Features decisive for effectiveness of school-based sexuality education in low- and middle-income countries A review

Objectives: Sexuality education is the cornerstone of the combination approaches towards better sexual and reproductive health among young people. This study evaluates the efficacy of school-based sexuality education and quantifies the relative importance of the variations in content and delivery of programmes in low- and middle-income countries. Methods: RCT and quasi-experimental studies were identified via: 1.Citations in the UNESCO International Technical Guidance on Sexuality Education; 2.Searching electronic databases hosted by EBSCO (MEDLINE, ERIC, PsychLIT, EMBASE, CINAHL, SSCI and other); and, 3.secondary reference searching of included articles. Immediate, short-term and long-term intervention effects on behavioural antecedents, sexual behaviour and SRH outcomes were synthesised as a function of frequency of studies reporting significant effects, and then segregated across variations of programmes' content and delivery. Results: 51 studies in reference to 38 sexuality education programmes were included in this review. Their impact was found to be predominantly substantial and sustained at both urban and rural locations. Three distinct types of sexuality education emerged from the thematic analysis of their content: informative (providing relevant information), comprehensive (building positive attitudes and skills) and transformative (creating supportive environment). The effectiveness of programmes was found to be remarkably associated with its content, with transformative interventions being more effective than comprehensive and, by inference, informative. In addition, providing sexuality education at earlier age, distributing the content across longer time periods and engaging young people to assist teachers throughout the delivery were observed as beneficial strategies towards enhancing the effects. Conclusions: Implementing sexuality education in schools is justified in light of its effectiveness. States should invest efforts in designing context and age appropriate programmes within a combination approach. Keywords: sexuality education, developing countries, school-based programmes, sexual behaviour, sexual health, young people, effectiveness, characteristicsmsc_inhunpub1777_ethesesunpu