Sexual Health – Quo Vadis? | Clare Azzopardi Lane

Dr Claire Azzopardi Lane, Department of Gender and Sexualities

The correlation between comprehensive sex education and national sexual health outcomes is well recognised in numerous international studies. Indeed, education policies which provide holistic, evidence-based sexual and reproductive health information go a long way in preventing unplanned pregnancies and sexually transmitted infections (STIs). Both formal and informal educational contexts, work places, health facilities and the wider community spaces are all possible platforms where sex education can be provided.

Although the focus is often primarily on the adolescent years, it is being increasingly recognised that sex education is a lifelong process. Since sexuality is a lifelong experience, sex education should be available to individuals of different age groups and of different social levels in various accessible contexts. Most importantly, sex education should reach those who are possibly in a position of vulnerability, such as individuals from marginalised groups, those with low literacy levels and limited educational backgrounds, migrants, sexual minorities and persons with disabilities.

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The Maltese socio-cultural context, due to its adherence to the Catholic faith, is characterised by adverse impacts on sexual norms, with negative ramifications on access to comprehensive, quality sex education. Cultural taboos, essentially derived from the strong influence of the Roman Catholic Church, especially its prohibitions associated with sexual behaviour, are believed to be the main barriers to the provision of adequate information about sexual and reproductive health.

Malta requires progressive educational policies that diligently implement and put into practice this kind of knowledge and information. The National Guidelines on Sexuality and Relationships Education in Maltese Schools have not been replaced since 2013 and still strongly promote abstinence. Advocates of such a stance argue that abstinence-based educational programmes discourage teenagers’ sexual activity – both in terms of frequency and onset – by increasing the perceived cost of having sex, leading to a lower incidence of teen pregnancy and STIs. However, critics posit that while teenagers’ decisions to engage in sexual intercourse are independent of what is taught in the school curriculum, the lack of information encourages risky sexual behaviour which could lead to higher rates of pregnancy and STIs. In fact, over the past decade the rate of teen births in Malta has constantly been the highest when compared to Greece, Spain, Italy, Portugal, Cyprus, and the rest of the European Union. This could be interpreted as a sign that current sex education programmes are not effective, not least when it comes to the access and use of contraception in this age group.

A study conducted in 2019 with young Maltese students aged between 15 and 25 years in state post-secondary education revealed that participants were more knowledgeable about HIV and AIDS then they were on STIs (1). Chlamydia was the STI that both gender cohorts had least knowledge of, and the majority of respondents had limited knowledge on how to access national sexual health services. Preferred sources of information identified by respondents included friends and the internet, followed by parents/guardians and television programmes, leaflets and magazines. Interestingly, school was not one of their preferred primary sources of information. Buttigieg, Debono and Gauci concluded that the delivery of sex education needs to be updated and scientifically based and that professionals working with young people require adequate training in order to deliver this content so that apart from focusing on safer sex practices, sex education should include giving consent, disclosing sexual boundaries and preferences and effectively expressing a decision.

Sexual and gender diversity are amongst the topics to be addressed in sex education to the extent that respect for diversity is listed by the World Health Organization as one of the outcomes of sex education, with schools to firmly base sex education on human rights and the normalisation of diversity. In 2017, the Malta LGBT+ Rights Movement (MGRM) conducted a survey among youth aged 13 to 22 attending State and Church schools which led to the Malta National School Climate Survey Report that highlighted the absence of LGBTIQ affirming education. This report concluded that making schools a place where diversity is not only tolerated but celebrated is a challenging feat that requires trained and committed educators.

Studies also found that the availability of sex education for persons with disabilities, especially those with intellectual disabilities, is generally provided at the discretion of educators and parents . Since persons with disabilities tend to be infantalised and often desexualised, they receiving limited - if any - information about sexuality when compared to their non-disabled peers. The content of sex education directed at persons with disabilities is often marred by issues of morality and often aimed at controlling sexual behaviours and highlighting the possibility of sexual abuse and the perils of procreation. Indeed, the National Guidelines on Sex Education in Maltese Schools refers to students with disability as “Special Needs” and automatically frames them as vulnerable. These guidelines claim that liaison between educators would ensure that information related to specific topics such as abstinence, abuse and contraception are delivered in an appropriate and inclusive way to all students irrespective of their levels of abilities.

Undoubtedly, comprehensive, inclusive and ongoing, sex-positive sex education is one of the most recommended aspects of optimal sexual and reproductive health attainments.

Sex education that targets persons of different age groups and from various social and educational levels, cultural backgrounds and that is accessible in a range on contexts is what the upcoming National Sexual Health Strategy for Malta should be aiming for.

Reference

1. Buttigieg, S. C., Debono, G. A., & Gauci, D. (2019). Needs assessment for sexual health services development in a small European Union member state. Health Services Management Research, 32(4), 180-190.