Short-Term Effects of a School-Based Comprehensive Sexuality Education Intervention Among Very Young Adolescents in Three Urban Indonesian Settings: A Quasi-Experimental Study.

PURPOSE: To evaluate the effects of a comprehensive sexuality education (CSE) intervention on short-term psychosocial outcomes related to healthy sexuality among very young adolescents in urban Indonesia. METHODS: A quasi-experimental study was conducted between 2018 and 2021 with students aged 10-14 years at 18 schools in Indonesia (Lampung, Denpasar, Semarang). Three schools per site were purposefully selected to receive the SEmangaT duniA RemajA intervention, a two-year, rights-based teacher-led CSE intervention delivered in classrooms (or online after the 2020 COVID-19 outbreak); and matched with three control schools. Surveys were completed by 3,825 students at pre- and posttest (82% retention). The final analytical sample included 1852 intervention and 1483 control students (N = 3,335). Difference-in-difference analysis was conducted to examine the intervention effect on healthy sexuality competencies (knowledge, skills, and attitudes) and personal sexual well-being. RESULTS: Baseline characteristics for intervention and control groups were similar in terms of sex (57% female) and age (mean 12 years). Students receiving SEmangaT duniA RemajA demonstrated significantly greater increase in competencies, including greater pregnancy knowledge, more gender equal attitudes, and communication about sexual and reproductive health and rights, compared to controls. There was no intervention effect on personal sexual well-being, except for self-efficacy to prevent pregnancy. Subgroup analysis indicated more significant effects among females and students in Semarang and Denpasar, than males or students in Lampung. DISCUSSION: While findings demonstrate the potential for CSE programs to improve healthy sexuality competencies in early adolescence, the effect appears to be highly contextualized which may be due to varying levels of implementation quality, especially since the COVID-19 outbreak.

Young people's choice and voice concerning sex and relationships: effects of the multicomponent Get Up Speak Out! Programme in Iganga, Uganda.

BACKGROUND: Young people in Uganda face challenges in achieving their sexual and reproductive health and rights (SRHR), such as lack of information, limited access to services, teenage pregnancy and sexually transmitted infections. To address this, their empowerment - including their ability to express themselves and make decisions, is a key strategy. This study assessed how young people's voice and choice concerning sex and relationships changed over the period of 3 years of implementation of the Get Up Speak Out! programme. METHODS: Data were collected through a household survey with young people (15-24 years) and through focus group discussions, in-depth interviews and key informant interviews with youth and community stakeholders in 2017 for the baseline and 2020 for the end-line. Using the difference-in-difference technique and thematic analysis, changes in key outcomes were assessed over time between intervention and control area. RESULTS: There were limited changes over time in the intervention area, which did not differ from changes in the control area. Young people were able to express themselves and expand their decision-making space on sex and relationships, in particular if they were older, male and in a relationship. Young women negotiated their agency, often by engaging in transactional sex. However, youth were still restricted in their self-expression and their choices as speaking about sexuality was taboo, particularly with adults. This was influenced by the political and religious climate around SRHR in Uganda, which emphasised abstinence as the best option for young people to prevent SRHR-related problems. CONCLUSIONS: Young people's SRHR remains a challenge in Uganda in the context of a conservative political and religious environment that reinforces social and gender norms around youth and young women's sexuality. The limited effect of the programme on increasing young people's voice and choice concerning relationships in Uganda can be understood in the context of a ban on comprehensive sexuality education (CSE) and the COVID-19 pandemic. These structural and emerging contextual factors enforce the taboo around youth sexuality and hinder their access to SRHR information and services. Multi-component and targeted programmes are needed to influence changes at the structural, community and individual level.