WHO Regional Office for Europe and BZgA

Standards for Sexuality Education in Europe

A framework

for policy makers,

educational and health authorities

and specialists

WHO Regional Office for Europe and BZgA

Standards for Sexuality Education in Europe

A framework for policy makers, educational and health authorities and specialists

Federal Centre for Health Education, BZgA Cologne 2010

Table of contents

Preface 5

Part 1: Introduction 9

1. Background and purpose 9

1.1 Formal and informal sexuality education 10

1.2 Historical context of sexuality education in schools 11

1.3 Development of sexuality education in schools in Europe 12

1.4 Variety of sexuality education arrangements in Europe 13

1.5 Europe in a global perspective 15

1.6 Parallel international sexuality education initiatives 16

2. Sexuality, sexual health and sexuality education –

definitions and concepts


3. Rationale for sexuality education 21

3.1 Core considerations for sexuality education 21

3.2 Psycho-sexual development of children 22

4. Principles and outcomes of sexuality education 27

5. Target groups and partners in sexuality education 28

6. How to deliver sexuality education –

general framework and basic requirements


6.1 Seven characteristics of sexuality education 29

6.2 Competence of educators 31

Part 2: Sexuality education matrix 33

1. Introduction to the matrix 33

1.1 Background to the matrix 33

1.2 The importance of support structures 34

1.3 Why should sexuality education start before the age of four? 34

1.4 How to read the matrix 35

2. The matrix 37

Bibliography 51

A. References 51

B. Scientific literature on psycho-sexual development of children 54

C. Curriculums and educational books 58

D. Websites 60


The WHO European Region faces many chal- lenges with regard to sexual health: rising rates of HIV and other sexually transmitted infections (STI), unintended teenage pregnancies and sexual violence, to name just a few. Children and young people are crucial to the improvement of sexual health in general. They need to know about sexu- ality in terms of both risk and enrichment, in order to develop a positive and responsible attitude to- wards it. In this way, they will be enabled to be- have responsibly not only towards themselves, but also towards others in the societies they live in.

This document has been developed as a response to the need for sexuality education standards that has recently become apparent in the WHO European Re- gion, which comprises 53 countries, covering a vast geographical region from the Atlantic to the Pacific oceans. Most Western European countries now have national guidelines or minimum standards for sexu- ality education, but no attempt has been made to recommend standards at the European Region or EU level. This document is intended as a first step in fill- ing this gap for the entire WHO European Region.

Furthermore, this document is intended to con- tribute to the introduction of holistic sexuality ed- ucation. Holistic sexuality education gives children and young people unbiased, scientifically correct information on all aspects of sexuality and, at the same time, helps them to develop the skills to act

WHO Regional Office for Europe and BZgA Standards for Sexuality Education in Europe 5

upon this information. Thus it contributes to the development of respectful, open-minded attitudes and helps to build equitable societies.

Traditionally, sexuality education has focused on the potential risks of sexuality, such as unin- tended pregnancy and STI. This negative focus is often frightening for children and young people: moreover, it does not respond to their need for information and skills and, in all too many cases, it simply has no relevance to their lives.

A holistic approach based on an understanding of sexuality as an area of human potential helps chil- dren and young people to develop essential skills to enable them to self-determine their sexuality and their relationships at the various developmen- tal stages. It supports them in becoming more empowered in order to live out their sexuality and their partnerships in a fulfilling and responsible manner. These skills are also essential for protect- ing themselves from possible risks.

Sexuality education is also part of a more general education, and thus affects the development of the child’s personality. Its preventive 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.

Between November 2008 and December 2009, a series of four workshops was organized by BZgA in Cologne, at which the invited experts

jointly developed the Standards.


The introduction of sexuality education – espe- cially in schools – is not always easy: resistance is very often encountered, mostly based on fears and misconceptions of sexuality education. We hope that these Standards can play a positive part in encouraging countries to start introducing sexual- ity education or to broaden existing programmes with a view to achieving holistic sexuality educa- tion.

This initiative was launched by the WHO Regional Office for Europe in 2008 and developed by the Federal Centre for Health Education (BZgA), a WHO Collaborating Centre for Sexual and Repro- ductive Health, in close cooperation with a group of experts. This group comprised 19 experts from nine Western European countries, with various backgrounds ranging from medicine to psychol- ogy and social sciences. All of them have extensive experience in the field of sexuality education, in either a theoretical or a more practical way. Gov- ernmental and nongovernmental organizations, international organizations and academia were represented in a process extending over one-and- a-half years, during which the group met four times for workshops. The group agreed upon the present Standards for sexuality education which,

The Federal Centre for Health Education (BZgA), as the publishing institution of these Standards, would like to express its deeply felt gratitude to- wards many persons: to Dr Gunta Lazdane of the WHO Regional Office for Europe for initiating this important process and to the expert group, consisting of Professor Dan Apter (Sexual Health Clinic, Väestöliittoo), Doortje Braeken (Interna- tional Planned Parenthood Federation – IPPF), Dr Raisa Cacciatore (Sexual Health Clinic, Väestöli- ittoo), Dr Marina Costa (PLANeS, Swiss Founda- tion for Sexual and Reproductive Health), Dr Pe- ter Decat (International Centre for Reproductive Health, University of Ghent), Ada Dortch (IPPF), Erika Frans (SENSOA), Olaf Kapella (Austrian Insti- tute for Family Studies, University of Vienna), Dr Evert Ketting (consultant on sexual and reproduc-

it is hoped, will serve countries as a guideline for the introduction of holistic sexuality education. These Standards will provide practical help for the development of appropriate curriculums; at the same time, they may be helpful for advocating for the introduction of holistic sexuality education in every country.

This document is divided into two main parts: the first part gives an overview of the underlying philosophy, rationale, definitions and principles of sexuality education and the elements it comprises. It introduces the wider concept of holistic sexual- ity education and argues why it is especially im- portant for young people and adolescents.

At the heart of the second part of the document is a matrix showing the topics which sexuality education needs to cover at certain age groups. This part is geared more towards the practical im- plementation of holistic school-based sexuality education, even though these Standards are not meant to be an implementation guide.


tive health and HIV/AIDS), Professor Daniel Kunz (Lucerne University of Applied Sciences and Arts), Dr Margareta Larsson (University of Uppsala), Dr Olga Loeber (European Society for Contraception), Anna Martinez (Sex Education Forum, National Children’s Bureau, United Kingdom), Dr Kristien Michielsen (International Centre for Reproductive Health, University of Ghent), Ulla Ollendorff (Nor- wegian Directorate of Health), Dr Simone Reuter (Contraception and Sexual Health Service, Not- tinghamshire Community Health), Sanderijn van der Doef (World Population Foundation), Dr In- eke van der Vlugt (Rutgers Nisso Group) and Ekua Yankah (UNESCO), who worked tirelessly and with great interest on this project. It was a pleasure to work with such dedicated colleagues.

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