Unesco CSE Study on Attitudes and Perceptions 2022

“I get a projector from the school, I download Positive learner attitudes: Learners’ expressed motivation
certain learning things when coming to teach, and and interest in the learning of CSE. Learners mentioned that
we [learners and teacher] move to the IT lab and I CSE learning was relevant and assisted them to navigate
use the projector to teach them.” the changes they experience during adolescence, such as
puberty, handling romantic relationships, and dealing with
- School club head, junior high school (Ghana, urban) violence. They also acknowledged that CSE helped them to
attain their future career aspirations.
Classroom environment: The classroom constitutes a
vital platform for the teaching and learning of CSE. With School clubs: School clubs facilitated the sharing of CSE
issues on SRH rarely discussed publicly, and less at home, information and bringing experts on different topics to
the classroom becomes an effective platform for teachers their schools. School clubs such as the Agents of Change
to teach, and for learners to express themselves freely. In and Glow Club (Zambia) covered all the CSE topics in their
this study, the results showed that teachers and learners club meetings. Other clubs that focussed on culture or the
do express themselves freely without any direct internal or environment, such as the Culture Club and Chongololo,
external restrictions. also covered CSE issues, especially those aligned to culture.
Members of the Culture Club indicated that the club had
Training and workshops: Teachers participated in helped them handle sexuality-related problems. Members
workshops and refresher courses to try and improve the from school clubs indicated that they receive additional
teaching and learning of CSE. They also employed different information on CSE topics from platforms like DREAMS,69 a
approaches, such as co-teaching and inviting guest speakers USAID-funded initiative which complements the information
and professionals to give talks on topics they were not they receive in school (from teachers or friends), home, and
confident and/or comfortable teaching, demonstrating their church.
commitment. Some of the schools benefitted from training
workshops which were often organized by NGOs: Community-level factors

“Right to Play and Discovery Learning Alliance Community awareness and buy-in to the teaching of CSE:
(DLA) came into the system. With Right to Play, The findings of the study indicate that the community were
they educate teachers on HIV so that, at least, as aware of the teaching of CSE in schools and of the content
a teacher, every lesson that you take the students taught. Most community members, including parents,
through a little bit of information on HIV is to be support the teaching of CSE, aside from their concerns
added for the child to have some knowledge about regarding the starting age for learners to receive CSE and
HIV and how to prevent him/herself from it…I the reservations on some topics, such as marriage. Moreover,
think with DLA, which was between February- teachers, heads of schools, and the community jointly
March this year, they organized a training worked together to ensure that teaching and learning were
workshop for boys and girls club mentors with the conducted according to the standards and regulations set by
community and the head teachers and we looked government as well as the SMC/PTA70.
at gender stereotyping … because when you
are talking about reproductive health it also cuts “The PTA through mother groups is also supportive
across gender.” of our school. They hold sensitization campaigns
to encourage students to avoid teenage
- Primary school teacher (Ghana, rural) pregnancies, HIV and STIs. They encourage those
girls with pregnancies to seek re-admission after
delivery. They also help on rape cases.”

- Primary school head teacher (Malawi, rural)

69 DREAMS: Partnership to Reduce HIV/AIDS In Adolescent Girls And Young Women |
USAID.

70 SMCs and PTAs include representatives from the community comprising parents
and community leaders.

49

© UNESCO One community leader commended the work of rural health
motivators in supporting learners with problems related to
their growth. In his own words:

“Some of the learners in my community are
orphaned and vulnerable. Without the guidance
and support of their parents, these young people
become the target of wolves who entice them into
sexual relationships. This often results to teenage
pregnancy, child marriages and unsafe abortion.
That’s where the important role of rural health
motivators comes in terms of educating and
supporting these vulnerable young people.”

- Religious leader (Zambia)

Contribution of parents: Parents are expected to
complement the efforts of teachers. The results from the
study showed that most of the learners received information
on SRH issues from their grandmothers, mothers, and the
church or mosque, all of whom focused on ‘abstinence only’.
Further, the evidence showed that the transfer of knowledge
from the parents to the adolescents was done to put fear into
the learners in an attempt to prevent teenage pregnancy.

“I had my knowledge from my grandmother when
she used to tell me to avoid sleeping with men
when I’m not married so since then I have decided
to train my children the same way.”

- Parent, female (Ghana, rural)

Contribution of NGOs: Several NGOs in the countries
whose activities fall in the domain of ASRH, such as Right
to Play and DLA in Ghana, Youth Net and Counselling
(YONECO) and CAMFED in Malawi, and Organized Useful
Rehabilitation Services (OURS) in Uganda contributed
towards the implementation of CSE. Some of these NGOs
were mentioned by the participants as supporting schools
in diverse forms, but mainly through the provision of SRH
information and materials to learners and teachers, and
logistics for the teaching and learning of CSE.

50

Community support structures reinforcing CSE: Youth clubs For example, in Uganda, monitoring of CSE is often
set up by various NGOs and community-based organizations integrated within the regular subjects of the curriculum,
(CBOs) cater for both in- and out-of-school youth and and there is no uniformity during monitoring due to
provide information about SRH, including HIV and AIDS lack of standardized tools. This may be because the
issues, as well as building life skills such as decision-making, national framework on sexuality education has not been
self-esteem, and resilience. Mother groups working hand-in- implemented and hence the operational guidelines and
hand with teachers and headmasters were also functional, monitoring framework are yet to be developed. As such,
especially in areas where girls dropped out of school due to monitoring is done in an ad-hoc and non-standardized
early pregnancies in order to encourage them to go back to fashion with regard to frequency and indicators used to
school after delivery. measure progress of CSE delivery, as explained below:

“Myself, I go to Namikango AIDS Youth club. We “In terms of standards…it is not there... but since
do discuss issues of SRH like STIs; how they may sexuality education is embedded in other subjects,
be prevented, and transmitted but also how a girl it is monitored like any other subjects.”
can become pregnant. We do discuss that when a
girl has just finished experiencing menstruation if - Key informant (Uganda)
she sleeps with a man; she can get pregnant right
away.” One of the attractions of integrating CSE into the core school
curriculum is that doing so effectively ensures that CSE is a
- Secondary school learner (Malawi, rural) cross-cutting issue or subject that is covered across several
subject areas, as opposed to it being a standalone, isolated
“YONECO sensitizes us on how we can prevent subject that is the mandate of one department. On the other
wayward behaviours by participating in youth hand, integrating CSE may make it difficult to monitor its
club activities, such as playing football and netball, delivery. Often, the responsibility of what and how much
and teaches those who cannot manage to abstain of the CSE content is covered and how, is left to the class
from having sex about ways of using condoms.” or subject teacher. Thus, it becomes almost impossible to
monitor the delivery of CSE across the different subjects into
- Secondary school learner (Malawi, rural) which its content is integrated.

Barriers to delivery of CSE In addition, when non-examinable, it becomes difficult to
determine or evaluate its learning outcomes. Moreover,
The results from the study identified several challenges both teachers and learners might not give it the time or
that affect the effective delivery of CSE. Among these were seriousness it deserves. In Botswana, for instance, CSE does
lack of monitoring of CSE, inadequate resources (including not form part of teachers’ performance appraisal landscape
CSE TLMs), insufficient number of trained teachers on CSE, and therefore, when other examinable subjects compete for
teachers’ lack of capacity to deliver CSE, inadequate number their time, it is often not prioritized.
of trained teachers for LWDs, limited supervision, and
insufficient time allocated for CSE. Religious and cultural It is important, therefore, to find creative ways of ensuring
beliefs, as well as poverty, were noted as barriers to CSE that CSE delivery can be monitored, and to ensure that
delivery as well. teachers are supported and motivated to deliver CSE in
innovative ways. Finding ways to evaluate the learning
National level barriers outcomes of CSE content separately from those of the
subject into which CSE is embedded is also needed.
Limited monitoring of CSE learning outcomes: This issue
was mainly mentioned by respondents in Botswana, Eswatini,
Malawi, and Uganda, who indicated that there is a lack of
M&E tools that are specific to CSE.

51

“What I am saying is that when you bring a Insufficient number of trained teachers: Along with there
concept like this one, which is a very critical not being enough trained CSE teachers, most school
concept, you must be able to say how adequately managers and teachers noted that even the teacher training
you have taught it; we need to have instruments of CSE curriculum does not do enough to prepare teachers to
measurement, some tools so that we can monitor teach CSE. Those who are qualified to teach both CSE and
delivery and evaluate the impact…. This is the gap special education to allow them to teach CSE to learners with
we have in as far as CSE delivery is concerned.” disabilities are even fewer. The following quotations highlight
this gap:
- National level respondent (Botswana)
“I do not want to conclude that our teachers
“We do not have special guidelines or rules that training, or pre-service programmes are adequate,
inform the way teachers should conduct their the Ministry has engaged consultants to carry out
lessons.” a study on pre-service and in-service of teachers
to include some of the things that we talk about
- KI, MoGE (Zambia) today. We are outdated with the way we train our
teachers.”

- National level respondent (Botswana)

“Inspectors must visit schools and help identify “We should be provided with in-service training.
things that need to be done in order to [make] the Either the school, health professionals or the
subject a success. Since the subject is not inspected, Ghana Education Service can organize regular in-
I am not sure if the teachers are doing the right service training on topics in RHE for us.”
thing.”
- Junior high school teacher (Ghana, peri-urban)
- High school deputy head teacher (Eswatini)
“I have never trained as a specialist on this subject,
Inadequate resources: Key informants concurred that the am teaching through what I learnt from college.
resources allocated to CSE were insufficient. As a result, We just teach with the little knowledge we
adequate orientations, trainings, and refresher courses acquired from the teaching college.”
for teachers, TLMs, and resource persons for some topics
cannot be delivered, thus impacting on the delivery of CSE. - Primary school CSE teacher (Malawi, rural)
Cooperating partners, particularly UNESCO, United Nations
Population Fund (UNFPA), and UNICEF were supporting the School-level barriers
government with technical and financial support for various
interventions, including the provision of books. However, Insufficient capacity to deliver CSE: The majority of teachers
the need for more resources is always there. In addition, in pointed out that they did not have adequate training to
the realms of inclusive education, LWDs, particularly those in effectively teach CSE. Most mentioned that they also did not
mixed schools, did not have all the teachers they required to have adequate TLMs, such as teaching aids and books. One
meet their needs, such as those that knew sign language. teacher expressed that the subject needs a lot of researching
as things change with time.

52

“You never have adequate knowledge for CSE “The other issue is the clientele, i.e., the teacher-
because there are new trends; there are new students ratio; every time when we have a
teaching methods and also new experiences, and qualified guidance and counselling teacher, the
new things that you encounter everyday so you challenge will be that the poor teacher is expected
cannot really say you have enough knowledge. to be handling huge enrolment, and they cannot
You have to keep on researching, keep on looking cope and cannot help the kids, more especially
around for new and innovative ways of teaching when they are supposed to provide individual
the subject.” counselling, even if she/he can group and teach
them but some of the students will require one to
- High school teacher (Eswatini) one counselling, imagine if one person has to offer
a load of over 1,000 students and expected to be
“I have not been trained to teach sexuality doing a good job.”
education, but I search for the information myself
to teach. As a female teacher, I [also] know some of - National level respondent (Botswana)
the needs of young girls better. I search through the
internet to search for information and teach them. Lack of CSE teaching aids and learning support material:
I sometimes refer to the textbooks on Religious and Generally, learners, teachers, school administrators, and
Moral Education and Social Studies to teach.” national level respondents have confirmed the dire shortage,
and in some cases total absence, of CSE teaching aids and
- Senior high school teacher (Ghana, urban) learning support materials (guides, reference materials or
charts) in most schools, which reduces effectiveness of CSE
Moreover, the teachers who are qualified to teach CSE often delivery. The TLMs influence the understanding of CSE in
face heavy workloads in the form of staff-student ratios, as diverse dimensions, including practical demonstrations
demonstrated below: and physical models to replicate the reality of abstract
information. The lack of teaching aids and learning support
“The big problem is the workload. If possible, materials is an especially limiting factor for delivery of CSE
maybe there should be a teacher who specializes content to learners with disabilities. In addition, CSE must
in G&C LSE, I think that way would be perfect.” now cover issues relating to new, emerging, and alternative
sexualities, such as same-sex relationships, but teachers and
- High school teacher (Eswatini) service providers lack reference and support materials to
use. As one health worker attached to one of the schools
observed:

“Nowadays we have several sexualities being
expressed, like we have lesbians and gays, men
who have sex with men (MSM) we have them,
however, the sexual health service is really tailored
or welcoming to sexual minorities. Even the IEC
materials, you cannot find poster as a gay man, or
same-sex couple, for example.”

- National level respondents (Botswana)

53

“If we get teaching and learning materials, that will As such, the topics that cover knowledge and services
be fine, but for the school having specific teaching pertaining to contraceptive and condom use were
and learning materials for CSE education, we don’t admonished by the religious leaders. In this study, it was
have.” noted that religious influence made teachers and learners
feel uncomfortable when certain sensitive topics were
- Junior high school teacher (Ghana, urban) discussed as well.

“Inadequate teaching and learning resources. Our “The challenges have to, first of all, do with religion.
teacher draws his own picture while some schools With some people, per their religious background,
have real pictures and model organs, but he draws will not want their children to learn about RHE. If it
on a flip chart. They don’t look nice.” is a mission school, for instance, you should know
the background of such school, and the interests
- Primary school student (Malawi, urban) the mission school has in RHE.”

Limited time allocated for CSE: Head teachers complained - Senior high school head (Ghana, rural)
about the insufficient time allocated to teach the subject.
In Eswatini, for example, only one period per week of 35 Parents concurred with this sentiment, for example:
minutes is allocated, which was not enough to effectively
teach the subject. The head teachers noted that specialized “On a religious level, talking about the use of
training is needed to improve the teaching and learning of contraceptives is considered as killing an unborn
the subject, besides the workshops conducted periodically. baby. Our religion is against abortion and we do
not allow or talk about it.”
Community-level barriers
- Parent (Zambia, rural).
Role of the community: While parents and community
showed support for CSE, there is nevertheless a recognition Influence of culture: In this study, cultural norms and beliefs
that they generally find it difficult to discuss sex and emerged as a significant factor both at community and
sexuality-related matters with their children, and are thus not personal levels. While the influence of these has weakened
playing their full role when it comes to reinforcement of the overtime, they nevertheless exert an influence at community
CSE messages at home. and personal levels in certain contexts, such as among the
most rural, poor, poorly educated, or elderly populations.
Influence of religion: Religious and cultural norms and values At personal level, these beliefs and norms acts as a barrier
have a strong influence on the uptake of CSE information against positive reinforcement of CSE messages by making
and overall implementation. In Zambia and Uganda, for parents feel unable or uncomfortable to discuss CSE content
instance, CSE faced strong opposition from the custodians with their children.
of religion and culture, to the extent implementation was
halted for a period of time. Religious barriers included a “We advise students not to have early sex but these
mismatch between religious teachings and CSE, with the students were initiated at initiation ceremonies
topic of sex being seen as taboo and not something to be where they were taught to prove that they are
talked about openly, especially to young children. In addition, grown up by having sex. They look down upon
it was noted that in spite of evidence showing that AYP are what we teach.”
starting sexual activities earlier, some religious leaders still
believed that there should be no sex before marriage and - Primary school CSE teacher (Malawi)
that any illicit sex constitutes sin. Moreover, some religions,
especially the Catholic and Muslim faiths, discourage the use
of family planning services and the use of condoms, instead
encouraging abstinence.

54

Poverty: The issue of poverty as a challenge to effective Conducive policy environment: Overall, the policy
teaching and learning of RHE was discussed during the environment is conducive for supporting the needs of
validation workshop by a few participants. The argument was learners with disabilities (see Annex 2). For example, the
that material poverty, in several instances, prevents some of MoET in Eswatini mentioned that it has formulated policies
the female learners putting into practice knowledge gained and implementation plans for CSE for LWDs, including
from CSE, such as negotiating safer sex: increasing the number of special schools to offer specialized
education for learners with special education needs. The
“I also emphasize the fact that poverty also School for the Deaf, for instance, was built to offer high
plays a very major role in this…All that the child school education for learners with hearing impairment.
needs, especially at the basic school are basic
materials – school uniform and food, and these School level factors
basic needs have become very difficult to get by
some of the learners in some public schools. This Availability of trained teachers: LWDs were highly
forces the children to go out to do what they are appreciative of the presence and availability of teachers with
not supposed to do; this aspect alone is what is special training, who understood their needs and way of
undermining our [teachers] progress.” communication. In addition, they recognized the importance
of CSE knowledge and skills and its impact on their daily lives.
- Primary school head (Ghana, urban) The learners were aware, however, that not all LWDs have
access to qualified teachers or schools where the needs of
4.3.5 Factors influencing CSE delivery for LWDs LWDs are catered for.

Facilitating factors for LWDs “In school we have a Disability Unit, we can talk
to them, we rely on them for support. Basically,
The facilitating factors for LWDs mirror those discussed they look after our well-being. They protect us
under section 4.3.4.1 for other learners. This section will from exploitation or abuse; through the skills they
therefore expand on issues specific to LWDs, which include a give us; and we can report and discuss any issue
conducive policy environment and teacher training (national that affects us, as LWD, so that we can focus on
level); availability of trained teachers, LWDs enthusiasm learning.”
for CSE curricula, positive attitudes of teachers, teachers’
strengthened capacity on CSE teaching methods, and - LWD, female (Botswana, urban)
availability of user-friendly TLMs (school level factors); and
community and NGO support. LWDs’ enthusiasm for CSE curriculum: LWDs generally
displayed enthusiasm for the CSE curriculum and expressed
National level factors their willingness to learn the subject. The learners displayed
a sense of confidence and readiness to engage with the CSE
Pre- and in-service training of teachers: There is curriculum, which they saw as a way of addressing a myriad
commitment to improve teacher training to incorporate CSE of other problems that affect them as LWDs.
and to ensuring availability of teachers qualified to delivery
CSE and other content to LWDs, as shown, for example “They make the environment more conducive for
by the review of pre- and in-service teacher training in us to relate better with them. We feel much more
Botswana during the time of this study in order to address comfortable, valued, and respected, and can
issues relating to relevance and adequacy of teacher training extend the same respect to others.”
curricula, teacher qualifications, and availability of qualified
teachers to ensure effective delivery of content in schools. - LWD, male (Botswana, urban)
The learners expressed appreciation for special needs schools
for providing specialized teachers who could communicate 55
with children with different disabilities and enable them
to learn CSE concepts, in addition to providing support for
learners to promote their independence such as support
for walking, proper toilet facilities suitable for students who
are physically impaired, and provision of menstrual hygiene
information and sanitary materials.

“Students become so excited and inquisitive Availability of user-friendly TLMs: Learners noted that
to know more about SE, and they are always the availability of sign language teachers and the required
attentive.” learning materials, especially CSE books, braille work, and
tactile and visual aids were some of the most important
- Primary school LWD (Uganda) factors facilitating the learning of CSE. During the study
findings validation workshop in Ghana, it was shared that
The LWDs also expressed that they are comfortable in the the MoE, through the Ghana Education Service (GES), had
learning environment because they are accepted, embraced, developed a dictionary for sign language to complement the
and supported just like learners without disabilities. delivery of CSE in special schools with learners with speech
and hearing impairment.
Positive attitudes of teachers: It was observed from the
learners that the teachers had positive attitudes to the “The sign language dictionary is already out and
teaching of CSE, and had cordial relationships with the there are plans to meeting with the GES fraternity
learners in discussing SRH issues. Positive attitudes towards and the Ghana health service and the media [to
the teaching of CSE provides a broader space for the learners discuss it].”
to interact with the teachers, often even after instructional
periods. As expressed by one of the learners: - GES official (Ghana)

“We feel very comfortable to approach a teacher to The study showed that most of the teachers used the
inquire information on RHE related issues.” available TLMs or improvised to support the teaching of
CSE. One special school in Eswatini, for instance, highlighted
- LWD, Ghana the use of software to project books and visual aids to assist
learners to master the concepts better, while in Zambia, one
Strengthened capacity on CSE teaching methods: teacher indicated that just before the lesson was conducted,
Capacity-building workshops provided the teachers he would ensure that he organizes aids which are tactile
with an opportunity to learn and be creative on how to (which means they can feel with their hands) in order for the
deliver CSE. Teachers in Malawi and Eswatini separated learners to feel what is being talked about in the lesson.
learners by disabilities or sex for proper delivery and use
of sign language, while Zambia and Malawi rearranged “We make tactile visual aids for teaching; I can give
the learners’ sitting plan to enable learners with visual and an example you draw and then you put a thread
hearing impairments to sit in the front rows to facilitate or beads which pupils can feel.”
teaching and learning. In Uganda, the teachers created a
buddy system where LWDs support one another or non- - Secondary school teacher of LWDs (Zambia)
disabled children support a LWD. This included interpreting
illustrated information for blind students and the pushing Community-level factors
of wheelchairs for physically disabled children to the CSE
class. One teacher from Zambia informed the researchers Community support: The parents and teachers recognized
that he believed pupils learn better when they discover that LWDs were more vulnerable because they may not even
for themselves. In his teaching, he used activities such as be able to protect or defend themselves should someone
discussions, reading comprehensions, and expositions or try to molest them sexually, and CSE lessons provided them
provocative questions in order to engage them. In instances with an ideal platform for acquiring information to reduce
where they were given comprehension, he would ask them their vulnerability to such abuses. Teachers were supported,
to read and discuss in class. He would come in to clarify any and the teaching of CSE has been accepted by parents and
misconceptions that learners may exhibit, and where learners members of the community, which encouraged the teachers
were showing limited knowledge. However, he emphasized to do their work freely and improve the delivery of CSE
that in all discussions a level of sensitivity was used, to make lessons. This recognition of the importance of parent-teacher
learners comfortable with what was being discussed. collaboration and the willingness to do what is necessary
to support delivery of CSE in school is a potential resource
56 that can be leveraged through innovative ways of engaging
parents and communities with schools.

Support from NGOs: Several NGOs also support special © UNESCO
needs schools with TLMs for the teaching of CSE. In
Uganda, for instance, NGOs such as OURS71 assisted LWDs
by providing technical support on disability management.
Other NGOs and neighbouring universities also supported
LWDs through SRH education and provision of menstrual
hygiene sanitary materials. As a head teacher of a school in
Ghana pointed out:

“There is this NGO based in Tamale that has
provided us with a television set and CDs (the
videos) containing some of the topics in it so when
they are teaching and the need arises they play
[put them on] to the pupils.”

- Junior high school head (Ghana, peri-urban)

Barriers to CSE delivery for LWDs

The major factors that influenced the delivery of CSE to
learners with disabilities according to the findings of the
study were the inadequacy and non-availability of CSE TLMs
for learners and teachers, insufficient number of trained
teachers skilled in handling learners with special needs, high
number of teachers not trained in CSE, lack of confidence
of teachers, influence of cultural and religious orientation,
communication gaps due to lack of teaching aids (in braille,
audio and/or, audio-visual), suitable classroom seats for
children and ramps for ease of movement for learners with
visual impairments and physical disabilities, and psychosocial
challenges such as discrimination and stigma from peers or
community members. While most of these barriers are similar
to those faced by other learners, when it comes to LWDs,
these challenges are worse in magnitude and impact. This
section will present the barriers that are specific to LWDs to
build on those presented in section 4.3.4.2.

National-level barriers

Insufficient number of trained teachers for learners with
special needs: One factor influencing the delivery of CSE
as mentioned by key informants at national level and head
teachers was with regard to the low number of trained
special education teachers. CSE trainings and support were
not fully tailored to teachers or learners with special needs
and this influenced the extent to which teachers and learners
with different disabilities were able to teach and learn, as
expressed below:

71 http://ruharomissionhospital.org/index.php/department/ours/.

57

“The trainers offering it or front liners offering School level barriers
this service are not well trained, they have their
positions, yes, but they are not qualified, and it is Communication barriers: The study found out that there
never clear the extent to which CSE is delivered, were communication challenges between teachers and
especially because they must balance it against LWDs, for example, learners with sight and/or auditory
other commitments.” disabilities required special services like braille or sign
language to interface with CSE materials. Thus, in addition to
- National Level Respondents, Curriculum, Botswana]. being qualified in CSE, the teacher required a qualification
that allows him/her to teach LWDs, including those with
sight and auditory disabilities.

“My teachers are not qualified to teach G&C LSE; “There are few challenges that have to do with
they are qualified to teach the academic subjects. communication. You know they are children who
They have attended workshops organized by the use sign language, and to communicate effectively
Career Guidance Department, but I think they are with them you need to be skilful in that area. I
not so capacitated with handling learners with realized that most of the teachers are not that
special needs.” good at communicating with the sign language
so we fall on the few who are good at the sign
- High school for the deaf head teacher (Eswatini) language to communicate to them and this makes
it difficult for the teachers to deliver RHE effectively
“Not all teachers are capable of dealing with these to the pupils. That is the major challenge.”
learners. However, at this school we have specialist
teachers. These are the ones who manage these - Junior high school head (Ghana, peri-urban)
learners with disabilities, but they also get support
from regular teachers because we sensitize them From the perspective of the teachers, there were
on other areas of how better they may support concepts, ideas, and vocabularies in CSE which were
learners with disabilities.” difficult to sign. This restricted the ability of the teacher to
communicate effectively, and for the learners to understand
- Primary school head teacher (Malawi) comprehensively.

“We need more teachers who can specialize in a “One of the major challenges has to do with some
specific topic and teachers who are equally visually of the vocabularies; they are very difficult to sign or
impaired so that they understand what we go express to them [learners] to understand.”
through.”
- Junior high school teacher (Ghana, peri-urban)
- Visually impaired learner (Zambia, rural)
Beyond the classroom, the results showed that the
communication gap occurred at two levels. The first level
had to do with communication among LWDs and their peers
in the community, because those in the community could
not sign, and thus the learners had difficulty sharing their
knowledge gained from CSE with them. The second level
related to communication with parents. As discussed earlier
in this report, parents are expected to complement the
efforts of teachers at home, but as not all parents can sign,
they are unable to serve this role.

58

“We face some challenges especially if we are at “The challenge is that children with disabilities
home! Because the parents and the people around do not understand what I am teaching them.
us do not understand sign language we do not Especially those with hearing difficulties they do
get education on RH, apart from the school that not get anything because of lack of material for
sometimes provides us with information on RH those who are disabled.”
issues, we do not receive any information on RH at
home.” - Primary school teacher (Malawi)

- Junior high school LWD, female (Ghana, peri-urban) “We only have one Grade 11 CSE book which we
use to teach even the Grade 12s, and as I have
Teachers lack of confidence: It was observed that some of mentioned earlier the CSE book is in ink and
the teachers lacked the confidence to teach certain topics, not braille. I rely on other teachers to help me by
especially on sex education. For instance, one of the learners reading the text then I write them down in braille.”
(with a disability) expressed that ‘some of the teachers are not
confident to teach topics on sex.’ - Teacher (Zambia, rural)

Other factors included being uncomfortable with teaching Stigma and discrimination: LWDs often experience violence,
some topics, non-systematic delivery, including elimination isolation, and stigma from their peers, including bullying.
of parts deemed unsuitable for age or those that teachers LWDs, especially those enrolled in mainstream schools with
are uncomfortable to teach, and teaching from experience non-disabled children, expressed that they felt discriminated
rather than following a given curriculum. against in peer relationships and when participating in
common activities, while learners who tried to assist fellow
“SE is not adequately covered…they skip some LWDs, like pushing their wheelchairs, tended to lose out on
details for example when talking about body their own time for classes and other activities. The feeling of
changes, they just give an example without giving being rejected could also influence their active participation
explanations such as hormones that make pubic during lessons.
hair grow and they just mention that a girl grows
breasts so they [learners] will wonder why this “As a disabled boy who is unable to walk, you keep
happens.” wondering whether you will ever find a marriage
partner who is not disabled, or do you have to find
- Teacher for LWDs (Uganda) one that is disabled just like you, so that disturbs us.”

Lack of adequate TLMs: Insufficient teaching and learning - Primary school LWD
materials such as braille books for visually impaired learners
was another impediment reported by teachers, as captured
below:

“Challenges that I face with learners living with “I think this culture of rejecting us has affected
visual impairments is that they don’t have learning us. So, you find that in most things we can’t
material that is brailled. So, you just teach them participate because of the sayings of the people
together with the others. But they do not get access and their beliefs.”
to information or material that is brailled.”
-LWD, Zambia (rural)
- High school teacher (Eswatini)
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Community level barriers 4.4 Learners access to SRH services

Religious and cultural beliefs and norms: Just as in the 4.4.1 Linkages between schools and health
case of other learners, LWDs also faced cultural norms, services
perceptions, and beliefs that act as barriers to effective
delivery of CSE. If parents have challenges discussing Schools are expected to have a collaborative relationship
sexuality with their children or are in denial about the need with health facilities or personnel to complement the
to discuss sexuality with their children, these challenges tend teaching and learning of CSE, as well as to facilitate access
to be more magnified in the case of children with disabilities. to services for learners. This is in line with the multisectoral
approach to addressing the SRH needs of young people,
“In our Setswana culture, talking about sex is as stipulated in the SRH policies for AYP enacted in the
deemed as being vulgar, so we are afraid to talk countries. There are several ways schools can maintain a link
about it at home with our elders or ask for clarity with health services, such as through the provision of health
because we do not want to be victimized as being services within the school, referrals of learners by the school
vulgar or disrespectful of our elders, that why we to health facilities, scheduled health worker visits to schools
prefer to keep quiet about it at home.” and school-initiated health worker visits to the schools, and
sharing of activities between the school and health service
- LWD, male (Botswana, urban) providers in the community, which includes health talks.

Community members, including parents, were aware of However, overall, the study findings indicate that the linkages
the cultural norms and values that make it a challenge for between the schools and health facilities were not strong in
them to openly discuss sexuality with their children, and any of the six countries. The results indicated that, while there
aware of the missed opportunity to reinforce what their was a routine schedule followed by some of the schools and
children learn at school and how this failure to be a source the health facilities attached to the schools for the provision
of information may make the children turn to other sources, of information and outreach services, other schools did
whose authenticity or credibility are not known, including not have a routine structure in place, and instead relied
the internet and social media platforms. on invitations or arrangement with the health facilities. In
Uganda, the links were reported to be weak and infrequently
“As parents we have agreed that CSE can be taught utilized. Likewise, in Malawi, linkages with primary and urban
in schools but there must be sensitivity to age, schools were found to be weak and sporadic, although it was
the content must be age appropriate. However, noted that among secondary schools in the rural areas the
socially and in our homes, we are reluctant to linkages were stronger. Similar sentiments were shared in
talk and be open about sexuality with our own Zambia, in that there were no systematic links. In Eswatini, on
children; however, out there in the community the other hand, four of the five schools that participated in
children hear about it from their peers and the study had existing linkages with health facilities.
strangers talking about it.”
Existing school-based health services
- Community member, female (Botswana, peri-urban)
The findings showed that, although not always strong,
linkages do exist between the MoEs and MoHs in the six
countries, both at policy and at local level. For instance,
in Eswatini, some schools had a nurse either stationed or
attached to the school to ensure easy and confidential access
to SRH by learners. In Uganda, three out of five participating
schools had existing services of a school nurse. The role of
the nurse included providing counselling services, clinical
care for routine infections, and management of specific SRH
challenges, such as menstrual pain and ongoing HIV care
for learners living with HIV. In Zambia, there was an officer
in charge of adolescent health whose mandate was to link
health representatives to schools.

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Referral of students to health facilities “We are only called to do health services when the
school suspects the learner is pregnant, we are
School head teachers and CSE teachers mentioned that called upon to do pregnancy checks.”
they occasionally referred learners to health facilities for SRH
information, services, and commodities. - Health service provider (Zambia, rural)
Designated youth-friendly corners
“We take our learners to [Lugazi HC IV] for Most health facilities have a youth-friendly service, which is
treatment and other services such as counselling tailored to the needs of youths. This could be in the form of
and guidance.” space (like a youth-friendly corner) within a regular health
facility, or it could be a whole facility that is dedicated to
- Secondary school head teacher (Uganda) servicing the SRH needs of youth. For instance, the MoH’s
one-stop centres in Zambia are managed by adolescents
Designated health worker visits to schools hence making the learners feel free to access relevant SRH
information. The quote from a health officer from Ghana
Most schools reported visits of health workers to schools sums this up:
to deliver talks and provide health services for learners. In
Uganda, for example, this was especially conducted during “Our place is a walk-in facility. We have a
national child health days (in April and October every year). reproductive health centre. As soon as you
Services delivered included immunization (HPV, tetanus introduce yourself that you are a youth or student
for girls) and deworming. In Zambia, the schools and the they will just sit you down and address any
health facilities linked for Health Week activities, such as mass question that you [want to] ask.”
community immunization and during monthly school health
programmes where learners were given SRH material. - Health officer (Ghana, urban)
Community outreach
Health worker visits/invites from the schools Conducting and intensifying joint outreach programmes and
activities between the schools, community, and SRH service
Schools call on health workers to give talks to learners providers was seen as one of the ways that learners’ access
about various issues pertaining to SRH, including dangers to SRH was improved. Health facilities brought services and
of early sexual debut and teenage pregnancies, STIs and HIV information to the schools as part of their activities under
and AIDS, personal hygiene (including menstrual hygiene), community service.
contraceptive education, and COVID-19. The health service
providers were also invited to schools through clubs. 61

“Normally, when schools invite us, they give us a
topic to come and talk about. But if it is we who
are going for the health screening for instance, we
also choose our topics. But we don’t just get up and
go, we go to discuss with the [school] authorities.”

- Health officer (Ghana, urban)

In Uganda, in certain cases, health workers were invited
specifically to conduct routine screening for pregnancy at
least once a term in schools, although these visits to schools
were infrequent. Similarly in Zambia, health personnel were
only called upon to conduct pregnancy checks on girls as
was requested by the school authorities, especially when
schools open or if there were suspicions that some girls
could be pregnant.

© UNESCO “We do outreaches and we have a schedule on it,
but in most cases, you will find out that in schools
sometimes it becomes difficult to talk about family
planning, we can teach them about it, but we
cannot give the commodity within the school
premises, an interested learner must make a follow
up at the facility to get the commodities. This
school policy is based on the erroneous perception
that providing these commodities is tantamount
to inviting learners to experiment with sex.”

- Healthcare provider (Botswana, peri-urban)

“We have our child welfare clinic and reproductive
health unit so we don’t actually do it on a routine
basis, and right now because of COVID-19 there is
some form of limitation so we go there when the
school invites us.”

- Health officer (Ghana, urban)

4.4.2 Experiences of access to services for
learners

Provision and access to SRH services form part of CSE and
completes the chain of SRH education. While the school
system mostly provides the information, the health system
provides both information and services required by the
learners. The study observed that nearly all the schools had
some kind of linkage with, at least, one health facility to
provide education and services to the learners. The study
findings indicated that, on average, girls accessed SRH
services more than boys. The commonly accessed SRH
services by girls were STI screening and treatment, missed
menses, family planning, and pregnancy issues, while boys
accessed mainly STI and circumcision services. In Uganda, it
was reported that boys were more confident compared to
girls in seeking SRH services, including testing for HIV and
accessing condoms. This was also noted in Zambia, where
in two health facilities (one peri-urban and one rural) boys
accessed SRH services more than the girls. The experience
of learners in accessing SRH is mostly positive, with many
indicating that they were given the attention and privacy
they expected.

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“Among our club members, there are some that are “Ah! Like in my community, we get help from the
HIV positive, so the club coordinates with health nearby clinic/hospital but the main problem is
workers and book ARVs for HIV positive students.” the way the nurses react towards us teenagers.
Instead of giving us the help we need, they give us
- Secondary school student club (Uganda) a negative attitude.”

- High school learner, female (Eswatini)

“It is the females who are more involved as they “The kind of treatment they get ends up
start earlier accessing contraceptives, unlike the discouraging them from returning. The health
males. In youth-friendly corners, the females stay officials will be picking on them regarding their
longer than the males.” age among others.”

- Health clinic (Zambia, urban) - Health officer (Ghana, urban)

“Female learners are the ones who access SRH However, it was reported that the MoHs have taken steps in
services. This is because they face more issues and addressing these negative attitudes. In Eswatini, for example,
hence, they need services like family planning or it was reported that nurses were now friendly towards
treatment for an STI and when they are pregnant learners and learners were prioritized by letting them jump
the boy will not even show up.” the queue when they attended clinics during school days.

- Health clinic (Zambia, rural) Proximity of health facilities from schools

4.4.3 Barriers for learners’ access to health The issue of long distances to the health facilities was
services highlighted as a major barrier. In this respect, the great
majority of learners did not access these facilities even if
Some barriers were identified that reduced access of they were referred by the CSE teachers at school. However,
SRHR services and information for learners. These included at times, the linkage between learners and health facilities
negative attitude of health service providers, long distances is done by community structures such as youth clubs, local
to health facilities, stockout of commodities, facility-based youth organizations, village health committees, and other
issues, time spent with learners, and the influence of community cadres.
gatekeepers or partners.
“You find when students go to the health centre
Negative attitudes of health service providers they take the whole day, sometimes they will be
understaffed and we therefore normally get other
It was reported that the attitudes of some of the health people to help us because the government health
service providers were not encouraging to the learners when facilities (HC IV) may not offer quick services to our
they wanted to access health services. The behaviour of such learners.”
providers and the attitudes they projected towards learners
were felt to be judgemental and undesirable, as expressed in - Secondary school head teacher (Uganda)
the following quotes:

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Stockout of commodities “The challenge or problem that we face is time
limitation in talking to learners. The other problem
Another challenge that was highlighted was the lack of is that the students are not allowed to have one-
adequate contraceptives and condoms in the health facilities on-one interaction so they are not able to express
for learners who needed them, thus exposing them to themselves well for the health professional to know
unprotected sex and the associated consequences of this. their problems very well to attend to them.”

“For us, we tend to lack supplies to reach out to the - Health officer (Ghana, urban)
youth. For instance, we tend to not have STI drugs.
The issue of sexually transmitted diseases here is The influence of gatekeepers
very high, so when the drugs come in they do not
last long. This is so because for the youth sex it’s not Since adults influence the decision-making of young people,
an issue as I have said.” especially in Africa where the child is expected to obey older
people, this affects the provision of services to AYP if the
- Health service provider (Malawi, rural) adult gatekeepers disapprove of the service, such as family
planning. In addition, AYP might not seek certain services,
Facility-based challenges such as treatment for STIs, if the health practitioners were
from the same community as them out of embarrassment or
In addition to not all health facilities having youth-friendly fear of being recognized. For example:
corners, other facility-based challenges included limited
numbers of health workers, lack of training in provision of “Imagine you go to the clinic and find this old
adolescent health services, and lack of job aids to deliver nurse who is friends with your mum, are you
relevant information. At places where learners or adolescents going to tell her that I have come for an abortion
mixed with adults, service provision was a challenge, as because I don’t want to keep the baby?”
pointed out by one of the participants.
- Learner (Zambia, rural)
“In this facility, we don’t have a teenage maternity
ward. Both the adults and young people mix up. “At government hospitals young people may face
So, when they [teenagers] come and see only challenges with nurses who will interrogate them
adults, they go and don’t return. Some of the clinics harshly. They would ask where they got STIs at the
have an adolescent maternity corner so when they age of 15 years.”
go there, they feel a lot more comfortable.”
- Health worker (Eswatini)
- Health officer (Ghana, urban)
4.4.4 Experiences of access to services for
Limited time with learners learners with disabilities

The study findings showed that the time available for service During the FGDs, LWDs expressed that they were eager to
providers to engage with learners is usually limited, thereby know more and have access to SRH services, particularly
restricting effective service provision. Young people have a condoms and other contraceptive methods. However, they
lot of SRH issues to discuss with health services providers, noted that they needed caregiver support to access the
and therefore adequate time is essential to enable them to services.
express themselves freely, and ask and receive responses to
questions, build confidence, and develop skills to address
SRH problems. Although learners were given first preference
at the health facilities, they were not offered adequate time
to attend to issues because the health workers had to attend
to other patients as well.

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Mixed experiences in terms of access to SRH services for 4.4.5 Barriers faced by LWDs
LWDs were reported, with those in Botswana, Eswatini,
Ghana, and Uganda indicating that they were free to access Over and above the barriers faced by other learners
SRH services and that the health service providers were discussed in section 4.4.3, LWDs are confronted with further
supportive, whereas in Malawi and Zambia, this was not the specific challenges. These include limited communication,
case. LWDs in Zambia indicated that it was not easy access lack of privacy and confidentiality, health facility structural
to SRH services such as contraceptives since the mission barriers, high cost of accessing SRH items and services such
schools don’t allow this. The following quotes demonstrate as sanitary materials, and parental and religious prohibitions
these different experiences: that become more pronounced by their being LWDs.

“When we have period pains we go to the hospital Communication gap
and we are not shy to tell the nurses. They are very
supportive.” The main challenge cited was limited communication
between LWDs and health service providers, especially in the
- Learner, female (Eswatini) case of learners with hearing or visual impairment, who thus
may need a third person to be present to act as interpreter,
therefore compromising their privacy and confidentiality.
While it was difficult for the LWDs to communicate freely
with health service providers owing to the inability of the
latter to sign, it was equally a challenge for other persons to
assist them.

“There is no support for us. After learning, the “First and foremost, bridge the communication
teacher would tell us that we can go to the gap that exist. The health personnel should be
hospital to hear more about how we can prevent taught sign language to be able to communicate
some of the diseases which come because of with us. We are not comfortable to use these
bad behaviour of engaging in sex. So as for us services because there is a huge communication
who have vision impairment we do not go to the barrier. There is very little support at the health
hospital because no one can take us there while post.”
our friends who are able to see they go to the
hospitals to receive advice from the doctor.” - LWD, male (Botswana, urban)

- Special needs primary school learner (Malawi)

“We have a clinic nearby when we go to get “The challenge I also face is who to interpret what I
condoms or go for VCT, our information is say and also what the doctor will say for me when
captured. After some time, the same nurses report I visit the hospital with a health problem. I do not
to your teacher that your pupils come here to get get any information from the doctor or the person
some condoms or get tested.” who would send me to the health facility.”

- LWD (Zambia, rural) - Junior high school LWD, female (Ghana, peri-urban)

Lack of privacy and confidentiality

Another critical challenge shared by LWDs was their reliance
on parents and other care givers to take them to facilities.
SRH issues require privacy and confidentiality but if they
are to be assisted at a health facility, they need someone
to accompany them. This again compromises privacy and
confidentiality.

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“There are long distances to health facilities where The health service providers further explained that learners
SRH services are provided. There is no one to escort are more concerned about getting pregnant than STIs.
us there because we have vision impairments. So, The reason for this was, according to the results, the fear of
we depend on our parents to go with us and they dropping out of school due to pregnancy compared to STIs,
are the same parents who say no to sex. So, we just which could be treated. Additionally, health service providers
stay home.” reported that a few female learners had approached the
health facilities seeking legal abortions, while others sought
- Special needs primary school learner (Malawi) medical care after illegal termination of a pregnancy.

In addition, lack of confidentiality and unethical or The other dimension of the health service providers’
discriminatory behaviour exhibited by health personnel experience had to do with how learners reacted to STIs. It
made it difficult for LWDs to access SRH services. For was observed that the learners did not seek services as early
example: as possible when contracting an STI. This could possibly be
explained by the risk perspectives of the learners, as follows:
“I was suffering from rashes in my private parts.
They just gave me a letter to go to Chipata General “What they are most scared of is pregnancy.
Hospital but after my colleague also suffered the Because they feel that one [pregnancy] is going to
same disease the nurse there was saying that I cause a halt in their education. So that one, they
think your colleague is the one who gave you this are scared! They know that after all the sexually
disease. And we have found him with STIs, I was transmitted diseases can be treated.”
confused.”
- Health officer (Ghana, urban)
- LWD (Zambia)
“Students, mostly boys come for circumcision and
Health facility structural barriers individually pick condoms, because they hear
those circumcisions prevent one from getting
Long distances to health facilities, which is already a barrier to HIV and for the adolescent girls they come for
access of SRH services for learners with mobility challenges, family planning methods usually -pills and the
was often compounded by the physical structures of health injectables.”
facilities that made it difficult for LWDs using wheelchairs to
manoeuvre because there were no ramps. - Health worker (Uganda, rural)

4.4.6 Health service provider experiences of Health service providers concurred with learners on the
access to services for learners challenges they faced in SRH provision due to resistance from
some parents and traditional and religious leaders who felt
It was noted from discussions with health service providers that it was improper to provide such services to unmarried
that learners visited the facilities to seek SRH information and youth. They also confirmed the lack of proper linkages for
services, including STI treatment, HIV testing and treatment, referral of learners between schools and health facilities.
and contraception (mostly male condoms for boys and
injectable contraceptives for girls). Health workers suggested
that the injectable contraceptive was a method of choice
because it is secretive and does not require the cooperation
of the sexual partner. They also reported that more girls
report and seek STI screening and treatment services than
boys, and girls also tend to be more forthcoming with
information about their problems.

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68 © stock.adobe.com

5. Conclusions

The conclusions presented here are based on the Factors that affect or influence delivery of CSE – barriers:
findings and are aligned to the four objectives of The results from the study identified several challenges that
the study. affect the effective delivery of CSE, including the lack of
CSE monitoring, inadequate resources (including teaching
Knowledge of CSE: The study findings showed that aids and learning support materials), insufficient number of
community leaders, community members, and parents trained teachers on CSE and inadequate teacher capacity
were knowledgeable about CSE, but while most knew it was to deliver CSE, limited supervision, and insufficient time
taught in schools, the level of awareness around the content allocated for the teaching of CSE. Moreover, the study
and its benefits varied. established that while there are barriers to CSE delivery for
learners generally, LWDs tend to face relatively more severe
Attitudes and perceptions towards CSE: Overall, the and more limiting barriers, especially in terms of teaching
findings show that CSE is perceived positively, particularly services and a conducive learning environment. For instance,
among learners, teachers, head teachers, and MoE officials. a specialized CSE teacher may lack the skills to cater for needs
Community leaders, community members, and parents also of learners with visual, hearing, or learning disabilities in
exhibited positive attitudes and perceptions towards its the same setting. Furthermore, there were concerns about
delivery in schools, anchored in cultural and religious beliefs, inadequate user-friendly teaching and learning materials,
norms, and values. Learners, both with and without special such as textbooks in braille. Religious and cultural beliefs
education needs, were able to articulate several benefits were also noted as a barrier to CSE delivery.
associated with receiving CSE and its relevance. The study
respondents indicated that CSE prepares learners to confront Linkages with health service providers and learners’
the changes (both physical and psychological) that come access to SRH services: The study found that, generally,
about as they transition from childhood to adulthood. CSE learners do access SRH services in their communities. Female
was perceived as a gateway to attaining life goals through learners tend to access the services more than male learners,
avoiding negative outcomes of SRH risks, such as early with the most sought services including HIV testing, STI
sexual debut, EUP, HIV and other STIs, drug and substance screening and treatment, pregnancy testing, provision of
abuse, and GBV. Nevertheless, some parents, community contraceptives (including condoms), circumcision for boys,
leaders, and religious leaders did express opposition and and SRH information. The study also established, however,
resistance towards the teaching of CSE, with areas of concern that while school-health facility linkages do exist, they are
pertaining to the appropriate age to start learning about not strong, dynamic, or sustained. Several barriers were
CSE, the methods of delivery, and appropriateness of content identified that hindered access of SRH services, even when
taking into consideration cultural and religious contexts. In referrals were made, including long distances between the
addition, there were perceptions from some teachers and school and a health facility, negative attitudes of health
community members that discussions around condom use providers towards learners, health workers having busy
or pregnancy prevention would promote engagement by schedules, lack of sufficient adolescent health information
learners in sexual practices. materials, health providers not trained in providing services
to young people, stock-out of commodities, and cultural and
Factors that affect or influence delivery of CSE – facilitating religious factors. Additional barriers for LWDs were limited
factors: The study found that the effectiveness of CSE communication, lack of privacy and confidentiality, and lack
delivery depended on many factors, including the policy of access compounded by the physical structures of health
environment, the quality of training for teachers providing facilities which made it difficult for LWDs using wheelchairs
CSE, orientation of head teachers, the availability of to manoeuvre because there were no ramps.
instructional materials in terms of textbooks (including
those for LWDs), time available for instruction, and family 69
involvement and community participation in matters
related to CSE. Overall, however, all the countries have an
enabling policy environment with various policies, strategies,
frameworks, and guidelines in place that facilitate the
implementation of CSE, albeit with some gaps noted in
Botswana, Eswatini, and Uganda where there are policies
pending either finalization or approval. Furthermore, all
six countries have CSE curricula in place that are based on
UNESCO’s ITGSE.

6. Recommendations

6.1. Develop/review and align 6.4. Develop, print, and distribute
policies to facilitate effective adequate teaching and
and efficient delivery of CSE learning materials for TTCs,
teachers, and learners
Countries need to continue reviewing and aligning policies,
particularly in Botswana, Eswatini, and Uganda. Specifically: MoEs, UNESCO, and other partners need to develop
adequate teaching and learning materials – including
· The School Health Policy, which is the overarching textbooks, guides, teaching aids, charts, and other
policy for delivery of CSE and SRH services, needs to be supplementary audio-visual materials – for TTCs, teachers,
approved in both Botswana and Uganda. and learners. In addition, these materials should be
converted into braille to meet the needs of learners with
· The MoH in Eswatini needs to finalize the STI guidelines visual impairment. The use of complementary audio-visual
so that there is a proper link between learners and health materials should be considered to strengthen CSE delivery.
workers.
6.5. Strengthen the monitoring of
· Guidelines for implementation of the national sexuality both the delivery of CSE and
education framework in Uganda needs to be developed associated learning outcomes
by the MoES.
Data collection tools need to be user-friendly and easy
6.2. Increase government support to feed into the EMIS and other related management
to facilitate the effective information systems. The outcomes of CSE delivery also need
implementation of CSE to be assessed, and CSE delivery should form part of teachers’
programmes key performance areas.

Because most SRH/CSE initiatives rely on donor funds, it 6.6. Strengthen parent-child
is important that governments in the six study countries communication (PCC) through
increase their commitment to allocating necessary resources community engagement
(financial, human, infrastructure) to improve delivery of CSE.
MoEs, MoHs, and other relevant line ministries need to
6.3. Scale-up pre-service training come up with creative and innovative ways to engage
on CSE and increase teachers’ with and capacitate parents and community structures,
capacity to deliver CSE through such as community development organizations, PTAs, and
regular in-service training community, civic, and religious leadership to reinforce CSE
messages that learners receive in school. This should include
Pre-service training of teachers on CSE in TTCs ensures addressing misconceptions and prejudices around the SRH
that all teachers have prior exposure to CSE before they needs of learners, including LWDs. Means of reaching out
are deployed. As such, an audit of the pre-service teacher to parents and community structures can be done through
training curriculum is required to check the extent to which community dialogues, interface meetings, and use of mass
it provides teachers with the skills and capacity to deliver media outlets.
CSE to all learners, including LWDs, with emphasis on value
clarification and techniques in delivering CSE comfortability,
confidence-building, and class control. Furthermore, there
needs to be regular re-orientation and refresher courses for
in-service teachers on delivery of CSE.

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6.7. Develop clear strategies to © shutterstock.com
strengthen school and health
facility linkages

MoEs and MoHs need to develop clear strategies and adopt
creative ways to strengthen linkages between schools
and health facilities to meet the SRHR needs among AYP
at community level, the majority of which are learners.
Attention also needs to be paid to client relationship and
satisfaction, and youth-friendly service delivery. Furthermore,
there is a need to expand the pool of health providers trained
in the provision of adolescent health services and ensure
they have access to job aids to deliver relevant information.

6.8. Strengthen collaboration
and coordination through
a multisectoral and multi-
pronged complementary
approach to CSE delivery

Given its complex nature, there is a need for multi- and
intersectoral collaboration at all levels (national, provincial/
regional, district, and community) for effective CSE
implementation. In addition, parent-teacher collaboration
and the willingness to do what is necessary to support
delivery of CSE in school is a potential resource that
can be leveraged through innovative ways of engaging
communities.

6.9. Countries need to document
best practices and experiences
for sharing, learning Document
best practices and experiences
for sharing, learning, and
replication

Countries implementing CSE need to document experiences,
lessons learnt, and best practices for sharing and learning
from each other. Documented information can be
disseminated through multiple platforms (social media,
conference fora) and channels (print and electronic).

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Country level findings © stock.adobe.com

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Botswana

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Attitudes, experiences, and Community knowledge and
practices attitudes towards CSE

Overall, learners’ attitudes towards CSE were positive. At community level, there is an openness and willingness
They saw CSE as an important part of their development even among the most rural communities to discuss issues
because it not only helps them understand and safely that were hitherto considered taboo to discuss with or in
negotiate the challenges of coming of age, such as avoiding the presence of youth. Since Botswana’s experience with
negative outcomes associated with sexual activities and HIV and AIDS prevention, care, and treatment programmes
relationships, but it is also as part of their preparation for a has led to an opening up of attitudes towards discussing
life of responsible citizenry through values that they will have sexuality issues, CSE is perceived as a continuation of the
acquired early in life, and impartation of critical interpersonal country’s youth-focussed HIV prevention and behaviour
skills that help them relate to their peers in a considered way, change communication programmes, which helps improve
even under challenging situations. The learners credited CSE its approval among parents and the community at large.
with facilitating growth and understanding in diverse areas of
life, including gender, culture, violence, sexual relationships While community members, teachers, and other stakeholders
and behaviour, and reproductive health. Learners were were supportive of the teaching of CSE, including teaching
generally comfortable with topics covered under CSE, with or providing information about contraceptives to learners, all
many indicating that the topics/syllabus were relevant as is. stakeholders were nevertheless adamant that contraceptives
Only on a few occasions did learners express discomfort with and related services should not be provided to learners in
some topics or content, and thus would suggest what topics schools as part of CSE. The fear was that it would encourage
to add or remove from CSE. experimentation and would also unduly burden the school
and teachers with issues that would be best handled by
LWDs72 also had positive attitudes towards CSE and displayed trained health professionals at the health facilities.
good knowledge. Given LWDs often face a myriad of other
problems such as stigma, discrimination, and low self- Capacity to deliver CSE
esteem, all of which have the potential to adversely affect
their learning and development, there was a relatively much Botswana has invested in upgrading teacher qualifications
clearer and more pronounced sense of appreciation of the and training, including capacity-building for CSE delivery
intrinsic value of CSE among this group compared to other and special needs training. The country also has a legal
learners. They saw CSE as the promise of protection and and policy framework that is generally conducive for the
propensity towards positive SRH outcomes and balanced sustained delivery of CSE. CSE content and curriculum
development. LWDs were also aware that schools and generally enjoys support among stakeholders, thanks in part
teachers face challenges and discomforts in delivering CSE to the LSE that Botswana has been implementing in schools
to them, and that some teachers were not comfortable and years of implementation of HIV and AIDS programming
teaching certain topics generally, but even more so to LWDs. and community intervention work. The fact that the CSE
While LWDs felt that the school was providing some level of curriculum is broad-based, covering important aspects
support to help them benefit from CSE, they nevertheless of personal development and not just sexuality, helps to
felt that more needs to be done and can be done, especially increase its acceptability even among those who might be
by way of engaging teachers who are better trained to deal inclined to question some aspects of CSE.
with LWDs, being provided with more time to engage with
CSE compared to other learners, and having access to CSE Despite these positive aspects, challenges remain. Delivery
teaching and learning aids that are suitable and appropriate of CSE is still affected by gaps in capacity, mainly emanating
for their level and type of disability. LWDs felt that the from limited teacher qualifications and training on CSE.
absence of CSE teaching aids and learning support materials There is also room for improvement in terms of the role of
disadvantaged them more than it does other learners stakeholders, mainly community members, parents, and
because they depend more on these materials to understand religious and cultural leaders in reinforcing CSE messages
the content. among learners at home and in the community. Currently,
CSE is integrated into the LSE curriculum, which is integrated
72 Botswana’s education policy encourages integration of learners with disability with into several core subjects, as well into other extracurricular
the rest of the learners, unless of course in cases of extreme disability, which may activities. While this integration has been perceived as a
require specialized care. As such, there is an expectation that teachers will cater for strength because it makes CSE everyone’s mandate and
the needs of all learners equally, including LWD. Most of the results and analysis business rather than the exclusive mandate of one subject,
on LWD presented in this report are based on the sample of interviews with LWDs this integration creates challenges for monitoring CSE
from a special needs school of which most were severely hearing impaired. delivery in the different subjects, and also provides no means
of assessing or attributing the outcomes of CSE delivery.

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Links with stakeholders Recommendations: Policy level

Schools maintain beneficial links with health services · Reconcile the national health policy with school
through referrals and shared activities, including health talks health policy to cater for provision of SRH
in schools. Some schools also have a nurse either stationed commodities: There is a need to fast-track approval
or attached to the school to ensure easy and confidential of the school health policy, which is the overarching
access to SRH by learners, while some health facilities are policy for delivery of CSE and SRH services. In addition,
either designated youth-friendly health facilities or maintain a the MoES needs to develop guidelines or strategies for
youth-friendly corner. Such designation is meant to improve implementation of the national sexuality education
learners’ confidence in the service, and ultimately to increase framework.
learners’ access to SRH services. The link between schools
and health services is thus very important for the realization · Create and implement a system to monitor both the
of the objectives of CSE. However, there was a feeling delivery of CSE and associated learning outcomes:
among teachers and health service providers that there The directorate of education standards in collaboration
is a need to address the apparent contradiction between with the National Curriculum Development Centre
the MoE’s school’s health policy, which does not allow for (NCDC) should develop a monitoring framework for CSE
distribution of family planning commodities to learners, and training and delivery in schools, paying special attention
the MoH’s policy on SRH, which perceives provision of SRH to quality standards for delivery of CSE for LWDs.
commodities as an essential part of SRH service.
· Teacher training and capacity-building to deliver CSE:
Suggestions for improvement To increase teachers’ capacity to deliver CSE, regular pre-
and in-service training is necessary. This requires an audit
Suggestions for improvement and sustenance of CSE of the teacher training curriculum to check the extent to
delivery include continued investment in teacher training which it supports the development of the requisite skills
and education, including increasing the number of teachers and capacity to deliver CSE to all learners, including LWDs.
with special education skills to ensure that learners with Alongside the issue of training and qualifications is the
disabilities are not left behind. In addition, more effective need to ensure adequate provision of CSE teaching aids
leveraging of the link between schools, health service and learning support materials for all learners, especially
providers, and community I needed to ensure effective for LWDs.
delivery and reinforcement of CSE messages among learners.
Increased use of electronic media and online platforms to Recommendations: Schools and communities
package, deliver, and interact with young people on CSE
and related messaging was seen as a way to reach and keep · Improve parents’ engagement with school &
learners engaged with CSE as well. The development and CSE delivery: Creative and innovative ways need to
deployment of relevant and culturally sensitive CSE teaching be developed to engage, empower, and capacitate
aids and learning support materials also emerged as a factor parents and community structures, such as community
that was considered important for effective and sustained development organizations, PTAs, and community,
delivery of CSE for all learners, and especially for LWDs. civic, and religious leadership to discuss sex and
sexuality related issues with children at home and in
Finally, there is a need to institute a system of CSE delivery the community in order to reinforce CSE messages that
M&E. This is necessary to provide information and data that learners receive in school.
can be used to guide decisions and provide the evidence
base of the programme itself. There was also a need to make · Strengthen school and health facilities linkages:
CSE delivery part of teachers’ key performance areas to Communities, schools, and health service providers also
ensure CSE delivery can also enjoy the same priority status need to find creative ways to strengthen school and
as other subjects that are examinable, and whose pass rates health facility linkages to facilitate learners’ access to SRH
are often used as indicators of a teacher’s performance. Being services and commodities, for example, through sharing
largely non-examinable means that teachers’ performance messaging and service contacts through electronic and
in delivery of CSE is not recognized or rewarded. The same social media platforms.
dilemma occurs on the part of learners in the sense that
while they may appreciate the value of CSE, being non-
examinable means that they may not allocate the same
importance to it as other subjects. Hence, making CSE
examinable or assessable was seen as one of the ways of
making sure that learners would give CSE the same priority
status as other subjects.

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Eswatini

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Learners’ knowledge and attitudes Community knowledge and
towards G&C LSE attitudes towards G&C LSE

The majority of learners were knowledgeable about CSE and Not all community members were knowledgeable and aware
showed a positive attitude towards the programme. They of the subject. However, those that were hearing about G&C
regarded the subject as very important, and reported that it LSE for the first time nevertheless held a positive attitude
equipped them with the necessary knowledge and life-long towards the subject as they believed that it would be helpful
skills to deal with the challenges they encountered in their to learners. Most community members acknowledged that
lives. Even learners that were not learning the subject were they were not comfortable talking about sexuality issues with
optimistic that it would benefit them when they heard about their children because they did not know how deep they
it. However, many of the learners expressed that the subject should go with the topics. Moreover, religious and cultural
was not taken seriously by their teachers, who used the backgrounds greatly influenced the community members’
time dedicated for G&C LSE to teach other subjects which position.
were examinable. They wanted teachers to use teaching
approaches that would allow learners to express themselves Information and access to
freely and make the subject interesting and relevant to them. contraceptive commodities
They also wanted teachers to go in-depth and to sometimes
group them according to gender when discussing certain The majority of teachers preferred teaching abstinence
topics deemed specific to a particular age group and gender. rather than the use of contraceptives because they strongly
believed that teaching learners about contraceptives
Learners with special education might encourage them to engage in sexual activity. For the
needs’ knowledge and attitudes same reason, all schools were against the idea of providing
contraceptives to learners. The views of teachers were shared
Learners with special education needs also demonstrated by the majority of community members, who also prioritized
that they were knowledgeable about G&C LSE. discussing abstinence over contraceptives with their
They explained that the lessons contributed to their children, although a few were more receptive to the teaching
understanding of sexuality, growth, and development and of sexuality education as long as it was age appropriate.
helped them avoid engaging in activities that may lead to
problems, such as EUP and unsafe abortion. There were There were existing linkages between schools and health
mixed perceptions on the teachers’ delivery of the subject services, and preventive, remedial, and rehabilitative services
among these learners. Some expressed satisfaction, but were provided to learners in the four regions of the country.
others pointed out challenges such as inadequate TLMs, The most common issues that the youth in Eswatini grappled
including lack of textbooks in braille for learners with visual with were STIs, HIV and AIDS, and EUPs, which is exacerbated
impairment, and lack of specialized training in the subject, by the unavailability of condoms in health centres. Moreover,
which was seen as a hindrance to effective delivery of the negative attitudes from health workers was another
subject. challenge young people faced when visiting public clinics to
seek medical help for STIs. It was also discovered that young
Teachers’ attitudes, perceptions, and experiences people faced difficulties in accessing SRH services within the
community they lived in because the health practitioners
Although, overall, teachers had a positive attitude towards knew them and they thus felt embarrassed to come for STI
G&C LSE, most acknowledged that there were certain topics treatment. In addition, some schools are situated very far
that made them feel uncomfortable to teach because of from the health facility, making it difficult for the learners to
their cultural and/or religious beliefs. Teachers agreed that access SRH services.
sexuality education should begin early and should be age
appropriate for the learners. This indicates ignorance on the Suggestions for improved CSE
part of teachers and highlights the necessity to scale-up delivery
specific training for them since G&C LSE was designed to be
age specific. Cultural and religious beliefs were the major The MoET should avail the various resources required for CSE
factors that influenced the delivery of the subject. in addition, delivery, including adequate TLMs, especially for LWDs. The
heavy teaching loads without remuneration and teaching MoET should also put in place M&E systems for G&C LSE for
and learning methods were not always suitable to the topics. tracking of implementation and quality assurance purposes.
The teachers further cited the lack of systems to monitor the
teaching of G&C LSE in schools as a challenge.

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G&C LSE teacher training should further be introduced in · The MoET should introduce G&C LSE teacher training in
tertiary institutions and in-service workshops should be tertiary institutions and
conducted to equip teachers with appropriate skills. In
addition, the government should scale up advocacy and · conduct in-service workshops to equip teachers to
sensitization of parents and community leaders through deliver G&C LSE.
capacity-building workshops on the importance of G&C LSE,
while the MoET should orient and involve school committee · Linkages between schools and health centres should be
members in G&C LSE so that they can support the effective supported through the use of rural health motivators.
delivery of the subject in schools and provide a link between
the school and the community. The MoET should also · The MoH needs to finalize the STI guidelines so that there
encourage teachers to use teaching and learning approaches is a proper link between learners and health workers, train
that are learner-centred, dynamic, and interactive. Head health practitioners to be more supportive to the learners
teachers and teachers need to facilitate the creation of instead of being judgemental when they come for SRH
learners’ clubs which can be a useful tool for identifying services, and build more health centres in close proximity
issues that affect learners and provide solutions to their of schools.
problems. Finally, the MoH should provide contraceptives in
the health centres for learners who might need them, and Recommendations: Schools
health practitioners should be encouraged to be welcoming
rather than having a negative attitude towards the learners · The MoET should orient and involve school committee
who come to access SRH services. members in G&C LSE so that they can support the
effective delivery of the subject and provide a link
Recommendations: Policy level between the school and the community with fewer
conflicts.
· The MoET should dedicate resources (financial, human,
material, infrastructure) to support the effective · The MoET should encourage teachers to use teaching
implementation of the programme. and learning approaches that are learner-centred and
to be creative in their delivery to make it interesting and
· The MoET and MoH should strengthen collaboration and relevant to the learners.
coordination to improve the complementary efforts in
implementing G&C LSE. · Head teachers should supervise the teaching
and learning of the subject and make use of staff
· The government should scale up advocacy and development to promote the subject in order to ensure
sensitization of parents and community members proper integration and reduce the negative attitude
through capacity-building workshops. towards the subject by other subject teachers..

· The MoET should provide adequate TLMs, including in · Head teachers and teachers should facilitate the creation
braille for learners with visual impairments and offer sign of learners’ clubs which can be useful in identifying issues
language for learners with hearing impairments. that affect learners and help provide solutions to their
problems.
· The MoET should put in place M&E systems for G&C
LSE, including hiring inspectors for quality assurance · Teachers must keep learners’ issues confidential.
purposes. · Teaching materials should include guidelines for parents

to engage with their children on G&C LSE.
· There is a need for more intentional engagement and

collaboration between teachers and parents on sexuality
issues.

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Ghana

80

Perspectives of learners about RHE Perspectives of government
officials about the status of RHE
The learners had positive attitudes and perceptions towards
RHE. They explained that the subject prepares them to The view of the government officials who participated in the
take decisions about how to relate with the opposite sex, study was that the integrative-curricular approach adopted
appreciate the developmental changes they experience, and in Ghanaian schools to teach RHE must remain. To them,
become conscious about SRH challenges, including STIs and the structure of the RHE curriculum and the approach to
pregnancy. They were, however, of the view that the time teaching provide a wider frame within which RHE could
spent on RHE was not adequate to enable them to grasp be taught in almost all the subjects. They argued that the
the needed knowledge and understanding they expected. existing timetable at the various levels are already packed
moreover, the content of RHE did not reflect broader issues with subjects, therefore, an additional subject will increase
about relationships, self-control, and sexual orientation. the workload on students and teachers.

Perspectives of LWDs Perspectives on contraceptive
education
The views of LWDs were consistent with their counterparts
in the mainstream education. This could be linked to the Most of the participants – all the health service workers,
common curriculum and syllabi used at all levels of pre- and some of the schools club heads, teachers, parents,
tertiary education in Ghana. Most of the learners believed community leaders, and religious leaders preferred
that they could be taught RHE in a mixed class of girls and contraceptive education to be given to learners at an
boys because all learners are humans, and this allows them appropriate age. They argued that some of the learners are
to learn about the opposite sexes. already sexually active and the knowledge gained by learners
could be used to prevent teenage pregnancies and STIs.
Perspectives of teachers and heads Others opined that the knowledge about contraceptives
of schools would also expose their side-effects, and that there is
a need for learner to have the knowledge. Others were
Teachers’ attitudes and perceptions towards the teaching and opposed to contraceptive education and argued that it
learning of RHE were not different from the learners. They would urge the learners to practice sex with contraceptives.
identified three factors that influenced delivery of RHE in They believed that abstinence-only should be stressed to
the classrooms, namely teacher-, religion-, and school-based prevent pregnancy and STIs, as well as the negative effects of
factors. The teacher-based factor related to the knowledge contraceptive use.
of the teachers on RHE. It was observed that, generally, the
teachers did not have adequate knowledge of RHE. This Factors influencing RHE delivery
was attributed to the insufficient training on RHE and SRH for learners
issues. The religion-based factor restricted teaching of certain
topics because teachers and learners were uncomfortable School- and community-based supporting factors to RHE
discussing them. As a result, certain parts of the body (such delivery were noted, including the content of the curriculum,
as the penis and vagina) were not mentioned. The school- knowledge and training of teachers, appropriate teaching
based factors comprised the classroom environment and use methods, friendly classroom environments, and training
of TLMs. While there was congenial classroom environment, workshops, as well as contribution of parents and NGOs in
concerns about inadequate TLMs were expressed. the provision of knowledge and TLMs. Similar factors were
noted by LWDs.
Knowledge, attitudes, and
perceptions of community on RHE Barriers to effective RHE delivery
for learners
The community-based participants saw teenage pregnancy
as the bane to girl-child education and believed that RHE The common barriers to RHE delivery that were mentioned
could reduce the prevalence to reduce the number of by the learners and teachers were inadequate knowledge
female learners who drop out of school due to pregnancy. on the part of some of the teachers, insufficient TLMs,
They perceived that the teaching of RHE is appropriate and religious influence, and material poverty. In addition to these,
imperative because it guides the learners to make relevant discomfort among learners, lack of confidence of teachers,
decisions in their lives. Some of them admitted that they and communication gaps were mentioned by the LWDs and
have gained some proportion of knowledge on SRH which their teachers.
they often teach their children, but acknowledged that with
respect to learners with disabilities, RHE in schools is critical 81
because the community cannot sign to communicate with,
for instance, learners with speech and hearing impairment.

Experiences of learners in · Teachers in colleges of education and those in special
accessing SRH services schools need to have adequate pre- and in-service
training in sign language to increase the RHE delivery to
It was found out that the learners could access SRH services learners with hearing and speech challenges. The MoE
from the health facility with little or no challenges. While through the GES could put in place a training plan to
some of the health facilities had adolescent [maternity] reflect this objective.
corners dedicated solely to young people, others made it
easier for the learners to access services. It was, however, · The GES could make available the needed TLMs in
observed that judgemental attitudes by some of the health desired quantities for teachers to enhance effective RHE
services providers hindered learners’ access. delivery. Additionally, the service could assist teachers to
develop their skills in TLM planning and development,
Linkages between schools and as well as support schools with funds to be used for the
health services development of TLMs.

Health officers mostly provide information on SRH during · The GES together with the community could develop
club activities and mainstream school activities. It was a coalition platform to discuss the delivery of RHE in
observed that the linkage was not generally formalized and schools. This is towards the attempt to harmonize the
documented, but arose out of friendly interactions, mutual objectives of RHE and community values and religious
responsibility, and collaborative teaching and learning. inclinations for effective RHE and outcome congruence.

Experiences of LWDs in accessing · Heads of schools need to liaise with health service
SRH services providers to develop a formal structure of linkage to
serve as a framework for planning and implementation
LWDs equally had unrestricted access to SRH education and of outreach plans for the provision of information and
services at the health facilities. However, communication services to the learners.
was noted as a common challenge, between health services
providers and those who assisted the learners to access SRH · The Ghana Health Service (GHS) could motivate
services. trainees at the training colleges and medical (and
dental) schools to be trained in sign language to enable
Recommendations: them to communicate with learners with hearing and
speech challenges., Those in service could likewise
· There is the need to revise the content of RHE to be encouraged by the GHS and the respective health
address the inadequacies observed in some of the facilities to develop the basic skills to be able to sign
topics, particularly personal hygiene, sex education, and effectively communicate with learners with
contraceptive education, sexual orientation, control of hearing and speech challenges. This would address the
sexual desires, rape, and domestic violence. The GES and communication gap and improve the provision of health
the MoE could consider this revision. services to these learners.

· Until new dimensions of knowledge and information · The health service facilities that do not have separate
emerge, the MoE and GES could develop a teaching adolescent units should consider redesigning the
manual for RHE to be used in pre-tertiary schools to structure to make room for the provision of SRH services
ensure age-appropriate, context-specific, and content- to this cohort to align with the tenets of privacy and
adequate information in Ghanaian schools. This would confidentiality. This would improve the provision of SRH
promote uniformity, consistency, and standardized RHE service and delivery to young people in general.
delivery.
· Lastly, attention should be placed on client relationship
· Regular and periodic in-service training could be and satisfaction, and youth-friendly service delivery
organized to equip and develop the knowledge and during in-service training organized for health service
skills of the teachers in the area of SRH to broaden providers. The objective of this recommendation is to
their knowledge horizon and confidence to be able to remove any traces of judgemental attitudes that some
effectively teach RHE. The GES could ensure that this in- of the health service providers demonstrate towards
service plan is formally structured and implemented. learners in particular.

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Malawi

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Learners’ knowledge and attitudes Overall, the LWDs felt not properly catered for, not only in
towards CSE terms of TLMs that were appropriate to meet their needs,
but also the mode of delivery by teachers. Other challenges
Learners indicated that CSE prepared them to confront the included lack of disaggregation of learners by type of
changes that come about as they transition from childhood disability so that the special needs of each student would
to adulthood. These changes were said to be both physical be addressed, and lack of specialized/special needs teachers
and psychological. In addition, they also indicated that that could communicate using sign language.
they acquired a great deal of life planning skills, such as
goal-setting and decision-making that they use to make Community knowledge and
choices about their current and future lives. It was revealed attitudes towards CSE
that these skills helped them resist pressure from peers
and others to indulge in risky behaviours, such as drug and By varying degrees, parents and community leaders
substance abuse, crime, early sex, and unprotected sex and expressed a great deal of consternation and discomfort that
their consequences in the form of early pregnancies, school sexuality issues were discussed with learners, particularly
dropout, and STIs, particularly HIV and AIDS. However, they those below the age of 18. This was a cause for concern for
also expressed concerns about gaps in the delivery of CSE parents and community leaders because it was perceived
by their teachers that included reluctance to deliver some that girls and boys were becoming sexually “loose” and unruly
critical topics within CSE, particularly those on SRH, due to due to the influence of CSE studies in school. This was an
moral and religious dilemmas. indication that parents and community leaders did not fully
understanding what CSE comprised of, and their outlook
LWDs’ knowledge and attitudes was limited to sexuality and sexual relationships. These
perceptions were found to also affect teachers because
LWDs’ attitudes towards CSE were favourable because of their they were being viewed as those that were promoting
perceived greater needs. They had special challenges that loose morals in the communities. This made it difficult for
placed them in more elevated situations of vulnerability to the teachers to get adequate support from parents and
be easily taken advantage of or abused by people. Some of communities to effectively deliver CSE. It was clear that
the most critical challenges pertained to low self-esteem, low religious and cultural beliefs were affecting the teaching and
confidence, and the desire to feel accepted that put them learning of some CSE topics as well.
at higher risks of sexual exploitation, abuse, and coercion.
In addition, there is greater susceptibility to sexual violence Information and access to
with the perpetrators knowing that due to their disability, contraceptive commodities
LWDs are physically unable to fight them or report to the
duty bearers about the violence on account of failure to In line with the MOE’s policy on abstinence, it was found
communicate, for those who have hearing impairment, that a great deal of teachers and head teachers were against
or inability to see the offender, for those who are visually the provision of contraceptive commodities to learners in
impaired. schools because they believed it would encourage them
to engage in illicit sex and overburden the teachers with
Teachers also emphasized the importance of CSE in dealing tasks that they are not skilled or qualified to handle. Others
with issues of self-esteem, self-worth, perseverance, were concerned about the side effects of the contraceptive
self-acceptance, decision-making, and how to deal with methods. Head teachers in particular were concerned that
stigmatization and discrimination that arise on the basis of providing condoms would create conflict between the
their disabilities. Teachers employed extra effort to ensure school and parents and community leaders due to their
that LWDs benefitted from the teaching and learning, for cultural and religious beliefs. On the linkages between the
example, it was revealed that learners with hearing and visual school and SRH service provision, the policy of not allowing
impairments were being placed in front rows. This is meant condoms and other contraceptives on school premises is still
to allow the learners to benefit from lip reading. However, critical. However, it was found that youth clubs (school-based
LWDs identified some critical challenges attributed more to and out of school) not only provide opportunities for learners
the system of teaching and the learning environment than to get additional CSE knowledge, but also facilitate access to
to the teachers themselves, although teachers who were SRH information and services in the communities or at health
embarrassed to teach certain topics were also mentioned as facilities.
a barrier to effective delivery of CSE.

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Suggestions for improved CSE Recommendations: District and community
delivery levels

Capacity-building initiatives for teachers in the form of · To build strong complementary partnerships with
specialized CSE training, refresher courses, and specialized stakeholders, district and school officials should
training to deliver CSE to meet the diverse needs of LWDs continuously engage parents through PTAs and SMCs
was consistently highlighted by study participants. This and communities through traditional, civic, and religious
should include clearly defined engagement and linkages leaders on CSE and its content to solicit their support and
with other professionals in health that can act as resource reduce controversies surrounding the teaching of CSE
persons. This is critical in ensuring quality and sustainable in the communities. Other means of reaching out to the
delivery of CSE in both primary and secondary schools. The general public in the communities such as community
insufficient number of teachers as well as inadequate CSE dialogues, interface meetings, and use of mass media
TLMs need to be addressed. outlets such as community radio programmes on CSE
and SRHR for young people need to be explored and
Recommendations: National level utilized consistently.

· Although CSE issues are now integrated into the · The district and community level education officials
primary and secondary schools and TTC curricula, it should ensure that community level structures,
is also critical that both pre- and in-service training of particularly mother groups, PTAs, and community
teachers is continuous. Periodic CSE refresher courses leaders have their capacity enhanced in terms of CSE
and orientation of teachers on CSE specific topics is also knowledge. The study has shown that they are pivotal in
necessary. complementing school-based CSE.

· The MoE and partners should ensure that production · There is a need for teachers to interrogate their own
of learners’ and teachers’ guides and supplementary cultural and religious beliefs concerning delivery of CSE
materials are prioritized in all schools and TTCs. In as members of the communities. This will minimize
addition, these materials should be converted into braille situations whereby teachers, particularly females and
or sign language to meet the needs of learners with those in the rural areas, do shy away from teaching some
visual and hearing impairment. topics.

· There is a need for the MoE to devise detailed strategies · Extra sources of information are critical in the delivery
on how LWDs can be included, especially in mixed or of some CSE topics such as SRH. In this respect, the
inclusive schools, and how their needs can be met in school needs to establish robust linkages with health
terms of CSE teaching and learning in both specialized facilities and health workers who can be called upon as
and mixed schools. resource persons for these topics to enhance learners’
understanding.
· The Moe should develop M&E tools and train Primary
Education Advisors (PEAs) and school heads on them to · Communities should be made to understand and deal
enhance monitoring and supervision of CSE delivery in with their prejudices towards learners, including LWDs,
schools. As LWDs have specific needs, the tools should be and should try as much as possible to abstain from using,
able to capture all manner of learners with disabilities and stigmatizing and judgmental language. In this regard,
the types of disability. They should also be easy to feed there is a need for continuing support and monitoring of
into the EMIS and other related management information teachers for the effective teaching of CSE.
systems.

· To address the issue of access to SRH services by learners,
particularly among LWDs who have difficulties travelling
and accessing the services at health facilities, coordinated
planning, delivery, monitoring, and resource mobilization
is required. In addition, the MoE and MoH need to have
clear strategies on how to meet the SRHR needs among
the youth at community level, the majority of which are
learners at various levels of education.

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Uganda

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Learners’ knowledge and attitudes Perceptions on SE delivery by teachers were mixed, with
towards CSE some LWDs expressing contentment with the existing
practices in which teachers accorded time and attention
Learners had a positive attitude towards learning SE due to the topics on SE, while others noted challenges with the
to the perceived benefits and relevance to their stages delivery of SE, including poor communication to learners
of growth. They expressed acquired knowledge and skills attributed to limited separation of learners by disabilities
from learning SE, such as prevention of HIV and teenage category, inadequate illustration materials suitable for
pregnancy through abstinence, hygiene habits, self- specific disabilities, and having insufficient teachers trained
confidence, and handling peer relationships. Learners in sign language to assist the learners with speech or hearing
however, had concerns on capacities of teachers to deliver impairments.
SE topics, ranging from clarity of content to consistency and
depth of information. The learners perceived some teachers Community members’ attitudes
to be shy or embarrassed by some topics, while others did and perceptions towards CSE
not give adequate explanations and rushed through the
learning materials. There was a perception that SE lessons Parents and community leaders had adequate knowledge
were not taken seriously mainly because some of the on what should constitute SE. They described the
content was not examinable. Learners highlighted that SE sources of knowledge mainly from lived experiences and
content was usually integrated in subjects such as Biology community sensitization meetings on SE. Community
or Christian Religious Education and other times delivered members perceived SE to be beneficial because learners
in extracurricular activities such as drama and talks at school acquired skills to reduce high rates of pregnancies, early
assembly. It was also delivered through sessions conducted marriages, and school dropouts by providing guidance on
by specially delegated teachers as an extracurricular appropriate behaviour. SE was perceived to complement
instruction. community efforts and bridge gaps in community delivery
of SE concepts. It also provided a more reliable and
Teachers’ knowledge and attitudes accurate source of information for learners compared to
towards CSE the media and peers. There were two polarized arguments
on comprehensiveness of SE, with the majority of voices
Teachers perceived SE as important in shaping learners’ being against inclusion of information on condoms and
behaviour and addressing pubertal challenges. However, other contraception methods. The minority group was
some teachers felt embarrassed and uncomfortable in more receptive to a more comprehensive approach as
discussing certain sexuality topics due to their personal long as it was age-appropriate. There were also concerns
values, norms, and cultures around sexuality. Even though regarding capacity of teachers in schools to deliver SE, which
sexuality education was integrated in several curriculum community participants felt was inadequate. Other concerns
subjects, some teachers felt it was not their responsibility were on the moral character of some teachers with learners
to teach SE. Teachers tended to prioritize core curriculum expressing that teachers were sometimes perpetrators of
subjects that were more likely to be examinable and did not sexual offences and would deliberately omit SE topics due to
care much about non-SE knowledge recall aspects that are shame.
not examinable, such as change in attitudes, skills, and/or
change in behaviour. There were perceptions that teachers Information and access to SRH
did not allocate enough time to SE and rushed through the services
materials.
There were reported linkages between schools and
LWDs’ knowledge and attitudes health facilities that were beneficial to the learners, but
towards CSE the structures were said to be weak and infrequently
utilized. Specific challenges to access of SRH services by
LWDs expressed favourable attitudes to SE. They learners included busy schedules for health workers (being
demonstrated acquired knowledge in handling menstruation few), inadequacies in health worker training, and limited
challenges and avoidance of negative peer relationships, illustration charts to adequately deliver adolescent SRH
early sexual debut, and HIV or teenage pregnancies. information and services. Learners were also constrained
by long distances needed to travel from schools to health
facilities, which likewise results in infrequent visits by health
workers to schools.

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Limited funding and lack of specific schedules within schools · Improved reporting and tracking of progress made
for health promotion also limited delivery of SRH information with SE implementation: Many guidelines have
and services within schools. LWDs had additional challenges been approved and are already being implemented,
including limited access to health facilities and lack of especially concerning sexual and gender-based violence
interpreters. They also faced economic challenges to access (SGBV) and HIV and AIDS, however, there is a need to
SRH commodities that have to be paid for. document the progress made and provide clarity on SE
implementation.
Suggestions for improvement
Recommendations: Schools and communities
At policy level, there is need to fast track approval and
implementation of relevant policies and guidelines to · Improve SE delivery and services for LWDs: The MoES
support implementation of SE, such as the school health needs to create a supportive learning environment that
policy. In addition, a monitoring framework is needed to is favourable for LWDs. This may include having LWDS
monitor implementation of SE in schools for consistency and in special schools or advocating for inclusiveness in the
quality of delivery. At school and community level, there is a mainstream schools while supporting LWDs. The latter
need for capacity-building initiatives for teachers in the form would be more cost-effective and could help LWD who
of specialized SE training, refresher courses, and specialized experience challenges to get support from learners who
trainings to deliver SE to meet the diverse needs of LWDs. are not disabled. In addition, there should be sensitization
There is also a need to strengthen linkages between schools of students with no disability to avoid discriminating
and health facilities within their catchment, including training against LWDs. It is important to arrange special sessions
of healthcare providers in delivery of youth-friendly services. for blind students and to employ a sign language
Finally, the multi-sectoral collaboration between different specialist to interpret information for the students with
ministries to enhance SE delivery should be strengthened, hearing and speech impairments.
including district and community level intersectoral
collaboration to involve all stakeholders in the delivery chain · Strengthen laws against sexual violence and ensure
of SE or SRH services for the youth. law enforcement is strictly applied to bring justice in
cases where LWDs experience sexual violence: There
Recommendations: Policy level also needs to be supportive avenues to aid reporting,
such as having sign language interpreters at police
· Enhance approval and implementation of relevant departments.
policies or guidelines to support SE delivery: There
is a need for advocacy to fast track approval of the · Improve teacher training and capacity-building
school health policy, which is the overarching policy for for delivery of SE: Pre-service teacher curricula in
delivery of SE and SRH services for AYP. Following the TTCs should include training courses on delivery of SE
government’s recommendations for policy development, with emphasis on value clarification, and techniques in
which calls for the need for a regulatory impact delivery, including comfortability, confidence-building,
assessment, certificate of financial implication from the and class control, with special emphasis on adolescent
ministry of finance, and cabinet approval, a collaborative development stages. Furthermore, there is a need for re-
effort will be needed to ensure all the requirements are orientation, refresher courses, and retooling of in-service
met for this policy approval. teachers on delivery of SE since it is integrated in several
subjects. The trained teachers need to be equipped with
· Strengthen monitoring systems for SE delivery: It is a standard curriculum on SE delivery and materials for
recommended that MoES, through the directorate of delivery, such as relevant study charts. These trainings
education standards, develops a monitoring framework should utilize the existing resources that have been
for SE training and delivery in schools, with special developed by the various related ministries, for example
attention on quality standards for delivery of SE for LWDs. on GBV, menstrual health, and HIV and AIDS.
This should be done with the active participation of the
MoE, MoH, school authorities, and the communities. · Strengthen school and health facilities linkages:
There is a need to strengthen linkages between schools
and neighbouring health facilities to facilitate teacher
training, referral, and prompt provision of SRH services
for learners. The schools should seek health services from
health facilities within their catchment area, while the
MoH should ensure health workers are trained to provide
adolescent-friendly services.

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· Expand the pool of health workers trained in the · Establish a special fund to enhance delivery of SE to
provision of adolescent health services and ensure supplement efforts from development partners: The
they have access to job aids to deliver relevant government should further consider subsidizing SRH
information: This will ensure that school children commodities such as sanitary materials and treatment for
requiring these services are assured of timely provision SRH conditions for school children. This could go a long
of such services at the health facilities. There should also way in making the items and services readily accessible to
be specific outreaches organized by health facilities to the school children.
schools to deliver SRH-related information, while health
facilities should be provided with adequate facilities to · Strengthen multisectoral and multi-pronged
aid delivery of services to LWDs, including adolescent approaches to SE delivery: SE implementation is
health corners, construction of ramps, health information complex and evidence in this research illustrates
charts in braille, and health workers trained in the use of the role of multiple actors and need for intersectoral
sign language. To support existing efforts from the MoH collaboration. This has been demonstrated at national
in training health workers in sign language, there should level with the formation of inter-ministerial committees
be complementary efforts at school level or within the to promote SE, however, multisectoral collaboration
community to ensure children with disabilities are equally at subnational level remains weak. There is therefore a
trained in communication skills. need to strengthen collaboration at district, sub-county,
and village level, including between teachers, learners,
· Build capacity of learners to seek SRH services: As parents, religious leaders, and other community leaders
only a few learners, especially boys, were utilizing the SRH as key stakeholders in SE implementation. This would
services, there is also need to build agency for girls to involve strengthening community support systems for
seek SRH services through self-esteem building, providing buy-in as well as community support structures, such as
SRH information, and addressing conservative gender PTAs and religious groups.
inequitable norms.

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Learners’ attitudes, practices, and In addition, the teachers observed delivering a CSE lesson
experiences during the study used lecture methods to teach as opposed
to learner-centred methodologies that stimulate active
Learners had a positive attitude towards learning CSE, largely learners’ participation. Limited number of CSE books,
influenced by the relevance of the information gained from inadequate attention given to CSE by school authorities and
CSE topics to their own lives. They indicated that CSE was teachers, and lack of universally and multi-sensory designed
necessary and useful to their lives as it enabled them to take teaching and learning materials to accommodate special
care of themselves, make informed decisions, delay sexual learners and teachers further compromised the effective
debut, and protect themselves from STIs and EUPs. Using the delivery of CSE.
knowledge gained from CSE, they were able to report cases
of forced marriages to the police. However, some learners, Community members’ knowledge,
particularly those from rural schools, felt uncomfortable attitudes, and perceptions of CSE
being taught topics such as menstrual hygiene and sex in
mixed groups of girls and boys and wanted such topics to Community and PTA members held positive attitudes
be taught to them separately and by a female teacher. This towards the delivery of CSE to learners, although their
was not the case with learners from urban and peri-urban perceptions were influenced by their beliefs, values, and
schools, who felt comfortable being taught all CSE topics traditional norms, as well as by their limited knowledge on
together. what CSE really is. As such, PTA members were categorical on
the CSE content they were not comfortable with, particularly
LWDs’ attitudes, practices, and marriage. Parents argued that children should start receiving
experiences sex education at the age of 13 and that Grade 5 to 7 learners
were not mature enough to learn things they cannot handle,
LWDs also expressed positive attitudes towards CSE such as sex, and that teaching them these topics promoted
and perceived it to be helping them to understand the promiscuity. Moreover, they believed the emphasis should
consequences of early sexual debut and having sound be on abstinence instead of the use of contraceptives.
judgement in situations that might lead to abuse. However, Nevertheless, they agreed that their children should be
they felt the delivery of CSE by teachers was not meeting taught about ways of preventing teenage pregnancies,
their needs as the teaching methodology used was not identification of a would-be abuser, and how to avoid being
targeted to their special needs. For example, learners with enticed or manipulated by older people and strangers,
visual impairment indicated that teachers often taught them especially those of the opposite sex. The appropriateness
the same way they would teach learners with sight, such and cultural sensitiveness of the CSE content, especially
as writing on the black board, and hence preferred having when talking about sex, marriage, condoms, and menstrual
teachers with visual impairment who would understand hygiene, was emphasized.
their special needs. They also complained about books being
in ink instead of braille. This was borne out in the study National MoGE representatives’
findings, which revealed that, compared to other categories attitudes and perceptions on
of learners, learners with visual impairment had limited delivery of CSE
knowledge of CSE topics and perceived CSE as sex education.
Respondents from the national MoGE perceived the teaching
Teachers’ attitudes, practices, and of CSE as an important tool that enabled learners to acquire
experiences correct information from appropriate sources, rather than
incorrect information from questionable sources, such as
Findings showed that although teachers held attitudes the internet. They agreed that the school was a controlled
supportive of the teaching of CSE, their attitudes were for environment that provided the information needed by
the most part aligned to the cultural framework of their learners while taking into consideration the appropriateness
communities and to their beliefs about what was appropriate of the information for that age. MoGE representatives even
for learners of a given age. The findings indicated that some proposed that the teaching of CSE should start from as
teachers who teach CSE did not receive adequate CSE early as the ECE stage. The role of guidance teachers was
training, leaving them to draw from their personal values highlighted as an important element in the delivery of CSE,
and attitudes in teaching CSE topics, thus compromising and the high numbers of teachers who had not yet been
objectivity in teaching CSE topics. trained in CSE was noted as a hindrance to its effective
delivery.

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Additionally, special education teachers had not been trained Provision of and access to SRH
on delivering CSE to LWDs, which was compounded by a lack services
of appropriate TLMs for these learners. The MoGE staff also
perceived that the analysis of learners’ performance in CSE Youth-friendly SRH services, including contraceptives, STI
was anchored in the general learners’ performance in carrier treatments, and HIV testing and treatment, were available
subjects, making it difficult to measure the specific desired at the health centres. In addition, one-stop centres were
outcomes of CSE. managed by adolescents, making it easier for learners to
access relevant SRH information. Findings showed that, on
Facilitating factors influencing average, girls accessed SRH services related to contraceptives
delivery of CSE and STI treatment, while boys commonly accessed condoms,
STI treatment, and HIV services. There also appeared to
Facilitating factors included perceived benefits of CSE, be good linkages between MoGE and MoH at policy and
especially towards reducing teenage pregnancies and early school level, including through health week activities such
sex debut among learners, as well as the fact that learners as mass community immunization, monthly school health
attached importance to CSE since it was integrated into programmes where learners were given SRH materials, and
carrier subjects that are examinable. Teachers indicated that during pregnancy checks. Specific challenges to access
adequate training on CSE delivery and the availability of of SRH services by learners included the negative attitude
TLMs for Grades 5 to 12 had the greatest influence on the among health workers towards LWDs, lack of confidentiality,
content and delivery of the curriculum, while head teachers unethical behaviour exhibited by health workers, and
highlighted that their orientation on CSE enabled them discriminatory tendencies exhibited by health personnel that
to appreciate and support their schools in the training of made it difficult for learners to access SRH services.
teachers and cascading of the training to other teaching
members. At community level, increased awareness by Recommendations: National level
parents on CSE facilitated buy-in to the teaching of CSE,
while national MoGE representatives noted monitoring of · Strengthen the training of teachers on CSE through the
teaching of CSE in schools as a facilitating factor. college hub model to improve the delivery of CSE to all
learners, including LWDs.
Barriers to CSE delivery
· Strengthen the Education support teams such as the
At policy level, the barriers contributing to the current CSE National Education Support Teams (NEST), Provincial
curriculum not effectively meeting the desired outcomes Education Support Teams (PEST), and District Education
included inadequate collaboration between MoE and Support Teams (DEST) on CSE delivery through training.
strategic stakeholders like the CSOs; lack of effective
monitoring systems to track CSE progress; lack of specific · Produce adequate TLMs for teachers (including teachers
CSE integration guidelines; and lack of resources to for learners with special needs) and learners, including for
adequately support the cascading training model. At school LWDs.
and community levels, the barriers included inadequate
TLMs; lack of trained school managers; personal attitudes · Strengthen mechanisms for coordinating CSE-related
and values towards CSE; religious and cultural factors that work between the MoGE and MoH to enhance
promoted the sacredness of sex, a culture of silence, and collaboration and engagement. This could be through
a life of secrecy; untrained CSE teachers; lack of family ensuring that the MoH is a member of the CSE
involvement; and inadequate CSE knowledge among coordinating committee. This will help the MoGE make
parents. informed decisions during policy formulation and
implementation.

Recommendations: Provincial and district level

· Increase CSE awareness among head teachers and
enhance M&E mechanisms, including provision of
adequate CSE educational materials to all schools
continuously.

· Create links among health facilities, CSOs, NGOs,
government ministries, and other stakeholders for
effective delivery of CSE in schools. This can be done
using existing collaboration meetings and events
conducted in the provinces and districts.

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Recommendations: Head teachers Recommendations: Teachers

· Strengthen the monitoring of CSE delivery in schools · Address teachers’ misunderstandings on CSE topics and
by conducting regular lesson plan checks and lesson allow them to challenge their own cultural and religious
observations. This will sharpen the teachers’ integration beliefs before starting to teach CSE.
skills and compel them to teach CSE with a purpose.
There is a need for the head teachers to arrange for inter- · Strengthen collaboration of teachers with personnel from
school visits and meetings and also share school CSE- the health facilities or other teachers on topics that they
related policy matters during these meetings. are unfamiliar or uncomfortable with to improve delivery
of CSE.
· Enhance the understanding of CSE by periodically
arranging training on relevant topics for school staff at
the zonal level to further create a conducive teaching and
learning environment.

· Orient parents and community members on the
importance of CSE through PTA committee meetings,
open days, and other community events.

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93

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Annexes

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Annex 1: Terms of Reference

Qualitative study on the attitudes, perceptions and experiences of
learners and teachers on comprehensive sexuality education

UNESCO is seeking the services of a contractor In 2013, and in response to these challenges faced by
to undertake a qualitative study on the attitudes, adolescents and young people in the region, ministers of
perceptions and experiences of learners and education and health from 21 Eastern and Southern African
teachers on comprehensive sexuality education (ESA) countries75 endorsed and affirmed their commitment
(CSE), across six countries in Eastern and Southern to better health outcomes for adolescents and young people
Africa (ESA), and one in Western and Central Africa in the region. In what is now known as the ESA Commitment,
(WCA). ministers agreed on a set of mid- and long-term targets,
among them reducing new HIV infections, reducing EUP, and
Background in Sub-Saharan Africa, there are 158 million eliminating child marriages and GBV among young people
young people aged 15-24; a number that is expected to rise in the region by 2020. In 2018, representatives of ministries
to 281 million by 2050. Having a high proportion of young of health and of education from 22 WCA countries agreed
people positions the region to benefit from the demographic on the path to reach a similar commitment for their region.
dividend as a large labour pool in comparison to dependents Central to the Commitment is the agreement to scale up
can lead to increased productivity and lower costs for basic comprehensive sexuality education (CSE) and access to
social services. This, in turn will increase saving by households sexual and reproductive health (SRH) services for adolescents
and governments. However, a large labour pool will only and young people (AYP).
be beneficial for development if is the people are healthy,
well educated, highly skilled, and has adequate quality job The ESA Commitment continues to be instrumental in
opportunities73. strengthening national responses to address HIV and SRH
needs and rights of adolescents and young people. Across
Societal shifts and vulnerabilities create a confluence of the region, there is growing recognition of the importance
factors that place today’s adolescents and young people at of high-quality, comprehensive sexuality education which
heightened risks for poor education and health outcomes. provides opportunities for young people to explore
They face many sexual and reproductive health challenges, their values and attitudes and to build decision-making,
including HIV and other sexually transmitted infections, early communication and risk reduction skills about many aspects
and unintended pregnancy (EUP), gender-based violence of sexuality.
(GBV) and child marriage. In much of the region, adolescent
girls and young women are at disproportionate risk and Comprehensive Sexuality Education (CSE)
acquire HIV five to seven years earlier than men; the rate
of unintended pregnancy in Africa stands at 89 per 1,000 Comprehensive sexuality education (CSE) is a “curriculum-
overall and at 112 per 1,000 in Eastern Africa, resulting in an based process of teaching and learning about the cognitive,
estimated 21.6 million unintended pregnancies per year; emotional, physical and social aspects of sexuality. It aims
and violence ranging from physical and sexual violence to to equip children and young people with the knowledge,
female genital mutilation and child marriage is common. By skills, attitudes and values that will empower them to realize
the age of 15, 12% of girls are already married and 16% have their health, well-being and dignity, develop respectful social
undergone female genital mutilation74. relationships, consider the well-being of others affected
by their choices, and understand and act upon their rights
throughout their lives76.

73 AFIDEP and UNFPA. 2015. Synthesis Report on the Demographic Dividend in Africa. 75 Angola, Botswana, Burundi, Democratic Republic of Congo (DRC), Eswatini,
74 UNICEF. 2016. The State of the World’s Children. Ethiopia, Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia,
Rwanda, Seychelles, South Africa, South Sudan, Tanzania, Uganda, Zambia, and
Zimbabwe.

76 UNESCO.2018. Revised International Technical Guidance on Sexuality Education

98