Stakeholder perspectives on the impacts of inadequate sexuality education on adolescents’ health at schools: A qualitative study in Savar City, Bangladesh

Abstract

Background: Sex education (SE) is regarded as essential to improving adolescents’ sexual and reproductive health and rights. In most impoverished nations, including Bangladesh, teenagers experience problems because they lack knowledge about sexuality, sex, physical changes, puberty, teenage pregnancy, early childbearing, and HIV/AIDS. For this reason, SE is essential. However, the schools in Bangladesh lack government guidance and an appropriate curriculum on SE, even though SE is not in the curriculum as a separate subject.

Objectives: This study explored stakeholders’ perceptions regarding inadequate SE at schools and how it impacts adolescents’ health. Also, this study identified barriers that hinder SE provision in schools as well as will provide some suggestions that might be helpful to the school curriculum and other program reviews for ensuring appropriate information access to meet the sexual and reproductive needs of adolescents.

Methods and materials: The research chose a phenomenological qualitative study design in a social constructivist paradigm. The study was conducted in Savar Upazila, Dhaka, Bangladesh, between May 2024 and July 2024. A non-probability purposive sampling technique was employed to select stakeholders as study participants Data was collected using two qualitative techniques: an In-depth Interview (IDI) and a Key Informant Interview (KII) followed by the semi-structured interview approach. Interviews were conducted both face-to-face and online. Data saturation was reached after 11 IDIs and 8 KIIs. A thematic analysis approach was utilized to analyze the collected data. Results: The study showed that adolescents had significant knowledge gaps regarding SE. Also, in this study, informants mentioned that SE should be stated at earlier grades as adolescents experience pubertal changes and menstruation earlier than before, and there is a risk of getting wrong information from the internet about sex and reproduction. The study found several perceived health impacts of adolescents due to inadequate SE in schools, such as sexual and reproductive (e.g., STDs, HIV/AIDS, uterine infection, etc.) and mental health (mood swings due to menstruation, stress, depression, and mental trauma), and experiencing teenage pregnancy due to early marriage. Despite numerous health effects, stakeholders mentioned that sexual and reproductive (SRH) content in school curricula is insufficient. Informants stressed that some content was already in the syllabus; however, teachers skipped those due to their shyness and discomfort. The current study discovered that parents were more aware of providing SRH information to girls than boys. Also, the study found that while all stakeholders value sexual education for adolescents, traditional social and cultural factors, religious beliefs, and taboo inhibits open discussion. Informants further mentioned that temporal factors, such as practicing short syllabi due to the COVID-19 emergency, hinder adolescents from knowing about SRH content. Stakeholders expressed the necessity to be supported in teaching SE in schools with an appropriate curriculum, teachers’ training, teaching materials, gender-specific teachers, and parental involvement in the teaching process. Informants also recommended that the imams and other influential people of the community (members and chairman) should be invited to understand the importance of SRH education, and later, they will motivate others. In addition, study results suggested that a separate subject in the curriculum highlighting SRH topics should be incorporated.

Conclusion: The perceived health impacts of adolescents due to inadequate SE in schools converge among stakeholders, including adolescents. Moreover, barriers in SE provision in schools leading to SRH’s knowledge insufficiency exacerbate adolescent health impacts. This calls for well-designed interventions. This study also recommends that the government implements measures to assess and monitor SE curricula once integrated into the curriculum and evaluate how schools address it.