Adolescent Health Education in Japan

Dr. Hisako Takamura
Professor, Health Education Studies
School of Nursing, jichi Medical School

Dr. Takamura began her presentation stating that at her school there is no "sex education" among their courses which could trigger heavy criticism, but they focus on sexuality education. This involves defining sexuality, and understanding that everyone is a sexual being.

Teachers and parents have previously thought that sex education is just about intercourse. It is difficult to shift from the old concept to the new concept. Under the old philosophy of "sex is life," major problems are created for young Japanese people. Their self-esteem and gender awareness can be lowered, while their participation in casual sex and the development of sexual networks is on the increase. Dr. Takamura stressed that they sought to give them the capacity for making their own decisions, by focusing on "sexuality is life."

Dr. Takamura explained that this was empowerment education, and required three elements to achieve it. The first element is to define our quality of life. The second one is to attain our defined goals, and the last is peer counseling.

Peer counseling is moving away from learning led by teachers, to sharing values within the same generation. It helps provide the mentality and the capacity to live fully - a goal of empowerment education.

Empowerment is the power to control one's own way of life, and the attainment of goals through cooperation with others. There are three types of empowerment; individual (psychological), organizational, and community, among which the first, individual, is the most important.

The process includes active listening, dialogue, heightening awareness, and progress towards individual and social action. The goal of empowerment education is to change the individual and group structure. The previous system of "sex education" didn't achieve the objectives of improving self-esteem, self-sufficiency, and healthy behaviors. To fill that gap, we use peer counseling.

The Healthy Family Plan 21 is a 10-year project, begun in 2001. It seeks to enhance health care for adolescents, support safe pregnancies and childbirth, provide support for infertile couples, and provide conditions for better children's healthcare.

The cornerstone of a concrete approach is having various groups and organizations cooperate to focus on adolescents. This new approach to adolescent reproductive health tries to provide knowledge and guidance toward leading a better quality of life.

Dr. Takamura explained how peer counseling had been developing throughout Japan. It had a natural and spontaneous birth at the Jichi Medical School, School of Nursing. The first sessions were held at a local community center and students took the initiative. After seeing that, the municipal governments, the municipal and prefectural health centers, and NGOs got involved, one of which was he Tochigi Society on Adolescent Health. This NGO is made up of people from diverse backgrounds and educational levels. The practical model for this NGO comes from Tochigi Prefecture, where they are working to promote cooperation between local and regional governments, school healthcare programs, and the NGO.

Four years ago Tochigi Prefecture had the worst abortions statistics in the country, and the highest rates of STDs. The prefectural health and welfare department trained peer counselors and set up peer counseling centers. The prefectural board of education conducted a survey on peer counseling and dispatched specialists, doctors and ob-gyns, to assist. Instead of discussions, these groups wanted to take action, and determined that peer counseling was the most effective way. Peer counseling is in effect expanding across the prefecture.

The Tochigi Workshop on Education trains peer counselors, using an approved curriculum. That curriculum includes a 30-hour basic course, 10 hours of training on sexuality, 10 hours on peer counseling, and 10 hours on the practical activities of the class. A follow-up 15-hour course, given after six months, includes five hours on brushing up on peer counseling skills, five hours on review of practical actions, and five hours on empowerment.

In a survey of adolescents, we learned that they 1) did not want to use condoms, and 2) did not think they would get pregnant. There was a need to educate them about contraception. It was necessary to open many channels, work that could not be done by the local government alone.

A female peer counselor said she had joined because she had had difficulty getting sexual advice. She said that her dates did not want to wear a condom. As a peer counselor, she was comfortable giving advice, as they were from the same generation. A male peer counselor said he became involved because he had a friend who had a difficult time with an abortion, and he had failed to give the friend good advice. It opened his mind to peer counseling. Email counseling has proven very popular, and provides the most number of contacts.

Scientific research had led to development of some of the training materials. With phone counseling, you cannot provide enough training. There is a manual for phone counseling, and the counselors are always brushing up on their training. Some have been to other countries to study adolescent reproductive health. Some of the counseling is done in an open area andeighty-seven percent of the people involved are female. They had a representative from Tunisia, who upon return home established a counseling center called "Clover Room".

Some of the issues going forward include:

1. Finding/training coordinators. In many areas public health nurses are coordinators. In other areas, = midwives or doctors are coordinators.
2. Training and fostering supervisors. In Japan, about 20 supervisors are being trained.
3. Training the peer counselors.
4. Setting up a system to launch peer counseling with other organizations.
5. Evaluating the effectiveness of peer counseling techniques.

The studies on other models of sexual education has also been conducted. Measurements include reductions in abortions and pregnancies. One study is interviewing those who received peer counseling. It contacts the people three to six months after the counseling session, and asks about what positive changes were made after the counseling.

The following are areas in which improvement was found after counseling among people who took the course.

1. a more specific life plan
2. improved knowledge of sexual activities
3. greater ability to express themselves
4. greater acceptance of their own sexuality
5. awareness that sex should be with a steady partner
6. ability to think about pregnancies and STDs when anticipating sexual activity
7. confidence about using a condom properly
8. that when going out with a member of the opposite sex, it is important to know the person
9. how to resist peer pressure
10. to be more confident rejecting a proposal for sex

Questions and Answers

Q: What is the target age group for training?

A: It depends on the prefecture. In some it is 16 to 20 year olds. In others it is 18 to 20 year olds.

Q: The Japan Family Planning Association�chow is it involved?

A: It can train someone from any prefecture.

Q: What is the family reaction to daughters on television talking about condom use?

A: Most families are quite favorable. Also, the discussion is not just about condoms, but about life plans, etc.

Q: Who operates the peer counseling rooms and where are they located?

A: The room is in a building facing a main street, and in a fashionable location. It is funded from the prefectural budget, but operation is delegated to the NGO.

Q: What are the most important criteria for selecting counselors?

A: Last year we developed new criteria. They call for the counselors to be both physically and mentally fit, and be willing to train.

Q: How do you attract counselors?

A: You offer them a chance to acquire knowledge and the opportunity to meet people of different backgrounds. A network is created where often the counselors themselves recruit other counselors.

Q: What is the role of communication skills?

A: Part of the training is negotiation skills.

Q: Why are there more girls than boys?

A: Among both adults and young people, there are always more girls involved. It is a problem. We want both boys and girls.

Editor's Note: This article is a summary of a presentation delivered by Dr. Hisako Takamura at the First 2005 Workshop. AUICK takes full editorial responsibility for the content.