Education on Sexual and Reproductive Health Within the Context of European Policy: A Literature Review
ABSTRACT Δίγλωσσο Τεύχος Introduction: The initiation of sexual activity in early age, the increasing percentages of teenage pregnancies, the abortions, the HIV/AIDS infection and he Sexual Transmitted Diseases (STD’s) are some of the factors that have a negative effect on young people’s sexual health in contemporary years (UNAIDS, 2004). Sexual and reproductive health is affected and formed through specific cultural frameworks, such as religion and family. Aim: The aim of this article is the review of the data in Greece and in Cyprus, in relation to sexual and reproductive health and education, in the bases of the European Union policies on this matter. Methodology: The methodology included the review of research studies and documents referring to the Greek and Cypriot data, related to the sexual and reproductive health and education through the European Union policy. Methods were based on literature review in the data bases of MEDLINE and CINAHL (1990-2009). Conclusion: The recent methodology of health education does not aim to the plain acquire of knowledge, but it aims to the development of skills intending to the adoption of positive behavior, which advocates and promotes health through the active and synergic learning and experiences. Educators and health professionals through teaching and daily practice have the opportunity to transfer knowledge and reform attitudes and behaviors relatively to the sexual and reproductive health. Both in Greece and in Cyprus, students in secondary education are taught different aspects of sexuality education in the context of their school programs. The European Parliament and the European Council have passed several directives highlighting the necessity of sexuality education, underlying a wide field of knowledge and learning.
Hellenic Journal of Nursing Science
Education on Sexual and Reproductive Health Within the
Context of European Policy:A Literature Review
C Ch hr ri is st ti ia an na a K Ko ou ut ta a, , P Ph hD D, , M Ms sc c, , B Bs sc c, , D Di ip pl l. .N N. ., , R RN N
Lecturer, Department of Nursing, School of Health Sciences
Cyprus University of Technology
M Ma ar ri ia a A At th ha an na as so op po ou ul lo ou u, , M MS Sc c, , B Bs sc c, , R RN N
Nurse, General-Lying in Hospital “Elena Venizelou
I In nt tr ro od du uc ct tiio on n:: The initiation of sexual activity in early age, the increasing percentages of teenage
pregnancies, the abortions, the HIV/AIDS infection and he Sexual Transmitted Diseases (STD’s) are some
of the factors that have a negative effect on young people’s sexual health in contemporary years (UNAIDS,
2004). Sexual and reproductive health is affected and formed through specific cultural frameworks, such
as religion and family.
A Aiim m:: The aim of this article is the review of the data in Greece and in Cyprus, in relation to sexual and
reproductive health and education, in the bases of the European Union policies on this matter.
M Me et th ho od do ollo og gy y:: The methodology included the review of research studies and documents referring to the
Greek and Cypriot data, related to the sexual and reproductive health and education through the
European Union policy. Methods were based on literature review in the data bases of MEDLINE and
C Co on nc cllu us siio on n:: The recent methodology of health education does not aim to the plain acquire of knowledge,
but it aims to the development of skills intending to the adoption of positive behavior, which advocates
and promotes health through the active and synergic learning and experiences. Educators and health
professionals through teaching and daily practice have the opportunity to transfer knowledge and reform
attitudes and behaviors relatively to the sexual and reproductive health. Both in Greece and in Cyprus,
students in secondary education are taught different aspects of sexuality education in the context of their
school programs. The European Parliament and the European Council have passed several directives
highlighting the necessity of sexuality education, underlying a wide field of knowledge and learning.
K Ke ey y w wo or rd ds s:: Sexual and reproductive health, education, European policy
Worldwide,sexuality education has been and still is a topic
very often discussed. It which consists of many dimensions,
such as the content, the time frame, the teaching methods,
the efficiency of the teachers, the appropriate age to begin
According to the European Directive 1567/ 2003 article 3,
teenagers have the right for “…a sufficient access to
information, training and… services in relation to sexual
and reproductive life…”. A multidimensional approach
seems to be essential due to the different factors that
contribute to the social and personal development for
dealing with issues such as HIV/ AIDS and unwanted
pregnancies. This approach should not deviate from the
existing socio-cultural infrastructure of each country;
neither can ignore the rights and responsibilities of young
people regarding sexual and reproductive health matters.
In Europe, 25% of teenagers they are sexually active at age
15 old,while this in the United States comes to 50% (Knerr,
2006;Warren et al,1998).In Cyprus,the average age for the
initiation of sexual activity is 16 years (Youth Organization
and Institute of Reproductive Medicine, 2006) and in
Greece is about 15-16 years of age (Youth Health Unit,
2009).Today,the initiation of sexual activity at early age,the
increasing percentages of teenage pregnancies, the
abortions, the HIV/ AIDS and the STD’s are some of the
factors that negatively influence youth’s sexual health
Volume 02 • Issue 02
According to the World Health Organization (WHO,2002),
sexuality is a dominant meaning of human existence
throughout life and includes gender roles, sexual orientation,
satisfaction, sexual relations and reproduction. Sexual and
reproductive health requires a positive approach,
characterized by respect for the meaning of sexuality and
sexual relationships, as well as the potential for pleasant and
safe experiences without coercion, discrimination and
Sexuality education, behaviour and sexuality itself (e.g.
initiation of sexual intercourse, are formed within a cultural
framework of each society and is influence by social values
and religious beliefs (Bonell et al, 2006). Further, family and
peers play an essential role in the development and
expression of attitudes and beliefs related to sexuality, while
research has shown that sexuality education may reduce risky
sexual behaviour (Aspy et al,2006;Wight et al,2002).In some
Scandinavian countries, parents seem to be more mature in
openly discussing sexuality issues with their children, rather
than in other countries,such as England or Greece.It appears
that young people in those countries are more informed and
prepared to make mature choices in their sexual life; the
initiation of sexual activity is prolonged and they have safer
sexual intercourse (McCafferty,2007).
Sexuality education is not limited in providing knowledge
about STD’s or contraception; it is a life long learning that
includes sexuality the relations and feelings related to the
sexual experience. It approaches sexuality as a normal,
natural, inseparable and positive part of life and that exist in
all stages of development and existence (Kavga- Paltoglou,
2008). Sexuality education should promote the gender
equality,self-esteem and respect for sexual and reproductive
In refer to sexuality education programs Kirby et al (2007)
stated that their effectiveness depends on the investigation of
educational needs and on their appropriate planning. An
effective sexuality education ‘course’,one can take in account
the knowledge, the attitude and the behavior that young
people adopt towards different sexual matters,such as sexual
relations and contraception (WHO, 2003). Ιn Greece and
Cyprus, students in secondary education, are taught some
sexuality matters within the context of their school program.
In these ‘courses’ the students are informed and discuss
topics like: sexual development, reproduction, contraception
interpersonal relations.This “new” knowledge seems to be
essential and be a base for young people in order to adopt
responsible lifestyle behaviors, ways of thinking and skills in
relation to sexual health (Davou and Sourtzi,2009).
Sexual Health and Education
The European dimension on education has to be
approached in the context of the wider Community
educational policy, as a factor that contributes to the
development of the Community and the establishment of a
uniform European conscience. In practice, the term is
directly related to the educational dimension. It is
establishment the theoretical framework of the
Community’s educational policy in the everyday practice at
school and health settings.Consequently,the essence of the
European dimension has to be correlated to the teaching
principles and the pedagogic methods; it has to be
combined and integrated within educational curricula;it has
to be promoted through books and literature and finally it
has to become part of continuous education for teachers
and health professionals (Danassis-Afentakis, 2003).
The European Union Directive 1567/ 2003 among other
• The freedom of all persons to have access to
information, education and services for teenagers.
• The support of heath policy and programmes on
sexual and reproductive health.
• The continuous provision and availability in low prices
of acceptable methods of contraception and
protection from STD’s, HIV/ AIDS
• The right for safe termination of pregnancy and the
opportunity to have counseling before and after.
• The training on family planning.
• The education on gender equality in relation to the
sexual relations behavior such as responsibilities.
The European Parliament and the European Council
clearly highlighted the necessity of sexuality education and
determine a wide leaning framework.
Moore and Rienzo (2000) suggested a more specific
context for sexuality education:
1.Human development (e.g. anatomy, physiology,
adolescence, body image, sexual identity).
2.Relations (e.g. family, love, marriage, dating).
3. Personal skills, Values (e.g. negotiation, decision-
4.Sexual behavior (e.g.masturbation,celibacy,phantasy).
5. Sexual health (e.g. contraception, abortion, violence).
6.Culture and Society (e.g. legislation, religion, mass
These suggestions seem to promote a more holistic
approach of sexuality education. They combine different
parameters, viewing adolescents as a bio- psycho- socio-
European politics gives certain directives, however, it is
the discretion of each country in what way and/or degree
will be included and applied in the context of their society
Sexual Education and European Policy Here
Hellenic Journal of Nursing Science
Almost in every European country, sexuality education
has been introduced in the school programs as an
obligatory or an optional ‘course’. In the countries that are
more progressive, such as Holland and Sweden, sexuality
education begins at the nursery school and continues at
primary school, while is taught multi-thematically.
It is important to mention that in the educational
procedure includes peer education and parent education
(Moore, 2000). In England, despite that the sexuality
education is applied multi-thematically, it seems there is no
holistic and/or systematic teaching approach. Probably, that
explains the existence of high percentages of abortions.
Further, the same problems may be seen in other
countries, where sexuality education is limited or
fragmentary or consciously focused on specific areas/topics.
In Romania for example, there is enough theoretical
knowledge mainly related to risky behavior. In Russia,
education is focused on topics primarily concern the
women (e.g. pregnancy, menstruation) and not sexual
relations between genders.In some countries the social and
religion beliefs create resistance that obstructs and
complicates objective education on sexuality (e.g. Poland,
Ireland) (Okun, 2000).
Sexual Education in other countries
Abortion [EU 2001/2128 (INI)]
In Greece the termination of pregnancy is under the law
1609/86 “Medical termination of pregnancy for the
protection of woman’s health”. Abortion is legal until the
12th week of pregnancy with the consent of the woman.
Between the 12th and the 20th week of pregnancy,
abortions are allowed only if special medical reasons exist in
national health system hospitals. In Cyprus, abortion is
permitted under certain circumstances (e.g. medical
reasons; Abortion law 1986, article 169A). In the public
hospitals is more difficult to be performed, mainly due to
socio-cultural reasons and stigmatization. In cases of rapes,
the police is obliged to have a medical (forensic) report a
long with a medical testimonial.Abortion is forbidden by the
Public Health [EU 2001/2128 (INI)]
In Cyprus there is no official public health service of
immediate help and support for young people, regarding
their sexual and reproductive health. Family Planning
Association is very active; however is a non-governmental
organization. In Greece, Family Planning is recognized as a
civil right in the national health system by the law 1397/83,in
which it is defined that is the exclusive responsible
institution for providing such services (Sourtzi, 2006).
Sexuality Education [EU 89/C 3/01; 2001/2128 (INI)]
In Cyprus, there is no legal or obligatory form of
sexuality education, however it does exist in health
education programs since 1992.In Greece,health education
was legally established at primary and secondary education:
“In primary and secondary educational institutions, health
education programs are implemented, that consist of the
curriculum and include specific teaching material and
activities, are applied…” (article 7, law 2817/ FEK 78/14-3-
2000).The health education curricula have been approved
by the corresponding departments of the Pedagogic
Institute and are implemented in the schools with a Minister
decision 2/6006/7-11-2001 and F11.2/818/78436/G1/25-7-2002
Circulars and the G2/43520/FEK/543/T. B’/ 1-5-2002.
Legislation related to the sexual and reproductive health in Greece and in Cyprus
Adolescents’ education and training on sexual health,
target at shaping a safer and healthier behavior, using
appropriate teaching methods, providing knowledge and
awareness regarding sexual behavior and practice.The recent
methodology of health education is not consisted of simply
providing informing and knowledge, but it refers to the
development of skills for adopting positive lifestyle and
behaviour that advocate and promotes health. Health
education is practiced by scientists regardless their
specialization, on the bases that they have comprehend its
fundamental meanings and principles (Kalokairinou and
Sexuality education in its wider meaning raises the issue of
access to the special youth services (information and service)
and especially deprived communities/groups regarding sexual
and reproductive health rights.
Abortion has not yet been legalized in many countries.
Even where is permitted,the administrative formalities create
an obstacle for many women.In some cases in many countries,
very strict time limit exists for the termination of pregnancies
and consequently this particular right is of no value in practice.
It seems extremely important to ensure the right and
possibility of proving information and referral to young people
to the appropriate support services, when is necessary.
Consequently, those involved with sexuality education
become a pressure group for the creation of such structures.
Educators and health professional through teaching role
and everyday practice, have the opportunity to shape
attitudes and behaviors. It is necessary to adopt a
comprehensive strategy within the educational and health
care system,through continuous education programs.
Sexuality education programs consist of scheduled
activities based on the needs assessment,the experiences and
the potential risks for the young people that are referring to.
They intend to the reinforcement of positive forms of
behavior and the prevention from influences or changes that
Volume 02 • Issue 02
imply an unhealthy life style.The programmes are based on
different theories (educational,sociological,health) aiming at
the formation and the alteration of behavior.Relatively to the
sexuality education, the teaching of mechanisms avoiding
psychological pressure by social or other factors is of prime
The modernization of books, the awareness and the
acquirement of skills of the teachers and health professionals
are essential. Sexuality education presupposes continuous,
evolutionary and responsible information, beginning at the
first years of one’s life and demands an interdisciplinary
collaboration in the educational system and in the wider
community (Vidaliaki et al.,1990).
The ultimate target of sexuality education is the
promotion of sexual and reproductive health, especially of
youth,and the prevention of unwanted pregnancies with all
the psycho-social and physiological effects they may result in.
taking advantage the possibility of prevention,this consist the
safest method.Young people with knowledge,self confidence
and positive sexual choices, promote their sexual and
reproductive health today and in the future (Danassis-
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behaviour on Lyceum students in relation to relations and
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