1Education in relational, emotional and sexual life (EVRAS) is part of health promotion at school, and often gives rise to different reactions due to the sensitive nature of these topics. However, it plays an essential part in the educational pathway and psychological and sexual development of children and young people, as it helps to make their role as citizens effective in a global perspective, whereby people are recognised as responsible individuals, capable of making choices with respect for themselves and for others, and ensuring that their rights are respected [Champagne, 2017].
2Since its inception in the 1970s in French-speaking Belgium, EVRAS has continued to develop, and now involves a wide range of stakeholders and practices. In 2012, a decree included it among the missions of compulsory education in the French Community. Nevertheless, in the French-speaking part of the Brussels-Capital Region (BCR), it is still not a reality for all young people attending school in the region, and more needs to be done [Bellanger et al., 2020]. For the 2018-2019 year, there were a total of 4672,5 hours of activities led by the secular and pluralist family planning centres in BCR. However, the geographical distribution of these activities is uneven. Furthermore, only 12,32 % of students benefited from at least one session with the family planning centres concerned [FLCPF, 2019]. These activities mainly concern secondary school students. The coverage rate is higher in the general stream (68 %) than in the other streams: technical (16 %), vocational (11 %), artistic (2 %), special needs (3 %) and co-operative education (CEFA, 0,5 %) [FLCPF, 2019]. These results fall short of the objective of widespread implementation pursued since 2012, and have led to the compulsory yet minimal integration of EVRAS into the curricula for the 6th year of primary school and the 4th year of secondary school from the start of the 2023 academic year1.
3In this context, this article looks at what could be done to ensure the widespread implementation of EVRAS in French-language compulsory education in the Brussels-Capital Region, and at what cost. The first part of the article defines EVRAS and provides an overview of international standards in this area. The second part looks at the implementation of EVRAS in French-speaking BCR in recent years, the political ambitions behind it and the obstacles slowing down the implementation process. Finally, we propose a model and estimate the cost of a widespread implementation.
- 2 The aim of the thematic analysis was to bring out the themes in the corpus in an inductive manner.
- 3 Fédération Laïque des Centres de Planning Familial, Fédération des Centres Pluralistes de Planning (...)
- 4 Documents provided by Fédération Laïque des Centres de Planning Familial, Fédération des Centres Pl (...)
4To carry out this study, we used a qualitative approach based on a review of the literature and semi-structured interviews with a thematic and iterative analysis2 in addition to the collection and analysis of quantitative data. A total of 17 interviews were conducted, lasting an average of one and a quarter hours, with the following breakdown: ten people who worked in head organisations3, eight in family planning centres (CPF), seven in school health promotion services (SPSE), two in youth organisations (OJ), one in a psychological/medical/social centre (CPMS) and one in an EVRAS unit. The interviews took place between January 2021 and March 2021. For quantitative data, we used the databases published by the Federal Planning Bureau and the Entreprise des Technologies Numériques de l'Information et de la Communication (ETNIC), as well as the JADE database set up by the Fédération Laïque des Centres de Planning Familial (FLCPF). Finally, we used the activity reports, accounting reports and other grey literature provided by several of these structures during the interviews4.
5EVRAS is one of the pillars of health promotion, defined by the WHO as “the process of enabling people to increase control over, and to improve, their health” [WHO, 1986]. It falls within the WHO definition of sexual and reproductive health and rights, and is considered a right for all, including the very young. In so doing, it is not reduced only to the prevention of risks and illnesses, but accompanies the development of social and emotional skills [UNESCO, 2021]. Several studies have highlighted the benefits of EVRAS in relation to young people's sexual behaviour, reducing unwanted pregnancies and the spread of sexually transmitted diseases, empowering young people and reducing gender-based inequalities and violence [BZgA, 2020; Fonner et al., 2014; Maticka-Tyndale and Tenkorang, 2010; Rutgers, 2017; Heßling and Bode, 2015; UNESCO, 2016].
6UNESCO, the International Planned Parenthood Federation (IPPF) and the WHO Regional Office for Europe recognise the importance of offering EVRAS on an ongoing basis in connection with compulsory education, from the earliest age and at all stages of development, with yearly sessions of at least one hour. In a spirit of health equity, they point out that vulnerable groups must receive special attention and that the context of every young person as well as socio-cultural factors must be integrated into the programmes [UNESCO, 2018; IPPF, 2006; WHO Regional Office for Europe et al., 2010].
7In French-speaking Belgium, the main objective of integrating EVRAS into the compulsory education system was to reduce the risks associated with sexual behaviour. Its fields of action have gradually expanded to include the relational and emotional dimensions of sexuality. EVRAS is thus defined by the June 2013 interministerial memorandum of understanding as “an educational process (...) according to a global approach in which sexuality is understood in the broad sense and includes the relational, emotional, social, cultural, philosophical and ethical dimensions” [Communauté française et al., 2013: 3]. This more global vision makes it possible to address sexist and homophobic stereotypes, violence in relationships and between the sexes, and respect and responsibility towards oneself and others. These topics give children and young people the opportunity to develop as future citizens who are capable of making responsible, informed choices. In Flanders (and consequently in the Dutch-language schools of Brussels), compulsory sex education is included in the educational objectives established by the Flemish government [AVOKOS, 2021]. However, as in French-language schools (before 2023), there are no regulations concerning the coverage rate to be implemented or priority levels of intervention.
8As there are many stakeholders involved in EVRAS in French-speaking BCR, only front-line stakeholders who are not school staff members were included in the analysis. They implement EVRAS formally, as classroom activities during school hours. Their work is in direct connection with the school, and makes EVRAS a reality for students.
- 5 https://servicejeunesse.cfwb.be/subventions/les-organisations-de-jeunesse/
9These stakeholders include service providers working directly in the classroom, such as PMS centres, school health promotion services, youth organisations5 (French Community) and family planning centres (French Community Commission). There is also a network of second-line stakeholders, intervening occasionally, including the Centre Bruxellois de Promotion de la Santé and the Centre de Documentation et d'Information Spécialisé sur la vie affective et sexuelle [Amerijckx et al., 2015].
10Given the institutional complexity in Belgium, the EVRAS stakeholders come under different levels of authority with different orientations and budgets, which makes its widespread implementation more difficult [Amerijckx et al., 2015].
- 6 Alter Visio, Cercles Homosexuels Estudiantins Francophones Fédérés, Centre Bruxellois de Promotion (...)
11In terms of its operationalisation – before the 2023 school year – EVRAS is mostly organised at the request of schools, in the form of regular or occasional interventions. Most of the time, these interventions take place in response to a specific issue within a class. In theory, EVRAS should be available to all students throughout compulsory education (mainstream and special needs, ages 5 to 18), from the third year of pre-school to the last year of secondary school, and in all streams. Let us note that some schools have set up EVRAS units, integrating activities into the educational structure of the school. This is a promising solution, yet the respondents6 consider it to be time-consuming and costly. This element has therefore not been integrated into the implementation strategies.
12The term “widespread implementation” refers to the implementation of EVRAS activities in schools (basic, secondary, special needs, co-operative), whether they are organised or subsidised by the FWB [Communauté française et al., 2013]. Plans for the widespread implementation of EVRAS date back to the early 2000s [Renard et al., 2003]. In 2012, this objective was included in the “educational missions” of schools. EVRAS became one of the missions of compulsory education, but schools are free to implement it individually [Parlement de la Communauté française, 2012]. Furthermore, in 2013, a memorandum of understanding on the widespread implementation of EVRAS was adopted by the three governments (FWB, COCOF and Walloon Region), along with a common reference framework [Communauté française et al., 2013]. In order to support this widespread implementation, a budget of €300,000 was allocated by COCOF and was increased to € 600 000 in 2018-2019. Finally, in 2019, the Brussels government reaffirmed its commitment to continue the widespread implementation under the new legislature [Commission Communautaire française de la Région de Bruxelles-Capitale, 2019]. In this spirit, a common framework has been defined by the various organising authorities, supplemented by the conclusions of the EVRAS Concerted Strategies7, which established a reference framework including a map of all stakeholders providing EVRAS, as well as a content guide based on the needs of young people and professionals [Stratégies Concertées EVRAS, 2022]. Finally, a cooperation agreement was adopted in July 2023. Alongside this legislative framework, various initiatives have attempted to nurture and support these dynamics, such as the work of the EVRAS Platform, which has issued recommendations in this area [Plateforme EVRAS, 2013].
- 8 JADE database, Fédération Laïque des CPF, calculation methodology available in the initial study.
13Despite this, EVRAS is still not available to all French-speaking students in Brussels. According to the latest available data, the health equity objective has not been reached. In fact, for the entire school system in French-speaking BCR, less than 20 % of students in compulsory education benefited from at least one EVRAS activity in 20188. This can be explained by two factors. Firstly, according to those working in the field, some schools are more reluctant than others to organise EVRAS activities and hinder their development. Secondly, without a precise framework defining EVRAS methods, its organisation is left to the discretion of schools and their teaching staff. This translates into activities which can be carried out by external professionals from CPF, or during classes which deal with the various aspects of EVRAS through the prism of biology alone. It has also happened on numerous occasions that certain external stakeholders invited by the schools have advocated values which were at odds with those advocated by EVRAS, including abstinence or choosing not to terminate a pregnancy [de Villers, 2017].
14In terms of organisation, we also note that there is an uneven distribution of activities between the different types of education. In 2003, a study had already identified these inequalities: 30 % of students in vocational education had never benefited from an EVRAS activity, compared with 26 % in technical education and 18 % in general education [Andrien et al., 2003]. Given these observations, a widespread implementation seems necessary and would improve health equity.
15The goal of widespread implementation is important, as the need for EVRAS is very real in French-speaking BCR. Young people's perception of their health reveals a social gradient in terms of health according to educational streams, which are markers of social inequality in themselves in Belgium [Bricteux et al., 2020]. Secondary school students in the general education stream have a better overall assessment of their health than those in the technical stream who, in turn, consider themselves to be in better health than those in the vocational stream [Desnouck et al., 2020]. Furthermore, 32 % of students in Brussels have their first sexual encounter before the age of 15. In addition, the lack of contraception is more frequent among young people in Brussels than in Wallonia, and they score less well in terms of knowledge about modes of HIV transmission [Bellanger et al., 2020].
16Despite the efforts, the implementation of EVRAS is no easy task, especially in Brussels. Each class is different and the specific context of each school must be taken into account, as many barriers exist due to cultural and religious aspects, as well as taboos and prejudices [Champagne, 2017]. In other words, the question of sexuality is still a difficult one in today's society, as already noted in the study by M. Adrien et al. [2003].
17The school system also creates certain barriers, first of all due to its organisation into different networks (official organised, official subsidised, private subsidised denominational, private subsidised non-denominational) which are not subject to the same obligations. For example, the COCOF decree making it compulsory to provide information on contraception and responsible parenthood does not apply to schools in the private denominational network [Lausberg, 2015]. The argument of infringement on academic freedom is also put forward by some teachers who do not wish to discuss these topics with their students. In addition, there are educational inequalities within Belgian French-language education, resulting in different amounts of information and different programme qualities for students [Lafontaine et al., 2003]. Access to quality EVRAS also reflects these educational inequalities which reinforce social inequalities in health. Finally, the lack of specific, ongoing training for teachers accentuates the feeling of invalidity in their approach to some of these issues.
18There is also some reluctance in the family sphere. Some feel that EVRAS does not respect parental freedom, even though the European Court of Human Rights has ruled that making EVRAS compulsory is not contrary to this freedom [European Court of Human Rights, 1976]. However, this does not stop some parents or parents' associations from lobbying against EVRAS activities within the schools.
19In addition, there is also a lack of intermediaries for young people within schools and between the various structures inside and outside schools, a lack of financial means for training and for paying an external facilitator, and a lack of human resources [Renard and Piette, 2004]. Finally, although EVRAS is included in the missions of compulsory education, there is not a specific number of hours dedicated to teaching this subject as there is for other subjects. This means that the activities take place during class time scheduled for other lessons. The three elements mentioned above are hindering the widespread implementation of EVRAS.
20In order to truly achieve this widespread implementation, it is essential to consider ways to introduce this extension, taking into account the specific characteristics of Brussels and the current state of progress of the project. In this perspective, the authors propose three strategies for the widespread implementation of EVRAS in French-speaking BCR. These are the result of a process of reflection led by the researchers, based on existing literature, recent activity statistics and a series of interviews with stakeholders in the field. Practical information on the organisation of activities and training in mainstream and special needs education was gathered during these interviews (duration of activities, group size, number of facilitators per activity, etc.).
- 9 Enseignement.be [no date].
21These strategies differ from one another in the number of academic levels they include in the implementation, from a minimal to a global perspective. They focus on the EVRAS activities carried out in schools during the compulsory school years by specialised external stakeholders (CPF, CPMS, SPSE and OJ). A distinction is made between mainstream and special education9, in view of the different needs with respect to EVRAS. Activities must be adapted to the needs of students in special education, and generally require more time and repetition of information. In addition to activities, the three implementation strategies include basic and thematic training for facilitators, which is essential in order to guarantee the quality of the activities.
22A first way to introduce EVRAS in French-speaking BCR is to implement a minimal activity model. According to this model, activities could be offered at a minimum number of academic levels (those currently benefiting from EVRAS), which would be just enough to guarantee widespread implementation. Table 1 details the academic levels targeted and the number of activities organised according to this strategy:
Table 1. Academic levels in the minimal model
- 10 Equivalent levels for special education.
Levels targeted
|
Mainstream education
|
Special education10
|
6th year primary
|
2*2h
|
5*1h
|
2nd year secondary
|
2*2h
|
5*1h
|
4th year secondary
|
2*2h
|
5*1h
|
TOTAL
|
6 activities, 12 hours
|
15 activities, 3 hours
|
- 11 Obtained from the Jade database of family planning centre activities.
23According to this model, a student in mainstream education would have 12 hours of activities throughout his or her schooling, compared with 15 hours for a student in special education. In addition to defining levels of action, each model includes an implementation plan over time as well as a budget, enabling an estimation of the financial resources required for its implementation. The yearly objectives in terms of the number of students to reach were determined on the basis of the coverage rates recently achieved by the different EVRAS stakeholders11. Based on these rates, an ambitious yet realistic rate of increase was defined for achieving widespread implementation (+10 % per year for the minimal model, +6 % per year for the intermediate model and +3 % for the ideal model – percentages which reflect larger absolute numbers of students for the intermediate and ideal models).
24For the minimal model, the implementation plan is described in Table 2. This was estimated based on CPF observations for 2018-2019 and the assumption that the distribution of activities between schedules and other stakeholders (SPSE, CPMS, OJ) that year was 70 %-30 %. The percentages of students to be reached represent the proportion of students covered by activities during the years targeted in the model. Therefore, the minimal model's objective of 42 % means that 42 % of students in the 6th year of primary school and the 2nd and 4th years of secondary school should benefit from activities.
Table 2. Implementation plan for the minimal model
- 12 For further details regarding the calculation of the percentages of students to be reached, see ann (...)
|
2021-2022
|
2022-2023
|
2023-2024
|
2024-2025
|
2025-2026
|
Percentage of students to be reached12
|
42 %
|
52 %
|
62 %
|
72 %
|
82 %
|
- 13 Total minimum budget = (activities budget + training budget) *1.1 (10% emergency interventions supp (...)
25In addition, budgeting was made possible thanks to the qualitative aspect of the study, which covered the organisation of activities and training as well as school population projections for 2021 to 2026. In order to calculate the budgets associated with each model, a budget simulator was created by the DULBEA team (Université libre de Bruxelles) [Duchêne et al., 2021]. The estimated budget includes the costs of activities (salary costs for facilitators and equipment) and training (salary costs for instructors and training coordinators as well as logistics costs). For the minimal model only, the budget includes a supplement dedicated to emergency interventions, i.e. interventions carried out at the request of schools, for example following an incident13.
26In order to implement the minimal model, the amounts shown in Table 3 are required. Note that the study was conducted in 2021, and could not take into account successive inflation and the various wage indexations (and those still to come). These estimates are therefore interesting for comparative purposes in choosing a scenario, but should be revised upwards when applied in order to keep up with the actual evolution of wages.
Table 3. Budgeting for the minimal model
|
2021-2022
|
2022-2023
|
2023-2024
|
2024-2025
|
2025-2026
|
Activities
|
€ 1 142 839
|
€ 1 423 185
|
€ 1 708 065
|
€ 1 987 768
|
€ 2 259 546
|
Training
|
€ 58 022
|
€ 77 297
|
€ 91 718
|
€ 105 681
|
€ 119 189
|
TOTAL
|
€ 1 200 861
|
€ 1 500 483
|
€ 1 799 783
|
€ 2 093 448
|
€ 2 378 735
|
Source: EVRAS simulator, DULBEA
27The intermediate implementation model is aimed at covering a higher number of academic levels than the first model, beginning at a young age. Activities are planned for seven different academic levels instead of three:
Table 4. Academic levels in the intermediate model
Levels targeted
|
Mainstream education
|
Special education
|
3rd year pre-school
|
2*1h
|
5*1h
|
2nd year primary
|
2*1h
|
5*1h
|
4th year primary
|
2*2h
|
5*1h
|
6th year primary
|
2*2h
|
5*1h
|
2nd year secondary
|
2*2h
|
5*1h
|
4th year secondary
|
2*2h
|
5*1h
|
6th year secondary
|
2*2h
|
5*1h
|
TOTAL
|
14 activities, 24 hours
|
35 activities, 35 hours
|
28The student coverage objectives are presented in Table 5. Due to the greater absolute number of students included in the model (which targets more levels), the percentages of students to be reached are initially lower than in the first scenario.
Table 5. Implementation plan for the intermediate model
|
2021-2022
|
2022-2023
|
2023-2024
|
2024-2025
|
2025-2026
|
Percentage of students to be reached
|
20 %
|
26 %
|
32 %
|
38 %
|
44 %
|
29According to this implementation plan, in 2021, the simulator estimated that the authorities would have to allocate the following amounts in order to cover the seven levels of the intermediate model:
Table 6. Budgeting for the intermediate model
|
2021-2022
|
2022-2023
|
2023-2024
|
2024-2025
|
2025-2026
|
Activities
|
€ 1 074 709
|
€ 1 405 260
|
€ 1 740 956
|
€ 2 071 772
|
€ 2 394 337
|
Training
|
€ 54 628
|
€ 77 418
|
€ 94 407
|
€ 110 947
|
€ 127 002
|
TOTAL
|
€ 1 129 337
|
€ 1 482 678
|
€ 1 835 363
|
€ 2 182 719
|
€ 2 521 339
|
Source: EVRAS simulator, DULBEA
30Finally, a third way to implement EVRAS would be to provide activities for each academic level, from the 3rd year of pre-school to the final year of secondary school (13 levels). The ideal model is the one recommended by health experts. It would enable continuous, repeated learning adapted to the age and level of development of children and young people, but would require greater financial resources.
Table 7. Academic levels in the ideal model
Levels targeted
|
Mainstream education
|
Special education
|
3rd year pre-school
|
2*1h
|
5*1h
|
1st year primary
|
2*1h
|
5*1h
|
2nd year primary
|
2*1h
|
5*1h
|
3rd year primary
|
2*1h
|
5*1h
|
4th year primary
|
2*2h
|
5*1h
|
5th year primary
|
2*2h
|
5*1h
|
6th year primary
|
2*2h
|
5*1h
|
1st year secondary
|
2*2h
|
5*1h
|
2nd year secondary
|
2*2h
|
5*1h
|
3rd year secondary
|
2*2h
|
5*1h
|
4th year secondary
|
2*2h
|
5*1h
|
5th year secondary
|
2*2h
|
5*1h
|
6th year secondary
|
2*2h
|
5*1h
|
TOTAL
|
26 activities, 44 hours
|
65 activities, 65 hours
|
31As with the other two strategies, an implementation plan has been established for five school years:
Table 8. Implementation plan for the ideal model
|
2021-2022
|
2022-2023
|
2023-2024
|
2024-2025
|
2025-2026
|
Percentage of students to be reached
|
16 %
|
19 %
|
22 %
|
25 %
|
28 %
|
32As this ideal model is the most complete, it is also the most expensive, as indicated in Table 9
Table 9. Budgeting for the ideal model
Ideal
|
2021-2022
|
2022-2023
|
2023-2024
|
2024-2025
|
2025-2026
|
Activities
|
€ 1 600 148
|
€ 1 911 244
|
€ 2 227 613
|
€ 2 536 750
|
€ 2 835 763
|
Training
|
€ 81 303
|
€ 102 465
|
€ 118 483
|
€ 133 884
|
€ 148 715
|
TOTAL
|
€ 1 681 451
|
€ 2 013 709
|
€ 2 346 096
|
€ 2 670 633
|
€ 2 984 478
|
Source: EVRAS simulator, DULBEA
33Regardless of the model selected, it appears that the cost associated with the widespread implementation of EVRAS rises steadily over the years, in keeping with the increasing coverage objectives to be reached. Wage indexations will also influence these budgets. Nevertheless, this cost needs to be put into perspective with the societal benefits expected from these activities. It is also important to underline the fact that these amounts are to be divided between different authorities. The study takes into account a number of specialised external EVRAS providers under different organising authorities (COCOF and FWB).
34There is no doubt about the importance of EVRAS [Éducation Santé, 2015; Amerijckx et al., 2015; UNESCO, 2018]. In 2019, the government of the French-speaking part of Brussels reaffirmed its ambition to continue the widespread implementation of EVRAS [Commission Communautaire française de la Région de Bruxelles-Capitale, 2019], resulting in the introduction of two compulsory sessions throughout schooling from the start of the 2023 academic year. However, there is still a long way to go before every young person attending a French-language school in Brussels benefits from sufficient, high-quality EVRAS.
35This research has allowed us to develop three concrete strategies for the implementation project, each with a plan in terms of timing and budget. The choice of model will depend on the priorities of political decision-makers and the budgets available. In addition, the comparative budgeting of the models should help guide their choice. The choice of model will depend on the priorities of political decision-makers and the budgets available, after the milestone of compulsory EVRAS – in a very restricted form – from September 2023.
36In addition, regardless of the model chosen, it is essential to consider the obstacles to widespread implementation. In order to ensure optimal and equitable coverage, the proposed activities will have to be adapted to the needs and characteristics of each individual (socio-economic, cultural, parental context, etc.). It will also be necessary to ensure that the activities reach new audiences. In this respect, it is particularly important to ensure a wide coverage of EVRAS activities for students in vocational or special education.
37Furthermore, in order to ensure the success of this widespread implementation, political decision-makers will need to monitor its practical introduction. This will involve being able to identify the work which has been done and still needs to be done, as well as the priorities to focus on (in particular by creating a precise, comprehensive register of EVRAS activities and stakeholders all using the same software). In addition, monitoring and evaluation of the activities will allow an assessment of their impact on the health of the young people involved. This will allow stakeholders to verify that the activities are meeting their objectives and are in line with the needs of students. Finally, it will be essential to strengthen coordination between the various stakeholders, which come under different levels of authority and pursue their own objectives. By pooling their efforts, EVRAS will go beyond the scope of political ambition to become a permanent and more ambitious element in the school curricula for young people in Brussels.
We would like to thank all those interviewed (Alter Visio, Cercles Homosexuels Estudiantins Francophones Fédérés, Centre Bruxellois de Promotion de la Santé, CPF Evere, CPF Leman, CPF Schaerbeek, Fédération des Centres Pluralistes de Planning Familial, Fédération Laïque des CPF, CPMS n°5 Ville de Bruxelles, SPSE Ixelles, SPSE Ville de Bruxelles, O'Yes, Stratégies Concertées EVRAS) for sharing their views and experience with EVRAS, as well as the Comité d'Accompagnement for its support.