Women’s HealthBest Practices in Sex Education Implemented by Local
Governments
December 2017

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Contents
1. Summary
1.1. Project Overview
1.2. Research Results
1.3. Main Lessons on the Promotion of Sex Education

2. Research Results
2.1.
2.2.
2.3.
2.4.

Case 1: Aomori Prefecture
Case 2: Gunma Prefecture
Case 3: Niigata Prefecture
Case 4: Saitama Prefecture© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)

1.1

Project Overview

Project Objective
Knowledge about sex and health is vital in order for women to live according to their own plans based on
their own initiative. Although the national Government has policies in place that aim to enhance sex
education throughout the general educational system, the way these policies are being implemented
varies from region to region. This project highlights best practices in sex education projects lead byprefectural governments. The objective of this project is to contribute to the promotion of sex education
within educational institutions throughout Japan through the wide sharing of these practices.

Research Method
Information was first gathered from publicly available resources on the sex education projects being
implemented across Japan. Interviews were then conducted over the phone with the people in charge ofeach project. An independent team selected the projects to be highlighted as best practices based on thecriteria below.
Basic policies on sex education
 Clear prefectural policies relating to sex education
 Implementation of sex education activities led by the prefectural government targeting
educational institutions
 Implementation of effective and sustainable projects
 Theme selection based on prefectural issues
 Continuation for at least 3 years; implementation of project evaluation initiatives
 Collaboration with local stakeholders
 Cooperation with major community stakeholders, such as boards of education, medical
providers, and so on
Lastly, face-to-face interviews were conducted with people from the governments of the following
prefectures, which were selected as the places where the very best practices are being implemented (inalphabetical order):

Aomori Prefecture
Gunma Prefecture
Niigata Prefecture (including Health Centers of Kashiwazaki City, Tokamachi City, andMinamiuonuma City, which are all collaborating with the Niigata Prefectural Government)
Saitama Prefecture

The interviewees included project officers from the prefectural government and lecturers such as
obstetricians and midwives who conduct sex education in schools.

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1.2

Research Results

Key takeaways on the promotion of effective sex education projects are as follows.
 Policy on the implementation of sex education
 Prefectures should have clear policies for sex education, including frameworks for sex
education, or the inclusion of sex education in in prefectural education plans.
 Prefectures should use a combination of budgets to fund initiatives, including Ministry of
Education, Culture, Sports, Science and Technology (MEXT) comprehensive school healthsupport project funding, local government budgets (which may come from multiple
departments and municipal budgets), and school budgets.
 Activities Planning: Project themes should be based on region-specific issues, recent issues, andschool needs
Prefectures should set themes based on MEXT’s Courses of Study, the opinions ofregional health care providers and education stakeholders, and feedback from school
teachers and students.
 Implementation: Project should use scientifically correct information and concrete
examples
Prefectures should make use of medical experts such as obstetricians, gynecologists,
and midwives as external lecturers to teach about recent issues in sex education andother specialized topics.
An agreement should be reached in advance about the circumstances of each school
and the mind and body development of the students among school teachers, external
lecturers, local government officials before external lecturers conduct classes forstudents. In addition, prefectures can work to promote an even quality of classes byencouraging lecturers to share opinions and presentation materials.
The sharing of best practices and concrete lesson plans can help reduce the burden onteachers and improve the quality of classes.
 Evaluation and Improvements: Prefectures should implement project evaluation
researchPrefectures should conduct quantitative and qualitative research studies and analyses
that consider the opinions of project participants, and changes in knowledge levels
before and after the implementation of each project. The results of such studies
should be discussed with relevant stakeholders and reflected in plans for subsequentfiscal years.
 Collaboration among stakeholders
 Sex education projects for educational institutions are usually carried out by the school
health education divisions in each prefectural government. These divisions should work forcollaboration with other health and medical divisions in order to facilitate the introductionof external lecturers to schools, or the provision of information on individual health topics.
 Prefectures should collaborate with local medical associations, dentist associations,
pharmacist associations, and midwives to reflect the opinions of experts to the contents ofsex education classes, and to facilitate dispatches of external lecturers to schools.

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1.3

Main Lessons on the Promotion of Sex Education

HGPI’s view on the promotion of sex education by local governments is as follows.
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Support for sex education projects by the national Government
 Local government initiatives could be strengthened by further efforts by the national
Government to communicate the importance of sex education.
 Evidence-based classes help students understand that sex education issues affect them
personally, and that helps them remember the lessons. A framework should be set up toallow schools to easily acquire batches of current, usable, and reliable national and local
data.
Use of external lecturers
 The use of regional health care providers as external lecturers can be helpful to students,
because they can offer concrete examples from local areas as well as expert knowledge.
These lectures also tend to be interesting for students, so students remember them.
 When dispatching health care providers to schools, time should be set aside to allow
students to share contact information with providers or have a consultation with them inorder to solve the problems of the students.
Training teachers and external instructors
 When dispatching external lecturers for sex education lessons, it is better to select people
who have received appropriate training on the actual situation at the school they will visit,
as well as the school’s thoughts about sex education.
 It is difficult for external lecturers to handle everything. Health education and healthteachers will continue to be important stakeholders responsible for health classes. On theother hand, some research respondents have noted that health education and healthteachers do not seem very interested in teaching such classes. Moving forward, theimportance of sex education and related knowledge should be communicated not only
directly to teachers, but also as a part of the teaching license acquisition process.
Sharing other sex education project best practices
 This project focused on activities by prefectural governments, but many othermunicipalities, professional bodies, educational institutions, and civil society organizations
are conducting sex education projects as well. A platform should be established to share
best practices.
Measuring the impact of education
 Some interviewees stated a desire for the creation of concrete methods that could be used
to measure the impact of education over the medium- to long-term. It is important thatmeasurement indicators and methods be established in order to improve sex education
initiatives even further.

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2.1

Case 1: Aomori Prefecture

Sexual and reproductive health education by obstetrician/gynecologists that has been integrated
into local curriculum for 35 years

Basic Information
 Guidelines for sexual and reproductive health education
 “Systematic and cross-sectional guidance through integrated school educational activities - Sex
education in schools- (Sukoyaka Aomorikko 6)“ (March 2011)
 Outline of the intervention
 Lectures on sexual health are provided by school obstetrician/gynecologists to prefectural highschools and special needs schools.
 Training sessions and seminars are provided for school teachers.

BackgroundIn 1978, there were a few prominent cases of prostitution and self-induced abortions by high school girls
in Aomori Prefecture. In response to those cases, an obstetrician from a prefectural medical association
proposed that obstetricians help to provide students with a formal education on “sexual and reproductive
health.” The obstetrician, who still serves as a school doctor, recognized the need for sex education inschools through the experience of seeing many teenage girl patients with problems such as unwanted
pregnancies or sexually transmitted diseases (STDs). As a result of that obstetrician’s efforts, a project
was launched in 1980 to deploy school obstetrician/gynecologists at prefectural girls’ high schools. Since
1992 the project has been integrated into the Prefecture’s system for sexual health education for bothboys and girls at co-ed schools.

Overview of Activities
 Deployment of school obstetrician/gynecologists
Target Students from 61 prefectural high schools (full-time, part-time, andcorrespondence schools) and 16 special needs schools. The program
generally targets first-year students, although that depends on the opinionsof schools/school doctors. In FY2016, 10,375 students attended lectures
 Sometimes teachers also participate in the lectures, such as nurse-teachers,
teachers specialized in health and physical education or student guidance, or
health managers
Lecturer There are six educational blocks in the prefecture. One obstetrician is
assigned to each block as a school doctor, with a few other obstetricians toassist them
Budget Salaries for school doctors are included in the prefectural budget
Frequency
 Once a year
Overview
 At the beginning of the fiscal year, schools plan out program content inresponse to a notice sent to them by the Prefectural Government. This is done
through direct consultation with school doctors
 Lecture content is based on official guidelines with a focus on hot topics in
Aomori, including the ways that people can become pregnant, contraception,
the prevention of STDs, and menstruation control
 Course evaluations are conducted using questionnaires before and after eachsession. Reports are written on the sessions and questionnaires. The
Prefectural Government collects feedback from each school and reports oncouncil meeting so that the comments can be reflected into the program for© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)

Special
Features of theProgramsubsequent years
 The lessons provided to high school students are more practical than thelessons given to junior high students. For instance, high school students might
receive lessons on the types of oral contraceptive pills and their usage.
Pictures and movies are utilized to help students understand content
 Meetings and textbook sharing sessions are conducted among lecturers one
or twice a yearSeminars on sexual and reproductive health
Target Teachers from elementary, junior high, high schools, and special support
schools, as well as school doctors and other professionals involved incommunity health in the prefecture 115 teachers participated in FY2017
Lecturer Lectures are provided by professionals specialized in sexual health from both
inside and outside Aomori prefecture, including prefectural officials, schoolobstetrician/gynecologists and doctors from medical associations
Budget Funding is provided by the Prefectural Government via a prefectural medical
association
Frequency
 Once a year
Overview
 The first iteration of the program began in FY1994 and focused on HIV/AIDS
education. It included information related to sexuality, life, and mental
health. From FY1997 onwards, the theme of the program has been sexual andreproductive health education
 The FY2017 program included reviews of the past sex education curricula,sexual abuse and crime, LGBT-related issues, the protection of the rights ofchildren, HIV/AIDS, and other topics

Teacher training on sexual and reproductive health education
Target Teachers from elementary, junior high and high schools in the prefecture(including substitute teachers) 50 teachers participated in FY2016
Lecturers
 School obstetrician/gynecologists
Budget Funded as a “School Health Support Project” of the Ministry of Education,
Culture, Sports, Science and Technology (MEXT)
Frequency
 Once a year
Overview
 Training takes place over the course of two meetings. A preliminary study
meeting is first held where teachers develop teaching plans on topics aroundsexual education. This is followed by a training session in which teachers
continue their learning through group work and practical lesson sessions

Strengths of the Initiative Since the program has been going on for 35 years, the obstetricians’ lectures are now well accepted
and integrated in school curriculums. (Comment from the Prefectural Government/Lecturer) Program activities are well balanced, covering both input from students and teachers. (Comment
from the Prefectural Government)

Current Issues of the Initiative
 Ensuring the availability of school obstetricians
 It is necessary to foster young obstetrician/gynecologists for the future. There is a concern overthe decline in the number of young doctors who want to specialize in obstetrics/gynecology inthe prefecture. (Comment from the Prefectural Government)© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)



Although many junior high schools and private schools also offer lectures on sexual health led
by school obstetricians, there are not enough obstetricians to provide lectures everywhere. It is
now essential to strengthen partnerships with midwives, public health nurses, nurse-teachersand school teachers. In doing so, each stakeholder should try to share common ground and work
to ensure the quality of the education being offered. (Comment from lecturer)
Conduct of effective program evaluation
 Although the program was conceived as a way to respond to the problems and needs of local
communities, no significant decline has been observed in cases of self-induced abortions among
young girls. It is critical that students recognize how these issues affect them personally, andutilize the knowledge the program provides to plan out their own lives. Measuring the longterm impact of the program continues to be a challenge. (Comment from the Prefectural
Government)

Direction for Future Development
 Continuation of the Project Prefecture will continue to implement and secure a budget for this well-balanced program.
(Comment from the Prefectural Government)
 Fostering of doctors to be involved in sex education
 More doctors need to be involved. The program should conduct lectures for doctors providing
information on the role and content of sexual health education. (Comment from lecturer)

Expectations for Other Stakeholders
 Government
 The “School Health Support Project” run by MEXT is a flexible program which enables
interventions catered to the needs of each region. The Prefecture hopes that program will be
continued. (Comment from the Prefectural Government) School teachers and parents
 Class teachers should participate as well. Class sessions could also be utilized as an opportunity
for parental learning and education through parental visits. (Comment from a lecturer)Interviewees Prefectural Government
Ms. Kanae Sakagami, Supervisor (Sub-Manager), Physical Education and Health Group, Sports
and Health Department, Aomori Prefectural Education Office
Ms. Minako Hamahashi, Supervisor, Physical Education and Health Group, Sports and Health
Department, Aomori Prefectural Education Office Lecturer (School Obstetrician/Gynecologist)
Mr. Yutaka Hasuo, Director, Aomori Women’s Healthcare Research InstituteInterview date: November 2017

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2.2

Case 2: Gumna Prefecture

Providing learning opportunities to all students, by incorporating the project into the prefectural
education planBasic Information
 Gunma’s sex education policies (public resources) Undisclosed to the public Outline of the initiative
 Lectures targeting students from public elementary, junior high and high schools (full-time andpart-time schools)
 Seminars targeting teachers from elementary, junior high, high schools, and special support
schoolsBackground The project has been operational for more than 10 years. The initial focus of the project was
HIV/AIDS, as can be seen in the project’s title, “sexuality and HIV/AIDS.”Overview of Activities
 Lectures on life, sexual/reproductive health and HIV/AIDS education (hereafter referred to as the“lectures”)
Target
Provide lectures by experts to all public elementary and junior highschools, and prefectural high schools (full-time and part-time schools). For
high schools, the lecture is provided to either all students or just first-year
students. It is also recommended to be offered to part-time schools andspecial needs schoolConduct of lectures is set by the “Phase 2 Gunma Prefecture Education
Promotion Basic Plan”, with a target of 100% of all the schools mentioned
above by 2018
For FY 2016, lectures were implemented in 80% of elementary and juniorhigh schools and 100% of high schools
LecturerA request is sent to the medical association (obstetricians’ association) to
identify potential lecturers. 16 lecturers have been listed up in FY2017
For elementary and junior high schools, lecturer information is shared
among school nurses and health supervisors, who send lecturers requests
BudgetFor high schools, the project is funded by the prefectural Government
every two years. Budgets for major cities (Maebashi, Takasaki) arecontributed by health and physical education departments, and budgets
in other cities are contributed by health and prevention departments.
When lectures are not funded by the prefectural Government, they are
conducted at the school’s expenseFor elementary and junior high schools, normally each school funds
activities themselves using PTA membership fees and so on. Sometimes
other budgets are utilized, such as budgets from the prefecture’s childwelfare department or municipalities
FrequencyOnce a year
OverviewFor high schools, every year implementation plans are submitted byschools in June, in response to notices sent out by the prefectural
Government. The content of lectures is decided upon by lecturers and© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)



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Expectations
for deploying
external
lecturers

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schools. After the implementation of lectures, reports are submitted by
February with details on the lecturers and content covered. In case a
lecture is not implemented, a request is sent to the school to carry out thelecture next year in line with prefectural policy
For elementary and junior high schools, local education offices consolidate
performance results from municipalities and report to the prefectural
Government in March every year
Although lecture content depends on lecturers and schools, junior highand high schools generally focus on scientific views on sexuality, secondary
sexual characteristics, the prevention of STDs, childbirth and infertility,
dating-related domestic violence, and other topics. Student participants
are selected according to age. Elementary schools mainly focus on life andchildbirth. Recently, new topics such as LGBT-related issues are also
included in the content of lectures
Implementation results are reported at the “Gunma Prefecture School
Health Council,” which is held once a year. Sometimes, the latest issues
around sexual health are shared and discussed during the council meeting
School teachers need to give lessons based on official guidelines andtextbooks. External lecturers help to complement these lessons, providing
information on the latest issues and technical matters
Lectures by external specialists also have a positive effect of stimulatinginterest among students

Teachers’ training on sexual/reproductive health and HIV/AIDS education (hereafter referred to as“training”)
Participants
School nurses, health supervisors, physical education managers, student
guidance counselors, and the management from elementary, junior high,high schools and special support schools in Gunma prefecture
300 teachers participated in FY 2016 (elementary schools). The prefectural
Government requested one representative from each school, and theparticipation rate was 80-90%
Lecturer
Mainly external lecturers, including officers from the Ministry of
Education, Culture, Sports, Science and Technology (MEXT), and healtheducation investigators
Budget
Implemented as a prefectural project
FrequencyOnce a year (training targets elementary schools one year and junior highand high schools the next)
Overview

Guidance is provided by MEXT, based on the handbook on the national
health education

Strength of the initiative Partnerships within the prefectural Government, as well as with external stakeholders
 Cost sharing with other departments has been continued for more than 10 years. Additionally,
the board of education and other departments collaborate with each other and share
information, including through the distribution of materials used in the training on datingrelated domestic violence for school nurses.
 The “Gunma Prefecture School Health Council” includes representatives from medical
associations, dental associations, and pharmaceutical associations. Participants haveopportunities to receive technical advice and support from them.

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Current Issues of the Initiative Expanding project to elementary and junior high schools
 Although projects for elementary and junior high schools aim to achieve the target of 100%
implementation, it is challenging to increase the number of schools implementing the initiatives
as the budget is not provided by the prefectural Government.
 Selection of topics and information to be offered “Sexuality and HIV/AIDS education” is considered a part of “health education.” It is difficult todetermine which topics should be focused on, as issues around health education are diverse
and include newly emerging issues such as LGBT-related issues, sexual crimes, internet related
problems, and so on. There is a limitation on the number of issues that can be covered in
lectures as well.
 For newer issues, it is challenging to collect the latest evidence-based information.

Direction for Future Development
 Continuation of activities
 Gunma Prefecture will continue the project and aim to achieve the targeted number of lectures
to be conducted in FY2018.



Expectations for Other Stakeholders
 Government (MEXT) MEXT should continue active interventions, such as by securing funding for sexual healtheducation and by organizing training sessions.
 MEXT should help the Prefecture by providing information on new topics and clarifying its
concrete goals and plans for education.

Interviewee
 Prefectural Government
Health and Physical Education Division, Gunma Prefectural Board of Education Secretariat
Interview date: December 2017

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2.3

Case 3: Niigata Prefecture

Providing sexual and reproductive health education (AIDS/STD Prevention) through acommunity- and needs-based approach led by health centersBasic information
 Guidelines for sexual and reproductive health education (public materials)
 Undisclosed to the public Outline of the intervention
 Health centers organize lectures on AIDS and sexually transmitted diseases (STDs) in educational
institutions as an AIDS countermeasure promotion project, which is one part of disease
countermeasures.

Background
The project has been carried out for more than 20 years. It seems to be initiated or promoted as an
HIV/AIDS education project for adolescents, as indicated in the “Stop HIV/AIDS project by healthcenters” document published by the Ministry of Health, Labour and Welfare (MHLW) in 1993, although
the specific details of the project’s beginnings are now unknown.

 Overview of Activities
As “sexual behavior” relates to both AIDS/STD prevention and the prevention of unwanted pregnancies, thisproject is implemented through coordination with the Maternal & Child Health Division.
Lectures on AIDS and STDs (hereafter referred to as the “lectures”)
TargetStudents from public and private elementary schools, junior high schools,
high schools, special needs schools, universities and technical schools.
Target schools and grades are selected by each health center
9,730 students from 44 schools participated in FY2016
LecturerEach health center selects a lecturer according to the characteristics of thecommunity.
Normally
thelectureisofferedby
local
obstetricians/gynecologists, midwives, or staff from health centers
Budget
Costs are managed by the “Specific Disease Prevention Project (HIV/AIDS
Project)” of the Prefecture’s Health Initiatives Division (Infection Control
Office). The allocation of the budget is decided upon following the annual
submission of implementation plans by the 12 health centers in theprefecture. These forms contain information on dates, venues,
participants, lecturers, and lecture content
FrequencyOnce a year at each school
Overview

Health centers decide on lecture content according to the issues and needsin the community

The Health Initiatives Division reviews lecture content through the reports
shared by health centers at the end of the fiscal yearThe state of the initiatives carried out by each health center is shared at
the Health Center Disease Infection Control Office Conference

Strength of the Initiative Health center initiatives and ownership Local health centers, which work closely with their communities, lead the planning and© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)



implementation of community-based projects, and are therefore able to develop content
specific to the needs in each community.
Cost sharing by two projects
 As sexual behavior is a common issue for not only the AIDS countermeasure promotion projectsof the Health Initiatives Division Infection Control Office, but also the health support projects of
the Maternal & Child Health Division, the framework of this project allows for joint planning andimplementation.

Current Issues of the Initiative
 Securing the availability of lecturers
 There is a critical shortage of doctors, especially obstetricians, in Niigata prefecture, making it
challenging to secure human resources for the project. Lectures are therefore sometimes
offered by a public health nurse from health centers. Lecturers are selected strategically byhealth centers, to provide an opportunity for networking between the residents and local
obstetricians/midwives.



Direction for Future Development
 Continuity of the project The prefectural Government will continue advocating for the project in order to secure thenecessary budget and to enable health centers to maintain their active and unique interventions.



Expectations for Other Stakeholders
 Government (MHLW) Secure a budget for AIDS countermeasures promotion projects.
 Schools Flexible actions to respond to the needs and reality of the students, including the provision oflessons by external lecturers in order to offer content beyond the official guidelines.

Interviewee
 Prefectural Government
Health Initiatives Division, Welfare and Health Department, Niigata PrefectureInterview date: December 2017

Health Center Activities: Case Study 1
Kashiwazaki Health CenterBackground This project has been implemented continuously for more than 15 years. Since 2013, informationexchange meetings have been held as part of the “Project on establishing continuous support
systems around pregnancy” (hereafter referred to as the “meeting”). The meeting was initiated to
discuss the way forward based on current issues. Participants include doctors, midwives frommidwives’ associations, nurse-teachers, public health nurses/midwives from municipal childcare
support centers, municipal contact points for boards of education, village maternal health managers,
and public health nurses from health centers. They discussed issues including continuous preventive
education for adolescents, establishing post-partem support systems and for women experiencing
artificial abortions. As a result, information exchange meeting members confirmed the necessity of© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)

strengthening school support systems and preventative education in efforts to provide continuous
preventative education to adolescents. These efforts are being implemented within adolescentsexual education meetings.
Overview of Activities
 Lectures on adolescent sexual health
Target
All 8 prefectural high schools and special support schools managed by the
Kashiwazaki Health Center. Most schools target first or second year
studentsAll of the 13 public junior high schools have also been targeted since
FY2017, although only some were targeted in FY2016 and previous years.
Lectures are offered in response to requests sent by schools. In FY2017,lectures were implemented in 10 schoolsFor elementary schools, lectures are conducted independently
Lecturer
Obstetrician/gynecologists and midwives from among the members of theinformation exchange meeting, as well as public health nurses from healthcenters
Budget
Funding is provided by the prefectural Government for high schools, andby municipal boards of education for junior high schools. Elementary
schools fund lectures themselves
FrequencyOnce a year
OverviewThe subjects depend on schools and target grades, but mainly include
AIDS/STD prevention, the image that students have about sexuality,
mechanisms of pregnancy and contraception, menstruation/premenstrual
syndrome (PMS) and control measures, and information on where to seek
advice

A questionnaire was conducted before and after lectures were carried out
in FY2017, as suggested by information exchange meeting members.
Students were asked about their image and knowledge of sexuality, actions
they could take to avoided STDs and unwanted pregnancies, and how to
ask someone for support when needed. The results are currently being
analyzed at health centers, but some positive changes have beenSpecialFeatures of the
Lectures

recognized in levels of knowledge as well as images related to sexuality
Provide practical information such as community data, real case examples,and contact details related to consultations
As there was a reported need for sexual education from a male point ofview, the project sent a male obstetrician to schools with a high proportionof boy studentsStrength of the Initiative
 Collaboration among different professionals
 The information sharing meetings enable lecturers, health centers and schools to sharecommon grounds and continue the project effectively.

Current Issues of the InitiativeProject evaluation


Indices to measures mid- to long-term impacts. (comment from Health Center)© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)



Selection of lecture methods and target audienceEffective indices in light of the actual situation of students as understood through the pre- andpost-lecture surveys. (comment from Health Center)

The issue of how to provide lectures at special support schools and involve parents effectively.
(comment from a Lecturer)

Direction for Future Development
Continue the project

Create a sustainable system to deploy external lecturers. (comment from Health Center)

Provide opportunities for individual supportExamine and identify approaches where guidance is provided in response to individual needs,in consideration of current issues, including increasing diversity in the way people express theirsexuality and the way that young people live. (comment from a Lecturer)

Expectations for Other Stakeholders
 Government
 It is hoped that the national Government will secure a budget for sexual education and continue
its active engagement on this issue. (comments from both Health Center and Lecturer) External lecturers
 Guidance should be given according to the needs of students and actual situation in each
community. (comment from Health Center)

Interviewees Health Center
Community Health Division, Health and Welfare Department, Kashiwazaki Regional Promotion
Bureau, Niigata Prefecture Lecturer (Adolescent Sex Education Lecturer)
Ms. Naomi Ishiguro, Midwife, Yuiku Maternity HomeInterview date: December 2017

Health Center’s Activities: Case Study 2
Minami-Uonuma Health CenterBackground Issues around STDs, including HIV/AIDS, were reviewed in 2010. Information exchange meetings on
sexuality related issues have been conducted since 2011. The meetings highlighted the need for
effective sexual health education for adolescents, as well as the shortage of human resources toprovide lecturers.
To address this issue, the Health Center recruited lecturers and developed education materials
through four discussion meetings on “adolescent sexuality and health support.” These meetings
were held between 2014 and 2016. Meeting members included nursing school teachers, nurseteachers from junior high and high schools, midwives from medical institutions and a midwifery
association, public health nurses from the Minami-Uonuma Health Center and municipal public© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)

health nurses, and members from the municipal board of education. Regarding the recruitment oflecturers, the Health Center made an initial approach to potential lecturers mainly via professionals
participating in the Training on Adolescent Health Support. Official requests were sent to thelecturer’s organizations if they accepted. The materials developed for this project were used inpractice in FY 2016, and an evaluation was conducted based on questionnaire given to students andlecturers. As the results showed a positive effect in improving levels of knowledge as well as theimage the students had about sexuality, the same materials are still being used, with updates tostatistics and data.
Overview of Activities
 Deployment of external lecturers
Target
Third-year students from 7 public junior high schools in Minami-Uonuma
city
Lecturer
7 midwives or public health nurses selected from medical institutions,municipalities, at-home midwives’ associations, medical schools, andhealth centers
Budget
Each school pays its own expenses for the deployment of lecturers
FrequencyOnce a year
OverviewA one-hour lecture is provided based on the materials developed, covering
themes such as the prevention of AIDS/STDs, body mechanisms, means toprevent unwanted pregnancies, and information on where to seek
support. Sometimes additional topics are included according to the
problems seen in each schoolSpecialFeatures of the
Project

Initiatives are shared by during information exchange meetings that takeplace during the Training on Adolescent Health Support
The Health Center tries to respond to the requests by schools based on
preliminary meetings with them, and decides on the content of healtheducation
The Health Center makes careful consideration of the way issues should be
explained, making sure to use expressions that are easy for students tounderstandStrength of the Initiative
 Collaboration among different professionals
 The Health Center’s jurisdiction covers on one city and one town, so face-to-face partnerships
are a strength of this project. It is easy to share information and opinions.



Current Issues of the Initiative

Ensuring the availability of lecturers
Each institution sends offers to lecturers, but the project largely relies of the passion of lectures.
It is unclear just how long this system will continue to function.

Updating education materialsWhen to review and revise the existing materials to reflect on the changing social environment
for adolescents.



Direction for Future Development
 Ensuring the continuity of the project© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)

There are plans to set a venue within FY2019 for a discussion on future initiatives.

Expectations for Other Stakeholders
 Schools
 Schools need to incorporate new approaches and information, in line with current situations
and the changing social environment that adolescents face.
 Municipalities
 Although currently the Health Center plays a primary role in connecting schools and otherstakeholders, it would be better to hand over management of this project to municipalities.
 The Health Center hopes adolescent education will be made part of the Childcare Support
Project in the future.

Interviewee
 Health Center
Pharmaceuticals and Prevention Division, Health and Welfare Department, Minami-Uonuma
Regional Promotion Bureau, Niigata PrefectureInterview date: December 2017

Health Centers’ Activities: Case Study 3
Tohkamachi Health Center and Maternal & Child Health Unit/Health Promotion Division at theMunicipal Citizen Welfare Department
Background This activity started from stakeholder gatherings at Tohkamachi Health Center, in response tofocused HIV/AIDS interventions by the national Government and the official launch of “Healthy
Parents and Child 21.” It has been operational for more than 10 years.

Overview of Activities
 Regular meetings for school nurses from high schools
When
Implemented every February as a part of a regular meeting for school
nurses from prefectural high schools, in partnerships with the HealthCenter and Tohkamachi City
Participant
Overview

School nurses from 6 high schools in the areas covered by Tohkamachi

Health Center
Share problems seen in each school
Discuss lecture content for the following year

Deployment of lecturers to offer sexual health education
TargetAll students from 6 prefectural high schools, special support schools, andsecondary schools in the areaElementary and junior high schools (excluding the aforementioned
secondary schools) organize their own separate programs
Lecturer
Lecturers are assigned according to requests indicated in plans submitted
by schools. Negotiations with lecturers are done by each schoolLecturers include local obstetricians, midwives from midwives’© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)

Budget

Frequency
Overview



associations, nursing school teachers, retired nurse-teachers, and so on
Four schools are funded by the prefecture and two schools are funded by
the municipal health department
Once a year



AIDS/STD

prevention,bodilymechanisms,

unwantedpregnancy

prevention mechanisms, and information on where to consult whenassistance is neededFor high schools: unwanted pregnancies, LGBT issues, suitable ages for
pregnancy, and cervical cancer. For junior high schools (first through thirdyear students), menstruation symptoms (PMS) and control measures,
messages to encourage students to have positive self-images, and so onSubjects covered mainly include body mechanisms, how to prevent
unwanted pregnancies, the prevention of STDs, and information on where
to consult when assistance is neededSome schools collect requests from students prior to lectures, andcompare changes in the levels of knowledge before and after lecturesSpecialFeatures of the
project



The health center also monitors chronological changes in the levels ofknowledge about STDs and contraception
Utilize materials to help understanding and stimulate interest among
students according to their ages, including the use of community data andpictures/moviesStrength of the Initiative
 Collaboration among different professionals
 Conducted as a joint project of the Health Center and the city Government.
 School nurses and lecturers (doctors/midwives) cooperate with each other to solve problems in
the community.
 Providing supportive environment for students
 Students can feel comfortable with the topic and that it is easier to seek advice since thelecturers are local healthcare providers.



Current Issues of the Initiative
 Ensuring quality of the lecture

Need training sessions for lecturers (obstetricians, midwives, public health nurses) to enable
them to offer quality education catered to the needs of schools and students. (comment from
Health Center)Support to individual cases


Although the deployment of lecturers is effective in improving overall knowledge levels, efforts
are needed to strengthen support for individual issues. (comment from the city Government)

Direction for Future Development
Ensuring quality of the lecturers


There is a need to provide lecturers with opportunities to learn from each other, such as use ofopen lectures for the lecturers themselves. (comment from Health Center)

Close partnerships with school nurses© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)



A system should be set up to provide personal counseling and support to students, incoordination with school nurses, using the access the city Government has to local information
on pregnancy and delivery situation. (comment from the city Government)

Since elementary schools, middle schools, and high schools conduct a consistent sexual
education program, there is a need for OBGYN institutions, school nurses, and the local
government to coordinate and discuss issues and measures. (comment from the city
Government)

Expectations for Other Stakeholders
 Government
 It is hoped that the national Government will provide places for students where they can accesscorrect information, advice and support. (comment from Health Center) Schools
 It is would be desirable for schools to use a unified set of educational materials. (comment fromthe city Government)Interviewees Health Center
Community Health Division, Health and Welfare Department, Tohkamachi Regional Promotion
Bureau, Niigata Prefecture
 City Government
Health Promotion Division, Tohkamachi Municipal Citizen Welfare Department
Interview date: December 2017

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2.3

Case 3: Saitama Prefecture

Providing equal opportunities for all students to acquire the same level of knowledge byenhancing teaching materials and teacher training

Basic Information
 Saitama’s sex education policies (public resources) Heisei 29 Nendo Gakko Kenko Kyoiku Hikkei (“FY2019 School Health Education Handbook”;
Available only in Japanese) Shin – Naruhodo Hoken Gakushu (Heisei 27) (“New – I Understand Health Education (2017)”;
Available only in Japanese) Outline of the initiative
 Training for teachers on best practices, the latest issues in the field of sex education, and theflow of classroom lessons.
 Annual efforts to develop sex education policies based on feedback from teachers.

Background In light of a push by the national Government to put more effort into sex education, in 2005 Saitama
Prefecture launched the "Committee to Promote Sex Education Practice in Saitama Prefecture" (later
renamed in 2017 as “Committee to Resolve Sex Education Issue in Saitama Prefecture”) (hereafter,
the “Committee”). Current committee members include professors from the Faculty of Education at
Saitama University (chairpersons), the principal of a local school (Vice Chairperson), three teachers
each from a local elementary school, a local junior high school, and a local high school (one school
nurse and two teachers of health and physical education), and administrative staff members fromlocal governments.
 The Committee works to propose lesson plans for sex education based on discussions with schools
about their needs. The Committee conducts research on lessons, and Committee members test out
lessons at their own schools. The Committee also holds workshops for teachers.



Overview of Activities
Based on the ideal that all students have the right to learn correct information about sex, theCommittee focuses its efforts on teachers. The Committee keeps track of a network of Health
Departments, etc. that schools can call upon if they want to have them come into classes tocomplement lessons based on the Courses of Study set out by the Ministry of Education, Culture,
Sports, Science and Technology (MEXT).
Workshops for teachers who conduct sex education (hereafter referred to as the “workshop”)
Target
Teachers of health and physical education, school nurses and healthsupervisors from elementary, junior high, and high schools. Approximately
500 people participate each year out of a target audience of 1,500 schools
in Saitama Prefecture. Many of them are school nurses
Lecturer
Lecturers are selected based on advice from Committee members andexpertsModel lessons are conducted by Committee members to demonstrate bestpractices
Budget
Workshops are funded by MEXT as a designated school general healthsupport project (funding has been secured through FY2017)
FrequencyOnce a year

© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)

Overview

During workshops, local government staff members give opening remarks,
followed by the introduction of model lessons (best practices), and apresentation from an external lecturer

Each workshop has a theme based on MEXT’s Courses of Study. However,they may also provide detailed information on topics such as infertility andsyphilis, which are problems in recent years

To respond to the needs in the field, the results of the feedbackquestionnaire filled by participants are discussed by the Committee andincorporated into plans for future fiscal years. Many teachers haveexpressed opinions about the actual implementation of lessons (teaching

SpecialFeatures of theWorkshopsThe School Health Education Handbook
Target
Teachers of health education at elementary, junior high, and high schools
BudgetFrequency of
Revisions
Overview

Funded as a project of Saitama Prefecture
Once a yearDiscusses important points and philosophies related to school healtheducation, the positioning of health education, the latest information onsex education topics, case studies, and so on. It has sections on sex
education and AIDS education
The Handbook also introduces other reference materials created by the
National Government and Saitama Prefecture such as Shin – Naruhodo
Hoken Gakushu (Heisei 27) (“New – I Understand Health Education(2017)”; Available only in Japanese), which is published by the Saitama
Prefectural Board of Education and Saitama Prefectural School HealthCouncil
The Handbook is revised each year based on information from the “Stateof School Health Education Survey” on the utilization of the Handbook inschools, and opinions of the Handbook gathered during Workshops
The Handbook aims to help teachers by providing specific lesson plans
where possible
Anyone can download the Handbook from the Saitama Prefecture websiteSpecialFeatures of the
Handbook

methods and use of class time)
The theme of the Workshop is examined and discussed every year to allow
participants to learn the wide range of information necessary for theirclasses
Lecturers teach about not only sex education lessons, but also offer hints
on health education in general, in order to increase participant
engagement in the Workshop

Strength of the Initiative

Extensive teaching materials

Saitama Prefecture creates teaching materials like the School Health Education Handbook every
year, which presents a clear vision on health education and case examples. Saitama Prefecture
made the decision to publish the Handbook on its website because there were many inquiries
about it from the governments of other prefectures. (Comment from Prefectural Government)© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)



Collaborations with other stakeholders


There is a close partnership with Health Departments. For example, a booklet published by the
Wellness and Longevity Division was introduced at the Workshop one year when the theme wasinfertility, and utilized in a model lesson at a high school. (Comment from Prefectural
Government)

Because a school nurse sits on the board of directors of Saitama Society of Maternal Health, its
academic conferences always set aside time for presentations on health education. This is avaluable opportunity to communicate the actual situations at schools to academia. (Comment
from a Lecturer)Current Issues of the InitiativeMedium- to long-term evaluation of activitiesHow should the impact of these initiatives on not only teachers, but also students, be evaluated?
How should the mid- to long-term impacts be evaluated? (Comment from Prefectural
Government)

Overflow of information on sexual health

Recently, information can be easily available through the internet, but not all of the informationis correct. Some students follow this information without questioning it and act inappropriately.
(Comment from a Lecturer)

Direction for Future Development


Continuation of activities
 The Prefectural government will try to secure an independent budget to continue the initiative.
(Comment from Prefectural Government)
Strengthening external lecturer dispatch support
 Connections have been made with medical associations, associations of dentists, pharmacist
associations, and midwife associations in Saitama Prefecture, but organized collaborations are
not taking place. The Prefectural government hopes to create a system that will allow schools
to find external lecturers easily, such as by creating a list of lecturer candidates. (Comment from
Prefectural Government)

Expectations for Other Stakeholders
 The National Government
 The national Government should continue to send the message that "sex education isimportant." (Comment from Prefectural Government) The national Government should strengthen training for health education teachers, for example,
by increasing the number of credits required at training institutions, including universities, sothey can give appropriate guidance at schools. (Comment from a Lecturer)
 The national Government should make it easier to find reliable data that can be utilized inclassrooms, such as nationwide survey results. (Comment from a Lecturer)
 To Health and Physical Education Teachers Teachers should first correctly grasp the purpose and content of each lesson before teachingclasses. (Comment from a Lecturer)© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)

Interviewees Prefectural Government
Mr. Hironari Masuda, Chief of Health and Physical Education Division, Prefectural Schools
Department, Education Bureau, Saitama Prefecture
Ms. Naomi Takeda, Supervisor of Health and Physical Education Division, Prefectural Schools
Department, Education Bureau, Saitama Prefecture Lecturer
High School Nurse-Teacher, Saitama Prefecture Committee on Sex Education
Interview date: November 2017

© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)

The Project TeamThe “Best Practices in Sex Education Implemented by Local Governments” Project Team
Yuko Imamura (HGPI, Senior Associate)
Mariko Oyamada (HGPI, Vice President)
Yukiko Yoshida (HGPI, Program Specialist)(In Japanese syllabary order)
Health and Global Policy Institute (HGPI) conducted this survey with the financial support of Bayer Yakuhin,Ltd. and MSD K.K. The Sponsor’s opinions were solicited, but HGPI exercised independent judgment indetermining whether any such opinions should be reflected in the survey.

© 2017 Japan Health Policy NOW* When quoting the research results, please specify the citation. (Contact: info@hgpi.org)