Comprehensive Sexuality Education
1. Context and background
Lao People’s Democratic Republic has the youngest population and the highest rate of adolescent pregnancy in Southeast Asia, with 60% of the population estimated to be under the age of 25, and 24% of women becoming mothers before the age of 18. The country has a high maternal mortality ratio, with 15% of maternal deaths occurring in young girls. Issues affecting the health and well-being of adolescents, including their sexual and reproductive health (SRH), are therefore extremely important (UNFPA, UNESCO and IPPF, 2019; UNFPA, 2021).
Sexuality education has been delivered in the country in some form since 2001, when it primarily focused on HIV & AIDS prevention. In 2007, the scope was extended to 11 provinces, particularly areas situated along the borders of countries that are at high risk for HIV & AIDS (Arrow, 2011). By 2010, sexuality education was being implemented as a life skills course in approximately 75% of secondary schools nationwide (UNESCO, 2021). Lao People’s Democratic Republic's commitment to the integration of comprehensive sexuality education (CSE) within the national curricula is further evident in its adoption of the International Conference on Population and Development (ICPD) Programme of Action 2014, where the Government committed to CSE curricula in primary and secondary education, and vocational training throughout the country. The country also has a number of development plans and policies that aim to strengthen the implementation of CSE, such as the Ninth Education and Sports Sector Development Plan 2021-25 and the National Youth and Adolescent Policy. In 2020, the Ministry of Education and Sports and UNFPA held a workshop to 'monitor the progress toward universal access for comprehensive sexuality education in Lao LDR' and present the rapid assessment of the CSE in secondary education and vocational training that had been conducted in Bokeo Province. The scaling up CSE to other provinces, such as Xiengkhoung, Houaphan, Oudomxay and Vientiane Capital was also discussed. According to the Vice Minister of the Ministry of Education and Sports , 'Comprehensive Sexuality Education saves lives…when well informed, adolescent girls will be able to protect themselves. Lao PDR will continue to integrate curriculums into schools to become nationwide and reach every young person in the country.' These developments and commitments have not been met with resistance or opposition within the country (UNESCO, 2021).
2. Terminology
At the primary education level, sexuality education is known as 'Life Skills Education'. At the secondary education level, it is referred to as 'Comprehensive Sexuality Education' (CSE) (UNFPA, UNESCO and IPPF, 2019). Official government documents use various terms to refer to sexuality education, including 'sexuality education', 'health and reproductive education', 'comprehensive reproductive health/ sexuality education', and 'comprehensive sexuality education'.
3. Laws and policies
3.1. Relevant international/regional agreements to which Lao People’s Democratic Republic is a signatory
Lao People’s Democratic Republic is a signatory of various international agreements on human rights and the protection of women, such as the the International Covenant on Economic, Social and Cultural Rights (1966), the International Covenant on Civil and Political Rights (1966), the Convention on the Elimination of all Forms of Discrimination Against Women (1979) and the Convention on the Rights of the Child (1989).
The table below gives a summary of the key agreements.
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INTERNATIONAL |
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Convention on the Elimination of All Forms of Discrimination against Women (CEDAW)
Ratification date: 1981 |
Acknowledges the need to guarantee sexuality education free from discrimination and stereotypes, conveying gender equality values. |
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Convention on the Rights of the Child (CRC)
Ratification date: 1991 |
Commits to the right to access appropriate health-related information. |
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Convention on the Rights of Persons with Disabilities (CRPD)
Ratification date: 2009 |
Commits to the highest attainable standard of health for persons with disabilities. |
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International Covenant on Economic, Social and Cultural Rights
Ratification date: 2007 |
Acknowledges that the right to sexual and reproductive health is an integral part of the right to health. |
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UNESCO Convention against Discrimination in Education
Not ratified |
Reaffirms that education is a human right. It highlights states' obligations to ensure free and compulsory education, bans any form of discrimination and promotes equality of educational opportunity. |
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The 1994 International Conference on Population and Development (ICPD) Programme of Action
Attended |
Calls for sexuality education, counselling and support mechanisms for adolescents, and identifies essential topics. |
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UN General Assembly 2016 Political Declaration on HIV and AIDS |
Includes commitments and calls to scale up and/or attention to scientifically accurate age- and culturally-appropriate comprehensive sexuality education. |
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Commission on the Status of Women 2016 Resolution on Women, the Girl Child and HIV and AIDS |
Includes commitments to make universally accessible and available quality comprehensive sexual and reproductive health-care services, commodities, information and education. |
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REGIONAL |
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The Asia and Pacific Ministerial Declaration on Population and Development (2013) (Asia Pacific) |
Commits to the design, funding and implementation of ‘comprehensive sexuality education and life skills’ programmes that ‘provide accurate information on human sexuality, gender equality, human rights, relationships, and sexual and reproductive health, while recognizing the role and responsibilities of parents. |
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3.2. Relevant national laws and policies mandating comprehensive sexuality education
The Education Law (amended in 2015) which governs all education levels in Lao People’s Democratic Republic makes no particular reference to sexuality education or related topics. However, there are a number of policies and strategy documents that refer to the provision of sexuality education for young people (UNFPA, UNESCO and IPPF, 2019). The eighth Education and Sports Sector Development Plan 2016-20 promotes nutrition, health and reproductive education in lower secondary education, while the National Youth and Adolescent Policy 2020-30 provides guidance on youth and adolescent development. References to sexuality education can also be found in the Law on HIV/AIDS Prevention and Control (2010), which suggests a need for 'improved advocacy and education on HIV/AIDs for a wide understanding throughout society, mainly at secondary schools, vocational schools, universities, factories, detention centres, correctional institutions, and the most at risk populations'. In addition, the National Population and Development Policy 2019-30 aims to 'improve reproductive health among disadvantaged and vulnerable groups and across regions', highlighting the 'empowerment of women in all areas relating to reproductive health and rights' and the 'need to incorporate sexuality education into formal and non-formal education and to promote the concept of reproductive rights'. For young people still in school, sexuality education programmes are considered the 'best means of improving their knowledge and awareness of the risks associated with adolescent pregnancy and also where they can obtain further assistance'.
The National Population and Development Policy 2019-30 specifically aims to implement the curriculum on reproductive health and sexuality education to primary and secondary schools, provide information and knowledge of how to access health services, and coordinate with the education sector on 'Comprehensive Reproductive Health/ Sexuality Education'. Sexuality education components can be found in the Decree on Hygiene, Disease Prevention and Health Promotion (2001), the National School Health Policy, the National Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health Policy 2020-30, and the National Strategy and Action Plan for Integrated Services on Reproductive, Maternal, Newborn and Child Health, 2016-25. Finally, the country’s ninth Education and Sports Sector Development Plan 2021-25 aims to 'integrate life skill – comprehensive sexual education as well as disaster response in the curricula' and 'expand gender, sexuality education, life skills, nutrition, disaster prevention, and UXO risk programs to primary schools'. A key priority of the Plan is that 'comprehensive sexuality education should also be included' in training and vocational education curricula. At the Nairobi Summit in 2019, the Government committed to several actions to uphold the rights and welfare of women and youth, including ensuring that CSE is fully integrated into school curricula nationwide by 2030.
3.3. Curricula
Lao People’s Democratic Republic has integrated comprehensive, gender-responsive life-skills-based HIV and sexuality education (ເພດຶສກສາ ທັກສະີຊິວດ) within the national curriculum at both primary and secondary level, starting from Grade 1 (UNFPA, UNESCO and IPPF, 2019). In a 2016 assessment of the Life Skills curriculum, several issues were identified with the CSE programme that had been adopted, including insufficient content in relation to: gender; rights; sexual behaviour; and equitable social norms. There was also no clear transition from primary to secondary level, and no connection with health services or parental and community involvement. In response to this assessment, the Ministry of Education and Sport worked closely with teachers, civil society, and United Nations agencies to strengthen the design and implementation of what is now referred to as 'Life Skills Education' in primary school settings, and 'Comprehensive Sexuality Education in secondary school settings. In this participatory process, learning objectives were defined and lesson plans for each grade were developed (UNESCO, 2021).
The CSE curriculum for lower and upper secondary education was reviewed in 2018 against the International Technical Guidance on Sexuality Education, with the aim for the 'revised curriculum (to) contribute to better sexual and reproductive health outcomes for young people and reduce unplanned pregnancies and subsequently reduce school dropouts particularly among adolescent girls'. In 2019, the revised curriculum was piloted in 45 secondary schools in Bokeo province, reaching over 25,000 students, with the agreement that the teaching of CSE would expand to secondary schools in Oudomxay, Hauphanh and Xieng Kuang provinces, as well as Vientiane Capital, covering an additional 28,000 students. In 2020, the UNPFA country office signed a memorandum of understanding with ChildFund Laos to scale up CSE for students at the secondary level and vocational education and training students.
Mandatory or optional
Sexuality education is mandatory for primary schools and optional in secondary schools, although this can also vary by school type (such as public, private, or faith-based schools) (UNFPA, UNESCO and IPPF, 2019).
Model of delivery
There are no specific subjects for sexuality education at primary or secondary level. At the primary level, CSE is integrated into certain subjects including moral education, and science and environment. At the secondary level CSE is integrated into certain subjects including biology, civic education and the safe use of social media (UNFPA, UNESCO and IPPF, 2019).
Comprehensiveness of content
The scope and coverage of sexuality education topics reportedly remains a challenge in the country. At the primary level, there is extensive coverage of love and relationships, and brief coverage of puberty, pregnancy and birth, HIV, sexual orientation and gender identity, gender and gender norms, and sexual abuse/violence in online media and technology (UNFPA, UNESCO and IPPF, 2019). Sexuality education topics not covered at primary level are contraception, marriage, access to safe abortion, and SRH services (UNFPA, 2021). At the secondary level, all the above subjects are covered extensively. In addition, sexuality education provides information that is relevant to several vulnerable populations, such as: young people living with HIV; young people out of school; young lesbian, gay, bisexual, transgender, intersex (LGBTI) people; young people living with a physical or intellectual disability; and indigenous people/ethnic minorities.
Learning resources
Teaching and learning materials resources that support the delivery of sexuality education in schools are made available. These may range from activity guides or short videos to fully scripted lesson plans.
3.4. Teachers
Teachers are specifically designated to teach sexuality education in schools. In 2009, an assessment of the CSE curriculum found that the quality of both in-service and pre-service teacher training could be improved, and that teachers did not feel confident in delivering CSE lessons. In 2012, a teacher training package on CSE was developed by the Ministry of Education and Sports, with technical support from UNFPA and the Vientiane Women and Youth Centre for Health and Development. Teachers are now required to undergo 40 hours of in-service and 40 hours of pre-service training before they can teach CSE subjects (UNFPA, UNESCO and IPPF, 2019). In 2019, trained teachers were delivering CSE to over 25,000 secondary students, while training modules were introduced in eight teacher training colleges across the country. Principals and representatives from parent-teacher associations are also included in the training to ensure that teachers have full support (UNESCO, 2021). At the secondary level, UNFPA also provided support in the development of a CSE teachers’ guidebook for secondary education based on the International Technical Guidance on Sexuality Education standards. There are also a number of textbooks, teaching aids, and reading materials on CSE to assist teachers, including the ‘Teachers’ Guidebook on CSE for Secondary Education’. According to the Education and Sports Sector Development Plan 2021-25, teacher manuals on CSE based on international technical sexuality education for lower and secondary education have been developed and teacher training on how to use them has begun. New Fundamental Quality Standards were being developed.
3.5. Schools
SRH services in Lao People’s Democratic Republic are limited, particularly for young people. The main providers are national and regional government health providers, private health providers, and civil society organizations or non-governmental organizations. There are only two youth-friendly health clinics in the whole country. While all services appear to be available for adolescents (including STI/HIV testing and treatment, gynecological care, contraceptive counseling, and safe abortion care), STI treatment/testing, gynecological care, and safe abortion care are not provided free of charge.
Initiatives to provide SRH information and services to young people include a nationwide telephone helpline run by the Vientiane Youth Centre Clinic and a mobile application Noi Yakhoo ('Noi wants to know') for adolescents and young people developed by the Ministry of Education and Sports and the Laos Youth Union, which answers learners’ questions about SRH (UNFPA, UNESCO and IPPF, 2019). As part of teacher training, local health service providers also participate in building important links between teachers and health staff and facilitating easy referral to adolescent-friendly health services (UNESCO, 2021).
4. Governance
4.1 Responsible ministries
The Ministry of Education and Sports is responsible for developing the CSE curriculum in the country, with the contribution of other government ministries, departments or representatives, teachers and educational professionals, healthcare professionals, young people, and civil society organizations. The Ministry develops sexuality education curriculum materials and teaching aids in collaboration with UNFPA (which provides financial and technical support), teachers, education professionals, health experts, young people, and representatives from Lao Women’s Union and the Lao Youth Union (UNFPA, UNESCO and IPPF, 2019).
4.2. Level of responsibility/decentralization and autonomy
The management of education has been gradually decentralized to the Provincial Education and Sports Services (responsible for overseeing the implementation of national policies, laws and curriculum in each province), the District Education and Sports Bureaus (planning and management units in each district and municipality), and the Village Education Development Committees (established as development units in each village in 2008).
4.3. Government budget allocation
While the specific government budget for CSE could not be found, the Government has contributed resources to the value of US$635,419 for SRH in the country. This includes a strengthened policy framework and forms of implementation to ensure universal and equitable access to SRH services, increased national capacity to deliver comprehensive midwifery services according to international standards, and greater availability and use of integrated SRH services.
5. Monitoring and reporting
While no specific indicator on sexuality education was found in the country’s EMIS, Lao People’s Democratic Republic provides coverage data (expressed in percentages of schools implementing life-skills-based HIV education in the previous year) in its UN General Assembly Special Session (UNGASS) country report. Moreover, the National Reproductive Health Survey collects data on women’s knowledge of STIs and HIV transmission by school teachers, while indicators related to reproductive health access are collected through five-year household surveys, such as the Lao Social Indicators Survey, the Labour Force Survey, and the Lao Expenditure and Consumption Survey. In 2016, the Noi 2030 Framework was also developed to raise awareness about adolescent issues in the country, to track and visualize the progress of these issues within Agenda 2030, and to ensure that adolescent girls do not get left behind.
