some also feel that the presence of certain congenital anomalies (particularly those that are lethal) make abortion lawful. Also, some scholars consider abortion appropriate in pregnancies resulting from rape or incest. Human beings are capable of many forms of sexual expression, orientation and identification. The existence of such a variety again is not found in any other species and thus further demonstrates our uniqueness among Allah’s creations. The potential for behaviour, such as homosexuality, does not mean that its practice is lawful in the eyes of Allah. Therefore, individuals are expected to control themselves and not act on their desires if such action is contrary to the guidelines of Islam. Homosexuality, like other forms of sexual relations outside of heterosexual marriage, is thus prohibited. In any discussion of prohibited acts follows the question of what happens if they nevertheless occur. Clearly, Islam is explicit about many aspects of human sexuality. Also, based on the numerous hadith showing the Prophet's willingness to discuss these matters openly, it should be obvious that education about matters related to sex is acceptable. Muslims may disagree about the age at which sex education begins; some don't discuss the subject at all. Explaining anatomy and the changes one's body experiences during puberty are essential for enabling young people to grow up with a healthy self-image. Also, in an age where sexual activity in many countries begins at an early age, Muslim adolescents must be informed to better enable them to deal with peer pressure. Sex education can be taught in a way that informs young people about sexuality in scientific and moral terms. In countries with very diverse populations, such as the United States, the main limitation in developing sex education curricula, particularly in public schools, is the inability to select a universally acceptable moral position. Therefore, young people are given facts and information, and advised that if they choose to engage in sexual relationships, they should take measures to prevent pregnancy and sexually transmitted diseases. The moral and religious aspects of sexuality can be incorporated either in schools of a particular religious denomination or in adjunctive coursework offered by religious institutions. Regardless of the challenges of each society, young people must be adequately informed. Also, in some Muslim communities, individuals are encouraged to marry at young ages. They need to be educated regarding sexuality prior to the marriage such that they know what to expect and can consider their options for birth control prior to consummating the marriage. Ibn al-Quyem in his book, Prophetic Medicine, assigned a full chapter to discussing the Islamic attitude to sexual and marital life, the interaction between the spouses, and the permissions and prohibitions concerning sexual intercourse between spouses. Muhammad Qutb in his book, Islam the Misunderstood Religion, discussed the subject in two chapters, one On Islam and Woman and the other, On Islam and Sexual Repression. Reading through the Quran and the Traditions of the Prophet, there are many verses and Traditions about the creation of human life, cleanliness and purity, interaction between tile spouses, and mention of sexual intercourse between the spouses. In the explanation of these verses and Traditions, issues did arise, questions were asked and both sexes were

involved jointly or separately. The following important points can be made: 1. In Islam sex has always been taken seriously and it should remain so. It is not a subject for fun or mere absolute pleasure. It is never discussed obscenely or subjected to scrutiny. Decency and due respect always characterise the subject. 2. Sex is never discussed in isolation for its sake or mere pleasure. It is always related to marital life and family life. It is viewed as a superior human relationship subject to strict regulations. Thus sex within a marital relationship is a worship that is rewarded. Outside a marital relationship sex is a punishable sin. 3. Sex is a privacy between the spouses. What goes on is confidential and should not be divulged to outside parties. The human factor in marital and sexual relationship is superior to mere pleasure. 4. Legislation concerning sex is not subject to change by pressure groups or change in social attitudes. 5. Like the rest of Islamic teaching, knowledge about those verses and Traditions on the subject is not age-specific and is not meant to start at a certain age. As the Muslim is leaming the Quran and Sunnah he or she will come across these teachings.

“Sex Education Acceptable In Islam” Interview of Islamic Scholar, SHEIKH SANUSI GUMBI of Kaduna, Nigeria, is interviewed by Ilyasu Ibn Muhammad At what age should a child be taught sex education? As we all know, there is nothing which Islam has not taught its followers. Sex education in Islam is taught theoretically and not practically. If a child is being taught sex education it is not permissible for his teacher to come into body contact with him during the period of study. As long as a person has reached the age of puberty, it is not permissible for him/her to see the thigh of another person. However, sex education can be taught properly. When we look at the book of Buhari, a hadith from the Prophet (PBUH) shows where he (the Prophet) was teaching his companions how to perform purification bath, he said, "if he sits in between her (thighs) and exhausts her, then a purification bath becomes compulsory." Here, he only made a statement which explains how intercourse may take place, but he did not say come and sit here let me demonstrate how it is done. Therefore when teaching, there is no harm in explaining how it is done. There is even no harm in drawing on the board, but not when the teacher and his students come in contact. We have books in Islam, which explain the purification bath, what spoils ablution; some of these things explains how the sperm or semen is emitted. Still, at what age should a child know about sexual intercourse? In modern times, a child of primary school, say age seven, should start knowing these

things, before he/she becomes fully mature. Is it proper for children to start knowing about sexual oriented vices like homosexuality at such age? Yes, it is in Islamic books of jurisprudence and history. It has shown that homosexuality and their likes exist. Children should be taught about this, likewise the punishment for it. If you go to our settlements in Northern Nigeria, remote areas where we grew up, you will find young children learning about these things. They learn about them and their punishments, so that by the time they grow up and mature, they will know how to deal with such cases. They should know that it is forbidden. What is the Islamic perspective on masturbation. Is it proper for young children to learn it? Whatever it is that Allah has ordered mankind to adhere to and forbid them from, there is no harm in young children knowing about them. They should know them thoroughly and then learn their virtues and vices. All that matters is that they should not see them being done practically, so that they will not attempt doing it. What is the Islamic view on contraception and what effect does it have on children knowing about them? Teaching children about contraceptives such as condom, is like encouraging them to go and have sex, because in the Hausa culture, what makes one to migrate to another area is the issue of pregnating a woman out of wedlock. With the introduction of condoms, these people of shameful character have found an avenue to do so as they wish. Therefore it has become necessary for children to know that these things have negative effects, even if they have advantages. They should know that it should be used when lawfully married. Is it permissible for young children to know the intensity of sexual arousement, like where to touch, how a partner should react, and other heated sensations, which cannot be mentioned here? If it is all in explanation, there is no fault. In Abu Hanifah's school of thought, he said, there is no harm for a person seeking marriage to smell the lady he intends marrying and vice versa and there is also no harm for them looking at each other properly, because they are expected to be life partners. there is no harm in children knowing all these things. All that matters is that there should be no practicals. As a young man growing up, there was a time my Mallam [teacher] was teaching me, you know how raw Sokoto Hausa is [the local language], he said penis in Hausa, he said virgina in Hausa and then was explaining how one enters the other then I laughed, he cautioned me not to laugh and said that "fiqhu cannot be taught without explanation." Even the Prophet (PBUH) was asked by a woman as is narrated by a Hadith reported by Aisha. The woman asked what the Islamic injunction of a woman who sees what a man sees, she was referring to wet dreams, because a woman can have a wet dream just as a man does. Before the Prophet (PBUH) was able to answer, Aisha said to the woman "why are you asking such a question? do you want to embarrass us in front of the Prophet?" the Prophet then said there is no shame in knowing one's religion. Ask everything that you do not understand.

In this part of the country, the mention of sexuality education makes people jittery due to lack of the knowledge of fiqh. Or is it the normal culture here? People here like to wear the garb of ignorance whereas they know what is true. Somehow they are 100 years backwards. Even what they read in the fiqh books have not fully been comprehended. When in the past sexuality education was not taught, it led people to pregnanting women out of wedlock, which is very shameful. Islam is not against theoretical sex education. It only frowns at the practical aspect. Sex is a natural thing. no animal is taught it. it happens naturally. What is the Islamic view on abortion? Abortion in Islam is haram (forbidden). However, there is the permissible abortion where a married woman is concerned, where it is discovered that if a child would become a nuisance to people if it was born with some deformity or something of that nature. Now, questions where thrown to scholars, where it was agreed that abortion is haram, except in a case where the foetus has not yet matured to become a living being. Still on sex education, some have the view that sex education should be left as parent's responsibility. What is your view? There are schools where human mannequins are brought in front of the class and these mannequins are used to demonstrate the sexual act. Muslims have frowned at such demonstrations because children would practice it when it is practically shown to them. However, it has to be taught because children will mature and like we have been stressing, it should be taught theoretically, so that when these children mature, they will know what to do in the light of difficult circumstances and situations that arise in relation to sexual intercourse.

…IN CHRISTIANITY What is an Orthodox Christian approach to sex, pornography, and the media? And what is the Orthodox view of sex? To do so, one should turn to the Bible, the first chapter of the first book. It reads: “God created man in his own image; in the image of God he created man; male and female he created them. Then God blessed them and said to them, Be fruitful and multiply, fill the earth and subdue it” (Gen. 1:27-8). (Then verse 31), “Then God saw everything that He had made, and indeed it was very good.” So sex - the malefemale distinction, the reproductive process, and the pleasures associated with it - is good - the Bible says “very good!” It’s part of the good world as God created it. One can also look at a couple of other examples from Scripture. First, from Proverbs 5:19. In the context here, the wise man is instructing his son to stay away from an adulterous woman. He says: “Rejoice with the wife of your youth. . . Let her breasts delight you at all times, be always enraptured by her love.” And believe it or not, the original Hebrew literally means “breasts,” although sometimes it is translated as “affection” to tone it down! God’s inspired Word teaches that a man should enjoy the physical love of his wife. However, one should not assume the godly enjoyment of sex in marriage is for men only. The Bible records that when the angel told Sara she would conceive and bear a son to Abraham, (she was about 90), she laughed, and said, “Shall I

have pleasure when both my husband and I are old?” (Gen. 18:12). In the world of the Bible, the pleasure of physical love was to be enjoyed by the woman as well as the man. (The Song of Solomon also makes this abundantly clear). This is why the Apostle Paul commands that husbands and wives not deny each other their desire unless they both agree for a period of prayer and fasting. But then he tells them to come together again so they can avoid temptation. So the Bible clearly teaches that the enjoyment of physical love between husband and wife is a good thing. It also teaches that celibacy and virginity embraced for the sake of dedicating oneself more completely to the Lord are good things. But there can be no question that the Bible regards sex in marriage to be a good gift that is blessed by God. The reason the Bible emphasises the importance of sex is because it is the physical expression of the union between husband and wife. Scripture says: “For this reason a man shall leave his father and mother and cleave unto his wife, and the two shall be one flesh” (Gen. 2:24). Sex is the means by which the husband and wife are physically united to another and the expression of the absolute oneness between them. Jesus said: “They are no longer two, but one flesh,” and “what God has joined together, let no man put apart” (Matt. 19:6). Sexual intercourse is the physical expression of oneness between husband and wife. This is why the Bible rejects sex outside of marriage. When two people are married, God joins the two into one. But if one indulges the symbol and expression of that oneness outside of the marriage bond where God intended it to be, one is outside the will of God. That’s why St. Paul wrote: “Do you not know that he who joins himself to a prostitute becomes one flesh with her?” (1 Cor. 6:16). Indulging in the physical act of union where there is no oneness is a gross violation of God’s holy design for sex. It is for this very reason that sex outside of marriage, (fornication and adultery), is condemned in Scripture in no uncertain terms. Scripture bluntly warns us that fornicators and adulterers will not inherit the kingdom of God (1 Cor. 6:9-10). (Of course, forgiveness is always available for those who would repent and confess.) Sex within marriage is good and under God’s blessing, and sex outside of marriage is sinful and under His curse. However, at times some people have become so hung-up about sex that it is not only unbiblical but ridiculous as well. Recently, a certain sect banned washing machines with windows. It was feared that a man might see a woman’s undergarments in the wash! Such absurdly puritanical approaches have nothing in common with a healthy biblical view of sexuality. Most people probably know that pornography is notoriously hard to define, and all kinds of legal battles are always raging about it. Generally, one can describe it as explicit photographs or descriptions of bodily parts or sexual acts. Most people find such literature degrading and dangerous. In most television shows, movies, and popular magazines, however, what one has is a softer, less explicit, less degrading, type of presentation. But as Christians, the same principles apply to both, even though there is sometimes a substantial difference between the two. The first principle for dealing with media sex is based on the saying of Jesus: “Whosoever looks upon a woman to lust after her has already committed adultery with her in his heart” (Matt. 5:28). Now, most sexual depictions in books, magazines, TV shows, movies, and stage shows are generally for the purpose of arousing passion in the viewer - in other words, causing a person to lust in

his/her heart. For example, at night on TV, ads for daytime soap-operas talk about “love in the afternoon” with scenes of people passionately making love. What’s the purpose of this? What’s really going on here? The second principle that one needs to understand about pornography and sex in the media is that what one is really dealing with is prostitution: men and women, actors and models, basically selling themselves for the sexual enjoyment of others. And what one is doing when s/he watches it or look at the magazines is engaging in a spiritual act of prostitution. Box ▼ ANN L. HANSON, Minister for Children, Families and Human Sexuality, United Church of Christ expresses her views on sexuality education Is it puzzling to see the words 'sexuality education' and 'religion' in the same sentence? Many people think these two subjects haven't much to do with each other. Or, in many instances, we think of one as having nothing to do with the other. I was born in northeastern Montana into a Christian family. No one in my home talked about sexuality. Oh, I was given the traditional 'book and box' of knowledge when I was eleven or twelve, and asked if I had any questions; but I was never exposed to anything bordering on healthy sexuality education. Now, I can't blame my parents— they didn't know anything different. And what did I learn about sexuality in my faith community? Absolutely nothing. The overall feeling I received about sexuality was: "It's a deep secret, it's kind of dirty, and you save it for the one you love!" But, I spent hours sharing knowledge and curiosity with my girlfriends and combing the drug store for 'just' the magazine that would give me the information I wanted and needed. Looking back, I don't know whether to laugh or weep. Now, many years (and three children and six grandchildren) later, I find myself as a sexuality educator in a religious setting. What can I say now that I couldn't say years ago about sexuality education and religion? As a Christian, I inherited a tradition that has sought to separate our bodies from our minds and spirits. Volumes have been written casting our bodies as a negative part of who we are. There were, and continue to be, inherent fears, misunderstandings and guilt about sexuality. However, many people of faith are working in life-affirming and, in many cases, life-saving ways to heal this separation and fear. Often, people equate sexuality with sex—particularly, sexual acts. However, sexuality includes so much more. It includes sensuality, intimacy, identity, health, and reproduction. Because sexuality is often used to influence, manipulate, and control others in ways that are harmful and destructive to the body and spirit, faith communities are called to support an ethic of human sexuality that embraces healing and health, justice and mutuality. Most religions celebrate wholeness for all people, including children and youth, and most believe that sexuality is a gift of the divine. Many people of diverse culture, race, and religion believe that, in order to provide an opportunity for wholeness, we must also provide information that will enable all people to make life affirming decisions— and this includes providing comprehensive information about sexuality.

Most religious leaders lift up the child as a symbol of hope. Many still profess, however, that we must protect our children and youth (and, in many instances, adults) from education about sexuality. Resistance to providing information and a forum for honest dialogue on issues related to human sexuality—either in faith communities or in secular settings—often comes from people's unwillingness to question firmly held beliefs. And, it's something we are not used to doing. However, the rewards can be great—healing can occur and knowledge gained that offer cause for celebration. My experience, as a sexuality educator to both youth and adults, has been one of the most powerful parts of my spiritual journey. Youth have told me that having sexuality education classes in their faith communities has been the best gift their church has ever given them—a place where any question will be answered and where guilt and fear have not been used as a way to control them. They have been appreciative, too, that caring and loving adults have respected them enough to give them the information upon which they can make responsible decisions. Parents and caretakers of children and youth are grateful for the ministry of sexuality education. And adults have rejoiced in the knowledge that their sexuality is, indeed, a precious gift of the holy!

… IN ASIA AND SOUTH ASIA The draft on sex education in schools in Malaysia is now in the final stage of preparation. The draft to provide holistic sex education to the youth by taking into account religious and social issues would soon be tabled to the Cabinet. The draft contains six components - human development, relationship, marriage and family, interpersonal skills, sexual health and behaviour and society and culture. The sex education covers five levels - level I for children aged four to six, level I for those aged between seven and nine, level II (10 to 12 years), level IV (13 to 18 years) and level V for those aged 19 years and above. Some people in the Malaysian media commended that their government has focused its attention on Malaysia’s sexual education and they believe that the public, especially the youth, are aware that this is very important. It is heartening to note that issues involving sex isn’t a total taboo anymore in our society. Some actually suggested that sexuality education should start from homes. To some parents, they said, sex is still a taboo subject. If the parents had studied this subject themselves, they would become qualified to teach children the subject today and things would be different. Malaysia’s draft guideline had been in the works for more than two years by a special committee comprising the aforementioned ministry, Health Ministry and Education Ministry, as well as academics and non-governmental organisations, when the forum was held to get feedback from the public. According to Malaysia’s Women, Family and Community Development Ministry, the rise of sexual violence against women and children, spread of HIV/ AIDS and sexually transmitted diseases has precipitated the national guidelines. Once approved by the cabinet, the guideline will be distributed for the reference of the general public, specifically for the aim of educating young people on sexuality. This is not a way to police or control the nation’s sexual behaviour, but rather to equip the young and rest of society to handle the changing sexual politics and dynamics in the world. Older children will learn about the dangers of reckless sexual behaviour and sexually transmitted diseases. Among the topics covered

are challenges of marriage and the rights of children. As a whole, the guideline is quite comprehensive, especially considering the complexity of the subject matter. Dr Ahmad Tajudin Othman from the Education School at Universiti Sains Malaysia (USM) pointed out that the main objective is to empower the young by teaching them respect and selfesteem, as well as to develop healthy relationships. Not surprising, issues of pre-marital sex and sexual orientation did not bode well with the more conservative participants in the forum, initiating calls for the inclusion of more spiritual values. At the opposite end of the pole, there were calls for a more open approach, particularly from the young. The biggest issue, conceded Dr Tajudin, has been trying to balance the different views and religious beliefs. In 1994, a sexuality education component was introduced to primary schools. Says Kong, the main aim of the component was to empower children to make informed decisions from an authoritative source of information. It was also to avoid the 4 Ms – misinformation, misconception, misconduct and misguided. Since it was introduced, the sexuality curriculum has undergone various revisions to keep up with the changes around the world. In 2003, the term “sexuality education” was introduced. They took the opportunity to introduce the term sexuality because they wanted to portray this positive message. We thought that it would be better for adolescence to learn from the proper source rather than pick it up from friends and the Internet. They did not want to use sex because they didn’t think that the Malaysian society was ready for it. Sex bears a connotation that it is something physical, that you are teaching sex to students. Majority of people in India favour introduction of sex education as part of the curriculum from class IX. This is the finding of the field research on "Sex education: Are we mature enough to accept it?” undertaken by the students of the post-graduate diploma in mass communication of Jaipuria Institute of Management (JIM), Lucknow. Findings of the research were presented recently. The students have spoken to parents, students, teachers and doctors. The findings indicated that nearly 77 per cent respondents agreed that sex education should be introduced as part of the curriculum in schools for class IX and XI. However, Activists have blame India’s coyness towards sex education for the spread of AIDS. “There is a large population of about 300 million young people in the age group 12-24 in India, and recent studies show their growing preference for pre-marital sex,” said Rakesh Kumar, director of the Centre for Health and Development, a Patna-based NGO. “The government has no plans for the sexual health education of this group,” he said. Nearly four million Indians are carriers of HIV, the virus that causes AIDS, making it the largest HIV-positive population in the world, after South Africa. Unofficial estimates put the figure at closer to five million. Various social groups suggest that in the next 100 years, India will have the highest number of AIDS cases in the world. Threequarters of those infected with the Human Immunodeficiency Virus live in five states, with the southern state of Tamil Nadu at the top, followed by Maharashtra, Karnataka, Andhra Pradesh and Manipur. A recent survey of youth in Mumbai, by Sexual and Reproductive Health and Rights of Youth, concluded that 64 per cent of youth aged 14 to 19 were no longer virgins; 43 per cent of them have visited prostitutes. In another survey by The Week magazine, of unmarried young Indians, 69 per cent of men admitted to premarital sex compared to 38 per cent of women. Forty-five per cent of Indians had premarital sex between the ages of 16 and 19, while 27 per cent were 15 years or under and 28 per cent were 20 years or older. Activists argue that the government should target and educate young people to stem the rampant spread of the disease, as the country’s rigid

social customs, where men enjoy privileged status, hinder the use of condoms. Government officials say they oppose introducing sex education in schools in a country considered by many to have puritanical attitudes toward sex. Sri Lanka has had made a paradigm shift: from Family Planning to Reproductive Health. The new Population and Reproductive Health Policy of the Government addresses the crucial population and reproductive health issues. As delegations are, of course, aware, these are issues that include: safe motherhood; sub-fertility; induced abortion; reproductive tract infections; sexually transmitted diseases; promotion of economic migration and urbanization and the control of their adverse effects; enhancement of public awareness as to population and reproductive health; and, of course, strengthening the infrastructure necessary for implementation and coordination at national and subnational levels. Fundamenta1 changes are taking place in the age-structure of the population of Sri Lanka. The “Adolescent”, the “Youth” and the “Elderly” of Sri Lanka are expected to grow significantly during the next decade. As to the last two such segments - “Youth” and “Elderly” - Sri Lanka will realise, in absolute terms, the largest number of “young” and, the largest number of “old” in its demographic history. The process of modernization imposes ever-increasing strains on the Youth. Drug abuse, sexual harassment, child prostitution, adolescent pregnancies and suicides cause concern. Sri Lanka sees the need to promote responsible sexual behaviour. There is a need to mitigate the effects of such social problems. The following measures have been identified as necessary as a matter of policy, and they are presently being implemented: provision of adequate information and education; the inclusion of sex-education and education in ethical behaviour in school curricula; the strengthening of youth worker education by means of information on drug abuse and sex-related problems at vocational training centres, institutions of higher learning, and work places; promotion of counsellmg on drug and substance abuse, human sexuality and psycho-social problems especially through the National Youth Service Council and non-governmental organizations; and implementation of programmes such as counselling to minimize the incidence of suicides among the youth.

SEXUAL BEHAVIOUR OF BANGLADESHI ADOLESCENTS Based on the qualitative data, a model was developed to show how a relationship develops between a boy and a girl. The model is made based on adolescents' views of the process of development of a relationship between a boy and a girl. Generally, boys roam around and tease girls. Eventually, they may make a more formal proposal to a girl they like. This may be in the form of letter writing. The girl, if she likes the boy and if the opportunity permits, might respond to the letter writing, and this may then escalate to chatting and develop into a relationship. As the relationship progresses, if it does continue, there may be an expectation of gift exchange. And, at this point, they may also begin to develop a physical relationship. They may hold hands. In some cases, holding hands may be the maximum extent of physical contact, but it may proceed further. They may go to a park, field, or a rooftop (especially at night in urban areas) and lay down with their head on their partner's lap. They may also kiss. For many of them, they said that if it

is "true love" the most that could happen is kissing. Their parents may not agree to this love affair, and, as a result, they may sneak away and get married. If the parents do agree, a 'love marriage' could be arranged. Or, the relationship may end. If the situation permits, "the couple" could also have pre-marital sex. This pre-marital sex, if unprotected, may lead to an unwanted pregnancy and/or STDs, including HIV/AIDS. Pre-marital affairs and sex The boys, girls and adults all mentioned that pre-marital affairs are a common phenomenon among adolescents. Many boys and some girls admitted that they themselves were or had been involved in pre-marital affairs. The girls were very concerned about the consequences of pre-marital affairs, including being labeled as a 'bad girl', pregnancy, forced to marry, forced to drop-out of school, etc. Relationship developed There was a general disapproval of pre-marital sex. Most respondents had some basic idea about sex from movies. Many strongly believed that in the case of "true love" there should not be any sexual relationship. They mentioned that if a relationship is 'true love', the most that could happen would be kissing or holding hands. None of the female participants admitted to having pre-marital sex, but some male participants did. Two male participants mentioned that they had sex with the same girl. Both boys and girls narrated stories about friends, family members, and neighbours who have had or were having premarital sex. One rural boy shared a story about pre-marital sex. He described one of the worst scenarios: ”In our village, there was a girl who made a physical relationship with her cousin. She got pregnant and after delivery her family members killed the child. The boy went away. Police arrested the girl. Later on, the girl committed suicide by drinking poison.” Qualitative data suggests that regarding the influences, both boys and girls were aware of both physical and mental changes that happen during puberty. They also indicated that there is an increase in the male sex drive as a boy grows up. The male and female respondents as well as the adults felt that the boys initiate pre-marital sex. Another influence is that, in Bangladesh, initiatives have been taken for delaying the age of marriage. By doing this, in effect, a longer period of adolescence is recognised. Thus, the time between childhood and adulthood has been created when the adolescents are increasingly interested in their development of sexuality and wanting to explore sexuality. And, with growing exposure to media, particularly movies and x-rated films, this curiosity is further developed which may also influence pre-marital sex. If they are in a relationship and they have the appropriate time and place, they might experiment with pre-marital sex. A number of participants also reported incidences of violence and rape. The only factor mentioned that could inhibit a pair from having pre-marital sex is 'true love.' Many adolescents mentioned that if they see their relationship as 'true love', they would not consider having pre-marital sex with their partners. Most participants seemed to be aware of the consequences of pre-marital sex. These include: social stigma, pregnancy, ’bad diseases,’ infanticide, suicide, and even murder of girls. Or, if they are in

love, the parents may agree to their marriage, or they may sneak away. In general, there is a great fear of social stigmas. The girls who are involved with or suspected of being involved in even a 'love affair' may be labeled as ‘kharap’ or 'bad.' The girls were worried about maintaining their prestige within the community. The parents were also concerned for their social status. A story was told by one participant, ”An unmarried girl in this area became pregnant. Her family members told everyone that she had a tumour, but it became clear that she had been pregnant after she gave birth to a baby boy. Then, the boy was forced to marry the girl, but later on, he left the girl and married another girl.” As this girl described, many girls also spoke about the possibility of the boy leaving them once they have had sex with them. There was also a great fear of pregnancy. Not only would being pregnant lower the girl and her family's social prestige, but she might seek an abortion--which may lead to other health problems, or her baby may be killed (infanticide). Stories were told of forced marriage, rape, suicide, and even murder of girls. ‘Kharap oshuk’ (bad diseases) were also mentioned as a consequence of pre-marital sex. The disease could be treated or it might lead to infertility. Finally, as a consequence of pre-marital sex, couple could be forced to marry, or girls could sneak away with boys if parents do not give consent to their marriage. Girls most often suffered the adverse consequences of an unwanted pregnancy resulting from pre-marital affair. Both boys and girls narrated stories, particularly stories that happened in rural areas where a girl had to face ‘salish’ (village trial). However, in one case, one of the girls blamed the girl: ”Sometimes a physical relationship may develop beyond one’s desire. However, I also think that the girls should be blamed for this type of accident. If a girl could understand the attitude of a boy then why would she get involved with him?” Extra-marital sex Both boys and girls knew people in their community who were engaged in extra-marital affairs. They knew of women whose husbands had been working abroad and who were said to be having affairs with adolescent boys. These boys were either relatives or their next-door neighbours. Although in one of the study areas, a large number of men were abroad due to work, similar comments were made in other study sites. The study participants described men who were having extra-marital affairs as those who were unhappy or dissatisfied in their married life. Commercial sex Both boys and girls knew about commercial sex workers (CSWs) and brothels. They termed this business as ‘chamrar babsha’ (body business) and brothels as ‘magi para/kharap para.’ Some of them knew about the exact location of some brothels. The commercial sex workers were commonly termed as 'Kharap meye' (bad girls). Some adolescent boys from urban areas explained that 'bad places' were not always well demarcated or isolated from the society. Some had idea about floating sex workers. One urban male adolescent said,

”In the past, there was a brothel in our locality. The government broke it down but this has also had a bad effect. Now, the bad girls roam around in different parks. Sometimes they rent a house and continue their business. If we hear this, we ask the landlord to evict them.” Many adolescents knew people in their community who had visited commercial sex workers. Some urban slum adolescents knew the names of the girls who were involved with commercial sex business. Some rural adolescents identified one or two girls residing in the village who were marked by the villagers as 'bad girls.' "Bad girls" or CSWs were also associated with "bad diseases" or STDs. Many participants had similar comments: ”If one goes to the bad places (brothels), they may get bad diseases, and they will fall ill (’chehara bhenge jai’)." Some adolescents knew that people might die of such bad diseases. According to them, mostly young boys and young men go to brothels. Some male adolescents admitted that they themselves had visited brothels. One boy claimed that he went to the brothel out of frustration after breaking up with a girl. Another male participant admitted that he visited brothels several times, but did not use a condom every time when he visited the brothel. He shared his experience and said, “I had a sexual relationship with a girl. Later, the relation ended. Then I began visiting a brothel. I got a disease from the brothel. After seeking treatments from the doctor, I was cured. Again, I visited the brothel 3-4 times. I used a condom twice while visiting the brothels. In the medicine shop if I go to buy condom then the shopkeeper asks me if I am married or not. I feel shy for this and do not go to the medicine shop anymore.” Homosexuality In each of the study areas, there was at least one adolescent boy participant who knew about an adult male who was having sex with adolescent boys, and adolescent boys who were having sex with boys of similar age. This activity was termed as ‘jeena.’ Sometimes the men who were doing so provided incentives to their young partners. Some of the men were said to have forced young boys to have anal sex. Masturbation Many boys believed that masturbation was bad for one's health; it causes weakness of the body and would change the shape of the penis. It is commonly believed that this activity might have some long-term adverse effects. However, they admitted that they did masturbate. They said that they used oil or soap as a lubricant. One male respondent thought that semen was made from blood. He explained why the body became weak after masturbation: ”From 20 drops of blood one drop of semen is made, so when semen comes out of the body that means the blood is going out of the body and the body becomes weak. A disease called ‘dhatu khoya rog’ may develop from this practice (masturbation) in which the

semen comes out automatically.” Since a majority of the study males believed that masturbation was a kind of sickness, on some occasions they sought treatment for this. Both survey and qualitative data suggest that there are differences in the ways that adolescents spend their time, depending on their schooling and working status. In general, adolescent boys spend most of their free time with friends, while girls spend most of their time with family members, such as mothers and sisters. Both boys and girls reported having a number of friends, but boys reported having a higher number of friends compared to girls. Although girls spend a shorter period of time with their friends, both boys and girls meet their friends everyday. The subjects relating to reproductive health (RH) discussed with friends differed between boys and girls. Boys usually talk about girl friends, marriage, sex, pubertal changes, such as wet dream and acne problem, whereas girls talk about marriage and menstrual problems. The survey data found that a number of adolescents are involved with club activities. About 20 per cent of both rural and urban boys in Bangladesh belong to clubs. In urban slums, they are involved with credit and sports clubs, while in urban non-slums, they are involved with sports, youth, and credit clubs and Boy Scout activities. Rural boys are involved with credit, youth, and sports clubs. Compared to boys, a lower proportion of girls are involved with club activities (11 per cent of rural girls and 7 per cent of urban girls). The clubs they are involved in include credit clubs for urban slum girls; sports, debate, credit clubs and the Girls Guide association for urban non-slum girls; and credit and BRAC Samity for rural girls. Differential analysis of adolescent's involvement with club activities relating to their age and education status suggests that probability of involving adolescents with such activities increases with their increasing age and increasing education status. Exposure to Media Adolescents have access to media as a prime source of information. Newspapers seem to be the least-exposed media. Reading newspaper appears to be a common daily practice only among the urban non-slum boys. Three-quarters of the girls in slums and rural areas said that they never read newspapers. In contrast, the proportion of adolescents who watch television daily is substantially higher in rural and urban areas alike. Adolescents seem to have special affinity with television. In the urban areas, over two-thirds of boys and girls interviewed said that they watch television everyday. Only rural girls seem to have a relatively lower access to television among the adolescent groups studied. The most commonly mentioned television programmes enjoyed by the adolescents were drama serial and Bengali movies. Radio represents an important source of information for rural adolescents. Over half of the rural boys and girls listen to radio daily. Adolescents’ Concerns and RH Needs In general, adolescents are concerned about education, jobs, health problems, and attention by elders. Adolescents who are in schools as well as out of schools both are concerned about continued education. Girls are especially worried, as they perceive that their parents might arrange marriage for them, and then their education will not continue.

Some married adolescent girls also expressed great eagerness to continue their studies. They perceive that education would help them in developing self-esteem and would give them a higher status in their in-laws’ household. Adolescents are also worried about monetary support for continuing their studies. Some adolescents who are out of school expressed that they are in dire need of a job. These adolescents are concerned about earning money and taking care of their families. In one extreme case, an adolescent girl aged 18 years, living in a rural area and working in a jute mill, commented, "I do not think about marriage or love-affairs at the moment. I do not have time for that. My father is very old, and he cannot earn money. I have to take care of our family. I work in a jute mill on a daily basis. The mill is three miles away from my place, and I go there on foot. When I do not have work I cannot manage food for my family. So, my only thinking is how to manage food for them, nothing else..." A number of adolescents are concerned about health problems which include: menstrual problems and vaginal discharge for girls; wet dream, masturbation, and size and shape of penis for boys. Some adolescents expressed worry about the lack of attention given to adolescents by both families and government. As elders and community people are not paying proper attention to them, according to them, they are getting involved in many self-destructive activities, such as drug and alcohol addiction. A comment made by an urban adolescent boy aged 19 years, "Unemployment is a major factor for youths to be considered. We have left our study, now we have nothing to do. So, we are getting involved in many bad activities, such as taking drugs and alcohol, roaming around, involving with girls, or going to brothels. There will be no improvement of youth society until the government engages them in different productive activities." Community concerns regarding adolescents Community members/parents are worried about adolescents. They are mainly concerned about marriage for their girls, pre-marital affairs, smoking, drug and alcohol addition, and continued education. It was found almost universal among the community people that they are worried about the marriage of their girls. Parents are always searching for a suitable bridegroom if they have an adolescent girl. They also feel socially insecure about their girls due to an increasing incidence of violence against women, kidnapping, and rape. The community people are also concerned about love affairs which are generally considered 'bad' by the society, and many adults perceive that these affairs will lead to pre-marital sex. Parents of adolescent girls are vitally concerned about interaction of their daughters with males and pre-marital affairs, because if a girl is known to be involved in a pre-marital affair, she is regarded as a 'bad girl' in the society and it is not easy to arrange a marriage for her. The community people also perceive pre-marital affairs as becoming more prevalent. A number of them consider it an effect of satellite TV: "Now-a-days boys and girls of 12/13 years old have an inclination toward band music,

but in the past they were fascinated by sports. The satellite TV is influencing them a lot. Naked films are shown through this TV, but at the same time, some good programmes are also shown. We always pick up the bad things. Boys and girls are picking up things that do not match with our culture. They develop inclination toward opposite sex and may lead to pre-marital sex..." RH needs of adolescents Qualitative studies have identified a variety of RH needs of adolescents from their own perspectives and from adult perspectives. The adolescents and adults also suggested different ways to address those needs. RH needs, as reported by the adolescents and the adults can be broadly divided into two categories: information needs and health service needs. The adolescents expressed that, in general, they are in need of information on seven different topics: physical changes during puberty (especially menstruation and wet dream), reproduction, marriage, pregnancy, family planning methods, STDs/RTIs, and AIDS. However, there are variations in information needs according to age and sex of adolescents. For example, adolescent girls who have not yet experienced menstruation (usually age 10-12 years) are in need of information on menstruation. It would help them prepare themselves to cope with menarche physically and mentally. Similarly, adolescent boys who are in the process of experiencing physical changes (usually age 13-15 years), such as wet dreams, are in need of information that wet dreams are normal developmental phenomena, and there is nothing to worry about. The study findings suggest that the adolescent boys aged 10-12 years are usually too young to have experienced transitional changes, and they would not yet identify RH needs which could relate to them. Adolescents aged 13-19 years (girls) and 16-19 years (boys) need some additional information. They want to know about reproduction, marriage, pregnancy, family planning (FP) methods, RTIs/STDs, and AIDS. They wanted to have this information before marriage. Many adolescents stated that if they were informed about marriage, pregnancy and FP methods beforehand, they would be able to plan their childbearing ahead of time. The adolescents (both boys and girls) expressed the needs for detailed information about FP methods, such as how to use, side effects, etc., and AIDS (transmission, ways of prevention). Although the adolescents were comparatively straightforward in expressing their RH needs, variations in views expressed by the adults were observed. For example, some parents are in favour of giving FP information before marriage, and some strongly opposed it. The later group argued that giving FP messages before marriage would make adolescents promiscuous. The former group commented that providing RH information to adolescents should be carefully handled, so that the community does not react negatively.

SEX AND THE MEDIA Early sexual initiation is an important social and health issue. A recent survey suggested that most sexually experienced teens wish they had waited longer to have intercourse; other data indicate that unplanned pregnancies and STDs are more common among those who begin sexual activity earlier. The American Academy of Pediatrics has suggested that portrayals of sex on entertainment television (TV) may contribute to precocious adolescent sex. Approximately two-thirds of TV programmes contain sexual content.

However, empirical data examining the relationships between exposure to sex on TV and adolescent sexual behaviours are rare and inadequate for addressing the issue of causal effects. A survey was conducted in the US on 1792 adolescents, 12 to 17 years of age. In baseline and 1-year follow-up interviews, participants reported their TV viewing habits and sexual experience and responded to measures of more than a dozen factors known to be associated with adolescent sexual initiation. TV viewing data were combined with the results of a scientific analysis of TV sexual content to derive measures of exposure to sexual content, depictions of sexual risks or safety, and depictions of sexual behaviour (versus talk about sex but no behaviour). Multivariate regression analysis indicated that adolescents who viewed more sexual content at baseline were more likely to initiate intercourse and progress to more advanced noncoital sexual activities during the subsequent year, controlling for respondent characteristics that might otherwise explain these relationships. The size of the adjusted intercourse effect was such that youths in the 90th per centile of TV sex viewing had a predicted probability of intercourse initiation that was approximately double that of youths in the 10th per centile, for all ages studied. Exposure to TV that included only talk about sex was associated with the same risks as exposure to TV that depicted sexual behaviour. African American youths who watched more depictions of sexual risks or safety were less likely to initiate intercourse in the subsequent year. Watching sex on TV predicts and may hasten adolescent sexual initiation. Reducing the amount of sexual content in entertainment programming, reducing adolescent exposure to this content, or increasing references to and depictions of possible negative consequences of sexual activity could appreciably delay the initiation of coital and noncoital activities. Alternatively, parents may be able to reduce the effects of sexual content by watching TV with their teenaged children and discussing their own beliefs about sex and the behaviours portrayed. Paediatricians should encourage these family discussions. Again, several years ago, US News and World Report magazine surveyed 500 leading businessmen, government officials, and professionals as to what was the most influential force in America. Television came in first. Many believe there is no greater force in America for influencing the way people think and behave than the media at large: TV especially, but also radio, movies, magazines, and to a lesser degree, newspapers. One of the best examples of this is the so-called “sexual revolution” of the ‘60s and ‘70s. There were other forces at work in society to bring this about, but, as far as one can tell, the media were primarily responsible for obsessively focusing on the subject, and under the guise of reporting about it, promoting it. The media has led the charge in dismantling one sexual standard after another. If one examines films, especially, from the 1940s to today, one can see how this process took place, step by step. The result is a total abandonment of our once cherished sexual standards. Originally, marriage was considered to be lifelong and indissoluble, but now divorce is acceptable and epidemic. Once adultery was considered a grievous sin and act of betrayal; now it’s called “having an affair” or “open marriage”, and is widely tolerated. Once sex outside of marriage was considered to be a sin and a shame; now premarital sex and “living together” are seen as completely normal. Once sex meant a man and a woman; now homosexuality is just a different “sexual preference” and is widely accepted

- it’s no more significant than the fact that some people like chocolate ice cream and some like vanilla. Who knows what is next? Only AIDS has slowed the progress of the media drive to investigate and promote acceptance of every kind of “sexual preference” or “lifestyle.” Why do advertisers use slinky women and sex to sell their products? One needs to wonder who exactly Pepsi is trying to sell to when they put Britney Spears in a half shirt with suspenders and low-slung, ripped jeans in a commercial with Bob Dole at the end staring lewdly at the TV screen. Could Pepsi be trying to get a married woman in her late 20s, to purchase this soft drink? Could it be someone’s husband that they're targeting? Probably. But who are they really getting to purchase their drinks? Most likely 13-yearold girls who are avid Britney Spears wanna-bes! But Pepsi is just one of many advertisers who think that sex, or women dancing around in slinky clothing, sells their product. And unfortunately, sometimes it does. And even more unfortunate is the fact these same advertisers are the ones that are causing young girls today to have eating disorders at the age of ten -or- go to their proms in halter-tops and short skirts. It's amazing how much has changed since the days when Marilyn Monroe was the ideal shape and size of a woman. So why do these advertisers use women and sex to sell their product? For the most part it's because the advertisements are created to conform to assumptions about the people who are purchasing the product or viewing the ad (whether it's on TV, in a magazine or on the radio.) The ads might appeal to a specific social class or to a specific sex. These ads are placed in different arenas in the hopes of getting in front of their ideal consumer. For instance, one will probably never see an ad for power tools in Cosmo magazine and one will probably never see a tampon commercial during the WWF! Advertisers are also looking for the best way to get one’s attention. Since one is bombarded with ads everywhere one turns, a lot of advertisers want to get shock value by forcing someone to look at what it is their selling. But, back to why women and sex sell products is because these ads are targeted toward men. If one was to put a commercial on TV of a man lounging on the couch with a remote control in his hand and sipping a Coke, not many men would find that appealing. But place a sexy woman on the couch with him, drooling over his wet Coke can and you've got a man ready to jump in the car to go get some! Because what the advertiser is selling is that if you go purchase Coke, somewhere in that scenario you're going to get a sexy woman. Why do children get involved in sex? There are many reasons why children get involved in sex. The most common reason, detachment from home can lead to attachment elsewhere. Sexual pressure on them is everywhere, from the TV where about 20,000 sexual scenes are broadcasted in advertisement, soap operas, prime time shows and MTV. The rock music nowadays fans the flames of sexual desires. Most parents do not know what kind of music their children are listening to. If they care and listen to rock songs like Eat Me Alive (Judas Priest), The Last American Virgin, (Tina Turner), Material Girl (Madonna), they will know that these songs have pornographic words and sentences which made Kandy Stroud, a former rock fan, begged parents to stop their children from listening to what she calls 'Pornographic Rock”. Six out of ten as young as eight years in Bangladesh watch Indian TV channels. These channels can be termed as sex stimulators,

be it a music or a drama serial. Instead, the parents should encourage their kids to watch channels like Discovery, History and Animal Planet; they are both educative and entertaining. Research shows music does affect sexual mood. It does so by activating melatonin, the hormone from the pineal gland in the brain, which is turned on by darkness and turned off by flashing lights. It is the same gland that has been thought to trigger puberty and affects the reproductive cycle and sex mood.

BANGLADESH The Dirty Word! Teenage pregnancies in Bangladesh are on the rise, especially in the rural areas. Many girls suffer at the hands of unskilled doctors, nurses and even quacks when they go for abortions. Unfortunately, statistics are not available, as most cases are not reported. According to Dr Sultana Jahan of Dhaka Medical College, a large number of unmarried, adolescent and even underage girls come for abortions. Almost none of them have had any sex education. "These young girls get sexually involved without knowing the consequences. None of them has any concept of protective sex," Jahan was quoted as saying. She added, "Even boys need sex education. This would reduce the rate of abortions and death of young girls." Many girls complain that due to conservative social norms, even parents are not forthcoming in sharing information on sex-related matters. Asking about sex is a no-no in an average Muslim Bangladeshi home. Lack of proper education results in many young people visiting pornographic sites on the Internet to satisfy their curiosity about sexual matters. This creates a negative impact on the mind. Boys keep thinking about girls but could not mix or talk with them freely. It also creates a mental distance between him and his parents and other family members. Such repressed lifestyles only make girls and boys more depressed and sometimes even violent. In Bangladeshi society, children are taught how to walk, talk and even how to behave with others. But when they want to know about the changes in their bodies and basic things about sex, there is no one to teach them. Experts say sex education could reduce the rate of rape by 50 per cent. It is not uncommon, in a country like Bangladesh, that conversation about sexual issue remains a taboo. It is high time, that such taboo should be unshackled. Otherwise, the ticking time bomb of HIV/AIDS could peter out risking 23 per cent adolescents of 130 million adolescents population of Bangladesh or face the supposedly sub-Saharan Africa’s consequence- it is said, within a span of ten years millions of children’s will vanish in the Sub-Saharan Africa, who are born with AIDS. Recently, during a news briefing in Dhaka on 29 September 04, an official of UNFPA, said, poor knowledge of sex among adolescents poses a threat to their reproductive health. According, to Suneeta Mukerjee, the country director, Bangladesh UNFPA, “Parents must speak freely with their growing children about sex to ensure healthy living.” On 31 August 2004, at Rangpur a town in Northern Bangladesh, 335 kilometres from Dhaka, an advocacy meeting was organised by Social Marketing Company (SMC). Severe concern over the prevailing STDs, HIV/AIDS in Bangladesh and in the surrounding countries was

discussed in the meeting. The present number of 13,000 HIV-positive patients in Bangladesh is not an accurate figure, the number is higher, reported the NGOs. Some NGO officials working in the field in Rangpur region said, the number of STD patients is alarmingly rising. The patients include even a large number of school-going children from class eight up to university levels. They are taking all types of drugs, Adopting all means opening the huge door for HIV/AIDS vulnerability. The advocacy meeting was participated by government, NGO officials, physicians, journalists, imams of different mosques and the elite of the town. Most opposition to sex education in Bangladesh is based on the assumption that knowledge is harmful. But research in this area reveals that ignorance and unresolved curiosity, not knowledge, are harmful. This issue was identified in a face-to-face interactive dialogue jointly organised by UNFPA and CWD (Concerned Women Development) in observance of “World AIDS Day” Participated by some twenty-four teens of both genders from the country. The teens identified religious ignorance, absence of appropriate approach on sex education in the curricula at secondary level of education as impediment to organising effective programmes against HIV/AIDS. For Bangladeshi parents, sex is a dirty word. They feel uncomfortable in discussing sex education with their children. But are we aware on an average a child is exposed to 9,000 sexual scenes per year. These parents should know that sex is not always dirty. It is an important aspect of our life. The main reason parents do not or cannot discuss sex education with their children is because of the their cultural upbringing, their religious training. They are often brought up in a state of ignorance in regard to sex issues. Sex education Bangladesh authorities said they would introduce sex education in its schools from 2004 in an effort to stem the spread of sexually transmitted diseases. "Sex education will be included in the school syllabus in 2004 under population studies courses," Bangladesh Today newspaper quoted Education Secretary Mohammad Shahidul Alam as saying. "With the alarming rise in incidences of sexually transmitted diseases and emergence of (the) AIDS pandemic, sex education has come to the forefront," he said. While Bangladesh has only a few hundred officially reported AIDS cases, social workers warn that premarital sex is prevalent in the predominantly Muslim country but that young people are ill-informed about the precautions they should take. According to government figures released in 2002, 248 people in Bangladesh have contracted HIV, the virus that leads to AIDS, and 20 people have died from disease. UN estimates put the number of HIV patients at about 13,000, which is still far below neighbouring India, where at least 3.97 million people have HIV, more than any country other than South Africa. Out of six million adolescent students in about 14,000 secondary schools 3.5 million male students are kept in dark about education on sex. A survey conducted by the Population Council, an NGO, revealed that less than 20 per cent of the female adolescent students who take home economics as a subject, got a chance to study on sexuality. The Population Council survey also found that only 13 per cent unmarried adolescents were able to name the STD like Syphilis and Gonorrhoea. Though 50 per cent of the adolescents could mention AIDS as a fatal disease, they did not know anything about its routes, transmission and means of prevention, the report added. Adequate knowledge

among the adolescents on safe sex is also absent, the findings said adding that only 34.6 per cent unmarried adolescents knew that using condoms can prevent transmission of STDs, HIV and AIDS. Professor GB Sufi of Zoology Department of Dhaka University said, "because of its private nature, sex was never so open an agenda in Bangladesh for discussion until recently when unsafe sex was exposed to be a major route for the spread of STDs, HIV and AIDS. Bangladesh is a very vulnerable country for these deadly diseases as the educational curriculum does not have the desired elements of sex education for the adolescents". Sufi said education on sex was very much needed at this time when the world had become a very vulnerable place for the human killer diseases. Some NGOs that work in promoting sexual education informally, said that millions of male adolescent students who studied in humanities and commerce group in Higher Secondary level, could not come to experience anything on sexual education and about their physical changes as well. An NGO activist said that though the present curriculum of science in higher secondary level contained several reproductive health issues, the information was incomplete, disordered and not written in detail. Thus millions of adolescents do not know anything - neither in the schools nor in the families - about the STDs, HIV and AIDS, he said. For Bangladeshi youth, sex education is not offered in government or out-of-school education programmes. In Bangladesh approximately 42 per cent of the population is less than 15 years, and between ages 15 and 19, one in three female youth is either a mother or pregnant with her first child. As many as 50 per cent of Bangladeshi youth may be sexually active. In one survey, 30 per cent of male clients at an STI clinic had sex with unmarried girls. HIV/AIDS rates are currently low but likely to increase steadily. Other sexually transmitted infections (STIs), late-term abortions and reproductive tract infections – though not as catastrophic as HIV/AIDS – are growing risks for Bangladeshi youth who are unprepared to meet these challenges. In 1997 a sexual and reproductive health project started, under the collaborative research model of two organisations – the International Centre for Diarrhoeal Disease Research (ICDDR, B) and the Bangladesh Rural Advancement Committee (BRAC), an NGO that pursues rural development in over 30,000 villages. This project was conducted in Matlab where about 30 per cent of the population are less than 15. In Matlab most farmers own less than two acres of land or are landless and more than half of the adult women are illiterate. The primary objective of this project was to investigate the socio-cultural context of risk and vulnerability among representative samples of rural Bangladeshi adults and youth, and out of this develop a sexual and reproductive health intervention. Exploratory research collected stories, experiences and ideas about what people experienced, what they believed, what they knew and how they interpreted sex, sexuality and risk. Interviews focused on learning about sex, extra- and premarital sex, expressions of sexual feelings, family and sexual violence, knowledge of reproductive tract infections and sexually transmitted diseases, including HIV/AIDS and sexual problems. Fifteen traditional birth attendants, Shasto Shabikas (community health workers), pharmacists, and Kabiraz (traditional healers) were interviewed. In addition interviews and focus group discussions were conducted with married women and men, ages 22-45, and never married girls and boys, ages 12-18. Interview data were transformed into storyboard

flipcharts. Following this, a total of 68 health providers received training in the content of the materials and how to facilitate discussion using the materials. For three months after the training, health providers integrated the materials into their ongoing work. Generational and gender differences were apparent in respondents' interpretations of sex and sexuality. Adults spoke disapprovingly of romantic love, but female youth were interested in and sometimes advocated love relationships. Unlike some of the adults, youth uniformly believed that sexual pleasure is the prerogative of both males and females. Adults had learned about sex from a sister-in-law, while youth tended to learn from their peers in school. While adults generally supported the idea of sex education for their children, mothers in particular opposed informing youth about condoms. Condoms were perceived as affording youth the possibility of engaging in premarital sex. Male youth were reticent to talk about sex while female youth were interested and enthusiastic with specific questions as to what they would like to learn. Youth agreed that if a girl becomes pregnant before marriage, the girl, not the boy, is blamed and ostracised. Justifiably female youth feared the social consequences of a pre-marital pregnancy. Boys viewed their problems as economic while girls felt theirs were related to delaying marriage and romantic love. Adolescents lacked knowledge of the prevention and treatment of sexual diseases. Sexual health was not publicly discussed and only privately discussed with people who were often ill informed. Youth felt there was much they wanted to learn about sex, but if they asked an adult, they would be embarrassed, criticised or beaten. Interview data revealed age and gender-specific themes. Composite stories derived from these themes were transformed into problem-solving picture stories and suggested solutions. The stories served as a mirror reflecting people's actual and reported sexual and reproductive health problem. These were in a sense telling people their own stories. For example, research revealed why and how a premarital pregnancy would have disastrous consequences for a girl's future. A composite story described in pictures how two young people meet, fall in love, have sex, and what problems occur after the girl becomes pregnant. The problem-solving stories suggested solutions and informational content were presented in a flipchart format. The back of each story page had simple explanations for health providers to use to describe the content. Because of lack of literacy, pictures were self-explanatory so providers could explain the stories without a written text. Evaluation interviews with 17 health providers highlighted two significant findings. First, adolescents came forward, albeit unobtrusively, to learn from the providers. One Shasto Shabika said, "Village girls come to me secretly for abortion and I try to counsel them about sex education. I give this education using the flipcharts and tell them, ‘If you follow this, you will not have problems.'" A male Kabiraz said, "The pictures of sexual intercourse initially caused some shyness, but with more explanation, people accepted this. I now teach these things to unmarried boys and girls." Second, health providers discussed sexual health with their own children and their children in turn became ad hoc peer educators. One Shasto Shabika explained that her daughter told her, "You educate others. Why not me?" So I explained the materials and the information to her. She became so interested that she put the pictures up in our house like a showcase. She also invites her friends to learn about this programme."

Improving face-to-face communication is a critical means of influencing normative beliefs and behaviour. But communication about sexual health with youth in Bangladesh is clouded with shame and silence. Guided by the collection of stories and interpretations of sexual experience, the transformation of this data into problem-solving stories and information, and the selection of health educators who had the recognised social license to communicate about sex, this project achieved a legitimate approach to sex education in a conservative society. In rural Bangladesh a sexual and reproductive health communication strategy for youth should reflect sensitivity to youth's beliefs and behaviour as well as to the feelings and psycho-social investments adults have about their children and in their future. Sexual abuse It is true that sexual abuse is not a new problem and has affected the impoverished section of Bangladesh for decades. But it has now become a problem in mainstream Bangladesh within families who are considered to be the middle and upper class. It is not the problem of middle and upper class; rather it is a problem of child abuse as a whole. Until one explores the status of sexual exploitation of children it is difficult to understand why sex education is needed. From a study in Bangladesh, both in rural and urban setting, it has been found out that both the boys and girls are traumatised by sexual abuse, more or less so depending upon the particular child and circumstances of the abuse. The average age of both boys and girls at the time of abuse was 11, and more than 20 per cent of the children were under 10. Sexual abuse happens in many forms but they have in general been split into two broad categories. They are: a) commercial sex abuse, b) noncommercial sex abuse. The nature of vulnerabilities and the relationship victims have with society varied considerably and that is why for both theoretical and intervention reasons, the abuses have been separated, but in many cases the lines are blurred and one may even encourage or cause another. There are neither single nor simple models or frameworks that fully explain or describe the varying patterns or consequences of Sexual Exploitation of Children (SEC). The behavioural patterns of causality in one setting, such as substance abuse, in another setting may be an instrument of entrapment and/or control - as in trafficking, and in another setting it may be perceived by the child victim as a means of escape and relief from suffering. Poverty of relationships, values and behaviours within families and communities may interfere with the child's ability to establish positive family and other social attachments that are among the essential elements of resiliency. To understand the health and psychosocial implications of the sexual exploitation of children requires an appreciation of the varying patterns of causality, circumstance and consequences in different countries and cultures. Few doubt, although direct scientific data are very limited, that the sexual exploitation of children results in serious, often life-long, even life threatening, consequences for the physical, psychological and social health and development of the child. These children become social outcasts and their future fertility and psychological capacity to establish healthy relationships and their own families is seriously compromised. At a community level, the commercial sexual exploitation of children represents erosion of human values and rights that threatens the health of society. In the developing world macro social and economic factor, such as poverty and social marginalisation appear to be important background factors, while the more individual characteristics of the child and family affect resiliency

or vulnerability. While poverty may be a contributing factor in the Commercial Sexual Exploitation of Children (CSEC) in some circumstances in the more industrialised countries, individual characteristics, the functional capacity of the family, and its experience maybe a more significant contributor to the occurrence of CSEC. And Bangladesh is of no exception in this case. There is no exact statistical figure for the number of child commercial sex workers operating in Bangladesh. We however, know that the number could run into thousands. The sexual abuse through commercial sex goes beyond the traditional full-time brothel workers or trafficked girls serving foreign clients but also exists and quite possibly in a larger number amongst urban girls who are forced to sell their bodies to survive. A study carried out during late 90's in an official brothel having 3000 prostitutes showed that 405 of the CSWs were less than 18 years of age. The same study reported that in a sample of 92 child prostitutes, the average age of entry was 13.5 years. Many of them are brought in by "sardarnis" who force the girl(s) to hand over all their earnings and the relationship is that of something akin to bonded labour. Boys also are part of the commercial sex world, though some of them may prefer a particular clientele. The shadowy world of male homosexuality has shown that many boys are part of a growing urban bonded children engaged in commercial sex. In case of non-commercial sexual exploitation, which affects the largest number of children, the society itself and sometimes even the family play a direct role in sexual abuse. In such case, the family refuses to open up because, in their alienation, they have a common goal of maintaining the imagined ideal of a society, which is educated, enlightened and therefore free from such vices. To protect that ideal they have to deny the existence of child abuse. Even the victims also protect the family by refusing to acknowledge any deviant behaviour, which the family may experience. In doing so, it tolerates and ultimately protects the abuser. While an abuser is forgiven and accepted by the society, the abused child wears the shroud of shame almost all of her/his life. Now the question is who the abuser in Non-commercial case? Although a great variety of relationships between victim and abuser were observed, it was found that family and other known individuals made up a substantial proportion of abusers. The majority of abusers were found to be men whereas women were responsible for 15 per cent of the abuses. For girls, abusers included local boys, older cousins, neighbours, tutors, strangers, uncles and father. For boys, cousins and uncles also featured, in addition to other members of village community, the mistress of a domestic servant, a family driver and a teacher. From the data, collected from the records of the CDC, where all the abused were serviced by their facilities, it has been observed that most of the abused children suffer from behavioural disorder arising from trauma. The most common symptoms are depression, suicidal tendencies and an inability to trust others. The medical neglect of the child is significant where no immediate steps are taken rather someone brought in much after the abuse as an afterthought by someone. Families' lacks of knowledge about how to help a sexually abused child to recover from his or her experience aggravate the trauma and damage the child's psychology. On the other hand, the rape and sexual abuse of girl children in poor and dis-empowered families by local landlords and eventual enforced prostitution demonstrates another typical form of abuse in Bangladesh. The Pattern of Exploitation from gender Perspective is another dimension to looked for.

The abuses reveal a pattern of exploitation of the vulnerable young children, girls, the poor, unprotected and emotionally needy. The pattern also highlights the way traditional values and social dynamics combine to intensify the victimisation of girls. The vulnerability to sexual abuse for girls arises when they start becoming sexually mature. They have to face abuse twice: physical as well as societal, which is through its customs, practices, censures and ostracise action. A girl in our society is socially programmed to find a match if possible. This lead the well off and the powerful to have a psychological advantage in abusing because the girl may be persuaded to consent to an unwelcome or forced sexual approach by the thought that the physical relations will end in marriage. Amongst the urban underprivileged, the girls, especially those working as maidservants, are the constant victims of sexual harassment. In some cases, if the girl becomes pregnant, she has to either go for an abortion or accept the future of painful responsibility of an illegitimate child. The bottom line for gender discrimination is that not only the abused girls fail to find groom, her sisters can't either whereas the abuser finds no problem in finding bride. Even if we compare the trauma level, we will find that boys are less if abused. But for girls, this option is very limited.

HOW MUCH DO BANGLADESHIS KNOW ABOUT THEIR SEXUAL LIFE? Marriage in Bangladesh, as in other South Asian countries, is commonly arranged by parents and is considered more as the union of families rather than simply that of the two partners. While boys do have some role in deciding the timing of their marriage or selecting their brides (at least they are consulted by their parents), girls, particularly in rural areas, do not have much say in when or whom they marry. Commonly, girls meet their bridegrooms only on the day of the marriage. While in educated families and in major urban centres, these practices are changing, they remain strong in most of the rural areas where 80 per cent of the population lives. The age at marriage for girls in Bangladesh still remains low, particularly in the rural areas where most girls marry at around 15 years of age. According to a survey, the age at marriage of girls has increased from 15 to 18 in the past 20 years, but still half of the rural girls and those living in slums are married before the age of 15. Analysis of the background characteristics of the informants showed the same pattern. About one-third of the informants in the survey were married and had experienced their first intercourse before they were 15 years of age. By the age of 16, nearly two-thirds of the women were married. One of the important mechanisms to maintain social control over women's sexuality is to deny their access to information on family formation and sexuality. This is done in various ways including attaching negative values to any discussion of sexuality, controlling their outside movements and friendship with members of the opposite sex, and discouraging access to literature on family formation and sexuality. An inquiry on whether the informants had knowledge about the sexual life in which a woman enters after marriage revealed that 24 out of the 54 informants (44 per cent) had no knowledge about sex before being married. As an illiterate informant from a rural area, aged 35 years, said: "I was married at a very early age [11 year], I did not have any idea about sex life. All I knew was that I had to cook for my husband and look after his household chores. When I

was married, even my periods had not started". Yet another informant, aged 19 years, educated up to class 4 and married at 14 years said: "No, I did not know anything about sex life before my marriage. ....... I came to know about this when I had my first intercourse". Girls are often informed about sexual intercourse just a few days before their marriage. Generally this responsibility is taken by sister-in-laws, married friends or some elder relatives in the family. For example, 12 informants mentioned that just days before their marriage, they were informed either in code words or vaguely about the sexual life in which they were entering soon. As one urban informant, aged 27 year, with 10 years of schooling, put it: "My sister-in-law told me to go close to your husband whenever he pulls you towards him and whatever he says you should follow. Do not say 'No' to him ....." A 28 year old, illiterate women from a rural area said: "I was not given any detailed information about sex except that if my husband call me to have sex then I should not refuse him. I should do whatever he wants me to do." Only 18 informants (33 per cent) were relatively well informed about sexual life in marriage. Most of them were educated (middle class and above) and often lived in urban areas. One 24-year-old informant, educated up to class 9, said: "I was aware of sex life well before my marriage. One of my married friends had told all about it ......." Another informant, aged 25, who studied up to class 12 said: "Yes, of course I knew about the sex life which takes place after marriage. And every educated person knows it very well. ........ my sister-in-law had taught me some techniques like how I can get close to my husband or protect myself from getting pregnant by taking pills regularly.........." The study clearly demonstrates that at the time of marriage the girls were prepared more to submit themselves to their husband's wishes (sexual as well as non-sexual) than armed with accurate information on sexuality and social relationships which could be helpful in the smooth transition from unmarried to married life. According to an older informant: "all these [meant smooth transition] could be best achieved and women's married life could be much more easier, if they mould themselves to what their husbands want from them". The respect for the perspective of the elders in families is an important reason for the

continuation of the early marriage of girls. It is believed that at a young age girls are like "tender bamboos" and can be moulded according to the wishes of her husband and new in-laws. If they are married at a later age, changing their behaviour according to husbands and in-laws wishes is difficult. Independent thinking and any suspicion assertion of authority of young women are often a major cause of domestic violence. It is still interesting to observe that overtime family planning has been de-sexualised in much of Bangladesh. Many of the informants reported that while they received no information on sexual life before marriage, their mother, grandmother, sister-in-laws or other female family members advised them to use pills regularly from the day of the marriage. While some of them were told that it is to protect them from early pregnancy ("the child will not enter in stomach"), many were not provided with any detailed information. One informant, aged 15, with 6 years of schooling said: "Yes, I had a vague knowledge about sex before my marriage. At the day of my marriage my sister-in-law gave me pills and said to take it. When I asked her the purpose of taking the pills, she didn't tell me anything regarding 'sex' or pregnancy but she said I might have a problem and I may need it." Before Bangladeshi girls marry, the main sources of information about sexual life, though often in vague terms, are sister-in-laws (33 per cent), close friends (30 per cent), other senior members of the family (9 per cent) and boy friends (about 9 per cent). Analysis of the information provided shows that in most of the cases, the information given by married friends is more detailed and accurate than that provided by relatives or sister-inlaws. However, if the sister-in-laws or other married sisters are of the same age, they may also provide accurate and detailed information on sexuality. As one rural woman, aged 23, with 9 years of schooling put it: "I was aware of sex life before my marriage. One of my friends had told me all what happens after marriage [meant sexual intercourse]. She is very naughty and all the time she used to talk with us about her sexual experiences and different ways it is performed. She said that we should know all these things as it will help us a lot when we will be married. She informed me about some family planning methods also." A typical example of vague information provided by a sister-in-law was given by an informant, aged 35 years, from an urban area: " Before going to my husband’s home my sister-in-law informed me about husband-wife sexual relationship. She said, ‘You must listen to your husband and don’t cry during sex.’ Behave exactly the way he wants (you to do). That was the first time I heard of sex". In contrast to girls, a different standard is maintained for boys and older males. For them, sex is desirable. It is "natural" and they should know about it. Interestingly, the male informants had learned about sexual life much before marriage and in much more detailed fashion. Their two most important sources of information were: sexually explicit ("blue") movies and friends. Analysis of their responses shows that even in rural areas a video cassette player (VCP) and cassettes of "blue" movies are easily available for rental.

Often they see these movies late at night or afternoon at a friend's home. Generally, these movies are seen in small groups of friends who contribute money for hiring the VCP and cassettes. Three male informants also reported that some of the cinema halls secretly organize special shows of "blue" movies at night. There is evidence that some boys have pre-marital sex with village girls or commercial sex workers following the viewing. A few visit commercial sex workers (CSWs) as part of preparing themselves for marriage. In general, at the time of marriage young men are well aware of sexual practices. As our data show, all the 28 male informants were well informed about sexual matters, with at least 5 of them having experienced sexual intercourse before marriage. Many reported kissing or touching the bodies of their girl friends or sister-in-laws. As a male informant reported: "I knew about sex life well before my marriage. We friends used to talk a lot about these issues. I had also seen some blue movies with my friends. We used to hire VCP and cassettes of blue movies and watch it in some friend's home at late night ........ yes I know one of my friends had sex with prostitute to get sexual experience just before marriage". Meanwhile, three issues on inter-spouse communication on sexuality were investigated. First, whether any discussion on sexual life took place within the first week of marriage, and if so, what was the content of the discussion? Second, whether they discussed family planning or their reproductive goals with their partners, and if so, at what stage of married life? In all cases questions were also asked about who had initiated the discussion. Finally, women were asked if and how they communicate their sexual desire to their partners? Each of these aspects is discussed separately. Out of the 54 informants 25 (46 per cent) reported the discussion of sex with their spouses on the first night of marriage, while 22 informants (41 per cent) said that no such discussion was held and their husbands literally pinned them down on the bed and had first intercourse forcefully. The remaining 7 refused to answer the question. One woman, aged 27, a graduate from the rural area narrated her experience: "I was married at 24 years. By that time I was fully aware of sex that takes place after marriage. On the first night, my husband initiated the discussion by asking whether I had any affair. We both talked for hours on sexual issues. And then suddenly he took me into his arms. I was so terrified. Then he told me that initially it [sexual intercourse] is difficult and painful. At first you will have some bleeding also. But it is not going to continue for a long time’. Finally, he persuaded me for intercourse." A 19 year old urban woman with 4 years of schooling said: "No, I did not know anything about sex life. My husband also did not say me anything about intercourse. He just wanted to have sex. When I resisted, he told me that if I don’t let him do whatever he wants then he’ll marry someone else. I gave it up". An urban woman aged 25 years with 10 years of schooling described her difficult experience:

"When I was sent in the bed room of my husband, he asked me to come close to him and take out his watch. But when I went to him, he caught me and forced me on the bed. ….. He had repeated intercourse on the same night forcefully, without any consideration to my pain, crying and begging that he should not do it again". The same pattern was observed both in rural and urban areas. However, when the age at marriage is considered in the analysis, a much larger proportion of those who got married at a mature age (20 year or more) had a discussion with their husbands on sexuality and had willingly participated in the first intercourse compared to those married at an early age. Among the informants who were married at age 20 or later, the first intercourse was negotiated and actively participated in by both the partners. In contrast, most other informants, as advised by their elders at the time of their marriage, either kept quiet and submitted to the sexual desire of their husbands or experienced a difficult, painful episode of forced sex. The content of their discussion varied considerably from vague terms like "this is the way a husband and wife have to live together [meant sex]" to a discussion of the actual process of intercourse, such as how initially it might be a painful experience but subsequently it will be enjoyable for both. A typical example of negotiated sex comes from an illiterate rural woman aged 25 who said: "I was vaguely aware of the sex life between men-women. On the marriage night I was so scared of having sex. At first I refused him. Then he sat close to me and explained that this is why we are married. If you refuse it to me then what else we will do? He took me in his arms and made me understand many things regarding sex, why initially intercourse is painful, the various ways sex is done ........ That was the first time I got detailed information about sex life. Many things that I knew earlier was wrong. So after having a long discussion I agreed with him and had sex." It was also observed that in the case of women who were married at 16 years or less and had either a small (4 years or less) or large (more than 10 years) age difference with their partners, generally the first intercourse occurred without any communication. Some of the possible reasons for the lack of communication among the young couples with little age difference could be shyness or the fact that they lacked knowledge about sexual matters. As one woman who was married at age 14 and had a 4 year age difference with her husband reported: "No, no one told me anything about sex before my marriage. I was not aware of it. My husband himself did not know much to teach me. So we did not have any such talk [meant sex]. But as time passed we got to know about it by ourselves." The perceived authority of the husband and the large age difference might have acted as an impediment to husband-wife communication. However, there were exceptions. When girls were married at a mature age (20+ years), the age difference between the husband and wife did not matter much. In another case, where the husband was 15 years older than the wife who was only 14 years old at the time of her marriage, the husband took the role of a tutor, explained to her all about sexual life and negotiated the first intercourse

with her after the third day of marriage. The analysis further shows that the initiation of discussion of sexual life, family planning or reproductive goals is nearly always the responsibility of men; women only rarely take the initiative in such discussions. Most of the informants felt that talking about sex even with their husband is "shameful". Some women felt that if they initiated discussion on this topic, their husbands may consider them shameless women and even suspect them of having pre/extramarital relationships. One of the informants mentioned about the saying in Bangladesh that a woman who initiates the discussion of sex or expresses her sexual desire, "she eats up the age of her husband [prematurely ages him]". In the Bangladesh context, it is important to investigate to what extent women are free enough to express their sexual desires to their partners. And if they express their desire, how? During the in-depth interview special attention was paid to this topic. The analysis shows that almost half of the women (24 out of 50) who answered these questions, said that they did not like to express their sexual desire to their husbands. Many of them confessed that they also have sexual desires but it would be shameful for them to let it know to their husbands. As one woman, aged 35 years with 5 years of schooling said: "Yes I have sexual urge but I could never tell him that. I think it is shameful for women to express their sexual urge." A similar view was expressed by a rural woman aged 24 years, who studied up to class 9: "I am married for 8 years and still I cannot tell him that I want to have sex. It looks very bad." In the words of a rural woman aged 27 with a graduate degree: "It is always husband who initiates it. And not only in my case, in Bangali culture, first husband has to show his desire and then the wife submits herself to his wishes." Some of them also felt that the demand for sex by their husbands was always more frequent than their own desire, so they felt satisfied. However, if their husbands do not come to them for sex, the best thing is to wait and try to suppress or hide their sexual desire. This norm is well reflected in the comments of a 35 year old, illiterate woman from the rural area: "Even if I want it (sex) desperately I won’t utter a single word about it. If he comes to me on his own, then I feel happy but if he doesn’t come then I just wait for him. I do not do anything to make him understand about my sexual desire." The study however, revealed that social change is occurring in Bangladesh and this change is influencing sexual relationships. The study shows that in contrast to the general expectation, at least 24 women (44 per cent) said that occasionally they do express their sexual desire to their husbands. According to the informants they use both verbal and non-verbal communication. Among the non-verbal communication, physical touch is the

most common technique used by the women to express their sexual urge. Most of the women who mentioned physical touch, reported pinching, pushing, pulling, getting close to husband or touching his body as signals of their sexual desire. "I have a habit of pinching him and when I do that he understands that what I am up to" (35 year old urban, graduate) "I touch his hand or he touches mine to make each-other understand that one of us is willing for sex." (25 year old illiterate urban women) It is interesting however, that none of the women had reported touching the genitals of their partners. When the same questions were asked to male informants, out of the 15 who mentioned physical touching, 9 said that their wives expressed their sexual urge by touching their genitals. The second most common way women use to communicate their sexual desire is the use of other non-physical signals. They include being dressed up nicely, trying to make themselves attractive, and increased eye-contact or facial expressions to express their sexual desire. "I try to make me look more beautiful to attract him and he knows that what I want" (24 year old urban women with 7 years schooling) Finishing household work quickly, making their children sleep early or removing the sleeping child from the bed were other non-verbal communication to indicate their sex desire. In the words of one urban women aged 27 with 10 years of schooling: "If I ever feel like to have sex, first I make my children sleep quickly, finish household chores and then come to him. By looking on my face he understand what I am up to. But if he doesn’t understand, I tell him ‘today I will sleep with you or let’s go to sleep." An illiterate urban informant, aged 30 years said: "I just shift the baby from the bed to one side so that when he comes to sleep he knows that I want to have sex." Three women said that they generally express their sexual desire directly. In one case, this was done on the insistence of her husband. According to her, he pursued her so frequently that at times she should also take the initiative in expressing her sexual desire. As expected, most of the women had endured a painful experience at their first sexual intercourse. The degree of trauma at the initiation of sex is dependant on her age at marriage, awareness about sexual life and the nature of the initial interaction with their husbands before experiencing intercourse. Further discussion on their current sexual behaviour revealed that once they had overcome the initial trauma and pain, they had started enjoying sex. Out of the 54 informants, two-thirds reported that they enjoy their sexual life. However, 8 women (15%) said that they would enjoy it only if it was less frequent. Out of the 11 women who said they do not like it, 3 were sexually unsatisfied with the sexual performance of their husbands. The remaining 8 women expressed their dislike for all sexual activity. Further analysis linking their present like or dislike of sex

with their initial sexual experiences revealed that about one-fifth of those women who disliked their initial experiences continued to dislike it. These women were married at a young age, were not aware of the nature of sex at the time of their marriage and had a painful and difficult experience at the initiation of sex. "......I had repeated forced sex by my husband without any considerations ......" Whereas three women who initially liked the sexual experience developed a disliking because sex was either too frequent or forced. "........for him love is only sex that too, every day. I love my husband. I want to be with him but I do not like sex any more ...... ". The analysis further revealed that women who were aware of sex before marriage, married at a relatively mature age (20 or above) and had negotiated their first intercourse with their partners had a smoother transition to marital life. Most of them had developed a more positive attitude towards sex, despite of the fact that the initial period after marriage was painful and occasionally they faced forced sex as well. "I think sex life is enjoyable for both the partners. Whenever and whatever way husband wants it, wife should agrees to it or else wife would never win husband's heart ..... we both now enjoy sex and love each other". "I like sex, but not if it is very frequent. Yet I have to do it for my husband's satisfaction. I do not like sex in day time. My husband generally had sex twice at night. I do not enjoy the second time. I would enjoy it a lot more if it happens at night and at an interval." In contrast to expectations, 25 out of 54 informants (46 %) reported sexual intercourse during menstruation. Among these 25 women, 8 reported it regularly, 11 mentioned it sometimes, while the remaining 5 reported it as infrequent. The results are surprising as in the whole Indian subcontinent, women are considered "polluted" during menstruation; during this time, they are discouraged to participate in household chores and any religious rituals. The concept of pollution is much more strictly observed among Hindus than among Muslims. Yet Islamic teaching prohibits sex during menstruation as it is considered a "sin". Though among Muslims, women are not considered "polluted" as among Hindus, they are not allowed to perform religious duties. The data shows that most of the informants were aware that sex during menstruation is considered a "sin" in their social context. Some of them also expressed their concern that intercourse during this period may actually physically harm them. They believed that during menstruation, the vagina becomes very tender and sexual intercourse during this period could cause gynaecological problems. Some of them also believed that intercourse during menstruation would affect the health of their husband, particularly if menstrual blood enters his body. "I think it is better not to have sex during menses. As that part (of women) is soft and intercourse during those period could be harmful. But my husband does not listen to me

and do it forcefully." (Urban woman aged 28 years, 10 years of schooling) "Intercourse should not be done during menstruation period. It cuts the length of husband’s life. But my husband does not listen to me and often do it forcefully." (Illiterate urban woman, aged 40) However, most of the women also felt that they could not do anything to stop their husband from satisfying their sexual desires. They believed that "men's sexual desire must be kept satisfied if women want to hold them", and as one informed related: "My husband stays away from home. Sometime he comes home during my menstruation period. At that time I have to have sex. I know sex during menstruation is a great sin. But he never listens to that. Intercourse during menstruation is very painful. But I do not feel angry with him. Whenever he comes home, he has strong urge for sex and you know it can’t be control". "Yes, he has sex with me regularly during my menses. Men cannot control themselves when they feel the sexual urge. So how can he control himself? I know it is very harmful but what can I do? I have to satisfy his sexual urge." (25 year old urban woman, 12 years of schooling) Many informants felt that to keep their husbands in control, the best thing is to let them have sex whenever and in whatever way they want. If refusing sex during menstruation makes their spouses angry, they feel that they are inviting a scolding, a beating or asking their partner to seek other women. It is interesting however, to note that out of the 25 women who reported sexual intercourse during menstruation, four reported that they enjoyed sex during the menstrual period. In the words of one woman: "Yes, we do have intercourse during menstruation period. Every one knows that it is more enjoyable than sex in regular days. My husband likes sex during menstruation more than any other time. I also enjoy it more". Yet another women felt that sex during menstruation is more enjoyable because "husband's sexual performance is prolonged and much better during in "wet time" [meant menses] than the normal "dry days". Analysis of the data on husband-wife communication revealed that despite of all the inhibitions in discussing sexual matters, the use of contraceptives was one of the easiest and most common topics which the informants discussed with their husbands. For instance out of 54, 65 per cent of the informants reported the discussion of contraceptive use - 21 (39 per cent) of them did it either on the marriage day or during the following two days. It is interesting that 5 of these informants had reported no discussion of sex or related matters. It appears that because of the persistent educational campaign on contraception, discussion of family planning has been de-sexualised and people do not

feel uncomfortable in discussing it. This observation is also supported by the fact that many informants who were married before 16 years were given either no or limited information about sex, but yet were advised by an elder member of their family to use pills from the day of the marriage. Some of the informants were aware of pills also because they had seen them being used by their sisters, sister-in-laws or relatives, without knowing how pregnancy actually occurs. Despite of this openness in family planning, generally women do not initiate the discussion and wait for husband to raise the issue; which in most cases do it at quite early stage of their married life. As expected in 77 per cent of the cases (27 of 35), the discussion was initiated by their husbands, almost immediately after marriage. It is perhaps more interesting to note that 23 per cent of the informants reported that they initiated the discussion, clearly a case of positive deviance. Further analysis of the background of these women revealed that all of them were from urban areas and only in one case was the discussion held immediately after marriage. The rest of the women waited to have these discussions only after having two or more children, i.e. when they had met their reproductive goals. In these cases their husbands were perhaps not inclined to use any family planning method and hence did not feel they had anything to discuss with their wives. The women thus had no other options but to take the initiative and argue for the opportunity to use family planning with their husbands. All this indicates that even in the case of family planning, women take the initiative only as the last resort. Again, women who were married at a mature age (20 years or more) were more confident than those who married young, and all had discussions on contraception with their partners, two-thirds almost immediately after marriage. In many cultures it is reported that women can't ask their husband to use family planning, particularly condom as it would be considered to be stepping beyond their boundaries by being more assertive than the cultural norms allows (John Hopkins University 1999). In other culture, women feared violence, desertion or accusation of infidelity if they proposed family planning. Fortunately, Bangladesh does not fall in those categories of society. A direct question to the informants whether they can ask their husbands to use condom, 36 women answered in affirmatively. Further analysis however, shows that the gender inequality does not allow them to insist on it. Women can suggest it but it is their husbands who make the final decision to use condom or not. Out of the 54 informants, two-thirds (36) were currently using some family planning method. The majority (26 out of 36) were pills users. Analysis of the content of discussions held between the informants and their spouses shows that it was mostly one sided. The informants were generally told by their husbands that they should start using pills. "Right after my marriage my husband asked me whether I want to have any child …......? I told him that whatever he would say I would do. He also did not want any child at that time. I remember that when I asked him weather he would use condom, he refused and told me to use pills. I told him that I do not have any problem to use any method." ( age 35 yrs. urban , 6 yrs of schooling) In a few cases (4 out of 36) the informants were told that they could use method of their choice.

"He initiated the discussion and said that we should use family planning. I agreed. Then he said to me that I may use whatever method I like to use. He also told me that he could help me in choosing a female family planning method." (age:35,10 years of schooling ) In general, their husbands did not want to use any male method, particularly condom. "After my marriage my husband decided that we should use contraceptive methods. I started using pills as my husband doesn’t like to use condom. He says that he cannot enjoy it. Initially I used to tell him that he should use condom but he just refused it. He told me that he won’t mind to stay without having sex but he would never use condom. He hates it......... If sometime I have problem while using pills then he tells me to switch to other female method. " ( urban women, age 24 , married at 22 yrs., 9 yrs. of schooling) However, four of the informants reported that their husbands were using a combination of condoms and calendar rhythm. In a few cases, husbands agreed to use condoms only temporarily, as the informants were having some problems with oral pills. The general sense emerging from the discussion was that the majority of males are open to the use of family planning. However, the males often considered family planning as the domain of women and expected them to take care of it. Many of the unwanted pregnancies which had been experienced by the informants were mainly because of the casual attitude of husbands towards the risk of pregnancy. About half of the informants actually felt that though it is a joint responsibility, women themselves should take care of it because ultimately it is they who suffer from the pain of pregnancy or abortion, if they unwillingly become pregnant. Husbands however, were not totally unconcerned. Among the couples who were using contraceptives, their husbands were doing several things to ensure protection from unwanted pregnancies. Examples included reminding their wives to take the pills, purchasing contraceptives from the market if required, and suggesting them to switch to another female method as the continuous use of pills is believed to make women infertile. About 9 per cent of the 54 informants reported that occasionally after using pills for 5-6 months when they wanted to "break harmful effect of pills", sometimes their husbands used a condom. Occasional refusing sex to their husbands is not uncommon. In the present study, 47 (87 per cent) out of the 54 informants reported denial of sex to their husbands. Four said that they had never refused sex to their husbands, while the remaining 3 did not answer to the question. Further enquiry on the husband's reaction to such sexual refusal shows that in 10 cases, husbands generally showed an understanding of their wives and they respected their feelings. In the remaining cases, the husband's reaction varied from getting angry, scolding, beating, threatening to go to other women or sending the wife to her parent's home. Ultimately, refusal often leads to forced sex. The study identifies forced sex as a regular phenomena within married life. Out of the 54 informants 32 (59 per cent) reported forced sex either regularly (14 out of 32) or sometime (18 out of 32). Another 18 women said that it never happened to them, while 4 women refused to answer this question. Forced sex is equally prevalent in both rural and

urban areas. Further probing of those who had reported forced sex revealed that most of them hated it, felt horrible and at times felt that it was crushing their self esteem. As one 25 year old rural woman phrased it: "Force sex is a bitter experience. At that time I hate everything. I feel like dying. A woman who has faced it will only understand what is forced sex. I feel horrible, both mentally and physically." An urban women observed: "I do not like sex hence often I refuse it to him. Sometimes when despite of his persuasion I insist not to have sex, he scolds and beats me and threats that he would go to some other woman. In such case I get scare and agree with him. I am a woman and I have to satisfy him against my wish. I have no say. I am afraid that if he sends me back to my parents home what will I do? They will not feed me for whole life." Surprisingly, there were 12 informants who reported that they enjoyed (3 sometimes, 9 often) "forced sex". Repeated questioning on what and why they enjoy forced sex did not give any definite clue. Four women said that though forced sex is bad, they take it as a sign of love of their husbands. It indicates they cannot live without having sex with their wives. Three others felt that though generally sex is initiated with force, subsequently they get emotional and start enjoying it. Three women reported that they feel that their husbands get more enjoyment in forced sex than regular sex. Hence, sometimes they don't mind giving their husbands the opportunity to have sex forcefully with them by denying their sexual urge. According to these informants, they also enjoy this game. When asked pointedly if they really thought that their husbands had forced them to have sex, they laughed and said 'no'. Three of them also said that it is their husband's right to have forced sex and they do not feel bad when their husbands exercise their right. One woman further mentioned that males are helpless; they can not control their sexual urge, hence she would not really consider it as forced. Further inquiry into the reasons for forced sex revealed that the most common reason was the denial of sex to their husbands. The reasons for their denying sex varied vastly from simple tiredness or sickness, to the expression of anger with their husband, and included at times the assertion of her authority to control her body and sexuality. At least four informants confessed that they had never refused sex to their husbands because they were afraid that they might go to some other women or send them back to their parent's home. Such feelings of helplessness or economic dependence on their husbands were repeatedly voiced by those who were subjected to forced sex. Despite the various social and economic changes which are taking place in Bangladesh, the ethos of a patriarchal society has largely remained unaltered. Gender inequality dominates every aspect of social and economic life. Social constructs like masculinity play a critical role in defining sexual relationships. Social control over women's sexuality is strong and different social mechanisms are used to support and perpetuate it over time. These observations are valid for both rural and urban areas of Bangladesh, though its

form and intensity may vary across different segments of population. These findings document that the majority of girls at the time of their marriage have only a vague or no knowledge of the sexual life in which they enter after marriage. As a result, their initial experiences are commonly shocking and painful. The trauma is compounded by their early marriage which also has devastating effect on their subsequent married life. The analysis shows that girls who marry at a mature age (20 years or more) and have adequate knowledge of sexual life at the time of their marriage, have generally an easier transition from unmarried to married life. Husband-wife communication on sex often occurs on the marriage night and generally the first intercourse is negotiated. These women also reported discussion on contraception within the first few days of married life. All these factors assist in developing a more positive attitude towards sexuality within marriage. In contrast, those who marry at an early age and had prior no or only vague information on sexual life, reported little or no husband-wife communication on sexuality and often their first intercourse was performed forcefully. The trauma of such an initiation into marriage has a long lasting effect on women's lives and contributes to the development of a negative attitude towards sexuality. This leads to many subsequent problems in their married life including their denial of sex and sexual violence by their partners. The findings thus clearly argue for delaying marriage of girls till they are physically and mentally mature. Further, they should be prepared for leading an enjoyable sexual life after marriage by providing them with sufficiently detailed and accurate knowledge about sexuality. Bringing about these desired changes are however, adversely affected by a very different standard maintained for the sexual behaviour of men and women. The importance given to the maintenance of virginity of girls and the strong sanctions associated with pre-martial sex for girls but not for boys is a clear illustration of conflicting gender-based standards. The observation that despite the negative values attached with the initiation of sexual discussion by women with their husbands, at least half of the women express their sexual desire to their partners is encouraging. They expressed their sexual interest either directly or through indirect verbal, non-verbal communication. Attempts should be made to build on this and through behaviour change communication efforts couples should be encouraged to have a more direct and open discussion of these issues. A serious bottleneck in developing such communication campaign is concept of "shame" attached to the expression of any sexual and reproductive desire by women. Certainly, more openness among couples will improve husband-wife understanding, and make their sexual life more enjoyable. Further, such discussion would also be helpful in addressing reproductive health needs of both partners. The observation that the discussion on family planning methods in Bangladesh has been desexualised offers a window of opportunity. It may provide the social space for families to expand their support and orientation of young girls and boys about to be married from merely family planning to the broader issues of reproduction and sexuality. These gatekeepers should be educated that such information will help girls in their relationships with their husbands, and the development of a positive attitude toward sexuality. In the long run it will be beneficial for the reproductive health of couples and perhaps reduce sexual violence as well. However, one should be careful not to over step the boundaries of our ability to generalize from this pilot study. Clearly the data were collected from a relatively small sample. The partners of these women were not given the opportunity to offer their perspective, and the limited

qualitative nature of the interviews with informants on this intimate topic may not capture the richness of their full experience. Nevertheless, their voices were heard above the redundant message of the most traditional social norms. It is fully appreciated that to bring about the desired attitudinal change among the gatekeepers and to address issues such as gender equity, masculinity and control over women’s sexuality, the larger socialisation process needs to be addressed. Social change of this nature will be difficult, and demands sustained commitment at all levels of the state and civil society. Yet a beginning could be made with well planned social dialogue and educational efforts both for gate keepers such as parents and policy makers, women and their spouses, and boys and girls of all ages. With the participation and the voice of communities, social change is possible.

INTERVIEW OF ZAKIA AFRIN What is the definition of sex education? Is the term 'sex education' is a misnomer? Shouldn't it be 'sexuality education'? I would rather prefer the term 'Physical education'. That way it doesn't get unwarranted scrutiny and scepticism from our conservative society. What do you think is the necessity of sexuality education? * For healthy adult life * Breaking through the artificiality given to sexual activities and learn that it is a normal human behaviour. * Consciousness about sexual diseases, early marriages and motherhood, population growth and healthy sexual life. Do you think we should introduce 'sexuality education' in the national education curriculum? * I believe we don’t need to reinvent the wheel rather be honest about education. There is lots of materials in our science books and surroundings. Teachers need to effectively manage their roles. Parents and guardians probably have the most important role in it. It is important to remember that The minute a child asks about his birth is the moment he needs to learn about human body. What would be the impacts of 'sexuality education' both in positive and negative terms? * Positive effects will include other than number 2 - decrease of spousal and other kinds of rapes, diseases and most importantly building preventive strategies for AIDS. Negative can happen if the education is focused to sex itself and not the consequences and healthiness of it. Will 'sexuality education' work for Bangladesh?

*Bangladesh has been praised by WHO for her infancy mortality rate reduction activity. Proper campaign against sexual diseases will help our fight against AIDS. Did you find your class mates sexually educated? What sort of problems did you have to face because of sexual ignorance? I am asking the impact of ignorance... * Young boys and girls have misconceptions about masturbation's and menstruation leading to unhappy times. Due to lack of proper reading materials, many turn to pornography to learn about sexual behaviours and thus become misled about the difference between normal and perversion.

DOES SEXUALITY EDUCATION WORK? The question is no longer should sex education be taught, but rather how should it be taught. Over 93 per cent of all public high schools in USA currently offer courses on sexuality or HIV. More than 510 junior or senior high schools have school-linked health clinics, and more than 300 schools make condoms available on campus. The question now is: are these programmes effective, and if not, how can we make them better? Kids need the right information to help protect themselves. The US has more than double the teenage pregnancy rate of any western industrialized country, with more than a million teenagers becoming pregnant each year. Teenagers have the highest rates of sexually transmitted diseases (STDs) of any age group, with one in four young people contracting an STD by the age of 21. STDs, including HIV, can damage teenagers' health and reproductive ability. And there is still no cure for AIDS. HIV infection is increasing most rapidly among young people. One in four new infections in the US occurs in people younger than 22. In 1994, 417 new AIDS cases were diagnosed among 13-19 year olds, and 2,684 new cases among 20-24 year olds. Since infection may occur up to 10 years before an AIDS diagnosis, most of those people were infected with HIV either as adolescents or pre-adolescents. Knowledge alone is not enough to change behaviours. Programmes that rely mainly on conveying information about sex or moral precepts-how the body's sexual system functions, what teens should and shouldn't do - have failed. However, programmes that focus on helping teenagers to change their behaviour-using role-playing, games, and exercises that strengthen social skills-have shown signs of success. In the US, controversy over what message should be given to children has hampered sex education programmes in schools. Too often statements of values ("my children should not have sex outside of marriage") come wrapped up in misstatements of fact ("sex education doesn't work anyway"). Should we do everything possible to suppress teenage sexual behaviour, or should we acknowledge that many teens are sexually active, and prepare them against the negative consequences? Emotional arguments can get in the way of an unbiased assessment of the effects of sex education. Other countries have been much more successful than the US in addressing the problem of teen pregnancies. Age at first intercourse is similar in the US and five other countries: Canada, England, France, the

Netherlands, and Sweden, yet all those countries have teen pregnancy rates that are at least less than half the US rate. Sex education in these other countries is based on the following components: a policy explicitly favouring sex education; openness about sex; consistent messages throughout society; and access to contraception. Often sex education curricula begin in high school, after many students have already begun experimenting sexually. Studies have shown that sex education begun before youth are sexually active helps young people stay abstinent and use protection when they do become sexually active. The sooner sex education begins, the better, even as early as elementary school. Reducing the Risk, a programme for high school students in urban and rural areas in California, used behaviour theory-based activities to reduce unprotected intercourse, either by helping teens avoid sex or use protection. Ninth and 10th graders attended 15 sessions as part of their regular health education classes and participated in role-playing and experimental activities to build skills and self-efficacy. As a result, a greater proportion of students who were abstinent before the program successfully remained abstinent, and unprotected intercourse was significantly reduced for those students who became sexually active. Postponing Sexual Involvement, a programme for African-American 8th graders in Atlanta, used peers (11th and 12th graders) to help youth understand social and peer pressures to have sex, and to develop and apply resistance skills. A unit of the programme also taught about human sexuality, decision-making, and contraceptives. This programme successfully reduced the number of abstinent students who initiated intercourse after the program, and increased contraceptive use among sexually experienced females. Healthy Oakland Teens (HOT) targets all 7th graders attending a junior high school in Oakland. Health educators teach basic sex and drug education, and 9th grade peer educators lead interactive exercises on values, decision-making, communication, and condom-use skills. After one year, students in the programme were much less likely to initiate sexual activities such as deep kissing, genital touching, and sexual intercourse. AIDS Prevention for Adolescents in School, a programme for 9th and 11th graders in schools in New York City, focused on correcting facts about AIDS, teaching cognitive skills to appraise risks of transmission, increasing knowledge of AIDS-prevention resources, clarifying personal values, understanding external influences, and teaching skills to delay intercourse and/or consistently use condoms. All sexually experienced students reported increased condom use after the programme. Although sex education programmes in schools have been around for many years, most programs have not been nearly as effective as hoped. Schools across the country need to take a rigorous look at their programmes, and begin to implement more innovative programs that have been proven effective. Educators, parents, and policy-makers should avoid emotional misconceptions about sex education; based on the rates of unwanted pregnancies and STDs including HIV among teenagers, we can no longer ignore the need for both education on how to postpone sexual involvement, and how to protect oneself when sexually active. A comprehensive risk prevention strategy uses multiple elements to protect as many of those at risk of pregnancy and STD/HIV infection as possible. Our

children deserve the best education they can get. In the UK, studies suggested that sex education lessons are doing little to change teenagers' sexual behaviour. One of the biggest studies ever conducted on the impact of sex education delivered by teachers suggested that specially designed programme aimed at Scottish secondary school pupils had no more impact on adolescents' sexual activity or risk taking than conventional lessons although it increased their knowledge of sexual health and marginally improved relationships. And a review of research in the US and Canada indicated that pregnancy prevention programmes for 11-18, including sex education classes, family planning clinics and other outside school initiatives had not delayed sexual intercourse, improved birth control or reduced teenage pregnancies. The papers in the British Medical Journal will fuel the long running debate over the value of sex education, the age at which it should start, the responsibility of parents and the role of the media and the internet in encouraging young people to experiment early. The study of 5,850 teenagers in 25 non-Catholic schools in the Tayside and Lothian regions of Scotland was led by Daniel Wight, of the medical research council's social and public health sciences unit at Glasgow University. Pupils liked the programme, which neither encouraged nor discouraged sexual activity and gave more information on practicalities such as handling condoms and accessing sexual health services as well as trying to improve teenagers' negotiation of sexual encounters. But it had no more effect on condom or contraceptive use or sexual activity generally than other sex education. The research team suggested that influence of such specialised sex education programmes might be less important than the influences of family, local culture and mass media. British secondary school pupils saw personal and social education in schools as requiring little effort because there were no exams. The potential for influencing sexual behaviour through conventional programmes may have already been reached. The Scottish executive said there was no single solution to the problems of teenage pregnancies "which are slowly decreasing but still too high". It would continue to work with parents to provide sexual health education and relationship advice in schools, GP surgeries, family planning clinics and drop-in centres. The Department of Health said: "International research shows that countries such as the Netherlands that have good sex and relationship education and high quality contraceptive advice services for young people have the lowest teenage conception rates." Most UK sex education programmes seem half-hearted in comparison, providing the bare biological facts, perhaps alongside a demonstration of how to put a condom on a cucumber. Unfortunately policy makers have recently lost a good source of information about what works and what doesn't. The US Centres for Disease Control and Prevention (CDC) in Atlanta, Georgia, commissioned a panel of external experts to carry out a rigorous review of various sex education programmes. The panel identified five strategies that were successful in reducing the rate of teenage pregnancy, all based on comprehensive sex education, and the details were posted on the organisation's website. But in 2002 that information disappeared and the CDC will no longer release it. According to the CDC press office, the review programme is being "re-evaluated". But sceptics fear it has been dumped because its conclusions don't fit with the Bush's administration's views. "They were inconsistent with the ideology to which this administration adheres," says Bill Smith of the Sexuality Information and Education

Council of the United States, a liberal sex education advocacy group based in New York. What of the study that made the newspaper headlines in the UK last year, showing that contraception provision is linked with higher STD rates? Perhaps it should not really be taken as a damning indictment of the liberal approach. The study looked at National Health Service family planning clinics, not school-based comprehensive sex education. Simply doling out condoms without tackling the wider issues is unlikely to have much impact. Anyway, should the correlation between sex clinics and STD levels really be so surprising? In fact, amid all the scare stories, the average age when a person first has sex now appears to be levelling out at around 17 in the US and 16 in the UK. And although rates of STDs are on the increase in the UK, teenage pregnancy and birth rates are on a downward trend, as they have been in most developed countries for several years. A report from the Alan Guttmacher Institute, a reproductive health research group in New York, concludes this is due to factors such as the rise of careers for women, and the increasing importance of education and training (Family Planning Perspectives, vol 32, p 14). Perhaps it is unsurprising, then, that it is among society's lowest income groups that teen pregnancy rates are highest. In the face of such complex societal forces, those who try to influence teenagers' behaviour on a day-to-day basis undoubtedly have a tough job on their hands. There may be no single solution. More research is needed to produce detailed information on which kind of sex education programmes work best, and in which contexts.

INTERVIEW OF DR. JULIA AHMED Executive Director, Bangladesh Women's Health Coalition

What is the definition of sex education? Is the term 'sex education' is a misnomer? Shouldn't it be 'sexuality education'? I think this is a very good observation. Yes, I think it should be ‘sexuality education’ because it broadens the whole subject. If we say only ‘sex education’, then the focus remains very limited. If we say ‘sex education’ people tend to think we are only talking about intercourse. Sexuality education is about a person’s self-esteem; it teaches you to make you think that you are a human being. It also means that one come to know about his or her body and how to use that body. Sexuality education also teaches us about our social responsibility. If we can educate the young people on this, as they grow up, they will learn to understand their own sexuality as well as sexuality of other people. What do you think is the necessity of sexuality education? We have seen from our adolescence that every human has a few phases in his or her life. There are some aspects that are directly linked with sexuality and they affect our lives very much. Puberty, for example, is a very significant phase of girls. Then a girl encounters an age when she starts to have periods. Then come the time to choose your partner for both male and female. When a couple wants to have babes, it would be very good for them if they are properly educated about their own sexuality.

Sexuality education helps you to make good and right decisions in your life. Your relation with your partner remains very good if you are sexually educated. Do you think we should introduce 'sexuality education' in the national education curriculum? Definitely. If we can include this in our national curriculum, we would be able to resolve many problems of our public health system. Many issues in this sector would then be institutionalised. Sexually transmitted infections are a big public health issue in Bangladesh and we can surely prevent STDs if we have sexuality education. But we have to know about it and the best time to make people know is adolescence. In terms of population pyramid, sexuality education will also enlighten people with the knowledge of reproductive health. When should we begin sexuality education for adolescence? I think this should start from Class V, because the attitude to life is basically formed at this age. What would be the impacts of 'sexuality education' both in positive and negative terms? Since the whole affair of sexuality education is still shrouded with mystery, our students will be enlightened by it. When we, from Bangladesh Women’s Health Coalition, started to impart sexuality education, the teachers themselves used to feel hesitant. But now they are asking for sexuality education themselves. So, in the beginning, many may oppose this, but eventually when they will understand the value of sexuality education, they will welcome it. There is a section of people who think ignorance is innocence and knowledge leads to promiscuity. This group of people will take sexuality education very negatively. They may even stop sending their children to schools. But this negative side will be very temporary. Will 'sexuality education' work for Bangladesh? Yes, we have already proved it through our work. And the media has a big role to play in this sector. What should be included in the sexuality education curriculum? First, we need to teach about the reproductive organs and their physiology. We have to

teach the adolescence about their responsibilities towards their parents and then we should teach them about gender. Then slowly we should teach them about decision making and self-esteem. Then slowly we should teach them about issues of public health. I can say this because we are already providing sexuality education to adolescent people. We actually wanted to change the outlook of the adolescent people by this education.

RECOMMENDATIONS

BIBLIOGRAPHY Baatout, Faisal. Qatar goes for own Islamic-style sex education. Middle East Online. March 16, 2005 Bangladeshi schools to have sex education from 2004. Agence France-Presse December 25, 2002, http://www.aegis.org/news/afp/2002/AF0212C9.html Bano, Masooda. Dissenting Note: The balancing act. The News, April 1, 2005. Curtis, Polly. Schools need 'hands-on' sex education. May 9, 2003 Carvel, John. Sex lessons for five-year-olds 'should be compulsory' Advisers urge school sex lessons for five-year-olds. The Guardian. July 11, 2003. Dell'Angela, Tracy. Study alleges sex ed shortcomings. Chicago Tribune. March 14, 2005 Donovan, Jane. Churches Share Values in Sexuality Education. Village Life News: November 21, 1996 Finger, William R. Sex Education Helps Prepare Young Adults. Family Health International Network: 2000, Vol. 20, No. 3. Ford, Liz. Abstinence 'lost' in sex education. The Observer. June 25, 2004 Guidelines on sex education in the final stage. Daily Express of Malaysia. April 1, 2005 Gaby Hinsliff, Amelia Hill and Jo Revill. Sex education for all pupils 'needed to fight STD epidemic. The Observer. Sunday March 20, 2005. George, Alison. Teenagers special: Going all the way. NewScientist.com news service. 05 March 2005

Hanson, Ann L. Minister for Children, Families and Human Sexuality, United Church of Christ. Sexuality Education and Religion? http://www.advocatesforyouth.org/parents/experts/hanson.htm Iranian girls not getting enough sex education, professor says. AFP. 11 May 2000. India: Sex Education Steers India's Truckers Away from AIDS Highway. Agence France Presse February 08, 2005. Jabeen, Tahera. Sex Education in Bangladesh. Alochona Muktangon, May 2002 Jiaojiao, Rong and Chihua, Wen. What is love? Women’s Features Service. May 9, 2004. Kathleen Cash, Hashima-E-Nasreen, Sharful Islam Khan, Abbas Bhuiya, Mushtaque R. Chowdhury and Sadia Chowdhury. Sexual health for rural Bangladeshi youth. Sexual Health Exchange. 2001-1 Khan, M.E. Peeping Behind the Closed Door: A Qualitative Study of Sexual Behaviour of MarriedWomen in Bangladesh. Population Council Katz, Nikki. Sex Sells Using Sex in http://womensissues.about.com/od/womenssexuality/a/teensexmyths.htm

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Smith, Claire. The sex lives of Scotland's children. The Scotsman, 24 March 2004. http://news.scotsman.com/topics.cfm?tid=1251&id=313602005&20050325143947

Sobnom, Tarannum. Sex education is a dirty word here. February 9, 2003 Tahmina, Qurratul Ain. Street Children Suffer Sexual Abuse. Inter Press Service. November 12, 2001 Teachers 'want pupils to be taught abortion facts'. The Observer. February 4, 2005 The Star, Sunday April 24, 2005 UNFPA Global Population Update. Issue 17 - March 16 2004 Weekly Trust, Kaduna Nigeria. July1, 2002. http://www.islamfortoday.com/sex01.htm http://www.themodernreligion.com/misc/sex/s4.html http://www.simplysearch4it.com/article/a00025/875.html Annexure - I

SEXUAL HEALTH GLOSSARY Abortifacient: A drug, herb, or device that can cause an abortion. Abortion: The termination of pregnancy before birth. Abstinence: Not having sex play. Abstinence-Only Curricula: Sexuality education programs that advocate sexual abstinence before marriage. They do not provide information about contraception, safer sex, or sexual orientation. Acquaintance Rape: Sexual intercourse coerced by someone known to the victim. Adolescence: The period of physical and emotional change between puberty and adulthood. Adultery: Sexual intercourse between a married person and someone who is not his or her spouse. Age of Consent: The age at which one is considered old enough to decide to have sexual intercourse. Age of Majority: The age at which one becomes a legal adult. Alveoli: Sacs inside the breast that produce milk. Androgens: Certain hormones that stimulate male sexual development and secondary male sex characteristics. They are most abundantly produced in the testicles of men but are also produced in small amounts in women's ovaries. The most common androgen is testosterone. Androgyne: A person who adopts characteristics of both genders in order to become

gender neutral as a way to have fun, entertain, make a political statement about gender roles, or gain emotional satisfaction. Androgyny: A gender identity that allows expression of both gender roles. Anorexia: An eating disorder often caused by poor body image in which people, usually women, don't eat or eat very little to remain or become thin. Anorgasmia: The inability to have an orgasm. Anus: The opening from the rectum from which solid waste (feces) leaves the body. Aphrodisiac: A substance that is supposed to increase sexual desire. Areola: The dark area surrounding the nipples of women and men. Asphyxophilia: A paraphilia in which sexual arousal becomes dependent on being strangled up to the point of passing out. Autoerotic: Providing sexual stimulation for one's self. Autoerotic Asphyxiation: Self-strangulation for sexual arousal. Balanitis: An inflammation of the glans and foreskin of the penis that can be caused by infections — including sexually transmitted infections — irritations, drugs, or other factors. Barrier Methods of Birth Control: Contraceptives that block sperm from entering the uterus. These are the male and female condoms, diaphragm, cervical cap, and spermicide. Bartholin's Glands: Glands in the labia minora on each side of the opening to the vagina that provide lubrication during sexual excitement. Basal Body Temperature Method: A method for predicting fertility in which women chart when ovulation occurs by taking their rectal temperature every morning before getting out of bed. Biastophilia: A paraphilia in which sexual arousal becomes dependent on sexually attacking a nonconsenting, surprised, terrified, and struggling stranger. This is a kind of rape, but most rapes are committed by normophilic men. Bimanual Exam: Physical examination of the internal reproductive organs of the pelvis. Bisexual: One who is attracted to people of both genders. Blue Balls: The genital aching that may occur when men do not have an ejaculation following sexual stimulation. Women may experience similar aches if they do not reach orgasm, but because of sexist influences in development of our language about sex, there is no common expression to describe a woman's symptoms. Body Image: One's attitudes and feelings about one's own body and appearance.

Breasts: Two glands on the chests of women. Men also have breast tissue. Breasts are considered sex organs because they are often sexually sensitive and may inspire sexual desire. They produce milk during and after pregnancy. Candida: A type of yeast and a common cause of vaginitis. Cerebral Cortex: The area of the brain associated with higher functions, including learning and perception. Cervix: The narrow lower part of the uterus (womb), with an opening connecting the uterus to the vagina. Chancroid: A sexually transmitted bacterium that causes open genital sores. Chastity Belts: A variety of devices designed to prevent women, men, or children from having sex. Used from medieval to modern times, these devices were also supposed to preserve morality. Some were meant to ensure fidelity in women in the absence of their husbands. Others were designed to prevent masturbation and nocturnal emissions in men and boys. Child Abuse: Sexual assault against a child by an older person. Chlamydia: A common sexually transmitted organism that can cause sterility in women and men. Circumcision: An operation to remove the foreskin of the penis. Climacteric: The time of change that leads to menopause. The physiological midlife changes for women and men. Clitoral clitoris.

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Clitoris: The female sex organ that is very sensitive to the touch — located between the labia at the top of the vulva. Colposcope: A viewing instrument with a bright light and magnifying lens that is used to examine the vagina and cervix. Combined Oral Contraceptives: Birth control pills that contain the hormones estrogen and progestin. Coming Out: The process of accepting and being open about one's sexual orientation. Companionate Love: Affection and deep emotional attachment that may be erotic. Comstock Act: An 1873 law that made it a federal crime to use the U.S. mail to distribute anything considered "obscene, lewd, lascivious, indecently filthy, or vile," including information about contraception, abortion, and sexual health. Conception: The moment when the pre-embryo attaches to the lining of the uterus and

pregnancy begins; term also used to describe the fertilization of the egg. Condom: A sheath of thin rubber, plastic, or animal tissue that is worn on the penis during sexual intercourse. It is an over-the-counter, reversible barrier method of birth control, and it also provides protection against the most serious sexually transmitted infections. There are also female condoms. Continuous Abstinence: Having no sex play for long periods of time — months or years. Contraception: The prevention of pregnancy; birth control. Contraceptive Creams and Jellies: Substances containing spermicide, which immobilizes sperm, preventing it from joining with the egg; used with diaphragms or cervical caps. These are over-the-counter, reversible barrier methods of birth control. Contraceptive Film: Inserted deep into the vagina, a square of tissue that melts into a thick liquid and blocks the entrance to the uterus with a spermicide to immobilize sperm, preventing it from joining with an egg; an over-the-counter, reversible barrier method of birth control. Most effective when used with a condom. Contraceptive Foam: Inserted deep into the vagina, a substance that blocks the entrance to the uterus with bubbles and contains a spermicide to immobilize sperm, preventing it from joining with an egg; an over-the-counter, reversible barrier method of birth control. Most effective when used with a condom. Contraceptive Suppository Capsule: Inserted deep into the vagina, a solid that melts into a fluid liquid to immobilize sperm, preventing it from joining with an egg; an overthe-counter, reversible barrier method of birth control. Most effective when used with a condom. Corpus Cavernosa: Two strips of tissue that lie on each side of the urethra in the penis. During sexual excitement, they fill with blood to create an erection. Corpus Spongiosum: The tissue that surrounds the urethra inside the penis and is responsible, like the corpus cavernosa, for an erection; also the type of tissue that forms the glans of the clitoris and the penis. Cremaster Reflex: An automatic response to stimulation — for example, cold temperature or touching the inside of the thigh — in which the cremaster muscle pulls the scrotum and testes closer to the body. Cross-Dresser: A person who sometimes wears clothing associated with the opposite sex in order to have fun, entertain, gain emotional satisfaction, or make a political statement about gender roles, for example, drag kings and drag queens. Cystitis: An infection of the bladder. Cytomegalovirus: An infection that may be transmitted through sexual or intimate contact that may cause permanent disability, including hearing loss and mental

retardation for infants and blindness and mental disorders for adults. Date Rape: Coerced sexual intercourse during a dating relationship. Delayed Ejaculation: Commonly used term for inhibited orgasm in men. Desire: A feeling of sexual attraction or arousal. The first stage of the sexual response cycle. Diaphragm: A soft rubber dome intended to fit securely over the cervix. Used with contraceptive cream or jelly, the diaphragm is a reversible barrier method of birth control available only by prescription. Dyspareunia: Painful intercourse for women that may be caused by hormonal imbalances, especially those that happen after menopause. Early Ejaculation: Ejaculation occurring before a man wants it to occur. Ectopic Pregnancy: A life-threatening pregnancy that develops outside the uterus, often in a fallopian tube. Egg: The reproductive cell in women; the largest cell in the human body. Ejaculation: The moment when semen spurts out of the opening of the urethra in the glans of the penis. Ejaculatory Inevitability: The moment during sexual excitement when a man cannot stop his ejaculation. The prostate begins contracting and pulsing out seminal fluid. Embryo: The organism that develops from the pre-embryo and begins to share the woman's blood supply about nine days after fertilization. Emergency Contraception: The use of oral contraceptives or IUDs to prevent pregnancy after unprotected intercourse. Emergency Hormonal Contraception: The use of oral contraceptives to prevent pregnancy after unprotected intercourse. Endometrium: The lining of the uterus that develops every month in order to nourish a fertilized egg. The lining is shed during menstruation if there is no fertilization. Erectile Dysfunction: The inability to become erect or maintain an erection with a partner. Erection: A "hard" penis when it becomes full of blood and stiffens. Erogenous Zone: Any area of the body very sensitive to sensual touch. Erotic: That which is sexually arousing. Erotophobia: Fear and anxiety about the erotic.

Estrogen: A hormone commonly made in a woman's ovaries. Estrogen's major effects are seen during puberty, menstruation, and pregnancy. Exhibitionism: A paraphilia in which sexual arousal becomes dependent on exposing the sex organs to those who will be surprised. Exhibitionists: Women or men who expose their sex organs to other people without their consent, usually in public places. External Sex and Reproductive Organs: The sex organs and structures on the outside of the body that are primarily used during sexual activity. These include the vulva in a woman and the penis and scrotum in a man. Extramarital Sex: Sexual intercourse by a married person with someone other than his or her spouse. Fake Orgasm: The pretense of having reached climax in order to end sex play or please a partner. Fallopian Tube: One of two narrow tubes that carry the egg from the ovary to the uterus. Fantasy: A sexually arousing thought and mental image. Female Circumcision: The practice of removing a girl's clitoral hood, clitoris, and/or the labia; often called female genital mutilation. This is practiced in some African, Near Eastern, and Southeast Asian cultures. Female Condom: A polyurethane sheath with flexible rings at each end that is inserted deep into the vagina like a diaphragm. It is an over-the-counter, reversible barrier method of birth control that may provide protection against many sexually transmitted infections. Female Genital Mutilation: Female circumcision. Fertilization: The joining of an egg and sperm. Fetal Alcohol Effects: Fetal abnormalities caused by alcohol during pregnancy that may not be as severe as those associated with fetal alcohol syndrome. Fetal Alcohol Syndrome: Fetal abnormalities affecting growth, the central nervous system, and facial features that are caused by women drinking alcohol during pregnancy. Fetishism: A paraphilia in which certain objects, substances, or parts of the body become necessary for sexual arousal. Fetus: The organism that develops from the embryo at the end of about seven weeks of pregnancy and receives nourishment through the placenta. Foreplay: Physical and sexual stimulation — kissing, touching, stroking, and massaging — that often happens in the excitement stage of sexual response; often occurs before intercourse, but can lead to orgasm without intercourse, in which case it can be called outercourse.

Fornication: Sexual intercourse between unmarried people. Gang Rape: Sexual assault committed by two or more people; also known as fraternity or party rape. Gay: Homosexual. Gender: One's biological, social, or legal status as male or female. Genitals: External sex and reproductive organs — the penis and scrotum in men, the vulva in women. Sometimes the internal reproductive organs are also called genitals. Glans: The soft, highly sensitive tip of the clitoris or penis. In men, the urethral opening is located in the glans. Gonads: The organs that produce reproductive cells — the ovaries of women, the testes of men. Gonorrhea: A sexually transmitted bacterium that can cause sterility, arthritis, and heart problems. Gynecology: Sexual and reproductive health care for women. Hermaphrodite: Someone with both female and male sex organs. Heterosexism: The bias that everyone is or should be heterosexual. Heterosexual: Someone who has sexual desire for people of the other gender. HIV (Human Immunodeficiency Virus): An infection that weakens the body's ability to fight disease and can cause AIDS. Homophobia: Fear and hatred of people who are gay, lesbian, or bisexual. Homosexual: Someone who has sexual desire for people of the same gender. Hormonal Contraceptives: Prescription methods of birth control that use hormones to prevent pregnancy. These include the Pill, implants, and injectables. Hormones: Chemicals that guide the changes in our bodies and influence how glands and organs work. HPV (Human Papilloma Virus): Any of 90 different types of infection, some of which may cause genital warts. Others may cause cancer of the cervix, vulva, or penis. HSV (Herpes Simplex Virus): An infection that can be sexually transmitted and cause a recurring rash with clusters of blistery sores on the vagina, cervix, penis, mouth, anus, buttocks, or elsewhere on the body. Hymen: A thin fleshy tissue that stretches across part of the opening to the vagina. Hyperphilia: Having sex more often than most people.

Hypoactive Sexual Desire: The lack of sexual desire. Hypophilia: Having sex very infrequently, or not at all. Hypothalamus: A small area in the brain that regulates basic animal functions. Implantation: The attachment of the pre-embryo to the lining of the uterus. Incest: Sexual activity between members of the same family. Infatuation: Impulsive, usually short-lived, emotional and erotic attachment to another person. Internal Sex and Reproductive Organs: The organs inside the body that are responsible for producing, moving, and nourishing human reproductive cells. Because internal organs may be sensitive or respond to sexual stimulation, these organs are also called sex organs. Intersex: people with ambiguous sex organs, neither exclusively female nor exclusively male, for example, people with androgen insensitivity syndrome, Kleinfelter syndrome, or congenital adrenal hyperplasia. Introitus: The tissue of the inner vulva that frames the opening to the vagina. Jock Itch: A very common fungal skin infection in the genital area of men that is caused by wearing tight clothing, sweating, or not drying the genitals carefully after bathing. It can cause a reddish, scaly rash that can become inflamed, very itchy, and painful. Kleptophilia: A paraphilia in which sexual arousal becomes dependent on stealing. Labia Majora: The larger, outer lips of the vulva. Labia Minora: The smaller, inner lips of the vulva. Lactobacilli: Bacteria present in healthy vaginas of women. They help relieve vaginitis by limiting the growth of candida, a yeast. LAM (Lactational Amenorrhea Method): Breast-feeding as birth control for up to six months after childbirth. Lesbian: A homosexual woman. Leukorrhea: A white, sticky vaginal discharge that is normal during adolescence. Levonorgestrel: A synthetic progestin similar to the hormone progesterone, which is produced by the body to regulate the menstrual cycle; the active ingredient in Norplant®. Libido: The sex drive. Limerance: A powerful and constantly distracting and obsessive infatuation. Lobes: Groups of alveoli sacs in women's breasts.

Long-Term Reorganization Phase: The second phase of rape trauma syndrome, in which the victim tries to regain control of life. Love: A strong caring for someone else. It comes in many forms. There can be love for romantic partners and also for close friends, for parents and children, for God, and for humankind. Lust: The desire for sexual pleasure. Marital Rape: Coerced sexual intercourse within marriage. Masturbation: Touching one's own sex organs for pleasure. Menarche: The time of a girl's first menstruation. Menopause: The time at "midlife" when menstruation stops; a woman's last period; usually occurs between the ages of 45 and 55. "Surgical" menopause, however — which results from removal of the ovaries — may occur earlier. Menstrual Cycle: The time from the first day of one period to the first day of the next period; a repeating pattern of fertility and infertility. Menstrual Flow: Blood, fluid, and tissue that are passed out of the uterus during the beginning of the menstrual cycle. Menstruation: The flow of blood, fluid, and tissue out of the uterus and through the vagina that usually lasts from three to five days. Milk Ducts: The passages in women's breasts through which milk flows from the alveoli to the nipple. "Morning-After" Pills: Emergency hormonal contraception that is taken within 72 hours of unprotected intercourse. Multiple Orgasms: More than one orgasm occurring within the same sexual encounter. Mutuality: Reciprocating equally with feelings and behavior. Nipple: The dark tissue in the center of the areola of each breast in women and men that can stand erect when stimulated by touch or cold. In a woman's breast, the nipple may release milk that is produced by the breast. Normophilia: Sexual preferences that are considered common or "normal" according to social norms. Norplant: A contraceptive system of six small soft capsules containing the hormone levonorgestrel that is inserted under the skin of the upper arm. A reversible method of birth control that is available only by prescription. Nymphomania: The desire by a woman to have sex very frequently with many different partners.

Oral Contraceptive: The birth control pill. Oral Sex: Sex play involving the mouth and sex organs. Orgasm: The peak of sexual arousal when all the muscles that were tightened during sexual arousal relax, causing a very pleasurable feeling that may involve the whole body. The fourth stage of the sexual response cycle. Outercourse: Sex play that does not include inserting the penis in the vagina or anus. Ovaries: The two organs that store eggs in a woman's body. Ovaries also produce hormones, including estrogen, progesterone, and testosterone. Ovulation: The time when an ovary releases an egg. Pap Test: A procedure used to examine the cells of the cervix in order to detect infection and hormonal conditions. It can also detect precancerous and cancerous cells. ParaGard (Copper T-380 A): An IUD that contains copper and can be left in place for 10 years. Paraphilia: A sex practice that becomes necessary for sexual arousal but that is not approved by social norms. Pedophilia: A paraphilia in which sexual arousal for an adult becomes dependent on having sexual contact or fantasies of sexual contact with a child. Peer Pressure: The efforts of a group of equals to maintain conformity to the group's social norms. Pelvic Exam: Physical examination of the vulva, vagina, cervix, uterus, and ovaries — usually includes taking cervical cells for a Pap test and a manual exam of the internal pelvic organs. Pelvic Girdle: A bony and muscular structure inside a woman's body that supports her internal sex and reproductive organs. Penis: A man's reproductive and sex organ that is formed of spongy tissue and fills with blood during sexual excitement, a process known as erection. Urine and seminal fluid pass through the penis. Perimenopause: The period of change leading to menopause. Period: The days during menstruation. Periodic Abstinence: Not having vaginal intercourse during the "unsafe days" of a woman's fertile phase in order to prevent pregnancy. Peyronie's Disease: A rare condition that is caused by fibrous growths inside the penis. Pheromones: Odors given off by animals that attract the other gender.

Pictophilia: A paraphilia in which sexual arousal becomes dependent on viewing pornographic pictures, movies, or videos with or without a partner. PID (Pelvic Inflammatory Disease): An infection of a woman's internal reproductive system that can lead to sterility, ectopic pregnancy, and chronic pain. It is often caused by sexually transmitted infections such as gonorrhea and chlamydia. Polygamy: Having more than one spouse. Pornography: Erotic imagery that is considered obscene and offensive. Post-Ovulation Method: A method of contraception using periodic abstinence or FAMs from the beginning of menstruation until the morning of the fourth day after predicted ovulation — more than half of the menstrual cycle. Pre-Ejaculate: The liquid that oozes out of the penis during sexual excitement before ejaculation; produced by the Cowper's glands. Pre-Embryo: The ball of cells that develops from the fertilized egg until after about nine days, when it attaches to the lining of the uterus and the embryo is formed. Premarital Sex: Sexual intercourse between people before marriage. Premature Ejaculation: Ejaculation occurring before a man wants it to occur — often before his partner reaches orgasm. Priapism: A continuous partial erection without sexual stimulation that is caused by dysfunctional blood flow into the corpus cavernosa. Primary Sex Characteristics: The body organs and reproductive structures and functions that differ between women and men. The differences include the external and internal sex and reproductive organs. It also includes a woman's ability to produce eggs and a man's ability to produce sperm. Prostate: An internal reproductive organ below the bladder that produces a fluid that helps sperm move. Prostatitis: An enlargement and inflammation of the prostate gland that results in a dull persistent pain in the lower back, testes, scrotum, and glans of the penis. There may also be a thin mucus discharge from the penis, especially in the morning. Prostitution: The performance of sexual acts for pay. Puberty: A time in life when a girl is becoming a woman and a boy is becoming a man. Puberty is marked by physical changes of the body such as breast development and menstruation in girls and facial hair growth and ejaculation in boys. Pubic Hair: Hair that grows in the genital area of women and men. Pubic hair is a secondary sex characteristic appearing at puberty.

Pubic Lice: Tiny insects that can be sexually transmitted. They live in pubic hair and cause intense itching in the genitals or anus. Rape: Coerced sexual intercourse. Rape Trauma Syndrome: The emotional and physical consequences one experiences after being sexually assaulted. Rapid Orgasm: When a woman climaxes more quickly than her partner and loses interest in continued sex play. Reality-Based Sexuality Education: Age-appropriate, culturally sensitive sexuality education programs that include open, nonjudgmental information about all aspects of sexuality; they encourage critical thinking, self-actualization, and behavioural changes through the empowerment of holistic knowledge about the body, sex, relationships, birth control, safer sex, gender role, and so on, by being realistic about people's lives. Also referred to as comprehensive sexuality education. Rectovaginal Exam: Physical examination of the reproductive organs and the tissues that separate the vagina and rectum. Rectum: The lowest end of the intestine before the anus, where solid waste (feces) is stored. Refractory Period: The time after ejaculation during which a man is not able to have an erection. Reproductive Cell: The unique cell — egg in women, sperm in men — that can join with its opposite to make reproduction possible. Retarded Ejaculation: Commonly used term for inhibited orgasm in men. Retrograde Ejaculation: An ejaculation from the prostate into the bladder. Rut: The period of sexual arousal in male animals that is a response to estrus. Sadism: A paraphilia in which sexual arousal becomes dependent on sexual role play or fantasy that includes giving punishment, discipline, or humiliation. Sanitary Pad: An absorbent "napkin" made of cotton or similar fibers that is worn against the vulva to absorb menstrual flow. Satyriasis: The desire by a man to have sex very frequently with many different partners. Scabies: Tiny mites that can be sexually transmitted. They burrow under the skin, causing intense itching — usually at night — and small bumps or rashes that appear in dirty-looking, small curling lines, especially on the penis, between the fingers, on buttocks, breasts, wrists, and thighs, and around the navel. Scrotum: A sac of skin, divided into two parts, enclosing the testes, epididymides, and a part of the vasa deferentia.

Secondary Sex Characteristics: Characteristics of the body that are caused by hormones, develop during puberty, and last through adult life. For women, these include breast development and widened hips. For men, they include facial hair development. Both genders develop pubic hair and underarm hair. Semen: Fluid containing sperm that is ejaculated during sexual excitement. Semen is composed of seminal fluid from the seminal vesicles, fluid from the prostate, and fluid from the Cowper's glands. Seminal Fluid: A fluid that nourishes and helps sperm to move. Seminal fluid is made in the seminal vesicles. Seminal Vesicle: One of two small organs located beneath the bladder that produce seminal fluid. Seminiferous Tubules: A network of tiny tubules in the testes that constantly produce sperm. Seminiferous tubules also produce androgens, the "male" sex hormones. Sexism: Bias against a certain gender — especially against women. Sexology: The scientific study of sex and sexuality through many disciplines including, but not limited to, anthropology, biology, sociology, history, psychology, medicine, and law. Sex Play: Any voluntary sexual activity, with or without a partner. Sex Therapy: Treatment to resolve a sexual problem or dysfunction such as premature ejaculation, inability to have orgasm, or low level of sexual desire. Sexual Abuse: Sexual activity that is harmful or not consensual. Sexual Addiction: The compulsive search for having very frequent sex. Sexual Assault: The use of force or coercion, physical or psychological, to make a person engage in sexual activity. Sexual Aversion Disorder: The fear of sexual contact. Sexual Compulsion: An obsession with having very frequent sex, often with many different sex partners. Sexual Dysfunction: A psychological or physical disorder of sexual function. Sexual Harassment: Unwanted sexual advances with suggestive gestures, language, or touching. Sexuality: The interplay of gender, gender role, gender identity, sexual orientation, sexual preference, and social norms as they affect physical, emotional, and spiritual life. Sexually Transmitted Infections (STIs): Infections that are often or usually passed from one person to another during sexual or intimate contact.

Sexual Orientation: The term used to describe the gender of the objects of our sexual desires. People who feel sexual desire for members of the other gender are heterosexual, or straight. People who feel sexual desire for people of the same gender are homosexual, or gay. Gay women are called lesbians. People who are attracted to both genders are bisexuals. Sexual Repression: The suppression of sexual activities, ideas, or identities that are perceived to be harmful or morally wrong. Sexual Response Cycle: The pattern of response to sexual stimulation. The five stages of the cycle are desire, excitement, plateau, orgasm, and resolution. Sexual Seduction: Legally, the encouragement of a younger or less mature person into an illegal sexual situation. Sexual Stereotype: An overly simplified judgment or bias regarding the sexuality of a person or group. Sex Worker: One who is paid for providing sex or sexually arousing conditions, including prostitution, striptease, lap dancing, commercial phone sex, and erotic massage. Sodomy: Oral or anal intercourse. Spectatoring: The habit of thinking about, comparing, grading, and monitoring one's sexual performance while having sex. Speculum: A plastic or metal instrument used to separate the walls of the vagina so the clinician can examine the vagina and cervix. Speculum Exam: Physical examination of the walls of the vagina and cervix that is accomplished by using a speculum. Sperm: The reproductive cells in men, produced in the seminiferous tubules of the testes. Spermarche: The time when sperm is first produced by the testes of a boy. Spermatogenesis: The process of producing sperm. Spermatogenesis occurs in the seminiferous tubules of the testes. Spermicides: Chemicals used to immobilize sperm and protect against certain sexually transmitted infections. Spirochete: Organism that causes syphilis. Squeeze Technique: A method for postponing early ejaculation. Statutory Rape: Sexual intercourse between an adult and anyone who is below the age of consent, whether or not it is voluntary. STD (Sexually Transmitted Disease): A sexually transmitted infection that has developed symptoms.

Sterilization: Surgical methods of birth control that are intended to be permanent — blocking of the fallopian tubes for women or the vasa deferentia for men. Straight: Heterosexual. Stranger Rape: Coerced sexual intercourse by an assailant unknown to the victim. Syphilis: A sexually transmitted organism that can lead to disorders, or death. Tenting: The expansion of the inner vagina during sexual excitement. Testes: Two ball-like glands inside the scrotum that produce sperm. Testicles: The testes. Testosterone: An androgen that is produced in the testes of men and in smaller amounts in the ovaries of women. Thelarche: The time when a girl's breasts begin to develop. Toxic Shock Syndrome: A rare but very dangerous overgrowth of bacteria in the vagina. Symptoms include vomiting, high fever, diarrhea, and a sunburn-type rash. Transgender: People who often choose to live the role of the opposite gender because their gender identity conflicts with their sexual anatomy. Also often used as an umbrella term to describe the community of androgyne, cross-dressing, transgender, transsexual, or transvestite people whose gender identities do not conform to the psycho-social gender role expectations of their societies. Transsexuals: People who desire to have their sexual anatomy altered because it is in conflict with their gender identity. Transvestite: People who cross dress for erotic satisfaction. Transvestophilia: A paraphilia in which sexual arousal becomes dependent on wearing clothing, especially underwear, associated with the other gender. Tubal Sterilization: Surgical blocking of the fallopian tubes that is intended to provide permanent birth control. Typical Use: Contraceptive effectiveness for women and men whose use is not consistent or always correct. Ureters: The two tubes that lead from the kidneys to the bladder. Urethra: The tube and opening from which women and men urinate. The urethra empties the bladder and carries urine to the urethral opening. In men, the urethra runs through the penis and also carries ejaculate and pre-ejaculate during sex play. Uterus: The pear-shaped, muscular reproductive organ from which women menstruate and where normal pregnancy develops; the womb.

UTI (Urinary Tract Infection): A bacterial infection of the bladder (also called cystitis), the ureters, or the urethra; can be sexually transmitted. Vagina: The stretchable passage that connects a woman's outer sex organs — the vulva — with the cervix and uterus. Vasectomy: Surgical blocking of the vasa deferentia in men that is intended to provide permanent birth control. Venereologist: One who studies sexually transmitted infections. Virginity: Never having had sexual intercourse. Vulva: A woman's external sex organs, including the clitoris, the labia (majora and minora), the opening to the vagina (introitus), and two Bartholin's glands. Wet Dreams: Erotic imaging during sleep that causes ejaculation.