Despite recognition of the need for CSE; the availability of evidence of the effectiveness and cost effectiveness of CSE; the availability of tools to advocate, plan, monitor, and evaluate programs; and the inclusion of CSE in international declarations and in regional/national plans of action, progress at implementation of CSE in many countries has slow or has even stalled. A major factor for this is deep-seated discomfort about adolescent sexuality, and political and cultural resistance to CSE. To address this knowledge gap, WHO RHR HRP is developing a portfolio of case studies to examine and delineate strategies for creating an enabling environment for CSE and overcoming resistance when this occurs. Case studies from Pakistan and Mexico have been published, and case studies from Nigeria, India, Uganda, and Texas USA are currently in development.
Working around the numerous and deep-seated social and religious barriers to sexuality education in Pakistan, two NGOs (Aahung and Rutgers Pakistan) have skillfully crafted and implemented large-scale sexuality education programs in Pakistan, collectively reaching more than 500,000 students.Aahung and Rutgers Pakistan built community support by strategically choosing issues to address, framing their work with care, having sensitive content vetted, and actively reaching out to gatekeepers to improve transparency and understanding. Meanwhile, they skillfully dealt with backlash by using supportive media persons as intermediaries, arranging for journalists to visit schools and see the programs for themselves, and organizing information-sharing and discussion sessions.
In 2003, Nigeria adopted a national comprehensive sexuality education (CSE) curriculum in response to the growing HIV/AIDS pandemic, and committed to country-wide scale-up. This curriculum was later modified, labeled Family Live and HIV Education (FLHE), and published in 2007. After one year of implementation, FLHE was operational in approximately half of the country’s states and was later expanded to 35 of the 36 total states. In Nigeria, a group of NGOs led by Action Health Incorporated and Association for Reproductive and Family Health demonstrated the need for sexuality education using HIV as the entry point, along with the feasibility and effectiveness of sexuality education in projects, and formed a national coalition to advocate for a national policy and strategy. The coalition then worked with internal and external change agents over eight years to contribute to a policy and national scale-up plan. This clear policy mandate, supported by teacher-centered guidelines and tools, provided the foundation for sustainability. Alongside this work, the National Council of Education committed to scaling up FLHE and initiated both pre-service and in-service teacher training. Meanwhile, to build engagement with stakeholders during scale-up, they used state-level advisory and advocacy committees involving politicians, religious and community leaders, teachers’ unions and parents’ groups, alongside proactive, energetic, and on-going consultations with supporters and opponents. Although the coalition experienced backlash, they could sustain their efforts through the help of the strong alliances that had been created.
Since the 1930s, Mexico has made substantial progress in providing adolescents with sexuality education through an evolving national school-based program. This analysis uses a historical lens to answer 2 key questions: (1) How has the nature of sexuality education in Mexico evolved from the 1930s to the 2010s? (2) How have the drivers, responses, support, and resistance to sexuality education impacted Mexico's experience implementing and sustaining school-based sexuality education? This analysis identified determined support for school-based sexuality education in the 4 historical time periods from a range of governmental and nongovernmental stakeholders. However, opposition to sexuality education also steadily rose in the time period considered, with a growing range of more organized and well-financed actors. The Mexican government's commitment to delivering school-based sexuality education has driven its inclusion in public schools, along with expansion of its curricula from primarily biological content to a more comprehensive approach.
Between 2006 and 2016, Udaan – a school-based adolescent education program (AEP) in Jharkhand, India – was the only at-scale state-run program in the country. It is one of the largest interventions of its kind in India, and has been recognized by the national governments as a model program for replication in other states. In Jharkhand State, vertical scale-up of Udaan was partially accomplished at the outset through inclusion of the program as an integral part of national policy, and was later aided by transfer of responsibility from the Health to Education Department. Horizontal scale-up, meanwhile, was accomplished through a strong and committed partnership between the Department of Education and C3, an Indian NGO which provided technical support. Additionally, the program tasked a Core Committee with planning, implementing, monitoring, and reviewing Udaan; built on capacity of existing government staff for implementation at lower levels; developed a school-based MIS; and reiteratively shared progress at midterm sharing meetings.