Traducción palabra por palabra

Implementation and enforcement pertains to the manner in which sex education and healthcare services are delivered in regards to legislation and policies. For example, key informants were concerned that despite a policy on the implementation of the HFLE program, schools made decisions about what aspects of the sexuality and sexual health module to implement, and that denominational school in particular choose to focus more heavily on abstinence and not (adequately) teaching about pregnancy prevention.

And so even though it [contraceptives] is in the curriculum of HFLE, it is not taught for example at Convent. Convent specifically goes for abstinence…they teach abstinence and chastity….they *public schools+ would tell you about condoms in terms of lessening your risk to HIV and AIDS and other STIs as well as pregnancy, the other schools like the public schools will teach that…

(Key Informant 2, IE)

However, the key informant further discussed that lack of implementation of certain aspects of the module in part attributed to some principals placing less priority on HFLE because it is not an examinable subject.

In contrast, some key informants perceived that unclear policies and/or legislation pertaining to the issues of parental consent for SRH services hindered the implementation of SRH services, such as the provision of contraceptives for adolescents. This results in inconsistent/unreliable provision of SRH services for adolescents, as discussed by a key informant in the HCCS sector:

…there are no specific guidelines for dealing with the adolescents… but how do you deal with an adolescent...So you would find that the care delivered to adolescents would vary from care provider to care provider. Those who feel comfortable giving the adolescent contraceptive would give it, others who don't feel comfortable they will not give it.

(Key informant 3, HCCS) The above excerpt is typical of stories discussed by key informants on this issue. In fact, the same key informant reported that it is against the law to provide health services to persons under age 18 without parental consent. However, other key informants reported being unaware of such a law, neither was such a law found during the document review. This is consistent with a report by Sealey-Burke (2006) who found that there is no law requiring parental consent for health services or SRH services. However, according to key informants,

the confusion seem to stem from the law regarding the age of sexual consent, which is 16 years and the age of majority, which is 18 years. This lack of clarity has implications for the consistent provision of SRH care for adolescents, and could negatively influence adolescents SRH help-seeking (section 7.3.4).

Furthermore, a key informant in the NGO sector perceived that the lack of consistent implementation contributes to the status of sex education in Grenada, and states that:

Sex is still a subject to be learned by the way. Contraception is a taboo subject and they believe contraception should be only for (pause) married people or people living in house (pause) family. So the education system does not put contraception in its right perspective as an element regarding sexual activity.

(Key informant 1, HCCS) However, respondents also recognized that there were other opportunities to provide safe sex information to students, apart from schools as discussed by this key informant in the IE sector.

You do what is required of you, having respect for the particular religion and the particular school… but you also tell the student that if you know you need further information, you know I can be contacted... A lot of students wanted to find out more about condom use and so on… so I told them invite me outside of the school and actually some of them have; they have done that through their community groups and so

(Key Informant 5, IE)

The ability to reach adolescents through community groups indicate that these groups may be avenues through which HFLE can target communities as outlined in their mission statement (section 4.3.1). Furthermore, community groups may be a potential source of information and advice for adolescents with SRH concerns, and could potentially facilitate health services utilization. Overall, respondents believed that the hard-line position of some schools regarding sex education was not adequately preparing students for the inevitability of sexual activity now or in later life.

Additionally, some key informants discussed that not all SRH-related laws were supportive of ASRH (e.g. abortion), and viewed law enforcement as problematic. For example, regarding the sexual abuse laws they believed that health workers were unaware of reporting procedures which limited the ability of the law to provide adequate protection for adolescent who might access health care services. For example, one key informant discussed that:

But in terms of sexual issues or because of the nature of it you would not find any standard protocol or so at the community level. Even in terms of suspected cases of where the child may be abused, no clear guidelines, for example, the doctor or the nurse see that child at the causality department, no clear guidelines to follow. They may choose to call the police, or may call domestic violence you know but there’s nothing in place as it relates to that.

(Key informant 3, HCCS) Although the Child Abuse Protocol (section 4.2.3) addresses reporting of sexual abuse by different sectors, according to key informant 3, the lack of operationalization of national policies across sectors is a barrier to effectively meeting the SRH help-seeking needs of adolescents. Problems with coordination are also implied, and are discussed in the next theme.