A systematic review of comprehensive sexuality education for South African adolescents

Comprehensive sexuality education (CSE) was implemented in South African schools in the year 2000 as part of the subject Life Orientation, with the aim of contributing positively to adolescent sexual health in a holistic manner. Continued high rate of teenage pregnancy and HIV infection is an indication; however, that the programme is not entirely successful. To establish why the aims of the programme and the consequences of learners’ sexual behaviour do not correspond, this systematic review aimed to determine how the programme contributes to the sexual health of adolescents and to make recommendations for its improvement. Nine databases were searched, after which two reviewers independently evaluated the methodological quality of the identified studies using an appraisal tool. The 22 articles that met the criteria for final inclusion were qualitative in nature and included cross-sectional and cohort studies. Results indicate that the contribution of the CSE programme is reflected in teachers, learners and the curriculum. Teachers are in need of expert training and learners are neither actively involved in the learning process nor the development of the programme as they need and would like to be. Recommendations include the development of context-specific training curricula for pre- and in-service teachers as developed collaboratively by various experts and stakeholders. Learners’ voices, active involvement, cultural context and needs are fundamental to the development and delivery of CSE. The teaching method and content of sexuality education should meet the contemporary needs of the 21st century adolescent to ensure optimal sexual health.