Breaking barriers: How addressing the taboo topic of sexuality can lead to better outcomes in sub-Saharan Africa

Every year, approximately 21 million girls aged 15 to 19 in low- and middle-income regions of the world become pregnant. Complications from pregnancy and childbirth are the leading cause of death among these young women. Groundbreaking research funded by IDRC and carried out in Burkina Faso, Kenya, Nigeria and The Gambia is generating evidence and testing innovative solutions to address the problem through comprehensive sexuality education (CSE) for adolescents.

The problem: The Gambia as a case study 

Concern about adolescent sexual and reproductive health (ASRH) in sub-Saharan Africa is growing, and the evidence shows that there is a pressing need to find solutions. The Gambia is one example that illustrates the scope of the problem. In a research project that evaluated adolescents’ perceptions of sexuality education, researchers reported that in one region, for example, one in five Gambian girls aged 15 to 19 are already mothers or pregnant with their first child.

Like other sub-Saharan African nations, the country is also seeing increased rates of sexually transmitted infections, teenage pregnancies outside of marriage and unwanted pregnancies. The consequences? Unsafe abortions, expulsion from home, dishonour for the girl’s family and herself, dropping out of school, child neglect and abuse.

At the root of this problem is a lack of timely, trusted information on sexual and reproductive health (SRH), misinformation about sex and limited access to ASRH services.

The solution: Comprehensive sexuality education  

CSE gives young people accurate, age-appropriate information about sexuality and their SRH, which is critical for their developmental and physical health and survival. This curriculum-based approach equips children and young people with skills, attitudes and values that empower them to:

• manage the physical and emotional changes of adolescence 
• live a healthy life with dignity and avoid abuse and learn how to deal with it 
• be respectful in their social and sexual relationships 
• think about their choices and their lifelong impact 
• understand their rights and know how to protect them   

CSE can be delivered in formal and non-formal settings, including at home, in school and in the community. When young people have access to high-quality CSE, the results positively impact their lives. As the WHO reports, “Young people are more likely to delay the onset of sexual activity — and when they do have sex, to practice safer sex — when they are better informed about their sexuality, sexual health and their rights.” CSE teaches them about respect, consent and how to get help if they need it, which reduces the risk of violence, exploitation and abuse.

Lesson 1: With improved sexuality education, the culture of silence fades  

The study in The Gambia revealed that adolescents were dissatisfied with what they were learning in school. The researchers found that:

• sexuality education content does not meet students’ needs
• teachers do not have the proper training or educational materials 
• schools do not prioritize sexuality education 

The research team implemented the following activities that show great potential for replication at other schools:

• Comprehensive sexuality education at schools across Banjul, the capital city, to educate children and key gatekeepers about ASRH. The intervention team took a creative approach, using drama and film shows to empower girls and boys with ASRH information and services. They trained teachers and led advocacy activities targeting community leaders, policymakers and educational officials. The team operated a public sensitization caravan to educate young people and adults, and they held regular meetings with community members and school boards to sensitize them to ASRH needs. The community outreach efforts led to the creation of permanent elderly women’s groups to counsel adolescents.  
• Training on how to make reusable sanitary pads to reduce school absences and dropping out due to menstruation for grade 8 to 11 students and teachers at St. John’s School for the Deaf near Banjul. Students learned about their periods, menstrual cycles, ovulation and its signs and symptoms, and premenstrual syndrome.

Key message: With education and awareness, young people, teachers, parents and community gatekeepers become more open to talking about the “taboo topic” of ASRH. 

Lesson 2: Gender norms and expectations impact sexual health among young teens  

Young teens are often neglected in sexuality education initiatives. With their sexuality just beginning, it’s an important time for education around gender roles and ASRH. A project conducted in Burkina Faso, Kenya and Nigeria successfully increased awareness in communities, schools and governments on the negative impacts of gendered socialization on sexual health outcomes for young teens aged 10 to 15.

The research team used participatory approaches to engage young teens, school administrators, teachers, parents, community leaders and policymakers. Young participants learned to identify and avoid circumstances that put them at risk, such as substance abuse, violence and crime, and predispose them to poor ASRH outcomes, such as unintended pregnancies and sexually transmitted infections.

The research findings and recommendations led to an agreement to revise the secondary school curriculum in Nigerian schools to include CSE, curriculum reviews in Burkina Faso, and improved parent-child dialogue in Kenya. Teachers in all three countries reported that the project offered them valuable knowledge and changed their perceptions of gender and sexuality.

Key message: Investing in early outreach to young teens (aged 10 to 15) can change perceptions related to gender and sexuality in positive ways and lead to better ASRH outcomes. 

Lesson 3: Co-developed community-based interventions improve outcomes 

A project in Ebonyi State, Nigeria used an innovative, community-embedded approach to develop ASRH interventions to improve communication and strengthen relationships within families and communities, and with teachers and health service providers.

Researchers and non-academic partners co-produced strategies for delivering adolescent health interventions. The non-academic group included government officials, traditional leaders, development partners, religious organizations and adolescent peer groups. Together, they implemented several activities, including:

• Greater openness about sexuality education: They planned and hosted a panel discussion on ASRH with students and teachers from 10 schools, conducted radio and television programs during COVID-19 lockdowns, and launched health clubs in schools and awareness campaigns with parents and community leaders.
• CSE training for healthcare staff: They trained more than 240 frontline health-care workers and health-service providers on how to deliver comprehensive, friendly ASRH services. 

The outcome is that ASRH has now become a priority in Ebonyi State. Education officials have revitalized CSE in the secondary school curriculum and demand for ASRH services has gone up. The research team also reported that the lines of communication are much more open about ASRH issues in schools, families and communities.

Key message: Collaborative approaches can shift mindsets about ASRH issues. Partners with more traditional views about contraception for adolescents gradually changed their positions based on the research project’s evidence about poor adolescent SRH outcomes.