and sexual and reproductive health: the late Dr Douglas Kirby, PAHO 1.paho/hq/dmdocuments/2008/PromotionSexualHealth.pdf ; and, WHO.

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UNESCO Education Sector Education is UNESCO™s top priority because it is a basic human right and the foundation on which to build peace and drive sustainable development. UNESCO is the United Nations™ specialized agency for education and the Education Sector provides global and regional leadership in education, strengthens national education systems and responds to contemporary global challenges through education with a special focus on gender equality and Africa. The Global Education 2030 Agenda UNESCO, as the United Nations™ specialized agency for education, is entrusted to lead and coordinate the Education 2030 Agenda, which is part of a global movement to eradicate poverty through 17 Sustainable Development Goals by 2030. Education, essential to achieve all of these goals, has its own dedicated Goal 4, which aims to fiensure inclusive and equitable quality education and promote lifelong learning opportunities for all.fl The Education 2030 Framework for Action provides guidance for the implementation of this ambitious goal and commitments. Published by the United Nations Educational, Scienti˜c and Cultural Organization (UNESCO), 7, place de Fontenoy, 75352 Paris 07 SP, France, UNAIDS Secretariat, 20, Avenue Appia, CH-1211 Geneva 27, Switzerland, The United Nations Population Fund (UNFPA), 605 Third Avenue, New York, NY 10158, United States of America, The United Nations Children™s Fund (UNICEF), UNICEF House, 3 United Nations Plaza, New York, NY 10017, United States of America, UN Women, 220 East 42nd Street, New York, NY 10017, United States of America, And The World Health Organization (WHO), 20, Avenue Appia, CH-1211 Geneva 27, Switzerland. © UNESCO 2018 UNESCO™s ISBN 978-92-3-100259-5 This publication is available in Open Access under the Attribution-NonCommercial-NoDerivs 3.0 IGO (CC-BY-NC-ND 3.0 IGO) license ( ). By using the content of this publication, the users accept to be bound by the terms of use of the UNESCO Open Access Repository ( Second revised edition First edition published in 2009 by the United Nations Educational, Scienti˜c and Cultural Organization The present license applies exclusively to the text content of the publication. For the use of any material not clearly identi˜ed as belonging to UNESCO, prior permission shall be requested from: or UNESCO Publishing, 7, place de Fontenoy, 75352 Paris 07 SP France. The designations employed and the presentation of material throughout this publication do not imply the expression of any opinion whatsoever on the part of UNESCO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The ideas and opinions expressed in this publication are those of the authors; they are not necessarily those of UNESCO and do not commit the Organization. Cover photo: Designed by Aurélia Mazoyer Printed by UNESCO Printed in France

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Foreword Foreword It has been almost a decade since the International technical guidance on sexuality education was ˜rst released in 2009. During this period, the global community has come to embrace a bold and transformative development agenda to achieve a just, equitable, tolerant, open and socially inclusive world in which the needs of the most vulnerable are met and where no one is left behind. The 2030 Agenda for sustainable development shows us that quality education, good health and well-being, gender equality and human rights are intrinsically intertwined. Over this period, more and more young people have joined together to call for their right to sexuality education, and to urge their leaders to deliver on political commitments for current and future generations. At the 2012 Global Youth Forum of the International Conference on Population and Development (ICPD), young people speci˜cally called on governments to ‘create enabling environments and policies to ensure that they have access to comprehensive sexuality education in formal and non- formal settings, through reducing barriers and allocating adequate budgets’. Young people have not stood alone in this e˚ort Œ they have been joined by communities, parents, faith leaders and stakeholders in the education sector who increasingly champion sexuality education as an essential component of a good quality education that is comprehensive and life skills-based; and which supports young people to develop the knowledge, skills, ethical values and attitudes they need to make conscious, healthy and respectful choices about relationships, sex and reproduction. Despite these advances, too many young people still make the transition from childhood to adulthood receiving inaccurate, incomplete or judgement-laden information a˚ecting their physical, social and emotional development. This inadequate preparation not only exacerbates the vulnerability of children and youth to exploitation and other harmful outcomes, but it also represents the failure of society™s duty bearers to ful˜l their obligations to an entire generation. This revised and fully updated edition of the International technical guidance on sexuality education bene˜ts from a new review of the current evidence, and rea˛rms the position of sexuality education within a framework of human rights and gender equality. It promotes structured learning about sex and relationships in a manner that is positive, a˛rming, and centered on the best interest of the young person. By outlining the essential components of e˚ective sexuality education programmes, the Guidance enables national authorities to design comprehensive curricula that will have a positive impact on young people™s health and well-being. Like the original Guidance, this revised version is voluntary, based on the latest scienti˜c evidence, and designed to support countries to implement e˚ective sexuality education programmes adapted to their contexts. We are convinced that if we do not meet young people™s calls for good quality comprehensive sexuality education, we will not achieve the Sustainable Development Goals (SDGs) we have set for 2030, and the commitment that has been made to leave no one behind. With this in mind, we are committed to supporting countries to apply the Guidance, and hope that teachers, health educators, youth development professionals, sexual and reproductive health advocates and youth leaders Œ among others Œ will use this resource to help countries to realize young people™s right to education, health and well-being, and to achieve an inclusive and gender equal society. Audrey Azoulay Director-General, UNESCO

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Acknowledgements Acknowledgements This revised edition of the International technical guidance on sexuality education was commissioned by the United Nations Educational, Scienti˜c and Cultural Organization (UNESCO). The updates to the guidance were carried out under the leadership of Soo-Hyang Choi, Director, Division of Inclusion, Peace and Sustainable Development; with overall guidance provided by Chris Castle, UNESCO Global Coordinator for HIV and AIDS; coordination by Joanna Herat in the Section of Health and Education; and support from Jenelle Babb, Cara Delmas, Rita Houkayem, Karin Nilsson, Anna Ewa Ruszkiewicz and Marina Todesco (former). The updated and additional written content for the overall Guidance was prepared by Marcela Rueda Gomez and Doortje Braeken (independent consultants); speci˜c updates to the key concepts, topics and learning objectives were developed by a team from Advocates for Youth, comprised of Nicole Cheetham, Debra Hauser and Nora Gelperin. Paul Montgomery and Wendy Knerr (University of Oxford Centre for Evidence-Based Intervention) carried out the review of evidence that informed the update of this 2018 edition of the Guidance. Copy-editing and proofreading of the manuscript was done by Jane Coombes (independent consultant). We are particularly grateful to Sweden and to UNAIDS for funding support, and to the following members of the Comprehensive Sexuality Education Advisory Group who provided valuable contributions to the development process by o˚ering information, review , feedback and other technical assistance: Qadeer Baig, Rutgers WPF (former); Doortje Braeken, International Planned Parenthood Federation (former); Shanti Conly, USAID (former); Esther Corona, World Association of Sexology; Helen Cahill, University of Melbourne; Pia Engstrand, Swedish International Development Cooperation Agency (Sida); Nyaradzayi Gumbonzvanda, Rozaria Memorial Trust and African Union Goodwill Ambassador on Ending Child Marriage; Nicole Haberland, Population Council; Wenli Liu, Beijing Normal University; Anna-Kay Magnus-Watson, Ministry of Education, Jamaica; Peter Mladenhov, Y-Peer; Sanet Steenkamp, Ministry of Education, Namibia; Remmy Shawa, Sonke Gender Justice (former); Aminata Traoré Seck, Ministry of Education, Senegal; Alice Welbourn, Salamander Trust; Christine Winkelmann, BZgA, and from UNDP, the following: Diego Antoni, Suki Beavers, Caitlin Boyce, Mandeep Dhaliwal, Natalia Linou, Noella Richard and Tilly Sellers, with additional input from Siri May (OutRight Action International, UNDP external reviewer). Our appreciation goes to colleagues from UN co-publishing partners for their inputs and review throughout the process: UNAIDS secretariat; Maria Bakaroudis, Elizabeth Benomar, Ilya Zhukov (UNFPA); Ted Chaiban, Susan Kasedde, Catherine Langevin Falcon, Vivian Lopez, Chewe Luo (UNICEF); Nazneen Damji, Elena Kudravsteva (UN Women); Ian Askew, Venkatraman Chandra-Mouli (WHO) along with UNESCO headquarters, regional and national ˜eld o˛ce sta˚ in Health and Education: Christophe Cornu, Mary Guinn Delaney, Xavier Hospital, Hongyan Li, Yong Feng Liu, Patricia Machawira, Alice Saili, Justine Sass, Ariana Stahmer and Tigran Yepoyan. Deep appreciation is also expressed to the individuals and organizations that participated in and gave input to the update of the UN International technical guidance on sexuality education Stakeholder Consultation and Advisory Group Meeting, which was held 25-27 October 2016 at UNESCO headquarters in Paris. The UN partners who have jointly published this Guidance wish to especially acknowledge two remarkable individuals whose professional dedication and service to young people™s well-being have left an indelible mark on the ˜elds of sexuality education and sexual and reproductive health: the late Dr Douglas Kirby, former Senior Scientist at Education, Training and Research (ETR) Associates, whose extensive research informed the development of the original Guidance; and the late Dr Babatunde Osotimehin, Executive Director of UNFPA.

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Table of contents 6Key concept 6: The Human Body and Development 64Key concept 7: Sexuality and Sexual Behaviour 69Key concept 8: Sexual and Reproductive Health .736 – Building support and planning for the implementation of CSE programmes ..816.1 Strengthening commitment for CSE ..826.2 Supporting CSE programme planning and implementation 867 – Delivering e˜ective CSE programmes 897.1 Introduction 907.2 Characteristics of e˚ective curriculum development 907.3 Designing and implementing CSE programmes 947.4 Monitoring and evaluation of CSE programmes 977.5 Scaling up CSE programmes .988 – References 1019 – Glossary . 11110 – Appendices 115Appendix I International agreements, instruments and standards related to comprehensive sexuality education (CSE) .116Appendix II List of participants in the Comprehensive Sexuality Education Advisory Group, 2016-2017 .123Appendix III List of participants in the UNESCO Stakeholder Consultation and Advisory Group meetings .124Appendix IV Criteria for selection of evaluation studies and review methods ..127Appendix V Studies referenced as part of the evidence review 2016 .129Appendix VI People contacted and key informant details for updating key concepts, topics, and learning objectives 2017 ..133Appendix VII Bibliography of references and resources used in the updating of the key concepts, topics and learning objectives 2017 ..134Appendix VIII Proposed indicator for monitoring life skills-based HIV and sexuality education ..138

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List of tables and boxes 7List of tables and boxes Tables Table 1. Key characteristics of the 2008 and 2016 evidence reviews ..30Table 2. Limitations of the evidence reviews 30Table 3. Common concerns about CSE ..84Table 4. Characteristics of an e˚ective CSE curriculum ..93Table 5. Stand-alone or integrated CSE – key considerations 94Table 6. Designing and implementing CSE programmes 97Table 7. Indicator recommended for use by countries within their Education Management Information System (EMIS) to examine the quality, comprehensiveness and coverage of life skills-based HIV and sexuality education ..98Boxes Box 1. Conceptual framework for sexuality in the context of CSE ..17Box 2. Examples of international UN standards and agreements between Member States, in relation to CSE .82Box 3. Youth participation in CSE advocacy and implementation ..86Box 4. UNESCO™s ten key principles for scaling up sexuality education .99

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Acronyms 9Acronyms AIDSAcquired immune de˜ciency syndrome CEFM Child Early and Forced Marriage CSEComprehensive sexuality education FGM/CFemale Genital Mutilation/Cutting EMISEducation Management Information System GBV Gender-based violence HIVHuman immunode˜ciency virus HPVHuman Papillomavirus ICTs Information and communication technologies ICPD International Conference on Population and Development ITGSE International technical guidance on sexuality education LAC Latin America and the Caribbean LGBTI Lesbian, gay, bisexual, transgender, intersex NGONon-governmental organization PoA Programme of Action PEPPost-exposure prophylaxis PrEP Pre-exposure prophylaxis RCT Randomized controlled trials SDGs Sustainable Development Goals SERAT Sexuality Education Review and Assessment Tool SRHSexual and reproductive health SRHRSexual and reproductive health and rights STIsSexually transmitted infections UNAIDSJoint United Nations Programme on HIV and AIDSUNDPUnited Nations Development Programme UNESCO United Nations Educational, Scienti˜c and Cultural Organization UNFPA United Nations Population Fund UNICEF United Nations Children™s Fund UN Women United Nations Entity for Gender Equality and the Empowerment of Women VMMCVoluntary medical male circumcision WHO World Health Organization YPLHIV Young people living with HIV

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