Comprehensive Sex Education Programs Research Articles

How to decrease teenage pregnancy: rural perspectives in Ecuador.

This study aimed to understand the sociocultural context of teenage pregnancy in an Ecuadorian city with a large indigenous population, to gauge the acceptability of a multifaceted pregnancy prevention program for adolescents, and to elicit perspectives on the optimal program design from adolescents and adult key informants. We ascertained qualitative data via an online, electronic survey administered from August to September 2020. Open- and closed-ended questions elicited perspectives relating to burden of adolescent pregnancies, acceptability of pregnancy prevention programs, and optimal design of future programs. Twenty-four adolescents (13-19 years of age) and 15 adult key informants working in the healthcare, business, and education sectors in Cotacachi completed the survey. Survey responses were analyzed using a structural and in vivo coding, and an inductive approach to consensus-building around key themes. Most adolescent survey respondents (75%) believed that teen pregnancy is "fairly common" in Cotacachi, and 41.7% believed differences in teen pregnancy rates are not associated with ethnicity. In comparison, 66.7% of adult survey respondents said teen pregnancy disproportionately occurs among indigenous teenagers. Additionally, 45.8% of adolescent and 80% of adult survey respondents believed that a comprehensive sexual education program would help reduce teenage pregnancy rates by imparting reliable sexual health knowledge. Adult respondents noted that the past programs were unsuccessful in preventing teenage pregnancy because of these programs' inability to fully engage teenagers' attention, very short time duration, or inappropriate consideration of cultural context. In Cotacachi, Ecuador, a sexual health education program is both desired and feasible according to adult and teenager key informants. A successful program must adapt to the cultural context and engage youth participation and attention.

Prevalence and Factors Associated with Adolescent Pregnancy Among an Indigenous Ethnic Group in Rural Nepal: A Community-based Cross-sectional Study.

The Chepang people, an indigenous ethnic group in Nepal, experience substantial marginalization and socioeconomic disadvantages, making their communities among the most vulnerable in the region. This study aimed to determine the prevalence and factors associated with adolescent pregnancy in the Chepang communities of Raksirang Rural Municipality, Makwanpur District, Bagmati Province, Nepal. A cross-sectional study was conducted from October 2022 to April 2023 among 231 Chepang women selected using simple random sampling from Raksirang Rural Municipality. A semi-structured questionnaire was used for interviewing the mothers. Bivariate and multivariate logistic regression analyses were performed, using odds ratios with 95% CIs. Variables with a variation inflation factor of more than 2 and a p-value of more than 0.25 were excluded from the final model. The study revealed that the prevalence rate of adolescent pregnancy among Chepang women was 71.4% (95% CI, 65.14-77.16). A large percentage of participants (72.73%) were married before the age of 18 years. Poor knowledge of adolescent pregnancy (adjusted odds ratio [AOR], 10.3; 95% CI, 8.42-14.87), unplanned pregnancy (AOR, 13.3; 95% CI, 10.76-19.2), and lack of sex education (AOR, 6.57; 95% CI, 3.85-11.27) were significantly associated with adolescent pregnancy. The prevalence of adolescent pregnancy among the Chepang community was high. These findings highlighted the importance of raising awareness about the potential consequences of adolescent pregnancy and implementing comprehensive sexuality education programs for preventing adolescent pregnancies within this community.

Exploring the multi-level impacts of a youth-led comprehensive sexuality education model in Madagascar using Human-centered Design methods.

Comprehensive sexuality education (CSE) is recognized as a critical tool for addressing sexuality and reproductive health challenges among adolescents. However, little is known about the broader impacts of CSE on populations beyond adolescents, such as schools, families, and communities. This study explores multi-level impacts of an innovative CSE program in Madagascar, which employs young adult CSE educators to teach a three-year curriculum in government middle schools across the country. The two-phased study embraced a participatory approach and qualitative Human-centered Design (HCD) methods. In phase 1, 90 school principals and administrators representing 45 schools participated in HCD workshops, which were held in six regional cities. Phase 2 took place one year later, which included 50 principals from partner schools, and focused on expanding and validating findings from phase 1. From the perspective of school principals and administrators, the results indicate several areas in which CSE programming is having spill-over effects, beyond direct adolescent student sexuality knowledge and behaviors. In the case of this youth-led model in Madagascar, the program has impacted the lives of students (e.g., increased academic motivation and confidence), their parents (e.g., strengthened family relationships and increased parental involvement in schools), their schools (e.g., increased perceived value of schools and teacher effectiveness), their communities (e.g., increased community connections), and impacted broader structural issues (e.g., improved equity and access to resources such as menstrual pads). While not all impacts of the CSE program were perceived as positive, the findings uncovered opportunities for targeting investments and refining CSE programming to maximize positive impacts at family, school, and community levels.

High-risk sexual behavior among Malaysian adolescents who use drugs: a mixed-methods study of a sample in rehabilitation

ABSTRACT Background The high-risk sexual behaviors of drug-using adolescents in Malaysia is an under-researched topic. Methods Eighty adolescents undergoing rehabilitation participated in this mixed-methods study. Results The sample was mostly males (70%), and the mean age was 18.2 years (SD = 1.40). More than three-fifths (63%) had used only methamphetamine and the mean duration of all drug use was 3.15 years. Sixty-nine percent reported previous sexual experience. High-risk sexual behaviors include having unprotected sex (11%), sex with more than one person (84%), and sex under the influence of drugs (94%). About 44% of the sample had intimate partners who use drugs. Most respondents (64%) were aware of the advantages of safe sex and were familiar with HIV transmission modes (74%). Results from multivariate logistic analysis indicate that females had significantly higher odds of engaging in unprotected sex and having intimate partners who use drugs, relative to males; males were, however, more likely to have sex under the influence of drugs. Responses from the interviews suggest that adolescents who use drugs engage in high-risk sexual behaviors primarily because drugs are used to enhance sex. Conclusions A comprehensive sex education program tailored for drug-using adolescents should be made an integral part of rehabilitation.

(048) Women's Knowledge about Female Masturbation

Abstract Introduction The scarcity of in-depth studies on female masturbation testifies to the lack of attention paid to this crucial subject and to the cultural hurdles to talking about such a subject. This absence of evidence prevents healthcare practitioners from understanding women's experiences, needs, and challenges regarding their sexuality and sexual autonomy. It is therefore imperative to fill this knowledge gap with research studies that look at the cultural, social, and religious specificities specific to female masturbation. Objective The main objective of this study is to assess the knowledge of women regarding female masturbation taking into consideration their cultural, social, and religious backgrounds. Methods We present a cross-sectional study based on an online 15-item questionnaire posted once per week, 5 weeks in a row from March 14, 2023. The online self-administered questionnaire was presented in the local written dialect. The questionnaire was divided into a sociodemographic section, a general knowledge assessment of genitalia and the sexual female function, and a section about the misconceptions and knowledge about female masturbation. All participants were self-designated female participants over the age of 18, recruited from sports centers' Facebook and Instagram pages. Results The study included 213 participants, 82% of who have attended high education institutions, and 70% were single. The mean age was 25 [18, 45]. Internet was the participants' primary informational source in 64%. Friends were the second source of information with 15%. With regard to the participants' knowledge, the results of the study reveal a diversity of levels of knowledge within our population. Some participants demonstrated a limited or incorrect understanding of female masturbation, often influenced by cultural, and religious beliefs or preconceived ideas. This inaccurate knowledge contributes to the spread of negative stereotypes and judgments about practice. Conclusions It is important to recognize that female masturbation often remains a difficult subject to discuss and is surrounded by social taboos. In light of our findings, it is clear that additional efforts are needed to promote better understanding and acceptance of female masturbation through comprehensive sexuality education programs. Disclosure No.

“My life would not be the same”: a qualitative, retrospective evaluation of the post-programme outcomes of an in-school comprehensive sexuality education programme in Madagascar

ABSTRACT Little is known about the outcomes of in-school comprehensive sexuality education (CSE) programmes two or more years after programme completion, particularly in low-income countries. Projet Jeune Leader, a youth-founded Malagasy organisation, conducted a retrospective, qualitative evaluation of a CSE programme in Madagascar. The objective was to explore how former participants assessed the programme’s influence on their behaviours and lives. Our team conducted in-depth interviews with 34 young people (16–24 years old) who had participated in the programme when they were in middle school. We then synthesised the data using qualitative thematic analysis. Most interviewees indicated that the CSE programme positively contributed to some aspect of their transition to adulthood. Some reported safer sex practices, refraining from drug and alcohol use, and pregnancy prevention, while others reported improved relationships, and acts of leadership. While it is not clear which elements of the programme facilitated these changes, participants made recurrent references to relatable CSE educators and engaging pedagogy in their responses. These results encourage further research on the multi-faceted, and in some cases, non-health-related, outcomes of in-school CSE programmes in low-income countries. The work also provides critical youth-driven insights into CSE programme design to guide future programme planning and evaluation efforts.

Sexual Health Literacy Level and Associated Sociodemographic Factors among Sri Lankan Adolescents: A Cross-sectional Analysis of Selected Urban and Rural Areas in Kandy District

Abstract Introduction: This study addresses a gap in the existing literature by investigating the sexual health literacy (SHL) of adolescents in the Kandy district of Sri Lanka. Methods: This was conducted in 2022 as a cross-sectional analysis study, it involved 1690 students aged 14–18 using multistage cluster sampling. Participants completed a self-administered questionnaire on SHL, and scores were calculated based on the HLS-EU Sinhala version. Results: Of 1675 adolescents, 49.6% lived in rural areas and 50.4% lived in urban areas. 52.5% were females and 47.5% were males. 14–16 years old were 59.8% and 17%–18% were 40.2%. The mean age was 14.0 years (standard deviation = 0.49). Regarding socioeconomic status, 46.4% (n = 777) were in the upper and lower quintiles. The results revealed that 47.4% of the total respondents exhibited limited SHL. Rural youth have significantly higher levels of limited SHL compared to their urban counterparts. The factors associated with SHL were identified through logistic regression as an urban residence (odds ratio [OR] = 0.61) and older age (17–18) (OR = 0.65) was negatively associated with limited SHL. Conclusion: These findings underscore the need for targeted and comprehensive sexuality education programs tailored to the specific needs of rural adolescents in Sri Lanka.

Factors Influencing Risky Sexual Behavior: A Study of Female Undergraduate Students of University of Lagos, Akoka, Nigeria

Background Out of 1.9 million people living with HIV in 2018, about 1.5% were within age 15 - 49 years although efforts have been made to limit the spread of HIV/AIDS in the country but it still retains an upward trajectory in certain states due to engagement of youths in risky sexual behaviours Thus, this study examined factors influencing risky sexual behaviors among female Undergraduate Students of University of Lagos, Akoka, Nigeria. Methods A quantitative methodological approach was adopted for this study. The study location was the University of Lagos in Nigeria. A total number of 400 sample sizes was considered for this study. The multi-stage sampling technique was applied. The questionnaire was used in the process of gathering data for this study. Frequency count and percentage, including valid percentage and cumulative percentage, were used. Results The findings of the study showed that a significant majority of respondents 367 respondents, (91.7%) have had sexual intercourse. Peer influence played a role in the first sexual activity for the majority of respondents, with 288 respondents (78.5%) indicating that their first sexual experience was influenced by their peers. The study also revealed that (62.2%) of respondents reported engaging in unprotected mouth-to-genital contact. Conclusions Notably, peer influence emerged as a crucial component of the first sexual encounters, demonstrating the influence of their peers on their choices. Recommendations such as government implementing comprehensive sex education programs that emphasize healthy relationships were made in tandem with the findings of this study

“Instead of Asking for Fare, You Ask Her to Pay with Sex”: Male Perspectives on the Factors Influencing Schoolgirls’ Participation in Age-Disparate Transactional Sex Relationships

Age-disparate transactional sex relationships are often coerced and exploitative. The gender and economic disparities between affluent men and economically disadvantaged girls often perpetuate these relationships, resulting in their exploitation. This qualitative study assessed men’s understanding of factors influencing schoolgirls’ engagement in age-disparate transactional sex relationships in two rural districts in Kenya. Four focus group sessions were conducted with men from two primary professions: motorcycle taxi operators (Boda Boda) and teachers from primary and secondary schools from two districts in Kitui South, Sub County, Kenya. Focus group data were analyzed using conventional content analysis. Several influential factors associated with schoolgirls’ engagement in these transactional relationships are discussed in three broad themes: access and coercion, parental influence, and peer-related factors. Study results indicate that schoolgirls in rural areas are more susceptible to predation by men willing to trade sexual favors with underage girls. These findings make it imperative to address the predation of adolescent girls by men involved in these transactional relationships by implementing comprehensive sex education programs that empower schoolgirls to recognize and resist coercion. Additionally, implementing measures involving community leaders, parents, and other stakeholders in a collective effort to combat the exploitation of underage girls is paramount. These measures should be accompanied by the stricter enforcement of laws and regulations to hold perpetrators accountable for their actions.

Exploring Perceptions and Experiences of Comprehensive Sex Education Among Adolescents

This study used a quantitative research technique to investigate teenagers' perspectives and experiences with Comprehensive Sex Education (CSE) programs. The study included replies from 450 teenagers aged 14 to 18, from various socioeconomic and cultural backgrounds. Adolescents valued the thorough covering of themes (mean = 4.56) and found the content relevant (mean = 4.72), highlighting good evaluations of CSE content and delivery. The study demonstrated the necessity of engaging teaching approaches (mean = 4.38) and provided light on the need for frank talks regarding sexual health (mean = 4.24). While participants reported feeling comfortable discussing sexual health (84.4%) and believing CSE enhanced their understanding (93.3%), the reported percentage of consistent contraceptive usage (40.0%) was lower, demonstrating the difficulty in transferring knowledge into conduct. These findings are consistent with past studies, highlighting the persistent challenge to overcome the knowledge-behavior divide. The study's conclusions call for CSE programs to include practical skill-building components as well as to foster inclusive spaces that encourage open discourse about sexual health. This study contributes to the conversation around adolescent sexual health education by stressing the need of participant-centered, holistic approaches that allow teenagers to make educated decisions about their sexual well-being.

Effectiveness of a Comprehensive School-Based Sex Education Program for Young Adolescents in the Netherlands.

Most sexual education programs traditionally focused on providing sexual information regarding the risks of sex. However, current studies on sexual behavior in youth show a need for truly comprehensive sex education approaches with a sex-positive focus on sexuality, that effectively improve sexual competence. Therefore, in the current study the effectiveness of "Love is…", a four lesson school-based program based on the Sexual Interactional Competence model and Attitude-Social-Influence-Self-Efficacy-model was studied. A cluster-randomized controlled trial on the effectiveness of "Love is…" was conducted in 2018-2020. The sample consisted of 1160 adolescents in grades 8 and 9 from nine schools in the Netherlands. The sample was 48% female, 34% Dutch/Caucasian, 41% none-religious and 50% higher educated. They were randomized at class level into a program group [n = 32 classes; 567 students (Mage = 13.74 (SD = 0.74))] and a control group [n = 31 classes; 593 students (Mage = 13.86 (SD = 0.73))]. Results showed that "Love is…" increased sexual knowledge, that adolescents in the program group showed less cyber victim blaming attitudes and increased in communications skills after the program. In conclusion, the current study shows that "Love is…" was effective not only on the knowledge level, but also regarding sexual attitudes and competences. However, due to the developmental process of sexuality, there is a necessity to continue lessons in following grades through booster sessions by reinforcing competences as communicating comfortably about sexuality.On 12 November 2019 the study design and hypotheses were registered in the Dutch Trial Registration, number NL8150. ( https://onderzoekmetmensen.nl/nl/trial/26676 ).

A comprehensive interventional program based on the needs and concerns related to female genital cosmetic surgeries: protocol for a multistage mixed methods study

BackgroundDissatisfaction with one's body and the subsequent rise in the cosmetic surgery trend pose significant public health concerns today. One unusual cosmetic surgical procedure involves enhancing the genital area. Numerous healthy women and girls have recently sought Genital Cosmetic Surgery (GCS) for beauty or improved sexual performance. There is a concern that this phenomenon may be linked to developing a new standard for vulvovaginal appearance. This stringent standard could potentially adversely affect women's mental health in the future, growing feelings of insecurity and possibly leading teenagers to consider plastic surgery.Implementing empowering and awareness-raising programs for women and girls is crucial, especially in light of the constantly evolving gender norms and the medicalization of sexuality and beauty as social constructs. It is essential that such training is integrated into comprehensive sexual education programs for adolescents. These efforts align perfectly with the SDG, recognizing that education in sexual and reproductive health, ensuring access to health, and empowering women are fundamental rights for women and girls. To accomplish these objectives, we will conduct this study to elucidate the needs and concerns related to the increasing trend of GCS. By doing so, we can concentrate on the factors motivating women to undergo GCS. This approach will enable us to develop effective interventions to empower women and girls considering GCS, thus enhancing their sexual and reproductive health.Methods and objectivesThe objectives of this multistage exploratory sequential mixed-method study will be structured into three phases:First phase: qualitative study.In-depth interviews will be conducted to elucidate the needs and concerns associated with GCS with women with a history of GCS, spouses of willing participants, and women actively seeking these procedures.A literature review in parallel with the qualitative phase will be conducted to gain insights into the needs and concerns of women worldwide considering GCS.Second phase: program design.To formulate an intervention grounded in the primary priorities identified during the qualitative stage and informed by the literature review.To prioritize the needs and concerns of women seeking GCS and to validate and endorse the intervention through input from an expert panel.Third phase: quantitative study.To assess and determine the effectiveness of the intervention designed to address the needs and concerns of women applying for GCS procedures.DiscussionThis study marks the first attempt to design and assess an intervention addressing the needs and concerns of cosmetic surgeries performed on the female genital and reproductive system. The hope is that this study's compilation and implementation will yield substantial evidence and documentation regarding the impact of educational interventions on women's and girls' sexual and reproductive empowerment. Given the rising prevalence of GCS among unmarried teenagers, this approach is of utmost significance. It underscores the necessity for gynecological and midwifery service providers to have comprehensive guidance on GCS. Such guidance can be an essential resource for healthcare providers in this field.

CONTRACEPTION KNOWLEDGE AMONG SECONDARY SCHOOL STUDENTS IN PORT HARCOURT METROPOLIS RIVERS STATE NIGERIA

This study investigates the factors associated with the knowledge of contraception among secondary school students in Port Harcourt Metropolis, Nigeria. A descriptive survey research design was employed, involving 900 students from both public and private secondary schools. A validated self-structured instrument with a reliability index of 0.76 was used for data collection. The study found that 76.1% of the respondents exhibited good knowledge of contraception, with 23.9% demonstrating poor knowledge. Disastrously, 80.3% of the students opinioned that contraceptives help prevent sexually transmitted diseases, and 63.7% understood their role in preventing unwanted pregnancies. However, misconceptions persisted, with 16.7% believing that other contraceptives prevent only pregnancy and 59.3% thinking that daily oral pills must be taken daily for effectiveness. Chi-square analysis revealed significant associations between knowledge of contraception and various factors. Age was found to be significant (χ² = 13.633, p = 0.008), with students aged 15-16 years exhibiting better knowledge. Gender was also significant (χ² = 5.705, p = 0.033), as female students had a higher level of understanding. Religion (χ² = 23.564, p = 0.002) and guardian (χ² = 20.432, p = 0.001) both significantly influenced knowledge, with Christian students and those guided by parents demonstrating better knowledge. Based on the findings, it was recommended that government in collaboration with health promotion experts, health educators and school administrators should design, develop and implement a targeted educational interventions to address misconceptions and disparities in knowledge; comprehensive sexual education programs should be implemented, tailored to students' diverse backgrounds, and designed to promote gender equity. KEYWORDS: contraception, Knowledge, students, associated factors, secondary Schools.

Factors associated with the choice of having multiple sexual partners among male college students with casual heterosexual sex in Zhejiang Province, Eastern China

BackgroundYoung students infected with HIV have become a significant public health issue in China, this study aimed to understand the factors influencing the choice of having multiple sexual partners among male college students who had casual heterosexual sex in Zhejiang Province and to scientifically justify developing HIV/AIDS intervention strategies among them.MethodsA stratified cluster sampling method was used for the survey of students from 13 colleges or universities in Zhejiang Province between October and November 2018. The questionnaire collected information on general demographic characteristics, knowledge of HIV/AIDS prevention and treatment, sexual attitudes and risk awareness, sexual behavioural characteristics, and acceptance of interventions. The univariable and multivariable analyses were conducted in this study.ResultsStudy participants included 362 male college students who exhibited casual heterosexual sex and were aware of the number of sexual partners they had. Among them, 222 students engaged in casual heterosexual sex with multiple sexual partners (61.33%). The results of the multivariable analysis revealed several factors associated with male students’ choice to have multiple sexual partners: monthly living expenses greater than or equal to 1501 CNY (adjusted OR = 2.24, 95% CI = 1.21–4.16), sexual behavior after consuming alcohol (adjusted OR = 2.19, 95% CI = 1.32–3.63), whose casual partner types were non-student (adjusted OR = 2.51, 95% CI = 1.45–4.22), and those who discussed using condoms during sexual intercourse (adjusted OR = 0.50, 95% CI = 0.28–0.89).ConclusionThe choice to engage in casual heterosexual sex with multiple partners was found to be associated with several factors among male college students, including economic status, engaging in sexual behavior after consuming alcohol, the type of the casual partner, and using condoms. These findings highlight the significance of implementing targeted interventions and comprehensive sexual health education programs within college settings in order to encourage safer sexual practices among students.

The Values in Perspective Comprehensive Sex Education Program: Experiences of Black Youth

Limited research is available on the acceptability of comprehensive sex education for economically marginalized Black youth. The current evaluation study collected quantitative self-report data from 109 high-school-aged predominately Black or African American economically marginalized youth after completing a comprehensive sex education program. Youth reported positive experiences with the program, improvement in socioemotional skill development, and increases in sexual risk avoidance behavior. Youth report of quality of experience predicted youth sexual risk avoidance. These findings serve as evidence for tailoring comprehensive sex education programs to youth demographic variables.

Exploring Challenges and Strategies in Advocating for Comprehensive Sexuality Education in Nigeria

This research aims to investigate the current state of sexuality education in Nigeria, identify the challenges faced in advocating for comprehensive sexuality education, and propose effective strategies to promote its implementation for improved sexual health outcomes among Nigerian youth. Sexuality education remains a critical yet often neglected aspect of youth development and public health in Nigeria. The country's socio-cultural context, conservative values, and religious beliefs have created barriers to the implementation of comprehensive sexuality education programmes. This paper seeks to address the gap in knowledge by examining the specific challenges that hinder the advancement of comprehensive sexuality education and by proposing evidence-based advocacy strategies to overcome these barriers. The study employs a mixed-methods approach, combining qualitative and quantitative research methods to provide a comprehensive understanding of the subject matter. Qualitative methods such as interviews, focus group discussions, and content analysis of relevant documents are used to explore the challenges and perceptions surrounding sexuality education in Nigeria. Additionally, quantitative surveys are administered to gather data on public attitudes towards sexuality education, perceived benefits, and barriers to implementation. The paper contributes to the ongoing dialogue on sexuality education in Nigeria by providing a nuanced understanding of the challenges and opportunities for advocacy. The proposed strategies will offer evidence-based solutions for promoting comprehensive sexuality education that is sensitive to Nigeria's cultural context. Ultimately, the research aims to inform policymakers, educators, and advocacy organizations about effective ways to advance comprehensive sexuality education for the holistic development and improved sexual health outcomes of Nigerian youth.

A Meta-Analysis of the Effects of Comprehensive Sexuality Education Programs on Children and Adolescents.

Childhood and adolescence are crucial periods for developing one's awareness of sexuality. Comprehensive Sexuality Education (CSE) during these stages is essential for overall growth, fostering healthy self-concepts, and addressing diverse sexual issues among children and adolescents globally. A meta-analysis was conducted to analyze the effectiveness of CSE programs. A literature search was performed on EMBASE, PubMed, CINAHL, Cochrane Library, and PsycInfo for studies published before 14 June 2023, and based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We used the Comprehensive Meta-Analysis (CMA, V4) software version 4.0 for the analysis and interpreted the effect sizes according to Cohen's definition. Between 2011 and 2020, 21 studies on CSE were published, with the United States having the most publications (17). Of the 34 studies reviewed, 20 were randomized controlled trials. The primary population for CSE was middle/high school students (15), with the most frequent age range being 10-19 years (26). The overall effect size of CSE was significant (effect size = 1.31, p < 0.001), with cognition (effect size = 5.76, p < 0.001) being the most significant. CSE is an effective educational tool for children and adolescents with a significant impact on variables such as cognition and abstinence. It should be incremental from childhood and adolescence to adulthood.

Naïve, uninformed and sexually abused: circumstances surrounding adolescent pregnancies in Malawi

BackgroundPregnancy and childbearing in adolescence could negatively affect girls’ health and socio-economic wellbeing across the life course. Previous studies on drivers of adolescent pregnancy in Africa have not fully considered the perspectives of parents/guardians vis-à-vis pregnant and parenting adolescents. Our study addresses this gap by examining pregnant and parenting adolescents’ and parents/guardians’ narratives about factors associated with early and unintended pregnancy.MethodologyThe descriptive study draws on qualitative data collected as part of a larger mixed-methods cross-sectional survey on the lived experiences of pregnant and parenting adolescents. Data were collected between March and May 2021 in Blantyre, Malawi, using semi-structured interview guides. We interviewed 18 pregnant and parenting adolescent girls, 10 parenting adolescent boys, and 16 parents/guardians of pregnant and parenting adolescents. Recorded interviews were transcribed verbatim into the English language by bilingual transcribers. We used the inductive-thematic analytical approach to summarize the data.FindingsThe data revealed several interconnected and structural reasons for adolescents’ vulnerability to early and unintended pregnancy. These include adolescents’ limited knowledge and access to contraceptives, poverty, sexual violence, school dropout, COVID-19 school closures, and being young and naively engaging in unprotected sex. While some parents agreed that poverty and school dropout or COVID-19 related school closure could lead to early pregnancies, most considered stubbornness, failure to adhere to abstinence advice and peer influence as responsible for adolescent pregnancies.ConclusionOur findings contribute to the evidence on the continued vulnerability of girls to unintended pregnancy. It highlights how parents and adolescents hold different views on reasons for early and unintended pregnancy, and documents how divergent views between girls and their parents may contribute to the lack of progress in reducing adolescent childbearing. Based on these findings, preventing unintended pregnancies will require altering community attitudes about young people’s use of contraceptives and engaging parents, education sector, civil society organizations and community and religious leaders to develop comprehensive sexuality education programs to empower in- and out-of school adolescents.

Comprehensive sexuality education for out-of-school young people living with HIV and young people with disabilities: findings from a formative research study in Malawi

This formative study was undertaken between June 2020 and April 2021 to provide evidence to inform the design and delivery of comprehensive sexuality education (CSE) in Malawi for young people living with HIV (YPLHIV) and young people with disabilities (YPWD). The study included a desk review of the situation of these two groups and a mapping of CSE programmes and delivery approaches in Malawi. The study findings show that YPWD and YPLHIV in Malawi are marginalised groups, face stigma and discrimination, and are more vulnerable to abuse, warranting CSE that addresses their needs. Yet, they are often left out of sexuality education such as school-based programmes (due to early school drop-outs) and out-of-school programmes, as well as traditional modes. Furthermore, in instances where they have access to sexuality education, there is little evidence to suggest that the sexuality education that they receive is designed to address their needs, thus raising questions about its relevance. There is need for tailored CSE that addresses the needs of these groups and that is delivered using an approach that is easily accessible to them.

Protocol for a multi-country implementation research study to assess the feasibility, acceptability, and effectiveness of context-specific actions to train and support facilitators to deliver sexuality education to young people in out-of-school settings

Comprehensive sexuality education (CSE) is a well-established component of the package of interventions required to improve adolescent sexual and reproductive health and rights. As the international community has increased its emphasis on equity and leaving no-one behind with the Agenda for Sustainable Development, attention has been drawn to the need for complementary CSE programmes to reach young people who are not in school, or whose needs are not met by in-school CSE programmes. CSE in out-of-school contexts presents unique considerations, especially those related to facilitation. In this manuscript, we present the protocol for a multi-country implementation research study in Colombia, Ethiopia, Ghana, and Malawi to assess the feasibility, acceptability, and effectiveness of context-specific actions to prepare and support facilitators to deliver CSE in out-of-school settings to defined groups of young people with varying needs and circumstances. This study will be led by the World Health Organization and the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, in partnership with local research institutions. It will be nested within a multi-country programme led by UNFPA, in partnership with local implementing partners and with financial support from the Government of Norway. This study will shed new insight into what it takes to effectively deliver CSE in out-of-school contexts, to enhance progress towards the achievement of SDG 3 “Ensure healthy lives and promote wellbeing for all at all ages” and SDG 5 “Achieve gender equality and empower all women and girls”.