Professional Documents
Culture Documents
Abstract
Background: We aimed to assess what is already known about sexuality education (SE)-related policy or practical
issues using review methods to search and critically appraise the existing SE approaches targeting children under age
12 yr.
Methods: We completed the data collection by an extensive search of the English and Persian published and unpub-
lished literature, evidence from experts in the topic, and by searching citations. The MeSH-terms were sexuality and
training, sexuality education and programs or approaches, sexuality and children, sexuality education and parents, sex
or sexuality education, sex education and parents or caregivers. A systematic search of medical and health-related da-
tabases, the Cochrane Library and Web of Science was undertaken for the years 1970–2015 together with citation
searching, reference list checking and recommendations from stakeholders to identify evidence for SE.
Results: According to the inclusion criteria, 20 documents were identified. They were synthesized into three main
categories as sexuality-related knowledge, attitudes, and parents‘ skills to manage children's sexual behavior and related
education. Employed approaches to children's sexuality were reported to be effective in developing healthy sexual be-
havior in children. Education was identified as the primary focus of the included packages and guidelines. Parents
were recognized as first line educators in SE. However, interventions aiming to improve parents' skills in SE for child-
ren were limited. In other words, developing skills in parents, and their competency in children‘s sexual behavior man-
agement were not specified in the existing programs.
Conclusion: Parents‘ skill-building must be the focus of SE programs in order to address children' sexual develop-
ment goals.
Introduction
Sexuality has physical, social, cultural and psycho- ual behavior is the result of a deeper and more
logical dimensions and sexual development is complex process called ―sexual socialization‖ (2-
part of human being‘s life. This dimension, as the 5). In other words, sexual behaviors are not only
other aspects of human development, begins at influenced by biological factors, but they also be-
birth reflected in one‘s sexual behaviors (1). Sex- come complicated through sexual socialization.
Children‘s sexual behaviors are strongly influ- selves against sexuality-related risks (24), enjoy
enced by children's age and by how they have sex in adulthood, and get prepared for a healthy
been socialized. Children‘s sexual socialization is and intimate interpersonal interaction (25, 26).
affected by the family and society‘s belief and Using comprehensive programs and appropriate
their function with respect to sexual matters (6- strategies for educating children on sexuality
9). seems to be essential (27, 28). Cultural influences
Sexual socialization is a process through which may alter the efficiency of any educational pro-
children acquire the essential beliefs, attitudes, grams (29, 30). This review aimed to assess what
values, cultural symbols, concepts and meanings is already known about SE-related policy or prac-
on sexuality (10, 11). In fact, identity formation, tice issue, by using systematic review methods to
role of sex, sexual skills and knowledge acquisi- search and critically appraise the existing SE ap-
tion, and development of sexual attitudes are proaches targeting children under age 12.
achieved in this process (12). Family, as the first
social group those children belong to from the Methods
early years of their lives; is considered the first
and the most important factor effective in child- In order to complete this review within a very
ren‘s sexual socialization (10, 11). Children ac- short time-frame, rapid review methods were
quire their knowledge, skills, and behavior from used to ensure the efficient identification and
home, school and society, and the skills they gain synthesis of the most relevant evidence. The fol-
can change their future (13). Therefore, SE by lowing keywords were used for search: sexuality
parents, as one of the main components of sexual training, sexuality education, sex education, sex-
socialization, is one of the best strategies for ual health, skill building, guidelines, packages, and
children‘s sexual health promotion (14, 15). children. Medical Subject Headings (MeSH) were
Sexual behaviors are common in children and also used. The terms included sexuality education
more than 50% of children get involved in differ- and program or approach, sexuality and children,
ent types of sexual behaviors before the age of 13 sexuality education and parents, sex or sexuality
(16). Like other age groups, children need good education, sex education and parents or caregiv-
care, supervision, and education during their sex- ers. A systematic search of medical and health-
ual development, and their main caregivers are related databases MEDLINE, EMBASE,
their first line educators (17,18). PubMed, Cumulative Index to Nursing and Al-
Parents are children‘s first and foremost teachers lied Health Literature (CINAHL), The Cochrane
in the field of sexuality. Most parents have not Library and Web of Science, Scopus, Google
received such education and when it comes to scholar, SID, Magiran, and Iranmedex was un-
SE, they tend to assign to schools what they dertaken for the years 1970–2015 together with
themselves are not willing to do (15). citation searching, reference list checking and
In Iran, the majority of parents are not well edu- recommendations from stakeholders to identify
cated with regard to sexuality-related issues. In evidence for SE. The rationale for limiting the
addition, there is no school-based sexual health review to 1970–2015 was that sex education for
education (19). As a result, it‘s hard and fearful children was originated from the Western socie-
for parents to engage their children in conversa- ties. Many American kindergartens started to im-
tions about sexuality (18). plement sexuality education curriculum since
Despite the importance of parents‘ role in SE, 1960s, and Sweden implemented sex education
they are not adequately prepared to communicate for all children and adolescents since 1970 (25).
about sexual issues (20-23). They are mainly una- We also searched key organizations and associa-
ble to manage properly their children's sexual be- tions including WHO, UNICEF UNAIDS and
haviors. Parents lack the adequate skills in em- Ministry of Health in countries such as Canada,
powering their young children to protect them-
Australia, the U.S., and Iran as well as active as- fied into three main categories based on sexuali-
sociations in the field of sexual health for child- ty-related knowledge, attitude, and skill (Table 1).
ren. In cases where the reported results were in- Employed approaches to children's sexuality were
complete, the authors were contacted and asked reported to be effective in developing healthy
for further details. The articles and gray docu- sexual behavior in children. Education was iden-
ments were assessed based on the inclusion and tified as the primary focus of the included pack-
exclusion criteria. ages and guidelines. Parents were recognized as
Inclusion criteria were studied design (articles, first line educators in SEs. However, approaches
gray documents, packages and guidelines intro- regarding improving parents' skills in SE for
duced in the field of SE); outcomes; and popula- children were limited in number. In other words,
tion (children aged 0-12); and interventions (de- skill-building approaches targeting parents, and
signed to improve child sexual development parents‘ competency in children‘s sexual behavior
through the provision of relevant knowledge, management were not specified in the existing
attitude, and skills of parents). Studies published programs.
in English and Persian was included in the study. - Knowledge: provides accurate information
We excluded programs targeted at the adolescent about human sexuality, including growth and de-
and the elderly. Duplicate publications of the velopment, reproductive system, normal sexual
same study and articles available only in abstract behavior, childbirth.
form were also excluded. Studies that met the - Attitude: offers opportunities for identification
inclusion criteria were critically appraised to as- of values, beliefs and culture (personal, family,
sess their quality. Guideline Evaluation Tool (38) friends, and community).
was used to assess study quality. This tool as- - Skill: promotes the acquisition of skills in rela-
sesses concepts and topics covered (human de- tion to competency in children‘s sexual behavior
velopment, relationships, personal skills, sexual management, impact on children‘s moral growth
behavior, sexual health, society and culture), ac- and development, the ability to make healthy de-
curacy and relevance (information is scientifically cisions, self-confidence, and sense of comfort
accurate; information is up-to-date; information with oneself and one‘s body, understanding of
is presented in a way that appeals to young children‘s normal sexual behaviors, appropriate
people; information, graphics, and materials response to children‘s sexual questions, identifi-
represent target populations). cation and reporting of child sexual abuse.
Two reviewers separately screened the search re-
sults for inclusion using a predefined inclusion Discussion
criteria form. The guidelines and packages con-
Although valuable and effective packages and
tents were evaluated based on their applications
guidelines in relation to SE for children were
in improving parents‘ knowledge, attitudes and
found in this review, feasibility, and possibility of
skills in SE and sexual behavior management for
their usage in accordance with the Iranian culture
children under 12 yr of age.
was in question.
Ethics Committee of Shahroud University of
Although cultural influences may alter the effi-
Medical Sciences approved this review with the
ciency of any given educational program, the ma-
ethical code of IR.SHMU.REC.2015.48.
jority of the included packages and guidelines
Results agree on 1) parents‘ role in SE; 2) education as
the primary focus of SE; 3) parents as the prima-
ry sexuality educators; 4) attention to the values
Of 1243 studies initially identified, after some
and culture of every society in SE for children; 5)
exclusion, 20 studies from different regions of
effectiveness of the educational programs in
the world were included in our as study shown in
children's sexuality.
(Fig. 1). The packages and guidelines were classi-
However, approaches to improving parents' prac- teachers (Table 1). For instance, teachers‘ role in
tical skills in SE for children were limited. In oth- children's sexual health promotion is undeniable,
er words, parents' competency in their children‘s and teachers can play an important role in pro-
sexual behavior management in day-to-day prac- moting sexual health (56) and formal school-
tice was not the focus of attention in these pro- based education can help parents acquire' the re-
grams. lated skills and knowledge (28, 57-59).
Some packages and guidelines were designed for Some packages and guidelines have been de-
parents (Table1). There is widespread agreement signed for parents and professionals (Table 1).
that parents are children‘s first and foremost edu- Professionals work in the area of promotion of
cators and that they play a central role in the de- sexual health and education; in particular, curricu-
velopment, growth, and management of child- lum and program planners, and educators in and
ren's sexual behaviors (50-52). out of a school setting, policy-makers, and health
This agreement can be found in several studies care practitioners. For parents who support the
and guidelines such as Bersamin et al. (53); Vi- implementation of a comprehensive SE program,
dourek (54); Goldman (55); Sexual Development the quality of SE for their children will improve
and Behavior in Children Information for Par- (60). Parents are given information and know-
ents and Caregivers (35), International Technical ledge in this field by professionals in order to ac-
Guidance of Sexuality Volume II (36), Guidelines quire the essential knowledge (61, 62) since par-
for Comprehensive Sexuality Education 3RD edi- ents does not have access to the appropriate re-
tor kindergarten through 12th Grade (38). sources (63, 64). Many resources pay attention to
In addition to parents‘ prominent role, some parents‘ role as sexual educators, emphasize edu-
packages and guidelines were found targeting at cation of parents by professionals as the first
sexual health promotion strategy for children (25, children's' sexuality must be the focus of SE pro-
44, 59), and focus on provision of educational grams. Children' sexual development goals will be
materials for enhancing knowledge, so that adults achieved if their first line educations become
can easily talk to their children (44, 65) and de- skillful.
stroy barriers of negative attitude towards SE for General principles of these packages and guide-
children (60). lines have generalizability and usability for other
In educational packages and guidelines, attention countries such as Iran but some details of these
to the values and culture of every society in SE packages and guidelines need to be repaired and
for children has been emphasized, and this has modified according to the culture of each coun-
been the strength of these programs. The influ- try. The implications of these findings for inter-
ence of parents' attitudes has extended well into vention design and development and further re-
all stages of life (53-55, 13). Sexuality is strongly search are discussed.
influenced by family and community norms. As
the sexual socialization of children, takes place Ethical considerations
first at home and then in the society, the role of
culture and family values is very substantial and Ethical issues (Including plagiarism, informed
overshadows children‘s sexuality (12, 21). consent, misconduct, data fabrication and/or fal-
Many of these programs were related to devel- sification, double publication and/or submission,
oped countries where SE for children is widely redundancy, etc.) have been completely observed
recognized (25), yet it remains unacceptable in by the authors.
some countries, and Iran is not an exception.
There is a lack of agreement on SE for children Acknowledgements
in Iran like other conservative societies. In devel-
oped countries, children receive formal and in- This study is a section of PhD thesis. The au-
formal education by parents, school, and profes- thors would like to acknowledge and thank the
sionals; yet despite Iran's progress in sexual and Research Deputy of Shahroud University of
reproduction health and its movement toward Medical Sciences for its financial support of this
healthy communities as defined by WHO (2004), study.
a formal comprehensive SE for children does not
exist (18, 66). Conflict of Interests
This study has some limitations as most of the The authors declare that there is no conflict of
packages and guidelines found in this review were interest.
stated theoretically. In other words, they were not
based on experimental studies. References
Conclusion 1. National Sexual Violence Resource Center (2013).
Sexual Assault awareness. An overview of
The findings in this review emphasized the im- healthy childhood sexual.
portance of SE for children. All programs focus http://www.nsvrc.org/sites/default/files/saam
on children‘s sexual growth and development. _2013_an-overview-of-healthy-childhood-
sexual-development.pdf
Synthesis of the findings reveals that skill- 2. Fourcroy JL (2006). Customs, culture and tradition
building targeting parents are not practically spe- what role do they play in a woman's sexuality. J
cified throughout the studies, packages or guide- Sex Med, 3(6):954-9.
lines. A possible explanation is that SE needs to 3. Shirpak K (2013). Sexuality in human and sexual health.
be contextualized through a given society. Build- Tehran, Iran: Arjmand Publication, p: 105.
ing skills for parents in management of their 4. Anarfi JK, Owusu AY (2011). The making of a
sexual being in Ghana: The state, religion and
education with young people. Cult Health Sex, 39. Children and Young People‘s Services Devon
12(4): 359-371. County Council, Devon Public Health Forum
30. Anonymous (2013). Talking to your preschool (2007). Sexual development in primary aged
children about sexuality Parent Package 6 years children.
old and younger. http://www.frfp.ca/parents- http://www.devon.gov.uk/sexual_deg_for_we
resources/parent-education/sexuality/talking- bsitebook.pdf
to-preschoolers-about-sexuality.pdf 40. The Children‘s Assessment Center in Grand
31. Walsh JT, Australia W, Australia W (2011). Talk Rapids, Michigan. Children‘s sexual Behavior
Soon. Talk Often: A Guide for Parents Talking and body safety a Guide for Parents.
to Their Kids about Sex. http://www.tncac.org/documents/3-child-
http://healthywa.wa.gov.au/~/media/Files/H sexual-behavior.pdf
ealthyWA/Original/Sexual- 41. Who Regional Office For Europe and BZgA
health/TSTO_V2.ashx (2010). Standards For Sexuality Education in
32. Fairfax County, Department of Family Services European. http://www.bzga-
(2007). Understanding the Sexual behaviors of whocc.de/en/publications/standards-in-
young children A Guide for parents and sexuality-education/
professionals. 42. Public Health Agency of Canada (2003). Canadian
http://www.fairfaxcounty.gov/dfs/pdf/cyf/se Guide lines for sexual Health Education.
xualbehaviorschildren_eng.pdf http://sexedu.org.tw/guidelines-eng.pdf
33. Anonymous (2013). Talking to your children about 43. Hyde A, Carney M, Drennan J, et al (2009). Parents'
Sexuality Parent Package 7-12 years old. approaches to educating their pre-adolescent
http://docplayer.net/32105804-Talking-to- and adolescent children about sexuality: Crisis
your-children-about-sexuality-parent-package-7- Pregnancy Agency.
12-years-old.html http://www.crisispregnancy.ie/wp-
34. Child Sexual Abuse Committee of the National content/uploads/2013/04/21.-
Child Traumatic Stress Network (2009). Sexual Parents%E2%80%99-Approaches-to-
Development and behavior in children Educating-their-Pre-adolescent-and-Adolescent-
information for parents and caregivers. Children-about-Sexuality.pdf
http://nctsn.org/nctsn_assets/pdfs/caring/sex 44. The University of Tennessee (2005). Keeping kids
ualdevelopmentandbehavior.pdf safe:
35. United Nations Educational, Scientific and cultural http://tennessee.gov/assets/entities/humanser
organization (2009). International Technical vices/attachments/keeping_kids_safe_content_
Guidance of Sexuality Volume II. updated_wdraft_cover.pdf
http://data.unaids.org/pub/externaldocument/ 45. Anonymous (2003). Raising Healthy kids Families
2009/20091210_international_guidance_sexuali talk about sexual Health For parents of young
ty_education_vol_2_en.pdf children.
36. Anonymous (2013). Children‘s sexual behaviors a http://www.advocatesforyouth.org/publication
parent‘s guide. s/publications-a-z/365-raising-healthy-kids-
https://www.princeedwardisland.ca/sites/defa families-talk-about-sexual-health
ult/files/publications/childrens_sexual_behavio 46. Planned Parenthood Federation of America (2017).
urs_2015.pdf What should I teach my high school-aged teen
37. Sexuality Information and Education Council of about sex and sexuality?
the United States (2004). Guide lines for https://www.plannedparenthood.org/learn/pa
comprehensive sexuality Education 3RD editor rents/high-school/what-should-i-teach-my-
kindergarten through 12thGrade. high-school-aged-teen-about-sex-and-sexua
http://sexedu.org.tw/guideline.pdf 47. Anonymous (2009). Talking with your child about
38. Gossart M (2002). There’s No place like home sex sexual and well-being.
education. A guide book for parents. Third edition http://www.healthscotland.com/uploads/docu
ed: planned parenthood of southwestern ments/1138-TalkingWithYourChild_1.pdf
Oregon.
48. Peel Public Health (2017). Healthy sexuality. 57. Liu W, Yufen SU (2014). School-based primary
https://www.peelregion.ca/health/sexuality/w school sexuality education for migrant children
hatis.htm in Beijing, China. Sex Education, 14(5): 568-581.
49. Novilla MLB, Barnes MD, Natalie G, Williams PN, 58. Goldman J D (2010). The new sexuality education
Rogers J (2006). Public health perspectives on curriculum for Queensland primary schools. Sex
the family: an ecological approach to promoting Educ, 10(1): 47-66.
health in the family and community. Fam 59. Byers ES, Sears HA, Weaver AD (2008). Parents‘
Community Health, 29(1):28-42. reports of sexual communication with children
50. HIV/AIDS JUNPo, UNICEF, WHO (2009). in kindergarten to grade 8. J Marriage Fam,
International technical guidance on sexuality 70(1):86-96.
education: an evidence-informed approach for 60. Sharon M B, Kevin H. Gross (2009). Exploring
schools, teachers and health educators: Parental Perspectives on Parent-Child Sex-
UNESCO. ual Communication. Am J Sex Educ, 4(1):
http://unesdoc.unesco.org/images/0018/0018 40- 57.
32/183281e.pdf 61. Clarke D (2008). Sexuality education in Asia: are we
51. Pike A, Coldwell J, Dunn J (2006). Family delivering? An assessment from a rights-based
relationships in middle childhood: Jessica Kingsley perspective.
Publishers. http://hivhealthclearinghouse.unesco.org
52. Bersamin M, Todd M, Fisher DA, et al (2008). 62. Walker J, Milton J (2006). Teachers' and parents'
Parenting practices and adolescent sexual roles in the sexuality education of primary
behavior: A longitudinal study. J Marriage Fam, school children: a comparison of experiences in
70(1):97-112. Leeds, UK and in Sydney, Australia. Sex
53. Vidourek RA, Bernard AL, King KA (2009). Education, 6(4):415-28.
Effective parent connectedness components in 63. Janet R H, Helen L J (2010). What Are Parents Re-
sexuality education interventions for African ally Saying When They Talk With Their Child-
American youth: A review of the literature. Am J ren About Sexuality? Am J Sex Educ, 5(2): 144-
Sex Educ, 4(3-4):225-47. 170.
54. Goldman JD (2008). Responding to parental 64. Kakavoulis A (2001). Family and Sex Educa-
objections to school sexuality education: A
selection of 12 objections. Sex Educ, 8(4):415-
tion: A survey of parental attitudes. Sex
38. Educ, 1(2): 163-174
55. Kirby DB, Laris B, Rolleri LA (2007). Sex and HIV 65. Merghati-Khoei E, Abolghasemi N (2013). Child
education programs: their impact on sexual sexual health: qualitative study, explaining the
behaviors of young people throughout the views of parents. J Sch Public Health Inst Public
world. J Adolesc Health, 40(3):206-17. Health Res, 11(2):65-74.
56. Pop MV, Rusu AS (2015). The Role of Parents in 66. Abolghasemi N, Merghati-Khoei E, Taghdissi H
Shaping and Improving the Sexual Health of (2010). Teachers' perceptions of sex education
Children–Lines of Developing Parental of primary school children. J Sch Public Health Inst
Sexuality Education Programmes. Procedia Soc Public Health Res, 8(2):27-39.
Behav Sci, 209:395-401.