School-based comprehensive sexuality education (CSE) can help adolescents achieve their full potential and realize their sexual and reproductive health and rights. This is particularly pressing in low- and middle-income countries (LMICs), where high rates of unintended pregnancy and STIs among adolescents can limit countries’ ability to capitalize on the demographic dividend. While many LMICs have developed CSE curricula, their full implementation is often hindered by challenges around program planning and roll-out at the national and local level. A better understanding of these barriers, and similarities and differences across countries, can help devise strategies to improve implementation; yet few studies have examined these barriers. This paper analyzes the challenges to the implementation of national CSE curricula in four LMICs: Ghana, Kenya, Peru and Guatemala. It presents qualitative findings from in-depth interviews with central and local government officials, civil society representatives, and community level stakeholders ranging from religious leaders to youth representatives. Qualitative findings are complemented by quantitative results from surveys of principals, teachers who teach CSE topics, and students aged 15–17 in a representative sample of 60–80 secondary schools distributed across three regions in each country, for a total of around 3000 students per country. Challenges encountered were strikingly similar across countries. Program planning-related challenges included insufficient and piecemeal funding for CSE; lack of coordination of the various efforts by central and local government, NGOs and development partners; and inadequate systems for monitoring and evaluating teachers and students on CSE. Curriculum implementation-related challenges included inadequate weight given to CSE when integrated into other subjects, insufficient adaptation of the curriculum to local contexts, and limited stakeholder participation in curriculum development. While challenges were similar across countries, the strategies used to overcome them were different, and offer useful lessons to improve implementation for these and other low- and middle-income countries facing similar challenges.
School-based comprehensive sexuality education (CSE) can help adolescents acquire crucial knowledge and skills to achieve their full potential, particularly in low-and middle-income countries with higher rates of negative sexual and reproductive outcomes. While many low-and middle-income countries have developed CSE curricula, little is known about how these are implemented in the classroom. This multi-country mixed-methods study analysed challenges to the implementation of national CSE curricula in schools in Ghana, Kenya, Peru and Guatemala, based on surveys of secondary school principals, teachers and students aged 15-17 years, and indepth interviews with central and local government, NGOs and youth organisations. In all four countries, inadequate teacher training remained a major hurdle to effective implementation, manifesting in teacher discomfort and inaccurate messaging. This was compounded by a lack of comprehensive teaching resources. CSE classes were focused mainly on biology at the expense of contraception, gender and rights, despite students' desire for greater coverage of these topics. Teaching methods lacked interactive activities necessary to develop skills and values. Findings offer useful lessons to improve school-level implementation in these and other countries facing similar challenges. Increasing teacher training and distributing comprehensive CSE materials responsive to adolescents' needs remain priorities in all countries.
This paper aims to identify, review, and evaluate publicly available national- and local-level data sources that collect information on the sexual and reproductive health (SRH) of immigrants in the United States. We review public-use sources from the last 30 years that include information on immigration, SRH, health service utilization, and race/ethnicity. For each source, we evaluated the strengths and challenges of the study design and content as they relate to studying immigrant SRH. We identified and reviewed 22 national and seven local sources. At the national level, the National Longitudinal Study of Adolescent to Adult Health and the National Survey of Family Growth contained the most information; at the local level, the New York City Community Health Survey was the most robust. These sources present opportunities to advance research, improve public health surveillance, and inform policies and programs related to the SRH of this rapidly growing and often underserved population.
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