SPHE Short Course
Consultation Paper 2013
Submission from
The Sexual Health Promotion Network
January 2014
1
1. Introduction
The Sexual Health Promotion Network (SHPN), comprising HSE Crisis Pregnancy
Programme staff and Health Promotions Officers with a remit for Sexual Health, was
established to co-ordinate HSE sexual health education and promotion activities and will play
a key role in the implementation of the National Sexual Health Strategy when published. This
submission sets out the views and concerns of the Network with regard to the draft SPHE
short course for Junior Cycle, with a specific focus on the learning outcomes relating to
sexuality and sexual health.
2. Relationships and Sexuality Education
Sexuality is an intrinsic part of what it is to be human and is fundamental to human health.1
Sexuality education is part of a more general education and affects the development of a
child’s personality. Its preventative nature not only contributes to the prevention of negative
consequences linked to sexuality, but can also improve quality of life, health and well-being.
In this way, sexuality education contributes to health promotion in general.2
“An effective school health programme can be one of the most cost-effective investments a
nation can make to simultaneously improve health and education”.3 In recognition of this,
there has been a long standing partnership between the Department of Education and Skills,
the Department of Health and the HSE which has focused on supporting the implementation
of Relationships and Sexuality Education in the context of Social and Personal Health
Education across the school system. Examples of joint work include the commissioning of
research and the development of the curriculum, of training and of teaching resources. At
Post Primary level, in addition to the need for the promotion of positive sexual health, this
partnership approach recognises the potential risks associated with sexual behavior in
adolescents that are primarily linked to the emotional and behavioural characteristics of this
developmental stage.
3. Adolescents, Sexual Behaviour and Sexual Health Improvements
Early sexual initiation has been linked with a range of negative health outcomes for young
people including regret at the timing of first sex, non-use of contraception and increased
likelihood of experiencing crisis pregnancy and sexually transmitted infections later in life.4
1
WHO (2006)
WHO Regional Office for Europe and BZgA (2010)
3
WHO (2013)
2
4
Layte et al. (2006)
2
In recent Irish research, 27% of 15-17 year olds report having had sex, a rate which,
compares favourably with those of other European countries.5 Indeed, the average age of
first sex in Ireland is 17, the legal age of consent, and this has remained stable over a 7 year
period.6
In addition, there has been a significant decline in the number of births to teenagers from
3,087 in 2001 to 1,639 in 2012. This equates to a decline in the teenage birth rate from 20
per thousand in 2001 to 12 per thousand in 2012.7,8 This is to be welcomed as teenage
pregnancy can pose a risk to the well-being of both the mother and the child; the mother
being at a greater risk of dropping out of education, of unemployment, of poverty and of
welfare dependence. All of these can have cumulative, negative impacts and are likely to
perpetuate intergenerational disadvantage. 9
Other recent indicators of improvement in relation to adolescent sexual health include:

The number of teenagers travelling to other jurisdictions for an abortion has halved.10

The number of births to teenagers has reduced by a third.11

Increased consistent use of contraception among 18 – 25 year olds.12,13

Increased uptake of methods of long acting reversible contraception among young adult
women.12, 13

Increased numbers of adults reporting that they received sex education in post primary
school.12, 13

Increase in numbers who report that the RSE they received was of a good quality.12, 13

Those who received RSE were 1.5 times more likely to use contraception at first sex than
those who did not.13
4. Proposed SPHE Curriculum and RSE
While it is difficult to scientifically link behavioural trends to specific causal factors, we
believe that the joint approach taken by Education and Health is likely to have been a
significant contributory factor to these positive developments. We also believe that the new
framework for Junior Cycle could be an opportunity to build on these successes and to further
5
Kelly et al. (2012)
McBride et al.( 2012)
7 CSO (2001)
8 CSO (2012)
9 Unicef (2013)
10 CPP stats generated from DoH UK abortion statistics reports
11 CPP stats generated from CSO Vital Statistics data
12 Rundle et al.(2004)
13 McBride et al (2012)
6
3
support the health, wellbeing and educational attainment of young people within the Irish
education system.
With this in mind, the SHPN has given careful consideration to the draft specification for the
Junior Cycle SPHE Short Course and in doing so, recognises that there are many potential
benefits for health and wellbeing. In particular, we welcome the continuing focus on the
development of the whole person and the inclusion of opportunities for creativity and
enterprise within the curriculum. We also welcome the opportunity afforded to schools to
develop relevant and engaging SPHE courses for their students which capitalise on the
expertise, enthusiasm and skills of trained SPHE teachers
However, the SPHN has strong concerns that these possible benefits will not be realised if
some fundamental issues relating to the proposed approach are not addressed; namely, a
required minimum, dedicated time commitment for the delivery of SPHE at Junior Cycle and
more specific reference to the key components of RSE. In the current format, there is no
required time commitment for those schools that do not choose the 180 hour short course
option and we fear that, for some students, this development will further erode their right to a
comprehensive education, in particular to the parts of RSE dealing with sex and sexuality. In
addition, without the support of detailed and specific guidance on content for SPHE teachers,
schools which have struggled with the implementation of the full RSE programme will have
even less incentive to improve. Furthermore, schools that are currently providing good levels
of RSE may be discouraged from doing so.
In relation to the specifics of the proposed National Council for Curriculum and Assessment
(NCCA) short-course, we note, with great concern, that learning outcomes relating to
sexuality and sexual health have been significantly reduced compared to the current
curriculum. There is no clear expression of sexuality and sexual health as holistic concepts
and contraception and STIs, amongst other topics, have been omitted. The SHPN believes
that it is important to note that this is not in keeping with the recommendations for the Junior
Cycle age group as set out by the WHO Standards for Sexuality Education in Europe.14 These
standards were developed by a group of experts with extensive theoretical and practical
experience in the field of sexuality education. The SPHN is concerned that the proposed
curriculum will result in significant gaps in the young people’s preparation for life.
14
WHO Regional Office for Europe and BZgA (2010)
4
5. Specific Comments on the Proposed Curriculum
The SHPN has some specific areas of concern regarding parts of the proposed curriculum,
these are outlined below:
Aim of the Short Course
The document for consultation states “This short course aims to develop students’ positive
sense of themselves and their physical, social, emotional and spiritual health and wellbeing. It
also aims to build young people’s capacity to develop and maintain healthy relationships”.
The SPHN notes that ‘sexual’ is omitted from the above listing of aspects of health, which is
a fundamental aspect of human health.
Strand 1: Being an Adolescent
Holistic Nature of Sexuality
The exploration and development of our sexuality involves looking at our relationship with
ourselves, with others and with the society in which we live. The RSE element of the
document would be strengthened by the inclusion of the definitions for sexuality and of
sexuality/sexual health.15 Learning Outcome 1.6 acknowledges the holistic nature of sexuality
but would further benefit from a direct reference to the fact that all humans are sexual beings
from the beginning to the end of their lives with associated needs and wants. These include
but are not restricted to those associated with sexual activity. 16 17
Strand 2: Sexuality and Sexual Health
Positioning of Sexuality and Sexual Health
Placing, ‘Sexuality and Sexual Health in Strand 2, in isolation from, ‘Special Relationships’
in Strand 3, is not conducive to encouraging health promoting decision-making and
behaviours within respectful relationships.
Use of Media, including Online and Social Media for Accessing Information and Interacting
Safely
‘Managing information and thinking’ is listed as a Key Skill but there is no associated
Learning Outcome, which details the need for critical analysis of information sources and
content. This is an essential skill in all areas of SPHE but particularly in relation to sexual
15
Ibid
WHO (2006)
17
WHO (2010)
16
5
health. In acknowledgement of the reality that information freely available on the internet in
relation to sexuality is often “distorted, unbalanced, unrealistic and often degrading,
particularly for women (internet pornography)”.18 The WHO sees the need to, “counteract
and correct misleading information and images conveyed through the media” as an essential
component of sexuality education.19 Added to this is the requirement for an outcome which
demonstrates students’ knowledge of the need for safe use of social media, an awareness of
the law in terms of what may and may not be posted online etc and the development of the
necessary, associated skills.
Safer Sex Practices, Contraception and STIs
There are no references in the proposed curriculum to safer sex practices, contraception or
sexually transmitted infections (STIs) in the Learning Outcomes. STIs are specifically
mentioned in the current SPHE curriculum for Junior Cycle and the decision to remove these
from the curriculum and to not include specific learning outcomes on protective behaviours
seems a regressive step.
This is particularly in light of the most recent data on STI
notifications in Ireland which reports that the majority of STI notifications in 2012 (over
70%) were to young adults under 30 years old; 11.3% being to young people aged 19 and
under.20 The HPV vaccination programme, which is offered to all 1st Year female students, is
one measure being taken to address this issue of STI transmission. However, this needs to be
accompanied by a parallel programme where students are educated in relation to STIs within
the wider concept of positive sexual health.
It is particularly vital that these topics are addressed within the Junior Cycle curriculum as,
for the majority of students who are not sexually active, initiating the discussions at an early
stage is a protective factor and is preparation for later life. For the significant minority who
are sexually active before 17, some of whom will be early school leavers, it is even more vital
that they receive timely access to relevant sexual health information, education and sexual
health services. Therefore, the SHPN is greatly concerned that the omission of specific
reference to safer sex practices, contraception and STIs may leave teachers and schools
feeling insufficiently supported or encouraged to cover these topics at Junior Cycle level.
The SPHN are concerned that a failure to cover these important health promoting areas would
reverse the excellent reductions that have been measured with regard to teenage pregnancy
and the increases regarding contraception usage among young adults.
18
19
20
WHO,(2010)
Ibid
HSE Health Protection Surveillance Centre (2013)
6
Alcohol, Substance Misuse and Relationship and Sexual Decision Making
There is a need for young people to explore the association between alcohol and substance
misuse and behaviours related to relationship and sexual health. The relationship between
alcohol and risky sexual behaviours is not always clear, however alcohol, in lowering
inhibitions, may reduce perception of risk which can result in earlier sexual debut, unplanned,
unprotected and regretted sexual activities and increased risk of sexual exploitation.
Age of Consent
The legal age of consent for sexual intercourse is not specifically mentioned and this is also
quite a significant omission. There is a common misconception among the public that the age
of consent is 16 (similar to the UK). Therefore it is important that young people are made
aware that the current legal age of consent in Ireland is 17 and that discussion in relation to
decision-making in relationships needs to take place within this context.
In addition to demonstrating assertive communication skills, there should be a reference to
the development of the skills involved in negotiating within a relationship including with
reference to the issues of consent and the practice of safer sex.
Crisis Pregnancy and Early Parenthood
There is no reference to Crisis Pregnancy and early parenthood. While specific learning
outcomes relating to pregnancy prevention are a key omission, so are learning outcomes
around fertility, teenage and unplanned pregnancy and young motherhood and fatherhood.
There have been reductions in the number of teenage women becoming pregnant in the past
number of years, however it is important that the school system addresses the education and
information needs of those who become pregnant and parents and provides all young people
with education and accurate information in this regard, as recommended by the WHO
standards.21
Gender
There is a strong need to include a consideration of the concept of gender and the associated
concepts of gender roles, gender expression and gender stereotyping and how they impact on
the students’ lives. The World Health Organisation states that “...societies are articulated and
regulated by a complex and pervasive set of rules and assumptions that permeate every aspect
of the society and the very construction of knowledge. The gender perspective has shown that
any consideration of human sexuality cannot be complete if it ignores the cultural concepts of
“masculinity” and “femininity”.22
21
WHO Regional Office for Europe and BZgA (2010).
22
PAHO and WHO (2000)
7
Sexual Orientation
While it is positive that sexual orientation is mentioned (2.12), it would also be important to
see a specific reference to the terms, Lesbian Gay and Bisexual and to see orientation
acknowledged within the relationships section rather than solely within Sexuality and Sexual
Health.
Gender Identity and Transgender
‘Gender identity’ and more specifically ‘Transgender’ are not mentioned in the Learning
Outcomes. This is a significant omission in the young people’s education generally and is
also unsupportive of Transgender young people and of the young people who have
Transgender family members. It should be rectified.
Strand 3
Title
We have a query in relation to the choice of the title ‘Team up’. It reads and sounds like an
instruction rather than a possible choice and appears out of step with the other titles
‘Relationship with Others’ would be a more accurate title
Special Relationships
Diverse family structures
Within the Special Relationships section, it would be useful to add a Learning Outcome in
relation to demonstrating an appreciation of the increasing diversity in relation to what
constitutes a family.
Love, Attraction and Desire
There is a need for young people to have a safe place to explore the concepts of love,
attraction and desire in order to have a clearer understanding of the feelings that may be
emerging and, therefore, be in a better position to make health promoting decisions.
8
6. Concluding Remarks
In conclusion, we strongly recommend that:

the NCCA specifies a minimum, dedicated SPHE time requirement for schools
which do not choose the 180 hour short course

within the short course, there is more specific reference to key sexual health topics
as set out in this document and in the WHO Standards for Sexuality Education in
Europe.

following the publication of the short course, the NCCA publish detailed guidance
to support teachers in the development of lessons in keeping with the overview
outlined.
9
References
CSO (2001). Annual Report on Vital Statistics. Dublin: Stationery Office
CSO (2012). Vital Statistics. Fourth Quarter and Yearly Summary. Dublin: Stationery Office
HSE Health Protection Surveillance Centre (2013). Trends in Sexually Transmitted
Infections in Ireland, 1995 – 2012. Dublin: HSE HPSC
Kelly, C., Gavin, A., Molcho, M. & Nic Gabhainn, S. (2012). The Irish Health Behaviours in
School-aged Children (HBSC) study 2010. Department of Health and National University of
Ireland, Galway
Layte, R., McGee, H., Quail, A., Rundle, K., Cousins, G., Donnelly, C., Mulcahy, F., Conroy,
R. (2006). The Irish Study of Sexual Health and Relationships. Dublin: Crisis Pregnancy
Agency and Department of Health and Children
McBride, O, Morgan, K and McGee, H. (2012). The Irish Contraception and Crisis
Pregnancy Study 2010 (ICCP-2010). Dublin: HSE Crisis Pregnancy Programme
PAHO and WHO (2000). Promotion of Sexual Health. Recommendations for Action, PAHO
and WHO
Rundle, K., Leigh, C., McGee,, H., & Layte, R. (2004). Irish Contraception and Crisis
Pregnancy (ICCP) Study. A Survey of the General Population. Dublin: Crisis Pregnancy
Agency
UNICEF (2013). Child Well Being in Rich Countries: A comparative overview. Innocenti
Report Card 11. Florence: UNICEF Office of Research
WHO (2006). Defining sexual health. Report of a technical consultation on sexual health, 2831 January 2002, Geneva. Geneva: WHO
WHO Regional Office for Europe and BZgA (2010). Standards for Sexuality Education in
Europe. A Framework for policy makers, educational and health authorities and specialists.
Cologne: Federal centre for Health Education, BZgA
10
Standards for Sexuality Education in Europe A framework for policy makers, educational and health authorities
and specialists (2010) WHO Regional Office for Europe and BZgA
Principles and outcomes of sexuality education
Holistic sexuality education should be based on the following principles.
1. Sexuality education is age-appropriate with regard to the young person’s level of development
and understanding, and culturally and socially responsive and gender-responsive. It corresponds to
the reality of young people’s lives.
2. Sexuality education is based on a (sexual and reproductive) human rights approach.
3. Sexuality education is based on a holistic concept of well-being, which includes health.
4. Sexuality education is firmly based on gender equality, self-determination and the acceptance
of diversity.
5. Sexuality education starts at birth.
6. Sexuality education has to be understood as a contribution towards a fair and compassionate
society by empowering individuals and communities.
7. Sexuality education is based on scientifically accurate information.
Sexuality education seeks the following outcomes:
1. To contribute to a social climate that is tolerant, open and respectful towards sexuality,
various lifestyles, attitudes and values.
2. To respect sexual diversity and gender differences and to be aware of sexual identity and
gender roles.
3. To empower people to make informed choices based on understanding, and acting responsibly
towards oneself and one’s partner.
4. To be aware of and have knowledge about the human body, its development and functions, in
particular regarding sexuality.
5. To be able to develop as a sexual being, meaning to learn to express feelings and needs, to
experience sexuality in a pleasurable manner and to develop one’s own gender roles and
sexual identity.
6. To have gained appropriate information about physical, cognitive, social, emotional and cultural
aspects of sexuality, contraception, prevention of STI and HIV and sexual coercion.
7. To have the necessary life skills to deal with all aspects of sexuality and relationships.
8. To have information about provision of and access to counselling and medical services, particularly
in the case of problems and questions related to sexuality.
9. To reflect on sexuality and diverse norms and values with regard to human rights in order to
develop one’s own critical attitudes.
10. To be able to build (sexual) relationships in which there is mutual understanding and respect
for one another’s needs and boundaries and to have equal relationships. This contributes to the
prevention of sexual abuse and violence.
11. To be able to communicate about sexuality, emotions and relationships and have the necessary
language to do so.
11
An extract from the World Health Organisation’s (2010), matrix
outlining appropriate topics for the Junior Cycle Age Group
12
13