What evidence is there for comprehensive sexuality education in lower and middle income countries? What measurable outcomes have been associated with delivering CSE? What are the most effective strategies for implementation at scale? (e.g. in relation to gender, age, content, involvement of parents, political buy-in etc.) What challenges are there to applying such approaches in policy and practice?
Comprehensive sexuality education (CSE) has strong support in the international discourse, and is supported by a relatively robust evidence base.
In general, the evidence suggests that CSE has positive impacts on behaviour change, such as increased condom use, girls’ empowerment and delayed sexual debut. This is achieved through increasing knowledge and changing attitudes. There is strong evidence to support the effectiveness of CSE programmes in these areas. However, there is less evidence on whether CSE can change biological indicators, notably incidences of STIs, including HIV, and pregnancies. The literature highlights that this is an area of research which needs more conclusive findings. CSE is mostly implemented through the lens of preventing HIV/AIDS, and is mostly directed at adolescent girls, giving the evidence base a strongly gendered dimension. Most programmes take place in schools. Haberland (2015) provides strong evidence that content on gender and power in intimate relationships is a key characteristic of effective sexuality and HIV education.
The literature generally recommends holistic strategies for delivery which involve parents, teachers and peers as well as young people, and which link to broader factors such as accessible health services and social norms change. Effective programmes seem to use interactive, learner-centred and skills-based teaching approaches.
The key challenge to CSE identified in the literature is that of cultural resistance, which often takes the form of religious or morality-based conservatism. The main argument put forward is that teaching CSE encourages young people to have sex earlier and to engage in sexual activity. There is strong evidence to counteract this point of view.
Browne, E. Comprehensive sexuality education (GSDRC Helpdesk Research Report 1226). Governance and Social Development Resource Centre, University of Birmingham, Birmingham, UK (2015) 14 pp.