Trends and Challenges in Comprehensive Sex Education (CSE) Research in Sub-Saharan Africa: a Narrative Review

Purpose of the Review Adolescent sexual and reproductive health remains a major public health challenge in Sub-Saharan Africa (SSA). Comprehensive sex education (CSE) has been hailed as a key strategy to inform young people about sexual health and wellbeing and prevent negative health outcomes. This paper presents an overview of the trends and challenges around sex education in SSA and puts forth key recommendations for future research and policy initiatives. Recent Findings This review employed a narrative approach to synthesize evidence on the implementation of comprehensive sex education in SSA. The literature review elicited four key themes: (i) comprehensiveness of CSE curricula, (ii) gender norms in CSE, (iii) prominence of ‘fear' narratives in CSE implementation, and (iv) CSE delivery methods. Additionally, the authors propose a fifth theme—‘Future-proofing CSE programs', based on their learnings from implementing sex education interventions during the COVID-19 pandemic. These five themes are presented through a narrative description of current research accompanied by reflections from the authors on the implementation of a parent-focused sex education program in Uganda. Summary Based on the insights from the literature review and the authors' reflections, three recommendations are put forward to guide the design of further CSE initiatives: (i) stakeholder engagement in determining CSE priorities and strategies, (ii) diverse delivery pathways for CSE programs, and (iii) active engagement of both boys and girls to challenge gender norms in CSE.

Intimate Partner Violence During COVID-19 Restrictions: A Study of 30 Countries From the I-SHARE Consortium.

Intimate partner violence (IPV) causes substantial physical and psychological trauma. Restrictions introduced in response to the COVID-19 pandemic, including lockdowns and movement restrictions, may exacerbate IPV risk and reduce access to IPV support services. This cross-sectional study examines IPV during COVID-19 restrictions in 30 countries from the International Sexual HeAlth and REproductive Health (I-SHARE) study conducted from July 20th, 2020, to February, 15th, 2021. IPV was a primary outcome measure adapted from a World Health Organization multicountry survey. Mixed-effects modeling was used to determine IPV correlates among participants stratified by cohabitation status. The sample included 23,067 participants from 30 countries. A total of 1,070/15,336 (7.0%) participants stated that they experienced IPV during COVID-19 restrictions. A total of 1,486/15,336 (9.2%) participants stated that they had experienced either physical or sexual partner violence before the restrictions, which then decreased to 1,070 (7.0%) after the restrictions. In general, identifying as a sexual minority and experiencing greater economic vulnerability were associated with higher odds of experiencing IPV during COVID-19 restrictions, which were accentuated among participants who were living with their partners. Greater stringency of COVID-19 restrictions and living in urban or semi-urban areas were associated with lower odds of experiencing IPV in some settings. The I-SHARE data suggest a substantial burden of IPV during COVID-19 restrictions. However, the restrictions were correlated with reduced IPV in some settings. There is a need for investing in specific support systems for survivors of IPV during the implementation of restrictions designed to contain infectious disease outbreaks.

Dramatic effects of COVID-19 public health measures and mass reverse migration on youth sexual and reproductive health in rural Uganda.

Introduction: Youth (aged 10 to 24 years) comprise nearly one-third of Uganda's population and often face challenges accessing sexual and reproductive health (SRH) services, with a disproportionately high incidence of negative SRH outcomes. Responding to COVID-19, Uganda implemented strict public health measures including broad public transportation, schooling, and business shut-downs, causing mass reverse-migration of youth from urban schools and workplaces back to rural home villages. Our study aimed to qualitatively describe the perceived unintended impacts of COVID-19 health measures on youth SRH in two rural districts. Methods: Semi-structured focus group discussions (FGD) and key informant interviews (KII) with purposively selected youth, parents, community leaders, community health worker (CHW) coordinators and supervisors, health providers, facility and district health managers, and district health officers were conducted to explore lived experiences and impressions of the impacts of COVID-19 measures on youth SRH. Interviews were recorded, transcribed, and coded using deductive thematic analysis. Results: Four COVID-19-related themes and three subthemes resulted from 15 FGDs and 2 KIIs (n=94). Public transportation shutdown and mandatory mask-wearing were barriers to youth SRH care-seeking. School/workplace closures and subsequent urban youth migration back to rural homes increased demand at ill-prepared, rural health facilities, further impeding care-seeking. Youth reported fear of discovery by parents, which deterred SRH service seeking. Lockdown led to family financial hardship, isolation, and overcrowding; youth mistreatment, gender-based violence, and forced marriage ensued with some youth reportedly entering partnerships as a means of escape. Idleness and increased social contact were perceived to lead to increased and earlier sexual activity. Reported SRH impacts included increased severity of infection and complications due to delayed care seeking, and surges in youth sexually transmitted infections, pregnancy, and abortion. Conclusion: COVID-19 public health measures reportedly reduced youth care seeking while increasing risky behaviours and negative SRH outcomes. Investment in youth SRH programming is critical to reverse unintended pandemic effects and regain momentum toward youth SRH targets. Future pandemic management must consider social and health disparities, and mitigate unintended risks of public health measures to youth SRH.

Gendered Experiences of Parent–Child Communication on Sexual and Reproductive Health Issues: A Qualitative Study Employing Community-Based Participatory Methods among Primary Caregivers and Community Stakeholders in Rural South-Western Uganda

Open and positive parent–child communication about sexual and reproductive health (SRH) is known to reduce negative SRH outcomes for young people. However, socio-cultural influences can inhibit meaningful SRH communication. Restrictive gender norms threaten the SRH of adolescents, as they make adolescent boys more likely to engage in risky sexual behavior and make girls more vulnerable to negative SRH outcomes. This study intended to critically understand the impact of gender norms and expectations on parent–child SRH communication in rural south-western Uganda. Methods: The study adopted a community-based participatory approach using community stakeholder engagement meetings (n = 2), in-depth interviews (n = 12), and three focus group discussions with parents (n = 18). The study considered biological parents, step-parents, grandparents, uncles and aunties, as long as they were primary caregivers of adolescents aged 10–14. Results: Participants elaborated on the socio-cultural aspects that shaped their experiences of parent–child SRH communication such as cultural gender norms, religion, and media influences. They also referred to socio-economic challenges, lack of knowledge, and the role of peers and schools. Conclusions: There is need for community-based interventions to improve parent–child SRH communication to address the deeply rooted cultural and gender contexts in rural south-western Uganda.