Cultural sensitivities and challenges in implementation

Comprehensive sexuality education (CSE) in India is at a critical juncture of balancing progressive educational goals with deep-rooted cultural sensitivities. This article examines the multifaceted landscape of CSE in India, examining its successes, setbacks, and the nuanced efforts required to make it a robust and impactful component of youth education.

The need for accurate and comprehensive sexual health information is undeniable. A 2019 study found that college students in Tamil Nadu rely on their peers for information about sex. Moreover, information asymmetry particularly affects women and girls; according to NFHS-5, only 21.6 percent of women have comprehensive knowledge about HIV/AIDS compared to 30.7 percent of men.

CSE can fill this knowledge gap by providing important information on topics such as sex, gender, roles, sexual orientation, desire, intimacy and reproduction. In 2021, a systematic literature review of 80 articles on school-based sex education found that it is associated with better understanding of gender and gender norms, improved knowledge and skills that support healthy relationships, and reduced violence in relationships and in partnerships.

Sexual health advocates call for a rights-based approach to sexuality education that recognizes young people’s right to access sexual health information and services.

The challenge is to integrate CSE effectively into a societal context that is often resistant to open discussions about sexuality. As key socialization institutions, schools can effectively disseminate messages promoting sexual health through CSE. Sexual health advocates have called for a rights-based approach to sexuality education that recognizes the right of adolescents to access information and services related to sexual health. UNFPA has issued a number of sexual health recommendations, including: International technical guidelines on sexuality education (2018) defines CSE as a curriculum-based teaching process that includes a comprehensive discussion of all areas of sexuality and aims to promote respectful relationships and informed decisions in children.

School-based sexuality education policies and programs in India

The School AIDS Education Programme (SAEP) was first introduced in 2002 to ensure compliance with India’s national AIDS policy on sexual health, contraception and prevention of sexually transmitted diseases by providing relevant information and counselling services. In 2006, the Government of India recognised the importance of adolescent reproductive and sexual health (ARSH) under the Reproductive Child Health (RCH II) programme. The Adolescent Education Programme (AEP) was introduced in the same year to equip adolescents with the knowledge to manage the risk of HIV infection and address basic sexual and reproductive health issues. After a largely positive report by UNFPA in 2010, there has been no independent evaluation of the AEP.

The 2017 National Health Policy expands the scope of reproductive and sexual health to include issues such as inadequate calorie intake, nutritional status and mental health issues related to misuse of technology, but does not address sexuality.

The Adolescent Friendly Health Clinics (AFHC), established under the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) programme, provide out-of-school sexuality education on contraception and STI/HIV prevention, as well as counselling on sex, gender, marriage postponement and pregnancy. The Rashtriya Kishore Swaasthya Karyakram (RKSK), launched in 2014 as part of a national adolescent health programme, strengthened the ARSH by introducing peer educators to impart information on five key components of adolescent health. The National Health Policy, 2017 expands the scope of reproductive and sexual health to include issues such as inadequate calorie intake, nutritional status and psychological issues related to technology misuse, but does not address sexuality.

Consensus building for CSE

The AEP was suspended in 2007 due to conservative backlash; opposition to sex education ranged from opposition to certain curriculum content to calls to end sex education programs altogether.

In his seminal work On the Division of Labour in Society (1893), Durkheim argued that social institutions produce shared values ​​that create social cohesion. As central social institutions, schools are expected to reinforce normative behaviours and attitudes in students. CSE is therefore seen as a challenge to the status quo because it empowers students to question norms regarding relationships, families and gender roles, as assessments indicate that students who have received CSE are more likely to have progressive attitudes towards gender and homosexuality. Resistance to CSE in India can be understood as a clash between commonly held cultural norms regarding sexuality and the principles of autonomy promoted by CSE.

A cross-sectional study of 233 parents of adolescent children in coastal South India suggests general acceptance of including sex education in the curriculum.

However, in some cases, the response to sex education in schools is positive. A cross-sectional study of 233 parents of adolescent children in the south coastal region of India shows that the inclusion of sex education in the curriculum is generally accepted. Community engagement is crucial to the success of such sex education programs.: The literature on Udaan in Jharkhand and a large-scale sexuality education programme in Pakistan emphasise community sensitisation through regular meetings, counselling sessions and community-based activities as the key to consensus building. It is untenable for sexuality education programmes to be separated from the cultural framework in which sex and sexuality are understood. In contexts where sexual and reproductive decisions are community-driven, comprehensive sexuality education programmes must strive to promote comprehensive intergenerational dialogue rather than simply conveying scientific facts in isolation.

Administrative and political challenges in implementing CSE

In addition to the lack of consensus, effective implementation of sex education is also hampered by administrative challenges. Although training of AEP facilitators is mandatory, there is confusion about the quality of instruction, the number of teachers trained, and the number of students who may have benefited from the program. Given the stigma associated with sex education in schools, teachers and facilitators must undergo rigorous training that enables them to reflexively challenge their misconceptions, helping them create open and safe learning spaces for students.

A thorough impact assessment combined with stakeholder consultations can provide valuable insights into the quality of services and interventions.

Public-private partnerships between government departments, NGOs and civil society organizations can improve the sustainability of programs by leveraging NGO resources. In addition, NGOs can play an important role in independently evaluating program effectiveness. Currently, monitoring largely focuses on administrative indicators such as the number of trainings conducted and students served. Rigorous impact evaluation coupled with stakeholder consultations can provide valuable insights into the quality of services and interventions. A rapid review of adolescent health programs in India highlights difficulties in organizing cross-departmental collaboration due to a lack of formalized structures. The review recommends developing a formal strategy with clear mechanisms, roles and responsibilities to build meaningful linkages.

A 2014 review of AEP training resources shows that the curriculum is ineffective, pointing to the obfuscation of the topic of sex in sexuality education through the use of euphemistic terminologies such as ‘life skills education’ and the restriction of the topic of sex to the contexts of conception and reproduction. Subsequent programs and policy frameworks on adolescent health (RKSK 2014, NHP 2017) also failed to mention sexuality, sexual diversity, relationships and communication, which are essential components of CSE.

While there have been calls to limit sex education to abstinence-only education, a 2021 systematic review shows that programs that promote abstinence alone fail to lower the age of initiation of sexual activity or the incidence of sexual risk behavior. It is important that the curriculum includes an open and honest discussion of the basics of sexuality, including the availability of contraception and maintaining healthy and respectful relationships. In addition, the curriculum should also be inclusive of sexual and gender minorities.

Results from a randomized controlled trial suggest that sexual health knowledge, norms, and attitudes toward safer sex increased among a target group exposed to a web-based sexual health program.

The focus is on integrating technology into sexuality education. For adolescents grappling with issues related to sexuality, there is simultaneously a scarcity and an overabundance of information online. Although India recorded a record high level of internet penetration in 2023, the reliability of online information remains a concern for adolescent sexual health. At the same time, technology-based interventions using text messaging or mobile and computer applications can be used to efficiently deliver comprehensive and private sexuality education. Results from a randomized controlled trial suggest that sexual health knowledge and norms and attitudes towards safer sex increased within the target population exposed to a web-based sexual health program.

Sustaining CSE in India requires an adaptive and inclusive approach that emphasizes community involvement, strong policy support, and technological innovation. By implementing these strategies, India can develop a CSE framework that promotes healthy, informed, and respectful attitudes toward sexuality among adolescents.

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Saberi Mallick is a research intern at the Observer Research Foundation

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