Sexual education: good ideas, bad framework


Sexual education: good ideas, bad framework

L. Peremans, V. Verhoeven, H. Philips, P. Van Royen, J. Denekens

Department of General Practice, University of Antwerp,


Introduction: Because of the increased figures for

abortions with adolescents the Belgian government decided in 2001 to give free

access to emergency contraception in the pharmacy. There is no evidence that

this strategy leads to a diminution of the abortion rate. In Belgium there was a

diminution in 2002 but it raised again in 2003 and especially in the age group

(20-24 years) from 3 692 in 2002 to 4 032 abortions in 2003.

Objectives: To evaluate which strategies can help

according to the view of Flemish health care providers en what their role can be

in preventing unintended pregnancies with adolescents.Method: In 2002-3 we

conducted twelve focus groups with pharmacists, general practitioners and school

physicians. A skilled moderator accompanied by an observer conducted the focus

groups using a semi – structured screenplay. The discussions were audio-taped

and analysed following the procedures of the grounded theory. Analysis was

partially manual and by the computer program QRS-Nudist.

Results: There is strong agreement about the role of the

school physicians, teachers and nurses. Class groups are not an ideal setting

because of a large difference in culture and personal development of the

adolescents. Small discussion groups and individual support would be more

convenient. Obstacles are: no long-term strategy and vision in spite of

well-formulated learning goals, no time and financial support. Not every school

physician feels good to talk about subjects as ‘the first time’,

masturbation, homosexuality. Young physicians have no opportunities to develop

experience. Collaboration with general practitioners is good, but financial

obstacles and fear regarding confidentiality and involvement of the parents are

obstacles. GPs ask also to be better informed about the campaigns in local

schools. These gave them the opportunity to discuss these issues in an

individual setting. School physicians would like to prepare adolescents to visit

their GP for contraceptive health and counselling about sexual transmitted

infections Over-the-counter sale of emergency contraception is not enough

because pharmacists have not enough opportunities to counsel women.

Conclusion: The government has to develop a better

framework with clear task definitions and financial recourses for school

physicians. Specific educational programs are necessary for physicians, nurses

and teachers. Adolescents have to be better informed about the professional

secret of GPs. A model of collective education focused on empowerment of

adolescents and collaboration between the different health care providers would

be ideal.

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