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Spotlight on Comprehensive Sexuality Education (CSE): What We Can Learn From the UNESCO Global Status Report


Comprehensive Sexuality Education (CSE) refers to a “broad-reaching, holistic, age-appropriate, multidimensional learning process that … enables young people to make healthy, deliberate and respectful decisions about sexuality and relationships.” In many regions, policy makers invoke CSE with initiatives that use different names, like “respectful relationship programming” or “life skills education,” and that may not be comprehensive in reality. CSE often takes place in schools as part of in-school curriculums, but also occurs in other settings such as youth clubs, sports practices, and community centers.

What puts the “Comprehensive” in “Comprehensive Sexuality Education”?

Characteristics of CSE:

  • Scientifically accurate
  • Incremental
  • Age- and developmentally appropriate
  • Curriculum-based
  • Comprehensive
  • Based on a human rights approach
  • Based on gender equality
  • Culturally relevant and context-appropriate
  • Transformative
  • Encourages development of life skills needed to support healthy choices

8 Key CSE Concepts:

  1. Relationships
  2. Values, Rights, Culture, and Sexuality
  3. Understanding Gender
  4. Violence and Staying Safe
  5. Skills for Health and Well-being
  6. The Human Body and Development
  7. Sexuality and Sexual Behavior
  8. Sexual and Reproductive Health

No matter the title or the context, young people across the globe have collectively continued to assert and advocate for their right to access quality CSE. Though opposition to CSE remains—often grounded in misinformation or misunderstandings regarding its purpose and content—overall, communities are increasingly recognizing CSE’s importance to the promotion of Adolescent and Youth Sexual and Reproductive Health (AYSRH).

Why is CSE so important to AYSRH?

Supporting young people in the fulfillment of their sexual and reproductive health needs is crucial. CSE equips and empowers them with knowledge to help them make informed decisions about their own lives. Comprehensive and inclusive sexuality education can help dispel harmful myths and norms about gender roles, menstruation, the LGBTQI+ community, AYSRH for people with disabilities, etc. Furthermore, CSE provides accurate information on family planning and accessing modern contraceptive methods in order to prevent unwanted pregnancy; skills to identify healthy relationships; resources to address intimate partner violence; and information to prevent, test, and treat Sexually transmitted infections (STIs). CSE is a commitment to the overall health and well-being of all people, regardless of gender, class, race, or ethnicity.

Still, a recent United Nations Educational, Scientific and Cultural Organization (UNESCO) report on the global status of CSE has shown that there remain vast disconnects and differences between:

  • What leaders and other stakeholders set out to do in order to address the needs of adolescents and youth
  • What studies and programmatic evaluations suggests should be done (what evidence-based approaches support)
  • And the quality of CSE that reaches its intended recipients

These gaps represent missed opportunities and misuses of CSE initiatives’ limited resources— including the monetary investment, time, and personnel training required to implement CSE for in-school and out-of-school youth alike. We know that CSE works, yet implementation remains challenging.

The 2021 UNESCO report outlined programmatic factors to consider when assessing the strengths and weaknesses of CSE provision so that changemakers can decide their next strategic step. Here is a mnemonic (adapted from the 2021 report) for ensuring that no element is missed when examining CSE landscapes and determining which areas require prioritization and improvement.

CSE infographic

Caption: The image above contains the message: “To recall key components contributing to CSE sustainability and effectiveness, just think: ACCESS.” The image includes a visual of the acronym ACCESS. A: Acts, policies, laws. C: Coverage. C: Curricula. E: Educators’ delivery. S: Supporting environment. S: Study quality and outcomes.

Acts, Policies, Laws

85% of the 155 countries that UNESCO surveyed have laws and policies in place related to CSE provision.

Though they are becoming more prevalent, many CSE-related mandates lack specificity and don’t account for the dedication of a budget stream to ensure that policies and programs are properly implemented. At the national level, many countries’ policies only account for incorporating CSE into secondary school education, thus overlooking opportunities to adapt CSE curriculums for students in elementary school (Very Young Adolescents or VYAs) and other populations.

Students from many countries report feeling that they were educated on AYSRH too late. They feel that CSE should be introduced from an earlier age.

Changes in government can put support for CSE at risk due to politicians’ varying stances on the topic. Advocates may consider vouching for the creation of a “permanent” CSE team within the relevant ministry. While a fixed team cannot be entirely immune to political shifts, its initial existence can at least strengthen CSE efforts’ sustainability and reinforce continuity between different CSE initiatives.

Coverage

CSE programming is not reaching many adolescents and youth, even in regions with supportive policies. In addition to uneven access among very young adolescents (VYAs), young people who occupy marginalized groups also have challenges accessing CSE. Specific subgroups—like married adolescents—need to be explicitly included in outreach strategies.

Check out this High Impact Practice Brief on effective community group engagement!

Digital media and especially mobile phones have taken off as novel means of building connections. Online platforms can provide personalized experiences to users whose needs aren’t adequately addressed by other, generalized programs. There are risks and problems that come with using digital communications: Vulnerable groups may not have reliable access to the required technology, and there are privacy and confidentiality considerations associated with online platforms. Still, there is promising evidence that digital CSE is not only effective in disseminating information, but also that it leads to concrete, significant positive behavior changes. Program planners should weigh the advantages, disadvantages, and uncertainties of integrating technology early on in the development process.

Curricula

Over 40% of UNESCO’s surveyed countries reported that the topics of gender, pregnancy, relationships, and violence are not officially incorporated into CSE curricula. UNESCO has a suggested list of key concepts to cover at varying stages of life, and Knowledge SUCCESS has a toolkit introducing adaptable teaching materials.

Practical tips to prepare curricula that are inclusive and informed by evidence:

  1. Carefully assess the resources (human, time, and financial) available to develop and implement curricula. Here are some resources for adaptable curricula that are relatively accessible.
  2. Pay attention to what young people in your setting may be learning elsewhere. Curricula should address misinformation and present a non-judgmental view of sexuality, sexual practices between consenting partners, and gender identities and expressions.
  3. Include interactive, participatory activities where appropriate. The experiential model of learning draws from the idea that we learn best when we first personally experience something, then have the opportunity to reflect on it afterwards.
  4. Coordinate with and connect program participants to other supports, like extra-curricular, community, or health facility-based partners. Partnerships with identity-specific community groups in particular can help young people from marginalized groups link up with the support that is most relevant to them. CSE programs should also promote the availability and accessibility of adolescent-responsive health services, contraceptive distribution locations and mechanisms, and reliable follow-ups, referrals, and individual counseling. Social marketing and voucher partnerships can address financial barriers to services and products.
  5. Instead of simply creating one-off interventions, consider how curricula components will fit together to address CSE over the course of several years. CSE programs must continue to reinforce and elaborate on key concepts across a young person’s life course. Revisiting valuable principles and deepening students’ understanding over time is the recommended “spiral curriculum” approach.

What doesn’t work when making adaptations to existing curricula

When making changes to curricula that others have created and vetted, try to avoid these alterations that can impact effectiveness.

Changes that don’t substantially affect desired outcomes include “changing language (translating and/or modifying vocabulary); replacing images to show youth, families or situations that look like the target audience or context; and replacing cultural references.”

Educators’ Delivery

CSE program effectiveness is critically impacted by the way in which teachers and educators deliver it. They play a vital role in creating safe(r) learning environments for diverse groups of students. They should know how to facilitate difficult discussions, protect student privacy and confidentiality, and appropriately act on disclosures of abuse or violence. CSE educators who perpetuate negative views of sexuality and emphasize abstinence do more harm than good.

When Preparing CSE Teachers and Facilitating Reflection

Training should be an ongoing process. Supervisors and school authorities should remain updated on new developments in the field. Online professional development content, along with other continuing learning opportunities, should be available to educators.

Check out this toolkit on supporting CSE teachers!

Supporting Environment

Resistance to the very idea of promoting CSE can pose a massive barrier to creating sustainable partnerships. UNESCO has an excellent resource on responding to common questions and concerns regarding CSE and its validity. These talking points can be used for advocacy and alliance-building at any point in the process of enriching CSE programs.

Check out this resource list for engaging with members of the community, including faith leaders, parents, and other health providers!

Short-Term Outcome Evaluation

The factors described so far highlight programmatic building blocks that must be present and strong in order to construct effective, sustainable CSE programs. Programmers should also identify a variety of quality indicators to monitor during and after project implementation. There should be consistent reviews of quantitative program data (e.g., number of learners reached), qualitative feedback, and assessments from observing sample learning sessions (if appropriate within the program’s context). Evaluations must account for indicators that align with the standards of greater systems—like national monitoring frameworks.

For more information and resources regarding monitoring and evaluation, check out:

Editor’s note: Some of the reports and materials linked to in this blog post may contain information that is not compliant with USAID global health legislative requirements, family planning guiding principles and policy requirements, and HIV/AIDS legal and policy requirements.

A teacher shows students condom use in an educational program to promote awareness of HIV/AIDS. Cambodia. Photo: © Masaru Goto / World Bank
Michelle Yao

AYSRH Content Practicum Student, Johns Hopkins Center for Communication Programs

Michelle Yao (she/her) is a full-time Master of Bioethics student at Johns Hopkins University. She holds a Bachelor of Health Sciences (with a Minor in English and Cultural Studies) from McMaster University in Ontario, Canada. She has previously worked on community initiatives and research centered on child and youth health, reproductive justice, environmental racism, and cultural awareness in health education. As a practicum student, she supports content creation for Knowledge SUCCESS, with a focus on addressing the topic of adolescent and youth sexual and reproductive health.

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