1.  THE SEX EDUCATION FORUM

  1.1  The Sex Education Forum is a leading authority on sex and relationships education. It is an independent umbrella body, based within the National Children Bureau. It brings together 52 national organisations involved in sex and relationships education in order to share good practice and articulate a common voice in support of appropriate and effective sex and relationships education for all children and young people at home, at schools and in other educational, health, youth, community and public care settings. All member organisations of the Sex Education Forum have agreed to a core framework document which lays out the rationale and principles on which sex and relationships education should be based[1].

  1.2  The objectives of the Forum are to:

—  Stimulate informed public debate about sex and relationships education.

—  Support parents, teachers, school governors, youth workers, social workers, health professionals, head teachers, senior managers and others by gathering and disseminating information about new initiatives, research, methodology, resource and support services.

—  Encourage appropriate initial and in-service training of all those involved.

  1.3  The Forum's achieves it objectives through the following three main functions:

—  Climate setting—through national and local policy development and media work.

—  Information dissemination through a website, information service, seminars, conferences and meetings and a termly newsletter Sex Education Matters which is sent to all schools in England.

—  Project development—through work in different settings and with different target groups to develop models of good practice and field test ideas.

2.  CURRENT PROJECTS, ACTIVITIES AND PUBLICATIONS

  2.1  The Sex Education Forum undertakes project work and production of a wide range of publications to support the work of policy-makers, practitioners, parents and others with an interest in sex and relationships education. All project work involves consultation with Forum members, relevant professionals and community representatives and young people, collation of relevant research and evidence and where relevant, mapping of existing practice. Recent and ongoing activities include the following:

—  The publication of "Faith, values and sex and relationships education"[2] a resource which seeks to enable people involved in sex education to take into account the many faith and cultural backgrounds of children and young people. The resource will be disseminated to schools via a series of regional and local seminars. The impact on materials on sex and relationships education in schools will be evaluated.

—  The development of a companion resource in partnership with the Black Health Agency which will address the provision of sex and relationships education to children and young people from black and ethnic minorities. This will be published in 2003.

—  A project to assess the quality and utility of existing resources and materials available to sex educators and to identify areas and issues for which resources and materials are not available. This is being undertaken through the development of a set of assessment criteria in consultation with teachers, health professionals and young people. Reviews of resources and materials will be undertaken by teachers, health professionals and young people and results will be made publicly available via the internet.

—  The development of training packs to support governors in primary, secondary and special sector schools in meeting their responsibilities with regard to the provision of sex and relationships education.

—  The development and dissemination of a factsheet supporting secondary schools in enhancing links with local sexual health services.

—  The publication of a factsheet, to be supported by the publication of a more detailed resource in 2003, supporting primary schools in enhancing provision of sex and relationships education[3].

—  The provision of a telephone and internet service providing information and advice about sex and relationships education to professionals and parents.

—  Contribution to the development of the Department for Education and Skills scheme to accredit for teachers of Personal, Social and Health Education for their expertise in sex and relationships education.

3.  THE DEFINITION, PURPOSE AND COMPONENTS OF SEX AND RELATIONSHIPS EDUCATION

  3.1  The Sex Education Forum believes that sex and relationships education involves lifelong learning about sex, sexuality, emotions, relationships and sexual health. It involves the acquisition of information, development of skills and formation of positive beliefs, values and attitudes. It should be appropriate to the age and maturity of children and young people reflect their needs and experiences, be consistent in terms of the messages provided and offered continuously and progressively so as to support them as they grow from childhood through adolescence into adulthood. The purpose of sex and relationships education is to support children and young people in managing adolescence and preparing them for adult life in which they can:

—  Be aware of and enjoy their sexuality.

—  Develop positive values and a moral framework that will guide their decisions, judgements and behaviour.

—  Have the confidence and self-esteem to value themselves and others.

—  Behave responsibly within sexual and personal relationships.

—  Communicate effectively.

—  Have sufficient information and skills to protect themselves and their partner from unintended/unwanted conceptions, sexually transmitted infections including HIV.

—  Neither exploit nor be exploited.

—  Access confidential advice and support.

  3.2  The three main components of sex and relationships education—the acquisition of information, development of skills and formation of positive beliefs, values and attitudes—are interdependent. Its effectiveness and utility is impaired if one receives insufficient emphasis or is omitted. For example, the acquisition of knowledge about contraception is of limited or little use to a young person without education which helps them to develop the social and personal skills to obtain contraceptives, negotiate their use with a partner and use them properly. A proper consideration of values, attitudes and beliefs is closely related to the development of personal and social skills and the acquisition and understanding of accurate and unbiased information.

  3.3  In terms of the acquisition of knowledge children and young people want simple, easy to understand, age appropriate information about how their bodies work, sexuality, the law, sexual reproduction, sexual behaviour, sexual health, emotions and relationships, the range of sexual health services available and related issue like their right to confidentiality. The information component of sex and relationships education will address the following:

—  What they already know and have experienced.

—  What they say they need.

—  Social, emotional, cultural, legal and biological aspects of sex, sexual development, sexuality and sexual health.

—  Potential consequences of unprotected sex, for example, unplanned and unintended pregnancy, young parenthood, sexually transmitted infections including HIV and Aids.

—  Positive and negative consequences of sexual behaviour.

—  Information which aims to educate against prejudice and discrimination.

—  Access to help and support.

  3.4  Children and young people want opportunities to clarify attitudes and values and to consider how they are affected by them. They want to develop a moral code in which they are clear about what they believe and why, and have respect for and interest in the beliefs of others. Consideration of their own values systems and those of others will include:

—  An acceptance and exploration of difference: young people come from different ethnic and religious backgrounds with correspondingly diverse moral and cultural frameworks and norms. It is important that diversity is valued and moral choices are considered, including the choice not to be sexually active.

—  An understanding of wider value systems such as those represented by the law and religion.

—  Developing a critical awareness of the value systems of others such as those represented in the media and within their peer and social networks.

—  Understanding that sexual intimacy involves strong emotional feelings, and should involve a sense of respect for one's own and other people's feelings, decisions, rights and bodies.

—  The placing of sexual relationships in context alongside other types of human relationships such as friendship, parenthood and other family relationships.

  3.5  Children and young people want to learn and to practise personal and social skills which will help them to develop and maintain relationships, to take responsibility for their own and other's sexual health, to access support and help and to make informed choices and decisions regarding their sexual health and emotional well-being. These life skills include:

—  Personal skills: managing emotions and relationships confidently and effectively and developing empathy for others; developing independence in thought and action and defending values.

—  Communication skills: listening to others, asking questions, expressing emotions, giving opinions, listening to the opinions of others and being assertive.

—  Skills for negotiating with friends and partners.

—  Practical skills: caring for self and others, accessing support and advice.

—  Decision-making skills: sensible choices made in the light of relevant information, making moral judgements about what to do and acting on them; acting responsibly as an individual and with others.

—  Problem-solving skills; managing and resolving conflict.

4.  THE RATIONALE FOR SEX AND RELATIONSHIPS EDUCATION

  4.1  The Sex Education Forum believes that young people have a right to sex education as part of their broader human rights which entitle them to access information about matters which affect them and self-determination. Young people also have a right to sex and relationships education as a means by which they are helped to protect themselves against abuse, exploitation, unintended pregnancies, sexually transmitted diseases and HIV/AIDS[4],[5] ,[6] ,[7] ,[8].

  4.2  In England children and young people have a specific entitlement to learn about sex and relationships in school. This entitlement is part of a broader set of opportunities which support their personal and social development as laid down in the National Curriculum 2000 of which the aims provide the context for sex and relationships education within personal, social, and health education. These aims are as follows:

—  The school curriculum should aim to provide opportunities for all pupils to learn and achieve.

—  The school curriculum should aim to promote pupils; spiritual, moral, social and cultural development and prepare all pupils for the opportunities and responsibilities of adult life.

  4.3  Young people consistently report that they want to receive sex and relationships education in schools, from their parents and carers and in other settings. Consultations with young people conducted by the Sex Education Forum show what they want sex and relationships education to comprise, who they want to be involved and how and when they want it to be provided[9]. They specifically recommend the following:

—  That they learn about: real-life dilemmas; sexuality and relationship issues including peer pressure, problems, friendships, being gay or lesbian, contraception, sexually transmitted diseases, HIV; the "pros and cons" about sex including when's the right time to have sex and where to get advice.

—  That the education be fun and accomplished through: role plays, games, videos, opportunities to explore dilemmas, practising communication, discussions that are open and multi-ethnic, comments and suggestion boxes allowing pupils to ask questions who would otherwise feel embarrassed and to give them a chance to express their needs.

—  To achieve this they ask for: society to be more open about sex, parents to be able to talk to their children without embarrassment, specialist teams of sex educators and additional training and support to teachers who chose to teach sex and relationships education and the involvement of outside agencies and organisations with specific knowledge or experiences including, young parents, lesbian and gay men and women, people with different life experiences, health professionals for sexual health services.

  4.4  Sex and relationships education is provided formally and informally by a variety of people and means including the following:

—  Family and friends: parents, relatives and carers, siblings and grandparents.

—  The media: TV, radio, magazines, newspapers and the internet.

—  Through entertainment: music, cinema, art, theatre and advertising.

—  School and educational settings: early years, nursery, primary, secondary, tertiary and special settings, from teachers and others such as school nurses, health promotion specialists and peer educators.

—  A range of community and youth work settings: youth advisory services, voluntary youth organisations.

—  Health settings: from doctors, nurses health visitors.

—  Public care settings: from carers, social workers, foster carers.

  4.5  Research in the UK shows that parents often feel ill-equipped to talk to their children about sex and relationships and that they look to schools to contribute to, or provide all of their children's education in this area. The results of research with parents in the late 1980's[10] showing high levels of parental support for sex and relationships education have been upheld by those in the largest scale study of parents' views on sex and relationships education undertaken in the 1990's[11]. More recently, smaller scale studies have shown similar results and found that parents want more schools to provide more comprehensive sex and relationships education to their children which begins earlier and addresses more of the topics which they find difficult, like abortion[12].

5.  THE CONTRIBUTION OF SEX AND RELATIONSHIPS EDUCATION TO PROMOTING SEXUAL HEALTH INCLUDING THE REDUCTION OF UNINTENDED TEENAGE PREGNANCIES AND SEXUALLY TRANSMITTED INFECTIONS

  5.1  The sexual health of young people living in Britain is a matter of public health concern. Recent, reliable studies of the sexual health and behaviour of young people in the UK[13],[14] show a fall in the median age of sexual intercourse to around 16 years old and a rise in the average number of sexual partners among young people. There is also evidence of an increase in condom at first intercourse. However, has also been a rise in cases of sexually transmitted infections among young people[15] and the numbers of unplanned pregnancies remain the highest in Europe, exceeding in rich nations only by those in the USA, although there are signs of a decrease in the last year[16]. Among those young people who have sex before they are 16 years old about a third of girls and slightly over a quarter of boys report that it happened too early. For young women reported regret is associated with feeling under pressure to have sex and not planning it with their partner[17]. All adverse outcomes, early sex, regret, sexually transmitted infection and unintended pregnancy are associated with lower social class and educational attainment, greater social exclusion and not receiving information about sex through school.

  5.2  Sex and relationships education can make an important contribution to the promotion of sexual health including the reduction of unintended teenage pregnancies and sexually transmitted infections but this is not its sole aim. Nor is this outcome solely dependent on the provision of sex and relationships education through schools. The role of sex and relationships education in schools is to contribute to improving sexual health by equipping children and young people with the means to understand, appraise and manage their sexual development and relationships in the context of contemporary society. Sexual health outcomes, where they are narrowly defined in terms of pregnancy or infection, can only be achieved by linking sex and relationships education provided in schools to better sexual health services and addressing other, wider social factors and influences.

  5.3  Reviews[18],[19] have identified the following components in effective programmes of sex and relationships education involving schools. These programmes have resulted in increased knowledge among young people, a clarification of their attitudes and values and enhancement of their personal and social skills. In some cases, these programmes have resulted in young people delaying when they have first have sexual intercourse and a reduction in sex risk-taking including increased used of contraceptives and sexual health services. In summary, research shows that effectiveness is associated with the following:

—  Aiming to empower young people, promote sexual self-acceptance and a positive and open view of sex and sexuality including accepting the positive aspects of young people's relationships and experiences.

—  Linking to sexual health services which are accessible and dedicated to young people.

—  Basis on appropriate theories about learning and health-related behaviour.

—  Reflecting the local context and needs.

—  Identifying and targeting vulnerable groups like school non-attenders and the socially marginalised and vulnerable young people.

—  Addressing social and media influences.

—  Reinforcing value messages like "it's ok to say no to sex".

—  Being in place before young people become sexually active, being sustained over time and developing in an age appropriate way that aims to consolidate knowledge.

—  Including active learning techniques.

  5.4  Very recent research evidence endorses this. For example, the interim findings of the SHARE study[20], which is evaluating the impact of a programme of sex and relationships education in schools for teenagers aged between 13 and 15 years old, confirm that sex and relationships education does not encourage earlier sexual activity, improves young people's knowledge about sexual health and relationships, increases their personal and social skills, and can have some positive impact on the quality of their relationships and increases advice and information-seeking from friends, parents and other sources. This programme was also received more positively by both teachers and students than conventional provision. Despite these important and positive outcomes the SHARE programme has not yet had any influence on condom use among the one third of the study sample who reported having had sex under the age of 16 years old.

  5.5  A recent systematic review of the effectiveness of programmes aiming to reduce unintended teenage conceptions endorsed the interim findings of the SHARE study identifying similar limitations in terms of affecting sexual behaviour for intervention which took place solely in schools or community-setting[21]. The one type of programme identified as significantly effective in terms of reducing teenage conceptions was multi-faceted—that is it involved school-based and community sex and relationships education linked to local services and training and support into employment.

  5.6  Importantly, this review found that the programmes which primarily aimed to promote abstinence from sex until marriage either had no effect or negative outcomes including, in one case, increasing the numbers of pregnancies to the sexual partners of young men who received the programme. Interestingly, the number of soundly evaluated programmes of sex and relationships education promoting abstinence remains very small despite 20 years of funding in the USA. The replication of effective programmes of comprehensive sex and relationships education which have achieved a delay in sexual intercourse, increased condom use or reduction in unprotected and unsafe sex among young people suggests that support for sex and relationships education seeking to promote abstinence may be more driven by moral concerns than a public health agenda[22],[23] ,[24].

  5.7  The authors of both the paper relating to the SHARE study and systematic review of effective interventions draw a similar inference about why many sex and relationships education programmes fail to significantly influence behaviour concluding that single-setting specific programmes of sex and relationships education can not override the potentially negative effects of wider social influences. They also make similar recommendations about enhancing effectiveness through making programmes more relevant to young people, starting to provide sex and relationships education earlier and placing a greater emphasis on the development of their negotiation and communication skills, promoting and connecting more effectively with local sexual health services and tackling issues about mutual respect within relationships and young people's discomfort in voicing their sexual needs and desires.

  5.8  The importance sex and relationships education in meeting public health concerns about adverse outcomes has also recently been highlighted in a review by UNICEF[25] which explored factors associated with teenage pregnancies and births in rich nations. UNICEF identify a number of radical social changes which have taken place in richer nations in the last 30 years with implications for the sexual behaviour of young people. Liberalisation of abortions laws, increased availability of contraception and increasing gender equality, the rejection of traditional sexual codes and mores and the emergence of more sexualised societies in which sexual images and messages permeate the social and cultural environment have transformed the background against which young people form sexual relationships. The age at which people first have children has risen and the age at which they start having sex has fallen. This review concludes that where nations come in the "league table" (and the UK has the highest rate of teenage pregnancy after the USA), is dependent on two factors. First, combinations of how far they have moved from traditional socio-sexual values and the extent to which young people have been prepared to cope in this cultural environment. Second, the proportion of teenagers which is motivated to avoid early parenthood because they have, "an expectation of reasonable education and employment and of being included in the opportunities and advantages of living in an economically advanced society". Clearly, the first factor can be addressed by sex and relationships education which can provide children and young people with the means to acquire information, develop skills and clarify attitudes which will enable them to critically appraise and negotiate their social lives. The second is highly dependent on wider social opportunities and equity.

  5.9  The Social Exclusion Unit report on teenage pregnancy[26] deals with these same concerns in the three factors which it identifies as being associated with high rates of teenage pregnancy in England: low expectations, ignorance and mixed messages. Low expectations reflect the fact that too many young people see no prospect of meaningful work and positive life opportunities; ignorance reflects the gap that has grown up between young people's needs for information and that with which they are provided with; and mixed messages reflects the ambivalence and embarrassment with which adult society approaches supporting children and young people in developing the skills with which to identify and appraise the different views, values, beliefs and moral positions on sex and sexuality with which they are faced.

6.  CURRENT POLICY CONTEXT

  6.1  During the last five years there have been significant advances in securing children and young people's entitlement to sex and relationships education as a result of the development of public policy. The contribution of the National Healthy Schools Standard[27], the framework for Personal, Social, Health Education and Citizenship[28] and the Sex and Relationships Guidance 0116/2000[29] to securing entitlement through schools must be acknowledged and applauded. The Teenage Pregnancy Strategy[30] and National Strategy for Sexual Health and HIV help widen the agenda for action to include a range of settings other than school and to join-up sexual health promotion and prevention activity across government departments in ways commensurate with the evidence base for effectiveness. However, analysis of the quantity and quality of current provision to children and young people suggests further policy development may be necessary to ensure sound principles are realised in practice.

7.  CURRENT PROVISION—THE REALITY

  7.1  Despite considerable evidence about what constitutes effective sex and relationships education in school young people have consistently complained the provision they receive is "too little, too late and too biological". Reliable data on the amount of provision children and young people receive is remains elusive but there is no doubt that public perceptions represent an over-estimation. This impression is no doubt fuelled in part by mischievous media coverage which seeks to portray sex and relationships education in a bad light in the service of wider moral and political agendas.

  7.2  For example, in the context of the SHARE study where a model programme of sex and relationships was being implemented, the entire provision only comprises 20 lessons over the course of two years of secondary school. Despite this, there was variability in the number of the sessions delivered by teachers and for some lessons less than 40% and never more than about 80% of teachers reported following the pack of SHARE teaching materials "very closely"[31]. Further research on the implementation of the SHARE programme has shown that teachers' confidence and skills are important determinants of pupils' level of comfort and hence engagement and participation in lessons[32].

  7.3  Another major study of sex and relationships in English schools has produced qualitative data from discussions with pupils showing low levels of participation, engagement and perceived new learning which is perceived to be partly an effect of poor teacher training and low commitment and confidence, lack of relevance of the information provided, inappropriate teaching styles and methods and a tendency on the part of teachers to moralise[33].

  7.4  One recent survey of secondary schools has shown that, "no single topic, however fundamental to sex education, is covered by every school" and that some subjects like homosexuality, sexual stereotyping, sexual harassment, negotiating relationships and religious and cultural views are covered by at most three quarters of schools at any time between years 7 and 11[34].

  7.5  A recent inspection of provision by the Office for Standards in Education (OFSTED) has shown that provision is still patchy and inconsistent and highlighted the need for development[35] of provision which deals with relationships, emotional issues and the development of young people's social and personal skills.

  7.6  These problems are associated with a number of factors including the following:

—  The product of the weak position Personal, Social, Health Education and Citizenship occupies in the school curriculum.

—  Weaknesses in initial and in-service teacher training and the lack of development of specialist teams of teachers for sex and relationships education.

—  The absence of clear learning objectives for sex and relationships education and associated poor monitoring of provision and assessment of pupils' learning.

—  Weaknesses in consultation processes with parents and pupils which may undermine teachers' confidence about teaching about sex and relationships particularly in relation to subjects and issues which are perceived to be sensitive.

—  In secondary schools in particular, teachers lack of familiar with active teaching and learning strategies which involve less didactic and more group work, discussion and student participation.

—  Lack of clarity about the aims, purpose and evidence base for sex and relationships education.

  7.7  The thrust of much current public policy making is towards addressing these weaknesses but policy development, although crucial, needs to be accompanied by greater clarity and consensus about the rationale and aims of sex education including a broader definition and understanding of how it contributes to the social and personal development of young people if it is to be realised in practice.

8.  BRIDGING THE GAP—DEVELOPING AND ENHANCING SEX AND RELATIONSHIPS EDUCATION FOR YOUNG PEOPLE AS COMPONENT IN SEXUAL HEALTH PROMOTION

  8.1  The context for sex and relationships education in England has improved considerably over recent years. However, there is still scope for work if the needs of children and young people and their parents and carers are to be met and the entitlement to sex and relationships education secured. A major step would be to de-politicise the issue. In countries where there is a pragmatic policy framework which accepts that children and young people need to learn about sex and relationships they tend to start having sex later and manage their sexual health more effectively as well as benefit from more positive relationships.

  8.2  It is clear that in England shifts in the sexual-social context and culture have not yet been matched by sufficient changes in the provision of education and support. A major obstacle in England remains the difficulty with publicly accepting that sex has a recreational as well as pro-creational dimension for many people. This dimension is one of the major changes in the social context and discourses about sex and sexuality in the last 30 years and sex and relationships education for young people must acknowledge and accept this if it is to be a relevant to children and young people and provide them with meaningful support.

  8.3  The Sex Education Forum highlights the importance of multi-dimensional approaches to sex education involving a range of people. Schools play an important part but this formal provision needs to support the sex and relationships education that is provided informally by parents, friends and others and in other contexts like youth and community settings, through health services and public welfare and care. While the basis for links between people in these settings is developing it is necessary to encourage and facilitate much greater levels of participation, consultation and collaboration between them.

  8.4  Much of the variability in sex and relationship education in school flows from its weak position within the curriculum. Making Personal, Social and Health Education a statutory part of the National Curriculum would help boost its status and ensure the entitlement of children and young people is fulfilled. Particular attention needs to be given to the situation in the primary sector where schools are not obliged to provide sex and relationships education outside the National Curriculum.

  8.5  Putting Personal, Social and Health Education on a statutory footing needs to be accompanied by greater commitment to the training and support of teachers, health professionals and other sex educators.

  8.6  The OFSTED report into sex and relationships education contained many useful recommendations including the development of specialist teams of teachers to provide sex and relationships education, develop learning objectives, improving monitoring and assessment of learning. Commitment should be sought for the implementation of them all.

  8.7  All young people should have access to free, confidential health advice and support linked closely to schools and communities and based on the needs of young people.

  8.8  All this needs to take place within the context of the development of a clear and explicit value framework for comprehensive sex and relationships education which binds all national initiatives, is guided by the evidence base and is underpinned by principles of empowerment and a positive model of sexuality.

November 2002

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