Sexuality Education for Youth and Adolescents in the Middle East and North Africa Region: A Window of Opportunity

The enabling role of Islam in the notion of sexuality education can serve as a window of opportunity for implementing culturally and contextually relevant sexuality education programs in the Middle East and North Africa region.


SEXUALITY EDUCATION FOR YOUTH AND ADOLESCENTS IN THE MIDDLE EAST AND NORTH AFRICA REGION
T he Middle East and North Africa (MENA) is home to 80 million youth, and its young adult population makes up 10% of the world's population.Concurrently, the region is home to more than half of the world's refugees, with more than one-third of young people living in fragile and conflict-affected countries. 1These conflict situations, with prevalent poverty and limited economic opportunities in the region, heighten the vulnerability of young people to HIV, sexually transmitted infections (STIs), unintended pregnancies, and unsafe abortion.In the Arab region, 2 in 5 pregnancies are still unintended and one-half of unintended pregnancies end in abortion. 2This vulnerability is further aggravated by the prevalent violence and collapsed health systems in the affected countries. 3The situation is even worse for adolescent girls who face complex challenges that alter the course of their development for their entire lives. 4espite having the lowest HIV prevalence in the world (less than 0.1%), the MENA region is one of few regions where the HIV epidemic has not waned and is increasing with a 31.0%increase of HIV infections since 2001. 5Youth in the MENA region are at particular risk of HIV due to challenges in accessing services, inhibition about discussing both sexual and reproductive health (SRH), and lack of credible sex education sources. 6hese demographic and socioeconomic transformations, coupled with evidence about the rise of HIV and STIs among young people in the region, led to concerns about protecting these vulnerable young people against these threats.The Sustainable Development Goals target 3.7 calls on countries to ensure universal access to SRH services, including information and education, by 2030. 7This viewpoint focuses on how young people in the MENA region obtain their SRH information, barriers they experience in accessing this information, and how their access can be increased to improve their overall health and well-being.
In the MENA region, young people become sexually active without being provided accurate information on their SRH.Parents and other adults feel embarrassed to discuss sexuality with their children and fear that discussion on sexuality may cause sexual arousal and subsequent sexual practice.They usually surrender their responsibility to schoolteachers, who feel embarrassed and feel that this responsibility lies with the family and not the school.Accordingly, young people resort to the Internet, online pornography, and peers as sources of SRH information, 8 which are often inaccurate and potentially harmful to equitable gender norms.
The culture of silence surrounding sexual health in the MENA region increases the vulnerability of young people to HIV, STIs, unintended pregnancies, and unsafe abortion. 6,9The situation is further aggravated by the current political turmoil and conflict zones where young people may resort to transactional sex for survival.Thus, sexuality education of young people in the MENA region is timely and critical yet not easy to achieve.
The MENA region is not homogenous, and countries vary dramatically in wealth, educational attainment, social norms, cultural values, and social and economic policies, including those that influence sexuality education or the lack thereof.Although a few countries have some form of sexuality education, it is inadequate overall.Countries in the MENA region, with common historical, linguistic, and religious characteristics, experience similar bottlenecks regarding the implementation of sexuality education programs.In these countries, sexuality education is perceived as a manifestation of the pervasive influence of the Western social norms that clash with Muslim values and norms about sex, especially the topics of premarital sex and homosexuality, which are frowned upon by conservative communities. 10

A WINDOW OF OPPORTUNITY
Most of the opponents of sexuality education build their arguments on the fact that Islam, the prevalent religion in the region, views sex before marriage as sinful and expects young people to remain nonsexual after puberty until marriage.Thus, they believe there is no room to accommodate sexuality education conceptualized in the Western context.Studies have highlighted that the controversial nature of sexuality education for young people is not the result of Islamic doctrine but rather of perceiving sex as a cultural taboo.Accordingly, barriers related to sexuality education are not grounded in Islam but in the culture of silence. 11,12Islam recognizes the power of sexual need and encourages age-specific education about matters related to sex according to Islamic values and principles. 7Quran, the holy book of Islam, emphasizes the importance of acquiring knowledge that is not limited to religious knowledge: "Are those who know equal to those who do not know?"(The Quran, 39:9).Hadith, the sayings of the Prophet Muhammad, also praised the seeker of knowledge.Furthermore, in the days of the Prophet Muhammad, Muslim men and women were never too shy to ask him questions related to sexual life. 13slam acknowledges human nature-that what is promoted religiously is not necessarily what is practiced and that risky behaviors that are not allowed by Islam are indeed practiced.14 Furthermore, the 2 key tenets of Islam that support harm reduction programs in Islamic countries-doing no harm to oneself or others and the worst harm is eliminated by a lesser harm-accommodate sexual education programs aimed at youth to reduce negative health consequences.In 2005, the Islamic Republic of Iran introduced HIV harm reduction interventions to reduce the harm related to injecting drug use and to prevent the spread of HIV among injecting drug users.The interventions included outreach activities for injecting drug users and providing them with sterile syringes. Ilicit drug use is prohibited in Islam.Yet, when viewed through the Islamic tenets, harm reduction programs are permissible and provide a practical solution to a problem that could result in far greater damage to society if left unaddressed.15,16 The enabling role of Islam in the notion of sexuality education can serve as a window of opportunity for the implementation of relevant programs in the MENA region and other Islamic countries.Efforts should be made to develop tailored programs adapted to the religious values and local context while incorporating the Western expertise and relevant lessons learned and best practices.Given that "no one size fits all," sexuality education programs should be adapted to the local context of the different countries of the MENA region.
In Islam, sexuality education seeks to guide individuals to channel their sexual needs and desires responsibly and in an honorable manner.Hence, the focus should be on the Islamic virtues of decency, modesty, chastity, and sexual responsibility, in addition to highlighting the concept of family life and SRH needs.Given the powerful impact of religious leaders who play a critical role in Muslim culture, hosting a founding conference on sexuality education with theological institutions should be considered a preparatory step.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors.