Sexual education and youth sexual health centers in Estonia - establishment and effect on sexual health indicators

Abstract

Aims: to give an overview of the development of the youth sexual health center network (2001); the introduction of comprehensive sexuality education (CSE) into school curricula; and their effect on the indicators of sexual and reproductive health. Methods: Based on the 2011 UNESCO study on the cost-effectiveness of CSE in Estonia, the 2015 Qalys Health Economics study on the cost of the youth sexual health center network in 1991-2013 and the 2011 WHO study HIV Epidemic in Estonia: Analysis of Strategic Information. Other statistical data is from the yearly publications of the Estonian Health Development Institute and the Estonian Health Agency. Results: Since the 1990s Estonia has seen substantial changes in sexual and reproductive health related attitudes, access to services and indicators. One of the key achievements is the establishment of the youth sexual health center network. The history of the network can be divided into several stages: from the initial idea to a few project-based centers up until a unified state-funded network. It is coordinated by the Estonian Sexual Health Association (ESHA) and financed by the Estonian Health Insurance Fund and the Estonian Health Development Institute. Stable and transparent financing by the state was the prerequisite of strategic planning and the development of universal quality standards. WHO has recognized the work of ESHA on youth sexual health center network as a best practice model (http://whqlibdoc.who.int/publications/2009/9789241598354_eng.pdf). Human studies (incl sexuality education) first became a part of the compulsory school curriculum in 1996. Curricula were updated in 2002 and 2010. Around 18% of the subject now focuses on CSE. The abortion rate has dropped from 70 (1992) to 16,78 (2015). Teen pregnancy rate has also decreased markedly. In 2015 the was birth rate of girls 15 - 19 almost 14, and abortion rate 16,08 The 2011 UNESCO study illustrated that school-based sexuality education together with youth sexual health centres are cost-effective in preventing HIV and unwanted pregnancies. Analysis of Strategic Information of HIV epidemic in Estonia has shown if those trends continue (compulsory high quality sexuality education, services of youth counselling centres, the decline in newly diagnosed HIV cases among IDUs) it may be possible to avoid a big increase in heterosexual HIV transmission in the general population. Conclusions: The significant positive changes in sexual and reproductive indicators in Estonia over the past 25 years can largely be attributed to the establishment of youth sexual health center network as well as the introduction of compulsory sexuality education.