Introduction
This Module synthesises the regional and country-specific findings on CSE implementation, uptake and barriers thereto in Malawi, Uganda and Ethiopia in an easy and accessible format. It is designed to give any user the evidentiary confidence to make accurate claims about local CSE implementation and outcomes, and to push back on assertions that CSE lacks evidence. YPAR findings are integrated throughout and provide useful youth centred findings that highlight how young people perceive and access CSE in Malawi, Uganda and Ethiopia.
This module leads with evidence, but the evidence itself is offered in support of the shared values approach set out in Module 1, not as a replacement for them. In direct conversation with a persuadable audience, lead with values and then use this module to make sure that whenever evidence is needed, it is accurate, sourced, and used with confidence. All resources used and referenced throughout this module are listed in the Resources section at the end of this Toolkit.
The regional and international evidence base
Decades of large-scale, peer-reviewed research on CSE point in a consistent direction. International findings include:
- CSE is associated with safer behaviour. It does not lead to earlier sexual activity.
- Young people who receive CSE report increased contraceptive use, lower teenage pregnancy and abortion rates, and less discrimination based on sexual orientation and gender differences.
- CSE is linked to improved recognition of, and response to, abuse, and to more gender-equitable attitudes among young people.
- Involving parents in CSE improves parent-adolescent communication about relationships and sexuality and is linked to safer-sex behaviours.
Various UN experts, including the Special Rapporteur on the right to Health; which includes the rights of everyone to the highest standard of physical and mental health conclude that the cost of inaction is high. Their compendium on CSE highlights the social cost of neglecting CSE implementation:
- Pregnancy related conditions are among the top causes of morbidity and mortality among girls from 15-19 years old.
- Globally in 2021, an estimated 14 per cent of adolescent girls and young women gave birth before the age of 18.
- Fifty-five per cent of unintended pregnancies among adolescent girls aged between 15–19 years end in abortions, which are often unsafe.
- Two out of every seven new HIV infections globally in 2019 were among young people (15–24 years) and adolescent girls and young women are still disproportionally affected.
These are the findings to lead with whenever evidence is needed. Module 3’s Claims-Response Matrix shows how to deploy each of these in response to anti-CSE narratives.
Malawi
CSE, referred to as Life Skills Education (LSE) in Malawi, was introduced in 2002 and made compulsory in primary schools by 2004. Aspects of CSE were integrated into LSE in 2015 to better respond to gender, rights, health and SRH needs. At secondary level, however, LSE is examinable but elective, making consistent delivery to older adolescents a real challenge. According to YPAR findings, CSE delivery has largely followed traditional models and has inadequately included marginalised groups such as young people with disabilities and young people living with HIV and AIDS.
Notable YPAR findings
- Exposure and access: Exposure to CSE was relatively common among the 384 young respondents in Malawi, although the breadth and depth of topics covered were often limited. Young people in rural areas reported fewer opportunities to access sexuality education due to limited outreach activities, shortages of trained teachers, and irregular engagement by health workers or development practitioners.
- Primary settings for CSE exposure: Schools were the predominant setting, followed by community settings, which respondents described as “more interactive and supportive of open discussion.”
- Sources of CSE information: Young people were found to further access CSE through multiple informal information pathways including their peers, social media, radio programmes, and, occasionally, parents or religious institutions. While these sources expanded access to sexuality information, they also contributed to uneven quality and reliability.
- Barriers: The most prevalent barrier to accessing SRHR services in Malawi was found to be religious barriers followed by a lack of knowledge and general access issues. Stigma and cost were found to be the lowest barriers. Young people in rural areas, out-of-school youth, girls, and with disabilities face greater barriers to accessing accurate and comprehensive information.
- CSE outcomes: Improved SRHR knowledge and confidence among young people led to an enhanced sense of agency and decision-making skills. These findings extended to both in- and out-of-school youth, as well as youth with disabilities.
Policy
- The Education Act, 2013: Does not directly refer to life skills or HIV education.
- The National Education Policy: States as one of the policy objectives to “coordinate and sustain a comprehensive response to HIV and AIDS” with a strategy to “provide Life Skills Education, voluntary HIV-testing, guidance and counselling services to all learners including victims of drug and substance abuse and victims of gender-based violence.”
- The National Sexual and Reproductive Health and Rights Policy: Calls on Ministry of Education to implement life skills curriculum in both primary and secondary schools. As well as the Ministry of Labour, Youth, Sports and Manpower Development to “equip youth with Life Skills and mobilse youth to participate in programmes that promote safe sexual behaviour.
- The 2018/19 Education Sector Performance Report: References CSE programs implemented with assistance from UN bodies. The programme description includes the following: “the project aims at primary education and will focus on competence building for teachers, capacity building for government at all levels, curriculum and policy development and advocacy for CSE in Malawi.”
Positive Outcomes
Young people have reported that youth friendly spaces such as community centres have created safe and supportive environments to talk about CSE:
“…youth centres have fellow young people, so we understand each other, we can talk and advise each other when we go there or when we are in our groups” Out-of-school Youth, Male 1).Young people highlighted how learning about puberty, menstruation, and general sexual health helped them feel more prepared for adolescence:“[CSE] has really helped me. Understanding my body has been helpful, I know when and what to do” (In-school Youth, FGD 2, Part 2).
Uganda
According to Uganda’s National Sexuality Education Framework, historically, sexuality education “was primarily handled by parents and relatives within the cultural setting of each family and community. This was reinforced by the teaching of the religious denomination that a family and child belonged to.” Therefore, evidence and conversations surrounding CSE should always be cognisant of the role that family and religion play in its uptake and implementation.
Currently, “Sexuality Education” is part of “Life Education” in the reformed lower secondary curriculum and is mandatory and examinable. Human Rights Watch has noted, however, that the Framework does not fully comply with international human rights standards, and focuses on a values-based approach rather than a rights-based one.
Notable YPAR findings
- Exposure and access: YPAR findings indicate high levels of exposure to CSE among the 422 young participants. With 86.2% indicating exposure to some form of CSE. However, findings reveal important gaps in the content and depth of CSE delivered to young people.
- Primary settings for CSE exposure: School settings are the primary source for CSE at 82.6%.
- Sources of CSE information: In addition to school settings, social media and online communities were identified as key extensions to peer networks in influencing young people’s attitudes around sexuality and CSE. Participants noted that they access information through social media platforms, including WhatsApp, YouTube, and TikTok.
- Barriers: Structural, sociocultural, and individual-level barriers, particularly stigma, geographic location, and institutional limitations, interact cumulatively to shape young people’s ability to access and engage with CSE services. In addition, safety, privacy, and comfort were identified as central to meaningful access to CSE.
- CSE outcomes: Participants noted that CSE empowered young people to make informed SRHR-related decisions with an increased confidence in protective and help-seeking abilities, particularly in refusing sex, thereby increasing safe behaviours among young people.
The YPAR study in Uganda notes that the study faced challenges in reaching a larger number of young people with disabilities and as a result, the perspectives of young people with disabilities were underrepresented. This means that although the Uganda findings do not speak specifically to the experiences of young people with disabilities, this should not be read as evidence that their needs are absent but rather that this particular study was not able to capture them in depth.
CSE backlash
The Ministry of Education withdrew the national sexuality education curriculum in 2016, after materials referencing sexual orientation were found in over 100 schools. A subsequent lawsuit by the Center for Health, Human Rights, and Development, supported by Save the Children and the International Planned Parenthood Federation, led to the National Sexuality Education Framework (2018). After three years without implementation, the Kampala High Court instructed the Education Ministry in November 2021 to develop and implement the policy within two years, reporting progress every six months.
Accurate and reliable CSE implementation in Uganda would assist with the following challenges:
- Over 55% of adolescent girls aged 15–19 are sexually active but have an unmet need for modern contraception.
- In 2024, approximately 5,000 new HIV infections were recorded weekly, with 70% of these found among adolescents and youth. In addition, adolescent girls and young women are nearly four times more likely to contract HIV than their male peers.
- There are high rates of teenage pregnancy with one in four teenage girls becoming pregnant by age 19, and nearly half marry before 18.
Positive outcomes
Youth in Uganda reported that CSE teaches valuable life skills:“They teach us about our rights, testing for HIV, [and] how to make decisions… like using condoms” (Out-of-school Youth, Male 2).
In addition, CSE has been shown to increase informed decision making in sexual activity such as the choice to abstain from sex and avoid pregnancy:As one in-school youth noted in Uganda: “I decided to abstain [from sex]. I am not ready to engage in those things”.
Ethiopia
Notable YPAR findings
- Exposure and access: While findings from the 438 young participants in Ethiopia show that overall exposure to sexuality education is relatively high, the depth and comprehensiveness of content remain limited. According to the report, CSE is predominantly delivered through biology-focused instruction, emphasising physical and disease-related aspects such as puberty and HIV, while critical components, including sexual relationships, consent, gender norms, decision-making, and life skills, are inconsistently addressed or largely absent.
- Primary settings for CSE exposure: School is the primary setting for CSE, which leaves those outside the school system with far less access. Only 17.4% of participants not enrolled in school had been exposed to CSE.
- Sources of CSE information: Education received at school is often supplemented with “informal sources” in Ethiopia. This includes through social media, radio and television.
- Barriers: Structural limitations include the absence of a standardised national CSE curriculum, weak coordination across sectors, and limited institutional capacity. Personal and social barriers include sociocultural and religious norms that often discourage open discussions of sexuality. The research highlighted the critical need for CSE to extend to rural youth and young people with disabilities, given how they are often marginalised from the kind of urban centric and able-bodied NGO programmes available to urban and able-bodied youth.
- CSE outcomes: CSE has been found to correlate to stronger SRHR knowledge for both men and women. This knowledge was then found to be positively and significantly associated with increased confidence in exercising safer sexual behaviours including the ability to say “no”, report abuse, buy and use condoms, discuss sexual activity, control risky sexual behaviours, and seek help. These findings extended to both in- and out-of-school youth, as well as youth with disabilities.
Ethiopia has the least established formal legal landscape governing the implementation of CSE of the three countries with adolescents with disabilities being largely excluded from existing interventions. Ethiopia faces steep challenges with stigma and misinformation surrounding CSE with additional challenges including the fact that only 17.2% of married women in high-fertility regions have autonomy over contraceptive use decisions, and stigma and misinformation hinder access for young or unmarried people. In addition, 13% of adolescent girls aged 15–19 have begun childbearing, with higher rates in rural areas.
In the absence of a standalone Education Act, the 2009 Education Sector Policy and Strategy on HIV & AIDS governs related content, calling for HIV and AIDS information to be mainstreamed into the school curriculum.
Socio-cultural barriers are documented as the main obstacle to CSE implementation, and teachers have been found to adapt content to local norms in ways that undermine the curriculum’s key points. Ethiopia’s federal system also produces significant regional variation in implementation, alongside a documented rise in opposition from national ministries to a nationwide curriculum.
Positive outcomes
YPAR findings indicate a desire for CSE:“It would be good if it [CSE] came out as an independent subject… like Biology, like Chemistry” (In-school youth).
CSE teaches valuable life skills:An out-of-school youth from Ethiopia noted: “I feel confident… using condoms and getting regular health check-ups is essential. I often report this and tell other kids about it”.
Further, one out-of-school youth described an increased awareness about preventive measures, especially to avoid pregnancy:“After taking the [CSE] training, I know what I should use so that there won’t be unplanned pregnancies or [STIs]”.
Cross-cutting finding: difference between policy and practice
Across all three countries, some form of policy grounding for sexuality or life-skills education already exists but research indicates that none delivers it fully or consistently.
- In Malawi, it is examinable but elective, so comprehensive roll out is compromised.
- In Uganda, it is mandatory and examinable on paper, but rollout has been repeatedly delayed by political constraints.
- In Ethiopia, it is not yet consistently formalised at national curriculum level, and a federal system makes its delivery inconsistent across the region.
Acknowledging evidence gaps
Confidence in the evidence base does not mean overstating what is known. Each country’s own gaps should be acknowledged rather than glossed over:
- Malawi lacks adequate national-level data on the coverage, cost, outcomes and impact of its own LSE programme.
- Uganda’s evidence base is strong on policy and legal history, but weaker on classroom-level delivery data since the 2018 Framework.
- Ethiopia’s evidence base is the least developed of the three, reflecting its less formalised policy landscape.
Where a user is asked for country-specific evidence this module does not yet contain, the honest answer is to say so rather than to overstate what is available.