Towards comprehensive sexuality education: a comparative analysis of the policy environment surrounding school-based sexuality education in Ghana, Peru, Kenya and Guatemala

Figures & data

Table 1. Types of key informants interviewed in each country.

	Kenya	Ghana	Peru	Guatemala
Government
Policy-makers	1	1	2	3
Curriculum developers	1	1	1	1
Program implementers (national or local government)	6	3	10	5
International cooperation	1	1	2	1
Civil society
National civil society organizations, advocates	9	2	4	4
Youth organizations	4	3	5	2
Community-based organizations (other than youth)	3	5	3	5
Religious and traditional leaders	2	4	3	4
Total	27	20	30	25

Table 2. Operationalisation of levers of success related to the policy environment analysed in this paper.

Levers of success	Key dimensions	Indicators
Tradition of addressing sexuality within the education system	Process over time that led to the current status of CSE in each country	stages influences of HIV and other international trends current situation (movement towards improving CSE in schools; stagnation; movement towards more conservative approach; unclear)
(2) High-level political support and commitment to CSE reflected in a favourable policy framework	Policy framework for CSE and governments’ active support of it	document status (CSE as part of a general policy (such as HIV) versus CSE-specific policy, general versus more specific and more binding provisions, higher versus lower policy level) coherence across policies from different sectors scope and comprehensiveness of documents
(3) Government willingness to subscribe to international commitments in support of sexuality education	International commitments to which governments agreed	number of commitments signed scope of commitments compliance mechanisms
(4) Availability of appropriate technical support from UN agencies and international NGOs	Governments’ reliance on such support over time	duration level of involvement impact on policies (as reported by stakeholders)
(5) Existence of civil society organisations (CSOs) willing to promote CSE even in the face of strong opposition	Presence and roles in supporting CSE	existence of these groups at the national level influence on policies active involvement in advocacy and policy-making process
(6) Active involvement of youth-focused groups or organisations	Presence and roles in supporting CSE	existence of these groups at the national level influence on policies active involvement in advocacy and policy-making process
(7) Partnerships (and formal mechanisms for these) between different ministries and between State and CSOs	Existence and scope of multi-sectoral approaches and coordination across ministries and with CSOs	number of active partnerships status (ad hoc, systematic) formally defined (or not) number and diversity of actors involved stages of policy development

Table 3. Overview of national legal and policy framework for provision of CSE in schools.

Ghana	Peru	Guatemala	Kenya
1969: National Population Policy, first edition (National Population Council). Provides framework for introduction of reproductive health education in schools throughout the 1970s, with an emphasis on abstinence. 1994 National Population Policy, revision (National Population Council). Adds HIV/AIDS 1996: National Reproductive Health Service Policy and Standards (MOH). Indicates government’s commitment to the health and wellbeing of women, children and adolescents. Included in policy’s strategies is integration of Family Life Education into school curricula. 2000: Adolescent Reproductive Health Policy (National Population Council and MOH). Adopted a multi-sectoral framework for the development of adolescent reproductive health programmes for in- and out-of-school youth. Led to inclusion of a reproductive health component in junior and senior high school curricula (Bekoe and Eshun 2013; Quashigah et al. 2014) 2010: National Youth Policy of Ghana (Ministry of Youth and Sports). Aims to improve youth knowledge about preventive health care and help them avoid early and “irresponsible” sexual activities and exposure to HIV/STIs. 2013: National HIV/AIDS and STI Policy (Ghana AIDS Commission). Advocates for integration of age-appropriate SRH education into curriculum, including lessons on HIV/AIDS and other STIs. 2015: Adolescent Reproductive Health Policy (MOH), revision of 2000 Policy.	1980–90: National Programme for Population Education (MOE). Incorporates content on sexuality education into Family Education and Civic Education classes. 1985: Law on National Population Policy. States that education sector is in charge of promoting and delivering programmes related to population and sexuality education in schools. 1996–2000: National Sexuality Education Programme (MOE). In addition to family planning, emphasised topics such as STIs, sexual violence and adolescent pregnancy. 1998–2002: National Population Programme (Ministry for Promotion of Women and Human Development-PROMUDEH). Aims to ensure young people know about SRH, can identify risks and prevention strategies for STIs/HIV, expand coverage of National Sexuality Education Programme to all public secondary schools and half of private schools. 2007: Law of Equal Opportunities between Men and Women no 28,923. Recognises right to CSE in article 6l (Gobierno del Peru 2007). 2008: Education Guidelines and Pedagogical Orientations for CSE (MOE). Offers guidance on CSE implementation in junior high school (Educación Básica Regular). States that MOE is in charge of implementation of CSE; but lacks detailed proposal for teacher training (Dirección de Tutoría y Orientación Educativa 2008) 2013: Multi-sectoral Plan for the Prevention of Pregnancy in Adolescents (2013–2021) (MOH). Objective 3 is to ensure inclusion of CSE in national curricular framework and teacher training programmes (Ministerio de Salud 2013).	2000: General Law for fighting HIV/AIDS and promoting, protecting and defending human rights in the face of HIV/AIDS (Decree 27–2000). Includes these topics in curriculum. 2001: Law on Social Development (Decree 42–2001). Indicates obligation to provide counsel and education to adolescents on sexuality, human rights and multiculturality and prohibits exclusion of pregnant adolescents from school; recognises right to CSE. 2005: Law on Universal and Equitable Access to Family Planning Services and their Integration in the Sexual and Reproductive Health Programme (Decree 87–2005). Indicates that content on rights and responsibilities for addressing health, sexuality and unintended pregnancy should be included in the curriculum. 2010: National Policy on Youth 2012–2020 (Ministry of Social Development-MIDES). Promotes better CSE coverage and quality in all school cycles with a focus on human rights, gender and ethnicity. 2010: Law on Healthy Pregnancy (Decree 32–2010) establishes strategy for including CSE in national curriculum, and aims to prevent adolescent pregnancy, guaranteeing pregnant students’ right to remain in school and detecting cases of violence.	2003: Adolescent Reproductive Health Development Policy (MOH). Aims to incorporate adolescent SRH education into the curricula of all education and training institutions. Promotes HIV/AIDS education programmes for adolescents in and out of school. 2004: Policy Framework for Education and Training (MOE). Emphasises giving young people the knowledge and skills to lead effective lives, and developing teachers’ communication skills, attitudes and values to help them better connect with students. 2004: Education Sector Policy on HIV and AIDS (MOE). Integrates life skills and HIV & AIDS education into curricula for all school levels, including co-curricular activities, using rights-based content. 2009: National School Health Policy (MOE & MOH). Provides framework for multi-sectoral approach to ensure that children are taught and helped to acquire positive values and life skills, including on SRH. 2013: Education Sector Policy on HIV and AIDS, revised (MOE). Re-emphasises need to provide age-appropriate and relevant information to prevent HIV among learners at all levels. 2015: National Adolescent Sexual and Reproductive Health Policy (MOH). Provides guidance to enhance SRH of adolescents and contribute to realization of their full potential, with specific objective of increased access to ASRH information and age-appropriate CSE.

Notes: MOE = Ministry of Education; MOH = Ministry of Health

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