Delivery of Sex and Relationship Education in schools, access to on-site sexual health services and free condoms

The Challenge

Adolescence is a critical period for establishing norms around sexual activity. Early sexual activity, inconsistent condom use and multiple sexual partners are recognized risk factors of Sexually Transmitted Infection (STI) transmission and unplanned pregnancy. The costs to the UK health service and wider public services has meant that promoting safe, healthy, positive sexual behaviour is a major public health priority.

Schools play an important role in the sexual health and wellbeing of students, primarily via Sex and Relationship Education (SRE). The World Health Organization and European Sexual Health Policies link SRE with improved uptake of contraception and a reduction in pregnancies for those aged under 18, as well as abortions and STIs.

The Research

This study carried out by a team of researchers from DECIPHer at Cardiff University, investigated how the sexual health outcomes of a representative sample of students aged 15-16 in Wales vary according to the person delivering SRE in schools, students’ access to on-site sexual health services and access to free condoms.

Data from students that took part in the 2015/2016 School Health Research Network questionnaire in Wales was analysed. The data was collected from across 59 schools, totalling 3781 students aged 15-16 who responded to questions about ever having had sex; age of sexual initiation and condom use at last intercourse.

School level data was also collected, examining who delivers school SRE, provision of on-site, school ‘drop-in’ sexual health services and provision of free condoms for students.

The Findings

The quality, quantity and style of SRE delivery varies across Wales.
A total of 24.9% of 15–16-year old students in Wales had engaged in sexual intercourse and 56.8% did not use a condom at last intercourse.
Compared to teachers, other types of SRE delivery (school nurses, specialist SRE/health education teachers, outside agencies) were associated with better sexual health outcomes; remaining sexually inactive, later age of first sexual intercourse and condom use.
Providing an on-site sexual health service was associated with increased condom use, whereas free on-site condom provision was associated with lower condom use.
SRE delivery by specialist SRE/health education teachers, school nurses and outside agencies is linked to positive sexual health outcomes.

The Impact

Making SRE a statutory part of the curriculum and ensuring comprehensive, sex-positive and stage appropriate content is essential to improving young people’s sexual behaviour and sexual health outcomes.

The success of any SRE taught in schools may be largely dependent on the educator delivering the SRE programme. This research suggests that SRE delivery by specialist SRE/health education teachers, school nurses and outside agencies are associated with positive sexual health outcomes when compared to teachers, and supports existing research which indicates that young people prefer non-teacher SRE delivery – as someone other than a classroom teacher may alter the classroom dynamic in ways which are likely to make young people more receptive to the topic.

The findings also inform the need to continue funding for, and coordination of on-site sexual health advice services in schools. The team highlight the importance of exploring in more detail the barriers to young people’s engagement with sexual health services on school sites, and the need to work with schools to ensure that young people’s access needs are met and that schools promote sex-positive environments.

For further information on the research visit: https://academic.oup.com/eurpub/article/28/2/309/4638449 / http://www.shrn.org.uk