Comprehensive Sexuality Education
1. Context and background
One-third of Albania’s population is under the age of 25. Sexual activity among young people has increased in recent years. According to the 2017-2018 Albanian Demographic Health Survey, knowledge about contraception is almost universal. While almost all youth are aware of modern contraception methods, usage rates are very low, with only 1.7% of youth in the 20–24-year age group using condoms. Most Albanians use traditional methods such as the withdrawal method. Nevertheless, teenage pregnancies in Albania are very rare, although the rate has increased slightly since 2008. Less than one-quarter of women do not know when the fertile days of the menstrual cycle are. While the HIV prevalence rate is also very low, an upward trend in recent years is evident. Comprehensive knowledge about HIV prevention and transmission is lacking, with only 3 out of 10 women and 2 out of 10 men demonstrating this knowledge. Stigma and discrimination towards people living with HIV is widespread and this can impact the public’s willingness to get tested and treated for the disease.
Health and sexuality education was first introduced in the Albanian public education system in 1995. Since then, modules have been reviewed and strengthened multiple times, often with the partnership and guidance from the United Nations Fund for Population Activities (UNFPA) and the Albanian Center for Population and Development (ACPD).
2. Terminology
Sexuality education in Albania is taught as ‘Sexuality education as life skills’. The curriculum describes this as a module that ‘prepares students to develop an active, productive, healthy and safe lifestyle; to select and implement behaviors that prevent diseases, weaknesses and various risks for themselves and others; that they become active participants in ensuring a healthy and cooperative environment.’ The curriculum aims to help students develop the knowledge and skills necessary to understand, analyse and evaluate ways of interacting and communicating with the opposite sex: negotiating, communicating, articulating desires and boundaries, and showing respect. Comprehensive sexuality education (CSE) emphasizes the need for students to create a personal plan for achieving and maintaining their sexual health.
Life skills are described as ‘a set of psycho-social and interpersonal competencies that help students make well-informed decisions, solve problems, think critically and creatively, communicate effectively, build healthy intellectual and emotional relationships with others, as well as build their lives in a healthy and safe way.’
In the module, the definitions of sexual health and sexuality are in accordance with the World Health Organization (2006).
3. Laws and policies
3.1. Relevant international/regional agreements to which the country is a signatory
| INTERNATIONAL | |
|---|---|
| Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) Ratified in 1994 |
Acknowledges the need to guarantee sexuality education free from discrimination and stereotypes, conveying the values of gender equality. |
| Convention on the Rights of the Child (CRC) Ratified in 1992 |
Commits to the right to access appropriate health-related information. |
| Convention on the Rights of Persons with Disabilities (CRPD) Ratified in 2013 |
Commits to the highest attainable standard of health for persons with disabilities. |
| International Covenant on Economic, Social and Cultural Rights Ratified in 1991 |
Acknowledges that the right to sexual and reproductive health is an integral part of the right to health. |
| UNESCO Convention against Discrimination in Education Ratified in 1963 |
Reaffirms that education is a human right. It highlights the obligations of states to ensure free and compulsory education, prohibits any form of discrimination and promotes the equality of educational opportunities. |
| The 1994 International Conference on Population and Development (ICPD) Programme of Action Attended the conference |
Calls for sexuality education, counselling and support mechanisms for adolescents, and identifies essential topics. |
| UN General Assembly 2016 Political Declaration on HIV and AIDS | Includes commitments and calls to scale up and/or pay attention to scientifically accurate age-appropriate and culturally appropriate comprehensive sexuality education. |
| Commission on the Status of Women 2016 Resolution on Women, the Girl Child and HIV and AIDS | Includes commitments to make comprehensive sexual and reproductive health-care services, commodities, information and education, universally accessible and available. |
| REGIONAL | |
| The European Social Charter (1996) Ratified in 2002 |
States must ‘provide advisory and educational facilities for the promotion of health’. Court cases relating to this have resulted in this specifying and including SRH education. |
3.2. Relevant national laws and policies mandating comprehensive sexuality education
The 1998 Constitution of Albania protects the individual’s right to education and seeks to provide the highest health standards possible. It also guarantees equality regardless of gender, race, religion, ethnicity, language, political, religious, or philosophical beliefs, economic status, education, social status, or parentage. The Law on the Pre-university Education System of the Republic of Albania 69/12 states that one of the aims of basic education is for students to learn about health care. The curriculum consists of the core curriculum, an optional curriculum, as well as the curriculum for complementary activities.
The 2009-2015 Reproductive Health Strategy seeks to improve reproductive health education in the country and increase access to reproductive health services. For youth (aged 10–19 years), age-appropriate and sensitive life skills training is important in enabling adolescents to engage with their own health and development, including their reproductive health.
In 2012, according to a report conducted by WHO, the Ministry of Health approved a by-law, entitled 'Approval of the Positioning Document for Inclusive Sexual Education for Young People in Albania'. The document confers the Directorate of Public Health with the responsibility to inform and direct health institutions, partner organizations, and civil society organizations (CSOs) to work further in the development of sexual education. The document specifies that the core principle of sexuality education is that it is comprehensive and based on human rights. The document identifies multi-sectoral efforts and dimensions of prevention education. Also in 2012, a report by UNFPA notes that a Memorandum of Understanding was agreed upon between the Ministry of Health and the Ministry of Education, Science, and Youth with the aim of improving school-based health services through ‘information, education and communication and improving the health behaviour of school-aged children’. The document notes that training for teachers and school health staff is designed to equip them to communicate effectively on important health topics (including sexual health education).
Law No. 9970, dated 24.07.2008 ‘On Gender Equality in Society,’ regulates the fundamental issues of gender equality in public life, of equal protection and treatment of women and men, equal opportunities for the enjoyment of rights, as well as their participation and assistance in the development of all walks of life.
The 2016-2020 National Strategy for Gender Equality (SGBGJ) and its successor the 2021-2030 National Strategy for Gender Equality, seek to build a society based on a healthy family, supportive community and to have consolidated institutions that implement legislation and their obligations responsibly. Regarding education, the strategies seek to ensure that the school curriculum is improved to cover the prevention of gender-based violence and violence against children and that teachers are trained to implement the curriculum change. The more recent strategy stressed the importance of education on sexual and reproductive rights as another instrument to empower women, young women, and girls in all their diversity. Measures and activities includes, ‘III.5.1.a. Improvement and accreditation of comprehensive education modules for health professionals on sexual and reproductive health, stressing the respect of these rights for women, men, young women, young men, girls and boys in all their diversity (from rural areas, ethnic minorities, persons with disabilities, LBTI+, the elderly, single mothers, survivors of violence/trafficking, girls who are mothers, migrants, and asylum seekers, etc.).’
The 2015-2020 National Youth Action Plan aims to improve existing legislation on youth sexual and reproductive health (SRH) and helps to establish ‘youth-friendly services’, increasing available information sources and the establishment of high-quality SRH services.
According to a report by UNFPA (2019), the Ministry of Education, Sports and Youth and the Institute of Educational Development (IZHA), together with UNFPA, developed a programme in 2015 to help to set standards and implement the health and sexuality education curriculum at the pre-university education level (spanning primary and secondary education) across the country. The two main goals of this programme were to develop and publish the health education curricula and to train current teachers to teach it.
The 2017-2021 Promotion of Health Action Plan’s objective 1.9 seeks to ‘improve knowledge and practices on SRH and family planning in the Albanian population’. For adolescents, this refers to reproductive health education as activities include ‘reviewing pre-university level school programmes to develop personal skills such as the Life Skills programme and the Sexual Education programme’ and training education and health care specialists.
The 2017-2021 Sexual and Reproductive Health Strategy and Action Plan’s main strategic objectives include: ‘encouraging and promoting good reproductive and sexual health’; increasing the prevalence of modern contraceptives; decreasing the number of STI and HIV cases; and more. Interventions include ‘improving the sexual and reproductive health of young people’ and ‘improving the sexual and reproductive health of adolescents through the improvement of knowledge, attitudes, and behaviours related to sexual and reproductive health, gender-sensitive among young people’. Specifically, the life skills programme is to be reviewed and strengthened at the nine-year and secondary education levels.
3.3. Curricula
Mandatory or optional
Sexuality education in Albania is mandatory for public schools.
Model of delivery
‘Sexuality and life skills education’ is integrated into the curriculum for grades 4–12 in the subjects of biology, physical education, and citizenship.
Comprehensiveness of content
The curricula in the field of ‘physical education, sports, and health’ in primary and secondary education aim for students to develop the necessary knowledge, skills and attitudes that ensure the well-being of their mental, emotional, physical and social health, as well as to help them to cope with life's challenges.
The curriculum package Sexuality Education as Life Skills includes content for all levels of the public education system. The curriculum is based on three areas: proper science, such as anatomy of the human body and hormonal changes; personal awareness and knowledge, such as understanding behavioural changes associated with puberty and knowing how to self-manage and self-regulate during these changes; and sexuality health topics beyond the ‘taboo boundaries’ which are necessary for students to know.
In primary school, students start learning about nature and then transition to animal and human reproduction cycles. Students are able to understand the concept of reproduction but not the mechanics of the process. In biology, students learn about body development and changes for certain age groups, reproductive organs, sexual maturity, and physiological needs. In lower-secondary school, the focus is mainly on the functions of the human body. At upper-secondary school this concept is expanded to include reproductive health topics as being essential to developing safe and healthy sexual behaviours in young people. In the physical education, sports and health class, sexuality education is taught through a focus on the cognitive, psychological and social characteristics of young people. This would include topics such as gender identity and gender identity values. Finally, in the citizenship subject, students study sexuality education through different lenses, such as the individual, the group and society as a whole. This includes ‘self-care; respect for the rights of others; being accountable for their behaviours and actions; respect for moral values; etiquette; positive behaviours; and the variety of relationships between individuals.’
The elective module for Sexuality Education as Life Skills for the upper-secondary school level is a 36-hour course covering ten themes: personal values; decision-making; relationships and lifestyle; sexual development and puberty; sexuality, the reproductive system and self-care; sexually transmitted infections (STIs); contraception; pregnancy and parenthood; the use of substances; and decision-making on sexual issues. For the duration of the course, students are to discuss sexuality as it relates to their personal values and decision-making as well as the impact of cultural and religious values. Communication is also highly valued and encouraged, whether it is with a sexual partner or with a parent/guardian. On the topic of sexuality, students are to look at aspects of sexual health, sexual health rights, sexual health – sex and sexuality, and sexual development throughout the life cycle. In this course, students examine healthy sexuality, responsible sexual behaviours, the impact of homophobia and heterosexism, and negative behaviours that reinforce homophobia and heterosexism. Students are also encouraged to reflect on the power dynamics of sexuality, recognize their rights, and speak out against discrimination and gender violence.
Learning resources
The Ministry of Education, Sports and Youth, the Institute of Educational Development and UNFPA have prepared educational materials for teachers and students. The Institute of Public Health (IPH) also produces informative and educational materials about SRH education and distributes them in all educational districts.
3.4. Teachers
Teacher preparedness and capacity building: Teacher profile standards for health education with a focus on ‘Sexuality education and life skills’ were jointly developed in 2017 by the Ministry of Education, Sports and Youth, the Institute of Educational Development and UNFPA.
Whether teachers are mandated to be trained in the provision/delivery of sexuality education either as part of PRESET or INSET: Since 2015, Albania has certified hundreds of teacher trainers specializing in health education issues focusing on sexuality education. The Institute of Educational Development has implemented the Sexual Education as Life Skills training programme for teachers at the levels of primary education, lower-secondary education and secondary education.
The 2015-2020 National Youth Action Plan calls for ‘periodic and accredited training (the National Centre for Continuous Education) for teachers of social subjects, physicians/nurses, psychologists/social workers on SRH topics, sexually transmitted infections, mental health, narcotics, smoking, alcohol consumption, addiction to gambling, communication methods, behavioural changes, etc.’
3.5. Schools
Access to school-based health services, including SRH: The Ministry of Health covers 100% of the procurement costs of contraceptives for the public sector, providing pills, condoms and injectables free of charge in over 425 public health facilities, such as hospitals, polyclinics and health centres. The 2009-2015 Reproductive Health Strategy, emphasizes the importance of ensuring easy accessibility of condoms at locations commonly visited by teenagers, such as schools. Schools also have health services that are funded by the Ministry of Health
4. Governance
4.1 Responsible ministries
The Ministry of Education, Sports and Youth and the Pre-University Education Quality Assurance Agency (ASCAP) (also known as the Institute of Educational Development (IZHA) are mainly responsible for the implementation of sexuality education. According to the UNFPA report, the Ministry of Health and Ministry of Education (Prot. No. 1855, Dt. 07/05/2012) adopted a Memorandum of Collaboration, which discussed improving school-based health services to include education, including sexual health education.
UNFPA and NGOs such as the International Planned Parenthood Foundation (IPPF) member association, the Albanian Center for Population and Development (ACPD) and others play a substantial role in advocating for and providing CSE to teachers, students and marginalized groups. For example, UNFPA helps with policy-making and developing the Sexuality and Life Skills curriculum. ACPD has previously signed MoUs with schools and the Municipality of Tirana to provide CSE. Discussions have been held with representatives from the Ministry of Health and Social Protection as well as the Ministry of Education, Sports and Youth to find opportunities to provide CSE outside of school with the approval of the ministry and through funding from the Ministry of Health and Social Protection
4.2. Level of responsibility/decentralization and autonomy
Schools and teachers have enough academic freedom to identify teaching topics and specific methodologies to cover issues relating to health and sexuality education. This helps to contextualize the programme within the specific socio-cultural characteristics of a school and its surrounding community.
4.3. Government budget allocation
According to the UNFPA report (2019), the Albanian government’s health and social institutions do not allocate funds for awareness-raising activities such as sexual education. Instead, many of the country’s programmes relies on outside resources such as international agencies.
The 2015-2020 National Youth Action Plan budgeted about US$3,350.000 out of the state budget and US$14,000 in uncovered funds for consultation meetings on the possibilities for legislation amendments regarding a number of specific social and health services in the SRH field. For the revision of health modules in biology and life skills subjects and the introduction of sexual education as a subject in the pre-university education system, the state budgeted about US$17,850.00 while US$381,000.00 was provided by UNFPA. The cost includes the entire process of developing, implementing and applying monitoring for the two new subjects. A budget of US$484,000.00 has been provided for training teachers of social subjects, physicians and nurses, psychologists, and social workers. There are also separate budgets for educational programmes on STIs and HIV as well as for the construction of health centres that are based on the ‘youth-friendly service model’. The 2017-2021 Sexual and Reproductive Health Strategy and Action Plan also contains a detailed budget.
5. Monitoring and reporting
The Educational Services Center (QSHA) is the institution responsible for evaluating students’ learning achievements in pre-university education. No information regarding the monitoring of the Sexuality and Life Skills programme is available.
