sex education in schools south africa

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Itumeleng Letsoalo is a Global Citizen Fellow and content writer in South Africa. Here, she explains why South Africa’s decision to expand its sex education programme is empowering for young people — especially girls — and why she finds the backlash against the decision so frustrating. 

When  reports came out a few months ago that South Africa’s Department of Basic Education will be expanding the Comprehensive Sexuality Education curriculum in the Life Orientation subject, my first thoughts were for the little girls who would have the opportunity to learn about their bodies. 

The programme expansion means that children will learn about the importance of consent, about how their bodies are theirs, and about how to recognise sexually inappropriate behaviour. 

As many women and girls in South Africa know, there is an excruciating pain that comes with being violated but not having the words to express it, because you don’t even know what this part of your body is and what it is meant for.

This is why we often hear people coming out to say: “I was raped when I was 8”. So often these people, realising only later what happened to them, are burdened with shame over their delay in speaking out instead of being supported. 

Expanding the sex education programme in schools will help protect children and their bodies from sexual violence, by teaching them what is and is not appropriate. 

So it’s frustrating for me that parents and organisations such as the Concerned Young People of SA  (CYPSA)  and the  Freedom of Religion SA  have been retaliating against the curriculum, saying that teaching children about their bodies will lead to an early interest in sex.

The backlash has been so determined that Basic Education Minister Angie Motshekga has  announced  that parents have the choice to opt their children out of the sex education ­curriculum. To me, this is one step forward and 10 steps back. 

Reports  say that the curriculum for Grade 4 to Grade 12 learners will also cover issues like masturbation, gender non-conformity, and single-parent families.

Quite frankly, these — along with the issues of consent and inappropriate sexual behaviour I mentioned above — are, to my mind, some of the most important topics in enforcing body autonomy for girls.

The Department of Basic Education has dismissed critics’ claims about encouraging an interest in sex among children — and made details  about the lesson plans public in an attempt to ease fears regarding the content of the curriculum.

In a  media statement last month, the department highlighted the need for the provision of age-appropriate sex education for children — citing high birth rates among adolescents and teenagers, and the fact that more than a third of girls and boys (35%) experience sexual violence before the age of 17. 

“This has necessitated the great need for the department to provide age-appropriate child abuse prevention education that builds resilience, confidence, and assertion amongst young people, who often do not know when they are being violated by sexual predators,” said the department. 

“The lessons focus on teaching about the respect for self, for the body of others, and most importantly, for children to identify inappropriate physical interactions,” it added.

The department also responded to “a certain organisation” that it says is persisting in “misleading the public by publishing the wrong information resulting in unnecessary confusion and panic among South Africans.” 

I was 10 years old when Life Orientation became one of my compulsory subjects in school. My teacher, Miss Michelle, taught us about HIV/AIDS, drugs and substance abuse, nutrition and the food pyramid , and physical education.

The curriculum continued in the same way until I got to High School — but then Life Orientation became a “free period” for us because it was felt that we weren’t being taught anything new or worthwhile.

Meanwhile, there was more than one pregnant girl in every grade, and the boys were watching porn in the corridors.

By the time most of our parents think it’s appropiate for us to learn about sex, it is unfortunality too late for some.

After the new curriculum was announced, the South African Teachers Union’s operational director Johan Kruger spoke out against it too — telling the media that teachers wouldn’t be comfortable teaching it. 

This is one of the many examples of barriers that stop us moving forward in sex education, protecting children and teenagers, and empowering girls and young women by teaching them about their bodies. 

The new approach to Comprehensive Sex Education was based, according to the Department of Basic Education, on intensive reports and other comprehensive research.

According to  the department , the 2016 review of International Technical Guidelines on Sexuality Education found that, contrary to popular belief, CSE does not sexualise children, nor does it increase sexual activity.

It does however delay sexual debut, promote safe sexual behaviour, and increase knowledge of different aspects of sexuality.

This education too would have definitely led to less discomfort for my schoolmates who openly identified as queer.

I remember them constantly being harassed with questions like: “Are you a girl or a boy?”, and “How do gay people have sex?”

But they had no source of information to answer either these questions or their own questions about their bodies and sexuality, because all we were taught is that “a boy meets a girl” and a “penis goes inside a vagina”.

A  2016 policy brief by Rhodes University suggests that Life Orientation (LO) teachers be given training to help those that believe homosexuality to be unnatural or immoral to challenge those beliefs.

“LO teachers should be trained in dealing with sexual and gender diversity, in order to avoid marginalising lesbian, gay, bisexual, transgender, intersex, and gender queer youth,” says the brief.

The brief further states that sex education should move away from prescribing certain fixed gender roles to young learners, and instead highlight fluidity and empowerment.

While CSE has caused a lot of uproar, there is no denying that the curriculum can do more good than bad, and will be beneficial to our society.

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Why Comprehensive Sex Education in South African Is so Important

Nov. 27, 2019

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Comprehensive sexuality education in six Southern African countries: perspectives from learners and teachers

Comprehensive sexuality education (CSE) promotes young people’s healthy sexual decisions. This study assessed the level of provision of CSE in schools in ten sites in six Southern African countries from the perspectives of learners and teachers. The data was from a needs assessment preceding the baseline evaluation of the SRHR-HIV Knows no Borders Project conducted in ten sites in six Southern African countries. A total of 161 learners from 10 schools and 96 teachers from 96 schools were interviewed. Among the teachers, 82.3% reported CSE was part of the school curriculum. Although basic education policies in Southern African countries are in tandem with international, regional and national policies, complete implementation of the policies remains unfulfilled owing to conflicting policies and socio-cultural values of diverse stakeholders. Awareness campaigns and trainings may help to promote positive perceptions among stakeholders about sensitive CSE topics and the distribution of SRH commodities in schools.

UN publishes new report on Comprehensive Sexuality Education

Despite good progress in some countries, too many are failing to ensure children and young people have the knowledge and skills they need for good health and well-being, according to findings from a new UN report on comprehensive sexuality education (CSE).

Too often, teachers are not prepared, students are not learning the range of topics they need to learn and misinformation undermines the development of CSE. Today, millions of children and young people still receive little information on how to manage the transition to adulthood.

The findings from the report, released by UNESCO, UNAIDS, UNFPA, UNICEF, UN Women and the WHO, are being released in the lead up to the  Generation Equality Forum ,  at which UNESCO will announce a set of concrete commitments on girls' education.

Assistant Director-General for Education at UNESCO, Stefania Giannini, said the findings released from  The journey towards comprehensive sexuality education: Global Status Report , reveal the progress countries are making towards providing good quality school based CSE to all learners but also highlight the fact that that much more needs to be done.

In Tunisia, a national law to combat violence against women mandates education for health and sexuality; in Sweden, sexuality education is expected to promote gender equality and the equal dignity of all; and in Chile, a range of teaching and learning materials on sexuality education is being developed to support teachers. In Pakistan, strong efforts are being made to build community support for CSE and ensure programmes are responsive to local context, while in South Africa, teachers are supported with lesson plans developed from the revised  UN Technical Guidance on Sexuality Education.

• Read the key findings from the Report here

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Let’s talk about sex education: race and shame in South Africa

Researcher in Histories of Childhood, Medicine, and Sexuality, University of the Witwatersrand

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Sarah Emily Duff receives funding from the National Research Foundation. She is a recipient of a Research Career Advancement Fellowship.

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There are many ways for young people to learn about sex. In talks between parents and children, in the sharing of information between peers, in initiation schools and in ceremonies preceding marriage, young people have learned about sex and sexual reproduction. They also learn about how societies define appropriate and inappropriate sexual behaviour.

The idea that sex education should be taught at school is fairly recent and is strongly connected to the increasingly important roles that schools play in moulding future citizens. Most sex education programmes in this space tended until quite recently to be fairly conservative. They taught children and young people that sex should only occur in monogamous, heterosexual marriage.

Debates about the need to make formal sexual education available to South African youth surfaced during the 1920s. This was a period of massive social change. The decade was marked by a series of strikes and protests as the segregationist state began to introduce legislation that marginalised black people socially, politically and economically.

It was also a period of rapid urbanisation and the growth of slums in which poor black and white South Africans lived cheek-by-jowl. Given the white government’s pre-occupation with race, this raised alarm bells because of the heightened opportunities for interracial sex.

It was against this backdrop that sex education became a political tool. Missionaries, public health officials and welfare activists used it to try and sculpt a new generation of respectable black African adults who would live meekly under white rule.

They also sought to teach white men and women about the significance of sex, reproduction and family to the stability of the South African state.

The missionaries’ position

In pre- and early colonial societies in southern African, sex education was woven into the processes that marked a person’s entry into adulthood. Boys and girls learned about sex, relationships and contraception through initiation rites. By the early 20th century, these rituals were sidelined as more young people left their rural homes and moved to cities.

Christian missionaries and ministers stepped into the gap. They wanted to provide sexual socialisation for young, urban black Africans. Sex education manuals formed a significant part of this strategy and most were published by missionary presses. These manuals sought to persuade young readers that sex was only legitimate after and within the confines of marriage.

One of the Church of England’s most popular publications was called God, Love, and Marriage. The text, written by a Bloemfontein-based Anglican nun named Sister Enid, provided only rudimentary information about puberty. It devoted far more space to discussing what constituted respectable, sober adulthood. It and other manuals were directed towards the creation of a respectable, Christian urban black African middle class.

Racial differences in sex ed

Sex education manuals for middle class white children were very different. They sought to police racial boundaries in a society where interracial sex was increasingly illegal. The segregationist state passed the Immorality Act in 1927, banning sex between different race groups. The apartheid state revised this legislation in 1950. It was only repealed in 1985.

In 1934 the Red Cross and Johannesburg Public Health Department published the slim illustrated manual Facts about Ourselves for Growing Boys and Girls. Its aim is, firstly, to explain human reproduction. This knowledge is framed so that readers are left in no doubt about the consequences of sex outside marriage. They are warned of “the most terrible diseases from which man has suffered” and reminded that children produced during pre- or extra marital sex are illegitimate.

In 16 pages, the manual devotes one paragraph to an account of sexual intercourse and suggests that it is wiser “to avoid undue interest in the sex organs.” Readers should, instead, “turn” their “thoughts elsewhere.”

That’s not to say the manual and others of its kind dismiss sex as entirely wrong. Facts about Ourselves says that as long as the sex in question involves a married couple, it is absolutely essential to the propagation of the “race”. This is the manual’s second purpose: persuading white youth that the security of white rule in South Africa is located in the family.

The author argues: “It is your duty to help your race to progress” by having children. One section describes how white youth should conduct themselves in the company of African men. Girls should take care not to wear clothing that would draw attention to their bodies and should never allow African men into their bedrooms: “The temptation to the native may be far more severe than is ever realised, and any wrong-doing on his part would be very terrible to a girl, while the law visits upon him a very dreadful punishment.” Indeed, legally, black men found guilty of having sex with white women were punished far more harshly than the women.

A changing curriculum

The content of Facts about Ourselves may shock the contemporary reader but its argument that sex should occur only between married men and women of the same race endured. When guidance classes were introduced to white schools in 1967 and black schools in 1981 they included only a little sex education and were equally conservative. Since 1994, sex education has been part of a compulsory subject in all South African schools called Life Orientation.

Researchers argue that Life Orientation tends to emphasise abstinence as the only form of appropriate sexual behaviour outside of marriage. This strategy has had little impact on reducing teenage pregnancy and rates of STDs internationally.

There does seem to be hope on the horizon, though. The National Adolescent Sexual and Reproductive Health and Rights Framework Strategy was approved by South Africa’s Cabinet earlier this year.

It advocates comprehensive sex education and aims to provide all young people, regardless of sexual orientation with advice, information, and support. If this strategy is implemented, young South Africans will for the first time be taught sex education that emphasises tolerance, understanding and respect rather than a curriculum that serves to shame and to divide.

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Basic Education clarifies comprehensive sexuality education to Portfolio Committee

The Department of Basic Education has told Members of Parliament that Comprehensive Sexuality Education has been part of the Life Orientation subject in schools since the year 2000, and that there is no new content that has been added to the curriculum.

The Department was briefing the Portfolio Committee on Basic Education following misleading media reports (front page of Sunday Times, 12 May 2019) that the department was planning to introduce new content to the Life Orientation curriculum.

Basic Education Deputy Minister Dr Reginah Mhaule told members of the portfolio committee that it is only the implementation fidelity that has however necessitated a review of the LO curriculum; an evaluation of the learning material available for Life Orientation and Comprehensive Sexuality Education; a review of teacher training for LO and CSE; and a review of curriculum delivery modalities.

Dr Mhaule said the reviews led to the development of scripted lesson plans, the development of state owned LO textbooks, an online teacher training course, the development of the “Teaching for All” initial education teaching programme and considerations of strengthened Continuing Professional Teacher Development (CPTD) courses.

The Department’s strategy was informed by research, which indicated the great need for age appropriate child abuse prevention education that builds resilience, confidence and assertion. Apartheid patterns of family disruption and parental (male) absence, as well as cultural barriers and conservative attitudes, were found to be preventing open conversations about sex and sexuality hence the Department needed to review the content.

The 2016 review of International Technical Guidelines on Sexuality Education found that the evidence base for CSE had expanded since 2008. This rigorous scientific review found:

• CSE does not sexualise children;
• Sexuality education does not increase sexual activity, sexual risk-taking behaviour or STI/HIV infection rates. On the contrary, CSE delays sexual debut and promotes safe sexual behavior; Increases knowledge of different aspects of sexuality and the risks of early and unintended pregnancy, HIV and other STIs;
• Decreases the number of sexual partners;
• Reduces sexual risk taking;
• Increases use of condoms and other forms of contraception.  

Dr Granville Whittle, the Deputy Director-General for Educational Enrichment Services, said Department has had to step up the implementation of the Life Orientation curriculum because the number of adolescent girls who had sexual relationships with older sexual partners continue to increase. HIV prevention knowledge has declined amongst learners, lower sexual debut and increasing risky sexual behaviour amongst adolescents was observed and that early sexual debut leads to mental health issues such as depression, vulnerability to violence and poor educational outcomes

Since 2013, the DBE has been implementing CSE through several co-curricular programmes. These include:

• Keeping Girls in Schools;
• Breaking the Silence;
• Determined, Resilient, Empowered, Aids-Free, Mentored and Safe (DREAMS)
• She Conquers; and
• Eastern and Southern African Commitment involves 21 countries. The scripted lesson plans will be utilised in all these countries.

Adolescent girls and young women (AGYW) exposed to these CSE programmes, adopted health seeking behaviour such as contraception and condom use, and increased HIV testing.

The Department emphasised on the following issues regarding concerns raised in the media:

The MPs largely welcomed the presentation and expressed relief at the work of the Department in seeking to educate young people about respect for their bodies and the bodies of others, HIV and Aids, as well as unwanted teenage pregnancies. Most importantly, the Committee welcomes that CSE does not sexualise children, but aims to provide age appropriate information regarding topics that people are reluctant to talk about in their homes.

Patamedi Ronald Moroatshehla urged the department to “continue providing clarity on this emotive issue and continue to encourage parents to talk to their children about these matters, which can be difficult and daunting to talk about,”

Dr Whittle further clarified that the Department had consulted extensively on CSE, and remains open to further consultation and engagement on this matter. He said the department kept a record of comments received from public engagements.

Media enquiries:   Elijah Mhlanga – Head of Communication Cell: 083 580 8275   

Hope Mokgathle - Ministry Spokesperson Cell: 079 817 0427

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Feature Story

Feature story

The importance of comprehensive sexuality education for africa’s young people.

07 December 2021

A message of support for the ESA Commitment from Professor Mbulelo Dyasi, Vice Chair, Board o

A message of support for the ESA Commitment from Professor Mbulelo Dyasi, Vice Chair, Board of Directors, INERELA+, delivered at ICASA 2021

As religious leaders, we have a trusting relationship between us and our congregations. As beholders of God’s truth and a belief system based on faith, our relationships with our congregants and communities are based on a strong basis of belief and as custodians of good values. This provides us with a platform to advocate and motivate for the betterment of our people from a faith perspective while we can also work together with our congregations in finding solutions to the challenges they face in their environments.

Today, we are in a situation where our nation and our continent are at the right place to advance in areas of economics, infrastructure and human resources. This is because we have young populations who are fast growing up to be productive citizens. These young people need direction and guidance to be able to make good decision, have positive family lives and be good citizens. And as religious leaders we play an important role in providing this guidance. Parents in our congregations know their role in providing this guidance. And we live in a modern society with modern education and health systems, so we need teachers, social workers and health workers to also provide this guidance. Each has a role to play in improving society.

We trust a government that acts in our best interests. Since 2000, the South African Government has been providing our children with the education and guidance they need. This education, called Life Orientation/Life Skills, where sexuality education is embedded, complements the values and direction that we provide as religious leaders through our sermons and that parents provide at home. We have to make sure that our children can negotiate issues of sexuality and relationships from a position of knowledge and power, rather than a position of ignorance and fear. From a position of truth and science, rather than a position of misinformation and helplessness.

There are those who try to spread fear and disinformation, creating panic and claiming to be the guardians of family values. The truth is that many of us who are believers, who are parents, who are teachers, are united on human dignity. And sexuality education promotes human dignity. Because sexuality education ensures that our children learn to treat each other with respect and dignity from an early age. It ensures that our children learn to think about what is right and safe for them, and how to avoid coercion, sexually transmitted infections, including HIV, and early and unintended pregnancies. It helps to keep our children safe from abuse by teaching them about their bodies.

Young Africans must have the facts and confidence to stay safe and healthy, live a dignified life and contribute positively to their community and countries. They must trust us, their elders, to tell them the truth. Therefore, as religious leaders we pledge our support today to the ESA Commitment, which seeks to enhance efforts in ensuring the health and well-being of our children and young people. We commit to work with our governments to accelerate action towards realizing the agreed upon targets so that in 2030 we can all see the vision of an AIDS-free generation.

As religious leaders we hereby endorse the ESA Commitment towards 2030 aiming to ensure that we close the gap of comprehensive knowledge of our young people to protect themselves from new HIV infections, early and unintended pregnancies and gender-based violence and early child marriages. We promise to engage with our constituencies to create an enabling environment for adolescents and young people to access sexual and reproductive health services and use our platforms to empower parents to be able to talk with their children on issues affecting their health and well-being. With the challenge of COVID-19, we also commit ourselves to work together with our communities in finding innovative ways to ensure access to information and essential services during times of crisis. Working together we will surely win the fight against HIV and other pandemics.

Professor Mbulelo Dyasi, Vice Chair, Board of Directors, INERELA+

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Comprehensive sexuality education: Why it matters

Angelica pino.

Limited, incomplete or incorrect knowledge and information related to sex, sexuality and sexual and reproductive health and rights among the youth contribute to gender-based violence, discrimination on the basis of sexual orientation, HIV, teenage pregnancies and other adverse health outcomes. There is an urgent need to increase and improve the provision of quality comprehensive sexuality education (CSE) across schools in South Africa and empower our youth.

South Africa regrettably has a high rate of teenage pregnancies, HIV infections and is considered one of the highest-ranking “rape capitals” in the world too. Equally disturbing is that South Africa is recorded as having the highest numbers of the HIV epidemic in the world. According to the UNAids 2017 Global Aids Update report, an estimated 7.7 million people were living with HIV.

Notably, the rate of infection is more prevalent among young women; where it is overwhelmingly nearly four times greater than that of men their age. Young women between the age of 15 and 24 made up 37% of new infections in South Africa in 2016, as per  Avert . Recent studies have also found that only 59% of young people in South Africa have comprehensive knowledge of ways to prevent HIV. It is estimated that only 5% of our schools provide CSE. Statistics show that pregnancy among school-going learners has increased at an alarming rate. Statistics SA recorded that in 2017, 10.9% of births were among girls aged 10 to 19.

Incongruent sources, a lack of adequate access to factual and accurate information as well prevailing myths and related stigma on sexual reproductive health and rights (SRHR) further exacerbate the high rates of teenage pregnancies, maternal deaths, STIs such as HIV and unsafe abortions. Despite these statistics, the debate on the effective introduction and implementation of CSE continues to rage on, all at the expense of our youth.

A greater focus on sexuality education is critical to youth well-being, as stated in the South African Integrated School Health Policy, 2012. This is a key example of the government’s efforts to promote youth health and well-being in schools. However, CSE has been a topical and controversial issue in the spotlight.

Groups such as the Concerned Young People of SA ( CYPSA ) and Freedom of Religion SA are advocating for the scrapping of CSE in schools. The perceived sensitive nature of the subject matter has been met with wide resistance particularly from parents and religious groups. Other challenges include the fact that many teachers and educators are also ill-equipped and not adequately trained to deliver CSE.

This dissenting narrative and opposition against CSE are unfortunate. Talking to young people about sex and sexuality does not increase their sexual activity. Rather, it provides them with the knowledge, understanding and skills to make informed decisions about all aspects of their lives. CSE enables young people to adopt positive sexual behaviours, such as delaying the age of sexual debut, reducing the frequency of sex and number of sexual partners, and increasing use of contraception, especially condoms.

According to UNFPA, providing CSE in South African schools led to a 33% reduction in genital herpes (HSV2) incidence in young people, a significant decrease in physical violence or sexual assault perpetrated by young men, and a lower proportion of young men engaging in transactional sex with a casual partner.

Scaling up access to quality CSE information in schools and other education institutions – that is culturally appropriate, gender-sensitive and informed by evidence – is vital. For this, we need a multi-pronged and multi-stakeholder approach.

Along with information, we need to ensure increased access to youth-friendly SRH services. This includes access to condoms, contraceptives, HIV counselling and testing, HIV/STI treatment, abortion care, safe delivery, prevention of mother-to-child transmission and other related SRHR services. Given the complex relationship between socioeconomic status, patriarchy, gender-based violence and sexual behaviour, CSE programmes should be multidimensional, integrated and holistic and teachers should be equipped with the training and information they need to be confident to implement such programmes successfully.

We need strong, enduring partnerships between schools, health sectors and community organisations and to pursue strategies to shift negative behavioural patterns and narratives. Developing role models to promote alternative narratives would help. I read about how the women’s rugby captain, Babalwa Latsha, spoke about her experiences relating to gender bias. The powerful impact of personal stories and experiences can help reach the youth and empower parents and teachers.

The youth are the future of our country and we, as a society, need to come together and ensure that they have all the resources and information to allow them to lead productive lives. Information about their health and bodies and the right to make decisions about them is central to this. No young person should have to suffer from preventable adverse health outcomes for want of accurate information and knowledge. We must empower the youth to be able to make the right decisions for themselves and their lives.

As governments, civil society and the private sector are about to gather in Nairobi in November to review the commitments made 25 years ago at the International Conference on Population and Development, the youth will be asking hard questions of “the elders”, including whether we are violating their human rights to information, education and health every time we deny them comprehensive sexuality education.

• November 1, 2019

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• South Africa 2020 , Spring 2020

South Africa’s sex education aims to reduce gender-based violence

• February 29, 2020

By Hannah Farrow Medill Reports

Growing up in South Africa’s Eastern Cape, Asa Jali had a narrow outlook on relationships. “You learn that if your boyfriend hits you, that’s how they show you love. So if he doesn’t, he doesn’t love you. If there’s no violence, he doesn’t love you,” Jali, 23, said.

Her views are common throughout the country. Like most of her friends, Jali didn’t learn anything about sex, let alone consent, in high school. “You don’t know anything about your vagina as well, what satisfaction means and how to get an orgasm.”

Despite South Africa’s Life Orientation curriculum — a nationwide program for grades four through 12 that includes robust sex education — gender-based violence remains a nationwide issue in South Africa. The Department of Basic Education reported in 2019 that more than one in three girls is sexually assaulted before the age of 17.

When asked about what she learned in Life Orientation, Jali said, “literally nothing.” She learned about sex through her experiences and from her friends telling her of theirs. “It’s only when you leave that space and come to this space that you learn that no, it’s not how it’s supposed to be,” Jali said, now a student at the University of the Witwatersrand.

Though the Life Orientation program was initiated after the fall of apartheid in 1994, reinforcing how it’s taught has become part of the government’s five-step emergency plan to decrease an alarming uptick in gender-based violence, or GBV, nationwide. According to the South African Police Service, rates of sexual assault rose from 88.3 per 100,000 in 2017-18 to 90.9 in 2018-19. Training the Life Orientation teachers is the state’s effort to stop this trend in South Africans’ lives.

The program begins in grade four, where some children don’t even know that they’re being abused, said Elijah Mhlanga, the spokesperson for the Department of Basic Education. “If you look at the content, we say, ‘Identify your body parts. Which ones do you think are sacred? Which ones do you think no one should touch? Which ones do you believe someone needs permission to touch?’” Mhlanga said. “And then once you tell them that, they start to realize that, ‘Oh, this person had been abusing me all this time.’”

Life Orientation was introduced as a text-only curriculum, and the material changes with the student’s age. In grade four, students learn how to respect their bodies and others’, how to identify bullying, and the basics of HIV/AIDS. In grade seven, lessons involve setting goals, what to expect during puberty, how to find healthy relationships, and the basics of sex. And by grade 12, students are learning to put their goals in action, identify and prevent STIs, and look ahead to the future.

The material hasn’t changed since 2000 — and isn’t going to, according to Mhlanga. “What we are changing is how it is taught,” Mhlanga said.

Life Orientation was implemented before social media, and the teachers would rely on magazines to teach the material. “When it was first put in place, there was no Facebook, there was no Twitter, there was no social media, which are now platforms that are giving young people access to information,” Mhlanga said.

This increased access also affected the instructors. “Teachers, when they go into Google, you type one word and you get a million results, and they wouldn’t know what to use, so they would end up using inappropriate content,” Mhlanga said. In some cases, he recalls, teachers would use explicit videos to explain sexual concepts.

At the State of the Nation address on Feb. 13, 2020, South African president Cyril Ramaposa said that around $100 million U.S. had been allocated to the emergency plan to combat these issues for the current fiscal year.

Part of that money is going towards scripted Life Orientation lesson plans and three printed booklets to accompany each grade: one for the teacher, one for the student, and one for the student’s parents. “We looked at UNESCO papers, we looked at the World Health Organization documents, which indicated to us that some of the tactics of teaching were outdated,” Mhlanga said. “We said we are going to introduce scripted lesson plans so that we standardize and make it uniform — the content, the plans, and the pace of the content — and make sure that all of what is taught is age-appropriate.”

They’re also sending teachers through training to ensure they’re both teaching the curriculum correctly and appropriately responding when students confide in them that they’ve been raped. Out of 410,000 teachers nationwide, 7,000 received training so far, up from 500 teachers in 2015.

“We felt that there was a need for us to fix that part in terms of the content that they’re using for teaching, but we also analyzed the ultimate objective of the curriculum,” Mhlanga said. “What we wanted to achieve was to reduce incidents of gender-based violence, sexual exploitation, also HIV infections, as well as sexually transmitted infections.”

Tsakani Mhlanga, Mhlanga’s daughter, said her experience in Life Orientation was positive. Her fellow classmates — all female, as is customary in South Africa’s majority single-sex high school system — had open and honest conversations around serious issues. “I think my parents have created a safe space for all of us,” Tsakani, 19, said. In their family, they openly speak about topics ranging from gender roles to sex to violence. But it’s not like that in the rest of her friends’ homes, where parents are more strict. Of one friend, she said, “Her mom is always just like, ‘No, you shouldn’t be worried about this. You’re a child.’ And I’m like, but it’s happening every day.”

And GBV is happening every day, particularly in black communities. The majority of rapes in South Africa are committed against black women. Gail Smith, senior manager for strategic integration at the mass media non-profit Soul City Institute, said poverty is a large driving factor. “Proximity to vulnerable girls is a reality of life in South Africa,” she said. “If you are a 15-year-old girl living in an informal settlement…your shack is unlikely to have toilets. If you wanted to go to the toilet at night, you would have to run the gamut of walking to find the closest pit latrine.” Because it’s dark, chances of being attacked going there are high, Smith said. These dangerous scenarios mean that even primary school-aged girls are exposed to adult risks.

“We are seeing 10-year-olds pregnant, presenting at clinics. The nurses, when receiving them in terms of the law, are meant to call in the police. They are not because they don’t understand the law themselves,” Smith said. “So what they are doing is they are processing these children into the system as if they are normal, grown women who are pregnant.” From April 2017 to March 2018, the Department of Basic Education reported 2,716 births from 10- to 14-year-old mothers. Among 15- to 19-year olds, there were 113,700 births.

Smith described black women’s role as being on the bottom of the social pyramid. “Because of the nature of apartheid — it wasn’t an irrational form of racism. It was super rational. It was well constructed. It was a race-based caste system that infiltrated everything,” she said. “In that caste system, native women or black women in particular were cemented into the bottom of the caste system by law in particular ways.”

The end of apartheid dismantled that legal system, but after years of race-based processes, black men still find it hard to climb the ranks, and black women find it even harder.

But why rape? “What is one of the most humiliating things you can do to someone?” Shenna Swemmer, a researcher for the Centre for Applied Legal Studies at the University of the Witwatersrand, answered the question with a question. “You think of the worst things you could do to someone…gang raping them, those types of things are the most terrible things you can do. You have this hatred — hatred to women, hatred to others, hatred to minorities — seems like a perfect way to degrade someone.”

It stems from powerlessness. “During apartheid era, our police and security didn’t see black women’s bodies as rape-able bodies, so it wasn’t a big deal if a black woman was raped,” Swemmer said. “Our country specifically, we have a very terrible history that has never been dealt with. We just sort of got told, ‘This is the new South Africa, you guys will carry on now and forget.’”

It’s not any safer in schools. “If you’re in a public school, and you’re a woman, you’re very likely to be raped,” she said. “Women, girl children, any kind of gender minority are not safe in any space in our country.”

Swemmer says what the country needs is to be educated. “We can deal with what’s happening at the moment — we have to deal with it,” Swemmer said. “But we have to now start creating places where people aren’t discriminatory in the same way.”

Nokuthula Mofokeng, a woman who went through school before Life Orientation, said she didn’t talk about sex growing up. “You can’t talk about sex. We’re blacks…you don’t learn. You find yourself, there, having sex. Next thing you’re pregnant and you’re like, ‘Oops.’ And only then when you go to the hospital you find out you shouldn’t have sex with boys without a condom,” Mofokeng, 34, said. “You’re already in a situation and you’re like, ‘Oh, that’s what happens. This [guy] came inside of me and now I’m pregnant.’”

Her partner, Kgomotso Maloka, 37, had a different experience. Her mom hosted a period party where a social worker held private conversations with her and her friends about sex and how to avoid infections and pregnancy — a very uncommon notion during that time.

Combining their different experiences, Maloka and Mofokeng are raising their 13-year-old son with open and honest conversations. “He’s at the age where he’s frickin’ masturbating and I’m like, ‘What am I supposed to say?’ He’s watching porn and I’m like, ‘You’re watching porn?!’” Mofokeng said.

Their son also has a girlfriend, and Maloka and Mofokeng treat her with the same bluntness. “I had a conversation with both of them. ‘You have boobs, you have a period. He’s got sperm. So if you guys, when you go on your park dates, and you take off your underwear, and he takes his thing and puts it inside of you: baby,’” Mofokeng said. “I’m not looking after a father.”

Access to porn is also different. “They’re exposed to a lot more than we were. So if you had to find a porn magazine, you had to find it somewhere. They can just log on and there you go,” Maloka said.

Life Orientation is a good thing, they said, resulting in greater contraceptive access and fewer preteen pregnancies for young relatives in their families.

The date is still to be determined when teacher training is implemented in every province, but they’re testing it in areas where violence and diseases are real problems, and their goal is to make a lasting impact, said Elijah with the Department of Basic Education. “Everything that we talk about comes from respect and consent as being the basic concepts that we want [the students] to internalize,” Mhlanga said. “We want each and every one of the learners to understand and carry that concept with them and practice it in all aspects of life.”

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Working to Advance Health Equity in Africa

Sexuality education in south african schools.

HEARD together with EDC, SFH and Mott MacDonald are implementing the School-Based Sexuality and HIV Prevention Education Activity, a 5-year contract. The activity will support the South African Government to reduce HIV infections in learners and teachers by assisting the Department of Basic Education to implement high quality, evidence-informed sexuality and HIV prevention education programs.

The five main objectives of the activity include the following:

• Increase number of teachers qualified to teach sexuality education
• Strengthen DBE’s capacity to provide education and training for teachers to teach sexuality and HIV education lessons in the classroom and improve life skills program
• Improve quality of school-based sexuality and HIV education programs – evidence informed and effective to reduce risky behaviours amongst school-going youth; improve learner knowledge and achievement in targeted areas of the life skills program
• Increase DBE capacity to work in partnership with the Department of Health to implement the Integrated School Health Program (ISHP); Reduce teenage pregnancy levels and retention of girls in school and increase potential to complete high school
• Improve systems to monitor and evaluate the effectiveness of the sexuality and HIV education program.

Methodological approach:

Related content, aids and the state perspectives on rhetoric, politics and management of aids in africa, hiv incidence provincial surveillance system (hipss): a longitudinal study to monitor hiv incidence trends in kwazulu-natal, south africa, a randomised controlled trial to evaluate adding self-administered oral hiv testing as a choice in clinic and non-clinic settings to increase hiv testing uptake among truck drivers in kenya, increasing the uptake of voluntary counselling and testing for hiv/aids and medical male circumcision among high school leaners in kwazulu-natal, south africa: a discrete choice experiment, the workplace vct and art uptake project (wvup).

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Addressing Learner-Centred Barriers to Sexuality Education in Rural Areas of South Africa: Learners’ Perspectives on Promoting Sexual Health Outcomes

Ayobami precious adekola.

Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria, South Africa

Azwihangwisi Helen Mavhandu-Mudzusi

Introduction.

The school-based sexuality education programmes in South Africa aim to improve the sexual and reproductive health of school-going adolescents. However, the high rate of unplanned pregnancy and sexually transmitted infections among learners in some schools in rural areas of King Cetshwayo district suggests that the programmes in these schools might not be effective due to certain learner-centred factors.

This qualitative study explored lived experiences of 84 learners from nine public schools in 2020 through focus group interviews. Data was analysed using Interpretative Phenomenological Analysis.

Learner-centred barriers to effective school-based sexuality education identified in this study were attitudes, age disparity, psychological status, peer pressure, socio-economic status, the exploratory attitude of learners, media, lack of role models, previous experiences, socio-economic status, and lack of parental love. These factors could reduce good sexual health. Learner-targeted interventions such as campaigns, using guest professionals, condom distribution, videos, on-site family planning, formal demonstrations, and on-site counselling could address these barriers.

Conclusions

Addressing these barriers and implementing the proposed interventions will enhance school-based sexuality education and consequently improve adolescents’ sexual health.

Policy Implications

The findings could guide programming, implementation, and delivery of school-based sexuality education leading to improved adolescents’ sexual and reproductive health.

An effective school-based sexuality education programme promotes a safe learning environment that accommodates gender equity and equips adolescents with knowledge and skills that empower them to make informed decisions about their sexuality (Ogolla & Ondia, 2019 ). However, risky sexual practices and high numbers of reported teenage pregnancy among learners in the rural areas indicate that there are factors that reduce the effectiveness of sexuality education in these communities. In South Africa, Du Preez et al. ( 2019 ) note that the prevalence of unplanned pregnancy among learners remains alarmingly high despite the implementation of school-based sexuality education. Besides a high rate of teenage pregnancy, the South African National AIDS Council (SANAC) ( 2017 ) reports that 37% of new HIV infections occur among school-going adolescent girls. This suggests that learners might be engaging in risky sexual practices that make them vulnerable to STIs, including HIV (Department of Basic Education (DBE), 2016 ). Another report indicates that most pregnant learners were from schools in rural areas (Statistics South Africa, 2016 ). While there is a large body of evidence that well-implemented school-based sexuality education programmes can promote positive sexual and reproductive health (SRH) outcomes among young people (Le Mat et al., 2020 ; Panchaud et al., 2019 ; Ponzetti, 2016 ; Tanton et al., 2015 ), the rising number of pregnant learners in rural areas of King Cetshwayo district (Office of the Premier, KwaZulu-Natal, 2020 ) suggests sexuality education programmes might not be effective due to certain factors in these communities. This prompted the researchers to conduct a study that explored learners’ lived experiences of sexuality education offered in these schools. This study identified, described, and interpreted learner-centred determinants that influence school-based sexuality education.

Sommer and Mmari ( 2015 ) define determinants as the conditions in which individuals are born, grow up, and work. These could be circumstances shaped by family, community, power, and access to resources at various levels that influence the effectiveness of sexuality education programmes. Contextual and interrelated factors such as family background, culture, religion, community, poverty, peers and societal influence affect adolescents’ SRH, and wellbeing are targeted by sexuality education. Viner et al. ( 2012 ) concur that these factors shape young people’s choices and chances to live healthy lives. This line of thought is supported by Khuzwayo and Taylor ( 2018 ), who assert that the microsystem within which an individual functions exerts significant influence on their efficacy and how they react to SRH education. In the same vein, Haberland and Rogow ( 2015 ) posit that an individual’s social environment has a significant influence on their sexual health and rights. A review of the literature revealed that these determinants may hinder the effectiveness of school-based sexuality education programmes.

Social Determinants Hindering the Effectiveness of School-Based Sexuality Education Programmes

It emerged from the literature review that culture, parental opinions, religious background, poverty, lack of access to SRH services, school-related factors, and substance abuse can limit the effectiveness of school-based sexuality education and its influence on adolescents’ SRH outcomes.

While one of the main purposes of school-based sexuality education is to empower adolescents to access SRH services, a study by Sommer and Mmari ( 2015 ) indicates that poverty hinders young people from doing this. Handa et al. ( 2017 ) assert that poverty fosters early sexual debuts and transactional sex among young people. A study conducted in a rural district of South Africa by Lambani ( 2015 ) revealed that 80% of pregnant teenage participants reported they engaged in unprotected sex because they were poor. Likewise, Ward et al. ( 2015 ) state that poverty imposes severe limitations on parents’ ability to influence their children positively, because poor parents cannot provide food and necessities for their children. These findings are corroborated by Khuzwayo and Taylor ( 2018 ), who report that young people choose their sex partners strategically for material and monetary gain. Therefore, poverty may increase risky sexual practices among school-going adolescents, thus undermining the key objectives of sexuality education programmes.

Parental Opinions

Wekesah et al. ( 2019 ) argue that parental opposition to key messages of sexuality education constitutes a significant challenge to its effectiveness. This is consistent with the findings of Van Wesenbeeck et al. ( 2016 ), who caution that efforts by teachers to empower young people with information and skills to help them achieve sexual health and wellbeing may fail if they receive conflicting messages at home. While parents are likely to support sexuality education that aligns with their cultural values and beliefs, it could undermine teachers’ fidelity to the sexuality education curriculum because they may skip some key aspects to avoid parental criticism (Wekesah et al., 2019 ). The same authors maintain that parents’ educational status may influence whether they accept the messages of school-based sexuality education programmes or not, because rural residents who are less educated are more inclined to reject sexuality education messages that contradict their cultural values and practices.

Cultural Norms

Cultural norms are prevalent customs, practices, and characteristics in a community (Khuzwayo & Taylor, 2018 ). These norms and practices can influence the effectiveness of school-based sexuality education programmes and adolescents’ SRH outcomes (Beyers, 2011 ). A South African study revealed that cultural norms could influence adolescents’ sexual behaviour negatively (Khuzwayo & Taylor, 2018 ). In addition, cultural norms are known triggers of moral panic, which may affect every aspect of implementing sexuality education in a community (UNESCO, 2019a ). The key concepts of sexuality education are gender equality, human rights, violence, and access to SRH services by the community actors. A study by Ndinda et al. ( 2017 ) elucidates how cultural norms act as a barrier to accessing and using SRH services such as contraceptives in the rural areas of South Africa. Furthermore, Francis ( 2013 ) indicates that sexuality education teachers feel pressure to promote certain values and moral positions acceptable to the community. A study conducted in Uganda revealed that the cultural perception that sexuality education encourages sexual activity and immorality among young people triggered strong resistance to its implementation by the government and educators (Ninsiima et al., 2019 ). In a study conducted in Kenya, Wanje et al. ( 2017 ) reveal that cultural norms can impede sexuality-related discussions between school-going adolescents and adults. Besides hindering the effectiveness of sexuality education for learners, Glover and Macleod ( 2016 ) concur that sexuality education concepts that contradict educators’ socio-cultural values make them uncomfortable, thereby affecting their ability to teach sexuality education lessons effectively.

Beyers ( 2011 ) argues that learners place higher value on knowledge obtained from cultural practices than on sexuality education information provided by teachers. Furthermore, certain acceptable cultural norms like having multiple sexual partners and testing female fertility through unprotected sex inadvertently promote risky sexual behaviour in young people, thus undermining the key messages of sexuality education (Khuzwayo & Taylor, 2018 ). This is supported by a recent study which indicated that cultural practices in some communities perpetuate gender inequality, which limits school-going adolescent girls’ ability to negotiate and make decisions; they may therefore have unhealthy sexual relationships (Ninsiima et al., 2019 ). Such gender power imbalance fosters gender-based violence, unprotected sex, and multiple sexual partners among young people (Khuzwayo & Taylor, 2018 ).

According to Olowu ( 2015 ), the religious beliefs of a particular community are likely to shape socio-cultural norms and attitudes towards school-based sexuality education programmes. Similarly, the teaching of some religious organisations triggers distrust of key messages of the school-based sexuality education curriculum like contraception, gender diversity, and gender equality, which are offensive to their beliefs and doctrine. Such teachings may promote stigmatisation of and discrimination against people living with HIV (PLHIV) and lesbian, gay, bisexual, transgender, and queer (LGBTQ) people (Armstrong-Mensah et al., 2019 ; Olowu, 2015 ).

A study by Olowu ( 2015 ) shows that some religious groups dissuade PLHIV people from adhering to prescribed anti-retroviral therapy and promote prayer as a cure for HIV. In a study conducted in the USA, Ponzetti ( 2016 ) reports that certain religious leaders propagate rigid gender concepts in addition to portraying any non-heterosexual and non-marital sexual activities as sins against God. Influential religious groups can also mobilise societal resistance to the implementation of school-based sexuality education, as was the case in Uganda where policymakers were pressured to remove curriculum contents that were deemed offensive to their religious beliefs (Ninsiima et al., 2019 ). Such religious stances and practices hinder young people from accessing SRH services and undermine the effectiveness of school-based sexuality education. Wekesah et al. ( 2019 ) argue that contradictory messages from religious groups undermine key sexuality information received by learners and put pressure on teachers to promote sexual abstinence over other contraception methods and avoid sensitive topics like condoms, abortion, gender equality, gender diversity, and sexual identity in lessons.

Substance Abuse

The tendency of young people to experiment and engage in risky behaviours usually increases at adolescence (Francis et al., 2019 ). This is corroborated by Albert-Lorincz et al. ( 2019 ), who indicate that such risky behaviours include experimentation with substance use. The Center for Disease Control and Prevention (CDC) ( 2018 ) warns that regular use of drugs such as opiates, ecstasy, alcohol, and other illegal substances negatively affects the health and wellbeing of the users. A study by Ritchwood et al. ( 2015 ) revealed a higher prevalence of risky sexual practices and early sexual debut among adolescents who regularly abuse substances compared to those who do not. This is supported by other studies which affirm that adolescents who use mind-altering substances are likely to engage in risky sexual practices leading to adverse SRH outcomes (Khadr et al., 2016 ; Muche et al., 2017 ). A similar conclusion, that drug use promotes risky sexual behaviours among adolescents, was reached by several other studies conducted in Ghana, Iran and South Africa (Doku, 2012 ; Francis et al., 2019 ; Yazdi-Feyzabadi et al., 2019 ). These studies highlight the need for a sustainable plan to address adolescents’ substance abuse to enhance the effectiveness of sexuality education.

Lack of Access to Sexual and Reproductive Health Facilities and Services

A report by the DBE ( 2017 ) revealed that lacking access to friendly, non-judgmental SRH services is a barrier to effective sexuality education for young people. According to Yakubu and Salisu ( 2018 ), sex-related stigma in community health facilities further contributes to low adolescent uptake of contraceptives and other sexual health services. This agrees with an earlier report by Haberland and Rogow ( 2015 ), which emphasises the need to link friendly SRH services with school-based sexuality education programmes to strengthen their effectiveness.

School-Related Factors

The availability of appropriate teaching and learning resources at school level is a critical determinant of school-based sexuality education programmes (Iyer et al., 2014 ). A lack of relevant resources coupled with educator-related factors such as lack of competence and cultural and religious views constitute a barrier to effective implementation of sexuality education programmes (Bonjour & Van der Vlugt, 2018 ). Glover and Macleod ( 2016 ) reflect that sexuality education teachers struggle with certain topics like sexual diversity, mainly due to lack of proper training or because it conflicts with their socio-cultural values. In addition, Smith and Harrison ( 2013 ) say that sexuality education teachers would prefer using invited speakers in schools for some topics because of their own perceived lack of expertise and learners’ fatigue with their handling of these topics. This is in line with the findings of Bonjour and Van der Vlugt ( 2018 ), who report that young people rate their sexuality educators’ handling of topics poorly. The reviewed literature indicated that continuous in-service training of teachers is crucial to the success of any school-based sexuality education programme (Haberland & Rogow, 2015 ; Ogolla & Ondia, 2019 ). Such training should enhance teachers’ pedagogical competency and fidelity to curricula implementation strategies.

While the reviewed literature addresses social determinants that are community- and educator-centred, this study aimed to use learners’ experiences and perspectives to describe and address learner-centred factors that could limit the positive impact of school-based sexuality education programmes on adolescents’ SRH.

This phenomenological study used the experiences and perspectives of adolescents to describe the determinants of school-based sexuality education in the rural areas of King Cetshwayo district. Polit and Beck ( 2017 ) argue that this design empowers researchers to gain deep insight into the shared experiences of the participants and to have a better understanding of the contexts in which these experiences occurred. The researcher asked participants critical and clarifying questions about sexuality education programmes in their schools. Thereafter, the researcher listened to and recorded participants’ self-described perspectives and experiences.

The study was conducted in rural areas of King Cetshwayo district in KwaZulu-Natal province. Nine public secondary schools that offer sexuality education as part of the mandatory subject Life Orientation were selected.

The researcher used purposive sampling to recruit Grade 10 and 11 secondary school learners to participate in the study. The research was conducted in 2020. The inclusion criteria were as follows: be a registered Grade 10 or Grade 11 learner in a school in the rural areas of King Cetshwayo district, be between 14 and 19 years old, and reside in the study area. Other inclusion criteria were fluency in either or both English and IsiZulu, willingness to be audio recorded, readiness to sign informed consent, and signed parental consent to participate in the study.

A total of 84 participants (49 girls and 35 boys) took part in this study. While the initial 84 participants were sufficient and there was no need for further recruitment of participants, the researcher was also guided by data saturation, which occurs when new information obtained from participants is a repetition of data obtained previously (Saunders et al., 2018 ). This implies that the researcher cannot develop new ideas and themes by collecting additional data. Mavhandu-Mudzusi ( 2016 ) explains that data saturation occurs when data collected from participants does not yield new insights which are relevant to the objectives of the study.

About 58% ( n  = 49) of the participants reported that they were sexually active; about 84% ( n  = 41) reported regular condom use, and about 59% ( n  = 29) of the sexually active participants claimed to have been involved in multiple sexual relationships in the past three years. Four female participants reported that they had been pregnant before and 25% ( n  = 21) reported they had no previous exposure to alcohol at the time of data collection.

Data Collection

The researcher conducted nine focus group interviews from March to July 2020. A focus group interview guide which was developed by the researcher and refined in a pilot study was used to mediate the interview process. The focus group interviews took place at the premises of the selected schools. Guided by Kvale’s (1996) interview guidelines, cited in Qu and Dumay ( 2011 ), the researcher asked the participants central questions such as: “Describe your experience and perceptions as a learner of the sexuality education offered at this school.” As the mediator of the interview process, the researcher probed and prompted participants where necessary to obtain rich and comprehensive data.

Each interview session was audio recorded and lasted for about 120 min. While some data was collected after the COVID-19 lockdown was relaxed, the researcher ensured that DBE COVID-19 safety protocols such as social distancing, hand sanitising, wearing facemasks, and using well-ventilated venues were strictly adhered to during each focus group interview. In addition, to enhance the audibility of the participants who were wearing masks, the researcher used a high-quality audio recorder. The researcher observed and captured participants’ non-verbal cues and recorded his own reflections on the data collection process in field notes. The collection of data and its analysis were iteratively done until data saturation was reached.

Data Analysis

The researcher transcribed the audio-recorded data from each focus group interview verbatim within 2 days into Microsoft Word. Guided by Noon ( 2018 ), the researcher independently analysed each of nine transcripts of the interviews using Interpretative Phenomenological Analysis (IPA) data analysis framework. The researcher read and re-read transcribed data and field notes while listening to the recorded audio of the interview. The researcher made notes regarding his reflections, observations, and thoughts relating to the participants’ narratives. Connections between emerged themes were identified, and related themes were categorised into superordinate themes. In addition, an expert independent IPA coder was engaged to analyse the transcribed data independently. The themes that emerged were compared, resulting in the final table of themes with two superordinate themes, several sub-themes, and relevant quotes from the participants.

Trustworthiness

The researcher followed Lincoln and Guba’s ( 1985 ) criteria to ensure the trustworthiness of the study. These criteria are transferability, dependability, confirmability, and credibility. The researcher carried out ongoing member checking to ensure credibility; to verify that participants’ perspectives and experiences were captured accurately, they were allowed to listen to the recordings and given the transcripts to confirm that their views were reflected accurately.

Additionally, the researcher enhanced the confirmability and dependability of the research by using field notes to document relevant information about settings such as times, dates and locations. The researcher’s colleagues and the expert coder independently transcribed the recorded data verbatim. In the same vein, the independent coder analysed the transcribed data and deduced independent themes. While the researcher kept an audit trail of all research activities, emerging themes found by both the researchers and the independent coder were compared to enhance the confirmability of the study. The researcher provided thick descriptions and rich details of the research context and participants’ demographic data to ensure transferability, which was strengthened by detailed descriptions of the study setting, sample, and research process. Likewise, the researcher provided robust descriptions of his assumptions and experiences during data collection to further enhance the transferability of the study.

Ethical Considerations

The University of South Africa and the KwaZulu-Natal provincial DBE granted ethical approval to conduct the research. Besides emphasising the participants’ rights of refusal and assuring them that their participation was voluntary, the researcher explained the nature, purpose, and potential benefits of the study to them. The participants were told they could withdraw from the study at any time without incurring any negative consequences. The researcher collected all completed and signed informed consent letters from the parents/guardians and consent forms from the participants before data collection commenced.

To protect the identities of the participants, pseudonyms were used in the transcripts and in reporting the data. All the focus group interviews took place in suitable, convenient, and comfortable venues to ensure confidentiality. To maintain anonymity during focus group interviews, the researcher adopted Sim and Waterfield’s ( 2019 ) approach, notifying the participants of the public nature of group interviews and the attendant anonymity issues. He also explained the importance of anonymity and how participants’ full cooperation was needed to meet this ethical requirement. Thereafter, the researcher asked participants who were unsure about the issue of anonymity to withdraw before the focus group interviews started. He also ascertained that all participants understood their responsibilities regarding anonymity.

Since some of the focus group interviews took place during the COVID-19 pandemic, the researcher ensured strict compliance with COVID-19 safety protocols: using well-ventilated venues, maintaining a two-metre distance between participants, providing 70% alcohol-based hand sanitisers, and wearing facemasks. The researcher kept all data safely in a secure electronic folder to prevent access by unauthorised persons.

The analysis of the data revealed prevailing learner-centred factors that are likely to hinder the impact of school-based sexuality education programmes on adolescents’ SRH. In addition, there were learner-targeted interventions that could mitigate these barriers. The themes that emerged were categorised as learner-centred barriers to effective school-based sexuality education and learner-targeted interventions to enhance school-based sexuality education programmes. Each theme has several sub-themes.

Learner-Centred Barriers to Effective School-Based Sexuality Education Programmes

This theme discusses learner-related factors that inhibit the effectiveness of sexuality education, based on the experiences and perspectives of the study participants.

The age of young people could hinder effective communication about sexuality between them and their educators or parents. Some participants felt the contents of the sexuality education curriculum in their schools were not appropriate for their ages, while others felt uncomfortable discussing sex-related topics with adults because they accepted their parents’ view that they were too young for such discussions.

I’m too young not in that way, my parents even say to me ‘you are too young for those things you are talking about.’ We are regarded as still too young to learn about sex. (Wandi, female, 17 years old) It is not comfortable because we are young and, in most cases, we are not that mature to learn those things at school because we mostly think that we are jumping, like we are, I don’t know how to put it, but it feels like we are not brought up to discuss sex with our elders. (Sisanda, female, 17 years old)

Rejecting sexuality education messages due to age constitutes a barrier to school-based sexuality education’s effectiveness. Besides their age, the results showed that the psychological status of school-going adolescents could limit the impact of sexuality education on their SRH.

Psychological Status

Some participants mentioned that their psychological state influenced their acceptance or rejection of knowledge acquired during sexuality education lessons:

Sometimes it depends; life is tough in this community, so we do things when we are under pressure or stress. To keep the stress out of ourselves, we do things we should not normally do to forget about our stress. When you are stressed, you may not even remember what you learnt in the class. You just want to feel good, and that why we do such things like smoking, drugs, and sex to forget. (Mthokosizi, male, 17 years old)

The findings revealed that negative attitudes in learners could upset the learning environment, thus making sexuality education lessons uncomfortable for other learners and educators. Some participants indicated that lack of respect, teasing, bullying, and mocking exhibited by some learners could affect the effectiveness of sexuality education.

When it comes to sexual intercourse and sexuality education, we are scared to express our views out, because others may perceive that we are not well behaved. Some people tease you if you are honest during class discussion. So, I am not comfortable discussing sexuality education in the class because I don’t want to deal with such issues and gossip after the lesson. Other learners at school know that I was once pregnant, and so whenever we are talking about learners’ pregnancy or sexual intercourse, they would pick on me, make jokes to each other, and laugh. (Zamile, female, 17 years old) There is a lack of respect for the teachers by some learners, and that is why they do not do what they learnt in sexuality education. (Fezeka, female, 16 years old)

Peer Pressure

It emerged that young people’s urge to measure up to their peers’ expectations could inhibit the effectiveness of sexuality education in their schools.

If everyone speaks about it that they have done it, so you might feel you have to do it too. Peer pressure makes you believe that you should do what everyone else has to do if you want to fit in. If you’re the only one in your group of friends who is not sexually active, you will be pressurised into sexual intercourse. (Nomfundo, female, 17 years old)

Socio-economic Status

Apart from peer pressure, the socio-economic status of learners could be a barrier to sexuality education effectiveness. One participant had this to say:

Poverty makes boys and girls end up selling their bodies in exchange for money to provide for their basic needs. Blessers seduce girls with money, saying if they have sexual intercourse with them, they will give them money, and a girl from a poor background would accept this. Similar things happen to the boys, too, in the community. (Mzomuhle, Male, 17 years old)

Exploratory Attitude

In addition to the socio-economic status of learners, the study indicated that adolescents’ curiosity pushes them to experiment sexually despite what they learned in sexuality education lessons.

We are teenagers who like to have experience with these things. Our teachers and our parents probably did it when they were teenagers too. Sometimes, we do not see ‘experimenting’ with friends as a wrong thing because many young people do that in the community. (Andile, female, 17 years old)

Lack of Positive Role Models

Besides an exploratory attitude, participants mentioned that lacking positive role models could be a barrier to accepting sexuality education messages.

Learners engage in sexual intercourse even when they are underage because they see their parents and people in the community doing these stuff. (Osiphayo, female, 17 years old) Some learners just want to be like their parents who sleep around with men or women, and this has nothing to do with what they were taught in LO. Even in school, some teachers do that, and some learners may want to be like them and sleep around. (Qiniso, male, 17 years old)

House Parties

Another learner-centred barrier to effective sexuality education was widespread adult-hosted house parties in the community. The findings revealed that older men frequently organised house parties to entice girls and boys into sexual activities.

We also have a house party organised by the adults for youngsters to get intoxicated with alcohol, which results in sexual intercourses that often lead to teenage pregnancy. House parties are the main reason teenagers do illegal stuff like drinking, smoking, and having sex. (Siphesihle, female, 16 years old)

It emerged that exposure to certain media could negatively influence the outcomes of school-based sexuality education.

We want to experience what we see on media rather than what we learn about sexuality. Many learners want to do the things they see on TV. They want to consume alcohol and drugs and have sex. (Zama, female, 16 years old)

Personality

The findings suggested that the personality traits of learners could act as a barrier to the effectiveness of sexuality education.

I am not the type of person that is open and comfortable during Life Orientation lessons. I’m shy, and I am introvert. In the class, I am not comfortable hearing about sexuality education in front of males, that’s why I do not like to discuss sex. (Zonke, female, 17 years old)

Lack of Parental Love

Participants reasoned that adolescent girls are likely to engage in risky sexual practices if they lack parental love at home.

Some girls may be lacking love from family members. Parents may not be giving them attention and love they deserve, and so they look for love from boys that could lead to risky sexual activities even though they have been taught about it. (Sibonile, female, 17 years old)

Lack of Recreational Facilities

Besides lack of parental love, a lack of after-school recreational facilities in the community increases the risk of negative SRH outcomes.

No recreation after school and learners hope they get invited to house party somewhere that may lead to risky sexual practices. Learners use sex to keep themselves entertained because there are no other forms of entertainments for them to deal with boredom. (Seneme, female, 17 years old)

Some participants opined that the previous experiences of learners could shape their attitude to sexuality education programmes in their schools.

Some learners who were rape victims can be uncomfortable during lessons on sexual violence without teachers knowing about it, only people close to them know this because they stay quiet. Others may have their reasons for not being comfortable. (Sthembiso, male, 18 years old)

Child-Support Grants

Some participants felt that the monthly child support grant is a motivation for girls from poor backgrounds to become pregnant. This implies that girls who want to benefit from a child-support grant could disregard messages on safe sexual practices.

Some girls tend to have sex to become pregnant so that they will get a grant from the government. They do this because they are poor. (Thabani, male, 17 years old)

Learners’ use of mind-altering substances could negatively impact the effectiveness of sexuality education. One participant said:

I think that substance abuse is one of the issues that leads to teenage pregnancy. When you use drugs, alcohol or something, you cannot control yourself; you can do just anything because of the substance abuse. (Samkelo, female, 17 years old)

Besides the learner-centred barriers that limit the impact of sexuality education on adolescents’ SRH, participants proposed interventions that could enhance the effectiveness of school-based sexuality education programmes.

Learner-Targeted Interventions to Enhance School-Based Sexuality Education Programmes

This theme focuses on proposed learner-targeted interventions aimed to enhance the effectiveness of sexuality education in schools. All the proposed interventions emerged from the data collected from the participants. UNESCO ( 2019b ) recommends that young people should be involved at every level of school-based sexuality education programming. The proposed learner-targeted interventions include awareness campaigns, guest health care professionals, on-site condom distribution, video shows, family planning at school, formal demonstrations, and on-site counselling services, in addition, sport activities, social media use, multi-stakeholder collaboration, help clubs, guidance by community leaders, and advocacy.

To mobilise stakeholders on SRH issues faced by adolescents, participants suggested an SRH awareness campaign that addresses misconceptions about school-based sexuality education and secures their support in addressing known adolescents’ SRH issues.

We need campaigns from different people. They can come together, work together in creating a campaign that could teach young people as to how should protect themselves in order not to fall pregnant at a young age. (Luyanda, male, 17 years old)

Guest Health Care Professionals

Besides SRH awareness campaigns, using skilled health care professionals as guest teachers is a suggestion by participants to enhance sexuality education effectiveness.

We can welcome people who are more educated in sexual education at least twice a year to give speeches or talk about it. Organise visits by healthcare workers to talk to learners during LO lessons and address sexuality issues. (Nomfundo, female, 17 years old)

Condom Distribution at School

There is a lack of friendly access to condoms. Participants believed that distributing condoms to learners would strengthen sexuality education and promote their SRH.

School should offer condoms in case learners do become sexually active, and they need to be protected. Condoms should be given out to everyone just to be safe. It is not easy to get condoms around. Also, teach more on how to use condoms properly. (Luvuyo, male, 16 years old)

The use of videos to deliver sexuality education is another intervention proposed by participants. They felt that using videos in lessons would help them to understand the concepts being discussed better.

Showing us videos will help us to have a better understanding of sexuality education. (Ntenga, male, 17 years old)

Family Planning Services at Schools

In addition to using videos as teaching aids in the classroom, participants suggested introducing on-site family planning services in schools to address the lack of accessible, convenient, non-judgmental and youth-friendly SRH services.

Distribute morning-after pills to girls and other things like implants, injections name them. We can’t stop learners from having sex, but we can help them to protect themselves. Distribute them in school so learners can have protected sex or mobile clinics should come to schools each month. That’s likely going to reduce teenage pregnancy and make it effective. (Qiniso, male, 17 years old)

Formal Demonstration

Talking to young people without demonstrating the message may not provide them with the skills they need to make the desired behavioural changes. Participants wanted sexuality education topics to be communicated in practical ways that would improve their comprehension and equip them with necessary skills.

No experimentation is being done by teachers, they need to show us. Things that we learnt we don’t know how to do them. Teachers must show us how it is done to make it more effective. Instead of just telling us, they should show us. (Ayanda, female, 17 years old)

On-Site Counselling Services

Some participants proposed that their schools should have an on-site counselling service manned by qualified counsellors rather than their Life Orientation educators.

The school needs supportive and relatable guidance and counsellor that is appealing to learners and know how to give good advice to us when we need it. Advise us about the actual truth about teenage pregnancies and the difficult life ahead not false stories. (Nosipho, female, 17 years old)

Sport and Entertainment

Another learner-targeted intervention that emerged is providing recreational facilities for after-school sport and entertainment. Participants felt that access to these facilities would engage them productively and promote positive SRH outcomes.

Our communities must keep us as teenagers busy, like having sports or participating more in sports and having some small events teaching us about the important life skills and rewards. We need recreational facilities in our community that will keep us busy after school. (Nompilo, female, 18 years old)

Use of Social Media

The study findings revealed that using digital platforms such as social media could strengthen school-based sexuality education due to the proliferation of mobile digital devices and the popularity of social media platforms among young people.

Using WhatsApp group to connect LO teachers and parents to share information could help. We are always on social media and all that, so we could use social media to let people, especially young people, know about sexuality. (Thando, male, 18 years old)

Forming Help Clubs

The formation of help clubs to generate social capital in the community is another proposed intervention that emerged from the study. Participants argued that help clubs would strengthen the commitment of young people to practise what they learn in sexuality education lessons.

I think in our community we need to form “Help Club” to help one another. In our community, we need to be our brothers and sisters’ keepers. We need to influence one another positively to make the right decisions. Also, outside the school, we need to remind ourselves of what we learnt about sexuality education at school. (Wandi, female, 17 years old)

Multi-stakeholder Collaboration

Participants felt that educators, parents, community actors, and religious groups should work together to improve the impact of sexuality education in the community.

If parents and teachers work together, we can improve the effectiveness of sexuality education in our community. Maybe we can reduce teenage pregnancy, STI cases and HIV among learners in the community if our parents, churches and community leaders get involved. School can also talk to our parents at least once a year to make it comfortable at home to speak to our parents about it. (Asande, female, 17 years old)

Guidance by Community Leaders

Using trained community leaders to counsel young people about sex may address misconceptions about sexuality education and promote positive SRH outcomes among adolescents in the communities.

In order to make the sexuality education work, I think the community leaders should be our other counsellors. (Luyanda, male, 17 years old)

Participants recommend using influential people and opinion leaders to promote the messages of the sexuality education curriculum among young people.

I think there should be event days that talk to youths about sexual life and in those events, they should invite famous people because as we are teenagers, we like famous people. We look up to them as our role models, and we do everything that they do. If we see the famous person telling us about the impact, it has in our lives maybe we can just listen to them because we look up to them as our role model. (Nompilo, female, 18 years old)

Learner-Centred Barriers

The impact of sexuality education on adolescents’ SRH is restricted by learner-related factors such as age, psychological status, an exploratory attitude, peer pressure, socio-economic status, lack of role models, house parties, media, personalities, lack of parental love, lack of recreational facilities, past experiences, child support grants, and substance abuse. These findings agree with several studies which indicate that the age difference between young people and their teachers or parents could hinder effective communication on sexuality-related topics both in schools and at home (Anyanwu et al., 2020 ; Motsomi et al., 2016 ; Pariera, 2016 ).

The psychological state of young people is another determinant of SRH outcomes. The study findings concur with the results of Anatale & Kelly’s, 2015 study, which revealed that young people with symptoms of depression are more likely to engage in harmful sexual activities. The attitudes of learners to sexuality education, coupled with their need to explore, could negatively impact sexuality education outcomes. This is supported by earlier studies which report that some learners did not take sexuality education lessons seriously and others were uncomfortable during lessons because of teasing from other learners regarding their sexual orientation and virginity (Bonjour & Van der Vlugt, 2018 ; Glover & Macleod, 2016 ). These studies maintain that learners’ negative attitudes could make others uncomfortable and upset the teaching and learning environment during sexuality education lessons.

In the same vein, the study showed young people’s curiosity and need to experiment could influence them to ignore SRH messages. This is line with the 2019 study by Francis et al., who note that adolescents’ tendency to explore their sexuality usually leads to increased risky behaviour. Similarly, a large body of evidence suggests that adolescents’ exploratory attitude to sex could affect SRH outcomes negatively (Albert-Lorincz et al., 2019 ; Cooper et al.,  2015 ; Bonjour & Van der Vlugt, 2018 ). However, learners’ attitudes toward school-based sexuality education could also have a positive influence on SRH outcomes (Ozuri & Akarah, 2016 ).

While sexuality education programmes aim to equip adolescents to challenge harmful peer pressure (UNESCO, 2018 ), it emerged that young people might not apply acquired sexuality knowledge due to peer pressure. This is consistent with the CDC’s 2018 report, which indicates that peer pressure could be a threat to adolescent decision-making. Cooper et al. ( 2015 ) say that peer influence is a significant factor that promotes adolescents’ sexual risk-taking. This aligns with the findings of Yakubu and Salisu ( 2018 ), who identify peer pressure as a barrier to effective school-based sexuality education in Sub-Saharan Africa. This suggests that any intervention to improve school-based sexuality education must address negative peer influence and seek to enhance young people’s decision-making skills.

Learners with a poor socio-economic background are likely to engage in risky sexual activities such as transactional and intergenerational sex to negotiate themselves out of difficult financial situations, regardless of knowledge acquired in school. This finding agrees with other studies that highlight poverty as a key contributor to negative SRH outcomes (Pop & Rusu, 2015 ; Willan, 2013 ). In the same vein, Ward et al.,  2015 study conducted in South Africa affirms that the economic background of young people could influence their sexual behaviour. This conclusion is supported by Handa et al.,  2017 finding that poverty is a driver of adolescents’ early sexual debut and transactional sex in Kenya. In addition, the sexual exposure that learners from poor homes experience daily could undermine the key SRH messages of school-based sexuality education programmes (Wood, 2013 ).

Learners unwittingly or intentionally learn certain habits from their parents, teachers, and community leaders, who may be their role models. The study found that the disposition of these role models influences the choices of young people in the community. The lack of positive role models could also undermine the effectiveness of school-based sexuality education. This is in line with the findings of Johnson et al. ( 2016 ), who report that young people develop their character and make their choices by looking up to their role models. Khuzwayo and Taylor ( 2018 ) also argue that when their role models and parents have many sexual partners, many adolescents will embrace and engage in risky sexual practices. A study by Hurd et al. ( 2009 ) concurs that lack of positive role models for adolescents is associated with negative SRH outcomes.

Some adults in the community regularly organise house parties to lure learners into risky sexual activities. This could weaken the impact of sexuality education on adolescents’ SRH, as young people could disregard knowledge acquired in lessons due to their vulnerability. Learners who attend these parties are exposed to mind-altering substances, making them vulnerable to risky sexual activities. This finding aligns with the report of Hittner et al. ( 2016 ), who assert that frequent unprotected sex and alcohol abuse among adolescents is associated with party attendance. Similarly, several studies agree that party attendance among adolescents is correlated with high-risk sexual behaviour (Bersamin et al., 2012 ; Okafor et al., 2018 ).

The exposure of young people to sexualised media that is inappropriate for their age is another barrier to effective sexuality education. This is supported by Lin et al. ( 2020 ), who posit that exposing adolescents to sexually explicit media is strongly related to risky and harmful sexual behaviour like unprotected sex and early sexual debut. Lanre-Babalola ( 2018 ) notes that media could be a tool to disseminate positive SRH messages among young people, but cautions that adolescents’ exposure to sexual content on media promotes risky sexual practices. Likewise, other studies highlighted the inherent dangers of adolescent exposure and access to sexualised media contents to their sexual health (Johnson & Bridges, 2018 ; Oladeji & Ayangunna, 2017 ).

The results indicate that the personalities of school-going adolescents could be a barrier to effective sexuality education. Young people’s personalities play a significant role in their learning (Luqman & Khalid, 2018 ). Furthermore, in a study conducted in Poland, Kurpisz et al. ( 2016 ) report that adolescents’ personality traits moderately influence their sexual behaviour and outcomes. Van Leeuwen and Mace ( 2016 ) clarify that different personality traits among young people are correlated with varying SRH outcomes. In line with the literature review, which showed that parental love is a determinant of adolescent SRH (Mmari et al., 2016 ; Sentino et al., 2018 ), the findings of this study reveal that lack of parental love pushed some young people to engage in risky sexual practices despite the information provided in class during sexuality education.

Recreational and sporting facilities could foster an environment that protects young people from risky sexual practices (De Wet et al., 2018 ). The lack of recreational facilities encourages risky sexual behaviour in adolescents who seek to relieve boredom after school hours. This finding is consistent with Akers et al. ( 2011 ) study, which shows that lack of access to neighbourhood recreational and sporting facilities by young people promotes risky sexual engagement. These authors maintain that adolescents who have access to sporting and recreational facilities or who are involved in community-based recreational activities are less likely to engage in risky sexual behaviour leading to adverse SRH outcomes.

The findings indicate that past negative sexual experiences could also inhibit the effectiveness of sexuality education if left unaddressed. An earlier study by Pringle et al. ( 2017 ) agrees that adolescents’ past sexual experiences could affect their personal attitude to sexuality and their sexual behaviour. This is reinforced by Castro et al. ( 2019 ), who indicate that young people who were sexually abused as children are likely to have an earlier sexual debut, multiple sexual partners, and engage in other harmful sexual practices.

It also emerged that monthly child-support grants could be a motivation to disregard SRH messages because adolescent girls want to receive this money by having children. While an earlier study by Mbulaheni et al. ( 2014 ) reports that the child support grant is a driver of teenage pregnancy in rural areas of South Africa, a more recent one by Ngubane and Maharaj ( 2018 ) disagrees that a child support grant encourages teenage pregnancy in rural areas of South Africa.

Our results showed that substance abuse among adolescents could increase earlier sexual debut and harmful sexual engagement. There is a large body of evidence that support this conclusion (Ritchwood et al., 2015 ; Muche et al., 2017 ; Guzmán & Stritto, 2012 ). Furthermore, the study by Du Preez et al. ( 2019 ) agrees that substance abuse among adolescents is a driver of teenage pregnancy. Therefore, access to mind-altering substances and their subsequent use by young people could lead to negative SRH outcomes.

Learner-Targeted Interventions

Campaigns to create awareness of how school-based sexuality education enhances adolescents’ SRH could shape the perceptions and opinions of key stakeholders. These campaigns could generate support for sexuality education and promote its acceptance in the community, creating a favourable and supportive environment for young people to practise what they learn in sexuality education lessons. Brug et al. ( 2011 ) note that awareness campaigns are essential for health promotion interventions targeting a particular population. Various health promotion campaigns such as immunisation, promotion of safe sexual practices, and prescribed medication adherence have been successfully used to enhance health outcomes in targeted populations (Kaur et al., 2015 ). This is supported by Cruz et al. ( 2013 ), who recommend that innovative materials should be used in such campaigns to enhance effective communication about the subject of interest. Periodic school visits by health care professionals is another proposed intervention that could enhance the impact of sexuality education on learners’ SRH. While the visits by these professionals may be insufficient in themselves, they could provide support for learners and teachers alike on certain topics they might not be comfortable with due to their culture, community norms, lack of skills and self-censorship (Goldman, 2011 ). This is in line with the recommendation of Pound et al. ( 2017 ), who report that many young people welcome and support visits by sexual health experts to address them on sexuality education in their schools because these people were perceived as less judgemental, more competent, and able to provide more confidentiality than their teachers.

While the DBE’s policy promotes discreet access to condoms for learners who meet the age requirement (DBE, 2017 ), the participants reported lack of access to condoms and proposed they should be distributed at school to enhance the effectiveness of sexuality education. This recommendation agrees with the findings of Wang et al. ( 2018 ), who argue that making condoms available to learners in schools promotes positive sexual behavioural outcomes, and Andrzejewski et al. ( 2019 ) and Brakman et al. ( 2017 ), who report that on-site provision of condoms in schools could decrease risky sexual behaviour. The findings of this study indicate that visual demonstration of sexuality education concepts could enhance learner understanding. Using visual resources to explain different phenomena to young people is a powerful strategy that can enhance their spatial thinking skills (Bobek & Tversky, 2016 ). Since young people prefer varied learning strategies, Bonjour and Van der Vlugt ( 2018 ) call on educators to incorporate visual resources like video and art in their lessons instead of relying only on textbooks. With limited studies available on parental and community acceptance of using video to teach sexuality education concepts in the classrooms, more studies are required to explore potential resistance of the stakeholders, educators’ competencies, learners’ comfort, and other ethical issues regarding video pedagogy in school-based sexuality education programme.

Participants also mentioned on-site school family planning services as a learner-targeted intervention that could improve the effectiveness of sexuality education. While the legal and policy environment in South Africa supports providing learners with school-based SRH services, logistical and resource constraints constitute barriers to its implementation (Khoza et al., 2019 ). The lack of accessible, youth-friendly, and non-judgemental SRH services in the community reported by the participants make this proposed intervention desirable. There is evidence that on-site school SRH services can successfully provide young people with age-appropriate, convenient and confidential SRH support (Acosta Price, 2016 ; Keeton et al., 2012 ; Schelar et al., 2016 ). School-based SRH services are one of the most effective strategies for providing adolescents in low-resource settings with SRH services (Mason-Jones et al., 2012 ).

The study revealed that some educators provide sexuality information without demonstration. Such an approach does not equip learners with the critical skills needed to initiate and carry out the desired SRH behavioural changes. Formal demonstration, along with other diverse pedagogical techniques, should be integrated into the sexuality education process (McLain, 2018 ). Participants advocated that sexuality education lessons should focus on practical application of the acquired knowledge, where concepts taught are demonstrated by educators and subsequently simulated by learners. Hidayati and Pardjono ( 2018 ) identify role play as an effective strategy for formal demonstration, and Erturk ( 2015 ) highlights that role play is learner-centred and can be used to demonstrate real-life scenarios relevant to the concepts being discussed.

Participants believed that having resident counsellors in their schools would make sexuality education more effective. This proposal is consistent with previous studies which show that school counsellors create a supportive environment that could enhance the SRH skills of learners while promoting positive sexuality education outcomes (Millner & Upton, 2016 ; Omeje et al., 2012 ).

Sport, recreational activities, and education are largely interconnected (De Coning, 2018 ). This opinion correlates with the participants’ suggestion that providing sport and recreational facilities could improve the impact of sexuality education on learners’ SRH. In addition, various studies in diverse settings established that sport and recreational activities enhance young people’s self-efficacy and SRH (Hershow et al.,  2015 ; Barkley et al.,  2016 ; De Coning, 2018 ).

Social media provides adolescents with attractive platforms for accessing SRH information (UNICEF, 2019 ) and can be harnessed to enhance the effectiveness of sexuality education. Previous studies have shown that using social media to deliver SRH information to adolescents is effective (Gabarron & Wynn, 2016 ; Ragsdale et al., 2015 ). While social media can reach large numbers of young people, Wadham et al. ( 2019 ) caution that its information and messages should be high-quality, scientifically accurate, engaging, and evidence-based. Social media is a potential platform from which to access information about SRH care and support services nearby and for collaboration between stakeholders such as parents, schools, and community members.

Setting up help clubs, which are voluntary, community-based non-formal organisations, can complement knowledge acquired at school. Bonjour and Van der Vlugt ( 2018 ) and Chirwa-Kambole et al. ( 2020 ) agree that help clubs could enhance the effectiveness of sexuality education, leading to positive SRH outcomes among adolescents.

The need for multi-stakeholder collaboration was suggested by the participants, who believed it could address issues such as parental objections, misconceptions, contradictory messages, and the culture of silence about sexuality education. Multi-stakeholder engagement could also promote the acceptance of school-based sexuality education by reluctant community actors. This recommended intervention is supported by a large body of knowledge which indicates that continuous multi-stakeholder collaboration is essential for school-based sexuality education to achieve its health and educational aims among young people (Zulu et al., 2019 ; Chandra-Mouli et al, 2015 ; Gudyanga et al.,  2019 ).

Additionally, providing training for parents and community leaders in sexuality education will foster a supportive environment for young people to practise what they learn in the classroom. The findings showed that using opinion leaders and social influencers to endorse and reinforce key SRH messages of school-based sexuality education to relevant stakeholders could promote its acceptance and enhance its effectiveness. Such interventions could be gender-specific, where experienced men will address young boys and experienced women will speak to adolescent girls. This aligns with the report of Pound et al. ( 2017 ), which mentions that same-sex group discussions could enhance the impact of sexuality education on adolescents’ SRH.

Limitations of the Study

The findings of this study were based on the experiences and perspectives of the school-going adolescents; therefore, parental and teachers’ voices were missing from this study. Some focus group interviews took place during the COVID-19 pandemic; therefore, the prevailing anxiety might have influenced how participants spoke about their perspectives and experiences. As a result, interpretations of this study’s findings should take these limitations into consideration.

Policy efforts should be focused on addressing the identified learner-centred barriers to effective school-based sexuality education. The provincial DBE should collaborate with the national Department of Health and other stakeholders to devise initiatives that will strengthen the impact of sexuality education on adolescents’ SRH. These initiatives should take into account the identified barriers and the proposed learner-targeted interventions. Besides policy efforts, the DBE should mobilise resources and goodwill of relevant stakeholders develop and implement intervention programmes that will promote access to non-judgemental and youth friendly SRH services by young people in the research setting. Furthermore, sexuality educators’ training should be prioritised to enhance their pedagogical efficiency. The study findings could guide policymakers and relevant stakeholders in programming, implementing and delivering effective school-based sexuality education, leading to improved SRH outcomes for adolescents.

This study revealed that age disparity, peer pressure, psychological status, exposure to sexualised media content, learners’ attitudes, peer pressure, socio-economic status, lack of recreational facilities, and substance abuse are learner-centred barriers that mitigate the effectiveness of school-based sexuality education in rural areas of King Cethswayo district, South Africa. Based on the shared experiences and views of the participants, we proposed learner-targeted interventions that could overcome these barriers resulting in effective school-based sexuality education and enhanced SRH outcomes among young people. The suggested interventions are multi-stakeholders’ collaboration, advocacy, school condom distribution, awareness campaigns, visual presentations, using guest health-care professionals, on-site family planning services, formal demonstrations, school counselling services, sport activities, using social media platforms, and forming help clubs. In addition, the intervention should incorporate pre-service, continuous in-service training and support for the educators. We argue that reviewing and revising existing policies on sexuality education in the light of the study findings could enhance the programming, implementation and delivery of school-based sexuality education, leading to positive SRH outcomes among adolescents.

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Contributor Information

Ayobami Precious Adekola, Email: moc.liamg@imaboyap .

Azwihangwisi Helen Mavhandu-Mudzusi, Email: az.ca.asinu@azdumm .

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