Navigating the Labyrinth of Reproductive Health Education

By Nidhi Tiwari

Introduction

How middle school students in India view reproductive health education (RHE) is not an area left unexplored today. There are a lot of perceptions on the study of RHE in various schools across the country. To put it in the words of Gen Z, units like Reproduction in Animals and Reaching the Age of Adolescence in grade VIII are the ‘it’ chapters, except that they are mostly spoken about in hushed tones, by children of all genders (Sharda, 2012). This article is not about the existing state of students’ perception of such sensitive and important topics. Rather, it is reminiscent of my own experience of teaching two of such units, which also happen to be the topics I started my teaching career with.

Induction into Teaching

Induction into Teaching (IiT) is a semester-long teaching time in the final year of B Ed at Azim Premji University. On my first day of school as a student teacher, I met the students, the principal of the school, fellow teachers and my cooperating teacher (CT). The role of a CT during these three months is pivotal. Each of the student teachers is associated with a CT who acts as a guide throughout the internship. Their role is to actively engage with us daily; supervise our classes; and assess, grade and provide us with regular feedback.

My CT had over 15 years of teaching experience. I was made aware of the units that I would teach much before the internship began, I had my share of apprehensions about whether I would be able to navigate through the content with ease, especially in the presence of a male CT in the classroom. This is slightly ironic for me to come to terms with, for these topics in particular, were those that I considered to be my strong point as a budding science teacher.

Starting independent teaching

I remember the first independent class I took. It was class VIII, and my CT was on leave. The ongoing chapter at the time was Reproduction in Animals. I was slightly nervous in anticipation of how my first class would go, on top of which was this extremely tricky unit. I had observed this class being taught the same unit by my CT, and I had a rough idea of how the students engage with the content. Sitting at the back of the classroom for almost a week, I had observed students chuckle on seeing diagrams and hearing terms related to the reproductive system. I had also observed some students asking questions that I had only come across during my pre-medical entrance exams preparation. Nonetheless, I went to the class with a plan of action for the day, which was to introduce the concept of internal and external fertilisation with examples.

From the moment I entered, there was a lot of chatter in the classroom. I started by asking a few questions about the previous class. Very few raised their hands and answered, and some others raised their hands to ask questions that they had. Now, due to the nature of this chapter, students ask all sorts of questions that interest them, but sometimes, it becomes a little tricky to judge if a question is genuine or if it is meant to just disconcert the teacher. A male student in the front row asked me where the female reproductive system is located. Immediately, there were murmurs in the classroom and I tried to control the class by asking him to repeat the question loudly so that everyone could hear. But things only changed for the worse. Some students started talking with each other and the class just became very chaotic. I was thinking of ways to deal with it, but before I could respond, a student sitting right next to the teacher’s table said to me, ‘Didi, inhe sab pata hai yeh bas aapko pareshaan karne ke liye sawal puch rahe hain.’ (Ma’am, they know everything; they are asking questions only to trouble you.) This was not something I had not been able to gauge by now.

Addressing the problem

The issue that seemed overwhelming to tackle was that while some of them were just being their regular selves – complaining about others or bothering them, the others were suddenly curious about the subject of reproduction. As I mentioned earlier, if it had been any other chapter to begin my teaching practice with, I would not have second-guessed their intentions about asking questions but with this topic, it became difficult to tackle questions as they came (especially, the ones who generally did not take interest in everyday class). I found it more challenging to address inquiries related to this subject coming from male students in comparison to their female counterparts. A study conducted across five districts in Bihar revealed similar findings, highlighting teachers’ lack of confidence in imparting adolescent education to students of the opposite sex (Mukhapatra, 1999).

Understanding the root cause

My motive was to become capable of creating a space that does not encourage these topics to remain taboo in society. To bring about such a fundamental change, I first needed to get to the core of this behaviour. Why were the girls in the classroom so shy in answering questions that they most definitely knew and had experienced? Why were the boys, on the other hand, giggling sitting on the last bench as they turned pages while I wrote on the blackboard? From my school experience, I recount multiple behavioural instances that are usually termed as ‘indiscipline’ by teachers in the classroom. However, I hypothesised that it stems from the lack of awareness or conversations around topics like sexuality and reproductive health in most schools.

A majority of the youth in Indian schools get the required information about sexual and reproductive health either from their peers or rely on pornographic material or similar websites (Shiradkar, 2022). The taboo prevailing on these topics in schools is solely due to the complete absence of a comprehensive sexual health education. Seldom do parents openly talk and educate their children about sex education or related topics. A cross-sectional study conducted in high schools established in the urban area of Varanasi, Uttar Pradesh in 2017, revealed that only 60 percent of high school female students had knowledge of menstruation before its onset, and in most cases were informed by their mothers. Additionally, merely 16.4 percent of boys attending classes IX and XI knew that the father is responsible for the sex of the child (Srivastava, 2017). These findings suggest that there is a notable dearth in the education of boys concerning sexual health matters, such as menstruation, except when it is part of a unit in middle school, which seems to neither provide the space and time for learning nor suffice for the kind of understanding that needs to be built in students at that age. Anecdotal evidence also suggests that mothers refrain from initiating dialogues with their sons on such subjects. This hesitance has even led to an inability to address inquiries from young growing boys arising from exposure to advertisements, such as those pertaining to sanitary pads on television.

Coming from such a repressed state of RHE, it is almost impractical to expect these students to treat this unit like any other. To a certain extent, there is a lack of respect for the opposite gender, evidently due to their displayed ignorance towards each other’s bodies. Specifically, women’s reproductive health is an area massively ignored by students. Joan C. Chrisler, Professor of Psychology of Women at the Connecticut College, London, talks about her baffling experiences with how little university-going students know, or understand, about women’s reproductive health. In her paper ‘Teaching Taboo Topics: Menstruation, Menopause, and the Psychology of Women’, Chrisler mentions instances of students’ using various terms interchangeably, such as menarche and dysmenorrhea, premenstrual syndrome (PMS) and premenstrual changes. Students often use terms like ‘during my menstrual cycle’ instead of ‘during menstruation’, not comprehending that the cycle is continuous (Chrisler, 2013). Similar findings were discussed in the previous segment in the context of Indian schools as well. This gives rise to the question: Why is women’s reproductive health as a whole being neglected by students not just in middle schools but even by the ‘otherwise intelligent and sophisticated’ adults in developed countries? A possible explanation at the grassroots level could be the stigmatisation of menstruation and other reproductive processes. The menses are considered not just impure but disgusting. In Indian society, even the sight of menstrual blood is something to be avoided, highlighting how taboo a topic it is. To understand Indian adolescents’ perspective towards sex education, a study of school-going students was conducted. Within the survey framework, students were asked to identify emotions attached to different pubertal changes. Among females, predominant emotions included shame, fear, and disgust, whereas males predominantly expressed curiosity. Being curious is natural, however, instances wherein this curiosity remains unaddressed through structured guidance often leads to students to seek information through inappropriate ways (Shiradkar, 2022).

Exposed to these many beliefs and repressed notions, we expect the student to register the information devoid of all these preexisting ideas. This is practically impossible. Just like how John Locke’s philosophy of a child’s mind being like a blank slate to be filled with information by teachers is now outdated, and the National Curriculum Framework (NCF) for School Education 2023 highlights the fact that the knowledge and understanding based on children’s experiences with which they come to school, … results in their intuitive theories about these topics (NCF-SE, 2023), the experiences of all the children with regard to sexual and reproductive health do not shape their understanding due to the extent to which it is repressed in society. In such a scenario, getting into a state where a teacher can tackle or break these preconceived notions becomes a necessary step.

Acceptance and encouraging conversations

Accepting the behaviour of students was the first conscious decision I made in my next class. When society itself does not take these topics naturally, how could I expect these children to be mature enough to sit in discipline to talk about things they were never given the platform to express? I also realised that their behaviour on this topic was not necessarily directed at me as a student teacher. Rather, it reflected their own notions on the subject, and I wanted to bring about a transformative shift in their pre-existing notions.

To foster sensitivity around the topic, I wanted to connect with the students on a personal level to make them critically think about their personal experiences. Gender fluidity was another crucial area that I wanted to touch upon, having realised its importance in the way students perceive people and their behaviour. My ideas were not very structured at the time, but I decided to make an attempt with a primary objective of taking a session on gender.

The session was held on the fourth day of my independent teaching. The intended learning objectives included understanding the difference between sex and gender, realising the importance of the uniqueness of every individual, and identifying gender as a socially constructed concept. To lay the foundation of the class, I utilised two digital resources in the form of stories called Rainbow Boys and Rainbow Girls. They are both short, illustrated stories with the important message of the uniqueness of every individual, and highlight the need to inculcate acceptance in society. We had a read-aloud session by students, which was followed by a discussion. I first spoke about what gender stereotyping is and how ingrained it is in our society. This was crucial in order to prod them into thinking and reflecting on their experiences and interactions with people and understanding the commonality of their experiences. I put forth some questions to think about ways in which we are conditioned to conform to these societal gender norms. It was critical to identify and acknowledge these norms in order to talk about the deeper issues.

The students were vocal in picking their personal experiences regarding gender stereotyping, and how they feel about it. Soon after this discussion, a student brought up the point of discrimination against transgenders in the conversation. This was not something I had thought of while planning my lesson for the day, but I was glad to have someone raise the issue because it highlighted the kind of impact the session had on them. This point culminated in a full-fledged discussion with students sharing personal anecdotes highlighting gender injustice and the rights of transgenders.

Realising why it is necessary to respect the body of the other gender was central to attempting to learn about it. This is where the session seemed to take the first step towards this purpose – it left a thought in them to reflect upon. The reason the students themselves volunteered to speak about transgenders and the social discrimination against them is because they have witnessed or experienced these, which might have made them uncomfortable or unhappy. None of the students were seen giggling or exchanging notes with their friends while we spoke about these topics that day. Contrary to my initial assumption, these students exhibit a commendable level of emotional intelligence, likely shaped by first-hand experiences within their households. This made me realise something crucial: when students share a personal connection with a topic, they tend to participate in it wholeheartedly. This implied that as long as I could foster a sense of care and respect in the students for others and their identities (of which the physical body is an integral part), the indiscipline in the classroom would be the least of my concerns. Moreover, it is perfectly okay if the students do not entirely comprehend the intricacies of gender fluidity and spectrum; what matters more is their ability to recognize societal gender stereotypes and their consequences. The goal is for students to become aware and vocal, irrespective of the setting (urban or rural) or whether they grasp the technical aspects completely. It becomes worthwhile even if they begin acknowledging and challenging gender-based remarks directed at any gender.

Identifying barriers and tackling dilemmas

The second example is from a library session. My CT was taking the same class to the library with me accompanying the students. The objective was to get the students to inculcate the habit of reading science books which would generate curiosity in them as science learners. The CT and I had chosen the books together. Two of these were the additions I had made to the school library, Lal Kitaab and Neeli Kitaab (Tarshi publications). The decision to include these books in the school library was made to equip students with resources that had clear, easy-to-understand information for adolescents. I vividly remember thinking that above all, this would prove to be helpful for students who do not feel comfortable asking questions related to RHE to their teachers.

The students were called roll-number-wise to come and pick up a book of their choice, get it registered by one of us, and read it for the rest of the hour. During this reading time, students kept coming to me and the CT to ask about things they did not understand in their respective books. This included the meaning of terms, diagrams, language use, etc. Towards the end of the class, two boys came to me holding Neeli Kitaab in their hands. One of them pointed at a text paragraph, asking, ‘Didi, iss shabd ka matlab kya hai?’ (What does this word mean?). I looked at the words, which were yaun sambandh, meaning sexual relations. I became so contemplative about having to explain this to the grade eight students, that I did not even check the context in which the term was used. I looked at the two students and told them that it meant ‘sexual relations’. Surprisingly, though they did not seem to understand it, they did not ask me to explain it further.

This incident left me with a lot of questions in my mind. Firstly, how does one explain such a concept to class VIII students? If the students had asked me to explain the term in simpler words, what approach would I have taken? It is quite strange that such concepts are not introduced formally to students, nor are school teachers equipped with ways in which they can tackle such questions without looking for an easy escape route. The experience also gave me a reality check on the kind of apprehensions that school teacher has while dealing with such topics (Mukhapatra, 1999). A study conducted in January 2019 revealed that 75.8 percent of secondary school teachers identified cultural barriers as the major challenge in the implementation of reproductive health classes (Joseph, 2021). Moreover, it highlighted the cultural incongruity among teachers, learners, and the family which often undermines the objectives of reproductive health information. (Mbananga, 2004)

Conclusion

The question, then, is how are we going to create an environment conducive to fostering open dialogues surrounding sexual and reproductive health instead of making them more repressed in society? For a country that is the most populated in the world, there is a need to have a better, more structured, and professional way of educating youngsters about reproduction and related topics, which will be possible only after overcoming the taboo surrounding these.

There is extensive research done on creating effective classroom pedagogies in schools across grades. However, there seems to be a dearth of literature on the pedagogy of sexual and reproductive health, especially in a rural context. The study involving South Indian secondary school teachers, mentioned earlier, underscores this lacuna, revealing a mere 4.7 percent of 236 participants expressing satisfaction with the availability of teaching aids for RHE classes at their schools (Joseph, 2021). This highlights the need for a more nuanced approach to training teachers in a way that they can normalise discussions around these topics, all while respectfully navigating the cultural beliefs in a given context. Only through such structured training can we envisage fostering open conversations around sensitive topics in the realm of sexual and reproductive health, which is imperative for creating a more aware and informed society.

AUTHOR
Nidhi Tiwari is a final year BSc BEd Biology student at Azim Premji University, Bengaluru

References

Sharda, M., & Watts, M. (2012). Health and Sex Education in India.

Joseph, N. (2021). Experiences and perception towards reproductive health education among secondary school teachers in South India.      https://www.semanticscholar.org/paper/Experiences-and-perception-towards-reproductive-in-Joseph-Mahato/1416b832cc5cda0ea894a232c4941a078d79b103

Needs assessment study on adolescent reproductive health and behaviours. Bihar. (1999). https://www.semanticscholar.org/paper/Needs-assessment-study-on-adolescent-reproductive/c9b84bd8bfb9bfe13b5414af04de8b6b8248db72

Chrisler, J. (2013). Teaching Taboo Topics. https://www.semanticscholar.org/paper/Teaching-Taboo-Topics-Chrisler/9c8e6879d4e0e7a88ac490353d2faa7e767efd64

Shiradkar, S. (2022). Sexuality Education – Understanding adolescents’ perspective. https://www.semanticscholar.org/paper/Sexuality-Education-Understanding-adolescents%E2%80%99-Shiradkar-Mahajan/3bc02b3b474e1a225d2b4bc6d854fed91f6a683e

Srivastava, U. (2017). Exploring Knowledge and Perceptions of School Adolescents regarding Pubertal Changes and Reproductive Health. https://www.semanticscholar.org/paper/Exploring-Knowledge-and-Perceptions-of-School-and-Srivastava-Singh/350f1e160fa5e340f845949ebc982292392f14d3

Mbananga, N. (2004). Cultural clashes in reproductive health information in schools. https://www.semanticscholar.org/paper/Cultural-clashes-in-reproductive-health-information-Mbananga/3c7ca514ac144522fd1e3071be66aec8bf9bc7b8

National Council of Educational Research and Training. (2023). National Curriculum Framework 2023. https://ncert.nic.in/pdf/NCFSE-2023-August_2023.pdf