Classroom implementation of national sexuality education curricula in four low- and middle-income countries

Abstract

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.

A Cross-Sectional Community Readiness Assessment for Implementing School-Based Comprehensive Sexuality Education in Islamabad, Pakistan

“…There is a need for increased awareness and priority building measures to garner community and leadership commitment to work towards developing and integrating sexuality education in the curriculum. Rigorous teacher training to deliver content on sexuality education has also been emphasized as an integral part of successfully integrating CSE into the curriculum [ 49 , 50 , 51 ]. In a study conducted in sub-Saharan Africa, one of the major barriers identified was the reluctance of teachers to teach sexuality education content [ 49 , 50 , 51 ].…”

“…Rigorous teacher training to deliver content on sexuality education has also been emphasized as an integral part of successfully integrating CSE into the curriculum [ 49 , 50 , 51 ]. In a study conducted in sub-Saharan Africa, one of the major barriers identified was the reluctance of teachers to teach sexuality education content [ 49 , 50 , 51 ]. The authors argued that the discomfort of teachers may nurture the perception of students that sexuality-related topics are taboo.…”

“…The authors argued that the discomfort of teachers may nurture the perception of students that sexuality-related topics are taboo. One of the reasons for this hesitation in teaching CSE was probably related to the lack of training and skills to efficiently introduce sexuality-related concepts to children, as poor or no teacher training is a common hurdle when implementing CSE programs in low- and middle-income countries [ 49 , 50 , 51 ].…”

Contraceptive and abortion practices of young Ghanaian women aged 15–24: evidence from a nationally representative survey

“…Compared to older women, young women were more heavily influenced by their friends’ opinions. For young people who are unable to access health facilities and who may lack comprehensive sexuality education in school [ 50 ], friends may provide a key source of information on contraceptives. The strong influence of friends on young women’s opinions about contraception could potentially be leveraged through tools such as social media, where experts and influencers can disseminate accurate contraceptive information that is then picked up and shared by young people among their social networks.…”

“Not just the consequences, but also the pleasurable sex”: a review of the content of comprehensive sexuality education for schooling early adolescents in Rwanda.

“…The content of CSE remains contested in many parts of the world due to variations in framing and notions of sexuality and fears related to disrupting identities and values of the communities and compromising children's innocence [12]. In addition, people fail to agree on what "comprehensive" entails in the context of CSE [13]. Because of these varied understandings and fears about CSE, several sexuality education guidelines have been developed [14][15][16][17][18].…”