Nepal


 * School-Based Sexuality Education in Nepal **

In accordance with structural functionalism (Nanda & Warms, 2011), the structure and content of Nepal's school-based sexuality education is a reflection of the country's cultural norms surrounding the topics of sex and sexuality. In effect, school-based sexuality education functions to support these cultural norms and expectations by educating young people in a particular way. After researching the methods and content of sexuality instruction in Nepal, one can make generalizations about some of the country's cultural values.
 * Introduction **

//Geographical Location// Nepal is located in Southeast Asia in the Himalayan mountains between China and India. Its capital is Kathmandu (Central Intelligence Agency [CIA], 2013).
 * Demographics of Nepal **



//Population// Nepal is populated by roughly 31.5 million people. Its population is comprised of over 125 caste/ethnic groups, with 81% practicing Hinduism. Half of the country is less than 24 years old (CIA, 2013). Nepal is made up of many diverse cultures, traditions, and languages (Mahat, Scoloveno & Ayres, 2014).

Formal sexuality education in Nepal is relatively new (Mahat et al., 2014). In 1998, the country adopted its first National Health Strategy. Then in 2000, the government created a National Adolescent Health and Development Strategy. These strategies outlined the structure and content of sexuality education throughout Nepal (Acharya, Van Teijlingen & Simkhada, 2009). The strategies are planned interventions for young people to increase their knowledge about reproductive health issues and service availability (Pokharel, Kulczycki & Shakya, 2006). There is a cultural shift in Nepal in regards to premarital and extramarital sex (Kaufman, Harman, & Shrestha, 2012). In a country that discourages premarital sex, there is a growing culture of young people who engage in the behavior more often than their parents' generation (Mahat et al., 2014). This is partly due to western modernization and globalization (Acharya et al., 2009). With a lack of knowledge about safer sex practices, this cultural shift could lead to the spread of STIs and HIV. Kaufman et al. (2012) also found that due to a loss of jobs, more Nepali men leave the country for work, engage in sexual activities abroad, and then are at a higher risk of transmitting STIs to their wives, who have little access to health care.
 * School-Based Sexuality Education in Nepal **

// Access to Sexuality Education // Sexuality education in Nepal does not reach all young people in the country. This is especially true for girls and rural communities. Sexuality education is usually taught in 9th or 10th grade, or the beginning of secondary school (Pokharel et al., 2006). However, not all students make their way through secondary school. It is estimated that 75% of Nepali girls never enroll in secondary education; the main reasons being early marriage and childbirth (Pokharel et al., 2006). By 20 years old, half of Nepali girls will have given birth (Pokharel et al., 2006). Girls in Nepal have a lower status, which affects their access to education, health care services, and employment opportunities (Kaufman, 2012). It seems that education about childbirth and reproductive health are missing a large target population of young girls who give birth at an early age.

// Teachers // Subject teachers are often selected to teach courses in sex and sexuality (Acharya et al., 2009). Mahat et al. (2014) note that these teachers are often uncomfortable, unprepared, and untrained. This is a reflection of Nepali culture's attitudes towards talking about sex and sexuality. Sex is considered a taboo topic. Most teachers avoid discussing the subject candidly due to fears of social stigmas related to sex (Acharya et al., 2009). Health workers and experts from Non-Government Organizations (NGOs) also sometimes teach sex and sexuality courses (Acharya et al., 2009). These people could be local or brought into the country through various organizations around the world. These workers tend to be more comfortable with the topics and trained; however, they are limited due to a lack of coordination and resources (Acharya et al., 2009).

// Methods // Acharya et al. (2009) explain that most sexuality education courses taught in Nepal extract their content from a chapter in a textbook called "Health, Population & Environment". Most courses focus on the factual and biological aspects of reproduction and childbirth (Pokharel et al., 2006). Classes are didactic, meaning they are usually structured with a teacher in the front of the room lecturing while students listen and take notes. Discussions and group activities are less used as methods of instruction. Audiovisual aids or group activities are not used; the textbook is the primary source of information (Acharya et al., 2009). Discussions about emotions or skill-based demonstrations may not be present because both teachers and students are timid to discuss sex openly (Mahat et al., 2014).

// Content // The Youth Activists Leadership Council (2012) wrote an Issue Brief on Sexuality Education in Nepal. The council outlined the curriculum currently taught in Nepal based on the book "Health, Population, & Environment." The curriculum explains the content material for grades six through twelve. However, the classes are usually taught only after ninth grade. According to the textbook, topics that are covered include the following: safe motherhood, family planning, reproductive physiology, HIV/AIDS, STIs, infertility, adolescent health, gender equality, pregnancy, and contraception. Topics that are not taught include the following: feelings and relationships, demonstrations, process of sex, explanation of abortion, parental communication, homosexuality, and love/sexual emotions (Pokharel et al., 2006; Youth Activists Leadership Council, 2012).

According to Koltko-Rivera (2004), the sexuality dimension is the "belief about the proper primary focus, aim, or purpose of interpersonal sexual activity" (p. 34). It is characterized by four categories: procreation, pleasure, relationship, and sacral. Based on the structure and content of Nepal's school-based sexuality education, it seems Nepal's primary focus of sex and sexuality is on procreation and relationships, rather than pleasure or spirituality. The curriculum's content primarily focuses on procreation (e.g. family planning, pregnancy, childbirth, and infertility). The instruction is based on facts over feelings, and there is no mention of pleasure or religious values explicitly in the curriculum. The research also suggests that early marriages are common, and that childbirth is expected to happen within the context of marriage. Some Nepali parents do not support sex education because they still try to control their children’s sexual behaviors to prove their child's and family's honor, self-restraint, and make them more suitable for marriage (Acharya et al., 2009). To ensure the family remains intact, young people are discouraged from engaging in premarital and extramarital sex (Mahat et al., 2014). Regardless of the culture's attitude towards sexual pleasure or religion/spirituality, the sexuality education provided reflects the culture's view that sex is for procreation and forming family bonds.
 * Sexuality Dimension **

According to Koltko-Rivera (2004), the relation to group dimension is the "belief about the natural priority of one’s personal agenda versus the agenda of one’s reference group" (p. 33). This dimension states that cultures usually lean towards individualism or collectivism on a continuum. Based on the structure and content of Nepal's school-based sexuality education, it seems Nepal is more of a collectivist culture where the “group’s agenda has priority over the individual’s plans and goals” (Koltko-Rivera, 2004, p. 33). In Nepal, sex is a taboo topic (Mahat et al., 2014). Many students do not discuss sex and sexuality openly because they fear judgment (Pokharel et al., 2006). Similarly, teachers are biased in their teaching and avoid most non-biological conversations about sex because many fear they may be censured socially (Pokharel et al., 2006). Further, it is considered inappropriate for women to be knowledgeable about sex or to vocalize sexual acts and reproductive biology terms (Kaufman et al., 2012). The group’s agenda of keeping topics of sex and sexuality secretive affects individuals’ attitudes and behaviors around sexuality.
 * Relation to Group Dimension (Interpersonal) **


 * Sources of Knowledge Dimension (Cognition) **

According to Koltko-Rivera (2004), the sources of knowledge dimension refers to “beliefs about reliable sources of knowledge” (p. 32). The categories include the following: authority, tradition, senses, rationality, science, intuition, divination, revelation, and nullity. Based on the structure and content of Nepal's school-based sexuality education, it seems Nepal’s reliable sources of knowledge are rooted in science and authority. The primary educational tool is a textbook which focuses on statistics, science, and biology ( Acharya et al., 2009). Also, health workers are seen as more knowledgeable about sexuality matters than family members, putting the source of knowledge into an authority figure with a health-related job (Acharya et al., 2009; Kaufman et al., 2012). The research also suggests that Western countries, such as the United Kingdom, are also seen as an authority as Nepali culture becomes more western and their sexuality education reflects that shift (Acharya et al., 2009).

It seems a large gap in sex education is with young girls before they are married and have children. When working with this population, it is especially important to discuss childbirth with girls before they reach secondary schools. As an educator with this population, it is important to be comfortable with the subject material and to encourage honest discussions about sexuality. It is also necessary to create a space that honors confidentiality. Educators should also teach self-efficacy in sexual decision making. Educators in Nepal must be well informed and well prepared to facilitate the courses and encourage students to engage in the material. Be aware that you are a source of knowledge for students and that this may be their only exposure to sexuality education.
 * Recommendations **


 * References **

Acharya, D. R., Van Teijlingen, E. R., Simkhada, P. (2009). Opportunities and challenges in school-based sex and sexual health education in Nepal. //Kathmandu University Medical Journal,// //7(28),// 445-453. Retrieved from[| http://dx.doi.org/10.3126/kumj.v7i4.2773]

Central Intelligence Agency [CIA]. (2013). The world factbook. Retrieved from []

Kaufman, M. R., Harman, J. J., Khati Shrestha, D. (2012). Let’s talk about sex: Development of a sexual health program for Nepali women. //AIDS Education and Prevention, 24(4),// 327-338. Retrieved from[| http://dx.doi.org/10.1521/aeap.2012.24.4.327]

Koltko-Rivera, M. E. (2004). The psychology of worldview. //Review of General Psychology, 8(1),// 3-58. doi: 10.1037/1089-2680.8.1.3

Mahat, G., Scoloveno, M. A., Ayres, C. (2014). Comparison of adolescents’ HIV/AIDS knowledge and self-efficacy across two cultures. //Journal of Cultural Diversity, 21(4),// 152-158. Retrieved from []

Nanda, S. & Warms, R. (2011). Cultural anthropology. Belmont, CA: Wadsworth.

Pokharel, S., Kulczycki, A., Shakya, S. (2006). School-based sex education in Western Nepal: Uncomfortable for both teachers and students. //Reproductive Health Matters, 14(28),// 156-161. Retrieved from http://www.jstor.org/stable/25475264

Youth Activists Leadership Council [YALC]. (2012). Issue brief on sexuality education in Nepal. Retrieved from []