UN agencies and professional medical associations unite to build support and resist attacks on Integrative Sexuality Education
Dr Venkatraman Chandra-Mouli
Eight years into the era of the Sustainable Development Goals, there is strong global support for many areas of Sexual and Reproductive Health and Rights (SRHR), including addressing maternal mortality, reducing unintended pregnancies among married couples, and eliminating violence against women. women and girls. In some other areas, however, there is highly visible, better-organized, and better-organized opposition to many aspects of Sexual and Reproductive Health and Rights, including the provision of comprehensive sexuality education (CSE) to children and adolescents, the provision of safe abortion care, and recognition and responding to the health needs and rights of people with diverse sexual orientations, gender identities, gender expressions and gender characteristics.
WHO is working with partners inside and outside the United Nations system to counter this resistance with good science. An example of this is the WHO’s response to a report entitled ‘Reviewing the evidence for CSE in schools’ published in 2019 by the US-based Institute for Research and Evaluation (IRE), which analyzed 43 studies on school RCTs conducted outside the US and concluded to be ineffective. IRE and its partners, such as Family Watch International, disseminated the report and presented it to governments and civil society actors inside and outside the US, challenging the UN’s extensive body of research and evidence on supporting the effectiveness of CSE and threatening the progress made in this area.
In a detailed re-analysis of the IRE report published in the journal Sexual and Reproductive Health MattersVan Treeck and colleagues concluded by commenting:Overall, our reanalysis reveals that the IRE review suffers from significant methodological flaws and contains several errors that compromise its conclusions about the CSE. Our reanalysis is a tool for the international community to counter CSE opposition campaigns based on bad science.In a supplemental commentary in the Journal of Adolescent Health, she and her co-authors went a step further:At best, our findings indicated that the IRE analysis lacks the necessary rigor to inform any recommendations regarding CSE planning. and worse, the report deliberately downplays the effectiveness of CSE interventions to support the authors’ ideologically driven anti-CSE stance.”
The IRE report is part of a campaign of better resourced, better organized and ambitious disinformation and opposition. In many countries, local resistance has led to reduced content and weak CSE performance. Just in the last couple of years, this has become bolder, more and more aggressive. This is evident from what happened at the WHO Executive Board and the World Health Assembly in 2022. A coalition of countries fought tooth and nail to oppose the inclusion of the term CSE in the organization’s HIV, STI and hepatitis B strategy. It took an alliance of countries to come together in the latest minutes of the World Health Assembly to crush the attack. The unprecedented battle for it is described in an article on the Health Policy Watch blog.
In the spring of 2023, The Telegraph published a series of attacks on the content of CSE schooling in the UK. These articles included sharp attacks on the WHO, mainly for the WHO EURO-Federal Center for Health Promotion Standards published in 2010: The articles and social media reactions about it, spread to other countries far and near.
In collaboration with the communication unit in the Office of the Director-General and the WHO European Office, as well as technical and communication professionals in UNESCO, UNFPA and UNAIDS, the WHO Division of Sexual and Reproductive Health and Research, which includes the co-funded Human Reproduction, developed a list of Questions & Answers for the CSE: Comprehensive sexuality education (who.int); created a video message on the high-profile platform Science in Five: https://youtu.be/wAp1EsqPb7I?si=umVCUzoBGGNHfWp6; actively updated on social media: and reached out to reporters with facts and figures to correct misinformation. In the last week of August 2023, HRP convened a meeting of UN agencies – UNFPA, UNESCO, UNAIDS, UN Women and WHO as a first step in developing a UN approach to building support and overcoming resistance to sexual and reproductive health health and rights.
WHO had already worked with partners inside and outside the United Nations system through the Global Cooperation Forum on CSE to counter disinformation about CSE: Global Collaborative Forum on Comprehensive Sexuality Education (unesco.org). To extend this support, WHO reached out to parliamentarians, through its long-standing engagement with the Inter-Parliamentary Union: Finding common ground in a connected world: MPs prioritize comprehensive sexuality education (CSE) (who.int). To further expand the support base for CSE, WHO approached global professional medical associations to ask them to provide statements of support for CSE. Five associations immediately responded with statements of support, including the World Association for Sexual Health, the International Association for Adolescent Health, the International Federation of Pediatrics and Adolescent Gynecology, the International Pediatric Association and the International Federation of Obstetricians and Gynaecologists:
At the 26th Conference of the World Association for Sexual Health (November 2-5, Antalya, Turkey) representatives of these professional associations gathered in a special session with UN agencies – UNFPA, UNESCO and WHO – to share their statements and discuss how to could be used to help build support and understanding for the CSE within the membership of these associations and beyond. This was followed by presentations from England (remote), India and Zambia on how professional medical associations and other civil society actors are committed to building support and overcoming resistance to the CSE.
Following the WAS conference, medical professional associations and UN agencies continued their discussions and agreed on a five-point action plan:
- To prepare a joint commentary by IPA, IAAH, FIGO, FIGJI and WAS – for submission to the WHO Bulletin or other appropriate high-profile global journal
- Translate statements of support so that they are available in all six UN languages (English, French, Spanish, Arabic, Chinese and Russian) and in Hindi and Portuguese
- Post the statements of support on the UNFPA-UNESCO and WHO Collaborative Forum websites, in easily accessible formats, so that organizations working in the CSE can use them in their advocacy work. (And as Jon Klein suggests, ensuring that organizations can also access other advocacy materials)
- Develop a plan to approach other influential global associations such as the International AIDS Society and the International Council of Nurses for statements of support
- To explore how country-level advocacy efforts could be aligned with ongoing efforts, e.g. from the Partnership for Maternal, Newborn and Child Health, the Rotary International Task Force on Maternal and Child Reproductive Health and others.
There is progress on each of these issues. An exciting area of development is the decision of Rotary International’s Reproductive Maternal and Child Health Task Force to work with UN agencies and professional medical associations in selected countries, through Rotary International’s national chapters, to stimulate dialogue in country level for the CSE.
In August 2023, Dr. Venkatraman Chandra-Mouli retired from the World Health Organization after working for the organization for 30 years. She continues to work on adolescent sexual and reproductive health.
Dr. Venkatraman Chandra-Mouli
