印尼残疾儿童和青少年的性教育

——以教师的性别为视角

文摘：残疾儿童和青少年(CAD)经常从事不适当的性行为行为。在印度尼西亚，对CAD的性教育的需求仍然不清楚。本研究调查教师在特殊学校提供性教育的态度，以澄清提供性教育的教师之间的性别差异。调查问卷被发送给180位老师。回收率为72.2%。百分之八十三的被调查者是穆斯林。我们的调查结果显示，特殊学校的教师认为性教育很重要。然而，性教育的内容是有限的。与男教师相比女教师教性教育是积极的。同样，女教师与男教师相比，教性教育的内容的数量更多。这些研究结果是一致的，有来自发达国家的报告显示，尽管印尼的文化和宗教背景不同。印尼的教师接受了对性的教育;然而,教育的材料和工具应该进一步发展。

关键字：残疾儿童和青少年；印度尼西亚；性教育；性行为；特殊学校

一、背景

在大多数发达国家，综合性的性教育被认为对所有人都是至关重要的。儿童和青少年、残疾儿童和青少年的性教育可能更适合的是这些孩子经常表现出不适当的性行为。之前的研究表明，个体间的不适当性行为经常与缺乏相关性行为知识和技能有关。

马特和杰斯玛2强调了性教育不足的问题，并报告说只有18%的有身体残疾的青少年使用避孕套来保护他们自己，使他们免受人类免疫缺陷病毒(HIV)的感染。有害的性行为(20% - -44%)与知识disabilities.3存在于青少年团体中。此外,据报道,有学习障碍的青少年(平均年龄:14.8岁)经历过性虐待。这些发现显示,对残疾儿童性行为的私人教育是很重要的职业，但是很难提供他们获得性教育的机会。

在发达国家,性教育被认为是重要的对所有儿童而言。此外,人们普遍认为,孩子们应该参与有关性活动的教育项目，以提高他们理解性和生殖以及性教育的知识，允许在学校为孩子们提供他们发展他们的决策技能的知识，性教育的终生性活动也很重要,因为它帮助残疾儿童和青少年来获取知识,保护他们免受性侵犯或不适当的性行为。

性行为引起的严重健康问题，包括青少年怀孕，性行为传播疾病，艾滋病毒在发展中国家和发达国家都越来越关注。在印度尼西亚，Hambali10报道了210名15到24岁的未婚学生的性生活活跃。超过一半的学生彼此交往一年后经历过性行为。在非洲，有54%的患有身体残疾的人在15岁之前就经历过性行为。然而，很少有研究把注意力集中在全面的性教育上，尤其是在儿童和青少年中。人们普遍认为，每个社区都有文化和习俗影响性教育的问题。以前的研究报告表明，对儿童进行性教育的活动，也同样存在受老师思想和态度的影响。

印尼是最大的伊斯兰国家，受到与性教育相关的宗教限制。然而，关于性行为和相关因素的争论已经出现，这是由于亚洲国家的非标准性的标准。1994年国际人口大会在发展方面表明，人们越来越重视对青少年进行性教育的需求。在与此同时，印尼的许多活动，尤其是爪哇，都是针对年轻人的。许多家长、教师和宗教领袖认为性教育应该集中在教育上。压制青年性。然而，越来越多的青少年怀孕，意味着婚前性行为的增加。

印度尼西亚教育部提出了一项全面的性教育(CSE)项目，包括生殖健康，残疾人的权利，性别，性，17种多样性暴力和，以及对人性的积极看法。性教育与现有的学校课程，如生物或科学，人口教育，运动,和宗教。尽管人们对性教育越来越感兴趣，但印度尼西亚对残疾儿童和青少年提供性方面的教育，没有得到很好的认可。在有效地提供性教育方面，教师的态度和知识是非常重要的。之前的研究指出伊斯兰国家男女之间对性行为和性活动的看法有很大的不同。有可能涉及到宗教习俗可能会加强性别角色和信仰。

本研究旨在从性别角度探讨教师对残疾儿童及青少年性教育的看法及态度。此外，还旨在评估印度尼西亚所选择的特殊学校的残疾儿童和青少年的性行为。

二、研究方法

（一）研究设计和参与者

采用截面式研究,男性和女性参与者的老师照顾残疾儿童在日惹。孩子们在特殊学校被照顾4至18年。一百三十名教师(平均年龄47.0plusmn;10.2年；女教师:72.3%)。在特殊学校参加本研究的是(SLB 1班,SLB 1班,SLB 4班)在日惹。在印尼老师在SLB班可能教育有不同类型、不同年龄的残疾的孩子。有563名儿童有不同类型的残疾(听力,44.0%;知识,43.8%;物理、5.3%;情感,4.6%;视觉、2.3%)在特殊学校。爪哇中部省份的人口超过300万,其中91.4%是在印度尼西亚穆斯林。特殊的公立学校包括幼儿园、小学、初中、高中。医学上有残疾的儿童和青少年需要先在医院或诊所检查,然后推荐参加一个特殊的学校，这被认为是适合的来满足他们的教育需求。大多数残疾儿童(即听觉、视觉、身体、智力和情感障碍)遵循医生的建议。基于这些学校的大小和位置,包括城市和农村地区。有76个特殊学校为我们选择参与者和仪器，对于我们研究在日惹的残疾儿童。

调查问卷最初基于前studies.19 20调查问卷由三个领域:(a)儿童和青少年的性行为,(b)性的内容教育,在教育残疾儿童困难。(c)“性的领域行为”包括7项有关性行为的儿童和青少年。“性教育”的内容包括23项，“残疾儿童教学的困难和地域”是性教育的主题。这个问题在英文版本翻译成印尼官方语言(印尼语)翻译,然后由另一个母语back-translated。翻译都验证了印度尼西亚的母语。

（二）数据收集

本研究在日惹省从2013年12月1日到2013年5月1日对三个特殊的公立学校进行了调查研究。儿童和青少年通过医务人员的检查判定他们的障碍(视觉、听力障碍、认知和其他障碍)。在研究的开始,教师通过书面知情的方式同意了。学校特殊教师的总数是181,其中有130例(71.8%)参与问卷调查。

（三）道德的考虑

本研究经教育部医学院,意大利Gadjah马达思班,医学研究伦理委员会(MHREC)批准和。也由当地政府Daerah Istimewa日惹,印尼许可的研究地方政府颁发的日惹地区。

（四）数据分析和预测

使用统计软件社会科学(SPSS)21.0版(Windows)对人口统计变量和性行为进行了分析。在教育孩子性教育的内容和难度比较基于残疾的类型使用卡方。预备考试完成后测量的有效性和可靠性这个问题。43名残疾儿童教师参加了预备调查。使用皮尔逊积差系数和克伦巴赫的alpha;分析了该方法的有效性和可靠性。这项研究表明,问卷具有较高的内部一致性(r = 0.95)，所有项目预约好的有效性。所有项目的问卷总分有显著相关性(性行为= 0.33 - -0.65,性教育的主题= 0.40 - -0.86,和困难教= 0.57 - -0.91)。

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Sex Education in Children and Adolescents With Disabilities in Yogyakarta, Indonesia From a Teachersrsquo; Gender Perspective

Satoko Tsuda, MSN1,2, Sri Hartini, PhD1,3, Elsi Dwi Hapsari, PhD3, and Satoshi Takada, MD,PhD1

Abstract

Children and adolescents with disabilities (CAD) frequently engage in inappropriate sexual behaviors. In Indonesia, the need for sex education for CAD remains unclear. This study investigated teacher attitudes toward providing sex education in special schools to clarify the gender differences among teachers providing sex education. Questionnaires were sent to 180 teachers. The response rate was 72.2%. Eighty-three percent of responders were Muslim. Our findings revealed that teachers in special schools considered sex education to be important. However, the number of sex education contents was limited, and female teachers were more positive about teaching sex education than male teachers. Equally, female teachers taught a greater number of sex education contents than did male teachers. These findings were consistent with reports from developed countries although cultural and religious background differed from those of Indonesia. Sex education for CAD was accepted by teachers in Indonesia; however, materials and tools for education should be developed further.

Keywords

children and adolescents with disabilities, Indonesia, sex education, sexual behavior, special school

Introduction

In most developed countries, comprehensive sex education is considered to be essential for all children and adolescents. Sex education for children and adolescents with disabilities may well be more appropriate as these children are often involved in displays of inappropriate sexual behaviors. Previous studies have shown that inappropriate sexual behaviors among individuals with disabilities are frequently related to lack of knowledge and skills regarding appropriate sexual behavior.1 Maart and Jelsma2 highlighted the problems of inadequate sex education and

1Kobe University, Kobe, Hyogo, Japan

2Tezukayama Gakuin University, Sakai, Osaka, Japan

3Universitas Gadjah Mada, Yogyakarta, Indonesia

Corresponding Author:

Satoshi Takada, Graduate School of Health Science, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, Hyogo 654-0142, Japan.

Email: satoshi@kobe-u.ac.jp

Tsuda et al 329

reported that only 18% of adolescents with physical disabilities used a condom to protect them- selves from contracting the human immunodeficiency virus (HIV). Another study found a high rate of harmful sexual behaviors (20%-44%) existed in adolescents with intellectual disabilities.3 Furthermore, it was reported that adolescents with learning disabilities (mean age: 14.8 years) experienced sexual abuse (exhibitionism and vaginal penetration) more frequently than those experiencing typical development.4 These findings revealed that it is difficult to provide appro- priate education of sexual behaviors for children with disabilities and that it is important to pro- vide opportunities for them to gain access to sex education.

In developed countries, sex education is recognized as being important for all children. Furthermore, it is widely believed that children should participate in activities relating to sex education programs in order to increase their knowledge and understanding of sexual and reproductive health.5-7 Sex education in schools provides children with knowledge that allows them to develop their decision-making skills about lifelong sexual activities independently.8 Sex education is also important as it helps children and adolescents with disabilities in particu- lar to obtain knowledge that would protect them from sexual abuse and or inappropriate sexual behaviors.

Serious health issues stemming from sexual activity, including teenage pregnancy, sexually transmitted disease, and HIV are of increasing concern in both developing and developed coun- tries.9 In Indonesia, Hambali10 reported on the sexual behaviors of 210 unmarried students aged 15 to 24 years who were sexually active. More than half of these students experienced sexual intercourse within 1 year after becoming acquainted with each other. In Africa, 54% of adoles- cents with physical disabilities had experienced sexual intercourse by the time they reached 15 years of age.1 However, few studies have focused attention on comprehensive sex education, particularly among children and adolescents with disabilities. The issue of sex education is widely believed to be influenced by cultures and various customs in each community. Previous studies have also reported that knowledge about sexual activity provided to children was also influenced by the teacherrsquo;s thoughts and attitude.11-13

Indonesia is the largest Islamic country to have religious restrictions related to sex education; however, much debate has emerged about sexual activity and associated factors due to the nor- mative standards of Asian countries.14 Since the 1994 International Conference on Population and Development, there has been increased focus on the need for sex education for youths. At the same time, numerous activities in Indonesia, especially Java, have been directed at young people. Many parents, teachers, and religious leaders considered that sex education should be focused on suppressing youth sexuality.15 However, the rising number of adolescent pregnancies outside marriage indicates an increase in premarital sex.16

The Ministry of Education in Indonesia has proposed a comprehensive sex education (CSE) program, which consists of reproductive health, the rights of people with disabilities, the concept of gender, sexuality,17 violence and diversity, and a positive view of human sexuality. Sex educa- tion is integrated into existi

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