The previous chapters of the current paper presented the theoretical foundations, described the methodological approach and presented the findings of this study. The findings, which were presented in the previous chapter, were revealed through semi-structured interviews with teachers on exploring teachers' perception about the implementation of sexual health education in Kazakhstan within the secondary school curriculum. The present chapter discusses emerging themes in the Findings chapter and connects them with the theoretical framework and other literature. The discussion of the current research was framed within the theory of social constructivism and self- efficacy theory. Also, this chapter discusses data findings that were synthesized and compared with the previous studies presented in the literature review.
The discussion is divided into three sections. The first section focuses on teachers' general viewpoint about inclusion of sexual health education in secondary school curriculum in Kazakhstan.
The second section focuses on cultural-based obstacles in the society, and the last one highlight teachers' self-efficacy and capacity building.
Framework
The theory of social constructivism was extensively discussed and written on by Vygotsky.
According to Vygotsky (1986), individuals and their living environment are tightly connected.
Besides, this link is fundamental in terms of construction and transfer of knowledge. Hence, learning occurs as the result of the social construction of knowledge which is the consequence of interrelated engagement between an individual and society. Social constructivism theory explains how teachers' knowledge and perception has been constructed and is applicable to explore the phenomenon of
teachers' attitudes toward sexual health education within the school curriculum. Indeed, when individuals' perception mostly depends on their culture and social context, social constructivism theory appropriately fits with the investigation of sexual health education concept while at the same time contradicting with the traditional context of Kazakhstan. In addition, self- efficacy theory was applied to explain teachers’ unwillingness to teach sexual health education in Kazakhstan. This theory is applicable to understand the reasons for teachers reluctance to deliver the sex-related topics such as lack of knowledge, skills and thereby confidence to overcome culture-based barriers.
Teachers’ perceptions
The results of this research suggest that teachers’ positive attitudes toward the inclusion of sexual health education are connected with their awareness of social problems among adolescents in Kazakhstan. Also, they recognize that lack of credible and relevant information from both teachers as well as parents force students search for information from internet thereby jeopardizing them with sometimes destructive sex-related information.
Teachers’ self-efficacy closely interconnected with their constructed knowledge about sex, as was explained in social constructivist theory. At the beginning of the data collection process, the majority of participants were reluctant to answer the questions about sexual health education and displayed disinterest in this topic. This is because education in Kazakhstan is more focused on students’ academic achievements rather than developing social life skills of students such as improving decision-making about health. Therefore, it is accepted that teachers do not play the central role of students' life beyond what is considered academic subjects. However, as the interview progressed, it was observed that respondents gradually shifted their viewpoints and delivered deep and valuable insights since they acknowledged the importance of this current issue in Kazakhstani society, which needs more attention. In this research all participants indicated they are very positive toward inclusion sexual health education into school curriculum. They recognized the social
responsibility in terms of addressing teenage sex related issues which can be connected with lack of appropriate information and knowledge (Shegesha, 2015). Therefore, as the interview progressed teachers firmly agreed with the idea of teaching and learning about sexual health issues within the school curriculum. Schools play an exceptional role in influencing the students' development of a healthy lifestyle, and inclusion of sexual health education into schools with involvement of medical specialists has the ability to cause behavioral change which leads to maintaining lifelong health (Milton, 2003 ).
Since sexual health education is not taught in Kazakhstani schools it is necessary to highlight the importance of providing sex related education in terms of human rights as well as education. It has been scrutinized that school-based sexual health education is mostly influenced by teachers' attitudes toward teaching it (Shegesha, 2015). The essential quality of effective school-based sexual health education mainly depends on teachers’ willingness to teach positive attitudes toward it (Kirby et al., 2005). Different studies which have been conducted in different countries show that teachers are very supportive toward teaching and learning information related to sexual health issues.
However, they also expressed some difficulties in delivering the materials connected with what are seen as more sensitive topics such as masturbation, condom use, sexual orientation, abortion and contraception (Shegesha, 2015).
Another study which confirmed the findings of this research revealed that teachers’ negative attitudes toward teaching the sex-related materials are due to a lack of a real and tangible program for implementation. Since teachers do not have a common educational program they are encouraged to prepare their own program without guidance, which is time consuming and then may miss important topics. Also, the lack of special training leads to teachers' confusion and discomfort, and they fear uncertainty if they go too far in delivering the materials (Christman, 2014). According to the Geuten (2009), teachers are dissatisfied with teaching actual sexual health education at their school for the reason of knowledge and skills absence. They state that they trained insufficiently.
Indeed, teachers of this study are very supportive of sexual health education for the young generation and claim the need to start speaking about sex-related issues since they acknowledge the significance of the escalated problems among the young generation. However, they are unconfident whether they are able to overcome their own culture-based barriers in order to deliver specific topics in sexual health education. Therefore, participants are unwilling to be accountable for sexual health education for the young generation, and claim that parents must take responsibility and have a more active involvement in their children’s life.
In this country, there is an avoidance of an open conversation on sexual health-related topics between parents and students, it is taboo, and it is not accepted to openly ask about sex related issues (Kabatova, 2018). According to Kabatova (2018), majority of parents in Kazakhstan are reluctant to speak openly with their children on the sex related topic due to the culture issues. Also, she claimed another reason for their reluctance is that parents do not know how to talk with children appropriately since they were not educated about sexual health as well. Hence, it causes students to be at risk from getting wrong and unreliable information from their peers or internet resources.
Teachers in this research were concerned that teaching sex-related topics at schools may be challenged by negative viewpoints coming from parents. It has been argued in other studies that parents seem to worry when their children ask sex-related questions. Hence, they express disagreement about promoting sexual health education in schools (Geuten, 2009). Consequently, these kinds of parents complain and are against schools offering this subject which may be a reason why teachers are not eager to teach or deliver information related to sex issues. As the results of other studies show, parents against teaching sexuality education since it may touch upon the issues related to the homosexuality which some still believe promotes immorality (Geuten, 2009).
Culture-based Barriers
It was revealed that local culture plays a central role in constructing dominant social rules about sexual life. Kazakh culture is deeply interrelated with Islamic morality and deeply ingrained cultural values. Having sex and giving birth out of marriage is prohibited and considered as a shame according to the religion of Islam. Therefore, any sex-related problems cannot be discussed in the traditional Kazakh family due to the deeply rooted social norms. However, culture needs to evolve and contemporary Kazakhstan is facing many social problems related to a lack of sexual health knowledge among teens. Adults do not know how to deal with these problems due to its sensitivity in the given context. It contributes to the community continuing to ignore sex-related difficulties and not openly discussing sexual health issues.
There is a dilemma in the implementation of sexual health education in Kazakhstan between modern social problems among adolescents and the traditional mindset of the population. Due to the moralistic treatment of sex-related issues in society which fostered a conspiracy of silence, there is a commonly accepted wrong and scientifically unproven assumption that providing sexual health education will encourage adolescents to become promiscuous (Shuby, 2004). It was also found that this is the same reason stakeholders are against inclusion of sexual health education in Russia (Gevorgyan et al., 2011). Given this cultural mindset, the government does not even make an effort to openly discuss these issues in their daily schedule. Therefore, educational authorities’ absence of commitment continues to ignore the fundamental rights of students to get quality health-related education by non-inclusion of the sexual health program in the school curriculum.
Respondents were corrected by the interviewer during the conversation process since they predominantly used the phrase “sexual health” in the context of “sexual relationships” (zhynystyq qatynas). This means the term “sex” (zhynys) in Kazakh language is deeply rooted with words such as “relationship” and “intercourse”. Therefore, it assumed that the conception of sexual health
education for teachers is associated with teaching how to have sex. This means, teachers misinterpret sexual health education by suggesting it would be only about learning to have sexual intercourse. This misunderstanding of concepts due to the lack of special training, leads to their reluctance to teach it. Since intimate sexual relationship until marriage is forbidden within the socio-cultural orientation and it is considered that sex-related information is only for adults (Sabah, Boujemaa, Salah-Eddine, Taoufik, & Dominique, 2010). Therefore, it results in teachers having a disinterested attitude toward teaching a sexual health education program (Guskey, 2003) which is a contradiction to their agreeing it was a subject needed within the school curriculum.
The current social problems due to the adolescents’ sexual illiteracy contribute to the critical need in breaking the silence about human sexuality education. Consequently, society and educators are faced with challenges on improving and overcoming socio-cultural barriers of school-based sexual health education programs.
Teachers’ capacity-building
One of the main issues of sexual health education misconception among teachers is the lack of any understanding of sex-related topics due to the cultural values of society. Inclusion of a sexual health education program at secondary schools in Kazakhstan is not mandated. Consequently, pedagogical universities and teacher preparation programs do not require the addition of professional training for teachers in specific subject areas. That is to say, teachers in Kazakhstan have a very narrow understanding about sexual health education, and their knowledge is restricted only to biology subjects. Hence, teachers are unaware and have limited understanding of sexual health education concepts.
Indeed, in light of the social constructivism theory it is assumed that teachers' unwillingness to teach sexual health education is connected with their perceived self-efficacy. This means that teachers' knowledge about sex is based on socio-culture aspects and therefore negatively effects
their self-belief in teaching a taboo topic thereby decreasing their motivation and willingness to deliver this subject. Further, lack of sexual health education policy and underestimating the role of education in resolution of social problems at the state level highlights the dominance of cultural values in social norms which play an essential role in beliefs of teachers' self-efficacy.
Sexual health education at schools touches on contraception and preventive methods to avoid unpleasant results as a result of participating in a sexual relationship. According to the results of some scholars, sexual health education should be taught from a personal perspective rather than the scientific standpoint, and effectiveness of this program was indicated by decreasing the rates of STIs and pregnancy among adolescents (Reynolds, 2009) as cited in (Helmer et al, 2015). However, school-based sexual health education defined as “an age-appropriate, culturally relevant approach to teaching about sex and relationships by providing scientifically accurate, realistic, non-judgmental information’ (UNESCO, 2009 p. 69), also implies a broader notion, and covers the issues of gender inequality, self-effectiveness, self-esteem, decision-making skills and healthy relationships. The results of research found that the sexual health education program for adolescents is often "clinical, didactic and unengaging, and are missing in relevant content" (Helmer et al., 2015). Helmer et al.(2015) stated that adolescents are interested in getting knowledge about first sexual experience and condom-use discussion in order to negotiate healthy relationships. Therefore, it is significant to pay attention to young people's wishes and address their needs. Making sexual health education priority for teens may positively affect their attitudes and empower them in making decisions about sex-related issues.
A misunderstanding of the sexual health education among school teachers was found in the current study. As the results show, the understanding of conception of sexual health education among teachers was limited to physiology development and the human reproductive system. The central issue of teaching sexual health education is lack of professional development training and the availability of prepared materials about school-based sexual health education. It is worth
highlighting that while teachers are supportive toward implementation of sexual health education at schools, they oppose teaching it themselves due to a lack or specific training and their own ingrained cultural views.
During the interview it was also found that topics of contraception as well as STI issues are not discussed thoroughly with students at the school throughout biology subject as well as during additional class hours. Consequently, students only received a basic awareness about preventive methods of unwanted pregnancy and diseases that can be a consequence of unprotected sex. One of the issues that emerge from these findings is that teachers are struggling with delivering the sex- related information within the biology subject, and they need professional development to empower skills and improve self-efficacy in addressing these issues (Haruna, Hu & Chu, 2018).
As it argued throughout this thesis, providing the sexual health education within the school curriculum is the fundamental opportunity to ensure students to receive the relevant sex-related knowledge, gain decision-making skills, and form the positive attitudes for a healthy life in terms of sexual health. Nevertheless, in order to make this achievable it is a significant to ensure teachers, who are the primary delivers of information related to the sex, have the comprehensive knowledge and skills.
Gender and education scholars claim that it is worthwhile to highlight the importance of special professional development training in teaching sexual health education for the reason
“sexuality is a topic that is surrounded by taboos, cultural and moral values, and that is difficult for the majority of teachers to address” (Kasonde, 2013). Indeed, special professional development training helps teachers to overcome the barriers. For example, research found that teachers who have trained in sexual health education deliver more information related to the sex rather than their non- trained colleagues (Martínez et al., 2012). As Wight and Buston (2003) stated that special professional training increased teachers' knowledge about sexual health education content, improved
their practice in employing the educational material, enabling them to gain the methodological skills which strengthen their self-belief thereby implementing the sexual health education successfully. It can be clearly seen from the study that teachers’ special development training is central to empower teachers’ self-efficacy.
According to the Methews et al., (2006), there is a connection between teachers' sense of self-efficacy and execution of HIV/AIDS education. For instance, teachers with high self-efficacy implement HIV/AIDS education as they feel sure it is an effective way to impact adolescents' behaviors. Namely, teachers feel success when they are able to speak on sexual health topics openly, involve the students in the content through participation in the learning process (Mathews et al.
2006).
According to the another study, teachers described the qualities of the most effective teachers as “being non-judgmental; being trustworthy; being open and honest; being a good listener;
having a sense of humor; establishing relationships/having rapport with the students; being comfortable with your own sexuality; respecting students’ rights to choices/decisions; being flexible” (Milton, 2003 p.179). That is to say, teachers who feel the high sense of self-efficacy are likely to realize sexual health education when they possess the above-mentioned characteristics in themselves. Consequently, it was suggested that sexual health education teachers should receive professional development training, so that these specific training would “ensure that teachers will have the desired qualities” which enables them to introduce sexual health education effectively (Milton, 2003 p.184). As the results of this study show, teachers have low self- efficacy since they do not have professional development training.
The response to the research questions have been discussed in this chapter. This chapter is divided into three sections that emerged from the results of this study. It was found that teachers are very supportive; however, due to the lack of capacity building in sexual health education, they are
not welcome to teach it. The socio-cultural values are identified as the main barrier to introducing school-based sexual health education in Kazakhstan.