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      Trends and Challenges in Comprehensive Sex Education (CSE) Research in Sub-Saharan Africa: a Narrative Review

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          Abstract

          Purpose of the Review

          Adolescent sexual and reproductive health remains a major public health challenge in Sub-Saharan Africa (SSA). Comprehensive sex education (CSE) has been hailed as a key strategy to inform young people about sexual health and wellbeing and prevent negative health outcomes. This paper presents an overview of the trends and challenges around sex education in SSA and puts forth key recommendations for future research and policy initiatives.

          Recent Findings

          This review employed a narrative approach to synthesize evidence on the implementation of comprehensive sex education in SSA. The literature review elicited four key themes: (i) comprehensiveness of CSE curricula, (ii) gender norms in CSE, (iii) prominence of ‘fear’ narratives in CSE implementation, and (iv) CSE delivery methods. Additionally, the authors propose a fifth theme—‘Future-proofing CSE programs’, based on their learnings from implementing sex education interventions during the COVID-19 pandemic. These five themes are presented through a narrative description of current research accompanied by reflections from the authors on the implementation of a parent-focused sex education program in Uganda.

          Summary

          Based on the insights from the literature review and the authors’ reflections, three recommendations are put forward to guide the design of further CSE initiatives: (i) stakeholder engagement in determining CSE priorities and strategies, (ii) diverse delivery pathways for CSE programs, and (iii) active engagement of both boys and girls to challenge gender norms in CSE.

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          Matthew J L Page, Joanne E McKenzie, Patrick Bossuyt … (2026)
          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            Adolescent sexual and reproductive health in sub-Saharan Africa: who is left behind?

            Dessalegn Y Melesse, Martin K. Mutua, Allysha Choudhury … (2020)
            Adolescent sexual and reproductive health (ASRH) continues to be a major public health challenge in sub-Saharan Africa where child marriage, adolescent childbearing, HIV transmission and low coverage of modern contraceptives are common in many countries. The evidence is still limited on inequalities in ASRH by gender, education, urban–rural residence and household wealth for many critical areas of sexual initiation, fertility, marriage, HIV, condom use and use of modern contraceptives for family planning. We conducted a review of published literature, a synthesis of national representative Demographic and Health Surveys data for 33 countries in sub-Saharan Africa, and analyses of recent trends of 10 countries with surveys in around 2004, 2010 and 2015. Our analysis demonstrates major inequalities and uneven progress in many key ASRH indicators within sub-Saharan Africa. Gender gaps are large with little evidence of change in gaps in age at sexual debut and first marriage, resulting in adolescent girls remaining particularly vulnerable to poor sexual health outcomes. There are also major and persistent inequalities in ASRH indicators by education, urban–rural residence and economic status of the household which need to be addressed to make progress towards the goal of equity as part of the sustainable development goals and universal health coverage. These persistent inequalities suggest the need for multisectoral approaches, which address the structural issues underlying poor ASRH, such as education, poverty, gender-based violence and lack of economic opportunity.
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              Sexuality education: emerging trends in evidence and practice.

              Nicole Haberland, Deborah Rogow (2015)
              The International Conference on Population and Development and related resolutions have repeatedly called on governments to provide adolescents and young people with comprehensive sexuality education (CSE). Drawing from these documents, reviews and meta-analyses of program evaluations, and situation analyses, this article summarizes the elements, effectiveness, quality, and country-level coverage of CSE. Throughout, it highlights the matter of a gender and rights perspective in CSE. It presents the policy and evidence-based rationales for emphasizing gender, power, and rights within programs--including citing an analysis finding that such an approach has a greater likelihood of reducing rates of sexually transmitted infections and unintended pregnancy--and notes a recent shift toward this approach. It discusses the logic of an "empowerment approach to CSE" that seeks to empower young people--especially girls and other marginalized young people--to see themselves and others as equal members in their relationships, able to protect their own health, and as individuals capable of engaging as active participants in society.
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                Author and article information

                Contributors
                Gily Coene:
                ORCID: http://orcid.org/0000-0002-8158-0718
                gily.coene@vub.be
                Journal
                Journal ID (nlm-ta): Curr Sex Health Rep
                Journal ID (iso-abbrev): Curr Sex Health Rep
                Title: Current Sexual Health Reports
                Publisher: Springer US (New York )
                ISSN (Print): 1548-3584
                ISSN (Electronic): 1548-3592
                Publication date (Electronic): 6 May 2023
                Pages: 1-9
                Affiliations
                [1 ]GRID grid.8767.e, ISNI 0000 0001 2290 8069, Centre of Expertise on Gender, Diversity and Intersectionality, , Vrije Universiteit Brussel, ; Pleinlaan 2, 1050 Brussels, Belgium
                [2 ]GRID grid.33440.30, ISNI 0000 0001 0232 6272, Faculty of Interdisciplinary Studies, , Mbarara University of Science and Technology, ; P.O. Box 1410, Mbarara, Uganda
                [3 ]GRID grid.413355.5, ISNI 0000 0001 2221 4219, African Population and Health Research Center, ; Nairobi, Kenya
                [4 ]GRID grid.33440.30, ISNI 0000 0001 0232 6272, Department of Psychiatry, Faculty of Medicine, , Mbarara University of Science and Technology, ; Mbarara, P.O. Box 1410, Uganda
                [5 ]GRID grid.451863.d, ISNI 0000 0001 2194 5036, The Nordic Africa Institute, ; Uppsala, Sweden
                Author information
                http://orcid.org/0000-0002-8158-0718
                Article
                Publisher ID: 362
                DOI: 10.1007/s11930-023-00362-1
                PMC ID: 10163565
                PubMed ID: 37362203
                SO-VID: caa4d58e-c623-4304-9327-084b715736fb
                Copyright © © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date accepted : 24 April 2023
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100022083, VLIRUOS;
                Categories
                Subject: Article

                Keywords: comprehensive sex education,sub-saharan africa,sexual and reproductive health,adolescent health,gender norms
                Data availability:
                Keywords: comprehensive sex education, sub-saharan africa, sexual and reproductive health, adolescent health, gender norms

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