Abstract

BackgroundReproductive health problems such as HIV, unwanted pregnancy and unsafe abortion among adolescents are closely linked to insufficient knowledge about sexuality and reproduction and lack of access to contraceptives. Supported by international agencies, Zambia has introduced an ambitious nation-wide program for comprehensive sexuality education (CSE) to be implemented into ordinary school activities by teachers. The curriculum is firmly based in a discourse of sexual and reproductive rights, not commonly found in the public debate on sexuality in Zambia. This paper explores how teachers perceive the curriculum and practice discretion when implementing the CSE in mid-level schools in Nyimba district in Zambia.MethodsUsing a case study design, data were collected through in-depth interviews with 18 teachers and analyzed thematically drawing upon theories of discretion and policy implementation.ResultsIndividual teachers make decisions on their own regarding what and when to teach CSE. This discretion implies holding back information from the learners, teaching abstinence as the only way of preventing pregnancy or cancelling sexuality education sessions altogether. Teachers’ choices about the CSE program were linked to lack of guidance on teaching of the curriculum, especially with regards to how to integrate sexuality education into existing subjects. Limited prioritization of CSE in the educational sector was observed. The incompatibility of CSE with local norms and understandings about adolescent sexuality combined with teacher-parent role dilemmas emerged as problematic in implementing the policy. Limited ownership of the new curriculum further undermined teachers’ motivation to actively include CSE in daily teaching activities. Use of discretion has resulted in arbitrary teaching thus affecting the acquisition of comprehensive sexual and reproductive health knowledge among learners.ConclusionThe CSE had limited legitimacy in the community and was met with resistance from teachers tasked with its’ implementation. In order to enhance ownership to the CSE program, local concerns about the contents of the curriculum and the parent-teacher role dilemma must be taken into consideration. Not addressing these challenges may undermine the policy’s intention of increasing knowledge about sexuality and reproduction and empowering adolescents to access contraceptive services and avoid unwanted pregnancies.

Highlights

  • Reproductive health problems such as HIV, unwanted pregnancy and unsafe abortion among adolescents are closely linked to insufficient knowledge about sexuality and reproduction and lack of access to contraceptives

  • In 2014, Zambia rolled out a new and ambitious framework for Comprehensive Sexuality Education (CSE) targeting children and adolescents enrolled in grades 5–12 in schools across the country [1,2,3,4]

  • In Zambia, sexual and reproductive health (SRH) knowledge is inadequate and unevenly distributed, leading to considerable SRH-related problems among Zambian adolescents [5,6,7]. Aimed to address such unequal access to knowledge about SRH, the development of a comprehensive sexuality education (CSE) programme was heavily supported by UNESCO [3, 4]

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Summary

Introduction

Reproductive health problems such as HIV, unwanted pregnancy and unsafe abortion among adolescents are closely linked to insufficient knowledge about sexuality and reproduction and lack of access to contraceptives. While abortions in Zambia are allowed on the broad grounds spelled out in the Termination of Pregnancy Act of 1972, the same law severely restricts access to safe and legal abortion services by demanding written consent of three medical doctors including a specialist for a legal abortion to take place [10, 11]. This is problematic in a country with critical shortage of health workers. The problem affects teenage girls in particular; approximately 80% of women taken to health facilities for abortion-related complications are adolescents [9, 14]

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