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Health Education

Sex education and the young some remaining dilemmas

Ellen Sieg,
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Ellen Sieg, (2003) "Sex education and the young some remaining dilemmas", Health Education, Vol. 103 Issue: 1,
pp.34-40, doi: 10.1108/09654280310459149
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Sex education and the In an era of HIV/AIDS, other sexually
young some transmitted infections (STIs) and a high
remaining dilemmas prevalence of teenage pregnancies, matters of
sex education have become issues of
widespread social concern. It is no longer
Ellen Sieg
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)
The author
indicated that England remains the country
Ellen Sieg is a PhD Studentship Holder, School of with the highest teenage pregnancy rate in
Medicine, Health Policy and Practice, University of Western Europe. England's teenage birth
East Anglia, Norwich, UK. rates are six times higher than those in The
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Keywords The year 2000 saw the largest annual

Sex education, Young people, Health care, Education, number of newly diagnosed HIV infections in
Strategy 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
Discusses some of the continuing obstacles that prevent heterosexually acquired HIV infections
sex and relationship education (SRE) programmes in diagnosed in the UK have outnumbered the
England from being more effective. The prevalence of infections acquired through sex between men.
teenage pregnancies and sexually transmitted infections However, and despite many well intended sex
that disproportionally affect the young indicate the education efforts, young people continue to
urgency with which action needs to be taken. Discusses
put themselves at risk of acquiring STIs by
current sex education practices in England with reference
engaging in unprotected sexual practices.
to recent SRE guidelines and strategies, and in the light of
Between a third and half of all UK teenagers
the findings of a focus group of health care and education
do not use contraception at first intercourse
workers who deliver SRE to young people. The focus
(Department of Health, 2001) and an
group uncovered several barriers to successful SRE.
alarming one in four young people in the UK
Suggests that apart from commissioning SRE guidelines
reportedly believe that the pill will protect
the Department for Education and Skills needs to take a
them from STIs (DfEE, 2000a). Sex
more overall and direct role in assuring that all young
education, even though it is an issue that has
people are offered an adequate SRE. Concludes that any
been of concern for several decades now,
real and lasting changes can only be achieved if sex and
cannot afford to lose anything of its urgent
relationship education goes beyond the individual to
include a focus on social and cultural processes.

Why invest in sex and relationship

Electronic access education (SRE)?
The Emerald Research Register for this journal is The Department for Education and Skills
available at (,
The presented discussion is part of the author's
The current issue and full text archive of this journal is ongoing PhD investigations. The author would like
available at 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.
Health Education
Volume 103 . Number 1 . 2003 . pp. 34-40
# MCB UP Limited . ISSN 0965-4283 Received August 2001
DOI 10.1108/09654280310459149 Accepted June 2002
Sex education and the young some remaining dilemmas Health Education
Ellen Sieg Volume 103 . Number 1 . 2003 . 34-40

accessed May 2002) has argued that in a sex and relationships (OFSTED, 2002)
society where sex is used to sell everything further clarifies that effective SRE should be
from food to fast cars, not talking to children based on a thorough assessment of what
about sex and relationships is unacceptable, young people need and want to learn in
as it leaves young people to learn from less regard to sexuality and relationships.
accurate, more confusing and possibly more However, there continues to be a gap
frightening sources. While there has been a between theoretical recommendations and
heated debate around whether or not SRE practical implementation. Pupils' own
could encourage early sexual activity and opinions and perspectives on what they need
experimentation amongst the young, to learn are still not very often integrated at
research, as well as international comparisons, the planning stage of SRE. It should
have now repeatedly shown that high quality accordingly not come as a surprise that
SRE, if anything, delays the start of sexual research findings have continued to indicate
activity by promoting a more responsible and that young people find their SRE to be of
mature attitude towards sex and sexual limited use in their lives (Thomson and Scott,
relationships (Sex Education Forum, 2000). 1991; Measor et al., 2000). In particular,
SRE in schools should be regarded as young people are saying that the content and
important as it can provide young people with nature of sex education does not match their
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a safe environment in which they can clarify own experiences and concerns around sex
their knowledge, values, attitudes and skills in and sexuality (Kirby et al., 1994), that sex
relation to sexuality, love and sexual education is too moralistic in its messages
relationships, thereby encouraging them to (Lear, 1997), and that there is too much
adopt sensible and mature positions from emphasis on the biological aspects of sex and
which to make their sexual decisions and sexuality with too little coverage of the
relationship choices. Research surveys have emotional and relationship aspects (Measor
repeatedly indicated that schools play such an et al., 2000; OFSTED, 2002).
essential part in the provision of adequate Regarding young people's continuing
SRE to young people because parents/carers scepticism about SRE in schools, it becomes
do not feel confident in their abilities to talk to important to look more closely at the factors
their children about sex and relationships. and issues that might prevent more effective
Parents repeatedly indicate not having the sex education from taking place. The SRE
right knowledge or skills to play a more active Guidelines for England and Wales (DfEE,
role in their children's SRE (Sex Education 2000a) and the revised National Curriculum
Forum, 1995) and, while theoretically the (DfEE, 2000b) propose that SRE is not to be
classroom might not be the best place for SRE taught in isolation but that it should be placed
to take place because of its highly personal within the wider personal, social and health
and embarrassing nature (Woodcock et al., education (PSHE) and citizenship
1992), from a practical point of view schools framework, and be supported by the National
are often the only place where almost all Healthy School Standards (NHSS) (DfEE,
young people can be reached (Wight, 1997). 1999).
The NHSS was launched in 1999 and
New directions but ``old dilemmas''? introduced a local, regional and national
It is now increasingly acknowledged that apart network to develop a nationally accredited
from having the right information and health and education partnership that aims to
knowledge base, young people also need to support schools in becoming ``healthy''.
develop ``healthy'' attitudes and values, and Within the wider NHSS framework, SRE is
the necessary social skills to put these into said to be best achieved through a whole
practice. Accordingly, the new SRE school approach which involves parents and
Guidelines for England and Wales (DfEE, carers, gives staff appropriate training and
2000a) draw upon attitudes and values, support, and ensures that pupils' views are
personal and social skills, as well as listened to.
knowledge and understanding, to promote
young people's sexual and emotional health Remaining constraints
and well-being. The new Office for Standards Previous research has argued that one of the
in Education (OFSTED the English and greatest constraints on providing good sex
Welsh schools' inspection agency) report on education to young people is the shortage of
Sex education and the young some remaining dilemmas Health Education
Ellen Sieg Volume 103 . Number 1 . 2003 . 34-40

appropriately trained teachers (West, 1999). quotations of the focus group discussion this
The Sex Education Forum (1995) has article aims to bridge the gap between the
described good practices in sex education as theoretical debate on outstanding SRE issues
including an exploration of values and moral and actual health care and education practices
issues, considering communication and ``on the ground''.
decision making in a relationship context, and Participants were chosen based upon their
focusing on self-esteem and awareness in direct working experiences with young people
ways that can foster young people's ability to in the area of sexual health and relationships.
avoid unwanted sexual experiences. Teachers While four of the six health care and
are encouraged to adopt active learning education professionals came from a social/
methods, such as role plays, quizzes, and youth work background, one was a general
drama work that encourage an active practitioner and one had no specific
involvement by all pupils. However, working qualification for working with young people
with such interactional teaching methods can regarding sexual health issues. While it would
require skills that go beyond the traditional certainly have been helpful to include also a
educational roles expected of teachers and is group of teachers and what they have to say
often experienced as personally challenging about their direct experiences of teaching
(Elsheikh et al., 2000). Accordingly teachers SRE in schools, this paper will concentrate
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will typically need additional training to build exclusively on the perspectives of health care
up their knowledge of sex and relationship and education professionals who are less tied
issues and to increase their confidence in to the school system, and who can
talking about these to young people (DfEE, consequently be expected to offer a more
1999). independent and critically reflective
As part of OFSTED's recent SRE review it perspective of SRE within schools.
has been emphasised that teachers, especially To explore health care and education
at secondary school level, should be provided professionals' insights about SRE issues a
with the opportunity to gain specialist qualitative research method was chosen, to
knowledge and expertise before they are allow for a detailed examination of their
expected to teach SRE to young people. professional experiences and reflections about
While the initial teacher training does not them. The following analysis is based upon a
prepare trainee teachers to become specialist focus group discussion with six health care
SRE or PHSE teachers, the Department for and education professionals which aimed to
Education and Skills (DfES) has piloted an explore some of the outstanding issues and
accreditation process for SRE teachers that is continuing dilemmas about being in charge of
aimed at raising the profile and improving the teaching SRE to young people. A focus group
effectiveness of SRE in schools. There is also discussion was employed as this method is
talk of enhancing school nurses' input to SRE acknowledged to be a participant-focused
by accrediting their input, as well as research technique and allows for the
discussion about offering a higher degree extraction of complex meaning frameworks
course or a nationally recognised diploma in and experienced complexities (Flick, 1998).
SRE (Sex Education Forum, 2002). The focus group discussion was guided by a
Currently, however, the quality of school- semi-structured topic route that prompted the
based SRE teachings remains highly varied, facilitator to cover certain topics in relation to
and while the DfES might be committed to SRE practices, by listing some key questions
develop specialist SRE training for teachers, and ``reminding phrases'' to be explored,
this remains to be implemented across the while simultaneously allowing for enough
various regional and local school settings. flexibility in following up the participants'
own constructions and emphases.
The discussion was tape recorded,
Methodology transcribed verbatim, and analysed by what
Parker (1997) has described as a theoretically
As a contribution to this continuing debate informed and context sensitive ``reading'' that
this paper will present data on a focus group is consistent with critical discourse analytical
discussion with six health care and practices. This analytical approach was
educational professionals who deliver SRE to chosen as it offers a way of moving beyond
young people in Norfolk. By presenting individual meanings and values to include an
Sex education and the young some remaining dilemmas Health Education
Ellen Sieg Volume 103 . Number 1 . 2003 . 34-40

understanding of how such meanings are necessary skills that a good sex education
socially, culturally and historically influenced provision demands (Measor et al., 2000). In
(Parker, 1997; Wetherell, 1998). The the focus group the following exchange took
discussion of the experiences and reflections place between four health care professionals
of these six health care and education and the interviewer:
professionals is intended to contribute to the There is a growing awareness, you know, that
wider and ongoing debate about the teaching health promotion isn't just providing
information, but what is absent is the money to
of SRE to young people.
do that, and some system where they can be
supported in doing that.
I mean it happens for some [good sex
Findings education], we are actually going back to having
self-esteem classes, but we do that only with this
`We know, we have known for years . . .'' very select group [school drop-outs who are said
But . . . to have ``particular needs''].
It is commonly assumed that part of the And they all need it, don't they?
problem with providing good sex education to Yeah, yeah, yes!
young people might stem from an insufficient Interviewer: So it's more money that is needed?
communication between theory and practice. Yeah, yes! More people!
That is to say, people in charge of
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This suggests that while there are guidelines

implementing SRE do not draw upon the on techniques and strategies for good sex
research findings that point towards effective education practices available, what is still
educational approaches and best practices lacking are the resources for potential sex
because they are simply not aware of them. educators to be appropriately trained and
However, according to the experiences of the supported. Clearly, commissioning guidelines
participants in this study, such an assumption and strategies as a ``token'' gesture of showing
can be questioned: concern for young people's developing
There is this thing about, we know what good sexualities and relationships is not sufficient,
sex education is, we have known for years, there and good sex education needs to be based
has been lots of research around what a PHSE
upon a long-term strategy that focuses on
education should look like . . .
deep processes of change that can affect
If you think about the research we have done
with young people, and other people have done individuals' self-images, self-esteem, and
with young people, what they are interested in is relationships to others (Hayes, 1995).
emotions, feelings, relationships, and they
constantly say that . . . Sex education is more than just another
While there seemed to be an awareness of
It has been argued that teachers might be
what is needed, and an appreciation of young
overburdened by the expectation of delivering
people's own perspectives and opinions on
good sex education since their traditional role
what they need to learn, what was lacking was
is one of teaching and assessing knowledge
said to be the consistent implementation of
(Cook and Dickens, 2000). The unequal
this knowledge in terms of offering good sex
power differential that marks the teacher-
education across all schools in the country:
pupil relationship might be counterproductive
I think there is real variable sex education, some
schools are very good actually and do some very
to the delivery of good SRE, which has been
good stuff and others are not so good. said to demand more equal relationships
Yes, there are individual good projects, I think, between educator and the ``to be educated''
and individual good workers who do some (Wight, 1997). Similar suggestions were
excellent stuff, but I think as a universal across made by the health care and education
the county, they are not having it! professionals in this study:
Within schools it's, it's taught like a subject, but
Money, money . . . it isn't a subject . . . it's about, it's about,
While the recent move towards accrediting whenever I do any stuff with it in a youth work
teachers for SRE in schools in order to raise setting I personalise it, you know, talk about
myself. I get asked questions and I answer them.
SRE's profile is certainly to be welcomed, the Now, there is not a lot of teachers that would do
current reality remains marked by a lack of that.
resources, leading to most sex educators not The whole thing is about getting along side
being trained sufficiently to develop the young people, befriending and trying to create an
Sex education and the young some remaining dilemmas Health Education
Ellen Sieg Volume 103 . Number 1 . 2003 . 34-40

equal relationship. I can't see that in, it is personal challenges and demands, teaching
absolutely the opposite in a classroom, it is very sex education to the young is often perceived
much about power relationships, you are in
as a ``high risk task'' amongst sex educators.
charge and controlling.
While the new guidelines and strategies might
The role of the teacher, with its inherent legal go some way towards clarifying some of the
constrains, might make it difficult for teachers remaining confusions, the health care and
to establish a relationship with the pupils that education professionals in this study
would allow for a more open communication suggested that anxieties about complaints and
about sex and relationships to take place. The insecurities about the appropriateness of
anxiety that teachers already have about having certain conversations with young
teaching SRE in schools might be fuelled by people continue to have a real impact on sex
the warning of the SRE Guidelines (DfEE, education practices. The following exchange
2000a) to make ``sensible decisions'' about took place:
when to avoid the answering of personal and It's . . . you can very easily fall through, one
sensitive questions within the whole class complaint that's been sent out and that's it.
setting, while the new OFSTED (2002) You can train a thousand kids and then there is
report promotes an effective SRE as offering one negative case and that has to pay.
positive and open views of sex and sexuality. (The first the health care and education professional
again): Oh yeah, that negative [case] one
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Clearly, teachers cannot reasonably be

certainly does!
expected to feel comfortable and confident
about teaching about sex and relationship In these discussions the tension and
issues if the policies and guidance do not uneasiness of working in such an explosive
sufficiently clarify what constitutes environment become apparent. Clearly, the
appropriate and inappropriate SRE practices: subject has the potential to bring educators
Teachers don't really know what they are meant into conflict with parents, schools, and even
to keep to themselves and what they are meant to the law. While individuals trained to deliver
share with their superiors. I suspect that the child SRE might be aware of the many constraints
might pick up the sort of anxiety of the teacher
and boundaries of providing sex education to
young people, and accordingly have a better
It's about real situations, giving them case
scenarios that actually make it third party, real idea of how to ``stay out of trouble'', it is
enough for them to relate it to their own lives reasonable for untrained SRE educators to
and what is going on for them. It is about trying feel nervous about delivering sex education to
to make it a safe enough place but also a real young people. This is reflected in the
enough place to really be able to talk about the following quotation:
But then if a child has asked you a question and
The focus group discussed the fact that sex you are not giving an answer, you are giving
education is more than simply just another them the idea that there is something wrong.
That can be very stressful.
subject to be taught, as it is about issues that
are of such central importance to young Teachers seem to have to cope with a double
people's lives and futures. It was felt that burden of teaching such a challenging subject
thought and consideration must be spent without being presented with clear guidance
about how the classroom could be made a on how they are allowed to teach it and how
better place for SRE with its demanding far they can go in answering youngsters'
interactive and personal features to take place. questions. It is not surprising then that the
The teacher-pupil relationship, inherently majority of teachers might opt to stick to the
unequal and characterised by the teacher's biological aspects of sex, sexuality and
power over, and judgement of, pupils' reproduction, avoiding uncomfortable
information intake, must further be territory and the possibility of coming up
considered and there needs to be clear against legal constraints. Certain areas of sex
guidance on how best to deal with pupils' education that are important to discuss from
personal disclosures and concerns. the young person's point of view are therefore
often left untouched, leaving young people to
The fear of complaints and ``getting find out for themselves (Measor et al., 2000).
oneself into trouble'' Furthermore, the unnecessary stress and
Because of sex education's potential to cause paranoia caused in sex educators about being
trouble for the educator and to pose strong allowed to answer young people's questions
Sex education and the young some remaining dilemmas Health Education
Ellen Sieg Volume 103 . Number 1 . 2003 . 34-40

freely is not only uncomfortable and deeply their self-esteem. It is essential that SRE
challenging to the educators, but also passes incorporates a cultural and social focus on the
on important messages about sex and factors and variables that need to be
sexuality to the young people themselves. As challenged so that young people can establish
Thomson and Scott (1991) have pointed out, positive and healthy sexual identities and
messages are passed on by what can and relationships (Measor et al., 2000).
cannot be talked about, setting boundaries For all this to be realised, teachers and
between ``acceptable'' and ``unacceptable'' other sex educators need to be more strongly
sexual practices and relationships. supported in the demanding responsibility of
providing sex education to the young (Measor
et al., 2000; OFSTED, 2002). In an era of
Conclusions rising HIV and STI infections, sex education
carries too much importance to be left
Over the last few decades, research money dependent on the efforts and good will of
and effort have been spent in exploring what individual schools, head teachers, SRE
young people want from sex education and teachers and/or governors (Ingham and
what the main problems are in providing good Kirkland, 1997; Pearson, 1999). Providing
sex education to young people. The review of teachers and other sex educators with a clear
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the literature and the discussion in this focus understanding of what an appropriate sex
group suggest that what is needed next is education entails is essential in reducing their
direct support in implementing the new SRE anxieties about educating young people about
guidelines and strategies and translating the sex and relationships issues, thereby
recommended practices into real life. increasing educators' confidence about SRE
In England and Wales, the DfES needs to and improving their educational practice
take a more active role in regard to SRE in (Cook and Dickens, 2000).
schools than merely commissioning strategies Sex education is essential for all pupils,
and guidelines that outline the provision of from all social backgrounds, not only the
adequate sex education. While certain socially deprived or the ones already branded
ambiguities remain to be clarified within the as showing ``behavioural problems''. The
bulk of the existing guidelines and emphasis in sex education should be primarily
recommendations to reassure sex educators interactional and social, aiming towards
about their rights and responsibilities to individuals' holistic well-being from an early
educate the young about sexuality and age onwards (Hines, 1995; Hayes, 1995;
relationship issues (Cook and Dickens, OFSTED, 2002). Research findings, young
2000), help and assistance is also and most people themselves and educators all point
urgently needed ``on the ground'' and with the towards ways of improving young people's sex
actual implementation of the recommended education, and it is important to implement
``good SRE practices''. The commissioning of the suggested changes in ways that can lead to
co-ordinators who could oversee the local persisting social and cultural changes. In light
implementation of SRE practices as based of the devastating consequences of HIV, STIs
upon the current SRE guidelines and and unplanned teenage pregnancies, any
subsequent recommendations might be one short-term fixes that fail to challenge the
sensible way for the DfES to respond. Such a deeper, social and cultural variables that allow
supervisory and coordinatory role could be these situations and circumstances to arise
meaningfully tied into the NHSS scheme and and be maintained need to be rejected.
the responsibilities of the local NHSS Providing good sex and relationship
co-ordinators. education to the young needs to be regarded
Furthermore, SRE approaches need to as a priority that requires a clear and positive
expand their individualistic focus and long-term vision that can open up new
emphasise issues such as self-esteem, personal opportunities and chances for the future. SRE
autonomy and interactional skills within a can then become an education for life that not
broader social and cultural framework. For merely warns young people about risks of
example, a group of young women could HIV, STI infections and unplanned
explore how social and cultural messages pregnancies, but also assists them in
about what women should look like, developing healthy and rewarding sexual
communicated through the media, impact on lifestyles and relationships.
Sex education and the young some remaining dilemmas Health Education
Ellen Sieg Volume 103 . Number 1 . 2003 . 34-40

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