Comprehensive Sexuality Education

1. Context and background

Mongolia is one of the least densely populated countries in the world. Much of the population is sparsely distributed across the country, with the highest population density in the two cities, Ulaanbaatar and Darhan. The youth population (aged 15-24) does not constitute a significant portion of the population. In the past few decades, the rates of infant and maternal mortality have decreased. The lack of intersectoral coordination and insufficient funding has prevented the delivery of comprehensive services that meet the needs and interests of youth and adolescents and ensure their rights. Family planning information and counselling and services are often unavailable for sexually active adolescents. The participation and cooperation of governmental, non-governmental and international organizations have played a major role in efforts to provide sexuality education.

2. Terminology

The health education (ЭРҮҮЛ МЭНД) curriculum refers to 'sexuality education' and 'reproductive health' ('бэлгийн боловсрол, нөхөн үржихүйн эрүүл мэнд').

3. Laws and policies

3.1. Relevant international/regional agreements to which Mongolia is a signatory

INTERNATIONAL
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.
Convention on the Rights of the Child (CRC) Ratification date: 1990	Commits to the right to access appropriate health-related information.
Convention on the Rights of Persons with Disabilities (CRPD) Accession date: 2009	Commits to the highest attainable standard of health for persons with disabilities.
International Covenant on Economic, Social and Cultural Rights Ratification date: 1974	Acknowledges that the right to sexual and reproductive health is an integral part of the right to health.
UNESCO Convention against Discrimination in Education Ratification date: 1964	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.
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.
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.
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.
REGIONAL
The Asia and Pacific Ministerial Declaration on Population and Development (2013) (Asia Pacific) Attended	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.

3.2. Relevant national laws and policies mandating comprehensive sexuality education

The Government of Mongolia uses a number of documents regarding reproductive health and rights. These include the Comprehensive National Development Policy (2008-2019), the State Policy on Population and Development (2016-2025) and the related Action Plan, State Policy on Health (2017), Family Law (1999), Law on Health (2011), Law on Supporting Youth Development (2017), State Policy on Public Health (2001), National Program on Reproductive Health (2017), National Strategy on Combatting STIs and AIDS (2005), the Program on Maternal, Child and Reproductive Health (2017), and the National Program on Supporting Youth Development (2018).

The country has been implementing national programmes on reproductive health since 1997, with the Fifth Program covering the period 2017-2020. The Law on Ensuring Gender Equality (2011) aimed to provide for the equitable delivery of health services, stating that the Government will implement measures to create services that respond to the specific health needs of men and women. More recently, the Cross-Sectoral Strategy Plan for Ensuring Gender Equality (2022-2030) supports equal opportunities for girls, boys, women and men to live and learn in a healthy and safe manner. The State Policy on Public Health (2001-2015) includes, among its objectives, preparing adolescents for sexual life and upgrading formal and informal training in order to improve health education. The objective of the Reproductive Health Program (phase IV), completed in 2016, was to update the content of the health education programme in secondary schools. The more recent National Program on Reproductive Health Action Plan 2016-2020 includes providing health education in the secondary school training curriculum and decreasing the spread of STIs by providing reproductive health education to adolescents and young adults. The State Policy on Population Development (2016-2025) includes issues related to sexuality, such as providing comprehensive education on SRH to adolescents and young adults, and protecting adolescent girls from early and unintended pregnancy, early childbearing, and abortion (which is legal and available upon request).

The integration of health education into the school curricula started in 1998-1999. The first health education standards were introduced in 2005 and since then health education classes have become compulsory in schools delivering general education. The 2002 Law on Education does not include any specific provision on sexuality education, though it does provide for educational measures comprising the basics of personal development, a healthy lifestyle, family life, life skills and health. Sexuality education was integrated into biology and physical activity classes from 2013. However, in response to pressure from some non-governmental organizations, the health programme was reinstated in the 2018-2019 academic year as its own subject.

As stated in the tenth periodic report (2020) submitted by Mongolia to the CEDAW, the Health curriculum was developed in 2018, approved by Order No. A/467 of the Ministry of Education, with implementation starting in all secondary schools.

The country also has provisions for protection against all forms of violence in the school context. In 2018, the procedure on 'Preventing violence against children in school environment and dormitories of educational institutions' was adopted by Order No. A/239 of the Ministry of Education. The regulation provides for the protection of children in dormitories, responses in the event of abuse, and the management of material and psychological effects.

3.3. Curricula

Mandatory or optional

Health was reintroduced as a mandatory subject, starting from the 2018-2019 academic year, under a resolution of the Minister of Education. The current curriculum also mandates that SRH education content is incorporated within other subjects.

Model of delivery

From 1998 to 2013, health education was delivered as a stand-alone subject for primary and secondary students. From 2013, students from the 6th grade onwards receive these lessons, which are integrated into biology and physical activity classes (Table 1). From 2018, health was introduced as a stand-alone subject called 'Good Health' (ЭРҮҮЛ МЭНД) with 'Reproductive health and sexuality education' (бэлгийн боловсрол, нөхөн үржихүйн эрүүл мэнд) incorporated into the revised curriculum. According to the tenth periodic report (2020) submitted by Mongolia to the CEDAW, reproductive and family education is provided to students in health, biology, social sciences, and civic education curricula in all secondary and high schools.

Table 1. Health education from 1998 to 2016.

№	Year	Subject name	Class/hour		Percentage of CSE`s content
			Class	Hour
1	1998-2004	Health	1-10	9	11%
2	2004-2013	Health	4-5	35	10-12%
			7-9	35	20-40%
			10-12	35	20-33%
3	2013-2016	Biology	6	35	12%
			;7-12	70	7-11%

Source: Arrow, 2017.

Comprehensiveness of content

CSE content is adapted in accordance with the age and psychological attributes of the students. Knowledge about human development and reproduction is taught for one to two academic hours in grades 6-12, with a focus on the anatomical and physiological aspects in biology classes, while in physical activity classes students are taught about nutrition, hygiene and first aid during exercises. There is no sexuality education content in the training module.

The 2013 programme included topics on human development, relationships, and reproductive health. It provided general information on those these topics but did not cover essential skills, rights or the development of attitudes. Content on individual skills, sexual behaviour, social and cultural aspects of sexual education was not found. Content covering issues such as pleasure, positive attitudes towards sexuality, consent, enjoyment and the promotion of safe sex was also not included. The content of the 2018 Reproductive health and sexuality education module was developed based on the UNFPA Operational Guidance for Comprehensive Sexuality Education, and includes core content on SRH rights such as human rights, relationships, communication, and understanding and accepting others. Objectives for the basic class include acquiring knowledge in: biological and social factors affecting health; relationships and environmental factors that affect health, including positive and negative emotions, relationships, love, pressure, harmful habits and environmental safety; and lifestyle and social services to protect health. including gender knowledge and understanding of stereotypes, sexuality education, reproductive health and first aid techniques. At the upper secondary level, students learn about lifestyle and social services to protect their health, including sexual education, reproductive health, marriage, pregnancy and childbirth, family planning and parental responsibilities. Besides classroom-based learning, the programme also relies on the the participation of parents and for them to take on a level of responsibility.

In line with Order No. A/390, in 2019 the Ministry of Education approved the Civic Ethics Education curriculum for elementary, middle and high school students. Aspects of sexuality education are covered in health as a learning subject. The most recent curriculum for primary, middle and secondary education was developed in 2019. For the primary education curriculum (БАГА БОЛОВСРОЛЫН СУРГАЛТЫН ХӨТӨЛБӨР, СУРАЛЦАХУЙН УДИРДАМЖ) topics include: how to identify and develop healthy relationships with family, friends and peers; how gender inequality is linked to power differences; the promotion of gender equality in the home, school, and society; identifying bullying behaviour, avoiding bullies and developing effective ways to respond; recognizing the difference between gender expression and identity; understanding he physical differences between men and women, and learning about physical growth in connection with physical, social and psychological changes during the transition to adulthood; and learning about personal space and how to respect it.

The middle education curriculum (СУУРЬ БОЛОВСРОЛЫН СУРГАЛТЫН ХӨТӨЛБӨР, СУРАЛЦАХУЙН УДИРДАМЖ) includes: distinguishing between healthy and unhealthy communication characteristics and peer pressure; role-playing on how to deal with pressure, friendship and love; understanding stigma and discrimination and their negative consequences; analysing of gender norms and stereotyping and its consequences; appreciating the importance of consent: recognizing that individual sexual decisions change; understanding gender identity and expression and demonstrating respect for orientation and expression; understanding the concept of sexual orientation, misconceptions about it, and acknowledging and respecting differences; learning about STIs, forms of transmission, symptoms, treatment and prevention, and measures to be taken in cases of possible infection.

The 2019 secondary education curriculum includes comprehensive aspects of sexuality education, including rights and responsibilities of communication; personal boundaries and needs; legislation and human rights; appropriate and inappropriate sexual behaviour; consensual sexual behaviour; methods of contraception, how to use it, and condoms; sexuality; and gender stereotypes. The curriculum also teaches students to be critical of the information provided by the media and how to identify reliable sources and stop misinformation; the steps that need to be taken to support pregnancies and births; health risks and infertility associated with early pregnancy and childbirth; early and unwanted and pregnancy and how to make decisions about it; consensual and safe sex; laws and policies on human rights; and sexual and gender-based violence, including online violence and bullying.

Learning resources

According to the tenth periodic report (2020) submitted by Mongolia to the CEDAW, health textbooks are being evaluated for compliance with the curriculum, and health textbooks for grades 4-12 are being updated and used in secondary schools, in line with the 2019 Order No. A/62 of the Minister of Education.

The 2018 Good Health Curriculum provides worksheets and other materials that may be used by teachers.

3.4. Teachers

Since 1998, trainings have been conducted for school teachers with financial support from the Ministry of Education, UNFPA, WHO and UNICEF. In addition, the Mongolian National University on Education started new classes for teachers of biology and health, and teachers of physical education and health. However, when health education classes were eliminated as a stand-alone subject from 2013, this impeded the trainings of teachers for health education at the Mongolian National University on Education.

In 2020, the Ministry of Education launched two teacher guides with methodological recommendations on the implementation of health curriculum for primary and secondary education. The guide for younger students includes topics such as personal hygiene and environmental health; food and movement; mental health; reproductive health, including gender equality, the reproductive system and changes in the body during the puberty; safety and first aid; relationships with peers and friends; differences of power and gender; creating a safe environment at home; and assessing the knowledge, skills and attitudes acquired in health education. For secondary school students, the guide provides models for teaching the issues mentioned above and also covers the concepts of: human sexuality; pregnancy and pregnancy symptoms; friendship and love; violence; making decisions about sex; sexual orientation and gender orientation; early and unwanted pregnancy and its consequences and risks related to it; gender-based violence; ways to combat human rights violations and violence; the responsibilities of parents; the responsibilities of couples in sexual intercourse; and planning for the future.

3.5. Schools

Guidelines for youth-friendly services were issued and approved in 2017. These documents provide a sustainable approach to youth-friendly services, and have been renamed from the original 'Adolescent-Friendly Health Care' to 'Youth Cabinets'. These cabinets provide STI diagnosis and treatment to adolescents and young people, provide counselling, and manage health problems in 11 target aimags (provinces) and 4 districts of Ulaanbaatar.

According to some non-governmental organizations, such as the Asian-Pacific Resource and Research Centre for Women (Arrow), there is a shortage of SRH services. In 2017, only 31 adolescent-friendly reproductive health centres were operating nationally.