Country Profile: Malaysia

Contents
Primary sources ............................................................................................................75 Policy............................................................................................................................75 Curriculum ...................................................................................................................76 Subject placement and teaching materials ...............................................................76 Skills-based approach of family health education....................................................77 Curriculum content...................................................................................................77 Primary school (Grade 1-6, ages 6-11) ................................................................77 Secondary schools (grades 7-11, ages 12-16) ......................................................78 Teacher training............................................................................................................82 Peer education ..............................................................................................................82 Barriers to implementing reproductive and sexual health education in schools ..........82

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Primary sources
Respondent • Dr Mary Huang, Lecturer, Department of Nutrition and Community Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia (September, 2000)

Documents • • • • PROSTAR: Community (Youths) Mobilisation Programme on AIDS, Ministry of Health, Malaysia, AIDS/STD Section. October 1999 (report) Huang, Mary Soo Lee, PhD (1999) Case Study on Adolescent Reproductive and Sexual Health – Malaysia (A report undertaken for UNESCO) Family Health Education, Curriculum Development Centre, Ministry of Education, Malaysia, September, 1995 (Outline of the reproductive and sexual health curriculum for primary and secondary school students) Malaysian AIDS Council (1995) Malaysian AIDS Charter: Shared rights, shared responsibilities.

Policy
There are currently no government policies relating to sexual and reproductive health in Malaysia. Despite this, there is a national-wide school-based program within schools, called Family Health Education (see curriculum section). The Malaysian AIDS Council, a non-government organization, has produced the Malaysian AIDS Charter. The Charter covers a range of HIV/AIDS related issues, one of which is school-based education. In section five, “Rights and responsibilities in relation to education”, the following point are made: • • • All individuals affected by HIV/AIDS shall have equal access to schools and education institutions Laws and policies shall not hamper the development and dissemination of HIV/AIDS education materials Educational materials shall incorporate shared religious values and principles to ensure responsible behaviour

The Malaysian AIDS Charter is only effective within non-government organizations. The Ministry of Health is currently developing a policy on adolescent and reproductive sexual health, though we have no specific detail in relation to its contents. It is unclear if the policy will cover school-based education. Malaysia is signatory to the ICPD Plan of Action. Whilst the Plan of Action endorsed reproductive health rights, the implementation of reproductive health programs and universal human rights, it also agreed that action should be conducted within the bounds of national sovereignty and be in accord with religious, ethical and cultural values. In the Malaysian context the sovereign proviso has worked to exclude those

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who are unmarried from having reproductive rights (as they relate to sexual activity). One only has the right to engage in sexual activity within marriage.

Curriculum
In Malaysia, school-based sexual and reproductive health education is called Family Health Education (FHE). FHE has been delivered to secondary school students since 1989 and elements of it were introduced into primary schools in 1994. Family Health Education, as the title suggests, is focused on the family as a basic institution. The stated aims of the curriculum are preserve the family institution for all time and provide “accurate and up-to-date knowledge about human sexuality in its biological, psychological, socio-cultural and moral dimensions.” School-based reproductive health education is grounded in a presupposition that young people will not engage in sexual activity until married. In 1990 the average age of marriage in Malaysia was above 23 and has been rising since the 1970s. The trend toward late marriage increases the need to deliver sexual and reproductive health to young people, many of whom may engage in premarital sex.

Subject placement and teaching materials
Family Health Education is integrated into a range of different subjects and includes the following:
Subject Physical and Health Education Science/Additional Science Biology Morality Education Islamic Education Comments Compulsory no examinable subject Compulsory and examinable Compulsory and examinable Compulsory and examinable for all non-Muslim students Compulsory and examinable for all Muslim students. Sex and sexual practice is not addressed per se. Abstinence, fidelity and cleanliness are discussed One-off presentations, although lacking in continuity, are more likely to specifically address sex behaviour.

Informal NGO presentations

Textbooks are standardised for the whole country. Workbooks are produced that are base on the curriculum. FHE comprises five modules with teacher lesson notes. We do not have copies of the modules and notes.

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Skills-based approach of family health education
FHE aims to improve students’ capacities in the following areas: • Self-esteem • Effective communication skills • Values clarification skills • Responsible decision making skills The approach is skills-based and employs interactive learning techniques such as discussion, debate, case studies, role-playing and simulation.

Curriculum content
Below is a brief outline of topics covered in Family Health Education, broken down by year and subject:

Primary school (Grade 1-6, ages 6-11) Physical and Health Education is the only primary school subject within which Family Health Education is delivered. Cleanliness and family relationships are the first topics to be introduced and are emphasised throughout primary school. Genital health is first mentioned in grade 5 in relation to menstruation hygiene. The differences between the sexes are emphasised throughout, and puberty is first mentioned in grade 4, and elaborated in grades 5 and 6. Physical and Health Education Grade 1 • Body cleanliness Grade 2 • Physical differences between sexes • Physical differences between boys and girls: physical, emotional and activity based • To express “pride and joy in one’s sex” • Process of a baby’s birth • Love for one’s parents Grade 3 • Identify family members and their geographical distribution • Explain the concept of the family including love, close ties, cooperation, loyalty to parents, etc. Grade 4 • Puberty: a stage of growth; physical changes during; differences between boys and girls

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Grade 5 • State the meaning of menstruation and nocturnal emissions • Practices of menstruation hygiene • Explain the meaning of sexually transmitted diseases • State how diseases are transmitted and prevented Grade 6 • Identify common physical problems faced by teenagers and how they are overcome

Secondary schools (grades 7-11, ages 12-16) In secondary schools, Family Health Education is taught in Physical and Health Education, Science, Additional Science, Biology and Islamic Education. Each is discussed below. Physical and Health Education The prevention of STDs is introduced in the final three years of high school but is most extensively dealt with in the final two years. STDs (including AIDS) are positioned as the effect of “unhealthy lifestyles”. Avoidance of “casual and promiscuous” sex is promoted. Safe sex is not discussed. Sexual relations and practice are framed by the family institution, including sex outside of marriage, elopements and teenage marriage (all of which are discussed under the heading of “common family problems”). The contents of Physical and Health Education are outlined below: Grade 7 • Describe physical, emotional, and social changes of teenage years • Discuss measures of dealing with strangers • Discuss, explain and exemplify a range of health-related issues: neglect, responsibility, consequences of neglect, and decision making Grade 8 • Explain personal, family and community health • Discuss positive and negative values that affect health • Explain the relationship between physical, mental, emotional, social and spiritual health; effect of conflict on health and overcoming those conflicts • Practise decision-making regarding emotional and social changes and pressures experienced during adolescence • Discuss the responsibility of guarding one’s own health during teenage years • Discuss physical changes that affect emotion and behaviour • Describe and discuss aspects of urogenital health Grade 9 • Discuss classroom friendship patterns • Investigate good behaviour and interaction

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Discuss needs of and responsibilities to friends, family and community Discuss a code of ethics for responsible social interaction outside of school Discuss personality development; the influence of others, and being responsible Discuss the implication of developing fertility on social etiquette and behaviours Discuss the roles and responsibilities of various family members and parenthood Discuss lifestyle diseases: e.g. sexually transmitted diseases, AIDS, drug abuse, cardiovascular disease, cancer, emotional stress, high blood pressure, and diabetes Grades 10 and 11 Discuss the concept and characteristics of a happy family Discus family member roles and responsibilities from a range of different perspectives o Before marriage: the institution of marriage; preparedness for marriage; money matters; the right match; marriage customs; religious and civil laws; governance of marriage; rights and responsibilities between husband and wife o Adjusting to married life: before and after children; conception and birth; misconceptions regarding fertility and pregnancy Discuss issues of marriage: family planning; domestic management; polygamy; different expectations; family interference; sexual problems (infertility and impotence) Investigate laws that govern the family and protect children Discuss common family problems: teenage marriage; elopements; pregnancies outside of marriage; broken families; runaway children; child abuse; spouse abuse Discuss the classification, sign and symptoms of disease: o Diseases spread though multiple means (i.e. AIDS [sic] and hepatitis B are spread through sexual intercourse, blood transfusions, injections, and the transfer of bodily fluids)1 o Sexually transmitted diseases: AIDS [sic], gonorrhoea, syphilis, hepatitis B and herpes Discuss disease prevention and control2 o Health education o Healthy habits o Avoidance of casual sex and promiscuity o Reporting cases of diseases to the relevant authorities o Early detection and treatment o Cooperating with the relevant authorities

Science; Additional Science and Biology The biological aspects of human reproduction, disease, and growth are extensively covered in all these subject areas. As would be expected, these subjects are dealt with from a scientific perspective. Contraception is not introduced until the final year of high school. Condoms are introduced as one of the many forms of contraception

1

Note that AIDS rather than HIV is identified as being spread through a range of practices. HIV is not differentiated from AIDS. Condoms are not specifically mentioned as method of preventing HIV gonorrhoea and syphilis.

2

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Reproduction o Sexual and asexual reproduction o Male and female sex organs o Sperm and ovum o The menstrual cycle and its effects o Fertilisation and implantation o Stages from pregnancy to birth o Nutrition and the foetus o Meiosis o Foetal development o Birth o Twins o Problem relating to fertilisation o The placenta and its functions o Reproductive technologies: artificial insemination, invitro fertilisation and contraceptive methods Disease o A range of viruses that cause diseases, including HIV (AIDS is referred to as being caused by a virus). It is noted that viruses in general are incurable and that practising a healthy lifestyle is the best form of prevention o Disease spread by sexual activity, such as AIDS (sic) and venereal diseases

Human growth and development o The development of secondary sexual characteristics The menstrual cycle and hormonal control Islamic Education Family Health Education is included in grades 9 and 11. The emphasis is on moral and spiritual virtue and the prevention of illicit deeds. It includes a discussion of: Grade 9 • The illicit deeds committed by man before Prophet Muhammad’s time • The consequences visited upon those who commit illicit deeds • Teachings that are exemplary (e.g. the story of Lot, his people and wife) Grade 11 • The blessings of marriage as ordained by Allah o To propagate lawful progeny o To produce a clean, new generation o To nurture love to prevent illicit deeds o To promote spiritual ties • How to produce a clean, new generation and how to overcome the problems of contemporary Islamic youth.

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Overview of curriculum content, and teaching practice
Content – Specific HIV/AIDS and STD knowledge Yes/No Yes Comments In Physical and Health Education HIV is not differentiated form AIDS. “AIDS” is positioned as being transmissible. In Science, AIDS is positioned as being cased by a virus but in Additional Science, AIDS is positioned as being “spread by sexual activity” Is extensively covered in Science and Additional Science and Biology

Human reproduction Puberty: physiological changes Puberty: psychosocial changes Sexual abstinence Fidelity Condoms as a contraception Condom as disease prevention Aspects of interpersonal sexual relationships Transmission modes “Safe sex” Gender relations Sexual preference (e.g. homosexuality) Style of delivery Mostly information Balance of info/ attitudes/values/skills Teaching/learning processes Mostly didactic Mostly interactive Teaching materials provided Assessed or graded

Yes Yes Yes Yes Yes Yes No Yes

Abstinence is stressed for the unmarried Fidelity is stressed for the married Discussed as a contraceptive in marriage. Introduced in the final year of high school See above Discussed only in the context of marriage, if at all.

Yes No Yes No

Mentioned in terms of “sex”, assumed to be vaginal intercourse. Anal and oral intercourse are not mentioned. Focused upon specific roles and responsibilities rather than gender inequality There is a presumption of heterosexuality in the Family Health Education curriculum Comments Significant attention to attitudes and values, esp. abstinence and fidelity Comments

Yes/No Yes Yes

Yes/No Yes No Yes Yes

Textbooks; lesson modules; lesson notes FHE is only assessed when incorporated into examinable subjects (i.e. Biology, Science, Religion and Moral Education) Comments Not necessarily examinable (see section on subject) 100% 100%

Coverage Compulsory Primary schools Secondary schools

Yes/No Yes Yes Yes

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Teacher training
We have very little information relating to teacher training. Some short-term inservice courses are conducted by The Ministry of Education and non-government organizations (e.g. Malaysian AIDS Council). Most training has focused on biological and scientific aspects of sexual and reproductive health. Skills-based approaches are increasingly common. Harm minimisation is sometimes used and frequently criticised.
Teacher Training Pre-service In-service: long term In-service: short term Yes/No ? No Yes Comments

Peer education
There are no existing school-based peer education programs. There is however a large scale peer education program funded by the Ministry of Education, ProStar (Community Youths Mobilisation Program on AIDS). As of mid-1999, 445 training sessions had been conducted and over 17000 facilitators had been trained. The project is ongoing and is focused upon healthy lifestyles and the development of good moral values.

Barriers to implementing reproductive and sexual health education in schools
• Sex education, understood as educating about sexual practice, is still not available in Malaysian schools despite a demonstrated need among young people (Huang, 1999: see Primary Sources above). The introduction of sex and sexual health education has met strong resistance from parents and religious leaders. For those political leaders who support sex education, they are fearful of the religious repercussions entailed. Family Health Education has been introduced into a variety of different school subjects. This has the danger of fragmenting the overall curriculum thus making it difficult to ensure that the content is covered in a coherent manner. There is a misunderstanding among teacher and parent associations that sex education will encourage sexual activity Religious leaders are totally opposed to discussing male/female relationships based upon an understand that religion forbids it and therefore the topic should not be discussed at all Given that contraception is forbidden to unmarried couples it is almost impossible to introduce harm minimisation approaches Young people may introduce the topic but teachers should not Students are aware of how HIV is transmitted but the curriculum introduces l transmission in the broadest terms (i.e. sexual transmission). It is unlikely that the relative risks of different sexual practices are understood.

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