Unesco CSE Study on Attitudes and Perceptions 2022

Consolidated Regional Report

Qualitative study on the attitudes, perceptions
and experiences of learners and teachers on
Comprehensive Sexuality Education (CSE)

Published by:
UNESCO Regional Office for Southern Africa
Education for Health and Wellbeing Sector
8 Kenilworth Road, Newlands
PO Box HG 435, Highlands, Harare, Zimbabwe
+263 (0) 242 776775
www.unesco.org/new/en/harare
Coordinated by:
UNESCO Regional Office for Southern Africa:
Patricia Machawira, Remmy Shawa, Ygainnia Hamandawana, Ruvarashe Matambo
UNESCO Multi-sectoral Regional Office for West Africa (Sahel):
Xavier Hospital, Sandisile Tshuma, Urban Akagwire

© UNESCO, 2022
This publication is available in Open Access under the Attribution-NonCommercial-NoDerivs 3.0 IGO (CC-BY-NC-ND 3.0 IGO)
license (http://creativecommons.org/licenses/by-nc-nd/3.0/igo/). By using the content of this publication, the users accept to
be bound by the terms of use of the UNESCO Open Access Repository (www.unesco.org/open-access/terms-use-ccbyncnden).
Reference Code: HAR/ED-HW/2022/14
Design and layout: Marike Strydom, Jade Rose Graphic Design
Editor: Danya-Zee Pedra
Cover photo: © UNESCO

Foreword

Prof Lidia Arthur Brito

Director and Representative, UNESCO Regional Office for Southern Africa

“By helping adolescents to realize their rights to health, well-being, education and full and equal participation
in society, we are equipping them to attain their full potential as adults”.

UN Secretary General, 2016-2030 Global Health Strategy for Women’s, Children’s and Adolescent’s Health
At the United Nations Educational, Scientific and Cultural Organization (UNESCO), we believe that a good quality education
is the foundation of health and well-being, and that Education is both a catalyst for development and a health intervention
in its own right. Through the flagship programme Our Rights, Our Lives, Our Future (O3), UNESCO continues to champion
Comprehensive Sexuality Education (CSE) and reaffirm its importance in addressing key challenges faced by adolescents and
young people across Sub-Saharan Africa, the region most affected by the HIV epidemic, early and unintended pregnancy (EUP),
gender-based violence (GBV), and child marriage among this young population. CSE not only teaches young people how to
prevent HIV, avoid early and unintended pregnancy, or why testing for HIV and knowing their status is important, it also helps
them develop important life skills and positive health-seeking behaviour. Moreover, there is overwhelming evidence that CSE
leads to positive outcomes, including delaying sexual debut, decreasing the number of sexual partners, increasing knowledge
and self-esteem, and changing negative attitudes and norms.
We are excited about this report which sheds light on facilitators and barriers to effective CSE delivery in schools, linkages
between schools and health facilities, and more importantly, the value of CSE from a cross section of learners, including
learners with disabilities, teachers, and community members. This report offers important recommendations on what can be
done to strengthen CSE delivery and ensure it meets the needs and expectations of the learners. These include the need for
governments to develop/review and align policies to facilitate an effective and efficient delivery of CSE; scaling up pre- and
in-service teacher training on CSE, strengthening the monitoring of both the delivery of CSE and associated learning outcomes,
and strengthening collaboration and coordination at different levels and across stakeholders to strengthen delivery.
We all have a duty to prepare young people for a healthy and productive life. We invite you to use this report to improve CSE
delivery in schools and to continue the discourse on CSE informed by the new body of knowledge generated by this report.
For more information on UNESCO work in Education for health and wellbeing please refer to our websites:
https://en.unesco.org/themes/education-health-and-well-being and https://cse-learning-platform-unesco.org/

01

Contents 04

Acronyms 07

Acknowledgements 08

Executive summary 13
13
1. Introduction 15
1.1 Background and context 15
1.2 The ESA Commitment 15
1.3 Our Rights, Our Lives, Our Future (O3) programme 16
1.4 Defining CSE
1.5 Global, regional, and national policy environmen 19

2. Purpose and objectives of the study 21
21
3. Methodological approach 21
3.1 Study sample 22
3.2 Data collection methods 23
3.3 Data collection, processing, and analysis
3.4 Limitations and challenges 25
25
4. Regional findings 25
4.1 Knowledge of CSE programmes 25
4.1.1 Operational terms for CSE in the study countries 26
4.1.2 Status of CSE implementation in the six countries 27
4.1.3 Community members knowledge of CSE 27
4.2 Attitudes and perceptions on CSE 28
4.2.1 Attitudes and perceptions of learners 30
4.2.2 Attitudes and perceptions of learners with disabilities 32
4.2.3 Attitudes and perceptions of teachers on CSE 34
4.2.4 Attitudes and perceptions of school managers 37
4.2.5 Attitudes and perceptions of community member 37
4.3 CSE delivery: Practices and experiences 40
4.3.1 Experiences of learners on teachers’ delivery of CSE 42
4.3.2 Experiences of learners with disabilities on teachers’ delivery of CSE 47
4.3.3 Experiences of teachers in the delivery of CSE 55
4.3.4 Factors influencing CSE delivery for learners 60
4.3.5 Factors influencing CSE delivery for LWDs 60
4.4 Learners access to SRH services 62
4.4.1 Linkages between schools and health services 63
4.4.2 Experiences of access to services for learners 64
4.4.3 Barriers for learners’ access to health services 65
4.4.4 Experiences of access to services for learners with disabilities 66
4.4.5 Barriers faced by LWDs
4.4.6 Health service provider experiences of access to services for learners

02

5. Conclusions 69
71
6. Recommendations 73
74
7. Country level findings 77
7.1 Botswana 80
7.2 Eswatini 83
7.3 Ghana 86
7.4 Malawi 90
7.5 Uganda 94
7.6 Zambia 97
98
8. References 106
108
9. Annexes 110
Annex 1: Terms of Reference 136
Annex 2: National laws, policies, and strategies
Annex 3: List and description of schools sampled 21
Annex 4: Evaluation tools 22
Annex 5: Consent forms 32

List of tables 37

Table 1: Number of key informants 03
Table 2: Distribution of FGDs
Table 3: Teachers proposed appropriate age to start CSE

List of figures

Figure 1: CSE Topics

Acronyms

AA-HA! Accelerated Action for the Health of Adolescents

AGYW Adolescent girls and young women

ASRH Adolescent sexual and reproductive health

ASRHR Adolescent sexual and reproductive health and rights

AU African Union Commission

AYP Adolescents and young people

CAQDAS Computer-Assisted Qualitative Data Analysis Software

CBO Community-based organization

CLSE Comprehensive Life Skills Education

CSE Comprehensive sexuality education

CSO Civil society organization

DLA Discovering Learning Alliance

EMIS Education Management Information System

ESA Eastern and Southern Africa

EUP Early and unintended pregnancy

FLE Family Life Education

FGD Focus group discussion

G&C LSE Guidance and Counselling Life Skills Education

GBV Gender-based violence

GES Ghana Education Service

GHS Ghana Health Service

ICPD International Conference on Population and Development

IDI In-depth interview

IRB Institutional Review Board

ITGSE International Technical Guidance on Sexuality Education

JHS Junior High School

KG Kindergarten

KI Key informant

KII Key informant interview

LGBTQI Lesbian, gay, bisexual, transgender, queer and intersex

LSE Life Skills Education

LWD Learner with disabilities

M&E Monitoring and evaluation

MoE Ministry of Education

© UNESCO

04

MoES Ministry of Education and Sport
MoET Ministry of Education and Training
MoGE Ministry of General Education
MoH Ministry of Health
NCDC National Curriculum Development Centre
NGO Non-governmental organization
O3 Our Rights, Our Lives, Our Future
OURS Organized Useful Rehabilitation Services
PCC Parent-child communication
PIASCY Presidential Initiative on AIDS Strategy for Communication to Youth
PTA Parent-teacher association
PWD People with disabilities
RHE Reproductive Health Education
SDG Sustainable Development Goal
SE Sexuality education
SHRP School Health and Reading Programme
SHS Senior high school
SMC School management committee
SGBV Sexual and gender-based violence
SHEP School Health Education Programme
SRGBV School-related gender-based violence
SRH Sexual and reproductive health
SRHR Sexual and reproductive health and rights
SSA Sub-Saharan Africa
STI Sexually transmitted infection
TLM Teaching and learning material
TTC Teacher training college
UNESCO United Nations Educational, Scientific and Cultural Organization
UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
USAID United States Agency for International Development
YONECO Youth Net and Counselling
YFHS Youth-friendly health service

© UNESCO

05

Acknowledgements

© UNESCO

Our most sincere gratitude goes to everyone who Uganda: Mr Mulindwa Ismael (Director for Basic and
contributed to the success of this project, from Secondary Education), Mr Ssemakula Henry (Guidance and
conceptualization, to design, implementation, Counselling, Ministry of Education and Sports), Ms Nanfuka
analysis, and reporting. Annete (National Curriculum Development Centre) and Dr
Dina Nakiganda (Assistant Commissioner for Adolescent and
We wish to thank the governments of Botswana, Eswatini, School Health, Ministry of Health).
Ghana, Malawi, Uganda, and Zambia, specifically the
Ministries of Education and the Ministries of Health for Zambia: Staff from the Directorates of Standards &
allowing the study team access to schools and health Curriculum, Directorate of Teacher Education & Specialized
facilities as part of the study fieldwork: Services the Comprehensive Sexuality Education
Coordinators, and the Provincial Education Standards Officer
Botswana: Ms Jane Gaongalelwe (National Life Skills for Eastern Province and the Examinations Council of Zambia.
and HIV and AIDS Officer), Ms Gobopaone Chabaditsile
(Principal Education Officer I), Mr S. Majawabe (Acting We would like to acknowledge the financial and technical
Director, Department of Curriculum & Development), Ms support provided by UNESCO Regional and Country Offices:
Neo Habangana (Director, Department of Special Support Dr Patricia Machawira (Regional Advisor, Education for
Services) and Mr Wonder Masebola (Director, Educational Health and Well-being), Dr Remmy Shawa (Regional Project
Planning, Research, Statistics, Monitoring & Evaluation). Officer), Ms Ygainnia Hamandawana (Regional Monitoring
and Evaluation Officer), Ms Ruvarashe Matambo (Programme
Eswatini: Ms Lindiwe Dlamini (Director of Educational Assistant), Mr Edwin Simelane (National Programme Officer,
Testing, Guidance and Psychological Services), Dr N.L. Eswatini), Dr Bethusile Mahlalela (National Programme
Dlamini (Director of Education) and Regional Public Matrons; Officer, Eswatini), Mr Martin Mosima (National Programme
Mr Stanfrey Khumalo (National Curriculum Centre), and Mr Officer, Botswana), Mr Urban Akagwire (National Programme
Sibusiso Masuku (Exams Council of Eswatini). Officer, Ghana), Ms Marietta Wildt (Associate National
Programme Officer, Malawi), Ms Naomi Mnthali (National
Ghana: Madam Esi Nkoom (Director, School Health Programme Officer, Malawi), Mr Draecabo Charles (National
Education Programme, Ghana Education Service) Programme Officer, Uganda), Mr Teddy Nabwire Chimulwa
(National Programme Officer, Uganda), Ms Alice Mwewa Saili
Malawi: Ms Chikondano Musa, Secretary for Education (National Senior Programme Officer, Zambia), Mr Remmy
Mukonka (Programme officer, In-school Implementation
06 and M&E, Zambia) and Mwilu Lenard Mumbi (National
Programme Officer, Zambia).

© UNESCO
© UNESCO

We extend our appreciation to the study participants Consultancy team
including head teachers, teachers, learners, learners with
disability, community leaders, parents and guardians, Dr Nyasha Madzingira: Regional team leader
community members, health service providers, and all the Dr Serai Daniel Rakgoasi: Botswana national expert
key informants identified in the six countries for availing of Dr Edmund Mazibuko: Eswatini national expert
their time to respond to survey questions and for helping Prof Kobina Esia-Donkoh: Ghana national expert
identify information-rich sources within communities and Dr Benjamin Kaneka: Malawi national expert
schools, as well as facilitating data collection. Dr Elizabeth Kemigisha: Uganda national expert
Dr Stellah Mungaila: Zambia national expert (posthumous)
We sincerely appreciate the input, comments, and guidance Tinashe Sande: Project manager
received from key stakeholders who participated in the Jacob Kandayi: Fieldwork coordinator
validation workshops for the study findings held in each of Deveria Mafuse: Fieldwork coordinator
the six countries. Munhamo Chisvo: Quality assurance support

We thank the research assistants who supported the national
experts in data collection, collation, and interpretation.
Without their commitment, sacrifice, and dedication,
conducting the study and completion within the time
frame would not have been possible. Last but not least,
we acknowledge Jimat Consultancy for managing the
assignment.

07

Executive summary

Introduction Methodology

In March 2020, the United Nations Educational, Scientific and This was a qualitative exploratory study of attitudes,
Cultural Organization UNESCO commissioned a qualitative perceptions, and experiences of learners, heads of schools,
study to assess the attitudes, perceptions, and experiences health workers, parents, community leaders, and national
of learners, including learners with disabilities (LWDs) and level education officials on CSE. Data was collected through
teachers on comprehensive sexuality education (CSE) in in-depth interviews (IDIs) with key informants (KIs); focus
Botswana, Eswatini, Ghana, Malawi, Uganda, and Zambia. group discussions (FGDs with learners and community
The study findings will be used to gain deeper insights into members; observation of CSE lesson delivery; documentation
the underlying reasons for the opinions around, motivations of most significant change stories; and a detailed review of
for, and barriers to CSE delivery, and in so doing contribute related documents.
to the evidence base on progress made towards the ESA
Commitment1 targets and the implementation of the A total of 33 schools (12 primary, 15 secondary, and six
Our Rights, Our Lives, Our Future (O3) programme. The O3 special needs schools for LWDs) across the six study countries
programme, implemented by UNESCO in 2018 in 33 sub- were purposively selected to represent urban, peri-urban,
Saharan African (SSA) countries, aims to address a number of and rural schools. These were either day and/or boarding
challenges faced by adolescents and young people (AYP) in schools, with a mix of types of school managing authority/
the Eastern and Southern African (ESA) region, including high governing bodies (government or mission-aided). The
HIV prevalence, early sexual debut, early and unintended research team conducted 196 IDIs with KIs (teachers, head
pregnancy (EUP), child marriage, dropping out of school, teachers, staff from government ministries, and other
gender-based violence (GBV), and limited access to sexual stakeholders) and 111 FGDs with learners, parents and
and reproductive health and rights (SRHR) services and guardians, including members of parent-teacher associations
information. The five-year programme supports delivery of (PTAs), and general community members. Each FGD
good quality CSE that empowers AYP and builds agency, comprised of 8-12 participants, reaching between 760 and
while developing the skills, knowledge, attitudes, and 1,140 discussants.
competencies required to mitigate these challenges.
All recorded interviews and discussions were transcribed,
Objectives translated from local languages into English, anonymized,
and finally analysed using thematic content analysis.
The objectives of the study were to: Interviews were grouped based on the themes emerging
around attitudes, perceptions, and experiences with regard
• Understand the attitudes, perceptions, and experiences to CSE, its delivery, barriers to implementation, and access
of learners, including LWDs, and teachers on CSE; to and utilization of sexual and reproductive health (SRH)
services among learners, including those with special
• Examine community members’ knowledge, attitudes, and education needs. In Botswana and Malawi, a Computer-
perceptions on CSE; Assisted Qualitative Data Analysis Software (CAQDAS)
package was used (Atlas Ti version 8), while in Uganda, the
• Identify the factors that affect or influence the delivery of NVivo qualitative data analysis computer software package
CSE; and was used for data management and analysis. The translated
transcripts of the audio recordings from the FGDs and IDIs
• Examine linkages, if any, between schools and health were entered into QACDAS for coding, annotating, and
facilities with regard to CSE. further analysis. The final interpretations were supported
by identified verbatim quotes to illustrate specific findings
1 The Eastern and Southern African Ministerial Commitment on Comprehensive within each particular theme. Data was then collated,
Sexuality Education and Sexual and Reproductive Health Services for Adolescents analysed, and triangulated to bring out the study findings.
and Young People, endorsed and affirmed by Ministers of Health and Education
from 21 countries in the region in 2013.

08

Limitations Key findings

COVID-19 lockdown and travel restrictions Terminology

Data collection occurred during the COVID-19 lockdown While CSE is now a globally recognized term, the terminology
period and school closures. This could have led to a selection or name used by each country varies, as shown across the six
bias of study participants due to limited mobility as part of study countries. In Zambia the term CSE is used, whereas in
the COVID-19 prevention measures. To address movement Malawi, it is Life Skills Education (LSE). In Botswana, LSE is also
restrictions, some teams had to obtain travel permits to used and forms part of the Guidance and Counselling (G&C)
access schools, while teachers supported the research teams programme. Similarly, in Eswatini, it is referred to as G&C
with mobilization of learners and community members to LSE, or Inqaba. Ghana uses the term Reproductive Health
participate in FGDs. Some schools in Botswana requested Education (RHE) and in Uganda, it is referred to as Sexuality
that the interviews be conducted virtually, and this was Education (SE)
adhered to.
Knowledge of CSE
Delays in ethical clearance
The study findings showed that community leaders,
Study timelines were affected by delays associated with community members, and parents were knowledgeable
access to approval letters from the Ministries of Education about CSE, but while most knew it was taught in schools, the
(MoEs) and the national Institutional Review Boards (IRBs), level of awareness around the content and its benefits varied.
especially in Ghana. For instance, it was high in Botswana, Eswatini, Ghana, and
Uganda, but less so in Malawi and Zambia.
Lack of diversity among LWDs
Attitudes and perceptions towards CSE
The selected schools had learners with only one form of
disability – in Uganda, the learners had physical disabilities Overall, the findings show that CSE is perceived positively,
but were able to communicate easily with researchers; in particularly among learners, teachers, head teachers, and
Eswatini, the learners were hearing impaired; and in Zambia, MoE officials. Community leaders, community members, and
they were visually impaired. This could have affected the parents also exhibited positive attitudes and perceptions
nature and diversity of issues affecting LWDs. towards its delivery in schools, anchored in cultural
and religious beliefs, norms, and values. Learners, both
Poor network connectivity with and without special education needs, were able to
articulate several benefits associated with receiving CSE
In some cases, researchers experienced poor network and its relevance. The study respondents indicated that CSE
connectivity that rendered sections of some interviews prepares learners to confront the changes (both physical
inaudible. In such instances, either a second attempt and psychological) that come about as they transition from
was made, often using other means such as a telephone childhood to adulthood. CSE was perceived as a gateway to
interview, or a research assistant was dispatched to conduct attaining life goals through avoiding negative outcomes of
interviews in person. SRH risks, such as early sexual debut, Early and Unintended
Pregnancy (EUP), HIV and other STIs, drug and substance
Despite these challenges, the team managed to complete abuse, and GBV. Nevertheless, some parents, community
the field data collection successfully. leaders, and religious leaders did express opposition and
resistance towards the teaching of CSE, with areas of concern
pertaining to the appropriate age to start learning about
CSE, the methods of delivery, and appropriateness of content
taking into consideration cultural and religious contexts.

09

In addition, there were perceptions from some teachers and Linkages with SRH services
community members that discussions around condom use
or pregnancy prevention would promote engagement by The study found that, generally, learners do access SRH
learners in sexual practices. services in their communities. Female learners tend to access
the services more than male learners, with the most sought
Practices and experiences services including HIV testing, STI screening and treatment,
pregnancy testing, provision of contraceptives (including
The study found that the effectiveness of CSE delivery condoms), circumcision for boys, and SRH information. The
depended on many factors, including the policy study also established, however, that while school-health
environment, the quality of training for teachers providing facility linkages do exist, they are not strong, dynamic, or
CSE, orientation of head teachers, the availability of sustained.
instructional materials in terms of textbooks (including
those for LWDs), time available for instruction, and family Linkages with heath facilities were through learners being
involvement and community participation in matters referred from school, designated health worker visits to
related to CSE. Overall, however, all the countries have schools, health worker visits/invites from the schools,
an enabling policy environment with various policies, health providers’ community outreach, and established
strategies, frameworks, and guidelines in place that facilitate youth-friendly corners. Several barriers were identified that
the implementation of CSE, including those addressing hindered access of SRH services, even when referrals were
adolescent SRH (ASRH), life skills-based CSE, out-of-school made, including long distances between the school and a
CSE, ending child marriage, youth-friendly health services, health facility, negative attitudes of health providers towards
teenage pregnancy and re-entry to school, and violence learners, health workers having busy schedules, lack of
prevention and response. Nevertheless, some policy gaps sufficient adolescent health information materials, health
were identified in specific countries, such as Botswana, providers not trained in providing services to young people,
Eswatini, and Uganda. stock-out of commodities, and cultural and religious factors.
Additional barriers for LWDs were limited communication,
Furthermore, the study confirmed that the CSE curricula in lack of privacy and confidentiality, and lack of access
the study countries are based on UNESCO’s International compounded by the physical structures of health facilities
Technical Guidance on Sexuality Education (ITGSE), an which made it difficult for LWDs using wheelchairs to
international benchmark on sexuality education. At the same manoeuvre because there were no ramps.
time, several challenges that affect the effective delivery of
CSE were identified, including the lack of CSE monitoring, Recommendations
inadequate resources (including teaching aids and learning
support materials), insufficient number of trained teachers on Develop/review and align policies to facilitate
CSE and inadequate teacher capacity to deliver CSE, limited effective and efficient delivery of CSE
supervision, and insufficient time allocated for the teaching
of CSE. Moreover, the study established that while there are Countries need to continue reviewing and aligning policies,
barriers to CSE delivery for learners generally, LWDs tend particularly in Botswana, Eswatini, and Uganda. Specifically:
to face relatively more severe and more limiting barriers,
especially in terms of teaching services and a conducive • The School Health Policy, which is the overarching
learning environment. For instance, a specialized CSE policy for delivery of CSE and SRH services, needs to be
teacher may lack the skills to cater for needs of learners with approved in both Botswana and Uganda.
visual, hearing, or learning disabilities in the same setting.
Furthermore, there were concerns about inadequate user- • The Ministry of Health (MoH) in Eswatini needs to finalize
friendly teaching and learning materials, such as textbooks the STI guidelines so that there is a proper link between
in braille. Religious and cultural beliefs were also noted as a learners and health workers.
barrier to CSE delivery.
• Guidelines for implementation of the national sexuality
education framework in Uganda needs to be developed
by the Ministry of Education and Sports (MoES).

10

Increase government support to facilitate the Strengthen parent-child communication (PCC)
effective implementation of CSE programmes through community engagement

Because most SRH/CSE initiatives rely on donor funds, it MoEs, MoHs, and other relevant line ministries need to
is important that governments in the six study countries come up with creative and innovative ways to engage
increase their commitment to allocating necessary resources with and capacitate parents and community structures,
(financial, human, infrastructure) to improve delivery of CSE. such as community development organizations, PTAs, and
community, civic, and religious leadership to reinforce CSE
Scale-up pre-service training on CSE and messages that learners receive in school. This should include
increase teachers’ capacity to deliver CSE addressing misconceptions and prejudices around the SRH
through regular in-service training needs of learners, including LWDs. Means of reaching out
to parents and community structures can be done through
Pre-service training of teachers on CSE in teacher training community dialogues, interface meetings, and use of mass
colleges (TTCs) ensures that all teachers have prior exposure media outlets.
to CSE before they are deployed. As such, an audit of the
pre-service teacher training curriculum is required to check Develop clear strategies to strengthen school
the extent to which it provides teachers with the skills and and health facility linkages
capacity to deliver CSE to all learners, including LWDs, with
emphasis on value clarification and techniques in delivering MoEs and MoHs need to develop clear strategies to
CSE comfortability, confidence-building, and class control. strengthen linkages between schools and health facilities to
Furthermore, there needs to be regular re-orientation and meet the SRHR needs among AYP at community level, the
refresher courses for in-service teachers on delivery of CSE. majority of which are learners.

Develop, print, and distribute adequate Strengthen collaboration and coordination
teaching and learning materials for TTCs, through a multisectoral and multi-pronged
teachers, and learners complementary approach to CSE delivery

MoEs, UNESCO, and other partners need to develop Given its complex nature, there is a need for multi- and
adequate teaching and learning materials – including inter-sectoral collaboration at all levels (national, provincial/
textbooks, guides, teaching aids, charts, and other regional, district, and community) for effective CSE
supplementary audio-visual materials – for TTCs, teachers, implementation.
and learners. In addition, these materials should be
converted into braille to meet the needs of learners with Document best practices and experiences for
visual impairment. The use of complementary audio-visual sharing, learning, and replication
materials should be considered to strengthen CSE delivery.
Countries implementing CSE need to document experiences,
Strengthen the monitoring of both the delivery lessons learnt, and best practices for sharing and learning
of CSE and associated learning outcomes from each other. Documented information can be
disseminated through multiple platforms (social media,
Data collection tools need to be user-friendly and easy to conference fora) and channels (print and electronic).
feed into the Education Management Information System
(EMIS) and other related management information systems.

11

12 © UNESCO

1. Introduction

In March 2020, the United Nations Educational, These may be difficult to attain, as AYP in the ESA region
Scientific and Cultural Organization UNESCO face a number of challenges that include poverty, high HIV
commissioned a qualitative study to assess the prevalence, economic hardships, early sexual debut, early
attitudes, perceptions, and experiences of learners, and unintended pregnancy (EUP), child marriage, dropping
including learners with disabilities (LWDs) and out of school, gender-based violence (GBV), and limited
teachers on comprehensive sexuality education access to sexual and reproductive health and rights (SRHR)
(CSE) in Botswana, Eswatini, Ghana, Malawi, services and information.
Uganda, and Zambia.
HIV prevalence among AYP is rising faster than that for
1.1 Background and context the general population. In Malawi, HIV prevalence among
adolescents (15-19 years) stands at 3.3% among girls and
The 23 countries in the Eastern and Southern African (ESA) 2.1% among boys.6 Similarly, in Eswatini, AYP aged between
region have an estimated total population of 600 million 15-24 years account for approximately 40% of new HIV
people. On the basis of an annual population growth rate infections,7 while HIV prevalence among 15-19-year age
of 2.58%, this means that the population will reach 1.1 group in Uganda was 1.1% (0.5% for boys and 1.8% for girls)
billion by 2050, representing 47% of Africa’s population.2 The and is four times higher in females aged 15-24 years.8 In
population is projected to reach 1.5 billion by 2080. Zambia, 3.3% of adolescent girls (15-19 years) and 1.6% of
adolescent boys (15-19 years) are living with HIV.9
As the demographic transition advances, one key social
concern is the fast-growing relative number of children. Birth Moreover, many AYP undergo early sexual debut, in some
trends indicate that there were about 12 million new babies cases leading to EUP and/or child marriages. Evidence
in ESA in 2000, but as of 20203, this number increased by suggests that adolescent pregnancy and subsequent
an additional 5 million babies each year – reaching close to childbearing are driven by early entry into sex, first birth, and
17 million – and will surpass 22 million in the 2040s. At the little or no contraceptive use.10 Early childbearing is often
same time, the number of children aged 0-4 years in ESA will associated with a young woman’s failure to complete her
increase by more than 30 million between 2020 and 2050, education, thus limiting her future job prospects and her
totalling 32 million for the cohort of 5-9 years (mainly primary own and her child’s economic well-being.
school age) and more than 34 million for 10-14 years (mainly
lower secondary school age). Evidence from surveys indicated that in Malawi, one in
eight adolescent girls have engaged in sex before the age
Adolescents and young people (AYP) aged 10-24 years of 15 years and 29% of girls aged 15-19 years had begun
were estimated at 160.2 million in the 23 countries of the childbearing, with 22% having had a pregnancy and 7%
ESA region in 2013, representing nearly 33% of the total being pregnant with their first child.11 In Eswatini, the
population. This number is expected to reach 282.2 million percentage of young people who engage in sex before the
by the year 2050.4 This means that the region has and age of 15 is 3% for girls and 2.8% for boys, rising to 48% for
will continue to have a significant number of dependent females and 34% for males by age 18.12 Similarly, in Uganda,
AYP requiring access to education, health care, social 11% of boys and 18% of girls 15-19 years reported to have
services, and the development of marketable skills for the begun sexual activity below the age of 15 years.13
foreseeable future. In order for the region to benefit from the
demographic dividend of this potentially large labour pool, 6 National Statistical Office (NSO) & ICF Macro. (2016). 2015-16 Malawi Demographic
investments are needed to ensure that young people are and Health Survey Report. Calverton, Maryland, USA: NSO and ICF Macro.
healthy, well-educated, and highly skilled, and have decent
jobs.5 7 Government of Eswatini. 2019. Eswatini National HIV Prevention Policy.
8 Uganda Population-based HIV Impact Assessment (UPHIA 2016- 2017).
2 World Bank Population Data for 2019, but the population data for Eritrea is for 2011. 9 Zambia Demographic and Health Survey (ZDHS) 2018 Key Indicators; Zambia
3 UNICEF, 2019. Population Dynamics and the Demographic Dividend Potential of
Demographic and Health Survey (ZDHS). 2014; Child Poverty Study 2018; 2017
Eastern and Southern Africa: A Primer November 2019. WHO/UNICEF Joint Monitoring Programme (JMP); PISA 2018.
4 World Bank Population Data for 2019, but the population data for Eritrea is for 2011. 10 Ibid.
5 AFIDEP and UNFPA. 2015. Synthesis Report on the Demographic Dividend in Africa. 11 National Statistical Office (NSO) & ICF Macro. (2016). 2015-16 Malawi Demographic
and Health Survey Report. Calverton, Maryland, USA: NSO and ICF Macro.
12 Swaziland Multi Indicator Cluster Survey 2014.
13 Uganda Bureau of Statistics (UBOS) and ICF. 2018. Uganda Demographic and
Health Survey 2016. Kampala, Uganda and Rockville, Maryland, USA: UBOS and ICF.

13

In 2017, 14% of adolescent women age 15-19 in Ghana This partly explains the high incidence of teenage pregnancy
had begun childbearing but only about 24% of teenagers and motherhood, child marriage, unsafe abortion, and STIs.
in the same age category ever used modern methods of Likewise in Malawi, it is estimated that only 13% of young
contraception.14 The scenario is the same in Zambia, where people access youth-friendly health services (YFHS),23 with
29% of girls aged 15-19 years have begun childbearing, 24% AGYW having the highest unmet need for contraception
had a live birth, and 5% were pregnant with their first child among sexually active women of reproductive age at an
at the time of the interview.15 In Uganda, teenage pregnancy estimated 22%.24 In Uganda, teenage pregnancy rates are
contributes to 17.8% of maternal mortality, attributed to high, correlating with low contraceptive uptake among
pregnancy complications and unsafe abortions.16 AYP aged 15-19 years (10% among the married and 42%
among the unmarried but sexually active)25. In Zambia,
As a result of early pregnancy and child marriage, the school AYP’s unmet need for contraception stands at 25.1%, with
drop-out rate of adolescent girls is high. In Zambia, 44% only 18% of sexually active unmarried girls and 36% of
of girls dropped out of school by Grade 12, mainly due to married girls between the ages of 15-19 years using modern
pregnancy and child marriage,17 while in Eswatini, about 80% contraceptives.26 Of note, existing policies around the age of
of girls aged 15-22 years who were out-of-school were said consent are said to contribute to those under 16 years being
to be sexually active, compared to 30% girls of the same age unable to access and use condoms even if they are sexually
who were in school,18 although the Ministry of Education active.27
and Training (MoET) reported an increase in the number of
cases of EUPs among school-going teenage girls during the People with disabilities (PWDs) often have challenges
COVID-19 lockdown.19 accessing information and services related to SRHR as well.
Indeed, a study by Abimanyi-Ochom et al. (2017) revealed
In addition, millions of adolescent girls and young women that PWDs were more likely to have earlier sexual debut,
(AGYW) in the region are burdened by GBV, discrimination, higher rates of STIs, and were less likely to return to the
and inequality. They are subject to multiple forms of health centre to collect their HIV test results compared to
violence, abuse, and exploitation, as well as harmful cultural their peers without disabilities.28 Research findings indicate
practices that precipitate early sexual debut and child that access to SRH services among AYP with disabilities is
marriage. AGYW are also exposed to initiation rites that hindered by non-accessible physical infrastructure, lack
expose them to sexual abuse, which in turn increases their of suitable and affordable transportation, communication
risk of HIV infection. For example, in Malawi, 65% of school barriers, negative attitudes of service providers, lack of
girls reported experiencing some form of abuse and 24% confidentiality, distant health facilities, long waiting times
reported experiencing some form of sexual violence.20 at health facilities, high costs of services, mistreatment, and
Similarly, a study conducted by the United Nations Children’s an overall inadequacy of service delivery.29, 30 This is further
Fund (UNICEF) in 2017 on violence against children and compounded by cultural norms and the perception from
young women in Eswatini found that GBV was on the able-bodied people that people with physical disabilities
increase, with one in every three women experiencing should be asexual.31, 32
sexual violence by the time they are 18 years and 4.6% of
married women aged 15-49 years reporting intimate partner 23 National Statistical Office (NSO) & ICF Macro. (2016). 2015-16 Malawi Demographic
violence.21 and Health Survey Report. Calverton, Maryland, USA: NSO and ICF Macro.

The challenges faced by AYP are exacerbated by limited 24 Ibid.
access to SRHR services and information. The Ghana 25 Uganda Bureau of Statistics (UBOS) and ICF. 2018. Uganda Demographic and Health
Demographic and Health Survey (GDHS) 2014 reported that
almost 51% of all adolescent females aged 15-19 years had Survey 2016. Kampala, Uganda and Rockville, Maryland, USA: UBOS and ICF.
an unmet need for family planning.22 26 Zambia Demographic and Health Survey, 2018/CSO 2019.
27 NAC/UNAIDS (2017). Zambia National HIV Prevention Coalition Roadmap: Results of
14 Ibid.
15 Zambia DHS, 2018. the stocktaking exercise.
16 Uganda Bureau of Statistics (UBOS) and ICF. 2018. Uganda Demographic and Health 28 Abimanyi-Ochom, Julie, et al. “HIV/AIDS Knowledge, Attitudes and Behaviour of

Survey 2016. Kampala, Uganda and Rockville, Maryland, USA: UBOS and ICF. Persons with and without Disabilities from the Uganda Demographic and Health
17 Statistical Bulletin 2018. Survey 2011: Differential access to HIV/AIDS information and services.” Plos One 12.4
18 Sitakhela Likusasa impact evaluation, revised 05/05/21. (2017).
19 Ministry of Education and Training Press Statement, 2021. 29 Kumi-Kyereme, Akwasi, Abdul-Aziz Seidu, and Eugene Kofuor Maafo Darteh. “Factors
20 Government of Malawi (2013) Violence against children and young women in contributing to challenges in accessing sexual and reproductive health services
among young people with disabilities in Ghana.” Global Social Welfare (2020): 1-10.
Malawi: Findings from a National Survey, Ministry of Gender and Social Welfare. 30 Mesiäislehto, Virpi, Hisayo Katsui, and Richard Sambaiga. “Disparities in accessing
21 UNICEF (2017). A study on violence against children and young women. sexual and reproductive health services at the intersection of disability and female
22 Amo-Adjei, Joshua, and Eugene KM Darteh. “Unmet/met need for contraception adolescence in Tanzania.” International Journal of Environmental Research and
Public Health 18, no. 4 (2021): 1657.
and self-reported abortion in Ghana.” Sexual & Reproductive Healthcare 13 (2017): 31 Ahumuza, S. E., Matovu, J. K., Ddamulira, J. B., & Muhanguzi, F. K. (2014). Challenges
118-124. in Accessing Sexual and Reproductive Health Services by People with Physical
Disabilities in Kampala, Uganda. Reproductive Health, 11(1), 59.
32 Roden, Rosemary Claire, Elizabeth Koss Schmidt, and Cynthia Holland-Hall.
“Sexual health education for adolescents and young adults with intellectual
and developmental disabilities: recommendations for accessible sexual and
reproductive health information.” The Lancet Child & Adolescent Health 4, no. 9
(2020): 699-708.

14

1.2 The ESA Commitment The five-year programme, which commenced in 2018,
supports delivery of good quality CSE that empowers AYP
In 2013, in response to the challenges detailed above, and builds agency, while developing the skills, knowledge,
ministers of education and health from 21 ESA countries33 attitudes, and competencies required for preventing HIV,
endorsed and affirmed the Eastern and Southern African reducing EUPs, and eliminating GBV. The O3 programme
Ministerial Commitment on Comprehensive Sexuality builds on current efforts by UNESCO to improve SRH,
Education and Sexual and Reproductive Health Services gender, and education outcomes for AYP, and has four
for Adolescents and Young People, now known as the ESA main objectives designed to contribute to the effective
Commitment. Central to the ESA Commitment was the strengthening of sexuality education programmes:
agreement to scale-up CSE and access to SRH services for
AYP. Indeed, a recent evaluation of the Commitment34 noted • Secure and sustain strong political commitment and
that it influenced the development of national adolescent support for AYP’s access to CSE and SRH services across
sexual and reproductive health and rights (ASRHR) policies, SSA.
strategies, and plans over the period, demonstrating its
relevance in advancing SRHR for AYP in the region. For • Support the delivery of accurate, rights-based, and
example, 17 out of 21 countries reported having a CSE good quality CSE programmes that provide knowledge,
strategy/framework for out-of-school AYP at the end of 2018. values, and skills essential for safer behaviours, reduced
By creating this type of enabling environment for service adolescent pregnancy, and gender equality.
delivery, governments in the region were able to collectively
influence a 4% increase in young people’s knowledge levels • Ensure that schools and community environments are
on preventing sexual transmission of HIV and rejecting major safer, healthier, and inclusive for all young people.
misconceptions about HIV prevention. Furthermore, aided
by progress in provision of YFHS and CSE, the region saw a • Strengthen the evidence base on CSE and safer school
decrease in new HIV infections by 108,708 between 2013 and environments.
2019. However, countries encountered similar challenges
with inadequate domestic funding and sensitivity around 1.4 Defining CSE
certain topics like sexuality education and the age of consent
for adolescents to be allowed to access SRH services. One of the interventions to improve SRH outcomes
among young people is through the provision of school-
The Commitment also contributed to achieving gender based sexuality education. Three variants of sexuality
equality by influencing the prioritization of policy changes education have been used in the region: abstinence only,
and support to end child, early and forced marriage, abstinence plus, and CSE. Abstinence only takes the most
school-related gender-based violence (SRGBV), and EUP. conservative approach, promoting sexual abstinence for
This included the introduction of programmes to prevent youth before marriage to reduce risk for pregnancy and/
and mitigate against child marriage in 16 countries, the or STIs. Abstinence plus programmes promote abstinence
introduction of education sector policies to address SRGBV as the main strategy for sexual risk reduction, but also
in 18 countries, and the implementation of national policies/ offer information on modern prevention methods against
strategies on pregnant learners in 16 countries by 2018.35 pregnancy and STI. However, both these approaches have
proven to be ineffective in reducing adolescent SRH risk
1.3 Our Rights, Our Lives, Our behaviours.
Future (O3) programme
As such, the International Technical Guidance on Sexuality
UNESCO is currently implementing the Our Rights, Our Lives, Education (ITGSE), first published in 2009 and revised in
Our Future (O3) programme across 33 countries in sub- 2018, was developed to assist education, health, and other
Saharan Africa (SSA). relevant authorities in the development and implementation
of school-based and out-of-school CSE programmes
33 Angola, Botswana, Burundi, Democratic Republic of Congo (DRC), Eswatini, and materials. The guidance emphasizes the need for
Ethiopia, Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, programmes that are informed by evidence, adapted to the
Rwanda, Seychelles, South Africa, South Sudan, Tanzania, Uganda, Zambia, and local context, and logically designed to measure and address
Zimbabwe. factors such as beliefs, values, attitudes, and skills which, in
turn, may affect health and well-being about sexuality.36
34 Evaluation of the ESA Ministerial Commitment on Comprehensive Sexuality
Education and SRH services for Adolescents and Young People – Evaluation Report 36 https://www.unaids.org/sites/default/files/media_asset/ITGSE_en.pdf.
2013-2020. This evaluation was conducted by the Swiss Tropical and Public Health
institute, on behalf of the ESA Commitment Partners.

35 Ibid

15

The ITGSE defines CSE as a curriculum-based process of Recent evidence from 22 systematic reviews and 77
teaching and learning about the cognitive, emotional, randomized controlled trials on CSE reaffirms what has been
physical, and social aspects of sexuality. It aims to equip established by previous researchers, that is, that CSE can lead
children and young people with knowledge, skills, attitudes, to improved SRH outcomes among adolescents, including
and values that will empower them to: (i) realize their health, delayed sexual debut, decreased frequency of sex, reduced
well-being and dignity; (ii) develop respectful social and number of sexual partners, decreased sexual risk taking, and
sexual relationships; (iii) consider how their choices affect their increased use of condoms and contraceptives.39 The review
own well-being and that of others; and (iv) understand and also demonstrated that there are other potential benefits
ensure the protection of their rights throughout their lives.37 of CSE programmes beyond health outcomes. These could
include preventing intimate and gender-based violence,
The ITGSE is a voluntary, evidence-informed guidance that increasing gender equitable norms, increasing self-efficacy
is designed to support countries to develop and implement and confidence, as well as building stronger and healthier
effective sexuality education programmes that are adapted relationships.38
to their national contexts. It promotes structured learning
about sex and relationships in a manner that is positive, 1.5 Global, regional, and national
affirming, and centred on the best interests of the young policy environment
person. By outlining the essential components of effective
sexuality education programmes, the ITGSE enables national At global level, the International Conference on Population
authorities to design comprehensive curricula that will have and Development (ICPD) 1994, affirmed that SRHR
a positive impact on young people’s health and well-being. are human rights.40 Following this affirmation, several
international instruments contributed to a global consensus
CSE is education delivered in formal and non-formal settings on how reproductive health rights are intrinsically linked
that is38: to other fundamental human rights. The Sustainable
Development Goals (SDGs) built on the progress made
• Scientifically accurate: the content of CSE is based under the ICPD with specific SDGs that promote adolescent
on facts and evidence related to SRH, sexuality and SRH, including Goal 3, target 7, which emphasizes universal
behaviours; access to SRH, family planning information and education,
and integration of reproductive health into national
• Incremental: CSE is a continuing educational process programmes, and Goal 5 on gender equity, targets 3 and
that starts at an early age, and where new information 6, which call for the elimination of harmful practices such
builds upon previous learning, using a spiral-curriculum as early or forced marriage and female genital mutilation,
approach; as well as universal access to SRH. Furthermore, Goal 4.1 on
equitable access to quality education aims to “ensure that
• Age- and developmentally-appropriate: the content of all girls and boys complete free, equitable quality primary
CSE is responsive to the changing needs and capabilities and secondary education leading to relevant and effective
of the child and the young person as they grow; learning outcomes”, while Goal 4.7 aims to “ensure that all
learners acquire the knowledge and skills needed to promote
• Curriculum based: CSE is included within a written sustainable development, including, among others, through
curriculum that guides educators’ efforts to support education for sustainable development and sustainable
students’ learning; lifestyles, human rights, gender equality, promotion of a
culture of peace and non-violence, global citizenship and
• Comprehensive: CSE provides opportunities to acquire appreciation of cultural diversity and of culture’s contribution
comprehensive, accurate, evidence-informed, and age- to sustainable development.”41
appropriate information on sexuality;
39 Montgomery, P. K., Wendy (2018). Review of the Evidence on Sexuality Education.
• Based on a human rights approach: CSE builds on and http://unesdoc.unesco.org/images/0026/002646/264649E.pdf.
promotes an understanding of universal human rights –
including the rights of children and young people – and 40 UNFPA. 2019. Accelerating the Promise: The Report on the Nairobi Summit on
the rights of all persons to health, education, information, ICPD25.
equality, and non-discrimination.
41 UNESCO (2017). Metadata for the global and thematic indicators for the
• Based on gender equality; follow-up and review of SDG 4 and Education 2030. http://gaml.uis.unesco.org/
• Culturally relevant and context appropriate; wp-content/uploads/sites/2/2018/10/metadata-global-thematic-indicators-sdg4-
• Transformative: CSE contributes to the formation education2030-2017-en_1.pdf.

of a fair and compassionate society by empowering
individuals and communities, promoting critical thinking
skills, and strengthening young people’s citizenship; and
• Develops life skills needed to support healthy
choices.

37 UNESCO. 2018. International Technical Guidance on Sexuality Education - An
Evidence-informed Approach.

38 Ibid.

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© UNESCO

Other related international guidance includes the Global AU Maputo Plan of Action 2016-2030,49 whose goal is to
Strategy for Women’s, Children’s and Adolescents’ Health end preventable maternal, new-born, child and adolescent
(2016-2030) that recognizes the need to end preventable deaths by expanding contraceptive use, reducing levels of
deaths, ensure health and well-being, and expand enabling unsafe abortion, ending child marriage, eradicating harmful
environments for women, children and – for the first time – traditional practices including female genital mutilation and
adolescents.42 Additional commitments are the World Health eliminating all forms of violence and discrimination against
Organization’s (WHO’s) Global Accelerated Action for the women and girls, and ensuring access to SRH for AYP by
Health of Adolescents (AA-HA!) developed in 2017 to provide 2030 in all countries in Africa. Further, the AU Decade for
guidance to support country implementation of strategies to Education of People with Disabilities 2010-201950 aimed to
improve adolescent health43; the Convention on the Rights ensure the full enjoyment by children with disabilities of all
of Persons with Disabilities (2006)44; the Convention on the human rights and fundamental freedoms on an equal basis
Rights of the Child (1989)45; and the Convention on the with other children; and the African Charter on the Rights
Elimination of All Forms of Discrimination Against Women and Welfare of the Child (1990)51 has 31 Articles on the rights
(1979).46 and welfare of the child, including the right to be heard,
to education, to birth registration, and to develop his/her
There are also a number of diverse commitments, strategies, personality, talents, mental, and physical abilities to the fullest
and policies at regional level to promote adolescent SRH, potential.
including the African Union (AU) Commission Agenda
2063,47 which highlights the need for advocacy for service At national level, the six countries in the study are signatories
providers to take on board child health and rights and to the global and regional commitments and conventions
provision of comprehensive services throughout the discussed above and have domesticated these. An
lifecycle; the AU Campaign to End Child Marriage in Africa: assessment of the national policy environment (refer to
Call to Action 2013,48 calling on governments to end the Annex 2) shows that various acts are in place, including the
harmful practice of child, early and forced marriage; the constitution and Education, Children and Penal Code, as well
as policies and strategies that cover SRHR, youth, gender,
42 https://www.who.int/life-course/partners/global-strategy/ YFHS, ending child marriages, prohibition of female genital
globalstrategyreport2016-2030-lowres.pdf. mutilation, CSE frameworks, HIV and AIDS mainstreaming,
and guidelines for teenage pregnancy and re-entry to school.
43 Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to
support country implementation. Geneva: World Health Organization; 2017. 49 African Union Commission. 2016. Maputo Plan of Action 2016-2030 Universal
Licence: CC BY-NC-SA 3.0 IGO. Access to Comprehensive Sexual and Reproductive Health Services in Africa.

44 UN. 2006. Convention on the Rights of Persons with Disabilities and Optional 50 African Union Commission. Continental Plan of Action for the African Decade of
Protocol. Persons with Disabilities 2010-2019.

45 United Nations. 1989. Convention on the Rights of the Child Adopted and opened 51 African Union Commission. 1990. The African Charter on the Rights and Welfare of
for signature, ratification and accession by General Assembly resolution 44/25 of 20 the Child.
Nov 1989 entry into force 2 September 1990, in accordance with article 49.

46 CEDAW 29th Session 30 June to 25 July 2003.
47 African Union Commission. 2015. Agenda 2063: The Africa We Want.
48 African Union Commission. 2013. Campaign to End Child Marriage in Africa: Call To

Action 2013.

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2. Purpose and
objectives of the
study

The study was commissioned by UNESCO and was
conducted across six countries, namely Botswana,
Eswatini, Ghana, Malawi, Uganda, and Zambia.

The study sought to gain deeper insights into the underlying
reasons for the opinions around, motivations for, and barriers
to CSE delivery. This will in turn contribute to the evidence
base on progress made towards the ESA Commitment
targets and the implementation of the O3 programme.
The objectives of the study were to:
1. Understand the attitudes, perceptions, and experiences

of learners, including LWDs, and teachers on CSE;
2. Examine community members’ knowledge, attitudes, and

perceptions on CSE;
3. Identify the factors that affect or influence the delivery of

CSE; and
4. Examine linkages, if any, between schools and health

facilities with regard to CSE.

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20 © UNESCO

3. Methodological approach

This was a qualitative exploratory study of The sampling strategies for schools and learners comprised
attitudes, perceptions, and experiences of of a number of considerations, including:
learners, heads of schools, health workers, parents,
community leaders, and national level education · Schools implementing CSE/LSE curricula, including
officials on CSE. special schools for LWDs;

Data was collected through in-depth interviews (IDIs) with · Representation of rural, urban, peri-urban, primary, and
key informants (KIs); focus group discussions (FGDs) with secondary schools;
learners and community members; observation of CSE lesson
delivery; documentation of most significant change stories; · Type of school managing authority/governing body (for
and a detailed review of related documents. These methods example, government or mission-aided);
were selected to enable the collection of primary and
secondary data with sufficient depth and breadth to answer · Learners who have been or are being taught CSE,
the broad questions of the study and achieve its objectives. including LWDs; and
The methods allowed for a thorough triangulation of data in
order to produce a verifiable body of evidence. · Sample school community members, such as parents/
guardians, community leaders, and parent-teacher
3.1 Study sample groups.

The population studied was drawn from 33 schools across Using a multi-stage cluster sampling strategy, 33 schools
the six countries. The primary target of the sampling frame (12 primary, 15 secondary, and six special needs schools for
consisted of the Ministry of Education (MoE) officials, head LWDs) were thus purposively selected across the six study
teachers, teachers, learners (including LWDs), members of countries. The schools represented urban, peri-urban, and
parent-teacher associations (PTAs) and school management rural schools, and were either day and/or boarding schools,
committees (SMCs), parents/guardians living near the with a mix of types of school managing authority/governing
identified schools and community leaders. To assess learners’ bodies (refer to Annex 3).
access to sexual and reproductive health (SRH) services, as
well as linkages between the schools and health facilities, 3.2 Data collection methods
the personnel in charge of the nearest health facilities to the
selected schools were interviewed. 3.2.1 Document review

Table 1: Number of key informants The literature review gave the team background information
on CSE in the six countries and guided the development
of tools that were used for primary data collection. The
documents reviewed included both published and non-
published national and global publications and national laws,
policies, and strategies pertaining to CSE (refer to References).

District Education Head teachers Teachers Health Community Total
officials workers leaders
Botswana 5 9 14 6 12 46
Eswatini 4 5 11 4 1 25
Ghana 5 5 10 5 10 35
Malawi 1 15 12 3 8 39
Uganda 8 53 652 553 27
Zambia 5 55 5 4 24
Total 23 54 45 24 30 196

52 The number includes FGDs held with child protection staff, including social workers and police.
53 Includes three members of the PTA.

21

3.2.2 Key informant interviews (KIIs) 3.2.3 Focus group discussions

A total of 196 IDIs were conducted with KIs who could share A total of 111 FGDs were conducted with learners, LWDs,
some insightful knowledge about CSE and its delivery, parents (PTA members), and general community members
including heads of sampled primary and secondary schools, to gather qualitative information on knowledge, attitudes,
education officials at national level, health workers at and perceptions on issues surrounding CSE teaching and
community health service provision level, and community learning. Each FGD comprised of 8-12 participants, reaching
leaders participated (Table 1). between 760 and 1,140 discussants. Table 2 presents the
distribution of FGDs for the population sub-groups.

Table 2: Distribution of FGDs

District Learners (mixed) LWDs Parents PTAs Teachers Total
Botswana 10 2 5 - - 17
Eswatini 4 4 2 1 1 12
Ghana 4 1 4 4 - 13
Malawi 16 1 8 - - 25
Uganda 12 1 6 2 3 24
Zambia 9 1 5 - 5 20
Total 55 9 29 6 9 111

3.3 Data collection, processing, There was extensive time to practice interview guides
and analysis among data collectors through role-play. The training was
conducted in accordance with COVID-19 health and safety
3.3.1 Ethical clearance protocols, including include social distancing, wearing
a mask, and regular hand sanitation. As the COVID-19
All countries received clearance from their MoEs and ethical epidermic continued to take hold, some of the training
clearance from the following Institutional Review Boards sessions had to be held virtually to minimize risk to the
(IRBs): team, for example, in Eswatini. Field data collection was
phased, from May 2020 to August 2021, due to delays in
· Botswana: Ministry of Basic Education and Ministry of receiving ethical clearance and the COVID-19 situation in the
Health Research Ethics Committee respective countries.

· Eswatini: MoET The research teams liaised with leadership of schools to
· Ghana: University of Cape Coast gain access to learners and teachers. In all schools, the
· Malawi: MoE team worked with teachers, who organized learners and
· Uganda: Mbarara University Research Ethics Committee staff interviews. The schools were also instrumental in
identifying and connecting the research team with KIs in the
and the Ministry of Education community, including health service providers and social
· Zambia: Excellence in Research Ethics and Science (ERES) workers. The research teams worked concurrently in the
selected schools and school communities. Each team was
Converge supervised by a field monitor for on-site questions, and the
lead investigator who oversaw the general data collection
3.3.2 Data collection activities. At the end of each day, the team held debrief
meetings to discuss key insights from the data collection and
Each national expert recruited and trained between four plan a way forward in addressing challenges experienced.
and six research assistants for data collection. The training
covered the study methodology, content, interview tools/
protocols, administration, field quality checks, and research
ethics. All tools were translated into local languages.54

54 Botswana (Setswana; Eswatini (Siswati); Ghana (Ga, Twi, and Dagbani); Malawi
(Chichewa) Uganda (Runyankole); and Zambia (Nyanja).

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© UNESCO

3.3.3 Data processing and analysis 3.4 Limitations and challenges

Transcription of interviews commenced during fieldwork, COVID-19 lockdown and travel restrictions: Data collection
with the bulk of it completed thereafter. All the recorded occurred during the COVID-19 lockdown period and
interviews were transcribed, transcripts were anonymized, school closures. This could have led to a selection bias of
translated from local language into English, and analysed. study participants due to limited mobility as part of the
The transcripts were quality assessed by comparing the COVID-19 prevention measures. To address movement
voice recording to the transcription and comparing the restrictions, some teams had to obtain travel permits to
untranslated transcript with the translated transcripts. access schools, while teachers supported the research teams
In addition, the national expert read the transcripts to with mobilization of learners and community members to
manually identify codes which were later organized into participate in FGDs. Some schools in Botswana requested
pre-determined themes as per the research questions. New that the interviews be conducted virtually, and this was
emerging themes were also recorded, and data organized as adhered to.
per the themes for analysis.
Delays in ethical clearance: Study timelines were affected by
In Botswana and Malawi, a Computer-Assisted Qualitative delays associated with access to approval letters from the
Data Analysis Software (CAQDAS) package was used (Atlas MoEs and the national IRBs, especially in Ghana.
Ti version 8), while in Uganda, the NVivo qualitative data
analysis computer software package was used for data Lack of diversity among LWDs: The selected schools had
management and analysis. The translated transcripts of the learners with only one form of disability – in Uganda,
audio recordings from the FGDs and IDIs were entered into the learners had physical disabilities but were able to
QACDAS for coding, annotating, and further analysis. In all communicate easily with researchers; in Eswatini, the learners
countries, quotes from primary data were used verbatim were hearing impaired; and in Zambia, they were visually
to clearly illustrate specific findings within each particular impaired. This could have affected the nature and diversity of
theme, including attitudes and perceptions to CSE, practices issues affecting LWDs.
regarding CSE, barriers to CSE implementation, CSE access,
and access to and use of SRH services by learners, including Poor network connectivity: In some cases, researchers
LWDs. Data was then collated, analysed, and triangulated to experienced poor network connectivity that rendered
bring out the study findings. sections of some interviews inaudible. In such instances,
either a second attempt was made, often using other means
such as a telephone interview, or a research assistant was
dispatched to conduct interviews in person.

Despite these challenges, the team managed to complete
the field data collection successfully.

23

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4. Regional findings

4.1 Knowledge of CSE G&C LSE is structured around three strands, namely Career
programmes Guidance, Health Promotion, and HIV and AIDS, and the
curriculum is supported by a syllabus and LSE teachers’
Most of the information presented in this section is derived handbook in five levels for learners aged 12-18 years and
from literature review and information shared by community above.
members on their knowledge of CSE.
In 2017, Ghana changed the terminology of CSE to RHE, in
4.1.1 Operational terms for CSE in the study response to opposition to the National Guidelines on CSE.
countries RHE is not explicitly included as a standalone, examinable
subject in the national curriculum, but various RHE topics
While CSE is now a globally recognized term, the terminology are integrated into several subjects from the fourth year of
or name used by each country varies, as shown across the six primary school, including Social Studies, Science, Biology, Our
study countries. In Zambia the term CSE is used, whereas in Word Our Planet, and Religious and Moral Education, among
Malawi, it is Life Skills Education (LSE). In Botswana, LSE is also others. In senior high school, the topics are integrated
used and forms part of the Guidance and Counselling (G&C) into two core, compulsory subjects (Social Studies and
programme. Similarly, in Eswatini, it is referred to as G&C Integrated Science) and two elective subjects (Biology and
LSE, or Inqaba.55 Ghana uses the term Reproductive Health Management in Living). The topics are thus examined under
Education (RHE) and in Uganda, it is referred to as Sexuality the general examination of the respective subjects in which
Education (SE). However, for the purposes of this report, the they are integrated. In addition, two main co-curricular
term CSE will be used for all countries. programmes have been introduced, namely the School
Health Education Programme (SHEP) and the HIV Alert
4.1.2 Status of CSE implementation in the six Programme, with support from the Ministry of Health (MoH)
countries and the Ghana Health Service.56

In Botswana, the integration of CSE into LSE, and delivery Malawi introduced LSE in primary schools in 2001 and
through the G&C programme, has expanded the secondary schools in 2003. At primary school level, LSE is
programme’s content to include other aspects of sexuality mandatory from Standards 2-8, while at secondary school
education other than HIV and AIDS, teenage pregnancy, level, LSE is only mandatory in Forms 1 and 2. In Forms
sexually transmitted infections (STIs), and family planning, 3 and 4, it is an elective subject. It is only an examinable
such as sexual rights and preferences, and thus made it subject in Standard 8 and Form 2. It is made up of six
more comprehensive. In primary school, LSE is integrated core elements, namely Health Promotion, Growth and
into Cultural Studies and Religious and Moral Education. In Development, Entrepreneurship and the World of Work,
secondary school, it is integrated into Integrated Science, Personal Development, Moral Development, and Sex and
Moral Education, Religious Education, and Biology. Topics Sexuality. In 2020/2021, a curriculum audit of the primary and
are either taught “as is’’ or infused during teaching. It is not secondary LSE curriculum was conducted to address some of
currently examinable. LSE content is also delivered through the emerging gaps in CSE topics through the development
other non-curricular activities, such as school assemblies, of supplementary materials for learners. The curriculum audit
meetings, and health talks. focused on alignment of topics and learning objectives to
the ITGSE, taking into account the Malawian context.
In Eswatini, ever since its relaunch in 2015, CSE has been
referred to as the G&C LSE curriculum. It is taught at both In Uganda, SE is currently integrated in the primary and
primary and secondary schools, but while it is systematically secondary school curricula, however, occasionally, it is taught
integrated into all learning areas (except mathematics) as a standalone subject as part of the Presidential Initiative on
at primary level (and is thus examinable through these AIDS Strategy to Youth (PIASCY) programme.
subjects), it is taught as a standalone subject at the
secondary level and is not examinable. 56 Awusabo-Asare, Kofi, Albert M. Abane, and Akwasi Kumi-Kyereme. Adolescent
sexual and reproductive health in Ghana: A synthesis of research evidence. New
55 UNESCO. Metadata for the global and thematic indicators for the follow-up York, NY: Alan Guttmacher Institute, 2004.
and review of SDG 4 and Education 2030; 2017. http://gaml.uis.unesco.org/wp-
content/uploads/sites/ 2/2018/10/metadata-global-thematic-indicators-sdg4- 25
education2030-2017-en_1.pdf [accessed 3rd Dec 2018].

In 2019, SE was integrated into the revised lower secondary Conversely, the indicator of community awareness of CSE
school and piloted in 20 districts, although rollout was in schools in some countries was their opposition and
affected by the COVID-19 pandemic. SE concepts are resistance to the programme, for example in Ghana57 and
delivered through different study subjects, such as Uganda. For instance, in 2017, the public resisted the attempt
reproductive health in science or biology for primary or by the government to introduce CSE in Ghana because
secondary levels, respectively, and values and culture in they perceived that the sponsors of CSE were the lesbian,
religious education or social studies. SE is also incorporated gay, bisexual, transgender, queer and intersex (LGBTQI)
in a number of co-curricular activities, including school community, which intended to introduce sexual orientations
assemblies, school clubs, and school open days with parents. (homosexuality) into Ghanaian pre-tertiary schools. Others
protested because they believed that Ghanaian children
In 2014, Zambia developed and rolled out a CSE curriculum were going to be taught about sexual rights, that is, that
targeting children aged 10-24 years in grades 5-12. The having sex is the right of a child. Similarly, strong opposition
curriculum is integrated into a number of examinable carrier is being seen from religious leaders in Uganda58. They argue
subjects at both primary and secondary level, including that it is too early to provide CSE to learners and this has
Integrated Science, Biology, Social Studies, Civic Education, created reluctance by the government to implement it.
Home Economics, and Religious Education. In addition, in Likewise, even though knowledge is high in Zambia, parents
2015, a curriculum for out-of-school AYP was developed still wanted to know more about what AYP were learning
by the Ministry of Youth and Sport and rolled out through in schools. Moreover, it was clear from the discussions with
selected non-governmental organizations (NGOs) in 2016. community members that their perception about CSE,
perhaps arising from lack of knowledge of its content, was
4.1.3 Community members knowledge of CSE negative overall, as they expressed unhappiness that issues
of sex and sexuality were being taught to their children in
Discussions with community members, including total disregard of their culture and traditions. It was further
community leaders and parents, indicated that they were reported that the subject was not only “spoiling” them, but
aware that CSE was being taught to learners in schools, also promoting sexual permissiveness among the youth in
however, their level of awareness around the content and the communities. Community knowledge of CSE was not
its benefits varied. For instance, the level of awareness was as high in Malawi, where it was clear from the discussions
deemed high in Botswana, Eswatini, Ghana, and Uganda, with them that their knowledge about what constitutes the
with most expressing confidently that they knew what the subject is limited to issues of sex and sexuality.
CSE curriculum entailed. Moreover, they generally approved
of its teaching in schools as part of the curriculum because “This subject should not be taught in schools
they perceived it as beneficial and necessary for children’s because from the creation of the world even our
learning, growth, and development. Community members own parents did not send us to school to learn
gave the following summation of their understanding of CSE: about sex and sexuality but rather to attain good
education.”
“I am very much aware of sexuality education; I
acquired this information during my tenure as a - Parent, FGD (Malawi, rural)
PTA member in our local school.”
“This issue of sexuality is God’s creation, it happens
- Community member, male (Botswana, urban) naturally. There is no need up to the extent of
studying sexuality in class.”
“It is aimed at assisting both the girl and boy child
in a holistic manner and looks at their needs and - FGD: Parents (Malawi)
assesses the well-being of the child. [It is] not only
school-based.” 57 Awusabu-Asare et al. in 2017 and Keogh et al. in 2019.
58 Uganda National Report: CSE Study.
- Community leader (Eswatini)

26

“I have little knowledge about CSE ... I need more “We have skills to reject sexual partnerships like
information.” avoiding being close to the males, avoid being in
company of males, convincing a sexual partner to
- FGD: Parents (Zambia, peri-urban) start sex after finishing school. We have all these
skills but the challenges are poverty and peer
4.2 Attitudes and perceptions on pressure.”
CSE
- FGD: Secondary school learners (Malawi, urban)
4.2.1 Attitudes and perceptions of learners
“I was also impressed by the SE topic on Human
Benefits of learning CSE Body and Development, because when you start
your menstruation periods, you start growing
Overall, learners had positive attitudes towards the teaching pubic hair and start developing breasts, it is
and learning of CSE and considered it as beneficial to them. normal so we should not get scared because we
They indicated that CSE prepares them to confront the are undergoing growth”.
changes (both physical and psychological) that come about
as they transition from childhood to adulthood. They saw - FGD: Primary school, female learner (Uganda)
CSE as an important part of their development because
it not only helped them understand and safely negotiate It was further highlighted in their narratives that CSE
the challenges of coming of age, but also as part of their equipped them with knowledge and skills relating to GBV,
preparation for life as a responsible citizen through values including rape, and ways in which to report it. They noted
acquired early in life, as part of CSE. Moreover, they perceived that before this exposure, there were certain things that
CSE as a gateway to attaining life goals through avoiding were done to them such as bullying and sexual harassment
negative outcomes of SRH risks, such as early sexual debut, that they did not see as violence. It was revealed during
EUP, HIV and other STIs, drug and substance abuse, and GBV. discussions that learners were able to identify different forms
They expressed that it helps them to learn positive ways with of violence, prevent, and effectively deal with them. Learners
which to navigate their sexual relationships and negotiate agreed that they were sharing the information with friends
for healthy and safe relationships while making positive life in their communities. The following quotes from learners
choices. As one learner observed about the benefits of CSE: in Malawi, Uganda, and Zambia clearly articulate these
sentiments:
“CSE is an eye opener; we learn new knowledge
and we can apply it to our lives. It equips us “Sexual abuse and harassment are also tackled.
with relevant skills for survival in this world. This Harassment happens a lot at school. When girls
knowledge protects us and keeps us safe from and boys are playing, a boy can touch a girl’s
being victims of abuse.” breast. We are taught that if these things happen,
we should report to the teachers.”
- Learner, male (Botswana, rural)
- FGD: Primary school learners (Malawi, rural)
Learners also explained that CSE has a great deal of
information pertaining to life planning skills that help them
navigate through their day-to-day lives, both within and
outside of school. Male and female learners alike expressed
satisfaction that they acquire skills that help them to make
the right decisions, set goals, and fight to defend those goals.
These sentiments are captured from a range of learners:

27

“Yes, we learnt about sexual violence especially “They should put us together because the make-up
the boys should desist from having inappropriate of boys and girls are different so when they put us
physical contacts with the girls, because it may together each sex will learn and know much about
negatively affect their studies.” the opposite sex.”

- FGD: Primary school, male learner (Uganda) - FGD: Junior high school, female learner
(Ghana, peri-urban)
“There was a pupil who was impregnated at the
age of 14, and the parents sent her away to stay Given that CSE topics are integrated in a number of subjects
with the man who impregnated her but she went per country, separation of learners by sex/gender may not
to the police to file the case and the man was be feasible as this would affect the timetable in trying to
arrested and imprisoned.” accommodate two classes in a period meant for one class,
and one teacher taking that class expected to take two
- FGD (Zambia, urban) classes. This is an area that needs continued discussion to
ascertain how best to handle it, especially for topics that are
Perceptions of learners on mixed or separate CSE classes deemed too sensitive to be delivered to female and male
for female and male learners learners in one class.

While some learners were of the view that CSE should be 4.2.2 Attitudes and perceptions of learners
taught separately for boys and girls, others favoured an with disabilities
approach where both sexes were taught together. For
example, those who favoured the separate-sexes approach Learners with special needs who participated in the
argued that this would make them feel much freer to ask study had varied disabilities, as such: hearing impairment
questions and express themselves in the absence of the (Botswana), visual impairment and those living with autism
other gender group. They saw this as one of the ways that (Eswatini), speech and hearing impairments (Ghana), visual,
CSE delivery and impact can be made more effective: speech, and hearing impairments (Malawi), physically
impaired and those with intellectual disabilities (Uganda),
“I feel it is better if we are taught separately so that and visual impairment (Zambia). Some learners were from
we can be free to express ourselves as boys. There special needs schools, while others were from mainstream
are things that we just cannot say or talk about in schools.
the presence of the girls, we need that privacy.”
LWDs, as with their peers without disabilities, had a positive
- LWD, male (Botswana, urban) attitude towards CSE and displayed good knowledge.
However, they acknowledged, as did their caregivers
However, there were those who were in favour of an (including teachers and parents), that they have unique
approach where both sexes are taught CSE together, needs for CSE because their challenges place them in a
because in their view, both males and females have similar more vulnerable position compared to other learners.
needs for CSE. Some of the most critical challenges as expressed by the
study participants pertained to low self-esteem, the desire
to feel accepted, and risks of sexual exploitation, abuse,
and coercion. LWDs indicated that CSE contributed to their
understanding of sexuality, growth, and development.

Benefits of learning CSE

Among other benefits, the learners revealed that they
acquired basic life skills on how to handle the changes that
occur in their bodies and avoid engaging in activities that
may lead to sexual relationships.

28

Skills acquired by learners to handle sexuality-related “Looking out for one another, if I see any form of
problems included abstaining/staying away from the violence, I report such acts immediately. We have
opposite sex, handling peer pressure, prevention against STIs built a solid rigid no violence tolerance scheme
and pregnancies, and teaching others to keep themselves among ourselves, which so far, it is working for us
safe, as captured in their own words below: well.”

“At school we are taught sexuality issues that we - LWD, female (Botswana, urban)
are not taught at home. My parents only told
me not to engage in sexual activities when they They also learned about strategies to build their self-esteem,
discovered that I was having my first menstrual especially in the face of discriminatory acts against them due
cycle. Otherwise, they do not talk about sexuality to their disability, as expressed by one LWD:
issues with us.”
“They teach us that if you are disabled and you
- FGD: Girls (Eswatini) meet someone else that is not, if that person
derides you, just ignore them because there is
“I have acquired the skill of easily identifying what’s a saying that ‘omuto tasheka mulema’ (young
right and what’s wrong and how to behave around children are not supposed to laugh at the
people.” disabled).”

- FGD (Zambia, urban) - FGD (Uganda)

“We learn that we should be firm and standing Perception of LWDs on mixed or separate female from
up for ourselves and what we believe, if someone male CSE classes
comes up with sexual offers, we quickly turn them
away and take a firm stand, letting them know As with their non-disabled peers, some LWDs felt that CSE
they should never approach us with such requests.” should be taught separately for boys and girls, while others
favoured an approach where both sexes were taught
- LWD, female (Botswana, urban) together. Respondents from Uganda, for example, indicated
that in some instances teachers went to the extent of
In addition, the LWDs explained that, as they are more separating learners by gender or nature of disability for more
susceptible to sexual violence and in many cases are unable effective delivery. Separation of boys from girls was perceived
to fight off perpetrators or report them, CSE also helps them as necessary to make the learners focus on what is being
to have the confidence to intervene, and “look out for one taught, as explained in the quote below:
another”, as one LWD explains:
“Most of the learners just laugh when the teacher is
teaching. When teaching about the body changes
of girls, boys laugh and when they teach about
body changes about boys the girls also laugh at
them.”

- FGD: Learners at special needs primary school (Malawi)

29

However, there were those who were in favour of an “This subject has lots of things which are educative.
approach where both sexes are taught CSE together, As Malawians we are not open and comfortable to
because in their view, both males and females have similar teach or advise these issues to our own biological
needs for CSE: children culturally. Children feel more comfortable
with teachers than their own parents on sexual
“I tend to differ; I think us as boys and girls can issues or anything related to CSE. Parents are
just be taught all in the same room so that we get always shy to their children. For instance, I don’t
to know and share ideas on issues affecting our talk to my daughter about issues of SRH, I do feel
sexualities as teenagers. Yes, we have privacy but shy always because of our culture. The advantage
let us look at a broader picture that we are both is that she is learning at school.”
teenagers. Teach us both as one.”
- Secondary school CSE teacher (Malawi)
- LWD, male (Botswana, urban)
Teachers also noted that learners with special education
4.2.3 Attitudes and perceptions of teachers on needs would benefit from CSE as most of them were
CSE vulnerable to abuse. They believed it is necessary for them to
be empowered through the subject so that they are able to
The study also explored teachers’ attitudes and perceptions identify signs and acts of abuse:
about subjects they feel should either be added, removed,
or packaged differently in the CSE curriculum. All these are “The subject is very necessary especially in our
important factors that can have a direct effect on the delivery school. You find that the learner is clueless about
of CSE and the impact that CSE can have on learners. In those issues, because she was born mentally
this study, it was observed that the teachers’ attitudes and challenged. For instance, no one teaches the girls
perceptions towards the teaching and learning of CSE were about menstruation and how to use sanitary pads.
favourable. Some learners have parents but they don’t take
care of their challenged children.”
Benefits of CSE/appropriateness of CSE content
- Teacher (Eswatini)
Teachers were unanimous about the necessity of teaching
CSE in schools, with most of the view that the topics On the other hand, there were diverse views among
currently covered by the CSE curriculum are appropriate. In teachers regarding teaching about contraceptives, with
addition, there was consensus about the need for learners some preferring teaching abstinence rather than the use of
to be exposed to some form of CSE from an early age in contraceptives, saying they strongly believe that teaching
light of the fact that very little occurs in the home by way of learners about contraceptives may encourage them to
conversations on sexuality, which makes CSE a critical part engage in sexual activity, and others being supportive of the
of the schools’ menu. Some of these benefits are captured current arrangement, as explained below:
below:

“It is necessary at schools because at home,
communication is very limited, it is very difficult
for their parents to teach them at home, so it
necessary that they get taught here in the school,
they are curious that they end up doing it, so we
do not want them to miss that opportunity so that
they may learn the risks of having sex.”

- Teacher, male (Botswana, urban)

30

“Well, for our girls, we do need contraception. “I think that it must be done as early as possible
Sometimes you look at this beautiful young girl because kids nowadays, with the technology
going to Form 1, and innocently going about that we are living in, it introduces them to so
these love affairs they have in the school, and you many things, they watch TVs, watch magazines,
look at the background, you look at… also you whatever they get information from. So, let us not
think about the future, and you know that well, wait for a child to go into Form 1 and teach them
there’s a serious problem, and you wish you would about these issues, its best if we teach them as
do something for that girl so that she doesn’t get early as five years, that is when they start asking us
pregnant, but then, eh, you cannot even suggest questions.”
that she goes to the clinic for contraception.
- Teacher, female (Botswana, rural)
- High school teacher (Eswatini)

“For the sake of girls, it should include “Children are very inquisitive and, they are so
contraceptives so that our young girls should be much exposed to cell phones, television, and other
safe by not getting early pregnancy and HIV; same gadgets. Unlike us, who used to believe everything
as for boys if they will be using condoms they can’t our parents told us, that babies come from an
make girls pregnant and they can’t get diseases like aeroplane. These gadgets reveal everything to
HIV and STIs.” them and mind you, they have these gadgets as
early as seven years. So, we should not wait for
- Primary school CSE teacher (Malawi, urban) the child to be a teenager, in order for us to start
teaching sexuality education. Parents should also
Perceptions on the right age for starting CSE be part and parcel of this kind of education by
telling their children the truth, not to wait for a
While most teachers were supportive of CSE, there was teacher to do so.”
however, some concern about the need to make sure that
CSE content is age-appropriate. The general feeling was - High school teacher (Eswatini)
that the current CSE content tends to be too advanced for
younger learners, suggesting that, to the extent possible, “As far as today’s life is concerned with radios
it should be considerate of the mental and psychological announcing that a two-year-old child has been
development and maturity of learners. Despite concerns raped, I don’t think that a child should reach
about age-appropriateness of CSE materials, with the maturity to start learning such topics. The learning
exception of Uganda, teachers were unanimous on the should start at infant stage from four to six years,
need to commence CSE earlier (“the earlier the better”) given when the child is able to speak properly asking
the fact that young people commence sexual activities at him/her questions and able to answer, little by
increasingly younger ages. Teachers from the other five little the child will be growing with the mentality
countries proposed a starting age as low as four years, while that having sex is bad, no one can entice her with
Uganda proposed nine years. The comments below and sweets to have sex and could report to parents.”
Table 3 summarize the proposed appropriate age to start
teaching CSE: - Secondary school CSE teacher (Malawi)

31

Table 3: Teachers’ proposed appropriate age to start CSE

Country Current CSE starting age Grade currently Teachers’ proposed age Proposed grade
Botswana 5 KG 5-7 years Pre-school /KG 1
Eswatini 6 1 5-9 years KG/Pre-school
Ghana 4 KG 4-12 years *KG - JHS
Malawi 8 3 4-6 years 1
Uganda 6 1 9-12 years Grade 4
Zambia 10 5 5 *ECE

*KG: kindergarten; JHS: Junior high school; Early childhood education

However, because of many structural factors, learners may 4.2.4 Attitudes and perceptions of school
not go through the education system at an equal pace managers
according to age. In other words, in any given class, there is
a high level of variability among learners in terms of age, and The main responsibility of heads of schools is for them to
CSE content may therefore need to be segmented for the ensure that there is an effective school system that creates an
various age groups in any particular class. Moreover, while enabling environment and provides the necessary logistics
CSE curricula are packaged in ways that are age-appropriate, for students and teachers to facilitate effective teaching and
there was a feeling that its integration into various subjects, learning. With respect to the teaching and learning of CSE,
including extracurricular activities and events like school the attitudes and perceptions of heads of schools are crucial
assemblies and health talks, makes it a challenge to ensure in providing a collegial teaching and learning environment
age-appropriateness of the message. and linking the school with health facilities for co-curricular
activities and provision of SRH information and services.
Perceptions of teachers on mixed or separate CSE classes
for female and male learners There was a general perception that CSE delivery is
inadequate due to several factors, including inadequate
There were divergent views among teachers regarding the capacity (limited number of teachers trained on CSE), lack
question of whether CSE should be taught to males and of orientation on extracurricular CSE instruction activities,
females separately or together in one group. Those who inadequate guides and reference materials or charts on CSE
felt that CSE should be taught to boys and girls separately with age-appropriate content, inadequate time allocated for
argued that this will make it possible for learners to be open CSE due to competing schedules, and teaching preference to
and not feel embarrassed about opening up on their issues deliver content that is examinable. These factors are further
in front of the other sex. Those who favoured the combined elaborated in sections 4.3.4 and 4.3.5.
approach argued that the SRH of boys and girls may not
be the same, but they are similar in nature and synergistic The findings from the study showed that the majority of the
in process and outcome, hence the need to have the two heads of schools and departments that participated in the
groups together. They argued having both sitting together research were supportive of the teaching and learning of CSE
for CSE classes will also ensure that boys and girls get to and that it should be taught from an early age. The basis of
hear and understand each other’s perspectives. The other their support is that CSE would prepare the learners to make
issue that was raised was that some topics need to be informed decisions about their SRH issues. However, some
handled according to the sex of the teacher. For example, held contrary views, especially those in religious-founded
menstruation related issues may best be handled by female (sometimes referred as mission) schools. Most education
teachers. institutions in Uganda were established in collaboration with
religious institutions, and even though they are identified
Other respondents took the middle view that it should be as government-aided, they retain the indirect management
at the discretion of teachers to decide when, how, and for by religious institutions. For example, in Eswatini, three of
which topics or activities they want to engage male and five head teachers interviewed admitted that they were
female learners separately or together. They argued that uncomfortable with the issue of sexuality education because
there might be topics for which it might be beneficial to they were Christians or worked in a Christian school. In
have boys and girls together, and others for which it might addition, although, in general, head teachers had favourable
be prudent to separate them. In their view, it will be difficult attitudes towards promotion of CSE, this was limited to
to imagine a prescribed way of delivering CSE that will be certain topics. For instance, some had reservations on
suitable in all contexts, circumstances, or topics. inclusion of topics related to contraception or condom use,
as illustrated in the extracts below:

32

“We would be doing a disservice to the church, for In addition, in Uganda, there is substantial opposition to the
instance ours is an Anglican Church based school. term “comprehensive sexuality education”, particularly since
We realize right from the church diocese, we know it is perceived as being driven by the NGO sector and that
they have been resisting this [SE] and so many this sector promotes SE programmes that encourage same
programmes had to stop because of this influence.” sex relations, rights for children to do what they want with
their bodies, and so forth, in contradiction to existing cultural
- Secondary school, government-aided head teacher values. In this vein, head teachers in Uganda agreed that
(Uganda) contraceptives and condoms should not be made available
at school, as they felt doing so would be encouraging
learners to engage in sexual activity. Likewise, one head
teacher from Zambia said that:

“The church-managed schools influence the “Talking about condoms seems like promoting sex
teaching of CSE. For example, at this school the … it shouldn’t be talked about or shown as it is an
only preventive measure is one - that is abstinence.” embarrassing thing.”

- Special needs primary school head teacher (Malawi, - Head teacher (Zambia, rural)
urban)
Similar sentiments were expressed by head teachers who
Furthermore, some head teachers agreed that some CSE were concerned that this would fuel feuds between the
topics on sex were uncomfortable for both teachers and school and parents, let alone community leaders, due to
pupils, making teachers skip the topics and hindering pupils’ their cultural and religious beliefs. It was noted that some
active class participation. They acknowledged the religious communities were already not comfortable with issues of
and cultural factors that promoted the fear of sex, culture of sex, sexuality, pregnancy, and childbearing being taught to
silence, and the life of secrecy. One head teacher urged that: their children, and therefore the provision of condoms at
school would bring about more controversies.

Someone who is male is not supposed to deliver “It could be difficult because as I said earlier that
sexuality education to a girl child because things according to culture, parents might be thinking
that concern a girl’s sexual life and well-being are that we are encouraging sex at school. But
discussed behind closed doors.’ students should go on their own if they want to get
provisions of those condoms not having a special
- Head teacher (Zambia, peri-urban) provision of condoms at or from school aaaa
no no no. I don’t think things can work, even this
The majority of head teachers agreed that learners should be being a religious institution. It would be difficult for
taught about contraceptives, but they put more emphasis the proprietors to accept it.”
on teaching abstinence. They believed that withholding
information about contraceptives to learners would not - Primary school head teacher (Malawi)
be helpful because learners were engaging in sex, as the
pregnancy rates revealed. However, some head teachers had Head teachers were also divided on the issue of allowing
reservations on inclusion of topics related to contraception pregnant learners back to school. One head teacher from
or condom use, expressing that they believe discussions on Eswatini recommended that pregnant learners should go
prevention methods may promote engagement in sexual home, take a break and resume school when they have
activity by the learners. delivered. Other head teachers wanted pregnant learners to
be allowed to come back to school. It was also revealed that
sometimes the learners refuse to come back to finish their
studies once they fall pregnant.

33

Furthermore, although some of the head teachers indicated In these cases, schools were perceived to offer more
that the current curriculum on CSE is adequate to address opportunities to discuss CSE related topics compared to the
its objectives, others disagreed. The argument raised by home environment during school breaks where parents may
those opposed was that the teaching and learning of CSE have limited time.
is intended to equip the learners to, for instance, prevent
teenage pregnancy. To them, as long as the schools and “I feel the teachers are doing great work. They are
communities continue to record teenage pregnancies, the bridging a gap that even some parents cannot
curriculum is inadequate to achieve its intended objectives. bridge and that is talking about issues of sexuality
As one of the school heads put it when asked if the to their children. That is the first advantage,
curriculum on CSE is adequate to achieve its objectives: secondly, children stand a better chance of not
being victims of sexual abuse, now that they are
“I don’t think so…with the extent to which teenage aware of sexual violence, certain touches that
pregnancy is on the rise… I am using my school makes them uncomfortable.”
locality as an example – when you have about six
of your senior high school girls getting pregnant - Community member, male (Botswana, peri-urban)
before writing the West African Senior School
Certificate Examination, then you can tell from “When such topics in RHE are being taught in the
that point of view. Aside from the school, if you schools it will guide the children to even avoid
come across the other statistics in the community child marriage even if their parents put pressure on
and other schools, it tells you that teenage them to do so. And also, the knowledge will help
pregnancy is still happening.” the children to prevent unwanted pregnancy and
also avoid bad associates and all sorts of social
- Senior high school head (Ghana, rural) vices.”

4.2.5 Attitudes and perceptions of community - Parent, (Ghana peri-urban)
members
However, some community members did not fully subscribe
There was a positive attitude among community members, to the benefits of teaching CSE. This concern had to do with
including community leaders and parents, towards CSE. the perception that learning CSE could lead to or encourage
They believed that CSE helped young people to be experimentation with sex.
knowledgeable about life issues in the wake of too much
influence from different sources. The parents were aware “According to our practice as Swazis there is
that young people are now exposed to a lot of information, great need to revive and strengthen the Liguma
some of which may be misleading, thus getting direct (informal girl grooming) and Lisangu (informal
information from reliable sources would benefit the learners. boy grooming) then as they grow up there should
Most parents and community members were ready to offer be a level where they can be taught.”
support for effective teaching and learning of the subject.
- Religious leader (Eswatini)
Benefits of CSE in schools

The majority of community members mentioned that CSE
teaching was valuable and would help reduce the high
cases of pregnancies, early marriages, and school dropouts.
CSE was also seen as a means to help children navigate
challenges during adolescence by acquiring prior knowledge
on how to handle stages, such as menstruation. The
participants noted that indeed CSE in school is important
because learners spend more time at school than at their
homes with parents.

34

“The disadvantage is that children will want to “For family planning methods I would never want
experiment and feed their curiosity therefore, a child to know about it because if a child gets to
putting their selves in danger like early pregnancy know how it works, she will rush into sex since she
complications.” knows she will not get pregnant.”

- Community member, female (Botswana, urban) - Parent, secondary school (Uganda)

CSE content In addition, some community members expressed that
they were uncomfortable with some of the topics taught to
Parents and other community members endorsed most learners, such as issues relating to sex and sexual intercourse
topics covered in teaching CSE. However, topics that and on marriage, which was seen a prerogative of parents to
members were not in total agreement about included teach their children. Culturally, marriage is only talked about
information on contraceptives, sex and sexual intercourse, to those that have reached a marrying age,59 as reflected in
and marriage. Some of the participants expressed their the following comments:
disagreement with contraceptive education as follows:

“I think we should rather preach to the children “For instance, issues that deal with marriage, those
about abstinence, we should teach them to avoid we leave for the parents and depending on the
premarital sex because it does not please God. level of the learner like we said, certain things are
That is what we should be teaching them to put uncomfortable to talk about.”
some fear in them instead of teaching them about
condoms and contraceptives.” - Community member (Zambia, peri-urban)

- Religious leader (Ghana, rural) “Sexual intercourse, because as we grow up from
our culture, we had never seen it that children
“You do not practice family planning before you are being taught how to have sex because we
are married. By teaching about these methods, the regarded that sex is for elders not children.”
aim is to promote sexuality.”
- Community member, male (Botswana, rural)
- Parents (Malawi, rural)
Perceptions on the right age for starting CSE
“They can be taught about them maybe form
the age of 16 years so that they are aware of Again, there was lack of consensus on the appropriate age
these contraceptives. They need to know about when CSE should be introduced to learners, however, overall,
them as a means of protection from unplanned community members tended to suggest ages that were
pregnancies, STI and HIV infection.” higher than those suggested by teachers. Most respondents
indicated that the commencement of adolescence or just
- Community member, male (Botswana, rural) before was the ideal age to introduce CSE, that is 12 years or
older, but some suggested the initiation should occur during
early childhood, as early as five years, as long as the content
was age-appropriate and incremental in terms of detail and
content based on learners’ level of development.

59 Zambia FGD with community members

35

For example, in Botswana, participants proposed between “Boys and girls should be taught differently, basing
10 and 16 years, in Eswatini between eight and 12 years, in on masculinity and femininity aspect of both
Malawi between five and 12 years, in Uganda between 14 genders.”
and 16 years or when visible signs of puberty show such
as breast development, voice changes or menstruation, - Community member, male (Botswana, urban)
and finally, in Zambia 12 years. The following excerpts
demonstrate the reasons justifying the choice of age:

“To me it should be 12 years or from Standard “I think they should be taught as one, they are both
5. That is the time when girls have just started children. And this will enable them to be aware
developing breasts in Chichewa, we call her buthu. how to handle and treat one another. So that they
At least this age is appropriate as they have just are aware of both genders needs and learn how to
started experiencing body development and handle and approach one another.”
changes.”
- Community member, female (Botswana, urban)
- Community leader (Malawi, urban)
In other cases, parents and community members focused on
“Five years is the right time because at 18 she is describing the environment in which CSE should be taught,
already old but at five years for example when using terms and phrases such as friendliness, openness,
children are playing on their own you will discover honest, free, friendly, frank, and reach out, to characterize the
that one is on top of the other and when you ask atmosphere that must pervade a CSE class environment, as
them what they are doing there will be finger demonstrated below:
pointing which simply means that sexuality
mentality starts at early as five years old.” “Build a relationship where openness is
encouraged to allow them to feel free to talk about
- Parent (Malawi, urban) sex and sexuality without feeling embarrassed,
ashamed, or attacked. This can be done at primary
“It starts with parent’s involvement in talking and level, bearing in mind that it is also more about
teaching their children about issues of sexuality. self-image, gender, and learning about choices
Parents and guardians need to open up to their and limitations of one’s boundaries.”
children so that they can reach out to them in
times of need; it is high time parents stop pushing - Community member, male (Botswana, peri-urban)
this issue to teachers to handle alone, it is not fair.”
Availability of contraceptives and condoms in schools
- Community member, male (Botswana, rural)
Community members were almost unanimous in their view
Perceptions of community members on mixed or that contraceptives and condoms should not be supplied
separate CSE classes for female and male learners in schools, expressing a concern that doing so will imply
that the school or society approves of their involvement
As with the other target groups, community members had in sex and will lead to heightened curiosity and need to
mixed opinions on whether CSE should be taught separately experiment.
for boys and girls or together, as demonstrated in the quotes
below:

36

“I am totally against children having access to 4.3 CSE delivery: Practices and
contraceptives. Giving them access is like saying go experiences
ahead and indulge yourselves which sends a very
wrong message. For their age and level of physical 4.3.1 Experiences of learners on teachers’
development, they do not even have a proper size delivery of CSE
condom.”
Learners shared their views about the delivery of CSE by their
- Community member, female (Botswana, rural) teachers during classroom instructional sessions around
three main areas: the content, the approach to the teaching,
and the time spent on teaching.

CSE content

“Condoms should not be distributed because what Overall, learners were comfortable with topics covered under
she/he fears is pregnancy and sexually transmitted CSE, with many indicating that the topics were relevant.
diseases and do not fear sin which is bad before Only on a few occasions did learners express discomfort
the eyes of God.” with some topics or content, and thus would suggest what
topics to add or remove from CSE. In Botswana, for instance,
- Parent (Malawi) learners appreciated the eight different topics that make up
CSE as shown in Figure 1, especially gender, violence, human
Figure 1: CSE topics body development, and relationships, as they felt these
build their capacity and skills to handle not only sexuality-
related matters, but also other socio-cultural issues, such as
domestic violence and GBV that occur in their families and
communities.

Key concept 1: Key concept 2: Key concept 3: Key concept 4:

Relationships Values, rights, culture and Understanding gender Violence and staying safe
sexuality
Topics: Topics: Topics:
• Families Topics: • The social construction • Violence
• Friendship, love and • Values and sexuality • Consent, privacy and
• Human rights and of gender and gender
romantic relationships norms bodily integrity
• Tolerance, inclusion and sexuality • Gender, equality, • Safe use of information
• Culture, society and stereotypes and bias
respect • Gender-based violence and communication
sexuality technologies (ITCs)
Key concept 5: Key concept 7:
Key concept 6: Key concept 8:
Skills for health and Sex, sexuality and the
wellbeing The human body and sexual life cycle Sexual and reproductive
development health
Topics: Topics:
• Norms and peer Topics: • Sex, sexuality and the Topics:
• Sexual and reproductive • Pregnancy and
influence on sexual sexual life cycle
behaviour anatomy and physiology • Sexual behaviour and pregnancy prevention
• Decision-making • Reproduction • HIV and AIDS stigma,
• Communication, refusal • Puberty sexual response
and negotiation skills • Body image care, treatment and
• Media literacy and support
sexuality • Understanding,
• Finding help and recignizing and reducing
support the risk of STIs, including
HIV

37

© UNESCO On the other hand, the learners felt somewhat dissatisfied
with the way CSE is delivered some of the time. For example,
although CSE is meant to be age-appropriate, learners in a
particular class at primary level may not be homogenous
in age, with some being two to three years younger than
others. In that case, there were learners who were of pre-
pubertal age who found it difficult to relate to CSE content
such as pregnancy and childbirth. These cases were,
however, very few and isolated. Similarly, some learners at
primary school60 felt that the materials they are taught are
more appropriate for junior and senior secondary level, and
also found it difficult to relate to it.

To mitigate the seemingly age-inappropriate CSE
content, teachers often engage in strategies to aid learner
comprehension of the CSE content. One such strategy is
to skim over the content without much depth. Another, as
reported by one young learner, is to teach CSE content in
vernacular instead of English. This seems to have quite the
opposite effect, as the excerpt below shows:

“When we talk about sex, I am never comfortable
in the class. Like last year when our teacher was
teaching us, she was explaining in Setswana, and I
felt like she was insulting us.”

- Learner, male (Botswana, rural)

Similarly, most of the learners who participated in the study
in Ghana commented that the CSE content they received
was not detailed enough to cover much of their knowledge
aspirations. To them, the content should also reflect
broader issues about relationships, self-control, and sexual
orientation.

“They [teachers] teach it [RHE] as a normal [simple]
subject and that is not nice. They have to go deeper
into the issues for our deeper understanding in
order to know how to go about with reproductive
health issues.”

- Primary school learner, female (Ghana, urban)

60 CSE curriculum is offered from Standard/Grade 5, upwards.

38

In Zambia, learners from the rural schools felt uncomfortable Teaching and learning materials
being taught topics such as menstrual hygiene and sex
together with boys, and wanted such topics to be taught to The learners were also aware of the lack and almost complete
them separately from boys. They cited being uncomfortable absence of CSE teaching and learning materials (TLMs)
and shy during such lessons limiting their participation. in schools, and the subsequent improvisation of TLMs by
The boys from the same rural schools on the other hand teachers. There was also some recognition, especially from
indicated that they were okay with learning together with young learners, of the lack of age-appropriateness of certain
the girls. The dynamics were different when it came to the content of the CSE.
girls and boys from peri-urban and urban schools, who
indicated that they were comfortable to be taught together. “They can teach, but they should research
These differing views reveal the extent to which learners in more; they teach us things (content) that is not
rural and urban areas are expected to conform to the set appropriate for our age, they teach us content for
cultural and gender norms practiced in their communities. Forms 1, 2, and 3.”

The approach to CSE teaching - Learner, female (Botswana, rural)

While learners were generally positive towards CSE, they also There is some evidence that the school may not be the only
expressed concerns about gaps in the delivery of CSE by source of information on CSE. Learners are exposed to and
their teachers. Although most learners were of the view that access a wide range of other sources, especially electronic
their teachers were doing their best in delivering CSE, some media, as a complementary source of information. They do
were nevertheless aware that teachers often displayed signs this either out of curiosity, or as a conscious strategy borne
of unease, discomfort, and sometimes embarrassment in out of the need to seek clarity on CSE topics which they feel
handling certain CSE topics, either because of culture, moral teachers are struggling to deliver; or indeed the absence of
dilemmas, personal values, or lack of training on CSE. Some TLMs in schools, which are easily accessible on the internet.
of the remarks from learners are shared below: Seeking such complementary sources could also be driven
by learners’ own sense of unease with the topic in class, thus
“They need confidence to say I’m a career guidance preferring to access information from a source that is private,
teacher and follow all the exercises in the book as the quote below suggests:
instead of skipping some of the topics.”

- High school learner, male (Eswatini)

“As long as the book is written we need to learn “I make [do] my own research on google where we
everything because if the teacher hides something learn about the reproductive system- all the topics
from us due to cultural and religious beliefs, the can pop up when I research, that is why I browse
teacher is denying us the right to know what is best through it.”
for us.”
- Learner, female (Botswana, urban)
- Secondary school learner (Malawi)
While the use of complementary sources of CSE-related
information, such as the internet, cannot be avoided, it could
result in misinformation if it becomes their main source
of information on CSE. This in turn would increase their
likelihood of negative SRH outcomes.

“Some teachers desist from some expressions when 39
teaching topics like reproduction. Instead of saying
the word “sperm” they resort to other different
terms.”

- Primary school learner, male (Uganda)

Time spent on teaching 4.3.2 Experiences of learners with disabilities
on teachers’ delivery of CSE
Learners expressed that teachers do not provide the
same attention to CSE sessions as they do for their routine The fact that LWDs have unique needs when it comes to
classes. The current education system demands learners to CSE compared to other learners is something that is not lost
pass examinations, however, some aspects of CSE are not on various stakeholders, including parents, teachers, school
routinely examined. As a result, some teachers do not give administrators, and even learners themselves. Moreover,
it sufficient attention and learners fail to take such topics LWDs often face other problems that already adversely
seriously. In addition, it was noted that the time allocated affect their learning and development, such as stigma and
to the subject was often diverted to teaching examinable discrimination; communication challenges, especially when
subjects. faced with teachers who are not qualified to teach LWDs, and
a society and school community that may not be accepting
“Time has been allocated for G&C LSE in the school of their disability. All these factors make the issue of effective
but teachers use this time to teach Maths. It must delivery of CSE to LWDs even more important, given its
be emphasized that the time allocated for G&C LSE intrinsic value around empowering and protecting AYP and
should be used as stipulated in the timetable.” ensuring SRH outcomes. However, the study found that,
while LWDs felt that teachers do their best to consider and
- High school learner, male (Eswatini) cater for the needs of LWDs when delivering CSE, their overall
experiences on the delivery of CSE were mixed.
“They [teachers] should teach us well and take
time to teach us. Something like Mathematics CSE content
and Science, they take time to teach it but with
reproductive health, we don’t have enough time.” Generally, LWDs found the CSE topics to be an important
source of information and knowledge about their bodies as
- Senior high school learner, female (Ghana, peri-urban) well as their relationships with peers and society in general.

However, it was also noted that some learners do not give “I think that they are important topics which
CSE the same level of commitment as they would do with help a lot; like we are taught about unwanted
other courses. Moreover, CSE sessions commonly generate a pregnancies, about sex, …they will be teaching us
lot of excitement, and learners, boys in particular, often laugh how to protect ourselves from the dangers, while
and make noise in class, thereby disrupting the seriousness it may feel CSE encourages us to engage in sex, we
of the learning environment. The boys also sometimes tease know they are just trying to educate us so that we
the girls about body changes they would be experiencing, have adequate knowledge and information about
which often make the girls very uncomfortable. sex education.”

“When the teacher taught us how girls’ breasts - LWD, male (Botswana, urban)
enlarge [during adolescence] the boys kept looking
at our breasts and laughing.” Teaching approach

- Primary school learner, female (Uganda) Learners felt although schools were providing some level
of support to help them benefit from CSE, more needs to
be done and can be done, especially by way of engaging
teachers who are better trained to deal with LWDs. The
following excerpt from a focus group discussion with a group
of LWDs shows how something as basic as communication
or language can be a barrier to full comprehension of CSE
content:

40

“We need more specialized personnel who can “Our needs are different because our friends
relate and communicate better with us; teachers who have no disability, when they are learning
who have been trained to meet our needs. We this subject, they are able to see pictures, they
would stand a better chance of closing the understand what the teachers are teaching and
communication challenge that seems to exist.” they are able to make decisions to have sex or not.
While us who have vision impairment, we don’t see
- LWD, male (Botswana, urban) anything when teachers draw on the board.”

In addition, there was an inadequate number of teachers that - Special needs primary school (Malawi)
were skilled in the use of sign language to assist learners with
hearing and speech impairments.

“SE teaching and learning materials are sometimes “It would be much better if we had more teachers
available, however, blind students are unable to who are visually impaired. At least people who
see charts and posters on SE, and this makes them would understand our situation that would be
unable to effectively participate and benefit from much better for us and teachers who do not have
the lessons”. any disability should at least be trained as special
teachers.”
- Primary school LWD (Uganda)
- LWD (Zambia)
Teaching and learning materials
Time spent teaching CSE
From the discussions with LWDs, it was apparent that their
main challenge was lack of tailor-made and appropriate TLMs As with their non-disabled peers, LWDs noted that some
suitable for specific disability types, such as charts in braille. teachers did not go into detail when teaching CSE topics or
They were concerned that the absence of such materials is were not taking the subject seriously and sometimes taught
likely to impact their learning, appreciation, and benefits of their own subjects during CSE teaching time. Furthermore,
CSE. Moreover, they felt that teachers who were not visually they felt the time allocated to CSE topics was not enough
impaired were not meeting their needs as they continued to since it was integrated into other subjects and topics. This
write on the board like they do when teaching the learners limited their understanding of CSE topics. The following
with sight, hence they preferred being taught by visually excerpts are just some of many from LWDs relating to what
impaired teachers who according to them, understood their needs to be done to ensure that the school environment was
needs. These issues were expressed during the FGDs with conducive to their learning of CSE:
learners in the following excerpts:

“Teaching aids are needed to demonstrate and “We need more time in being taught as compared
simplify what we learn. We would be able learn to the mainstream students, more time should be
better and see, making us to grasp and this will allocated to our lessons.”
stick in our memories.”
- LWD, female (Botswana, urban)
- LWD, male (Botswana, urban)

41

“They should have adequate time for us to teach us Based on the evaluation results, a different training modality
well even if we don’t understand something, they of using teacher training colleges (TTCs) as training hubs
should take their time to teach us to understand.” has been implemented since September 2020. Teachers are
invited directly from schools to the college for a five-day
- Junior high school LWD, female (Ghana, urban) CSE training. To date, 1,275 teachers have been trained in
Zambia. The college hub model has been described as an
Overall, the need for improvement of delivery of CSE to LWDs improvement on the cascade model.61 
was noted, as well as the need to eliminate all cultural beliefs
and practices that promote discrimination against learners In Malawi, CSE is taught in all TTCs and is a compulsory
with disabilities. In addition, materials for learners with subject for primary school teacher trainees. To ensure
disabilities need to be provided, teachers should be trained long-term sustainability, principals, tutors, and heads of
to handle learners with disabilities, and disability-friendly departments from all 15 TTCs in the country have also
environments need to be created for learners with visual been trained. In Uganda, in 2019, UNESCO supported the
impairments and physical challenges. Ministry of Education and Sports (MoES) to train 289 in-
service teachers on sexuality education using the National
4.3.3 Experiences of teachers in the delivery of Sexuality Education Framework. However, in the area that
CSE was sampled for interviews, most teachers alluded to the fact
that they have not benefitted from in-service CSE training.
This section covers CSE topics that teachers felt In Eswatini, while the majority of teachers noted that they
uncomfortable teaching, the reasons for such discomfort, took a module that addressed topics discussed in the G&C
and their strategies for dealing with these topics. curriculum during their tertiary education, including those
related to HIV and AIDS and LSE, others stated that they only
Teacher training attended workshops, not specialized in-service training.

In Zambia, the Ministry of General Education (MoGE) in Across all study countries, the teachers’ concern about their
collaboration with UNESCO implemented the cascade model inadequate knowledge on CSE was attributed to inadequate
of training from 2014 to 2018. Under this model, a maximum training on CSE topics and SRH at the colleges of education
of two teachers per school participated in a five-day CSE and universities where teachers are trained. As such, teachers
training, after which they were expected to orient their who do not receive post-school (or in-service) training do not
counterparts at their respective schools. By the end of 2018, acquire adequate knowledge on the subject, as reflected in
while a total of 66,989 in-service teachers were trained in the the following quotes:
effective delivery of CSE at the classroom level, an evaluation
showed that there were gaps in this training model, “I am a trained teacher generally, but not
including that it was not as effective as it was envisioned to specifically an RHE trained teacher. I was trained as
be at the school level. The teachers to whom the training a science teacher. What I know is knowledge I have
was cascaded by the master trainers expressed that the gathered academically, societally, and to some
time for the orientation was not adequate, with one teacher extent religiously.”
indicating that:
- Senior high school teacher (Ghana, urban)

“It was only the guidance counsellor that “Government and organizations should organize
participated in the training and who later oriented trainings for teachers who have not been trained
the rest of the teachers which only took a few in this subject so that every teacher has knowledge
hours, he only gave ideas on how to integrate the of CSE and they should not refrain from teaching
CSE in the curriculum. Other teachers also need sensitive topics,”.
that five-day training.”
- Secondary school CSE teacher (Malawi, rural)
- CSE teacher (Zambia, peri-urban)
61 UNESCO National Office February 2021
42

The teachers also expressed that there were instances where Nevertheless, the study revealed that many teachers
they skipped certain topics because the learners became were not trained in CSE and, as a result, they often lacked
shy and uncomfortable due to their religious inclinations. confidence in handling and teaching learners’ sexuality
As a result, certain parts of the body (private parts) were issues, and felt uncomfortable in discussing some topics, thus
not mentioned. Others indicated that other [religious hindering effective delivery of CSE. This emphasizes the need
or personal] values of some of the teachers made them for ongoing teacher training and mentorship. Some of the
uncomfortable when teaching RHE. teachers remarked:

“Sometimes when you are teaching such issues, “I can’t say I have adequate knowledge because
you have to look at the facial expressions of the I never took a course. Maybe if I did a course
students; if you think mentioning certain body and acquired the necessary skills, I would be
parts will worry the students much, you have comfortable. But we just attended a workshop
to overlook the parts when teaching such topic and then went to teach but if we can get proper
[menstruation]…You know, this is a Moslem- training that is accredited then one can say that
dominated community, so you are not supposed they have adequate knowledge.”
to talk about the nakedness of your fellow human
being. They think that if you talk about those - High school teacher (Eswatini)
things, it means you are a bad boy or a bad girl.”
“I will say 60%, because there are always new
- Primary school teacher (Ghana, rural) things which need to be learned and impart[ed]
to the students. Though I have some knowledge I
On the other hand, CSE teachers were generally confident cannot say it is adequate, and I also need to learn
about what they knew about the subject matter. Some of more.”
the teachers interviewed reported to be well-equipped with
knowledge and skills to deliver on the subject, as captured - Primary school teacher (Ghana, rural)
below in their responses:
Innovative strategies used in CSE delivery
“I am a trained CSE teacher, I attended training in
Lilongwe in 2018. The duration of that training was It was established that overall, in spite of some challenges
three days.” and reservations on certain topics, teachers enjoyed
delivering CSE to learners mainly because it is easily
- Secondary school CSE teacher (Malawi) applicable to their day-to-day lives and supports their
preparations for their future. Teaching methodologies
“I am a Geography and Social Studies teacher. varied depending on the teacher and the given subject
Since these subjects are related, I teach CSE being taught. Teaching methods included role plays,
because there is no teacher. That is why I was given demonstrations, sharing real life experiences, and group
this subject.” discussions with discreet or written contributions.
Information technologies such as use of computers to
- Secondary school teacher (Malawi, rural) search online information on CSE were also used, but on
rare occasions. Sometimes the CSE sessions were interactive,
thus allowing learners to share experiences freely. Under
certain circumstances, teachers reported that they invited
other experienced teachers in CSE or nearby health workers
to engage with learners for comprehensive discussions on
specific CSE topics as resource-persons. Some teachers also
used out-of-class activities such as sport or drama to further
discuss CSE-related topics.

43

Teachers employed some of these methods as a way of CSE topics which teachers find uncomfortable to teach
getting around the topics that they deemed to be sensitive
and uncomfortable for them to talk about. In addition, Generally, teachers admitted that there were certain topics
learners were sometimes grouped according to gender that made them uncomfortable to teach because of cultural
depending on the topics or were split in such a way that and religious beliefs. They indicated that they had difficulty
male teachers attend male learners and female teachers with content that makes explicit reference to sex and sexual
attend female learners. These findings demonstrate that CSE acts, and spelling out some sexuality terms such as ‘sex
can be taught effectively using an integrated approach. The organs’ because of their sensitivity. Traditionally, sexuality
subsequent quotes capture the essence of these sentiments: topics in Africa are handled with discretion and privacy,
and deep-seated cultural beliefs and norms often result in
“It’s an enjoyable subject because learners do reluctance to openly discuss sexuality issues. This discomfort
enjoy it. You know these standard 6 learners are seems to get heightened if such content that the teacher
all in adolescent stage. Explaining to them about feels uncomfortable teaching must be delivered to learners
drawings on flip charts they feel happy and laugh who, in the view of the teacher, are too young to be receive
heartily. They see naked people and they always such content in the first place. This is especially so because
propose for double periods hence they are always CSE teachers, particularly those teaching at lower levels, must
happy during the time when the subject is being often translate the CSE content to learners’ native languages
taught. So, it’s an enjoyable subject for both to aid learner understanding.
teachers and learners.”
This discomfort with some CSE topics was also
- Primary school CSE teacher (Malawi, urban) disproportionately more likely to be experienced by teachers
who have indicated having had little or no training on CSE.
In such cases, the discomfort is often experienced as a clash
between their cultural and personal values and CSE content.
One of the key strategies for dealing with uncomfortable
topics is either to skip the topic or quickly gloss over it, and
not facilitate as much learner interaction as they would if
they were comfortable with the topics.

“I organize group discussions and mix male and “In most cases in our SiSwati language when
female students so that they should be discussing referring to people having sex we avoid using
as a group on their experiences. In so doing, the terms that directly mean the act but use general
students are able to interact with and learn from words. This then hinders the effectiveness of the
each other.” lesson because learners lose the seriousness/gist of
the matter.”
- Primary school CSE teacher (Malawi, urban)
- High school teacher (Eswatini)
“When it comes to topics that make me feel
uncomfortable, I form different groups and give “Translating the names of body parts into the
them papers to write for me what they know.... and local language [Runyankore]; it sounds vulgar and
if I find that they have included something about makes one uneasy.”
the topic it is discussed.”
- Primary school teacher (Uganda, rural)
- LWDs teacher (Uganda)
Teachers also expressed discomfort with topics on sexual
abuse, sexual orientation, and HIV and AIDS.

44

“The topic on HIV is sensitive because as teachers © UNESCO
we teach learners with multiple lovers that may
lead to increased chances of contracting HIV. There
are learners who were infected with HIV from birth
or through other means beyond their control. This
creates anger and confusion in the child who was
infected.”

- High school teacher (Eswatini)

With regard to teaching about sexual orientation, a
number of teachers said they felt as if they were condoning
homosexuality, which was against their religious beliefs.62
Some teachers from a mission school expressed that as
a school they have a zero tolerance towards homosexual
behaviour. Another teacher stated that:

“Maybe they’re sensitive or, it’s just that out
of your personal beliefs as a teacher, it’s very
difficult maybe to talk about… specifically
it’s homosexuality. It’s more like you’re giving
them the go ahead or maybe you’re just
introducing something new that you expect
them to experience, and also the personal values
or personal beliefs, they tend to cloud one’s
judgement in some cases.”

- High school teacher (Eswatini)

Similarly, some of the teachers expressed concerns about
teaching certain CSE concepts because they conflict with
their personal values. Consequently, they are likely not to
adequately cover some topics. They felt talking about sex
related topics may encourage learners to engage in sexual
activity. Teachers also felt that their values did not match
the curriculum guidelines on CSE. In other words, they face
a dilemma in terms of what the scope of the CSE topics
should be and what they feel comfortable to teach. There
was significant inclination towards promoting abstinence
or discussing topics surrounding growth and development,
such as menstruation, as these fitted well within their
comfort zone.

62 See article in Uganda media on the debate on CSE https://capitalradio.co.ug/
news/2016-09-09-the-sex-education-debate-has-been-blown-out-of-proportion-
unfpa/.

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“In my class of Senior 6 when I am teaching a The lack of teaching resources or TLMs was equally
topic about family planning in Christian Religious mentioned as a concern as far as teaching learners with
Education, I do not feel comfortable because disabilities was concerned. Some of the teachers at special
when we are talking about sex, it is as if I am schools indicated that they could not effectively teach
encouraging them instead.” because the sign language is limited with respect to the
concepts in SRH.
- Secondary school teacher (Uganda, peri-urban)
“Sometimes due to communication barriers, I’m
In addition, some male teachers felt uncomfortable teaching not able to teach… because most of the concepts
some CSE topics such as menstrual hygiene to female we use don’t have signs so when it gets there it is
learners, and other teachers (both male and females) felt very difficult to explain those concepts for them to
uncomfortable teaching about sex to older learners. Male understand.”
teachers opted to either use what they termed ‘diplomacy
and courage’ because they had to teach anyway. - Junior high school teacher (Ghana, peri-urban)

Overall, the clash between teachers’ beliefs/values and the This gap in TLMs is, however, being addressed by the
teaching of certain CSE topics was one of the challenges that countries. For example, the Government of Zambia, in
negatively affected the delivery of CSE. collaboration with UNESCO, supported the development
and finalization of CSE learner and teacher books for Grades
Teaching and learning materials 5-7 and 8-12. The books were piloted in schools across
seven provinces63 reaching a total of 11,760 learners and
Teachers and head teachers confirmed what learners had 294 teachers in 36 schools in 2015. However, the learner and
observed regarding the inadequate availability of TLMs. teacher books for Grades 7 and 12 were only printed and
distributed in July 2020, and there is still a short fall of about
“We don’t have adequate learning materials for 1,521,604 CSE textbooks for Grades 5-1264. This compromises
students with disabilities but for those without at the delivery of CSE.
least we have some learning materials. We have no
materials for demonstrations. Teachers just draw In Uganda, the PIASCY reached up to 15,000 schools
on flip charts.” countrywide covering both government and private
schools, and the distribution of PIASCY textbooks is
- Special needs primary school head teacher (Malawi) ongoing. In addition, the School Health and Reading
Programme (SHRP), funded by the United States Agency for
“We do not have materials for teaching CSE topics! International Development (USAID) is a recent programme
Just as I said the TLM is used to demonstrate, but that embraces the component of CSE, which has reached
for us to get a real material… even a chart or more than 547,000 children in 2,067 schools with HIV and
picture displaying a pregnant girl, we do not have.” AIDS prevention education65. Furthermore, the MoES has
published a book providing guidance on CSE-related matters,
- Primary school teacher (Ghana, rural) including menstrual hygiene management.66

In Eswatini, UNESCO has assisted in the development of G&C
LSE teaching syllabus and teachers’ handbook, as well as
providing the ‘Our Talks’ parent-child communication (PCC)
manual. In 2014, the MoET, in collaboration with UNESCO,
also supported the development of handbooks for teachers
titled Guidance And Counselling Life Skills Education for all
levels.

63 Luapula, Northwestern, Eastern, Muchinga, Western, Copperbelt, and Southern.
64 UNESCO National Office.
65 See RTI International website: https://www.rti.org/impact/supporting-child-

literacy-and-health-uganda.
66 UNESCO National Office.

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4.3.4 Factors influencing CSE delivery for Multisector collaboration: MoE collaboration with other
learners line ministries, such as for gender, youth, health and social
welfare, as well as with technical working groups, civil
Facilitating factors society organizations (CSOs), and development partners has
facilitated the implementation of CSE. In Malawi, for example,
The overall effectiveness of CSE depends on many factors, the Department of Teacher Education, which has the
including the policy environment, the quality of training for mandate for teacher training, covers issues related to training,
teachers providing CSE, orientation of head teachers, the the Ministry of Youth and Sports provides policy guidance
availability of instructional materials in terms of textbooks on issues pertaining to young people and on implementing
(including those for LWDs), time available for instruction, and CSE for out-of-school youth, and the Ministry of Health and
family involvement and community participation in matters Population provides youth-friendly services and information.
related to CSE. In Uganda, there are linkages between the MoES and the
Ministry of Gender, as well as an intersectoral committee
National level factors on violence against children and the National Coalition for
Menstrual Hygiene Management.
International benchmark on CSE: The CSE curricula for
the six countries in the study are based on the ITGSE, Integration of CSE in curricula: There are two predominant
which allows for comparison and comparability with other ways that CSE is offered in schools: it is either delivered
countries around the world. Learners, school managers, as a standalone curriculum or subject, or integrated into
teachers, and community members were all satisfied with several subjects and activities in the school curriculum.
the comprehensive nature of the topics that make up the The structure and content are thus uniform, standardized,
CSE curriculum. Learners were especially appreciative of the and consistent across all schools in a country. A national
content and focus of each of the eight CSE topics.67 respondent observed the following about the pros and cons
of integrating CSE into other subjects:
Policy environment: A review of literature indicates that
the governments of the six countries in the study have all “Normally the best way to bring in the
put in place policies and strategies that create a conducive contemporary issues, social issue is to integrate
environment for the implementation of CSE in schools. A or infuse them into different subjects, but when
number of policies were developed between 2012 and you integrate and infuse the danger is that you
2020, including those addressing ASRH, life skills-based CSE, lose the ability to determine whether the subject
out-of-school CSE, ending child marriage, YFHS, teenage is being taught, especially given that schools are
pregnancy and re-entry to school, and violence prevention exam-focused. Therefore, it is important that after
and response (refer to Annex 2).68 This was corroborated by integrating and infusing CSE into these subjects,
key informants who expressed the view that the countries we must be in a position to actually say ‘how do
had an adequate legal and policy framework to facilitate we intercede it to be examinable?’”
CSE delivery in schools. Moreover, the MoEs support the
deployment of resources for CSE learning and monitor its - National level respondent (Botswana)
implementation. However, there were some policies that
have been developed but still await finalization or approval Monitoring of teaching of CSE in schools: The Education
in Botswana, Eswatini, and Uganda, to which key informants Management Information System (EMIS) has data collection
noted that the process should be hastened, specifically: tools that help to monitor and evaluate teaching and
learning in primary and secondary schools. In Zambia, for
· The School Health Policy, which is the overarching example, CSE is monitored by the MoGE through the Annual
policy for delivery of CSE and SRH services, needs to be School Census form, which is used to collect various types
approved in both Botswana and Uganda. of information, including pregnancies and dropout rates. To
confirm whether schools had standardized monitoring forms
· The MoH in Eswatini needs to finalize the STI guidelines specifically for monitoring the teaching of CSE, the MoGE key
so that there is a proper link between learners and health informant pointed out that:
workers.

· Guidelines for implementation of the national sexuality
education framework in Uganda needs to be developed
by the MoES.

67 1) Human body & development; 2) Values, rights & culture; 3) Gender; 4) Violence &
staying safe; 5) Relationships; 6) Skills for health and well-being; 7) Sexual behaviour;
and 8) Sexual and reproductive health.

68 Note that the policy titles may differ per country, but all address related issues.

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“The Ministry was able to review the head teachers However, other head teachers explained that they were
monitoring instruments to capture issues of CSE. only able to supply limited support and felt constrained to
Of interest in this context are things like enrolment effectively implement CSE due to challenges of inadequate
figures, vulnerable learners, dropouts, and early capacity of the schools brought about by an insufficient
pregnancies. The tool pursues further to find the number of teachers, even for other subjects, leading to
reasons for increased cases of dropouts and early heavy workloads among teachers and lack of orientation,
pregnancies.” specialized trainings, and refresher courses, particularly in
matters related to SRH.
- MoGE-HQ (Zambia)
Pre- and in-service teacher training in CSE: Governments
In Malawi, UNESCO has been pivotal in supporting the review continued supporting pre- and in-service CSE training
of the teachers’ manual to integrate sex and sexuality; review through TTCs, thus improving the capacity of teachers to
of the school census checklist to include questions on life deliver CSE effectively, as noted earlier by some teachers.
skills; and integration of these indicators into the monitoring Despite the gaps noted on the cascading model, those
tool to gather data on LSE/CSE teaching. This was followed trained under the model oriented their counterparts at their
up by the training of EMIS officers on LSE/CSE data collection schools. Others indicated that they have been equipped to
and analysis. teach CSE as a result of workshops they have attended. One
of the participants had this to say:
The barrier of limited monitoring of CSE was raised mainly
by Botswana, Eswatini, and Uganda. As further discussed “Thanks to the various NGOs in the district, we
under section 4.3.4.2, indications are that there is a lack of are taken through various training concerning
monitoring and evaluation (M&E) tools that are specific to reproductive health and STIs and others, so when it
CSE. comes to the discussions on those things it always
makes it very simple because more demonstrations
School-level supporting factors are done and proper practices are studied.”

The teaching of CSE encompasses several aspects, including - Junior high school teacher (Ghana, rural)
the content of the curriculum, adequate training of teachers,
appropriate teaching methods, a friendly classroom Available TLMs: Quality teaching in general, and most
environment, and training and orientation for teachers. importantly, in CSE, requires the use of appropriate and
To ensure the quality of instruction and delivery, the effective TLMs to communicate well to the learners and
availability of trained teachers, and their knowledge, skills, enhance understanding of topics being delivered. For
and willingness to confidently teach are essential. Equally, example, teachers in Zambia indicated that the availability
an enabling and congenial social environment free from of TLMs for Grades 5 to 12 had the greatest influence on
distraction and influences constitutes a key aspect needed the content and delivery of the curriculum. However, most
for successful CSE instruction. participants reported the lack of TLMs in their respective
schools, notwithstanding the syllabi and textbooks for the
Orientation of head teachers on CSE: In many cases, subjects that have topics on CSE. As such, some of the
sensitization of head teachers on CSE enabled them to teachers improvised and looked for teaching materials and
appreciate and support their schools in the training of teaching aids to facilitate the delivery of CSE.
teachers and cascading of the training to other teaching
members. Through this orientation, they were able to share “I have some charts, I did it myself while I was in the
information with their staff on the importance of CSE and university, that is the male and female sex organs
its benefits to the learners. They further supported the and the menstrual cycle so when it’s a reproductive
delivery of the subject by providing TLMs, and ensured that health class related to that, I bring them to school.
the subject was taught even where it was not examined. Sometimes, I use pictures from their textbooks.”
They also added the subject into the school timetable and
supported their teachers to attend workshops. - Senior high school teacher (Ghana, rural)

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