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Classroom-based sex education programmes largely ineffectual, but incentives to stay at school can help

Posted on 8 November 2016

A global review of school-based interventions for preventing HIV, sexually transmitted infections (STIs), and pregnancy in adolescents shows sex education programmes have no impact in lowering numbers of young people affected, although staying on at school can reduce pregnancy and some STIs.

Cochrane Infectious Diseases Group

Researchers from the University of York, Liverpool School of Tropical Medicine, South African Medical Research Council and Stellenbosch University carried out a Cochrane review to assess the impact and effectiveness of school-based interventions.

In the first review of its kind to look at measurable biological outcomes, researchers studied eight trials involving more than 55,000 participants from sub-Saharan Africa, Latin America and Europe. They evaluated six curriculum-based programmes that aimed to delay sex, reduce STIs and pregnancy and two incentive-based programmes aimed at encouraging students to stay in school.

Measurable outcomes

School-based sexual and reproductive health programmes are widely accepted as an approach to reducing high risk behaviour, with curriculum-based sexuality programmes popular in many countries.

While there is some evidence that they can improve knowledge and reduce self-reported risk-taking, little was previously known about the number of young people who contracted STIs including HIV, and the number of adolescent pregnancies following such programmes.

Dr Amanda Mason-Jones, Senior Lecturer in Global Public Health and lead author of the review, said: “Previous studies have focused on self-reported outcomes only - this is the first review and meta-analysis to look at only measurable biological outcomes.

“As they are currently designed, sex education programmes alone probably have no effect on the number of young people infected with HIV, other STIs or the number of pregnancies, especially if condoms and contraceptives or other health service provision are also not freely available to young people.”

However, researchers also found in those studies which provided incentives, such as free school uniform or small cash payments to young people who stay in school, one showed a reduction in STI infections, and overall there was a significant reduction in adolescent pregnancies of about 22 per 1000 – though more evidence is needed to confirm this.

More research needed

Dr Mason-Jones continued: “It is clear that there needs to be further high quality research undertaken in this area so that policy makers can be better informed about keeping young people, especially girls, in education for longer.

“Sexually active adolescents in some countries, particularly girls, are at high risk of contracting HIV and other STIs; while early, unintended pregnancy can have a major impact on their lives.

“Schools or further education and training facilities may provide a positive environment for information and guidance about healthy relationships, but this needs to be combined with the appropriate health services that meet the needs of young people and in turn can help improve their life chances.”

Further information:

  • The Cochrane review was coordinated by the Cochrane Infectious Diseases Group (CIDG), based at the Liverpool School of Tropical Medicine. The CIDG has been in operation since 1994, led by Professor Paul Garner, and is supported by over 600 authors from 52 countries.

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