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Abstract

Sex education has been found to be associated with informed sexual decision making and enhanced sexual well-being. But in Pakistan, sex education has been remained a subject of taboo and stigma and has been associated with a number of myths. This article tries to discuss the current state of sex education in Pakistan by justifying the need for the sex education and uncovering the factors responsible for the non-implementation of sex education on mass level in Pakistan. Two major factors considered responsible for a lack of implementation of sex education are several myths associated with the sex education and portrayal of sex education as fundamentally non-Islamic. This article analyzes the scientific validity of several myths associated with the sex education and proposes that sex education is not against the Islamic traditions and values. The sex education needs to be embedded in existing cultural and educational setup of Pakistan so that it may be accepted. This study highlights the comprehensive nature of United Nations Educational, Scientific and Cultural Organization (UNESCO) guidelines in the development and implementation of sex education and explores the implementation of sex education under the umbrella of Life Skills Based Education (LSBE) developed by the School Education and Literacy Department of Government of Sindh. This article further proposes steps to implement LSBE on mass level by involving parents, religious leaders, teachers, provincial education boards, and universities. It is further suggested that LSBE should be delivered as part of traditional educational system in a step by step manner and should be in accordance with the cultural norms of Pakistan.

Keywords

Sex education sexuality behavior sexuality education Pakistan

Why Sex Education Is Needed in Specific Context of Pakistan?

Around one-fourth of Pakistan’s population consists of adolescents and young adults according to Sixth Population and Housing Census.¹ In Pakistan, adolescents become sexually active without having scientific sexual information because sex education has traditionally been considered a taboo.² Even, parents find it difficult to talk to their children regarding sexuality due to taboo and shame associated with sexuality education. The adolescents and young adults get sex education from their peers or friends which is often nonscientific and does not provide any benefit rather increases the chances of engaging in certain dangerous behaviors as well such as unsafe intercourse and unsafe abortion. Interestingly, adolescents and young adults now turn to Internet for getting sex education which in most cases contains nonscientific views related to different aspects of human sexuality. On the other hand, there are unwanted teenage pregnancies, abortions, sexually transmitted infections (STIs) including human immunodeficiency virus (HIV), and incidents of rape in Pakistan which have grown significantly in the past years.^3-4 All these factors point toward a dire need to impart sex education to adolescents and young adults especially.

In Pakistan, the adolescents do not have sufficient scientific information to understand their transition from childhood to adulthood, thereby, making it hard for them to comprehend the sexual development changes.⁵ In Pakistan, parents are often considered the only source of sexual education but adolescents especially the females find it difficult to talk to their parents for sexuality-related matters due to cultural taboos.^6-8 The traditional institutions like parents and teachers often do not provide adequate sexuality-related information to adolescents in Pakistan.^7,9 Given such scenario, the sexuality information accessed by adolescents is often nonscientific, stereotypic, and exploitative.^7,10 Similar situation is also present in other Muslim majority countries like Malaysia¹¹ and Iran¹² where it is not permissible for young adults to talk about sexual matters. Given the context of nonavailability of sex education and taboo around it, the chances of developing unexpected pregnancies, and STIs including HIV become manifold.⁷

Lack of sex education has serious repercussions for Pakistani boys and girls. The boys consider masturbation as sinful as often told by peer groups and girls consider self-pleasuring a sin like boys do. Similarly, the lack of sex education often results in poor hygienic habits during menstrual cycles. The emotional and psychological changes occurring during puberty often have a deep psychological impact on adolescents. In the absence of sex education and formal support, these emotional changes lead to psychological problems like depression and suicide.^13-14 Sexual abuse is an increasing issue both for boys and girls in Pakistan that is due to lack of sex education besides the role of media and Internet.^7,14 In cases of sexual abuse, perpetrators were found to be acquaintances or relatives of the children and victims were found ignorant of necessary skills to guard themselves against such assaults.^3,15 There is evidence that sex education can reduce the number of child sexual abuse cases, unwanted pregnancies, and HIV infections.¹⁶ Moreover, the lack of sex education has often been cited as one of the biggest etiological factors in the development of nonorganic sexual dysfunctions, difficulties, and STIs in Pakistani young adults.^4,17-18

A study conducted in 2012 estimated the prevalence of abortions to be 2.2 million in Pakistan. The study further asserted that abortion rate stood at 50 per 1000 women.¹⁹ These figures are quite alarming in a country where abortion is considered illegal yet the country have such huge figures. The provision of sex education could easily have resulted in less abortion rates by providing people with knowledge of safe sex practices.⁴ Another study found that a vast majority of men suffering from STIs had poor knowledge regarding these infections.²⁰ This clearly reiterates that sex education should be made compulsory part of educational programs in Pakistan. Moreover, the focus on making sex education a compulsory component of education would help to improve the overall socioeconomic condition of masses better; thus, it would help lower poverty levels and would provide more employment opportunities.²

What Sex Education Is? Components, Characteristics, and Benefits of Sex Education

Sex education can be defined as comprehensive sexuality education (CSE) which encompasses discussion of cognitive, emotional, physical, and social aspects of human sexuality.²¹ According to United Nations Educational, Scientific and Cultural Organization (UNESCO) guidelines, sexuality education should be imparted for the healthy development and well-being of adolescents and young adults. The main aim of sex education is to equip adolescents and young adults with knowledge and skills so that they may function well in emotional and sexual spheres and could enhance their overall well-being.²²

Components of Sex Education

The components of sex education can be grouped under eight modules:

Module 1: Relationships, love, and family, long-term commitment and parenting

Module 2: Values, human rights, culture, and society with regard to sexuality

Module 3: Gender, norms, stereotyping, gender equality, gender-based violence

Module 4: Interpersonal space and violence, consent and privacy, body integrity

Module 5: Norms and peer influence on sexual decision making, sexual communication and assertiveness, finding help, and support in sexual matters

Module 6: Sexual and reproductive anatomy and physiology, puberty, body image

Module 7: Sexual life cycle, sexual response, and sexual difficulties

Module 8: Reproduction, pregnancy, family planning, HIV/AIDS prevention, STIs

Characteristics of Sex Education

The UNESCO guidelines further stress the following characteristics of sex education²²:

Scientifically accurate and based on evidence

Sex education based on human rights approach

Incremental and progressing gradually

Sex education based on gender equality

Age and developmentally appropriate

Culturally relevant and norm appropriate

Curriculum based

Transformative and inclusive

Comprehensive covering all aspects of human sexuality step wise

Should help develop life skills so that individuals may make informed and appropriate decision making

It is to be noted that Sindh School Education and Literacy Department (SE&LD) developed a culturally relevant and Pakistan appropriate curriculum for the provision of sex education in schools of the province. The comprehensive components of sex education were covered under seven units to be implemented in Sindh schools which targeted at providing rights-based inclusive and age and culturally appropriate education to adolescents.²³

Benefits of Sex Education

Sex education is becoming more important in the current digital age when the adolescents have access to the Internet. When parents or teachers do not give proper sex education to adolescents, they turn to peers or Internet and chances of getting wrong information and engaging in nonhealthy sexual behaviors such as unsafe intercourse become high. Sex education reduces the chances of engaging in risky sexual behaviors such as unprotected sexual intercourse.²⁴

Sex education can benefit adolescents against the negative impact of pornography. The adolescents may develop unrealistic beliefs in the absence of sex education which in turn lower their self-esteem and they become victim of self-blaming. They may turn to drugs as well to boost their self-esteem.

Sex education not only provides knowledge and information about sexual health, rather it prepares adolescents to form relationships with realistic goals and expectations. Such relationships are long lasting and adolescents do not become victim of promiscuity.²⁵

Being aware about one’s body and sexual activity equips oneself to fight off the dangers of sexual abuse. In Pakistan, pedophilia is increasing at an alarming rate.²⁶ Sex education can guard against the odds of sexual abuse.

The provision of sex education to masses will equip them with the updated scientific knowledge regarding safe sex practices and birth control strategies. This will help Pakistan greatly as Pakistan is currently facing the problem of huge population that is increasing at an unprecedented rate.^2,4

Why Sex Education Could Not Be Implemented in Pakistan?

Sex education is denied to adolescents in Pakistan on the pretext that they would develop premarital sexual relationships which is against the fabric of Pakistani society.^7,27 The parents and other elder agents of our society consistently fail to understand that their children will eventually learn about sexuality through other means that are often inaccurate and nonscientific as well.²⁸ In a study with Pakistani adolescents, majority were found to use Internet as a source of sexuality-related information because of ease in accessing Internet.⁷ In fact, the resistance against sex education in Pakistan is based on some common myths which are outlined below:

Sex education is pornographic in nature and would teach our kids obscenity and they would start having premarital sexual affairs.

Sex education has its origin in Western thought and ideology. Majority of the Pakistanis view Western content as inappropriate and repugnant to Pakistani moral values. Majority Pakistanis believe that we do not have issues like single teen pregnancies so we do not need sex education.

Sex education will not be beneficial for men as they do not get raped. This notion is presented as Pakistan is a patriarchal society.

Sex education is just irrelevant and has no medical and societal benefits.

Sex education would make our kids addicted to sexual activity.

Sex education is not right for kids. Obviously, they would get it after being married.²⁸

All of these myths do not have their bases in scientific medical knowledge, so they are dangerous for the young people in particular. The relationship of lack of sex education and belief in sexuality-related myths is circular; belief in the common myths represents lack of sex education which then leads to further strengthen the belief in the common myths⁴ Sex education consists of scientific information, knowledge, and a set of practical skills designed for making one’s sexual life comfortable²⁹ and maintaining overall well-being.³⁰ Sex education, in fact, delays the onset of first sexual activity.²⁴

A recent study with young married Pakistani men revealed that majority of them believed in sexuality myths and had wrong information about sexual activity. All of those men suffered from psychogenic erectile dysfunction. They were treated with psychosexual education in addition to other techniques as part of treatment plan to resolve their issue of psychogenic erectile dysfunction. The results were promising, all men improved significantly in response to psychosexual education and therapy.¹⁷ Similarly, another study with Pakistani men reported that psychosexual education-based therapy was effective at maintaining the improvement in symptoms of erectile dysfunction later at 15–18 months follow-up.³¹

A study was conducted with 188 young men visiting an outpatient department of a large hospital in Karachi Pakistan. Thirty-one and sixty-three percent of the respondents believed that masturbation could lead to physical illnesses and to weakness. Sixty-nine percent of the respondents reported feeling guilty about masturbation. Similarly, 32% of the respondents felt guilt about nocturnal emissions.³² On the other hand, female respondents also found to have little knowledge and misconceptions regarding sexuality.³³ The situation is still same as measured by a more recent study conducted by Bashir et al.⁷ Majority of female respondents had little knowledge about menstruation, pregnancy, and HIV infection. This situation can clearly document the lack of sex education in Pakistan.

Sex education is often debunked in Pakistani society on the pretext of being un-Islamic. The reality is on the contrary. There is nothing un-Islamic about having sex education. In fact, the Islamic sources such as Quran give detailed information relating to sexual matters. For example, it is stated in Quran, “You are allowed intercourse at night with your wives during the month of fasting. They are as intimate for you as your own clothes, and vice versa” (Quran 2:187).³⁴ Rather, Islam values the age appropriate provision of sexuality education as Quran places a strong emphasis on acquiring knowledge, “Are those who know equal to those who do not know”? (Quran 39: 9).³⁴ This is also evident from the life history of Prophet Muhammad (PBUH) where both men and women did not get shy and used to ask any question related to human sexuality.²⁷ Another Hadith was, “Blessed are the women of the Helpers, their modesty did not stand in the way of their seeking knowledge about their religion” (Prophet Muhammad - Bukhari and Muslim). Moreover, there is a practical difference in believing in Islamic principles and living one’s life according to Islamic principles. Islam teaches and encourages the practice of chastity and prohibits premarital and extramarital sexual activity in order to stop the occurrence of unplanned pregnancy, and STIs. Interestingly, there are a considerable number of young males in Pakistan who engage themselves in premarital sex, although it is considered a major sin in Islam.³⁵ Moreover, the statistics of unplanned pregnancies, unsafe abortions, and STIs necessitates the implementation of sex education in Pakistan.⁴ Accordingly, sex education is difficult to implement in Pakistan due to the taboo and stigma it carries which is embedded in cultural practices of the region. Unfortunately, the cultural taboo and stigma are often attributed to the Islamic doctrines. Islamic doctrines do not prohibit the provision or implementation of sex education according to its sources; hence, the general public needs to be taught the legitimacy and acceptance of sex education in Islamic ideology in order to make the sex education acceptable in the society.²⁷ Besides, the lack of political will, political and economic instability, lack of capacity and issues over the constitutional power to implement the education policies remained as barriers in the implementation of sex education in Pakistan.^2,23

Recommendations and Policy Implications in Specific Context of Pakistan

Given the conservative nature of Pakistani society, it is advisable not to discuss and spread sex education openly. It should be embedded in the educational and family structures of the Pakistan so that people may accept it. Although some sexuality topics are taught in biology class in schools, those do not provide a full authentic information to the adolescents. The sex education should be tailored to the history, culture, and religion of Pakistan. The Western model of provision of sex education cannot work in Pakistan.

The starting point is to teach kids the names of genital organs just as we do teach them about other parts of the body.¹⁴ The kids may be given appropriate information in response to question, “where have we come from”? Providing kids with these little pieces of information satisfies their curiosities and does not lead them to negative sources as well. Surprisingly, sex education is not resisted by adolescents of Pakistan rather they want it to be implemented at community levels so that they may develop understanding of changes occurring in their bodies during adolescence.^4,7

As sex education is a culturally sensitive and taboo topic in Pakistan, a more gradual and careful approach is needed which could sensitize people in a gradual manner. For this purpose, medical doctors may be appropriately trained to impart such information at the community level.^32,36

For imparting sex education, the following hierarchies of organizations may be mobilized:

Family (parents)

Teachers including religious teachers. Enlightened religious scholars need to be given the task as to assist ministry of education to develop curriculum for sex education keeping in view the religious teachings and cultural sensitivity of Pakistani society so that sex education may not get any resistance while being introduced at various educational levels.

Governmental bodies including ministry of education and curriculum and ministry of family planning may be engaged in implementing sex education through different sources and programs. In this regard, the School Education and Literacy Department (SE&LD) of Government of Sindh province developed policy guidelines for the integration of components of sex education into Life Skills Based Education (LSBE) to make it culturally and religiously appropriate (School Education & Literacy Department, (n.d.). These components and guidelines had been developed by adapting the “Its All One Curriculum” developed by the Population Council.³⁷ It is to be noted that these components need to be tested on pilot basis before being implemented from ages 11 to 18 years. It is pertinent to mention that generally parents in Pakistan admit their children at very young age in to the educational system; therefore, age limit should be the criteria rather than grade for the implementation of sex education.

The role of Rutgers WPF in this regard cannot be understated as they worked in close collaboration with provincial governments of Punjab and Sindh to implement sex education as integrated into LSBE from 2004 to 2013. During this period, the elements of sex education under the title of LSBE were taught to 312807 students in 1188 schools.³⁶ This project could not be expanded to more schools because of backlash against the components of sex education by the general public and Islamic scholars.²

Unfortunately, the same efforts could not be initiated by other provinces. In Pakistan after the 18^th Amendment in Constitution, Education has become a provincial matter to be decided by the provincial Assemblies. In this context, all provincial education textbook boards and provincial education boards need to develop a mechanism to introduce and implement sex education in the respective province.² So, initially, the involvement of universities in this regard may be appropriate to run and spread the program.

Keeping in mind the divide in political opinion regarding the implementation of sex education in Pakistan, universities may be involved in the pilot testing of the project of development and implementation of sex education as universities in Pakistan are autonomous bodies and do have their own statutory bodies for recommendations of curriculum. For instance, universities may introduce a compulsory course entitled Life Skills Based Education (LSBE) where few components of sex education may be added. For the purpose, trained teachers should be assigned the task to teach those components to university level BS (Hons) students. Initially, the project may be run as a pilot program by few public sector universities so that difficulties and problems regarding the implementation of the program could be identified. Only then, it could be scaled up.

For implementing the LSBE, information, behavioral skills, and motivation-based model known as IBM may be followed.³⁸ This model entails imparting specific sexuality-related information and knowledge, developing and assessing the motivation for the implementation and learning of sex education, and specific behavioral skills for the sex education program.

The teens and young adults should be provided sex education through bibliographic-based sources. In this context, a book “Sex Education for Muslims” authored by Dr. Syed Mubeen Akhtar is a forward step in making the people learn scientific knowledge about sexuality.³⁹ As more and more people now turn to electronic sources to learn about different aspects of life and education, so a specific channel may be started by governmental bodies where specific portions of this book should be shared with the community in shape of “shorts” taught by trained teachers.

Conclusion

The increased incidence of unwanted pregnancies, unsafe and illegal abortions, STIs, and HIV infections emphasize the need for the implementation of LSBE across the board for adolescents and young adults in Pakistan⁴⁰ which can not only make them gain scientific knowledge but also equip them with practical skills for the success in their sexual and family relationships. For the implementation of LSBE in Pakistan, all stakeholders including parents, teachers, religious leaders, and provincial government institutions including universities need to work in close collaboration to formulate age and culture appropriate contents of sexuality education.²⁹

Footnotes

CRediT Author Statement

AB and BL were involved in conception and design, revision of the article, and final approval. AB acquired data, analyzed, and interpreted data. AB helped in drafting of the article. BL was involved in supervision.

Declaration of Conflicting Interests

The authors declare that there is no conflict of interest regarding the publication of this article.

Ethical Approval

Not applicable.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

Informed Consent

Not applicable.

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