11.N. Workshop: School-based sexual health education: from evidence to implementation and evaluation

Abstract   Sexual and reproductive health (SRH) is a key dimension of health and well-being of individuals. Sexuality Education (SE) is one of the most important means of promoting sexual well-being of youth and a key component of HIV and sexually transmitted infections (STIs) prevention. International treaties and global health organisations explicitly urge governments to take the necessary measures to ensure the provision of SE, that should: be age-appropriate, start as soon as possible, promote mature decision-making, be directed towards improving gender inequalities and engage young people in all phases of activities. It is widely recognised that school plays a central role in learning about health and health promotion skills, including sexuality and sexual health. Although school-based SE (SBSE) alone may not be enough to ensure the rights of young people to SRH and prevent STIs, school programs are a very cost-effective way to contribute to these goals. Moreover, addressing these topics in schools is a thematic indicator for monitoring the UN Education Agenda 2030. Existing evidence indicates a great variability in the offer of school-based SE throughout the world. GEM report (2016) reveals that basic school curricula and educational standards rarely include SE programs, and multi-country reviews show limited progress in developing national strategies for the implementation of SE or in developing high-quality programs implemented on a large scale. Theoretical and research evidence indicate that SE, and in particular Comprehensive Sexuality Education (CSE), positively impacts the behaviour of young people, improving SRH outcomes by reducing risk-taking. UNESCO in 2018 defined CSE as “a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. It aims to equip children and young people with knowledge, skills, attitudes and values that will empower them to: realize their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and, understand and ensure the protection of their rights throughout their lives”. In 2022, Italy is one of a few European countries that still lacks a comprehensive approach to SE that is coherently and equally implemented across the country and SE is not yet included in Italian schools’ curricula. As a consequence, several studies conducted on Italian young people report that they have poor sexual health knowledge, a low and inconsistent use of condoms and contraception, very little access to SRH services such as youth sexual health clinics and high levels of gender-based violence and homotransphobia. Moreover, 20% of all STIs detected in Italy affect young people. Yet, according to Italian students, school has clearly been pinpointed as the most appropriate place to receive information about SE. Key messages • Some European countries, including Italy, do not include SE in national school curricula. Often, available SBSE programs lack a comprehensive approach, with limited coverage across the countries. • Including CSE in national school curricula is an action urgently needed in order to provide young people with evidence-based, age-appropriate and accurate information on SRH and wellbeing.


Background:
The COVID-19 pandemic placed a call for action worldwide.Based on scientific investigation, governments need to assess strategic priorities.Health system capacity constraints and failures in response to the pandemic have social, medical, productivity, and economic implications.It compounds health equity issues and confronts with excess mortality, higher chronic disease prevalence, and risk factors.Despite initial progress in vaccination against COVID-19 and attempts to speed up vaccination, the Western Balkan lags behind.Infodemic and low trust in institutions are among the main factors associated with low success and adverse effects on other vaccination programs.This presentation aims to shed light on the importance of health literacy in resilient communities supported by inclusive governance.

Methods:
A narrative review based on literature on inclusive governance, health literacy, and resilient communities during COVID-19 and other emergencies.Primary sources are databases, scientific articles, Health System Response Monitor, and observations by ECDC and OECD.

Results:
Results show that characteristics of resilient communities in possessing knowledge and ability to assess risk, manage an emergency, monitor change, and address threats stand out.Many studies highlight the interconnectedness of community members with the wider external environment and their participation in decision-making to improve health services.Examples include interventions for developing future vaccination programs in program planning, conducting sound evaluations, transferring results to those who need to know, and receiving feedback.The key to this success is enhancing digital and health literacy.Conclusions: COVID-19 requires cross-sectional strategies to reinforce collaborative gains and build resilient communities, ready to apply population strategies for prevention.Inclusive governance and a bottom-up approach will be essential to optimize the response to future challenges.

11.N. Workshop: School-based sexual health education: from evidence to implementation and evaluation
Abstract citation ID: ckac129.739 Organised by: University of Pisa (Italy), Federal Centre for Health Education -WHO Collaborating Centre for Sexual and Reproductive Health, EUPHA-IDC Chair persons: Lara Tavoschi (Italy), Johanna Marquardt (Germany) Contact: lara.tavoschi@unipi.itSexual and reproductive health (SRH) is a key dimension of health and well-being of individuals.Sexuality Education (SE) is one of the most important means of promoting sexual wellbeing of youth and a key component of HIV and sexually transmitted infections (STIs) prevention.International treaties and global health organisations explicitly urge governments to take the necessary measures to ensure the provision of SE, that should: be age-appropriate, start as soon as possible, promote mature decision-making, be directed towards improving gender inequalities and engage young people in all phases of activities.It is widely recognised that school plays a central role in learning about health and health promotion skills, including sexuality and sexual health.Although school-based SE (SBSE) alone may not be enough to ensure the rights of young people to SRH and prevent STIs, school programs are a very costeffective way to contribute to these goals.Moreover, addressing these topics in schools is a thematic indicator for monitoring the UN Education Agenda 2030.Existing evidence indicates a great variability in the offer of school-based SE throughout the world.GEM report (2016) reveals that basic school curricula and educational standards rarely include SE programs, and multi-country reviews show limited progress in developing national strategies for the implementation of SE or in developing high-quality programs implemented on a large scale.Theoretical and research evidence indicate that SE, and in particular Comprehensive Sexuality Education (CSE), positively impacts the behaviour of young people, improving SRH outcomes by reducing risk-taking.UNESCO in 2018 defined CSE as ''a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality.It aims to equip children and young people with knowledge, skills, attitudes and values that will empower them to: realize their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and, understand and ensure the protection of their rights throughout their lives''.In 2022, Italy is one of a few European countries that still lacks a comprehensive approach to SE that is coherently and equally implemented across the country and SE is not yet included in Italian schools' curricula.As a consequence, several studies conducted on Italian young people report that they have poor sexual health knowledge, a low and inconsistent use of condoms and contraception, very little access to SRH services such as youth sexual health clinics and high levels of gender-based violence and homotransphobia.Moreover, 20% of all STIs detected in Italy affect young people.Yet, according to Italian students, school has clearly been pinpointed as the most appropriate place to receive information about SE.

Key messages:
Some Yet, in about half of the countries, there is still some reticence in understanding the benefits of SE for the health and well-being of young people.In countries with fully developed comprehensive SE programmes, the school is the main source of information on sexuality for young people.In the other countries young people tend to rely on information from friends or peers and the internet.The findings also showed a gap in teacher training on sexuality education.

Methods:
The Survey included a detailed questionnaire, among member associations of IPPF EN and government agencies responsible for SE.A random sample was drawn from the 50 states of the region which is considered representative for the entire region.All 25 IPPF EN members and 16 of the 25 government agencies responded.

Results and discussion:
Remarkable progress has been made in developing and integrating SE in formal school curricula.In 11 of the 21 countries, SE is a mandatory teaching subject, and in six additional countries it is partly mandatory.In four additional countries it is optional.Despite the progress, there are still shortcomings and gaps in providing the full spectrum of SE.

Conclusions:
If provided, SE tends to focus primarily on the biological aspects and prevention of HIV/STIs and unwanted pregnancy.
There is a need to broaden the spectrum of topics that are addressed to include gender equality, sexuality, violence and sexual abuse, human rights and empowerment.

Conclusions:
This pilot activity represented a first step towards the development of a standardised, evidence-based and comprehensive approach to SBSE, for future implementation across the country.
The SBSE was structured in: a) 5 interactive interventions of 2 hours each with students (4 theoretical and practical modules; 1 final intervention for students-led discussion and evaluation); b) introductory and closing meetings with teachers and with parents.The modules addressed the following dimensions: changes in adolescence; emotions and relationships; sexual identities and diversity; sexual consent, STIs/pregnancy prevention, sexual health services.Additional materials were developed: a. pre/post evaluation tools for educators and students; b. pre-implementation checklist for schools; c. materials for teachers' and parents' engagement before/after the SBSE activity.