Evaluaton Of Content About Human Sexuality And Procreation Of School Textbooks In Lithuania
Sexual education plays an essential role in teaching youth healthy lifestyles and creating mature relationships. The schools textbooks are the most common educational resource and their content is of utmost importance. Correct information can create preconditions for the empowerment of adolescents in making healthy decisions and avoiding risky sexual behaviour.
Keywords: Sexuality educationfertility awarenessrisky sexual behaviourmechanism of action of hormonal contraceptionresponsible parenthood
Sexual health and healthy fertility function are one of the most important components of the
quality of person’s life. Fertility is the natural person’s good through which woman and man give life to
their child while realizing themselves in parenthood. Fertility is not just only function of human body as
for example digestion or blood system, because the realization of human fertility function is directly
related to three persons: man, woman and child. A disorder of fertility function and an inability to have
children are a big challenge for spouses. Today there is a lot of talk about the causes of infertility, their
diagnostics and treatment. Infertility affects both men and women and is directly related to bad
psychological wellbeing, depression, low self-esteem. (Chachamovich, JR, Chachamovich E, Ezer &
others, 2010). Experience of infertility is a source of psychological distress: infertile women are more
likely to experience higher levels of distress than comparison groups, infertility has been observed to
result in divorce, loss of economic resources (Greil, Slauson-Blevins, McQuillan, 2010). Dr. Ruchi
Galundia’s (2016) study showed that women in married couples with primary infertility experience
deeper emotional distress as compared to men. The spread of infertility is different in every country. The
National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277
Health Surveys (Mascarenhas, Flaxman, Boerma & oth.),which sought to determine the tendencies of the
spread of infertility in 190 countries comparing data from 1990 and 2010 and evaluating many factors
causing infertility, presents conclusions that in 2010, among women 20–44 years of age who were
exposed to the risk of pregnancy, 1.9% were unable to attain a live birth (primary infertility). Out of
women who had had at least one live birth and were exposed to the risk of pregnancy, 10.5% were unable
to have another child (secondary infertility). According to WHO, sexually transmitted infections are the
main preventable cause of infertility, particularly in women (WHO, 2007, 8). It is difficult to comment on
the most prevalent causes of infertility in Lithuania, because no representative studies have been carried
out. The only available data come from private infertility clinics providing modern assisted reproductive
technologies, which show that among those actively seeking treatment, the main cause of infertility in
women in 2001 was damage to the Fallopian tubes, reflected in the high rates of STDs (Kalediene,
Good sexual health and fertility function very much depend on sexual behaviour. Teens’ sexual
activities are considered as risky sexual behaviour ( WHO, 216, 179). Teens’ choice between healthy
lifestyle and risky sexual behaviour, which can have many negative consequences, such as getting
infected with STDs, AIDS/HIV and teen pregnancy, very much depend on their beliefs. The strongest risk
and protective factors are teens' own sexual beliefs, values, attitudes, skills, and intentions. Teens are
more likely to have sex, to have sex more frequently and to have more partners, if they have permissive
attitudes toward premarital sex (Kirby, 2007). Therefore, the prevention of early sexual activities should
be the most important goal of health and sexual education for teens. In order to help teenagers make more
informed decision about when to begin sexual activity, it is necessary that they receive all the relevant
information to make the decision (Irala, Urdiain, Lopez (2008).
Sexual education plays an essential role in teaching youth healthy lifestyles and creating mature
relationship. In 2016 the Minister of science and education of Lithuania approved “The General
Programme of Health and sexuality education and preparation for family life” (here after “Programme”)
which is implemented in accordance with the following principles: each person is unique, sexuality is
treated as all-encompassing reality of person. The Programme sets these goals for health and sexual
education: to relate sexual expression with fertility and the ability to have children in the future, to relate
sexuality with creation of mature relationships, love and responsible parenthood; to take responsible
decisions on the debut of sexual life; to evaluate possible consequences of risky sexual behaviour in
future perspective; to choose the right solutions for avoiding negative consequences; as well as to educate
on moral values, one of the most important of which is to respect human life since its conception, (The
Ministry of Science and Education of Lithuania, 2016). Sexual education is a component of health
education and preparation for family in Lithuanian schools. The programme is integrated in various
subjects, but mostly is taught during biology classes. The school textbooks are the most common
educational resource and their content is of utmost importance. The article raises the issue that the content
of biology textbooks does not comply with the principle norms, moral values and goals of Programme
What kind of information about human sexuality, fertility and procreation is presented in the content of
school textbooks of biology subject?
Purpose of the Study
The evaluation of the content of textbooks in the areas of human sexuality and procreation in order to find
out to what extent these textbooks promote healthy lifestyles, positive attitude toward fertility function as
well as avoidance of risky sexual behaviour among adolescent students.
The research was carried out in three stages: 1) the purification of parameters of evaluation (dimensions,
criteria, indicators) and construction of evaluation instrument; 2) the selection of textbooks; 3) the
evaluation and analysis of evaluation data.
The selection of the text books
These criteria were set for the selection of textbooks: 1) textbooks must be included in the official
„List of general education textbooks“ by the Ministry of Science and Education; 2) the content of
textbook contains sexuality and procreation topics; 3) textbooks are most often chosen by biology
teachers. According to these criteria, 9 textbooks were selected. Their list and pages of evaluated content
are presented in Table 01.
5.2. Construction of evaluation instrument
The evaluation instrument is a construct, comprised of evaluation dimensions, criteria that match
them and indicators of these criteria in the evaluated text. According to the provisions and goals of the
Programme, 3 dimensions, 8 criteria and their indicators in evaluated text were picked out. When defining
indicators, the most attention was paid to their possibility to evaluate whether scientific facts about human
sexuality and procreation in textbooks are correct and matching the Programme, whether the information
in textbooks presumes the formation of responsible, mature relationships, responsible parenthood, the
delay of sexual behaviour. 42 indicators were picked out in total (see Table 2). The abundance of
indicators allows avoiding mistakes and inaccuracies while evaluating.
The instrument of evaluation used was an evaluation checklist dedicated to each textbook. On the
evaluation checklist every indicator has a quantitative evaluation expression from -1 to +1, where +1
means that textbook statement conforms to an indicator, i.e. matches with the provisions and goals of the
Programme. -1 means that textbook statement conflicts with an indicator and does not match the
provisions and goals of the Programme. 0 means that textbook does not contain information of the
indicator. Separately, scientifically false information was also evaluated by counting scientifically false
facts, where 1 means one false statement. For ethical reasons, the names of authors of the textbook being
reviewed was not feasible on the checklist.
In all evaluated textbooks there was information which contradicts with the provisions of the
Programme and most of textbooks contain scientifically false information. 1, 2 and 4 textbooks contain
the least amount of scientifically false statements because these textbooks are for 5-6 grades and there are
no family planning, fertility, artificial fertilization and abortion topics.
6.1. Sexuality as all-encompassing reality of the person
All evaluated textbooks, which talk about human procreation, do not make a difference between
human procreation and animal reproduction. The emergence of humans is illustrated in the general
context of animal’s reproduction. The sexuality is reduced to the difference of male and female sexual
organs. In the context of procreation the physiology of sexual organs is presented as autonomous,
independent from the activity of human brain. Textbooks do not contain information that human is
capable to control sexual desire by will. Only one textbook positively evaluates teens’ abstention from
sexual behaviour: (9, 100).
Responsible motherhood and fatherhood means that men and women are not only gifted with the
ability to have children, but also with the intellectual ability and capacity to understand and fully
appreciate their fertility (Narbekovas, 2011). Fertility awareness means the knowledge of how one’s own
reproductive system functions, and the biological and sociological facts about human fertility. It means
the ability to know if a woman is fertile or infertile in order to determine if having sexual intercourse on
the particular day could result in pregnancy. It is the full appreciation of one’s own sexuality and
procreative power. Knowing one’s body and fertility empowers the person to make a truly healthy,
informed and responsible decision on his/her sexual behaviour. Fertility awareness is a way to help young
people understand their maturing bodies and how to protect their own reproductive health (Institute for
Reproductive Health, 2011). Discussing physical and emotional changes and signs of fertility during
puberty helps young people become knowledgeable about how their bodies function and empowers them
to make appropriate decisions about sexual behaviour. Helping young people understand their fertility
dispels myths and misconceptions about reproductive health and makes them better prepared for
adulthood (Institute for Reproductive Health, (2011). The main aspects that teens should be introduced to
while learning about fertility are the neurophysiology of human sexual system, the hypothalamuspituitary
axis and the regulation of the menstrual cycle of woman, the real signs of fertility and how to
recognise them (Direito, 2011). But evaluated textbooks the essential information for fertility awareness
is not presented. Only one textbook presents the neurophysiologic regulation of the menstrual cycle of
woman and correctly names gonadotrophic and sexual hormones, regulating woman’s menstrual cycle,
and their interaction (1, 100). Other textbooks do not name these hormones, they are called “some sexual
hormones” (1, 234). Also the meaning of sexual hormones for general woman’s health is not presented.
With regard to fertility awareness, textbooks presented the most misleading and scientifically false
information. They used incorrect terms “sexual cycle” instead of “menstrual cycle” (8,238), incorrectly
indicated the principles of fertility awareness (the measurement of body temperature, mucus observation
method), incorrectly indicated the use of emergency contraception, and incorrect facts about conception.
6.3. The Family planning and mechanism of action of hormonal contraception
To assure that a given choice about FP methods is truly informed, women need to know about all the
characteristics, factors and issues that could influence their decisions (Lopez-del Burgo, Mikolajczyk,
Osorio & oth. 2013). Natural family planning (NFP) for avoiding pregnancy is a highly effective family
planning method (Frank-Herrmann,Heil, Gnoth &oth., 2007). The scientific findings of the effectiveness
of methods based on fertility awareness allow stating that they are “competitive” with modern
contraception, not mentioning the absence of side effects of these methods or their economic attraction
(Juškevičius, 2007, 15). But only one of evaluated textbooks indicates that NFP method is effective (7,
115). Other textbooks state that “… NFP is not as reliable as artificial” (8, 253), “is only suitable for
women who have regular cycle” (9,1; 6, 103; 5, 241). Most often NFP is presented as rhythmic calendar
method, even though this method is based on preliminary calculation and not on constant monitoring of
the cycle, as it is required by modern methodology of NFP methods (Direito, 2011).
When talking about hormonal contraception with teens, it is very important to present them with the
correct information on: 1) the mechanism of action of hormonal contraception, 2) side effects and 3) the
necessity to consult with a doctor.
1) Hormonal contraception, emergency contraceptive pill act primarily by inhibiting fertilization but
they may also exhibit postfertilization effects (Larimore, Stanford, 2000). Mechanisms of actions which
have postfertilization and postimplantation effects mean that they interfere with the development of an
embryo (Lopez-del Burgo, Mikolajczyk, Osorio & oth. 2012). Therefore, the revelation of the
postfertilization effects of hormonal contraception is very important for the implementation of the
provisions of the Programme on respect for human life since moment of conception. But none of
textbooks explain the mechanism of postfertilization action of hormonal contraception.
2) Only two textbooks (7 and 8) talk about side effects of hormonal contraception, they reveal the
danger of thromboembolism in relation with smoking.
3) Four textbooks (or 67%) – 5, 6, 8 and 9 – indicate that it is necessary to consult with a doctor
before starting to use hormonal contraception.
6.4. The authentic context of the origins of human life
It means that only human children and parents live in a special relationship, which is initiated before the
child's birth and continues until the very end of their lives. Human life has to be transmitted according to the
human nature and under the conditions that are most favourable for a child to be conceived, grow and develop.
Only biology textbooks for juniors present the conception of human life in the context of love, family and
parenthood: “the conception takes place when mother and father”, “husband and wife makes a family. But
family becomes complete when there are children” (1, 58). None of the textbooks present sexual pubescence as
a joyous fact that teenager becomes a fertile person who can have children in the future. Most often sexual
pubescence is described as a problem causing unpleasant changes: “due to the activity of sexual hormones the
mood of teenagers constantly changes, they feel self-doubt…“ (3, 131); “during menstruation many women
feel tired, they are irritable, they suffer from bad mood, feel the need to cry…” (6, 55); “during menstruation
women experience headaches and pains in lower abdomen” (9, 236); “not only body, but also the psyche
changes” (8, 248).
6.5. The respect to human life since its conception
Three most important criteria are essential in order to implement this important provision. 1) Knowing
when human life starts; 2) positive attitude towards pregnancy and understanding that abortion terminates life;
3) protection of embryos in case of artificial fertilization.
crucial role in the formation of human conscience, because in an ambiguous situation, only conscience can
dictate which action is good and which is bad. False conscience, for instance, if based on false information,
simply enslaves and destroys personal freedom (Irving, 2000). If it is recognized that human life does not
begin at the moment of conception, then abortion will not terminate human life and no moral problems should
arise. However, if it is human life, then “the moral principles of respect and inviolability” must be applied
(Have, Meulen, Leeuwen, 2003, 283).Only one out of 9 evaluated textbooks states that new life begins from
the moment of conception (7, 99). None of the textbooks contain the term “embryo” to describe new life. The
terms used are: “germ” (8-258, 7-99, 104), “fertilized egg cell” (9, 134), “zygote” (2-145, 5-239, 6-93, 9-96),
“ball of cells” (3-135).
in negative context: „how to avoid pregnancy, unexpected pregnancy, unwanted pregnancy“ (5-242, 244, 9-99,
243, 244), „pregnancy prevention“ (8, 254). Practically there is no information about abortion, two textbooks
(5 and 9) explains the consequences for women who terminate pregnancy, male responsibility is not discussed
in any of evaluated textbooks, and none of them state that abortion is the termination of human life.
3) None of evaluated textbooks talk about the protection of embryos in case of artificial fertilization.
The evaluation of textbooks allows stating that the content of evaluated biology textbooks does not
comply with the provisions and norms of the “General Programme of Health and sexuality education and
preparation for family life”. Most of textbooks human procreation present in general context of animal
reproduction and do not make a clear difference between human procreation and animal reproduction.
Only one textbook for 12-13 year old teens talks about human conception in the context of parenthood
and family. Pregnancy is discussed mostly in negative context. Sexual puberty is presented as a problem.
Human sexuality is reduced to the difference of male and female sexual organs. Only one textbook
present the neurophysiologic regulation of sexual system and describes the hypothalamus-pituitary axis
and the regulation of the menstrual cycle of woman. Other textbooks present information which allows
the formation of opinion that sexual organs function autonomously, independently from the activities of
human brain. Textbooks do not discuss the management of sexual desire by will. Only one textbook
presents information that the best solution for teens is sexual abstinence.
None of textbooks use the term “embryo”, the beginning of human life is called “germ, fertilized
egg cell, zygote, ball of cells”. Only one textbook clearly states that human life starts from the moment of
Only two textbooks (7 and 8) talk about negative side effects of hormonal contraception, they
reveal the danger of thromboembolism in relation with smoking. But none of textbooks explain the
mechanism of post fertilization action of hormonal contraception.
Results suggest a need for alternative textbooks based on better scientific evidence. It is essential
that textbooks provide correct information about the human fertility, fertility awareness and a more
integrated concept of sexuality. The correct information can create preconditions for empowering
adolescents to make healthy decisions and avoid risk sexual behaviour.
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