Comprehensive Sexuality Education

1. Context and background

2. Terminology

3. Laws and policies

4. Governance

5. Monitoring and reporting

 

1. Context and background

Sexual health indicators in Uganda show negative trends, with rising levels of early unintended pregnancies, unsafe abortions, STIs, child abuse, and gender-based violence and sexual abuse.

According to the Democratic and Health Surveys 2016, 25% of teenage girls are either pregnant or have already had their first child. Of the 28% girls who were sexually active while still at school, 80.1% became pregnant. Of this, 97% dropped out of school because of the pregnancy. By age 15, only 32% of young women and 38% of young men aged 15-24 had never had intercourse.

In 2016, the Parliament of the Republic of Uganda banned comprehensive sexuality education (CSE) in schools. The ban came after the discovery of sexual reproductive health (SRH) books in more than 100 schools that included coverage of sexual orientation and a non-negative portrayal of masturbation. In November 2021, the High Court in Kampala instructed the Education Ministry to develop and implement the CSE policy for school learners. The judge ordered that the policy must be completed within two years, with the Ministry reporting on the progress to the registrar of the court every six months.

 

2. Terminology

The 2018 National Sexuality Education Framework defines sexuality education as a lifelong process of acquiring information and forming attitudes, beliefs, and values about vital issues such as sexual development, reproductive health, interpersonal relationships, affection, intimacy, body image, and gender roles. It addresses the socio-cultural, biological, psychological, and spiritual dimensions of sexuality by: providing information; exploring feelings, values, and attitudes; and developing communication skills, decision-making, and critical-thinking skills in accordance with the laws and policies of Uganda.

 

3. Laws and policies
 

3.1. Relevant international/regional agreements to which Uganda is a signatory

 

3.2. Relevant national laws and policies mandating comprehensive sexuality education

The 1995 National Constitution, the National Children’s Act (1997 as amended in 2020) and the National Education Act (2008) guarantee the right of all children to education, irrespective of sex, or other economic or social standings; protection from any form of violence, including harmful practices; and the right to access health care services and a clean and healthy environment. There is no specific mention of the inclusion of health, reproductive, or sexuality education in the school setting.

Over the past few years, enabling policies have been drafted to promote and include SRH education in schools. The National Population Policy Plan (2011-2015) states that information and access to safe, affordable and acceptable methods of contraceptives are essential for both men and women. The promotion of mutually respectful and equitable gender relations is also addressed, with emphasis placed on the educational needs of children and the service needs of adolescents. The National Standards and Guidelines for Reducing Maternal Morbidity and Mortality from Unsafe Abortion in Uganda (2015) focuses on the empowerment of youth, providing information on SRH services, especially access to contraceptive services, the availability, accessibility of quality reproductive health programmes and services for youth, and family planning and contraceptive use.

The Government started including sexuality education in school programmes through the School Health Education Programme ), the Health Education Network, Safeguard the Youth from AIDS, and the Presidential Initiative on AIDS Strategy for Communication to Youth, which was launched in 2003 and updated in 2015. 

The National School Health Policy for Uganda (2018) promotes the integration of life-skills based education at all levels of education and the improvement of access to, and utilization of, SRH services among young people. The Policy also encourages linkages between schools and health facilities to ensure access to services for those in need. 

The National Sexuality Education Framework (2018) is the overarching national framework for sexuality education in Uganda. The Framework covers topics such as human reproduction, including anatomy, prevention of pregnancy, body image and sexuality, gender-based violence and sexual abuse. However, the contents are centered around religious and cultural values 'because Uganda is a God-fearing nation with morals and virtues of an African setting'. The Framework also establishes concrete values such as 'protection of life' and 'reverence of the sanctity of life'. It also emphasizes sexual abstinence, preparing for long-term relationships, and notes 'deviant' sexual behaviours. The policy objectives include: ensuring young people have better access to age-appropriate information on sexuality and related health risks; increased resilience for resisting the temptation to engage in risky sexual relationships and behaviours; promoting healthy behaviours such as sexual abstinence and health-seeking behaviours; strengthening the centrality of the family as the primary 'go-to' educator on matters of sexuality education; providing a safe school environment, where students feel protected from all forms of sexual abuse and violence, including sexual harassment and exploitation; and building young people’s ability to manage the influence of the media in a healthy way. The Framework is organized into four key themes: human development, relationships, sexual behaviour, and sexual health.

The National Sexuality Education Framework (2018) established that schools shall conduct sexuality education and teach life skills using age-appropriate messages.

The Health Sector Development Plan 2015/16 – 2019/2024 promotes adolescent and youth SRH, including the establishment and operationalizing of adolescent-friendly corners at all levels of health care, and the promotion of SRH education in schools and communities.  

 

3.3. Curricula

Mandatory or optional

Sexuality education is mandatory and examinable in primary and secondary education.

Model of delivery

Sexuality education is delivered across a number of school subjects. Reproductive Health is integrated as a cross-cutting topic in the lower secondary level curriculum into Life Education, which includes physical education and sexuality education. The themes of the Human Body and Health themes are included in the lower primary curriculum. At the upper primary level, sexuality education is integrated into English, science, social studies, religious education and geography. The Ministry of Education and Sports developed a Life Education Learning Area Syllabus for lower secondary schools.

Comprehensiveness of content

The National Sexuality Education Framework (2018) established four key themes, which include a range of topics. The Framework divided students into five age groups: early childhood (aged 3-5; for pre-primary learners in nursery); lower primary (aged 6-9; from primary 1 to 4. 3); upper primary (aged 10-12; from primary 5 to 7. 4); lower secondary (aged 13-16, from senior 1 to 4. 5); A-level or tertiary institutions (17+ years; senior 5 to 6 students, tertiary institutions of learning i.e. colleges, institutes and universities).

According to the 2021 Evaluation Report of Uganda's Ministerial Commitment on comprehensive sexuality education and sexual and reproductive health services for adolescents and young people in Eastern and Southern Africa, the Life Education Learning Area syllabus imparts a range of skills, including sections on sexuality education that seek to: (a) increase knowledge about HIV, STI, early pregnancy, and how to manage relationships; (b) develop learners’ ability to protect themselves against sexual abuse, deal with threatening sexual behaviour, and resist peer pressure; (c) seek to challenge attitudes and beliefs from peer pressure or cultures that encourage early sex; and (d) encourage abstinence while providing knowledge about protection for those who are sexually active. In general, while sexuality issues are included, they have been carefully selected to fit in with the country's cultural environment and government policies. 

Learning resources

The overall purpose of the 2020 Revised Guidelines for the Prevention and Management of Teenage Pregnancy in School Setting in Uganda is to support the prevention and management of teenage pregnancy in school settings, specifically to: outline modes of service delivery within a learning institution setting that enable prevention of pregnancy among girls; propose linkages for a minimum care package for prevention and management of teenage pregnancy in learning institution settings, and outline steps and services that should be in place to re-integrate the adolescent mothers into the learning institutions. The Reporting, Tracking, Referral and Response (RTRR) Guidelines on Violence against Children in Schools (2015/2020), provides guidelines on violence against children in schools in Uganda and further support adolescents in acquiring better knowledge and skills that enhance their ability to resist pregnancy.

 

3.4. Teachers

The National Sexuality Education Framework mandates the Ministry of Education and Sport to ensure that the curricula for teacher training institutions, including universities, are revised to incorporate the Framework. In-service teachers will be sensitized and empowered to deliver the curriculum, and religious institutions are to actively engage in the monitoring and evaluation of the implementation of the Framework. The process of reviewing teacher training curricula to integrate sexuality education is ongoing. 

 The Presidential Initiative on AIDS Strategy for Communicating to Youth offers training for in-service primary and secondary school teachers on HIV & AIDS information. Teacher Development Management System Coordinators are trained to offer school-based training to teachers in their area. Furthermore, the 2020 Revised Guidelines for the Prevention and Management of Teenage Pregnancy in School Setting in Uganda, mentions 'as part of Continuous Professional Development (CPD), personnel providing health services in schools, tutors, teachers and instructors will be equipped with counselling, and psycho-social support skills as well as skills to identify learners that need these services, and motivated to provide such services regularly.'

 

3.5. Schools

According to the 2020 Revised Guidelines for the Prevention and Management of Teenage Pregnancy in School Setting in Uganda, there should be a minimum set of procedures that each school must ensure, such as having a school health committee with a trained counsellor who may be a member of the school staff or a counsellor from the nearby health facility to provide general counselling to learners, and testing for pregnancy. The School Health Policy, which is still pending Cabinet approval, aims to initiate or strengthen the referral and communication system between schools and health facilities.

 

4. Governance
 

4.1 Responsible ministries

The Ministry of Education and Sport leads the implementation and oversight of the National Sexuality Education Framework, reviews the school curricula and incorporates sexuality education and life-skills training in schools. Other ministries provide technical, supportive and complementary support, such as the Ministry of Health and the Ministry of Gender, Labour and Social Development. Civil society organizations also play a supportive and complementary role. The National Curriculum Development Centre develops the appropriate curriculum, textbooks and messages according to the National Sexuality Education Framework.

4.2. Level of responsibility/decentralization and autonomy

Educational institutions are responsible for implementing sexual education programmes, following the ministerial guidelines, and structuring the school environment to include SRH components, such as establishing a school health committee.

4.3. Government budget allocation

The national budget allocation for the education sector covers the delivery of sexuality education as it is integrated within the curriculum.

 

5. Monitoring and reporting

The National Sexuality Education Framework establishes different monitoring and evaluation indicators to measure the effectiveness of the programme. The Framework mandates the Ministry of Education and Sport to include sexuality education in its routine monitoring and support supervision activities. According to the Framework, teachers are expected to conduct formative and summative assessment as they teach sexuality education; the Uganda National Examinations Board is to cover sexuality education in the national examination processes; the Uganda Bureau of Statistics is to collect data on relevant indicators during the regular population-based surveys, such as the Uganda AIDS Indicator Survey and the Uganda Demographic and Health Survey. Sexuality Education is also to feature prominently in the Annual Sectoral Performance Review Report of the Ministry of Education and Sport. The 2020 Revised Guidelines for the Prevention and Management of Teenage Pregnancy in School Setting in Uganda, states that the Ministry of Education and Sport will determine and develop reporting formats and reporting lines that will feed a national data source for the prevention of teenage pregnancy in school settings.