Aomori Prefecture

<Link> Best Practices in Sex Education Implemented by Local Governments (Summary)
Best Practices Implemented By Local Governments > Aomori Prefecture > Gunma Prefecture > Niigata Prefecture > Saitama Prefecture

Sexual and reproductive health education by obstetrician/gynecologists that has been integrated into local curriculum for 35 years

Basic Information

Guidelines for sexual and reproductive health education
- “Systematic and cross-sectional guidance through integrated school educational activities – Sex education in schools- (Sukoyaka Aomorikko 6)“ (March 2011)
Outline of the intervention
- Lectures on sexual health are provided by school obstetrician/gynecologists to prefectural high schools and special support schools.
- Training sessions and seminars are provided for school teachers.

Background

In 1978, there were a few prominent cases of prostitution and self-induced abortions by high school girls in Aomori Prefecture. In response to those cases, an obstetrician from a prefectural medical association proposed that obstetricians help to provide students with a formal education on “sexual and reproductive health.” The obstetrician, who still serves as a school doctor, recognized the need for sex education in schools through the experience of seeing many teenage girl patients with problems such as unwanted pregnancies or sexually transmitted diseases (STDs). As a result of that obstetrician’s efforts, a project was launched in 1980 to deploy school obstetrician/gynecologists at prefectural girls’ high schools. Since 1992 the project has been integrated into the Prefecture’s system for sexual health education for both boys and girls at co-ed schools.

Overview of activities

■ Deployment of school obstetrician/gynecologists

Target	Students from 61 prefectural high schools (full-time, part-time, and correspondence schools) and 16 special needs schools. The program generally targets first-year students, although that depends on the opinions of schools/school doctors. In FY2016, 10,375 students attended lectures Sometimes teachers also participate in the lectures, such as nurse-teachers, teachers specialized in health and physical education or student guidance, or health managers
Lecturers	There are six educational blocks in the prefecture. One obstetrician is assigned to each block as a school doctor, with a few other obstetricians to assist them
Budget	Salaries for school doctors are included in the prefectural budget
Frequency	Once a year
Overview	At the beginning of the fiscal year, schools plan out program content in response to a notice sent to them by the Prefectural Government. This is done through direct consultation with school doctors Lecture content is based on official guidelines with a focus on hot topics in Aomori, including the ways that people can become pregnant, contraception, the prevention of STDs, and menstruation control Course evaluations are conducted using questionnaires before and after each session. Reports are written on the sessions and questionnaires. The Prefectural Government collects feedback from each school and reports on council meeting so that the comments can be reflected into the program for subsequent years
Special Features of the Program	The lessons provided to high school students are more practical than the lessons given to junior high students. For instance, high school students might receive lessons on the types of oral contraceptive pills and their usage. Pictures and movies are utilized to help students understand content Meetings and textbook sharing sessions are conducted among lecturers one or twice a year

■ Seminars on sexual and reproductive health

Target	Teachers from elementary, junior high, high schools, and special support schools, as well as school doctors and other professionals involved in community health in the prefecture 115 teachers participated in FY2017
Lecturers	Lectures are provided by professionals specialized in sexual health from both inside and outside Aomori prefecture, including prefectural officials, school obstetrician/gynecologists and doctors from medical associations
Budget	Funding is provided by the Prefectural Government via a prefectural medical association
Frequency	Once a year
Overview	The first iteration of the program began in FY1994 and focused on HIV/AIDS education. It included information related to sexuality, life, and mental health. From FY1997 onwards, the theme of the program has been sexual and reproductive health education. The FY2017 program included reviews of the past sex education curricula, sexual abuse and crime, LGBT-related issues, the protection of the rights of children, HIV/AIDS, and other topics

■ Teacher training on sexual and reproductive health education

Target	Teachers from elementary, junior high and high schools in the prefecture (including substitute teachers) 50 teachers participated in FY2016
Lecturers	School obstetrician/gynecologists
Budget	Funded as a “School Health Support Project” of the Ministry of Education, Culture, Sports, Science and Technology (MEXT)
Frequency	Once a year
Overview	Training takes place over the course of two meetings. A preliminary study meeting is first held where teachers develop teaching plans on topics around sexual education. This is followed by a training session in which teachers continue their learning through group work and practical lesson sessions

Strengths of the Initiative

Since the program has been going on for 35 years, the obstetricians’ lectures are now well accepted and integrated in school curriculums. (Comment from the Prefectural Government/Lecturer)
Program activities are well balanced, covering both input from students and teachers. (Comment from the Prefectural Government)

Current Issues of the Initiative

Ensuring the availability of school obstetricians
- It is necessary to foster young obstetrician/gynecologists for the future. There is a concern over the decline in the number of young doctors who want to specialize in obstetrics/gynecology in the prefecture. (Comment from the Prefectural Government)
- Although many junior high schools and private schools also offer lectures on sexual health led by school obstetricians, there are not enough obstetricians to provide lectures everywhere. It is now essential to strengthen partnerships with midwives, public health nurses, school nurses and school teachers. In doing so, each stakeholder should try to share common ground and work to ensure the quality of the education being offered. (Comment from a Lecturer)
Conduct of effective program evaluation
- Although the program was conceived as a way to respond to the problems and needs of local communities, no significant decline has been observed in cases of self-induced abortions among young girls. It is critical that students recognize how these issues affect them personally, and utilize the knowledge the program provides to plan out their own lives. Measuring the long-term impact of the program continues to be a challenge. (Comment from the Prefectural Government)

Direction for Future Development

The Prefecture will continue to implement and secure a budget for this well-balanced program. (Comment from the Prefectural Government)
More doctors need to be involved. The program should conduct lectures for doctors providing information on the role and content of sexual health education. (Comment from a Lecturer)

Expectations for other stakeholders

Government
- The “School Health Support Project” run by MEXT is a flexible program which enables interventions catered to the needs of each region. The Prefecture hopes that program will be continued. (Comment from the Prefectural Government)
School teachers and parents
- Class teachers should participate as well. Class sessions could also be utilized as an opportunity for parental learning and education through parental visits. (Comment from a Lecturer)

Interviewees

Prefectural Government
- Ms. Kanae Sakagami, Supervisor (Sub-Manager), Physical Education and Health Group, Sports and Health Department, Aomori Prefectural Education Office
- Ms. Minako Hamahashi, Supervisor, Physical Education and Health Group, Sports and Health Department, Aomori Prefectural Education Office

Lecturer (School Obstetrician/Gynecologist)
- Yutaka Hasuo, Director, Aomori Women’s Healthcare Research Institute

Interview date: November 2017