Oyun Lkhagvasuren, Health Education Project, Mongolia
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Mongolia, located between China and Russia, is a country with a unique
history and rich culture. As you can see from the map, our land
territory is large, but the total population is only 2.4 million.
Twenty-five percent are adolescents aged 10-19. Because our country was
once part of the socialist system, we have a centralized public
education system. Consequently, school enrollment is high, and the
population is highly literate. But, as in many cultures, discussion of
sexuality was taboo in Mongolia for centuries. With the collapse of the
socialist system, Mongolia has been experiencing changes in its
political, economic, social, and cultural structures.
Sexuality Education in Mongolia: Reflections about Training EducatorsOne of the changes has been a dramatic increase in sexual activity among adolescents, which has led to increased numbers of sexually transmitted infections and unwanted pregnancies, as well as a heightened risk of HIV. When the Ministry of Health became aware of the health problems facing Mongolia's youth, it stepped forward to respond to this problem by proposing sexuality education as a mandatory component of health education in the school setting.
Every Child, Every School, Every Year: The Government Mandates Sexuality Education in Mongolia
To begin this new program, we partnered with the Ministries of Education and Finance, and reached out to international reproductive health and sexuality organizations. Since Mongolia has a centralized public education system, universal implementation of a sexuality education program seemed feasible. Moreover, many Mongolians lead a nomadic existence and send their children to schools, making them an important institution in our culture. Yet we had a lot of work to do to change the minds of some representatives within the Education Ministry, who initially thought sexuality education would promote promiscuity. We invited these skeptics to our training, introduced them to the concept of comprehensive sexuality education, and shared with them our thoughts on how we would implement the program. We also listened carefully to their suggestions and tried to build a partnership with them. As a matter of fact, one particular individual who wasn't fond of the program at the beginning turned out to be one of our strongest supporters and advocates. Once the policymakers from the Education, Health, and Finance ministries had agreed to include sexuality education in school curricula, it was only a matter of time and resources before we started it. Perhaps we haven't experienced any serious ideological fuss about introducing sex education because most Mongolians practice Buddhism, not Christianity.
Investing in Local Capacity-Building and Locally Developed Curricula
In 1997-1998, the Mongolian government made a wise agreement, in my opinion, with UNFPA: instead of translating and adapting sexuality education curricula from other countries, as is often done, they decided to invest in training a team of national experts in human sexuality. The technical advice for this program was provided by Margaret Sanger International. The idea was that these national experts would design and develop our own sexuality education curricula, prepare and conduct training programs for teachers, and develop teacher and student manuals. I brought these textbooks with me today, and although they are in Mongolian, I am sure the pictures will help you to understand the key messages.
Effective Training of Sexuality Educators: Lessons Learned in Mongolia
We've learned through our experience that there is no shortcut in developing a successful, sustainable sexuality education program. And since sexuality educators are the key players in implementing the program, we needed to invest a lot of time and resources in their training.
Four key issues needed to be addressed during this training: recognition that the topic is complex; introduction of interactive teaching methods, development of teacher comfort with the topic, and exploration of teachers' own values and beliefs.
1. Complexity of Topic
Teaching sexuality is complicated by the fact that for our lessons to be effective they need to address multiple areas of learning. Often we don't realize the breadth of sexuality as a topic. Sexuality spans many disciplines, from psychology and sociology to medicine. It is not enough for teachers to just teach the scientific facts. They also need to address the related social and emotional concerns, as well as the topic's practical implications. Teachers not only have to be comfortable teaching physiology and anatomy, they must also be ready to address complicated topics like love and gender. And they need to work with students to develop complex communication skills, such as negotiation or refusals.
Let me give you an example. When looking at the menstrual cycle, students will first have to learn about the physiology of the female body. However, they also need to evaluate common sociocultural beliefs regarding menstruation. In Mongolia, for example, there is a widespread belief that menstruation is bad blood coming out of the body. Students need to think through whether or not this is true and why. Finally, students will have to learn how to handle the effects of menstruation on their everyday lives. This might include teaching girls about care during menstruation, how to keep a menstrual calendar, and how to manage their new fertility.
2. Interactive, Learner-centered Teaching Methods
We decided to adopt interactive teaching methods. We understood that they would help students reexamine their values and change their behaviors by allowing them to try out new ones in a safe environment. Students also learn facts more effectively this way, through thinking and analysis.
However, these methods were new to Mongolia and required practice to master. They demand that the teacher take an active role in guiding the students toward information, as well as helping them to think critically about their opinions and attitudes. Inexperienced teachers often have trouble using the new methods at first.
Here is an example of a role-play teaching assertive communication. A boy asks a girl out on a date. The girl is supposed to tell him directly, but kindly, that she's not interested in him romantically. Commonly, students would offer excuses like, "I have to study for a test tomorrow" instead of expressing their feelings directly. Inexperienced teachers will often say, "Thank you. Next group."
Only through supervised practice time in our training have we been able to coach the teachers to understand that they need to recognize the mistakes of the students on the spot and challenge them by asking questions like, "Was that assertive? Why not? Could you do it again more assertively?"
3. Developing Teacher Comfort with the Topic
In Mongolia, talking about, let alone teaching, sexuality is considered taboo. For example, after the first year of health education, we went to the countryside to do an evaluation of the program. In talking with the teachers (who at that time had not yet been trained), we learned that most of them felt uncomfortable teaching reproductive health and sexuality. In one extreme case, a teacher who was supposed to teach about reproductive anatomy was so embarrassed that she simply opened the teacher's book to the page with the diagrams and left the classroom, leaving the students to figure out the lesson by themselves.
Time needs to be spent in training on desensitizing the teachers. In order to develop comfort with talking about anatomy, we do a lot of activities that require the participants to use the correct names of organs and to remember their functions. Useful exercises include building models of the reproductive system and explaining how it works, or engaging in fun activities that require the participants to say the names of organs repeatedly. These kinds of activities force participants to focus on the exercise itself rather than on the content, and soon they find themselves talking easily and naturally about what was previously taboo.
4. Exploring Teachers' Own Values and Beliefs
Teachers have to examine their own views and beliefs during training. This way, they learn how to keep them out of the classroom and allow students to explore their own values freely. For example, a student might ask, "What do you think about abortion?" Untrained teachers might not realize that they should NOT give their own opinion about abortion. Learning to draw a variety of opinions from the students and explore the range of views that exist in any society, however, takes time and training. Teachers must come to know their biases before they can successfully keep them out of class discussions.
Having gone through the initial training for national experts myself, I can say that the process of reassessing your own long-held beliefs in the face of new information is difficult and time-consuming. During our training we were exposed to a lot of new information and many new ideas. Sometimes it took much discussion and thought over a period of weeks or months to absorb what we were learning. A good example is discussion about gender roles. In my heart and soul, I know that I do respect men more then women because my culture taught me that men are superior, wiser, and smarter. And yet, in my head, I am questioning this because it's not always true. We can see intellectually that women should be able to do the same things as men. But we are still working, even today, to believe that it is really okay for a woman to initiate a relationship with a man.
The process of exploring one's own beliefs is slow but important, and we realized while training the teachers that we need to be both patient and persistent. They, too, would be exploring values, feelings, and attitudes that they had left unquestioned for 25, 30, or 40 years.
I have tried to provide a brief overview of our sexuality education program. I would like to leave you with the thought that through the exciting process of implementing sexuality education in Mongolia, we have come to understand that sexuality is an essential part of every person's life. Sexuality is not only about disease or pregnancy prevention, but rather it is about much broader and deeper issues essential to living whole and fulfilling lives. We can't underestimate the importance of teaching our children about sexuality to ensure their health and wellbeing. They will use the knowledge and skills throughout their lives. Therefore it's crucial to invest in their teachers' training. If attention is given to the needs of teachers and an adequate training program is developed, implementation of a sexuality education program is not only possible and rewarding, but also invaluable to our children.
This speech was part of Adolescents at the Crossroads, a panel presentation on adolescent sexuality education organized by IWHC in cooperation with Aahung (Pakistan), Action Health Incorporated (Nigeria), the Youth Coalition, the United Nations Population Fund, the World Health Organization, and the World Bank, during the UN General Assembly Special Session on Children (May 8-10, 2002).