Twenty years ago, political leaders, public health experts, and activists at the International Conference on Population and Development in Cairo came to a consensus that reproductive health is a human right. Often referred to as the “Cairo agenda,” their agreement shifted the conversation from “population control” to the notion that women and men, girls and boys, should be able to have control over their own lives and bodies—to decide if and when they want to have children.
A central part of the Cairo agenda is providing comprehensive sexuality education to adolescents so that they can exercise this right. But twenty years on, where do we stand? In the United States the contentious debate between abstinence-only education and sex education that characterized the early 2000’s seems a thing of the past. But what about on a global scale: Can young people in Dhaka and Dakar access the information and health services they need to make decisions about their futures? Are girls more empowered than two decades ago to see themselves as equal members in their relationships and to protect themselves and their health?
While some countries are making progress in promoting gender equality and improving sexual and reproductive health, the Cairo agenda is far from fulfilled. A recent UNESCO report found that comprehensive sexuality education “is a long way from being institutionalized in most low- and middle-income countries where the HIV epidemic poses a disproportionate burden.” And while the clamor for abstinence-only education has lessened in the United States, it is still prevalent elsewhere—despite an abundance of evidence that this approach is not effective.
This month, the Journal of Adolescent Health published an analysis of adolescent sexual and reproductive health efforts worldwide, including comprehensive sexuality education programs. The evidence suggests that when comprehensive sexuality education includes a focus on gender equality, human rights, and power dynamics in relationships, there is a greater likelihood of reducing rates of sexually transmitted infections and unintended pregnancy. For example, the Stepping Stones curriculum used in South Africa, which encourages discussion on gender equity and power dynamics, resulted in a 33 percent reduction in the incidence of Herpes simplex virus and led to fewer reported incidents of intimate partner violence.
Effective programs not only educate, they empower young people, especially girls and other marginalized youth, to see themselves as equal partners in their relationships.
This empowerment approach to comprehensive sexuality education is gaining ground on the global agenda. In recent years, the UN Commission on Population and Development has passed resolutions that call on governments to provide education on not only sexual and reproductive health, but gender equality and human rights.
Still, we have to do a better job of reaching the most vulnerable adolescents, including: girls who are out-of-school, married, living in extreme poverty, or engaged in transactional sex, and boys who are in gangs, substance abusers, HIV-positive, or those who have learning disabilities. The earlier we reach these individuals, with not only sexuality education, but interventions addressing gender and human rights, the more likely we will be able to tackle harmful social norms before they set in. And, the more likely these youth are to lead better and healthier lives.
There are some shining lights emerging from the Global South: for example, in Colombia comprehensive sexuality education is explicitly rights-based, gender-focused, and critical-thinking oriented and is tailored for different age groups, from kindergarten through high school.
We need to advocate for more governments to take an empowerment approach to sexuality education and to make this a key part of their health and development programs. As world leaders meet this year to prioritize a set of development goals that will shape government budgets and programs for decades to come, we must gather and share the growing evidence that health, rights, and gender are inextricably intertwined and essential to achieving global development.
The fight for evidence-based sexuality education is not over or won yet.
This blog post is the first of a five-part series summarizing the research featured in the January 2015 special supplement to the Journal of Adolescent Health. The supplement reviews the progress on adolescent sexual and reproductive health and rights since the 1994 International Conference on Population and Development.