Asia-Pacific Journal of Public Health

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Sexuality Education in Malaysia: Perceived Issues and Barriers by Professionals

Zahra Fazli Khalaf, Wah Yun Low, Effat Merghati-Khoei and Behzad Ghorbani
Asia Pac J Public Health 2014 26: 358 originally published online 30 January 2014
DOI: 10.1177/1010539513517258

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APHXXX10.1177/1010539513517258Asia-Pacific Journal of Public HealthFazli Khalaf et al

Original Article
Asia-Pacific Journal of Public Health
2014, Vol. 26(4) 358­–366
Sexuality Education in Malaysia: © 2014 APJPH
Reprints and permissions:
Perceived Issues and Barriers by sagepub.com/journalsPermissions.nav
DOI: 10.1177/1010539513517258
Professionals aph.sagepub.com

Zahra Fazli Khalaf, MSc1, Wah Yun Low, PhD1, Effat Merghati-
Khoei, PhD2, and Behzad Ghorbani, MD3

Abstract
This research explored the perspectives of Malaysian professionals on the issues and barriers
affecting the implementation of sexuality education in Malaysia. This qualitative study involved
in-depth interviews with 15 key professionals working in the field of sexuality and reproductive
health in Malaysia. Thematic analysis was selected to analyze data. Barriers to sexuality
education were perceived from 5 aspects: feasibility, acceptability, accountability, strategies, and
community unawareness. Respondents believed that implementing national sexuality education
is a time-consuming project. They regarded Malaysian multicultural society as a barrier to
national sexuality education, and they believed that school-based sexuality education is not
easily accomplished in Malaysia; also abstinence-only policy restricts the access of young people
to accurate information. Lack of community involvement was perceived as a key concern to
sexuality education. Campaigning to promote awareness of families, teachers, community
leaders, and policy makers are recommended to help establishing national sexuality education
in Malaysia.

Keywords
adolescent health, health education, health care services, social determinants of health,
reproductive epidemiology

Introduction
Worldwide campaigns have been enhanced to distribute information and health care facilities for
sexuality health promotion and sexually transmitted infection/HIV/AIDS prevention. However,
these efforts have not resulted in completely satisfying achievements. Currently, regional trends
and mode of sexually transmitted infections have changed around the world, for example, about
half of the new HIV infections occur among young people in developing countries.1,2 The trend
toward high-risk behaviors among young people is alarming in Malaysia. Reports have revealed

1University of Malaya, Kuala Lumpur, Malaysia

2IranianNational Center of Addiction Studies (INCAS), Iranian Institute for Reduction of High-Risk Behaviors, Tehran
University of Medical Sciences, Tehran, Iran
3Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran

Corresponding Author:
Zahra Fazli Khalaf, Medical Education and Research Development Unit, Faculty of Medicine, University of Malaya,
50603, Kuala Lumpur, Malaysia.
Email: zahra.fazli@siswa.um.edu.my

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Fazli Khalaf et al 359

that 45% of all new HIV infections in Malaysia occur among people aged between 15 and 24
years.3 The rate of teenage pregnancies and the number of abandoned babies seem to be increas-
ing as well.4-6
Insufficient education is reported to be the primary reason for high-risk behaviors and trans-
mission of the HIV infection.1,7-10 Despite the existing data and evidence on increasing premarital
sexual practices among Malaysian young people,4,6,7,11-15 Malaysia lacks an implementation of
national sexuality education program.9 Although such programs have been considered as extra-
curricular educations for adolescents and young people by nongovernmental organizations
(NGOs) and international organizations, such as IPPF, UNFPA, UNAIDS, they are not sufficient
to provide a national sexuality education.1 While more than 60% of Malaysia’s population is
under the age of 35,16 lack of prevention programs will result in a health threatening situation
and, therefore, a drain on human resource in a large proportion of population.17,18
Recent reports have indicated that the implementation of a pilot project in some primary and
secondary schools of Malaysia, called “Social and Reproductive Health Education” (SRHE),9
can be considered as a primary step to implementation of a national sexuality education. However,
contradictory statements by some people in policy making positions have obscured the future
implementation of this program.
It seems that some existing issues and barriers hinder the implementation of national sexuality
education in Malaysia that have not been explored deeply in published data. This qualitative
research aimed to explore the perceptions of Malaysian key professional on issues and barriers
affecting the sexuality education in Malaysia.

Methods
Study Design and Site
Given the purpose of the study, as well as the fact that issues and barriers to implementation of
sexuality education in Malaysia have not been fully explored, we applied qualitative research as
the methodological approach for this study. Qualitative research seeks to uncover meanings and
places primary value in interpreting the reasons given by clients.19
The second author, as one of the well-known researchers and professionals in the study field,
helped in identifying the key informants. We explored the National Population and Family
Development Board of Malaysia, Ministry of Health of Malaysia, Ministry of Education of
Malaysia, NGOs, and international organizations based in Kuala Lumpur to identify the key
experts and professionals involved in youth sexuality health in Malaysia.

Study Population, Sampling, and Method of Data Collection

Fifteen key professionals participated in the study in 2011. Respondents included faculty mem-
bers, government officials, health providers, social scientists, health care system managers,
women rights activists, NGOs and international organization officials, youth group workers, and
theologians in the capital city of Kuala Lumpur. Each of them had been involved in various areas
of policy making, research, education, consulting, and advisory process of sexual and reproduc-
tive health education programs within the last decade in Malaysia (Table 1).
A purposeful sampling method was selected whereby a snowballing technique was employed
to identify the key professionals. Face-to-face interview technique consisting of open-ended
questions was adopted to collect the data pertinent to this study. The interview protocol was pre-
pared based on a literature review followed by a series of discussions among the research team
(Appendix). The first author carried out the interviews in English, and the interviews lasted
between 45 and 110 minutes. All interviews were audio-taped.

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360 Asia-Pacific Journal of Public Health 26(4)

Table 1.  Characteristics of the Participants.

No. Age Gender Position Organizational Affiliation

 1 44 Female Physician Ministry of Health of Malaysia
 2 46 Female Physician Ministry of Health of Malaysia
 3 48 Female Social scientist Ministry of Women, Family and Community
Development of Malaysia
 4 53 Male Ustaz (Islamic informant) A cultural center in Kuala Lumpur
 5 39 Male Counselor Ministry of Education of Malaysia
 6 44 Female Ustazah (Islamic informant) The Sisters in Islam Group (an Islamic group that
advocates for justice and women rights)
 7 52 Male Professor of population A public university
statistics
 8 47 Female Social worker United Nations Population Fund Malaysia
 9 33 Female Reproductive health United Nations Population Fund Malaysia
researcher
10 59 Female Health care informant International Federation of Planned Parenthood
Malaysia
11 32 Female Nurse, health educator A government-based health care clinic
12 47 Female Faculty member, specialized A public medical school and hospital
in HIV/AIDS
13 23 Male Counselor A government-based club for youth
14 21 Female Counselor A government-based club for youth
15 45 Female Lawyer A nongovernmental organization for women rights

Data Management and Analysis

All the audio files were transcribed verbatim by the interviewer. The transcripts were sent to the
research clients so that the members could check over the transcribed data. All text-based data
was edited and saved as text files to import into NVIVO Qualitative Data Management Software.
All qualitative data was coded and analyzed using NVIVO, Version 8, software.
The process of data analysis ran alongside the process of data collection.20 Thematic analysis
was used to extract meaningful themes from the transcripts. Concepts and incidents that seemed
to be related to the same phenomenon were grouped together under an assigned code.19,21 Then,
related codes were categorized and merged into broader themes that corresponded to issues and
barriers affecting the implementation of sexuality education in Malaysia.

Ethical Considerations
Ethics approval was obtained from the ethics committee of the University of Malaya Medical
Center. Prior to conducting the interviews, an information sheet describing the research objec-
tives and questions was sent to all participants. Written consent was obtained from the respon-
dents and confidentiality of data was assured. After transcribing and checking the data, all the
audio files were destroyed.

Results
Findings have been summarized in 5 major themes that present the professionals’ perspectives on
key issues and barriers facing the implementation of national sexuality education in Malaysia.

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Fazli Khalaf et al 361

Feasibility: Implementing National Sexuality Education Program as a Time-

Consuming Project
Key informants acknowledged that over the last decade policy and practices regarding sexuality
education have changed in Malaysia. They mentioned some pilots and projects that have been
implemented during the last decade, and also the government policy that has considered the
importance of implementation of a national sexuality education program. However, their evalu-
ations of the current policy making process were very varied, as were their opinions on the pro-
cedure of the education. Many of them believed that implementing a national sexuality education
program is a time-consuming effort and needs a long-term investigation and negotiation among
researchers, policy makers and educators. As an official from the ministry of Education stated,

We have already attempted many forums to look at the education systems, to look at the existing
curriculum, and the modules in the former education system. We are already doing that and we have
recommended on what messages should be put in the curriculum, in the modules teaching. We have
done that but it took a long time before it became a policy. The government said yes, let’s do it, it is
a policy. All teachers should be trained. There should be money for training, the text books should
change, and the content is challenging.

However, nongovernment activists who had been engaging in the program as well as researchers
and advisory teams believed that the process of implementing this program has become a pro-
longed action. As a respondent from nongovernment organization said, “Over 40 years now, we
don’t even have completed a comprehensive module for sexual education in schools. This method
has been role up again and again. There have been some pilots, but not comprehensive yet.”
Government’s slow pace on nationalizing sexuality education program indicates that there are
some issues and concerns at different levels of the program such as policy making process, financial
and human resources, and providing content of education that make it a time-consuming project.

Acceptability: Multicultural Society as a Barrier to National Sexuality Education

Beside the technical and official concerns, existence of different views on sexuality education
and sociocultural constraints play an important role in the implementation of a national sexuality
education. Since Malaysia is a multicultural society that consists of 3 main ethnic groups (Malay,
Chinese, and Indian) with different religions, cultures, and socioeconomic backgrounds, taking a
unified approach to sexuality education might challenge the sociocultural values of this popula-
tion. However, there have been several debates at various levels of policy makers; implementa-
tion of this program has been erratic due to moral and religious concerns.

For example, the Chinese community is expected to be more urban, modern, and educated. But
Malays are basically from the rural areas and this may be the first or second generation of urban
Malays that have come from the rural areas. They are Muslims and the biggest religious community
in Malaysia. So their standard and understanding about sexuality education for children is different,
there is a very big gap when the government tries to do a little sexuality education in schools, so all
sensitive matters should be observed. (Official manager of an NGO for sexual and reproductive
health)

Cultural constraints also influence the quality of sexuality education by restricting the distri-
bution of proper and accurate information. As an official of the Ministry of Health explained,

Some schools have provided some forms of sexuality education, but for them to teach school children
is a taboo. They try to teach them about using condom. In general, there is nobody to teach them
about how to use condom, they only say ‘use it’! That is why you see condom use failure.

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362 Asia-Pacific Journal of Public Health 26(4)

Although, all the respondents emphasized on implementing the sexuality education as a cru-
cial component of a preventive health care program, there was a great deal of concern regarding
the content of education due to sociocultural and religious constraints.

Accountability: School-Based (Curriculum-Based) Sexuality Education Is Not Easily

Accomplished in Malaysia
Respondents believed that the Ministry of Education will encounter difficulties in training teach-
ers, changing text books, and incorporating the subject in school curriculum, because the school
system has adapted to an established procedure that may resist changing.

It might be very difficult because the teachers adapted to kind of things for many years. Our school
system is based on examination and it is very pressurized on both teachers and students. And the
teachers are not equipped. (Official of the Ministry of Education)

On the other hand, school teachers as sexuality educators may delimitate the distribution of
accurate information due to existing traditional style of teacher–student relationship in Malaysian
schools.

When it comes to the integrity of real teaching about understanding of sexuality on relationship, on
sex, safe sex, and sexual responsibility aspects, this is the part that even teachers shy away from.
They are only able to teach in sciences or in what we call living skills, life skills, but the real rash text
of the sexuality education is not taught. Teachers are very conservative and very shy about teaching
this aspect, so the educator should be someone else out of school, such as nurses. (Official of an
international organization for family planning and reproductive health)

Many respondents insisted that the Ministry of Education should work hand in hand with
NGOs and the health care system and appoint professional sexuality educators and consultants in
schools to guarantee the progress of the program.

Strategies: Abstinence-Only Policy Does Not Work

According to the respondents, current presumption on sexuality education in Malaysia is based
on abstinence and avoidance of premarital sexual contact. There are serious concerns that sexual-
ity education might increase the premarital sexual behaviors among children and adolescents.
Such concerns about sexuality education may decrease the effectiveness of the program by
neglecting a considerable proportion of adolescents and young people who have already engaged
in premarital relationships.

I think, generally, premarital sex is on the rise, it is definitely more prevalent, and there is evidence
in research. Life style of the people change as we get modernized, and this one is very easily coming
in without family, parents and society realizing it. Premarital sex is definitely very frequent among
young people, so we should face the reality and teach them based on their current needs not just
superficial education. (Researcher of sexual health and official of a NGO for HIV/AIDS)

Another respondent believed that access to accurate information is a right for young people,
and the education content must provide all needed information.

In reality, we can’t rely on abstinence; you can say there are religious and cultural counts on things.
But everybody has the rights to choose, so you must give a range of information, a range of method,
a range of ways for them to choose, then from the education, they will choose the right choice. This

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Fazli Khalaf et al 363

is neglected when preparing the material for education. (Faculty member and consultant to sexuality
education program)

According to the respondents, there is a lack of awareness of proper perspective on sexuality edu-
cation among policy makers. While there is evidence of sexual activity among adolescents and young
people in published reports, policy makers still insist on abstinence-only sexuality education.

Community Unawareness: Lack of Community Involvement in Sexuality Education

According to the respondents, parents and families do not place importance on children’s sexual
development. They do not understand their children’s sexual needs or the need to educate them.
Respondents believed that there is a big gap between parents and health providers’ views on
sexuality education. Generally, Malaysian parents lack an awareness of their children’s sexual
behaviors and do not consider them as sexual beings and, therefore, do not share effective coop-
eration with policy makers in sexuality education program.

This is the biggest gap that we have in this country. Parents don’t understand the sexual needs of
children and adolescents; they don’t want to know about the sexual behavior of their children and
don’t talk to them about sex. They put the responsibility on schools, health care system, and . . .
(Official from the Ministry of Women, Family and Community Development)

Sexuality issues are regarded as negative matters in Malaysian society. Media and public dis-
courses mostly broadcast the criminal and illegal aspects of sexuality. Sexuality education and
sexual and reproductive health are not the area of interest of public media, so they do not play
effective role in informing community about the importance of such issues.

The media should give proper information to the public. But sometimes when they carry news on all these
things [sexual matters] become very negative. It is a negative think to the society. So, when something is
portrayed as so negative, all normal people don’t want to know about it. (A youth group worker)

The respondents agreed that broad change in public attitudes toward sexuality and reproduc-
tive health behaviors of youth is a prerequisite to providing them with desperately needed sexual
and reproductive health services.

Discussion
The professionals believed that current pace on implementation of national sexuality education
for young people in Malaysia is not satisfying. There are several issues and barriers that influence
the implementation of such a program.
The issue of content of education has been subject to great deal of debates in a number of
countries due to cultural and religious obligations,9,22 but in the case of Malaysia, it seems that
“the issue continues to be at an impasse.”9 According to the studies around the world, there is
strong evidence that sexuality education programs do not increase sexual practices; instead, some
programs have decreased the prevalence of premarital sex among young people.22-24
According to the recent review of policies and strategies to implement sexuality education in the
Asia Pacific region, “implementation of this policy has been erratic due to opposition from various
parties on moral and religious grounds in Malaysia.”9 This review implies that there is resistance
among religious groups against dissemination of information about sexual health. According to the
Islamic family law in Malaysia, Ulama (religious scholars) have taken authorities to speak on sex-
ual and reproductive health issues such as marriage, sexual behaviors, abortion, family planning,
and so on.25 While each state has its own religious council, interpretation and implementation of

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364 Asia-Pacific Journal of Public Health 26(4)

Islamic laws differ from state to state, thus creating a barrier to efforts by the federal government to
standardize a national policy on a sensitive issue such as sexuality education.
Providing accurate information for children and adolescents was emphasized by the key infor-
mants. The abstinence-only sexuality education that is supposed to be implemented in Malaysian
schools might limit the exchange of accurate information, be ineffective in reducing sexual risk-
taking behaviors,22,26,27 and threaten the fundamental human rights to health information.28
Since providing sexuality education is an issue of concern, if school teachers are not equipped
or interested in the program, the school system is recommended to appoint and train health care
providers (eg, nurses, midwives) for sexuality education; such a policy has been applied in sexu-
ality education programs of some countries such as Nigeria and Chile.29,30
The importance of parents’ involvement in sexuality education of children has been strongly
emphasized in various research.31 The expert respondents also believed that Malaysian parents
should take responsibility in sexuality education program, as they have the opportunity and abil-
ity to influence their children’s sexual behavior decisions.
NGOs have played an essential role in implementation of extracurricular sexuality education in
Malaysia within the last decades. At this juncture when the national sexuality education program
continues at an impasse, involving NGOs in the program and working hand in hand with policy
makers would help exchange the experiences and provide an extra potential for faster actions.
This study is not without its limitations. Our sample was limited to key informants of sexuality
and reproductive health in the capital city of Kuala Lumpur who had been involved in sexuality
education programs within the past decades. However, they were popular activists in this field in
Malaysia, and adding other informants from different areas could be helpful in providing more com-
prehensive data. Interviewing young people and parents could also help in identifying the gaps in
sexuality health education, which would be considered as another sample for future exploration.

Conclusions
Sexuality education in Malaysia suffers from several barriers and issues that have slackened the
implementation of a national program. Unawareness of the community and lack of its active
involvement in sexuality education are key areas of concern. The key informants recommended
campaigning to promote awareness of families, teachers, community leaders, religious authori-
ties, and policy makers to make the desired change in public opinion surrounding sexual and
reproductive health in order to help establishing a national sexuality education in Malaysia.

Appendix
Interview Guideline for Key Professionals

1. How do you describe the sexual understanding of young people in Malaysia? (Expected gender roles
in sexual relationship, expected sexual behaviors, premarital sex, rational and irrational beliefs,
sexual satisfaction, multi-partnership)
2. What is the current scenario on intimate/sexual relationship of young people in Malaysia?
(Probe: Dating patterns, courting behaviors, male and female differences in dating and courting
norms, pattern of sexual behaviors, premarital sex, sexual initiation age, level of sexual intimacy,
psychological pressure to have sex, sexual abuse, commercial sex, unsafe sex)
3. Is there any sexuality education implemented in Malaysia? What are your views on this? (Probe:
What are the pros and cons of having sexuality education, when should it be done, where and by
whom? And how do you think this will effect on sexual behaviors of young people in Malaysia?)
4. What are the roles of the various agencies in the sexual understanding and sexual behaviors of
young people in Malaysia? (1) Family and Friends, (2) NGOs, (3) government (eg, policies and
regulations), (4) school/universities (any sexuality education taught in school?), (5) religious
authorities, (6) media (Internet, pornography, etc)

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Fazli Khalaf et al 365

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article.

Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publi-
cation of this article: Financial support from the Health and Translational Medicine Research Cluster,
University of Malaya, Kuala Lumpur, Malaysia (Grant Number RG 248/10 HTM) is acknowledged.

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