A total of 257 teachers were eligible to take part in this study. However, only 236 (91.8%) of them returned satisfactorily filled questionnaires.
The mean age of the teachers was 40.3 ± 9.5 years. (Table 1) Only 60 (25.4%) taught science-related subjects while the rest taught other subjects. The mean years of teaching experience among the participants were 11.9 ± 7.1 years. The years of teaching experience ranged from 1 to 33 years. (Table 2)
Table 1
Socio demographic distribution of school teachers (n = 236).
Characteristics | Number | Percentage |
Age (years) | | |
≤ 25 | 7 | 3.0 |
26–30 | 39 | 16.5 |
31–35 | 37 | 15.7 |
36–40 | 40 | 16.9 |
41–45 | 46 | 19.5 |
46–50 | 29 | 12.3 |
51–55 | 14 | 5.9 |
> 55 | 24 | 10.2 |
Gender | | |
Males | 88 | 37.3 |
Females | 148 | 62.7 |
Type of family | | |
Nuclear | 138 | 58.5 |
Joint | 98 | 41.5 |
Native place | | |
Urban | 189 | 80.1 |
Rural | 47 | 19.9 |
Total | 236 | 100.0 |
Table 2
Distribution of teachers based upon school related characteristics (n = 236).
Characteristics | Number | Percentage |
Type of school (based on ownership) | | |
Government | 80 | 33.9 |
Aided | 81 | 34.3 |
Private | 75 | 31.8 |
Type of school (based on co-education status) | | |
Co-educational school | 227 | 96.2 |
All-boys school | 3 | 1.3 |
All-girls school | 6 | 2.5 |
Educational background | | |
Science | 93 | 39.4 |
Arts | 143 | 60.6 |
Subjects taught at school | | |
Science related | 60 | 25.4 |
Others | 176 | 74.6 |
Teaching experience (years) | | |
1–5 | 53 | 22.5 |
6–10 | 71 | 30.1 |
11–15 | 46 | 19.5 |
16–20 | 35 | 14.8 |
21–25 | 21 | 8.9 |
> 25 | 10 | 4.2 |
Total | 236 | 100.0 |
Only 21 (8.9%) teachers were trained in RHE. Overall, the training in RHE was observed to be inadequate among the participants. (Table 3)
Table 3
Characteristics related to reproductive health education (RHE) training among school teachers.
Characteristics | Number | Percentage |
Trained in RHE (n = 236) | | |
Yes | 21 | 8.9 |
No | 215 | 91.1 |
Number of training sessions attended (n = 21) | | |
1 | 8 | 38.1 |
2 | 10 | 47.6 |
3 | 3 | 14.3 |
The time gap between the most recent training session with the present time (n = 21) | | |
≤ 2 years | 4 | 19.1 |
2.1-3 years | 5 | 23.8 |
3.1-5 years | 3 | 14.2 |
5.1–10 years | 4 | 19.1 |
> 10 years | 5 | 23.8 |
Personnel who conducted the most recent training (n = 21) | | |
Medical professionals | 15 | 71.4 |
Teachers | 6 | 28.6 |
The venue of training (n = 21) | | |
At the school | 21 | 100.0 |
Certified training (n = 21) | | |
Yes | 2 | 9.5 |
No | 19 | 90.5 |
Other sources of information about RHE (n = 236)† | | |
Textbooks | 183 | 77.5 |
Internet | 141 | 59.7 |
Television | 137 | 58.0 |
Colleagues | 119 | 50.4 |
†Multiple responses |
As many as 215 (91.1%) of the total participants agreed/strongly agreed that there was a necessity for RHE for school students. Overall, the teachers had a favorable perception of RHE. (Table 4)
Table 4
Perception regarding reproductive health education among school teachers.
Characteristics | Number | Percentage |
The necessity of RHE for school students | | |
Strongly agree | 67 | 28.4 |
Agree | 148 | 62.7 |
Neutral | 14 | 5.9 |
Disagree/strongly disagree | 7 | 3.0 |
When should it be introduced for school children (n = 215) | | |
1st to 5th standard | 23 | 10.7 |
6th to 7th standard | 88 | 40.9 |
8th to 10th standard | 104 | 48.4 |
When should it be introduced if not during schooling years (n = 7) | | |
During pre-university course | 6 | 85.7 |
Before marriage | 1 | 14.3 |
RHE should be introduced to which gender | | |
Both boys and girls | 222 | 94.1 |
Only girls | 14 | 5.9 |
Should RHE sessions be taken separately for boys and girls | | |
Strongly agree | 82 | 34.8 |
Agree | 92 | 39.0 |
Neutral | 14 | 5.9 |
Disagree | 42 | 17.8 |
Strongly disagree | 6 | 2.5 |
The same gender teacher should teach RHE to the same gender students | | |
Strongly agree | 13 | 5.5 |
Agree | 65 | 27.5 |
Neutral | 70 | 29.7 |
Disagree | 73 | 30.9 |
Strongly disagree | 15 | 6.4 |
Suitable teaching aids to conduct RHE at schools† | | |
Posters | 130 | 55.1 |
Flip charts | 112 | 47.5 |
Video films | 91 | 38.6 |
Models | 66 | 28.0 |
RHE should be a separate chapter in science textbooks | | |
Strongly agree | 48 | 20.3 |
Agree | 108 | 45.8 |
Neutral | 48 | 20.3 |
Disagree | 31 | 13.2 |
Strongly disagree | 1 | 0.4 |
RHE classes to be taught after usual teaching hours at schools | | |
Yes | 29 | 12.3 |
No | 142 | 60.2 |
Not sure | 65 | 27.5 |
Should curriculum makers take teacher’s suggestions while preparing a RHE module | | |
Yes | 230 | 97.5 |
No | 6 | 2.5 |
Reasons for the same (n = 230) | | |
Teachers directly deal with students | 69 | 30.0 |
Teachers understand students the best | 7 | 3.0 |
Need for permanent personnel at schools to exclusively deal with reproductive health-related problems among students | | |
Strongly agree | 15 | 6.4 |
Agree | 106 | 44.9 |
Neutral | 98 | 41.5 |
Disagree | 12 | 5.1 |
Strongly disagree | 5 | 2.1 |
Provision of sexual education as a part of RHE will promote premarital sexual activity among the students | | |
Strongly agree | 7 | 3.0 |
Agree | 88 | 37.3 |
Neutral | 72 | 30.5 |
Disagree | 67 | 28.4 |
Strongly disagree | 2 | 0.8 |
Total | 236 | 100.0 |
†Multiple responses |
When the teachers were asked regarding who they felt were the right persons to teach RHE to the students, the majority [156 (66.1%)] stated biology teachers. The other personnel identified by participants suitable for this task were student counsellors [88 (37.3%)], obstetricians [83 (35.2%)], any trained personnel [83 (35.2%)], medical officers [66 (28%)], teachers [47 (19.9%)], pediatricians [41 (17.4%)], parents [38 (16.1%)], class teachers [29 (12.3%)], senior teachers [10 (4.2%)] and school principals [10 (4.2%)]. Reasons for these preferences were: due to their proficiency in knowledge regarding reproductive health [223 (94.5%)], their accessibility [32 (13.6%)] and familiarity [25 (10.6%)] with the students, as stated by the participants.
The common topics under RHE to be covered at schools as opined by the participants were concepts of puberty [209 (88.6%)], awareness of good/bad touch [177 (75%)], menstrual hygiene [174 (73.7%)], information on sexually transmitted diseases (STDs) [159 (67.4%)], description and functions of reproductive organs [143 (60.6%)], benefits of ideal family size [140 (59.3%)], information about right age at marriage [139 (58.9%)], concept of menarche [136 (57.6%)], information about right age at pregnancy [134 (56.8%)], sexual abuse/harassment [133 (56.4%)] and about contraceptives [38 (16.1%)].
Topics under RHE which the participants specifically suggested to be introduced before secondary school were: awareness of good/bad touch [55 (23.3%)], about concepts of puberty [20 (8.5%)], description and functions of reproductive organs [13 (5.5%)] and menstrual hygiene [6 (2.5%)].
Topics under RHE which the participants specifically suggested to be introduced after secondary school were: issues concerning teenage pregnancies [48 (20.3%)], about contraceptives [33 (14%)], information on STDs [5 (2.1%)] and description and functions of reproductive organs [5 (2.1%)].
The common challenges involved in teaching RHE in schools as opined by teachers were: cultural barriers [179 (75.8%)], parental objections [94 (39.8%)], lack of a standardized teaching module [61 (25.8%)], teachers not being trained in RHE [52 (22%)], school administrators not recognizing the importance of RHE [15 (6.4%)] and unavailability of sufficient resource materials at schools to conduct RHE sessions [(11 (4.7%)].
The common problems that would be encountered if there were no RHE at schools as perceived by the participants were: students ending up acquiring incorrect information about reproductive health from various informal sources [109 (46.2%)], students ending up in an anxious state when they encounter issues concerning reproductive health [102 (43.2%)], greater risk of teenage pregnancies [45 (19.1%)], more chances of premarital sexual experiences [39 (16.5%)], more instances of abortions [16 (6.8%)] and risk of having an unsuccessful marital life in future [15 (6.4%)].
Out of the 215 teachers who agreed/strongly agreed with the introduction of RHE in schools, 76 (35.3%) felt that it would help students to understand more about themselves and 29 (13.5%) felt that it would benefit students in getting all their misconceptions cleared regarding this topic. Among the 14 teachers who felt that RHE is to be introduced only for the girls, 6 (42.9%) thought so because girls need to be aware of consequences following sexual misadventures.
The cumulative perception scores of the participants ranged from 17 to 30. Among them, 185 (78.4%) had average while 51 (21.6%) had a good perception towards RHE.
Implementation of RHE at schools was done in only 3 (16.7%) out of the 18 schools. Implementation of RHE was observed in a government, aided and private school. All these were co-educational schools. Formal RHE classes were given only in the private school and it was for students from 6th to 10th standard. Sessions were taken by both teachers from the same institute and by teachers from other institutes. In the other two schools, RHE sessions were offered informally for only 10th standard students and the resource persons were teachers from the same institution.
A total of 14 (5.9%) teachers had taken classes on RHE. Overall, the majority of the participants felt that the resource materials for conducting RHE classes at the surveyed schools were not adequate. (Table 5)
Table 5
Experiences of teachers with reproductive health education sessions at the surveyed schools.
Characteristics | Number | Percentage |
Content of RHE delivered at the school | | |
Adequate | 18 | 7.6 |
Inadequate | 88 | 37.3 |
Not sure | 130 | 55.1 |
Availability of teaching aids at schools to conduct RHE | | |
Adequate | 11 | 4.7 |
Inadequate | 90 | 38.1 |
Not sure | 135 | 57.2 |
Taken classes on RHE | | |
Yes | 14 | 5.9 |
No | 222 | 94.1 |
If not, willingness to take with appropriate training (n = 222) | | |
Agree | 135 | 60.8 |
Neutral | 54 | 24.3 |
Disagree | 12 | 5.4 |
Strongly disagree | 21 | 9.5 |
Topics under RHE for which additional training is required† | | |
Sexually transmitted diseases | 56 | 23.7 |
Counseling children with issues related to RHE | 53 | 22.5 |
Physiology of menstruation | 21 | 8.9 |
Feeling of uneasiness while taking classes on RHE (n = 14) | | |
Neutral | 1 | 7.1 |
Disagree | 7 | 50.0 |
Strongly disagree | 6 | 42.9 |
Feeling of uneasiness while taking classes on RHE to the opposite gender (n = 14) | | |
Neutral | 3 | 21.4 |
Disagree | 7 | 50.0 |
Strongly disagree | 4 | 28.6 |
Disruptive behavior by students during RHE sessions (n = 14) | | |
Yes | 2 | 14.3 |
No | 12 | 85.7 |
Parental objection for taking classes on RHE (n = 14) | | |
Yes | 4 | 28.6 |
No | 10 | 71.4 |
Total | 236 | 100.0 |
†Multiple responses |
Out of the 21 teachers who underwent training in RHE in the past, 3 (14.3%) had taken classes on RHE for the students. Among the 215 teachers who did not undergo any form of training in RHE, 11 (5.1%) had taken classes on RHE for the students (p = 0.116). Out of the 14 teachers who had taken classes in RHE, 11 (78.6%) did not undergo any form of training in RHE.
Some of the open suggestions/observations given by teachers regarding reproductive health were: school students often find it uncomfortable in accepting their bodily changes during puberty (5), the current teaching of RHE at schools is inadequate (3), provision of sexual education as a part of RHE may promote premarital sexual activity among the students (3), the mass media have promoted obscenity leading to promiscuous behavior among the students (1) and that there are several misconceptions present regarding menstruation among girls (1).
Participants aged ≤ 40 years, females, those belonging to nuclear families, those who underwent training in RHE and those who had taken classes in RHE, had significantly good perception level towards RHE as compared to the rest (Table 6).
Table 6
Association between determinants and perception level towards reproductive health education among school teachers.
Characteristics | Perception level towards RHE | Total |
| Good No. (%) | Average No. (%) | |
Age group | | | |
≤ 40 years | 36(29.3) | 87(70.7) | 123 |
> 40 years | 15(13.3) | 98(86.7) | 113 |
| | | X2 = 8.893, p = 0.003 |
Gender | | | |
Male | 12(13.6) | 76(86.4) | 88 |
Female | 39(26.4) | 109(73.6) | 148 |
| | | X2 = 5.267, p = 0.022 |
Type of family | | | |
Nuclear | 40(29) | 98(71) | 138 |
Joint | 11(11.2) | 87(88.8) | 98 |
| | | X2 = 10.671, p = 0.001 |
Underwent training in RHE | | | |
Yes | 9(42.9) | 12(57.1) | 21 |
No | 42(19.5) | 173(80.5) | 215 |
| | | X2 = 6.143 p = 0.013 |
Taken classes on RHE | | | |
Yes | 8(57.1) | 6(42.9) | 14 |
No | 43(19.4) | 179(80.6) | 222 |
| | | X2 = 11.092, p = 0.001 |
Total | 51 | 185 | 236 |
In multivariable analysis, participants aged ≤ 40 years (p = 0.031), those belonging to nuclear families (p = 0.013) and those who had taken classes in RHE (p = 0.037), had significantly good perception level towards RHE as compared to others (Table 7).
Table 7
Binary logistic regression analysis of variables associated with good perception level towards reproductive health education among the school teachers (n = 236).
Characteristics | Unadjusted OR | 95% CI for unadjusted OR | P value | Adjusted OR | 95% CI for adjusted OR | P value |
Lower | Upper | Lower | Upper |
Age (years) | | | | | | | | |
≤ 40 | 2.703 | 1.386 | 5.272 | 0.003 | 2.147 | 1.073 | 4.299 | 0.031 |
> 40 | 1 | | | | 1 | | | |
Gender | | | | | | | | |
Males | 1 | | | | 1 | | | |
Females | 2.266 | 1.114 | 4.61 | 0.022 | 1.014 | 0.429 | 2.396 | 0.975 |
Type of family | | | | | | | | |
Nuclear | 3.228 | 1.56 | 6.679 | 0.001 | 2.579 | 1.219 | 5.459 | 0.013 |
Joint | 1 | | | | 1 | | | |
Underwent training in RHE | | | | | | | | |
Yes | 3.089 | 1.222 | 7.812 | 0.013 | 2.163 | 0.813 | 5.751 | 0.122 |
No | 1 | | | | 1 | | | |
Taken classes in RHE | | | | | | | | |
Yes | 5.55 | 1.83 | 16.835 | 0.001 | 3.4 | 1.08 | 10.709 | 0.037 |
No | 1 | | | | 1 | | | |