Comprehensive sexuality education (CSE) programming adaptations in response to disruptions caused by the COVID-19 pandemic

Abstract

Introduction As we are approaching the three-year mark of the initial wave of the pandemic, the world continues to grapple with the lasting impacts of COVID-19. Governments all over the world have taken unprecedented steps to fight the pandemic through far-reaching public health measures and widespread lockdowns as well as fiscal and monetary policies to restart their economies. The United Nations Population Fund (UNFPA) 1 defines young people as individuals between the ages of 10 and 24 years old: adolescents (aged 10–19) and youth (aged 15–24).* Young people felt the impact of the pandemic directly and immediately. With almost no notice, 1.6 billion young people in 188 countries 2 were being kept away from school and universities due to physical distancing measures. They found themselves in the middle of an experiment in new ways of teaching and learning, or shut out of the education system altogether. Even as the pandemic entered its third year, 405 million schoolchildren in 23 countries continued to be affected by full or partial school closures. 3 This large-scale interruption of learning has severe consequences – from compromising nutrition to limiting access to health care, raising school dropout rates, and depriving young people of social support and resources. It has also significantly impacted our ability to equip young people with the information and skills to make well-informed decisions about their lives and bodies and develop healthy relationships via the provision of comprehensive sexuality education (CSE). Responding to adolescents’ and youth’s sexual and reproductive needs and rights during their transition towards adulthood is key in supporting evolving capacities to advance youth agency and empowerment. CSE equips young people with the foundation to make well-informed decisions about their lives and bodies and develop healthy relationships. Continuation of CSE delivery during a crisis such as the pandemic is critical to realise young people’s sexual and reproductive health and rights. This commentary aims to examine the COVID-19 disruptions to CSE programming, responses, and strategies from countries and organisations to overcome challenges caused by COVID restrictions, and to explore the potential for digital technologies to deliver information and education in new ways. Context While it is still difficult to provide global estimates of the effects of COVID on adolescents’ sexual and reproductive health outcomes, it is clear that COVID has taken a toll on young people’s health and well-being, including mental health, lower educational and learning outcomes, and direr economic prospects for young people. Longitudinal quantitative survey data and in-depth qualitative interviews, collected in Syria, Palestine, and Jordan, showed that within nine months into the pandemic, 19.3% of adolescents presented with symptoms of moderate-to-severe depression; 4 and most adolescents reported an increase in stressful events related to their households. 4 Studies documenting learning loss from a total of 34 countries, 5 including those from higher and lower income groups, have found on average an estimated four to five months of lost learning, along with increases in inequality. One study in Pakistan revealed that the average student lost between 0.3 and 0.8 years of learning-adjusted schooling, 6 and in India, 92% of students lost at least one specific language ability and 82% lost at least one specific mathematical ability from the previous year. 7 Authors of one of the reviews on the impact of the pandemic on sexual and reproductive health needs and access to services by adolescents in low- and middle-income countries conclude that COVID-19 has had a high impact on indications of limited access to sexual and reproductive health services including contraception, menstrual products, and HIV treatments; increased risks of child marriage; a rise in gender-based violence; and increased involvement of adolescents in risky or exploitative work. 8 An online survey distributed to 2,700 young people found that 40% of participants from Kenya, Uganda, and Zimbabwe felt less in control of their lives; and 35% of respondents from Ghana and 67% from Kenya reported feeling more depressed. 9 During 2020, global youth employment fell by 8.7%, which is twice as high as the drop among adults. 10 Young women in middle-income countries have been particularly affected by unemployment. 11 Household income loss during the COVID-19 pandemic directly impacted youth romantic partnerships. 12 Worries about income and mental health issues led to poorer sexual and reproductive health, for example, through an increase in child marriages or unintended pregnancies. 9 How CSE-implementing countries, organisations, and communities responded to the COVID-19 disruptions Adaptations in programme planning and development Outreach and community engagement, as well as including the young people we target, are key for implementing successful CSE programmes. These activities proved challenging to conduct during the COVID-19 crisis as traditionally they require in-person consultations, meetings, and visiting communities. In Nepal and Tajikistan, trained young people from non-governmental organisations were instrumental in reaching their peers and promoting youth involvement in the COVID-19 response and SRH education: during the pandemic, youth consultants explored already existing CSE programmes outside of the school sector to provide peers with online information on COVID-19 prevention and sexual and reproductive health and rights (SRHR), upholding young people’s rights to continued access to relevant information to realise their health and well-being. 13 A multisectoral and integrated approach to deliver SRHR information and life skills can include non-CSE-related life skills: literacy and numeracy, vocational training, and livelihood skills. Out-of-school CSE serves as an opportunity to be more flexible than in school settings, and can more easily be adapted based on young people’s current needs and the life situation they find themselves in. This is the case for young people in humanitarian settings where additional hardship was added when COVID-19 prevention measures, such as lockdown, were enforced in refugee camps. In Jordan, CSE was integrated into the humanitarian response through out-of-school CSE modules delivered for Syrian refugees in youth centres and women’s and girls’ safe spaces, integrating CSE into existing programmes such as gender-based-violence prevention work. During lockdown, youth centres provided adolescents and young people with essential SRH and GBV awareness online training, and maintained provision of information around youth well-being, mentorship, and health. In Bangladesh, the provision of dignity kits with basic supplies that enable recipients to take care of their sexual and reproductive health was integrated with the distribution of information on COVID-19 precautionary measures, helplines to report incidents of gender-based violence, and links to SRHR services, information, and education. 13 Ensuring that parents understand, support, and get involved with the delivery of CSE is essential to ensure long-term results, especially within the pandemic lockdowns. In Jordan, online resources were used to increase parent-to-child communication on sexuality: more than two million parents were reached in 2020 with the social media campaign “See it with their eyes” that showcases how parents are viewed by their children during adolescence if the parents are not listening or taking care of their children during this phase. 13 Digital adaptations in delivering CSE programmes The digital divide has been a big challenge during school closures, most notably in sub-Saharan Africa, which has the lowest rate of internet access at home. 3 In Zimbabwe, where only 23% of citizens have access to computers and only 48% to televisions, 54 CSE radio lessons were recorded and aired at primary and secondary schools during the pandemic. 13 In Honduras, a television show Es Cosa De Dos (It is a Matter of Two) was designed to empower girls, educate the public and lower the incidence of teen pregnancy, and to address gender inequality, sexist practices, sexual violence, abuse of power, intergenerational cycles of poverty and adolescent pregnancy, through the experiences of characters who face challenges that are very real to girls in Honduras. 13 At the beginning of the pandemic, UNFPA recommended that CSE programmes should increasingly explore delivering through digital platforms. 14 In 2020, in Turkey, AMAZE videos were adapted for use by school counsellors and parents; the online self-learning CSE platform was developed for vocational training institutions. 13 The innovation project Providing Comprehensive Sexuality Education through Live-streaming was successfully piloted in China. The assessment revealed significant positive changes in SRHR knowledge and attitudes among participants. For example, after completing the CSE course, students’ HIV/STI prevention knowledge increased by 24%. 15 The pandemic forced organisations to use creative and flexible strategies to deliver CSE to children and young people, particularly girls, in insecure environments and hard-to-reach areas. More than three million girls were reached in Guatemala by WhatsApp campaigns promoting podcasts and low-resolution videos, including in the indigenous language Q’eqchi’. 13 Conclusion The global COVID-19 pandemic and its implications on CSE programming provided us with important knowledge on adaptations in the times of crisis. But it also gave us crucial lessons learnt, for use in the post-COVID era. First, the COVID-19 pandemic has been a strong reminder that schools are much more than just places of learning, and provide critical contributions towards learner health and well-being, including through the provision of CSE. 16 As well as covering SRH risks, CSE addresses issues and promotes skills learners need in order to build resilience during challenging times. Such areas as addressing mental health issues, online safety and security, sexual health, and psychosocial support, which are already included in the international UN technical guidance on CSE, 17 were identified as critical during the pandemic to ensure young people’s well-being. In addition, CSE delivered out-of-school has in many places filled a vacuum when schools closed, and served as key for leaving no one behind. Taking into account the need for CSE programmes to shift to digital space, it is crucial in the post-pandemic era to address the drivers of existing inequities, such as inequities in accessing digital platforms and technology (the digital divide), particularly for girls and young women and populations left further behind. One of the ways to address the digital divide is partnering with organisations working on entertainment education using distance education platforms such as radio and television, among other community communication platforms, to disseminate CSE content and messaging. The pandemic taught us how to reach left-behind populations of young people more effectively. Virtual outreach showed a lot of potential for engaging adolescents and young people and for reaching marginalised groups of young people with sexual and reproductive health information and services: through digital platforms, local radio channels, television, smartphones, house-to-house flyers, megaphones, etc. Lessons learnt show the importance of applying technology and digital platforms that are appropriate in the specific context to ensure that we are reaching the right people. Other challenges encountered are practical skills-building for CSE facilitators that cannot be done completely online, and there are limitations to monitoring community-based activities. These experiences serve as crucial learning to inform current and future CSE delivery as we live in a world of “polycrisis”, with ongoing humanitarian emergencies due to war and conflict already adding to the challenges created by the COVID-19 pandemic. CSE programming delivered in humanitarian settings during the pandemic also showed the opportunity for out-of-school CSE programmes to integrate and link with multi-component programmes and services. Engaging gatekeepers is critical to the success of taking up these adaptations in CSE programming, as they help to ensure an enabling environment for CSE. When working with youth organisations, it is important to fully understand their experience with sexual and reproductive health matters and to ensure that CSE curricula are properly adapted. Such engagement is especially crucial for the scale-up of CSE, so that all implementing partners deliver a standardised package.