We were immediately intrigued when asked to give a school-based sexual health presentation to adolescents in Thailand. As Nurse Practitioner students, we recognize the importance of sexual education and prevention in this age group and were more than happy to share our knowledge and expertise. After touring the school and meeting with faculty, we sat down with our Thai sisters to plan our school health day.
The presentation was to be about one hour in length for a group of twenty 12-15 year olds. We were given limited direction on what topics to cover, we just knew that we would have to demonstrate the right way to apply a condom. After some discussion, we decided to discuss healthy relationships and consent, common sexually transmitted infections (STI) and prevention, condom storage and use, contraceptive methods, including cost and effectiveness, teen pregnancy statistics and prevention, and overall sexual risk reduction. We also developed a pre- and post-tests to assess baseline knowledge and knowledge gained after the presentation. It was a lot of material to cover in 1 hour and we had 24 hours to prepare, so we got to work!
We had the prior knowledge of Thailand having universal health coverage but had many questions regarding trends, standards, and access to care involving sexual health: for this information, we consulted with our Thai sisters coupled with some internet surfing. We came to find out that the cultural expectation in Thailand is that adolescents remain abstinent until marriage. Also, sexual health education is not standardized in the Thai school system. Similar to many other countries, teen pregnancy rates have been on the rise in Thailand. According to the United Nations Population Fund, more than one million babies were born to teen mothers in Thailand over the last 15 years, increasing 31% from 2000 to 2014. Contraception, condoms and STI testing are widely available through local Primary Care Units (PCU), but require a parental consent for anyone under the age of 18. Local pharmacies also offer over-the-counter oral contraceptives and condoms for those of any age at a cost. It was eye opening to learn about organization and access of the Thai healthcare system in relation to sexual health.
We were struck by both the similarities and differences of sexual education between Thailand and the United States. Unlike the United States, where sexual education standards are decided at the state level, the schools and communities have more flexibility with delivery of content. One thing that we found out was pretty universal is that teens will be teens, and sex can be silly and uncomfortable to talk about. The students seemed curious and receptive to the information we were providing, but they also had their moments of uncomfortable giggles. However, we believe the students learned essential information that will help them stay healthy for years to come.