Comprehensive Sexuality Education

The 1991 Constitution of North Macedonia (amended in 2011) protects every citizen’s right to health care and a free and accessible education. Discrimination based on sex, race, religion or national, social or political affiliation is prohibited.  

Education is governed by the Law on Primary Education and the Law on Secondary Education. The recent 2020 Law on Primary Education is based on principles such as equality, availability, accessibility and inclusiveness. The Law seeks to promote awareness of similarities and the acceptance of differences, interculturalism, and multiculturalism, as well as care for physical safety and health. The Law explicitly prohibits discrimination in primary education on all grounds, including sexual orientation and gender identity. Article 48 of the Law stipulates that schools have a responsibility to address the sexual and reproductive health of students by providing accurate information that is grounded in scientific research, promoting human rights and gender equality, and fostering respect for diversity. 

The 2005 National Youth Strategy, in force until 2024, aims to improve the general position of young people and address their needs and interests. The Strategy’s goals include: ‘Assistance to young people in overcoming the inevitable challenges in the period of adolescence; Respect for the rights and freedoms of young people as an integral part of the body of human rights and freedoms; and Recognition and understanding of young people’s needs and assignment of social resources towards meeting these needs’.  

The Health and Prevention section includes objectives such as: ‘broad education of children and youth; practice of healthy lifestyles; active participation of the young people in the implementation of health and prevention programs; prevention of sexually transmissible diseases, especially education and prevention of sexually transmissible infections, types of infections, ways in which they can be transmitted, consequences and prevention; and protection of and respect for the individual and his/her private life’. Strategies include the provision of programmes to raise their awareness of ‘the dire health consequences of modern diseases such as HIV/AIDS, the situation in the world and in the country and the ways to prevent such diseases’. As well as programmes for youth education on ‘personal health and hygiene, sexual and reproductive health, prevention of drugs, alcohol and tobacco abuse, all aimed at reducing youth health risks by learning and accepting healthy lifestyles, concern and care for one’s own health’. 

According to the 2009 Youth Action Plan, North Macedonia aims to improve the sexual and reproductive health of its youth through ‘comprehensive work with young people regarding their education on HIV&AIDS prevention, ...peer education on sexual and reproductive health, family planning involving both sexes, distribution of condoms in schools, universities, and social institutions, and education on the types of contraception and their usage’. 

The 2012-2020 National Strategy for Sexual and Reproductive Health aims to improve the provision of sexual and reproductive services, especially for women and adolescents. Strategic interventions include education and awareness about sexual and reproductive rights and the introduction into the school curriculum of sexuality education that promotes positive aspects of sexuality, is gender-sensitive, and that is age-appropriate. The preparation of guidelines for the implementation of sexuality education in primary and secondary schools forms part of the strategy. The Strategy also tracks the number of education policy-makers and civil servants who are informed on the sexual and reproductive rights framework. The Strategy calls for the cooperation of the Ministry of Health, educational institutions and civil society organizations to implement educational topics such as contraception use and sexual reproductive rights, as well as educating women about their right to make decisions about contraception and abortion.  

The 2021 Concept Note on Education includes a number of reforms in the primary education sector. The note calls for an overhaul of the curriculum and contains many provisions on gender sensitivity and gender equality, inclusiveness, and interculturality. The concept note states that elective subjects should be offered to help students ‘build negative attitude towards all types of gender discrimination, including discrimination based on sexual orientation.’ Sexuality education is to be offered as an optional course for students in grades 4 –9 of primary education.

The 2008 Life Skills course is comprised of five themes: ‘self’ – personal development; ‘self and you’– interpersonal relationships; ‘self and the other’ – social relations; ‘self and health’ – healthy living; and ‘self and the environment’ – relationship with the external environment. Sexuality education topics are predominately found in ‘self’, ‘self and you’, and ‘self and health’. Students in grades 1-3 learn skills and discuss topics such as family dynamics, communication, relationships, and how to ask for help in an abusive situation. In the higher grades (7–9), students learn more about sexual and reproductive health (SRH). They learn about changes during adolescence, puberty, media literacy, and human rights. They might discuss how adolescence affects their relationships with their parents or peers as they go through puberty. They also explore: reproductive health in more depth, such as how to care for one’s body; STIs and HIV, how they are spread, and how to prevent them; contraception, condom use, consent and pregnancy. They also learn how to identify sexual abuse and harassment and report them. Students also learn about sexual orientation and sexuality as a natural part of human development.  

In secondary education, Life Skills includes seven topics: personal development, healthy living, relationships with others, responsible citizenship, relationship to the environment, global processes and influences, and preparation for independence. In personal development, students learn about adolescence and adulthood, prepare for the roles and responsibilities of building a family, and establish healthy relationships with friends and family. In healthy living, students learn about hygiene, unwanted pregnancy, STIs, HIV, protecting against diseases, and belonging to different groups (according to gender, age, disability, sexual orientation, and ethnicity).  

As the standalone Sexual Education course was only recently announced, how it features in the new curriculum could not be found.

Teacher preparedness and capacity building: The 2009 Youth Action Plan calls for the training of peer educator trainers for sexual and reproductive health and family planning. 

Whether teachers are mandated to be trained on provision/delivery of sexuality education either as part of PRESET or INSET: According to the secondary education Life Skills curriculum, any teacher who meets the national criteria for subject teaching in the school is equipped to teach the Life Skills curriculum. Teachers must meet basic competency requirements to teach according to the curricula and standards, and according to the needs of the students. In 2020, a new comprehensive sexuality education programme was piloted in four schools were and all teachers were trained to teach the subject.

Access to school-based health services, including SRH: The 2009 Youth Action Plan calls for the distribution of condoms in schools, universities and social institutions. Estimated results include the delivery of half a million condoms a year to youth. According to the Law on Primary Education, schools cooperate with health institutions to provide health care for students, such as conducting regular systematic medical examinations and vaccinations. 

The 2012-2020 National Strategy for Sexual and Reproductive Health calls for the establishment of a network of youth-friendly counselling centres that are friendly and adapted to the needs of young people, offering free and confidential SRH services, ‘especially free contraceptive counselling and free contraceptives’.