Health Education

Sex education and the young some remaining dilemmas

Ellen Sieg,
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Sex education and the
young some
remaining dilemmas
Ellen Sieg
The author
Ellen Sieg is a PhD Studentship Holder, School of
Medicine, Health Policy and Practice, University of
East Anglia, Norwich, UK.
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Keywords
Sex education, Young people, Health care, Education,
Strategy
Abstract
Discusses some of the continuing obstacles that prevent
sex and relationship education (SRE) programmes in
England from being more effective. The prevalence of
teenage pregnancies and sexually transmitted infections
that disproportionally affect the young indicate the
urgency with which action needs to be taken. Discusses
current sex education practices in England with reference
to recent SRE guidelines and strategies, and in the light of
the findings of a focus group of health care and education
workers who deliver SRE to young people. The focus
group uncovered several barriers to successful SRE.
Suggests that apart from commissioning SRE guidelines
the Department for Education and Skills needs to take a
more overall and direct role in assuring that all young
people are offered an adequate SRE. Concludes that any
real and lasting changes can only be achieved if sex and
relationship education goes beyond the individual to
include a focus on social and cultural processes.
Electronic access
The Emerald Research Register for this journal is
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http://www.emeraldinsight.com/researchregister
The current issue and full text archive of this journal is
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http://www.emeraldinsight.com/0965-4283.htm
Health Education
Volume 103 . Number 1 . 2003 . pp. 34-40
# MCB UP Limited . ISSN 0965-4283
DOI 10.1108/09654280310459149
34
Introduction
In an era of HIV/AIDS, other sexually
transmitted infections (STIs) and a high
prevalence of teenage pregnancies, matters of
sex education have become issues of
widespread social concern. It is no longer
possible to confine people's sexual
relationships and practices exclusively to the
private domain and public responses are
strongly demanded and discussed (Diorio and
Munro, 2000; Hines, 1995; Hayes, 1995).
The new National Strategy for Sexual Health
and HIV (Department of Health, 2001)
indicated that England remains the country
with the highest teenage pregnancy rate in
Western Europe. England's teenage birth
rates are six times higher than those in The
Netherlands.
The year 2000 saw the largest annual
number of newly diagnosed HIV infections in
the UK since the start of the epidemic, with
STI and HIV infections currently increasing
most rapidly for the 16-24 year olds.
Furthermore, since 1999 numbers of
heterosexually acquired HIV infections
diagnosed in the UK have outnumbered the
infections acquired through sex between men.
However, and despite many well intended sex
education efforts, young people continue to
put themselves at risk of acquiring STIs by
engaging in unprotected sexual practices.
Between a third and half of all UK teenagers
do not use contraception at first intercourse
(Department of Health, 2001) and an
alarming one in four young people in the UK
reportedly believe that the pill will protect
them from STIs (DfEE, 2000a). Sex
education, even though it is an issue that has
been of concern for several decades now,
cannot afford to lose anything of its urgent
character.
Why invest in sex and relationship
education (SRE)?
The Department for Education and Skills
(www.dfes.gov.uk/sreandparents/index.shtml,
The presented discussion is part of the author's
ongoing PhD investigations. The author would like
to thank Professor Mildred Blaxter and Dr Roger
Ingham for commenting on an earlier version of
this article as well as all participants for kindly
taking part in this study.
Received August 2001
Accepted June 2002
 Sex education and the young some remaining dilemmas
Ellen Sieg
accessed May 2002) has argued that in a
society where sex is used to sell everything
from food to fast cars, not talking to children
about sex and relationships is unacceptable,
as it leaves young people to learn from less
accurate, more confusing and possibly more
frightening sources. While there has been a
heated debate around whether or not SRE
could encourage early sexual activity and
experimentation amongst the young,
research, as well as international comparisons,
have now repeatedly shown that high quality
SRE, if anything, delays the start of sexual
activity by promoting a more responsible and
mature attitude towards sex and sexual
relationships (Sex Education Forum, 2000).
SRE in schools should be regarded as
important as it can provide young people with
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a safe environment in which they can clarify
their knowledge, values, attitudes and skills in
relation to sexuality, love and sexual
relationships, thereby encouraging them to
adopt sensible and mature positions from
which to make their sexual decisions and
relationship choices. Research surveys have
repeatedly indicated that schools play such an
essential part in the provision of adequate
SRE to young people because parents/carers
do not feel confident in their abilities to talk to
their children about sex and relationships.
Parents repeatedly indicate not having the
right knowledge or skills to play a more active
role in their children's SRE (Sex Education
Forum, 1995) and, while theoretically the
classroom might not be the best place for SRE
to take place because of its highly personal
and embarrassing nature (Woodcock et al.,
1992), from a practical point of view schools
are often the only place where almost all
young people can be reached (Wight, 1997).
New directions but ``old dilemmas''?
It is now increasingly acknowledged that apart
from having the right information and
knowledge base, young people also need to
develop ``healthy'' attitudes and values, and
the necessary social skills to put these into
practice. Accordingly, the new SRE
Guidelines for England and Wales (DfEE,
2000a) draw upon attitudes and values,
personal and social skills, as well as
knowledge and understanding, to promote
young people's sexual and emotional health
and well-being. The new Office for Standards
in Education (OFSTED the English and
Welsh schools' inspection agency) report on
35
Health Education
Volume 103 . Number 1 . 2003 . 34-40
sex and relationships (OFSTED, 2002)
further clarifies that effective SRE should be
based on a thorough assessment of what
young people need and want to learn in
regard to sexuality and relationships.
However, there continues to be a gap
between theoretical recommendations and
practical implementation. Pupils' own
opinions and perspectives on what they need
to learn are still not very often integrated at
the planning stage of SRE. It should
accordingly not come as a surprise that
research findings have continued to indicate
that young people find their SRE to be of
limited use in their lives (Thomson and Scott,
1991; Measor et al., 2000). In particular,
young people are saying that the content and
nature of sex education does not match their
own experiences and concerns around sex
and sexuality (Kirby et al., 1994), that sex
education is too moralistic in its messages
(Lear, 1997), and that there is too much
emphasis on the biological aspects of sex and
sexuality with too little coverage of the
emotional and relationship aspects (Measor
et al., 2000; OFSTED, 2002).
Regarding young people's continuing
scepticism about SRE in schools, it becomes
important to look more closely at the factors
and issues that might prevent more effective
sex education from taking place. The SRE
Guidelines for England and Wales (DfEE,
2000a) and the revised National Curriculum
(DfEE, 2000b) propose that SRE is not to be
taught in isolation but that it should be placed
within the wider personal, social and health
education (PSHE) and citizenship
framework, and be supported by the National
Healthy School Standards (NHSS) (DfEE,
1999).
The NHSS was launched in 1999 and
introduced a local, regional and national
network to develop a nationally accredited
health and education partnership that aims to
support schools in becoming ``healthy''.
Within the wider NHSS framework, SRE is
said to be best achieved through a whole
school approach which involves parents and
carers, gives staff appropriate training and
support, and ensures that pupils' views are
listened to.
Remaining constraints
Previous research has argued that one of the
greatest constraints on providing good sex
education to young people is the shortage of
 Sex education and the young some remaining dilemmas
Ellen Sieg
appropriately trained teachers (West, 1999).
The Sex Education Forum (1995) has
described good practices in sex education as
including an exploration of values and moral
issues, considering communication and
decision making in a relationship context, and
focusing on self-esteem and awareness in
ways that can foster young people's ability to
avoid unwanted sexual experiences. Teachers
are encouraged to adopt active learning
methods, such as role plays, quizzes, and
drama work that encourage an active
involvement by all pupils. However, working
with such interactional teaching methods can
require skills that go beyond the traditional
educational roles expected of teachers and is
often experienced as personally challenging
(Elsheikh et al., 2000). Accordingly teachers
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will typically need additional training to build
up their knowledge of sex and relationship
issues and to increase their confidence in
talking about these to young people (DfEE,
1999).
As part of OFSTED's recent SRE review it
has been emphasised that teachers, especially
at secondary school level, should be provided
with the opportunity to gain specialist
knowledge and expertise before they are
expected to teach SRE to young people.
While the initial teacher training does not
prepare trainee teachers to become specialist
SRE or PHSE teachers, the Department for
Education and Skills (DfES) has piloted an
accreditation process for SRE teachers that is
aimed at raising the profile and improving the
effectiveness of SRE in schools. There is also
talk of enhancing school nurses' input to SRE
by accrediting their input, as well as
discussion about offering a higher degree
course or a nationally recognised diploma in
SRE (Sex Education Forum, 2002).
Currently, however, the quality of school-
based SRE teachings remains highly varied,
and while the DfES might be committed to
develop specialist SRE training for teachers,
this remains to be implemented across the
various regional and local school settings.
Methodology
As a contribution to this continuing debate
this paper will present data on a focus group
discussion with six health care and
educational professionals who deliver SRE to
young people in Norfolk. By presenting
36
Health Education
Volume 103 . Number 1 . 2003 . 34-40
quotations of the focus group discussion this
article aims to bridge the gap between the
theoretical debate on outstanding SRE issues
and actual health care and education practices
``on the ground''.
Participants were chosen based upon their
direct working experiences with young people
in the area of sexual health and relationships.
While four of the six health care and
education professionals came from a social/
youth work background, one was a general
practitioner and one had no specific
qualification for working with young people
regarding sexual health issues. While it would
certainly have been helpful to include also a
group of teachers and what they have to say
about their direct experiences of teaching
SRE in schools, this paper will concentrate
exclusively on the perspectives of health care
and education professionals who are less tied
to the school system, and who can
consequently be expected to offer a more
independent and critically reflective
perspective of SRE within schools.
To explore health care and education
professionals' insights about SRE issues a
qualitative research method was chosen, to
allow for a detailed examination of their
professional experiences and reflections about
them. The following analysis is based upon a
focus group discussion with six health care
and education professionals which aimed to
explore some of the outstanding issues and
continuing dilemmas about being in charge of
teaching SRE to young people. A focus group
discussion was employed as this method is
acknowledged to be a participant-focused
research technique and allows for the
extraction of complex meaning frameworks
and experienced complexities (Flick, 1998).
The focus group discussion was guided by a
semi-structured topic route that prompted the
facilitator to cover certain topics in relation to
SRE practices, by listing some key questions
and ``reminding phrases'' to be explored,
while simultaneously allowing for enough
flexibility in following up the participants'
own constructions and emphases.
The discussion was tape recorded,
transcribed verbatim, and analysed by what
Parker (1997) has described as a theoretically
informed and context sensitive ``reading'' that
is consistent with critical discourse analytical
practices. This analytical approach was
chosen as it offers a way of moving beyond
individual meanings and values to include an
 Sex education and the young some remaining dilemmas
Ellen Sieg
understanding of how such meanings are
socially, culturally and historically influenced
(Parker, 1997; Wetherell, 1998). The
discussion of the experiences and reflections
of these six health care and education
professionals is intended to contribute to the
wider and ongoing debate about the teaching
of SRE to young people.
Findings
`We know, we have known for years . . .''
But . . .
It is commonly assumed that part of the
problem with providing good sex education to
young people might stem from an insufficient
communication between theory and practice.
That is to say, people in charge of
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implementing SRE do not draw upon the
research findings that point towards effective
educational approaches and best practices
because they are simply not aware of them.
However, according to the experiences of the
participants in this study, such an assumption
can be questioned:
There is this thing about, we know what good
sex education is, we have known for years, there
has been lots of research around what a PHSE
education should look like . . .
If you think about the research we have done
with young people, and other people have done
with young people, what they are interested in is
emotions, feelings, relationships, and they
constantly say that . . .
While there seemed to be an awareness of
what is needed, and an appreciation of young
people's own perspectives and opinions on
what they need to learn, what was lacking was
said to be the consistent implementation of
this knowledge in terms of offering good sex
education across all schools in the country:
I think there is real variable sex education, some
schools are very good actually and do some very
good stuff and others are not so good.
Yes, there are individual good projects, I think,
and individual good workers who do some
excellent stuff, but I think as a universal across
the county, they are not having it!
Money, money . . .
While the recent move towards accrediting
teachers for SRE in schools in order to raise
SRE's profile is certainly to be welcomed, the
current reality remains marked by a lack of
resources, leading to most sex educators not
being trained sufficiently to develop the
37
Health Education
Volume 103 . Number 1 . 2003 . 34-40
necessary skills that a good sex education
provision demands (Measor et al., 2000). In
the focus group the following exchange took
place between four health care professionals
and the interviewer:
There is a growing awareness, you know, that
health promotion isn't just providing
information, but what is absent is the money to
do that, and some system where they can be
supported in doing that.
I mean it happens for some [good sex
education], we are actually going back to having
self-esteem classes, but we do that only with this
very select group [school drop-outs who are said
to have ``particular needs''].
And they all need it, don't they?
Yeah, yeah, yes!
Interviewer: So it's more money that is needed?
Yeah, yes! More people!
This suggests that while there are guidelines
on techniques and strategies for good sex
education practices available, what is still
lacking are the resources for potential sex
educators to be appropriately trained and
supported. Clearly, commissioning guidelines
and strategies as a ``token'' gesture of showing
concern for young people's developing
sexualities and relationships is not sufficient,
and good sex education needs to be based
upon a long-term strategy that focuses on
deep processes of change that can affect
individuals' self-images, self-esteem, and
relationships to others (Hayes, 1995).
Sex education is more than just another
subject
It has been argued that teachers might be
overburdened by the expectation of delivering
good sex education since their traditional role
is one of teaching and assessing knowledge
(Cook and Dickens, 2000). The unequal
power differential that marks the teacher-
pupil relationship might be counterproductive
to the delivery of good SRE, which has been
said to demand more equal relationships
between educator and the ``to be educated''
(Wight, 1997). Similar suggestions were
made by the health care and education
professionals in this study:
Within schools it's, it's taught like a subject, but
it isn't a subject . . . it's about, it's about,
whenever I do any stuff with it in a youth work
setting I personalise it, you know, talk about
myself. I get asked questions and I answer them.
Now, there is not a lot of teachers that would do
that.
The whole thing is about getting along side
young people, befriending and trying to create an
 Sex education and the young some remaining dilemmas
Ellen Sieg
equal relationship. I can't see that in, it is
absolutely the opposite in a classroom, it is very
much about power relationships, you are in
charge and controlling.
The role of the teacher, with its inherent legal
constrains, might make it difficult for teachers
to establish a relationship with the pupils that
would allow for a more open communication
about sex and relationships to take place. The
anxiety that teachers already have about
teaching SRE in schools might be fuelled by
the warning of the SRE Guidelines (DfEE,
2000a) to make ``sensible decisions'' about
when to avoid the answering of personal and
sensitive questions within the whole class
setting, while the new OFSTED (2002)
report promotes an effective SRE as offering
positive and open views of sex and sexuality.
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Clearly, teachers cannot reasonably be
expected to feel comfortable and confident
about teaching about sex and relationship
issues if the policies and guidance do not
sufficiently clarify what constitutes
appropriate and inappropriate SRE practices:
Teachers don't really know what they are meant
to keep to themselves and what they are meant to
share with their superiors. I suspect that the child
might pick up the sort of anxiety of the teacher
really.
It's about real situations, giving them case
scenarios that actually make it third party, real
enough for them to relate it to their own lives
and what is going on for them. It is about trying
to make it a safe enough place but also a real
enough place to really be able to talk about the
issues.
The focus group discussed the fact that sex
education is more than simply just another
subject to be taught, as it is about issues that
are of such central importance to young
people's lives and futures. It was felt that
thought and consideration must be spent
about how the classroom could be made a
better place for SRE with its demanding
interactive and personal features to take place.
The teacher-pupil relationship, inherently
unequal and characterised by the teacher's
power over, and judgement of, pupils'
information intake, must further be
considered and there needs to be clear
guidance on how best to deal with pupils'
personal disclosures and concerns.
The fear of complaints and ``getting
oneself into trouble''
Because of sex education's potential to cause
trouble for the educator and to pose strong
38
Health Education
Volume 103 . Number 1 . 2003 . 34-40
personal challenges and demands, teaching
sex education to the young is often perceived
as a ``high risk task'' amongst sex educators.
While the new guidelines and strategies might
go some way towards clarifying some of the
remaining confusions, the health care and
education professionals in this study
suggested that anxieties about complaints and
insecurities about the appropriateness of
having certain conversations with young
people continue to have a real impact on sex
education practices. The following exchange
took place:
It's . . . you can very easily fall through, one
complaint that's been sent out and that's it.
You can train a thousand kids and then there is
one negative case and that has to pay.
(The first the health care and education professional
again): Oh yeah, that negative [case] one
certainly does!
In these discussions the tension and
uneasiness of working in such an explosive
environment become apparent. Clearly, the
subject has the potential to bring educators
into conflict with parents, schools, and even
the law. While individuals trained to deliver
SRE might be aware of the many constraints
and boundaries of providing sex education to
young people, and accordingly have a better
idea of how to ``stay out of trouble'', it is
reasonable for untrained SRE educators to
feel nervous about delivering sex education to
young people. This is reflected in the
following quotation:
But then if a child has asked you a question and
you are not giving an answer, you are giving
them the idea that there is something wrong.
That can be very stressful.
Teachers seem to have to cope with a double
burden of teaching such a challenging subject
without being presented with clear guidance
on how they are allowed to teach it and how
far they can go in answering youngsters'
questions. It is not surprising then that the
majority of teachers might opt to stick to the
biological aspects of sex, sexuality and
reproduction, avoiding uncomfortable
territory and the possibility of coming up
against legal constraints. Certain areas of sex
education that are important to discuss from
the young person's point of view are therefore
often left untouched, leaving young people to
find out for themselves (Measor et al., 2000).
Furthermore, the unnecessary stress and
paranoia caused in sex educators about being
allowed to answer young people's questions
 Sex education and the young some remaining dilemmas
Ellen Sieg
freely is not only uncomfortable and deeply
challenging to the educators, but also passes
on important messages about sex and
sexuality to the young people themselves. As
Thomson and Scott (1991) have pointed out,
messages are passed on by what can and
cannot be talked about, setting boundaries
between ``acceptable'' and ``unacceptable''
sexual practices and relationships.
Conclusions
Over the last few decades, research money
and effort have been spent in exploring what
young people want from sex education and
what the main problems are in providing good
sex education to young people. The review of
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the literature and the discussion in this focus
group suggest that what is needed next is
direct support in implementing the new SRE
guidelines and strategies and translating the
recommended practices into real life.
In England and Wales, the DfES needs to
take a more active role in regard to SRE in
schools than merely commissioning strategies
and guidelines that outline the provision of
adequate sex education. While certain
ambiguities remain to be clarified within the
bulk of the existing guidelines and
recommendations to reassure sex educators
about their rights and responsibilities to
educate the young about sexuality and
relationship issues (Cook and Dickens,
2000), help and assistance is also and most
urgently needed ``on the ground'' and with the
actual implementation of the recommended
``good SRE practices''. The commissioning of
co-ordinators who could oversee the local
implementation of SRE practices as based
upon the current SRE guidelines and
subsequent recommendations might be one
sensible way for the DfES to respond. Such a
supervisory and coordinatory role could be
meaningfully tied into the NHSS scheme and
the responsibilities of the local NHSS
co-ordinators.
Furthermore, SRE approaches need to
expand their individualistic focus and
emphasise issues such as self-esteem, personal
autonomy and interactional skills within a
broader social and cultural framework. For
example, a group of young women could
explore how social and cultural messages
about what women should look like,
communicated through the media, impact on
39
Health Education
Volume 103 . Number 1 . 2003 . 34-40
their self-esteem. It is essential that SRE
incorporates a cultural and social focus on the
factors and variables that need to be
challenged so that young people can establish
positive and healthy sexual identities and
relationships (Measor et al., 2000).
For all this to be realised, teachers and
other sex educators need to be more strongly
supported in the demanding responsibility of
providing sex education to the young (Measor
et al., 2000; OFSTED, 2002). In an era of
rising HIV and STI infections, sex education
carries too much importance to be left
dependent on the efforts and good will of
individual schools, head teachers, SRE
teachers and/or governors (Ingham and
Kirkland, 1997; Pearson, 1999). Providing
teachers and other sex educators with a clear
understanding of what an appropriate sex
education entails is essential in reducing their
anxieties about educating young people about
sex and relationships issues, thereby
increasing educators' confidence about SRE
and improving their educational practice
(Cook and Dickens, 2000).
Sex education is essential for all pupils,
from all social backgrounds, not only the
socially deprived or the ones already branded
as showing ``behavioural problems''. The
emphasis in sex education should be primarily
interactional and social, aiming towards
individuals' holistic well-being from an early
age onwards (Hines, 1995; Hayes, 1995;
OFSTED, 2002). Research findings, young
people themselves and educators all point
towards ways of improving young people's sex
education, and it is important to implement
the suggested changes in ways that can lead to
persisting social and cultural changes. In light
of the devastating consequences of HIV, STIs
and unplanned teenage pregnancies, any
short-term fixes that fail to challenge the
deeper, social and cultural variables that allow
these situations and circumstances to arise
and be maintained need to be rejected.
Providing good sex and relationship
education to the young needs to be regarded
as a priority that requires a clear and positive
long-term vision that can open up new
opportunities and chances for the future. SRE
can then become an education for life that not
merely warns young people about risks of
HIV, STI infections and unplanned
pregnancies, but also assists them in
developing healthy and rewarding sexual
lifestyles and relationships.
 Sex education and the young some remaining dilemmas
Ellen Sieg
While these theoretical deliberations are
merely based on one focus group discussion,
the author nevertheless hopes that the article
has highlighted some important issues and
contributed to the wider and continuing
debate on promoting the quality of sex and
relationship education.
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