Comprehensive Sexuality Education

1. Context and background

2. Terminology

3. Laws and policies

4. Governance

5. Monitoring and reporting

 

1. Context and background

Zambia is one of the most advanced countries in the Eastern and Southern Africa region in terms of the provision of sexuality education and sexual and reproductive health (SRH) services for young people (ICF, 2018). With the country having one of the highest HIV prevalence rates in the world (UNAIDS, 2020), the Government of the Republic of Zambia has demonstrated the political will to invest substantially in prevention efforts. Negative outcomes relating to the sexual and reproductive health (SRH) of the country’s young people, such as rising numbers of early and unintended pregnancies, new HIV infections and other STIs, gender-based violence, and child marriages resulting in school dropouts are other key issues that have served as a motivation to advance sexuality education (APHRC, 2019). 

As early as 1996, the main policy of the Ministry of General Education, Educating our Future, recognized that the 'development of life-skills and in the areas of sexuality and personal relationships' is one way of halting the further spread of HIV among school-going children, and initially integrated the health education programme, including life skills and the sexuality and personal relationships programme, into the school curriculum and syllabi. In 2011, Zambia enacted the Education Act, which aimed to 'promote education on sexuality, reproductive health, HIV and AIDS and personal relationships in any educational institution', and developed a Life Skills Education Framework to provide specific guidelines for implementation. In 2013, the revision of the school curriculum provided an opportunity to further strengthen the provision of sexuality education, with the development of the 2013 Comprehensive Sexuality Education Framework (for grades 5-12), which was integrated into the 2013 Zambia Education Curriculum Framework and rolled out nationally to schools in 2014. The importance of sexuality education has been further institutionalized through various government policies, including (but not limited to) the National HIV/AIDS Policy for the Education Sector (2004) and the National HIV & AIDS Strategic Framework (2017-21). The country’s Education and Skills Sector Plan (2017-21) aims to 'enhance comprehensive sexuality education (CSE) through guidance and counselling' and expand its integration within the school system. The overall score for the institutional context indicator in Zambia in the Sexuality Education Review and Assessment Tool (SERAT) was 72% in 2015, indicating the strong features in place in the country that support sexuality education. In addition, in UNESCO’s CSE Scale-Up in Practice Report 2017, it was highlighted that the conducive environment and numerous achievements led to the successful scale-up of sexuality education in Zambia, and that this was partially due to the Ministry of General Education taking ownership of it. In 2020, CSE had reached 2 million primary and secondary students throughout the country (UNESCO, 2021).

 

2. Terminology

In the 2013 Comprehensive Sexuality Education Framework, sexuality education is referred to as 'reproductive health and sexuality education'. While the term is not specifically defined in the Framework, it comprises six thematic areas: i) relationships; ii) values, attitudes and skills; iii) culture, society and human rights; iv) human development; v) sexual behaviour; and vi) sexual and reproductive health. There are specific definitions included for a variety of terms covered in the Framework, such as sex, gender, gender equality, gender equity, gender identity, gender inequalities, gender norms, gender roles and gender-based violence. The 2013 Zambia Education Curriculum Framework similarly uses both terms (reproductive health and sexuality education and CSE), highlighting national concerns and cross-cutting themes in life skills, gender, human rights, population and family life education, reproductive health and sexuality, and HIV & AIDS. While CSE is not defined, cross-cutting issues are defined as 'issues of national concern which affect all people such as democracy, good governance, gender equality, sustainable environment, life skills and HIV and AIDS'. The 2017 Educational Statistical Bulletin, published by the Ministry of General Education, refers to 'life skills-based HIV and Sexuality Education'.

 

3. Laws and policies
 

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

Zambia is a signatory of various international and regional agreements that advance the status of women and protect and promote children’s rights. The Government has signed and ratified all relevant major international instruments, including the Convention on the Rights of the Child (CRC) in 1991, the Convention on the Rights of People with Disabilities (CRPD) in 2010, the International Covenant on Economic, Social and Cultural Rights in 1984, the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) in 1985, and the International Conference on Population and Development (ICPD) Programme of Action 1994. Zambia is also a signatory of the African Charter on Human and People‘s Rights (ACPHR), the African Charter on the Rights and Welfare of the Child, and the Southern African Development Community (SADC) Declaration on Gender and Development and its addendum on the 'Prevention and Eradication of Gender-Based Violence (GBV)'. In addition, the Government has taken a leading role in ending forced child marriages by signing the Ministerial Commitment on comprehensive sexuality education and sexual and reproductive health services for adolescents and young people in Eastern and Southern African (ESA) in 2013. The ESA Ministerial Commitment was then renewed and expanded in 2021. To fulfil its obligations under these treaties, instruments and agreements, Zambia has established various key institutions such as the Ministry of Gender and Child Development, the Human Rights Commission, the Zambia Women‘s Parliamentary Caucus, and the Police Victim Support Units ( National Gender Policy 2014; SERAT, 2015).

The table below provides brief detail about how these commitments relate to sexuality education.

 

3.2. Relevant national laws and policies mandating comprehensive sexuality education

According to the 2011 Education Act, the Minister of General Education promulgates regulations 'providing for the development and adoption of guidelines to promote education on sexuality, reproductive health, HIV and AIDS and personal relationships in any educational institution'. Recognizing the 'importance of education and the formation of attitudes in relation to HIV/AIDS', the 1996 Educating our Future: National Policy on Education states that 'each school will provide its pupils with suitable education in sexuality and relationships', which will 'serve as the channels for messages about HIV/AIDS', by working closely with parents and communities. The Ministry of General Education specifically expects that upon completion of Grade 9, each student must have attained a suitable level of competence in 'life-skills necessary for the promotion of personal health, interpersonal relations, and healthy sexuality'. In addition, the 2014 National Gender Policy aims for the 'integration of Comprehensive Sexuality Education into the national school curriculum'. This is further mandated in the 2013 Zambia Education Curriculum Framework, which states that the school curriculum must be tailored in such a way that 'population and family life education is well integrated and implemented through Comprehensive Sexuality Education (CSE)'. The 2013 Comprehensive Sexuality Education Framework (for grades 5-12) was specifically developed to enrich the provision of reproductive health and sexuality education, which is a cross-cutting theme in the Zambia Education Curriculum Framework. According to the revised CSE Framework, 'properly designed and implemented sexuality education can play a significant role in reducing the risk of STI including HIV transmission, unintended pregnancies, cohesive or abusive sexual activity and exploitation'. Effective sexuality education is viewed as an essential part of HIV prevention and as being critical in achieving universal targets for reproductive health, treatment, care and support. It is specifically hoped that the integration of CSE into the school curriculum is to 'contribute to the reduction of the various education challenges that come by due to limited information on sexuality education among youths', helping youth make informed decisions.

 

3.3. Curricula

The 2013 Comprehensive Sexuality Education Framework (for grades 5-12) was developed as part of the revised Zambia Education Curriculum Framework in 2013 in order to enrich the provision of reproductive health and sexuality education. Based on the United Nations International Technical Guidance on Sexuality Education, it aims to provide young people with age-appropriate, culturally relevant, and scientifically accurate information so that they can gain the knowledge, values, positive attitudes and skills to help them address challenges with regard to their sexuality. The revised framework replaced the Life Skills Education Framework and was designed to be gender-responsive and introduced from Grade 5 by policy, covering both upper primary and secondary education. It aims to cover all learners, including disabled youth in both mainstream and special schools (ICF, 2018). The programme was developed through extensive consultations with key stakeholders, including parent-teacher associations, policy-makers, religious organizations, local communities, SRH service providers, teachers and students (SERAT, 2015). The CSE curriculum framework is delivered and available in all national schools, now reaching 95% of students in grades 5-12, compared to only 25.8% before the programme was launched in 2013 (ICF, 2018). In 2020, it reached 2 million primary and secondary students across the country (UNESCO, 2021).  

Zambia has also adopted an out-of-school CSE programme targeted at out-of-school youth based on the 2015 National Youth Policy, which is led by the Ministry of Youth, Sport and Child Development (APHRC, 2019).

Mandatory or optional

CSE is included in the mandatory school curriculum for both primary and secondary education (UNESCO, 2021).

Model of delivery

According to the CSE Framework, Reproductive Health and Sexuality Education is not taken as a stand-alone subject. Instead, it is fully integrated into carrier subjects at both primary and secondary levels, such as integrated science (primary and lower secondary), integrated social studies (primary and lower secondary), biology (upper secondary), civic education (upper secondary), home economics and religious education. These are all stand-alone and examinable subjects. However, home economics, which is a carrier subject into which CSE has been integrated, is elective (APHRC, 2019).

Comprehensiveness of content

The Ministry of General Education took advantage of the 2013 curriculum review to properly revise the Life Skills Education Framework and transform it into the 2013 Comprehensive Sexuality Education Framework. The revised CSE Framework was developed in accordance with the UN International Technical Guidance on Sexuality Education, aiming to offer more comprehensive, age-appropriate, gender-responsive, scientifically accurate, and culturally relevant sexuality education content in all schools. It explores all aspects of human sexuality through six themes: i) relationships; ii) values, attitudes and skills; iii) culture, society and human rights; iv) human development; v) sexual behaviour; and vi) sexual and reproductive health. Each theme includes various sub-themes, as well as specific outcomes and details of content in terms of knowledge, skills and values. The Framework also includes a logic model, which describes the specific outcome for each grade, topic/area of focus, expected behavioural change, and goals (CSE Framework, 2013).

While the Framework officially covers grades 5-12, students in lower grades do receive some sexuality education although this is not considered comprehensive. Sexuality education is only considered to be comprehensively covered from upper primary (Grade 5 onwards) (ICF, 2018). 

According to the SERAT, the programme implemented in Zambia scores high overall in content in relation to concept and focus, covering all the main themes defined in the UN Guidance, including interpersonal relationships, sexuality and sexual behaviour, communication, negotiation and decision-making, human development, SRH, and youth empowerment. It was judged to have clear cognitive, affective and skills-based objectives that intend to reduce levels of HIV & AIDS, STIs, unintended pregnancies and gender-based violence in Zambian schools (SERAT, 2015). However, studies have shown that the comprehensiveness of the content taught can also depend on how, when and what teachers may decide to focus on due to selective teaching and the lack of detailed direction in teaching and integrating CSE. 

In terms of topics not addressed, the SERAT results show that the only content not addressed in the subjects for 9-12 year-olds is the process of engagement for marriage, how gender norms perpetuate illegal child marriages, and the influence of laws on marriage and parenting. In addition, according to SERAT, content on human rights, social norms, gender, knowledge, feelings and life skills needs to be improved. In the content for 12-15 year-olds, there were some weaknesses in relation to access by people living with HIV to social networks and advocacy skills on human rights. The program was generally found to be strong in its focal areas, with one weakness in knowledge around sexuality and sexual behaviour. Content for 15-18 year-olds was similarly found to be strong, with the only issues not addressed being shame, fear, and other feelings that young people may experience which may hamper disclosure of issues such as their HIV status or pregnancy (SERAT, 2015).

Learning resources

The teaching materials for CSE were developed and printed by the Ministry of General Education, with technical assistance from UNESCO for grades 5,6, 8, 9, 10 and 11. The books were distributed in schools in late 2017, with those designed for grades 7 and 12 finalized in 2018 (ICF, 2018). Teachers have expressed the need for additional lesson plans, teaching aids, and materials (such as reproductive health charts), and the need for more definitions and more in-depth information in the teachers’ materials. In addition, there have been concerns that the CSE Framework does not address the needs of learners with special educational needs. According to the Education and Skills Sector Plan 2017-21, the development and printing of textbooks for grades 7 and 12 was scheduled to continue up to 2021. The Government plans to work with curriculum developers to develop textbooks for students with special educational needs in primary and secondary schools (ICF, 2018).

 

3.4. Teachers

In an effort to ensure the quality of CSE delivery, the Ministry of General Education placed strong emphasis on teacher training, initially developing in-service training of teachers at the national and provincial levels, who in turn trained teachers at the district and school levels. Although this model yielded some positive results, an evaluation revealed that it led to some uneven training, as some teachers in certain provinces received shortened, insufficient, and incomplete training. As a result, a new teacher training model was developed in 2019, which utilizes teacher training colleges (considered 'centres of excellence') as education hubs. Under this new model, these colleges deliver first-hand information to teachers through a five-day sexuality education training course, which aims to impart confidence, skills and refined participatory methods. Well-trained teachers then serve as role models and resources for the training hubs, while technical support is provided through civil society organizations and other ministries (such as the Ministry of Health). The quality of teacher training and delivery of sexuality education is then assessed by a separate independent monitoring institution. Besides assessing the quality in teacher training, the monitoring institution has also been engaged to assess the quality of CSE delivered in schools. Both pre-service and in-service teachers are trained to deliver sexuality education, with training largely focused on enhancing content in the curriculum, emphasizing a student-centered approach in teaching, and helping teachers reconcile their own values and attitudes and feel confident delivering sexuality education (APHRC, 2019).

 

3.5. Schools

The Education and Skills Sector Plan 2017-21 aims to 'enhance comprehensive sexuality education (CSE) through guidance and counselling” as well as “enhance multisectoral collaboration between schools and health'. The delivery of sexuality education and training of teachers has also created a strong demand for access to youth-friendly SRH services, with a substantial number of young people being referred to these services. Access to appropriate SRH information and health services for adolescents and young people has mainly been sought through collaboration with the Ministry of Health, the Ministry of General Education, the Adolescent Health and Technical Working Group, and UNESCO. The aim is to 'help increase the youth-friendliness of government health centres and strengthen linkages from schools to health facilities'. In 2018, 159,000 young people had been referred to SRH services and 69 schools were visited with health talks.  Joint training in CSE and adolescent health was organised for Ministry of General Education teachers and Ministry of Health health care workers in 2016, with a total of 117 participants (85 teachers and 32 healthcare workers), to ensure better understanding of the referral process. Additionally, youth-friendly guidelines and training packages for health providers were finalized to help with access to these services, while UNESCO provided technical support in the development of various national strategy documents that aimed to enhance these services, including the Adolescent Health Strategy 2017-21 and the National AIDS Strategic Framework 2017-21 (ICF, 2018). There have also been several accounts of efforts to reach parents and caregivers to build general support for CSE throughout the country (UNESCO, 2021).

 

4. Governance
 

4.1 Responsible ministries

The Ministry of General Education, which oversees primary and secondary education in Zambia, is mainly responsible for the implementation and monitoring of the in-school 2013 Comprehensive Sexuality Education Framework (for grades 5-12), and leads CSE curriculum development and teacher training. Zambia has adopted a multisectoral approach in the design, adoption, and implementation of the CSE curriculum. CSE implementation is generally coordinated through the Adolescent Health Technical Working Group, which is chaired at the Ministry of Health , co-chaired by the Ministry of General Education, and made up of diverse stakeholders from other government ministries, civil society organizations, non-governmental organizations, resource mobilizers and funders. Besides the Ministry of General Education, which is responsible for in-school CSE, the Ministry of Health leads in the provision of SRH services to adolescents, the Ministry of Youth, Sport and Child Development leads the implementation of out-of-school CSE through youth resource centres, and the Ministry of National Guidance and Religious Affairs reviews the CSE curriculum to ensure that it aligns with national values (APHRC, 2019). 

CSE in Zambia is also largely supported by various civil society organizations and United Nations entities through advocacy, funding and resource mobilization (ICF, 2018). The education system is viewed as playing a crucial role in shaping the behaviours and attitudes of young people and being a key partner in the prevention of HIV, STIs and unintended pregnancies (SERAT, 2015).

4.2. Level of responsibility/decentralization and autonomy

The Government has an ongoing commitment to decentralize education services from the central government to the provincial, district and school levels. While the central government has developed the CSE Framework, its implementation is devolved to local authorities. Teachers and coordinators at the provincial, district and zonal levels were trained in the revised CSE curriculum, with training cascading to other teachers at the district and school levels (SERAT, 2015; ESSP 2017-21).

4.3. Government budget allocation

According to the Education and Skills Sector Plan 2017-21, the annual budgetary projections for the enhancement of the implementation of CSE are projected at an annual cost of 9.3 million ZMW and a total cost of 23 million ZMW (including teacher training and textbook development/printing for grades 7 and 12).

 

5. Monitoring and reporting

Zambia was the first country in Sub-Saharan Africa to include all the globally recommended indicators for HIV (including sexuality education and trained standards officers) in their national EMIS in order to monitor implementation (UNESCO, 2021). The Educational Statistical Bulletin published by the Ministry of General Education includes a section on HIV & AIDS and sexuality education, with information on the number of schools and students receiving life skills-based HIV & AIDS and sexuality education, the number of teachers receiving sexuality education training, the number of schools that have implemented HIV & AIDS workplace policy programmes, the number of schools that have adopted rules and guidelines for staff and learners related to discrimination, and the number of schools that have organized sexuality education orientation sessions. There is also information on school dropout rates and the number of early pregnancies and readmissions, which are used to explore trends in SRH outcomes in the country to inform sexuality education implementation strategies. Existing education-sector monitoring instruments (including head teacher reports) were also revised to include indicators on sexuality education, with information on enrolment figures, school dropouts, early pregnancies, and child marriages among pupils (disaggregated by student sex, and then clustered from the school to district and national levels). However, there is no national level data on the outcomes and impact of sexuality education for youth in Zambia (SERAT, 2015; APHRC, 2019).