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Sex Education Amongst Teenagers In Delhi

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Abstract

Purpose - The purpose of the study is two-fold. First, it tries to investigate the affect of attitude teenagers posses towards sex and sex education on the level of sex awareness they have. Also, it tries to establish whether gender is a moderator of the relationship between teenagers attitude and sex awareness.

Design/Methodology/Approach - A questionnaire was given to the students of schools and colleges in Delhi asking their attitudes towards sex, attitude towards sex education and their level of sex awareness. The results of this questionnaire were then analyzed to validate the study.

Findings - Positive correlation was found between the attitudes and the level of sex awareness. Also, partial mediation effect of the attitude towards sex education was proved. Another important finding was that the beta coefficient of attitude towards sex and sex awareness was negative in case of males but positive in case of females, showing the effect of gender as a moderator.

Research Limitations/Implications - The limitations of the research were that no existing study of attitude towards sex education of teenagers was done. Also, our research was targeted only towards the urban population which can be stretched to rural population as a part of future researches. Future research can also include a higher difficulty level questionnaire testing sex awareness among teenagers.

Practical Implications - Sex education is very necessary for the students in India because they receive information from different media's which is incomplete and incorrect.

Originality/Value - The study is one of the first to test the attitude of teenagers towards sex education bringing out the importance of sex education in today's society.

Keywords - Sex awareness, Attitude towards sex, Sex education

Paper type - Research Paper

Introduction

In India, teenagers receive most sex related information from media such as media and peers. Schools have not played an active role in providing sex education to the students. It is very important for the students to know about sex and the bodily and health effects that sex causes. India has the highest number of HIV/AIDS infectants in the world. Teenagers are the most vulnerable to such sexually transmitted diseases, and even more with the lack of knowledge that they possess. Even the knowledge that the teenagers possess is incomplete and inaccurate as it is received from secondary sources. Sex awareness is affected by the attitude of teenagers towards sex and sex education. Several authors have tried to define attitude in several different ways. Shaw and Wright (1967) opined that attitude entails an existing predisposition to respond to social objects, which in interactions with situational and other dispositional variables, guides and directs the overt behavior of the individual. In India sex is considered as a taboo. Most families do not feel comfortable talking about sex. Females face societal restrictions till they are married. All these factors heavily affect the attitude that teenagers share towards sex. We have also tried to measure the attitude of teenagers towards sex education as it is considered a great help to impart sex awareness among students from an early age in their life. Sex education in schools does not only give the students the information they require about sex at the correct time but also give them complete and correct information as it comes through the right source. Gender has been taken as a moderator which affects sex awareness. The societal obligation that exists in India gives existence to a different kind of attitude towards sex between boys and girls. Even though both the gender live in the same society study in same institutions, there are various restrictions that are put on the females which is exhibited in their attitudes. The aim of the study is to verify the mediation effect of gender on the three related components, namely attitude towards sex, attitude towards sex education and level of sex awareness.

Research Background and Hypothesis

Attitude towards sex education

Sex Education is an instrument which schools in many countries have included as a means to impart knowledge among the students about sex and its related impact on health. In India, sex education is a means still to show its dominance in schools. Teenagers today require basic knowledge about reproductive biology so as to develop better understanding about their own body and health. Sex education in schools becomes all the more important because this information needs to come through the correct medium. Teenagers receive information about this from almost everywhere, especially mediums which do not give them correct and complete information. Ignorance in such matters is exacerbated through low school attendance, attitudes that prohibit discussion about sexual matters and lack of sex education (Bott & Jejeebhoy 2003; McCauley & Salter 1995). There have been studies in the past which demonstrate lack of knowledge among teenager regarding reproductive biology (Gupta 1988). There are potential difficulties in incorporating sex education in the education policies of a state. According to authors like Beattie and Meredith (1989), sex education is a potential are of political discredit. . Oz (1991), Kirby et al. (1979) and Sonenstein and Pittman (1984) mentioned these difficulties in the USA. In Europe, Csincsak et al. (1994) referred to the same difficulties that Lo´pez (1990) had also identified in Spain. The European countries where sex education was more integrated into the educational policies were the Scandinavian countries (Meredith 1990). Sex Education in South- Asian countries has never really picked-up. In India, there have been talks of making sex education a mandatory part of the course curriculum but it is a very tough proposition. As per the current state, there are a very few schools (mostly in the urban parts of the country) where sex education is being provided. This dismal state should work as an initiator for the education ministry to make sex education a part of the course so that the students learn about the same from legitimate sources rather that sources which give them incorrect and incomplete information.

Instrument: We have used a questionnaire on a Likert scale (5-point scale ranging from strongly disagree to strongly agree) which was used in the study on Validity of a scale to measure teachers' attitudes towards sex education (Helena and Gonc, 2006). The questionnaire was used on teachers but here we are trying to study the attitude of teenagers towards sex education with the same set of questions. Such a study about attitude towards sex education among teenagers in India is lacking at present and hence we have tried to bridge this gap through our study.

Sex Awareness

Sex Awareness, literally means the awareness about sex and related issues. The related issues could range from the bodily effects of sex to the various health concerns that it can cause. Teenagers, in general have various sources to learn about sex. The sources range from school, peers, family to media. In India, peers play a very important role while imparting knowledge about sex to each other. Studies have found that many young men get information about sexuality and reproductive health from media and friends (Adjahoto, Hodonou, De souza, & Tete, 2000; Ali, Bhatti, & Ushijima, 2004; Hoy, 2001; Masilamani, 2003; Patil, Chaturvedi, & Malkar, 2002). However, teenager are also willing to use more suitable sources to learn more about their reproductive health (Ali, Bhatti, & Ushijima; Kapamadzija, Bjelica, & Segedi, 2000; Zheng, 1997). Another study showed that although the level of knowledge about puberty, menstruation, sex organs, reproduction, contraception, pregnancy, RTIs, HIV were low among young teenagers, older teenagers had better knowledge about the same (Gupta 1988). A study conducted by the Centre for Population Studies and CINI (2003) found that over 90% of the young adults of the peri-urban areas around Kolkata were aware of HIV/AIDS, about 50% had knowledge about the transmission of the virus, and a large portion was aware of at least one of the reversible methods of birth control. A survey conducted by The NACO National Behavioral Surveillance reported that about 30% of the boys (15-19 years old) know how the HIV virus is transmitted, with very slight variations between urban and rural boys (NACO & UNICEF, 2002). This shows that the knowledge levels are not extremely low among the teenagers in India but still need a considerable amount of improvement. Another reason for the increasing importance to imbibe sex awareness among teenagers is that the national average age of marriage for women in our country is 16.4 years (IIPS, 2000; Santhya & Jejeebhoy, 2003).

Instrument: To measure the awareness about sex among teenagers a simple open-ended questionnaire is used which has been taken up from Teenager Male Reproductive Health: Awareness and Behavior among Peri-Urban and Rural Boys in West Bengal, India (Mohan Das and Ray 2007). The answers have been rated on a 5 point scale with 1 for a wrong answer and 5 for the correct answer, so as to measure how well aware one is about sex and related issues.

Attitude towards Sex

In India, most teenagers are not very comfortable talking about sex with their family, which exhibits the fact that sex is considered a taboo in our country. According to a study done by International Herald Tribune (2006), even talking about sex is considered to be a taboo in wide parts of the country. The attitude of teenagers towards sex has changed over the years. The Family planning Association of India has conducted two surveys among people of the age of 15-29 years twice in the years 1990 and 1993 in 13 and 16 cities, respectively. In 1990, 67% of all males and 87% of all females surveyed disapproved of sexual relations. Whereas in 1993, survey showed that the proportion had decreased, especially among the males. There are various components that affect the attitude of teenagers towards sex. Evidence has shown that teenagers with more liberal attitudes towards sexuality are more likely to experience premarital sex (Rakesh 1992). A study conducted by Mohan Ghule et al (2007) showed that majority of the students of rural college in Maharashtra, India expressed conservative attitudes towards premarital sexuality. At the same time, a study done by Goparaju (1993) showed that the college students reported liberal attitudes to pre-marital sex. Religious beliefs also play an important role on the attitude towards sex. The negative influence of self-religiosity on attitudes towards sex clearly show that individuals who perceive themselves as more religious display conservative attitudes towards sex. (Rangaiyan 1996). Another component that affects one's attitude towards sex is the kind of social upbringing. Young people living in urban areas have a more liberal attitude towards sexuality and are more likely to engage in pre-marital sexual inter-course as compared to their rural counterparts. (Promote et al. 1987; Orubuloye et al. 1991).

Instrument: The questionnaire chosen uses a 5-point likert scale to judge the attitude of teenagers towards sex. The questionnaire was used in the study Attitude Towards Premarital Sex among Rural College Youth in Maharashtra, India (Ghule, Balaiah and Joshi 2007). The questionnaire tests the attitude that both boys and girls have towards sex and if societal obligations and restrictions do play a part on such an attitude.

Moderator: Boys and Girls

We want to study the mediation affect of gender on the level of sex awareness that teenagers exhibit in India. Numerous studies have shown that the level of sex awareness exhibits variations when the two genders are compared. Across cultures, males and females are socialized by separate sets of practices, symbols, representations, norms, and social values starting from their childhood upbringing that influence their expressions of masculinity and femininity, respectively (Bruce, Lloyd, & Leonard, 1995; Lamas, 1996; Ortner & Whitehead, 1996; Scott, 1996; Verma, 1997). In general, men are socialized to be dominant, aggressive, to cultivate toughness, and to take risks (O'Neil, Good, & Holmes, 1995), whereas women are socialized to be polite and well-mannered. Males have been found to be more likely to engage in premarital sex and to have more positive attitudes towards premarital sex than do females (Carrol et al. 1985; Hendrick et al. 1985; Cernada et al. 1986; Alexander et al. 1989; Rangaiyan 1996; Abraham 2001). The Indian society has always seen females being imposed restrictions upon. Most parents prefer their daughters going in convent schools (although this notion is taking a change in the past few years), not allowing them to socialize with the other sex and getting them married as soon as they attain reproductive age. The mediation effect between the two genders will validate whether or not the studies regarding the societal restrictions put on women and sex being considered a taboo especially for the females are true.

Attitude towards Sexuality and Sexual Awareness

Human sexual behavior is instinctive as well as learnt which is why societal values and norms interfere with this behavior. Cultural myths and taboos result in sexual ignorance. (Avasthi A. K., et al., 1992). Adolescence, which is a transition between childhood and adulthood, is marked by reproductive development, which is why adolescents need to be aware of the physiological and emotional changes their bodies undergo. However, most adolescents in India lack reproductive health knowledge mostly due to various socio-cultural factors. (Das B. M. et al, 2007). This lack of awareness eventually contributes to the spread of STDs such as AIDS (Kumar A., et al, 1997).

Starting from childhood, males and females are socialized by different sets of practices and norms. Boys are expected to be aggressive and tough which automatically drives them to high risk sexual behavior, which poses potential risk for them as well as their sexual partners. (Das B. M. et al, 2007). Such attitudes towards sexuality eventually affect sex awareness, especially among adolescents. Adolescents in India are either sexually unaware or clouded in myths deep-rooted in Indian culture. Reproductive health needs and sexual urges of adolescents though different from those of adults are poorly understood. (Das B. M. et al, 2007).

A society's sexual behavior is controlled by the extent to which social control and self-restraint is valued by the society. Of late, in India, social and community controls have weakened, giving way to greater individual freedom. This autonomy though available to all classes of men, is limited, in the case of women, only to upper and middle classes to a certain extent. However such social values restraining sexuality have not been replaced by sexual education (HIV and AIDS Prevention and Care). This results in unsafe sexual practices, without increasing awareness. (Ambati, B. K. et al, 1997) It just leads to increasing cases of sexual assaults on women and girls, which are conducive to the spread of AIDS in women (HIV and AIDS Prevention and Care).

Parents hardly discuss sexual issues with their wards. Hence, adolescents rely on peers, media and fiction for information related to sexuality, which might not always be accurate. Knowledge of sexually transmitted diseases is limited. (Patil S. S., et al.)

Attitude towards Sexuality and Attitude towards Sexual Education

The sexually conservative nature of Indian society inhibits educational efforts, especially since discussing sexual issues at a personal level is discouraged. (Ambati, B. K. et al, 1997) (Bhan N. B., et al. 2004) showed that hesitance in talking about reproductive health results in a poor level of sex knowledge (i.e. knowledge regarding HIV, AIDS and menarche) among girls. Adolescents usually are expressive about their sexual desires, mostly when talking about crushes. Sexual fantasies used as a source of arousal for masturbation. However fear of the consequences of discovery on reputation inhibits adolescents from seeking out correct information about these issues. (Bhugra D. et al., 2007) They are mostly concerned about masturbation and nocturnal ejection. (Patil S. S., et al)

Social taboos against open discussion of sexuality lead to a lack of awareness among the general public, minimal skills and training among health professionals. (Garg S. et al., 2007.) As a result, India is currently facing an emergence of STIs and HIV. Any program to raise awareness of STIs and HIV needs to keep in mind the underlying attitude of the society towards sex, since this affects attitude towards sexual education. The effectiveness of sexual education is highly inhibited by a negative attitude towards it.

Indian socialization process is such that boys are expected to be independent and self-reliant. This makes them ignore reproductive health problems and rely on self-treatments. (Das B. M., et al., 2007) Females have a more negative attitude towards sexuality as compared to males. (Avasthi A. K., et al., 1992.) Adolescent girls find the concept of homosexuality horrifying and the practice of masturbation unacceptable; they believe in myths that masturbation could lead to impotence and weakness. (Bhugra D. et al., 2007) Such lack of openness about sexual issues also extends to half-hearted acceptance of sex education.

On the positive side, the fact that premarital sex is considered a taboo ensures that girls are aware of contraception for fear of discovery. In fact fear of pregnancy, parental trust and expectations, and societal pressures stops many youngsters from indulging in premarital sex. (Bhugra D. et al., 2007). In this case, societal pressure ensures a positive attitude when it comes to issues such as pregnancy, transmission of STDs, etc. However, at times adolescents, especially boys overcome societal attitude to sex in gathering basic sexual and reproductive information. They resort to indirect methods like fiction, peer interaction, media, etc. (Bhugra D. et al., 2007). However, these sources aren't always accurate which in turn clouds sexual education. There is an urgent need to encourage flow of information via more direct sources.

Attitude towards Sexual Education and Sexual Awareness

The topic of introducing sex education in school has been debated over and over again. The controversy surrounding this reflects the attitude of the society towards sexual education. In short, sex education requires a positive attitude of professionals delivering these courses. (Reis M. H. A., et al., 2006.) This would go a long way in increasing the effectiveness of these programs thereby increasing sex awareness.

An educational intervention program carried out among rural adolescent girls in Karnataka indicated the potential of such programs in increasing reproductive health knowledge among this segment. (Rao R. S. P., et al., 2008.) Adolescent pregnancies contribute to 10-15% of total pregnancies in India, largely due to early marriages. Among the two genders, girls are more vulnerable because they can be coerced for unprotected sex and because they are biologically more susceptible to STDs including HIV infection. Early childbearing also has an adverse impact on their long-term economic potential. Thus sexual education goes a long way in improving sexual awareness. Despite the controversy surrounding effectiveness of health education, it has been established that it at least leads to increased awareness among adolescent girls empowering them to take care of their own reproductive health. (Rao R. S. P., et al., 2008.)

For diseases like HIV with no cure, education is very important; prevention being the only route. (Ambati, B. K., et al., 1997) The Medical Termination of Pregnancy Act legalized abortion in India, the intention being to reduce illegal abortion and consequent maternal mortality. However, unsafe abortions levels are still high, especially among low-income rural women and adolescents. (Johnston H. B., 2002.) It is essential to target and educate adolescents about reproductive health issues. Knowledge about major routes of HIV transmission is high without any intervention mostly due to exposure to media. (Patil S. S., at al.) This is indicative of the fact that sexual educational programs along these lines could increase sexual awareness.

Methods

Sample

A sample of 180 respondents consisting of 108 boys and 72 girls from schools and colleges of Delhi has been taken for the study. The survey was sent to 250 students of which 180 finally responded back, i.e. a response rate of 72% was achieved. Among the 180 responses, 30 responses were received from personal interviews whereas 150 responses were received from e-mails. The questionnaire was given mostly to urban schools and colleges in Delhi.

Measures

The above three constructs were measured as follows:

Attitude towards Sex : Likert Scale (1=strongly disagree, 5=strongly agree)

Attitude towards Sex Education is measured by a likert scale with questionnaire taken from the study 'Validity of a scale to measure teachers' attitudes towards sex education' (Helena and Gonc, 2006).

Attitude towards Sex Education: Likert Scale (1=strongly disagree, 5=strongly agree)

Attitude towards Sex is measured by a likert scale with the questionnaire taken from the study 'Attitude Towards Premarital Sex among Rural College Youth in Maharashtra, India' (Ghule, Balaiah and Joshi 2007).

Sex Awareness: Open-ended questions (1=incorrect answer, 5=correct answer)

Sex Awareness is measured by open ended questions with the questionnaire taken from the study 'Teenager Male Reproductive Health: Awareness and Behavior among Peri-Urban and Rural Boys in West Bengal, India' (Mohan Das and Ray 2007).

Analysis & Results

All the constructs are positively and strongly correlated to each other, which confirm the empirical evidences on these relationships. Sexual awareness is strongly related to attitude to sex as well as attitude to sex education.

Mediation Analysis

All the results obtained in this test are statistically significant, level of significance being considerably less than 0.05 in each case. Step 1 indicates that attitude to sex is significantly related to sex awareness (beta = 0.925, R2 = 0.854). Hence, there is an effect that could be mediated. Step 2 indicates that attitude to sex is significantly related to attitude to sex education (beta = 0.724, R2 = 0.522). Thus, antecedent variable is significantly related to the mediator. Step 3 shows a strong link between mediator and sex awareness. (beta = 0.883, R2 = 0.778). Step 4 indicates that sex awareness depends upon both attitude to sex and attitude to sex education (R2 = 0.950). The relationship between attitude to sex and sex awareness is lower (beta = 0.600 as compared to earlier beta = 0.925) when attitude to sex education is included in the model. This indicates that attitude to sex education acts as mediator. However, since the relationship between attitude to sex and sex awareness is highly significant, the mediation effect is partial, not complete. Thus, the model holds good with attitude to sex education having a partial mediating effect.

Moderation Analysis

The following are results of regression analysis carried out separately on females and males.

Moderation effect - regression analysis

When the same linear regression analysis is carried out separately on adolescent boys and girls, the results obtained are different for both the groups. For females, the partial mediation model still holds good. (beta = 0.830 for attitude to sex and sex awareness, beta = 0.552 when attitude to sex is also included in the relationship) However for males, the results change drastically. Attitude to sex is not a driving factor for sex awareness in this case (beta = -0.304, R2 = 0.084). Though, when attitude to sex education is included in the analysis, some relation is observed between attitude to sex and sex awareness (beta = 0.360, R2 = 0.661), which is primarily because attitude to sex education is strongly related to sex awareness. (beta = 0.771, R2 = 0.590). Thus, sex education can enhance sex awareness in boys even though attitude to sex has no effect.

Discussion and Implications

The study has been able to verify the positive correlation between the various constructs, namely the attitude towards sex, attitude towards sex education and sex awareness with the moderator effect of gender. This shows that there is a link between the attitude that teenagers possess towards sex and the level of awareness they have. The study has shown a very interesting trend that a majority of the teenagers think of sex education as important and would like to impart it in the school curriculum. This presses on the need of our education system to include sex education as a part of the education that is provided in the schools itself, so that the youth is able to learn about it from an early stage in life. Sex education has been implemented well in other nations and various studies show that the level of sex awareness in such countries is much higher than that in our country. There have been enough talks about including sex education as a part of the course curriculum and now it is time that the education system incorporates this change.

Another very striking development of this study is that because the teenagers are not been given information from the right sources, they are receiving incomplete and incorrect information from various mediums. The teenagers mostly receive sex related information from peers and media. This makes it all the more important for us to provide the students with the right channel and medium to get information about sex and its related issues. India is largely affected by various sexually transmitted diseases and to prevent this growth , sex awareness is a must.

The societal restrictions that the Indian culture has had on the females are also exhibited with the differences in attitude towards sex among the two genders. Families need to loosen the restrictions that it has made on females so that they can also grow and be aware about the world as much as their male counterparts. Families need to be more liberal about discussing sex with children and should not consider sex as a taboo.

Limitations and Conclusion

Firstly the study was concentrated only to the urban section of students in Delhi and this does not show the general attitude of teenagers all over, especially those in the rural parts of the country, whose upbringing and social values are totally different from those of the urban population. This can work as moderator for future studies which can focus upon the difference in attitudes and awareness about sex of the two different classes- rural and urban. There are various studies that have been done for the same. Urban teenagers have better knowledge about reproductive health matters and legal provisions related to abortion and age of marriage (Das and Ray 2007).

A gap that we found in the available studies was the non-existence of a study of the attitude towards sex education of students in India. Studies have been done regarding the level of sex awareness and attitude towards sex, but the attitude of teenagers towards sex education has never been studied. We have used the scales and the questionnaire from a study done in Portugal regarding the attitude of school teachers towards sex education. The set of questions are competent enough to be used for students as their main aim lies in measuring the attitude (whether positive or negative) of respondents towards sex education.

Another limitation of our study was that we have used very basic questions to measure the level of sex awareness among students. The questions test the basic knowledge of teenagers about reproduction and sexual organs. A higher difficulty level questionnaire could also have been prepared but as we were apprehensive about the acceptance of these questions by our respondents, we restricted our study to a basic level of questionnaire.

In summary, despite the above limitations the study explains the relationship between the attitude towards sex and sex awareness among teenagers. It also explains the partial mediation affect of the attitude towards sex education of the teenagers. The moderator effect of gender exhibits the differences that still exists between the attitudes of the two genders towards sex owing to the culture and society we are a part of.

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