UN agencies and medical professional associations coming together to build support and to stand up to attacks on Comprehensive Sexuality Education
Dr Venkatraman Chandra-Mouli

Eight years into the Sustainable Development Goals era, there is strong global support for many areas of Sexual and Reproductive Health and Rights (SRHR) including addressing maternal mortality, reducing unintended pregnancies in married couples, and eliminating violence against women and girls. In some other areas, however, there is highly visible, better resourced, and better organized opposition to many aspects of Sexual and Reproductive Health and Rights, including the provision of comprehensive sexuality education (CSE) to children and adolescents, the provision of safe abortion care, and acknowledging and responding to the health needs and rights of persons with diverse sexual orientations, gender identities, gender expressions, and sex characteristics.

WHO has been working with partners within and outside the United Nations system to stand up to this resistance with good science. One example of this is WHO’s response to a report titled ‘Rexamining the evidence for CSE in schools’ published in 2019 by the USA -based Institute for Research and Evaluation (IRE), which analysed 43 studies on school-based CSE carried out outside the USA and concluded that they were not effective. The IRE and its partners such as Family Watch International disseminated the report and presented it to governments and civil society bodies within and outside the USA, challenging the UN’s extensive body of research and evidence in support of the effectiveness of CSE, and threatening the progress being made in this area.

In a detailed re-analysis of the IRE report published in the journal Sexual and Reproductive Health Matters, Van Treeck and colleagues concluded with the comment: “Overall, our reanalysis reveals that the IRE review suffers from significant methodological flaws and contains many errors which compromise its conclusions about CSE. Our reanalysis is a tool for the international community to refute CSE opposition campaigns based on poor science.” In a complementary commentary in the Journal of Adolescent Health, she and her co-authors went a step further: “At best our findings indicated that the IRE analysis lacks the rigour necessary to inform any recommendations on CSE programming; and at worse, the report intentionally downplays the effectiveness of CSE interventions to support the authors’ ideologically-driven stance against CSE.”

The IRE report is part of a better resourced, better organized, and ambitious misinformation and opposition campaign. In many countries, local resistance has led to watered-down content and weak delivery of CSE. Just in the last two years, this has become bolder, ever more aggressive. This is illustrated by what happened in WHO’s Executive Board and the World Health Assembly in 2022. A coalition of countries fought tooth and nail to oppose the inclusion of the term CSE in the organization’s HIV, STI, and Hepatitis B Strategy. It took an alliance of countries to come together in the closing minutes of the World Health Assembly to crush the attack. The unprecedented battle over this is described a Health Policy Watch blog piece.

In the spring of 2023, The Telegraph published a number of attacks on the content of school of school based CSE in the UK. These articles included sharp attacks on WHO, primarily on the WHO EURO-Federal Center for Health Promotion Standards published in 2010: https://www.bzga-whocc.de/en/publications/standards-for-sexuality-education/. The articles and the social media reactions to it, spilled over to other countries far and near.

Working with the communications unit in the Director General’s office and in WHO’s European office, as well as technical and communication professionals in UNESCO, UNFPA and UNAIDS, WHO’s Department of Sexual and Reproductive Health and Research, which includes the cosponsored Human Reproduction Programme, developed a list of Questions & Answers on CSE: Comprehensive sexuality education (who.int); produced a video message in its high profile Science in Five platform: https://youtu.be/wAp1EsqPb7I?si=umVCUzoBGGNHfWp6; did active social media outreach: and reached out to journalists with facts and figures to correct the misinformation. In the last week of August 2023, HRP convened a meeting of UN agencies – UNFPA, UNESCO, UNAIDS, UN Women and WHO as a first step in developing a UN wide approach to building support and overcoming resistance to sexual and reproductive health and rights.

WHO had already been working with its partners within and outside the United Nations system through the Global CSE Partnership Forum to stand up to misinformation about CSE: Global Partnership Forum on comprehensive sexuality education (unesco.org). To extend this support, WHO reached out to parliamentarians, through its longstanding engagement with the Inter Parliamentary Union: Finding common ground in a connected world: parliamentarians prioritize comprehensive sexuality education (CSE) (who.int). To further extend it support base for CSE, WHO reached out to global medical professional associations to request them to provide statements of support for CSE. Five associations promptly responded with statements of support including the World Association of Sexual Health, the International Association of Adolescent Health, the International Federation of Paediatric and Adolescent Gynaecology, the International Paediatric Association, and the International Federation of Obstetricians and Gynaecologists:

At the 26th Congress of the World Association of Sexual Health (2-5 November, Antalya, Turkiye) representatives of these professional associations came together in a special session with UN agencies – UNFPA, UNESCO and WHO – to share their statements and discuss how they could be used to contribute to building support and understanding for CSE within the membership of these associations and beyond. This was followed by presentations from England (remotely), India and Zambia on how medical professional associations and other civil society bodies are being engaged to build support and overcome resistance to CSE.

In follow up to the WAS Congress, the medical professional associations and the UN agencies continued their discussions agreed on a five-point plan of action:

• To prepare a joint commentary by IPA, IAAH, FIGO, FIGIJ and WAS – to submit to the WHO Bulletin, or another appropriate high profile global journal
• To translate the statements of support, so that they are available in all six UN languages (English, French, Spanish, Arabic, Chinese and Russian) and in Hindi and Portuguese
• To post the statements of support in the websites of the UNFPA-UNESCO Partnership Forum, and WHO, in easily accessible formats so that organizations working on CSE could use them in their advocacy work. (And as proposed by Jon Klein, ensuring that organizations can also access other advocacy materials)
• To develop plan for reaching out to other influential global associations such as the International AIDS Society, and the International Council of Nurses for statements of support
• To explore how country-level advocacy efforts could align with ongoing efforts e.g., by the Partnership for Maternal, Newborn, and Child Health, Rotary International’s Action Group for Reproductive Maternal and Child Health and others.

There is progress on each of these issues. One exciting area of development is a decision by Rotary International’s Reproductive Maternal and Child Health Action Group to work with UN agencies and medical professional associations in selected countries, through national chapters of Rotary International, to stimulate country-level dialogues on CSE.

In August 2023, Dr Venkatraman Chandra-Mouli retired from the World Health Organization, after working for the organization for 30 years. He continues to work on adolescent sexual and reproductive health. 
Dr. Venkatraman Chandra-Mouli