Abstract
Despite international recommendations and supportive evidence, there are few examples of scaled-up and sustained programs to provide adolescents with sexuality education. Moreover, despite acknowledgment that building community support and responding to resistance are key challenges, there is a lack of detailed discussion on specific programmatic strategies to address these issues. This article reviews the work of 2 organizations-Aahung and Rutgers Pakistan-that are successfully implementing large-scale sexuality education programs in Pakistan, collectively reaching more than 500,000 students. This review aims to answer the following questions: (1) How did Aahung and Rutgers Pakistan work to understand Pakistani society and culture and shape their programs to build community support? (2) How did Aahung and Rutgers Pakistan overcome resistance to their efforts? We reviewed program documents and publications, synthesized key themes, identified questions of interest, and engaged key informants from Aahung and Rutgers Pakistan's leadership. The success of Aahung and Rutgers Pakistan was grounded in their readiness to understand the nuanced context within the communities, collaborate with groups of stakeholders-including parents, school officials, religious leaders, media personnel, and adolescents themselves-to ensure support, and stand up to forces of resistance to pursue their goals. Specific strategies included working with communities to select content, tactfully selecting and framing issues with careful consideration for sensitivities, engaging adolescents' influencers, strengthening media presence, showcasing school programs to increase understanding and transparency, and choosing opportune times to introduce messages. The successful strategies used by Aahung and Rutgers Pakistan to promote adolescent sexual and reproductive health through sexuality education can inform programs worldwide. Additionally, the programmatic weaknesses identified can guide future planning and action by Aahung and Rutgers Pakistan. We call on other programs to continue sharing challenges, specifically related to resistance, with sexuality education programs in order to develop a toolbox of additional strategies for community uptake.
Highlights
Pakistan has long been a challenging setting for the promotion of adolescent sexual and reproductive health (SRH).[1,2] As in many other countries worldwide, there is little acknowledgment that adolescents have sex, whether consensual or coerced, before marriage and many believe that exposure to sexuality education will incite unwanted behavior
The success of Aahung and Rutgers Pakistan was grounded in their readiness to understand the nuanced context within the communities, collaborate with groups of stakeholders—including parents, school officials, religious leaders, media personnel, and adolescents themselves—to ensure support, and stand up to forces of resistance to pursue their goals
The successful strategies used by Aahung and Rutgers Pakistan to promote adolescent sexual and reproductive health through sexuality education can inform programs worldwide
Summary
Pakistan has long been a challenging setting for the promotion of adolescent sexual and reproductive health (SRH).[1,2] As in many other countries worldwide, there is little acknowledgment that adolescents have sex, whether consensual or coerced, before marriage and many believe that exposure to sexuality education will incite unwanted behavior. While there are numerous descriptions of projects and programs on sexuality education, there is a lack of research and discussion on successful strategies to create support for and overcome resistance to its implementation in schools and communities.[6,7,8] The landmark1994 International Conference on Population and Development called on countries to educate young people about SRH using age-appropriate and context-specific content and strategies.[9] since this call, organized resistance and misconceptions about sexuality education have challenged efforts. A 2014 report from the United Nations Educational, Scientific and Cultural Organization (UNESCO) noted that there are few examples of scaled-up and sustained programs on these issues.[10] The growing body of evidence on the scale-up of sexuality education programs has noted resistance as a challenge, but it has not provided a detailed discussion of the nature of resistance or strategies to overcome them.
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