A woman cannot get pregnant if she has sex standing: Matters arising from the lack of comprehensive sexuality education in Africa

Introduction

Comprehensive Sexuality Education (CSE) remains a sensitive topic in most parts of the world as parents, teachers, religious leaders, politicians and human rights defenders have continued to share polarized opinions about what should be taught, by whom and at what age. Even among countries in Africa that have incorporated CSE into their teaching programs, most teachers still find topics such as abortion, sexual pleasure, contraceptives, pornography,  homosexuality, masturbation and bisexuality to corrupt social norms and erode children’s innocence. Where these topics are touched, the discussion is always in a negative light, in contradiction to CSE, underpinning the broader opposition to adolescent reproductive health rights and the misrepresentation of CSE in discourse. Therefore, this policy brief aims to shed more light on CSE, its misrepresentation in Africa and how the misrepresentation can be questioned or replaced.

I – Knowledge is Power

The phrase, “Knowledge is power”, by Sir Francis Bacon[1] has earned prominence in modern vocabulary because of the role knowledge plays in shaping our personality and behaviour. The world in which adolescents grow up nowadays is very different from that of their parents and many young people do not have the basic information about their sexuality and the little they know is crowded with myths. For instance, in many parts of Africa, some adolescents still think that a young woman cannot get pregnant if she has sex standing up while others believe  that an HIV-positive man can be cured by having sex with a virgin[2]. Addressing the sexual and reproductive health needs of adolescents in Sub-Saharan Africa through CSE is vital, given the devastating high rate of HIV/AIDS, unintended pregnancies and unsafe abortions

According to UNESCO, CSE refers to a curriculum-based process of teaching and learning about the cognitive, emotional, physical, and social aspects of sexuality. CSE programs helps to equip young people with knowledge, skills, attitudes, and values that empowers them to realize their dignity, develop respectful social and sexual relationships, including how their choices affect their well-being and that of others[3]. Therefore, CSE goes beyond the mechanism of reproduction and covers topics such as relationships, sexual orientation, gender identity, consent, communication, sexual and reproductive rights. It also creates a safe and supportive learning environment where adolescents feel comfortable asking questions, sharing their concerns, and engaging in open discussions about sexuality. CSE promotes open dialogue and provides the rightful knowledge and communication skills for healthy relationships while recognizing the importance of involving parents, guardians, schools, and families in adolescent education process. It is important to note that in the absence of age-appropriate CSE from those who are supposed to provide this knowledge, teenagers have no other option but to rely on social media or peers and most of what they get is inappropriate for their age.

II – Why is CSE a stitch that can save nine?

The principle underpinning the idiom “a stitch in time saves nine” is that proactive measures can potentially prevent more significant problems from arising. In the context of Adolescent Sexual and Reproductive Health Rights (ASRHR), CSE has shown a reduction in unintended pregnancies and unsafe abortion in countries where it is practised, including a decrease in sexual harassment, reduced rate of transmission of sexually transmissible diseases such as HIV/AIDS, and an improvement in knowledge and access to contraception, including reproductive health services[4].

 

The discourse around CSE is attracting growing global interest and attention nowadays because half of the world population is under the age of 25, with nearly 90% of these youths living in low and middle-income countries and prone to reproductive health problems[5]. For instance, in 2019, 21 million pregnancies occurred in adolescents between 15–19 years in low- and middle-income countries (LMICs), majority in Sub-Saharan Africa, where adolescents make up 23% of the population and house 80% of HIV infection[6]. Worst still, sociocultural power dynamics have normalized harmful cultural practices such as early marriage, female genital mutilation and gender inequality. Therefore, CSE is a stitch that can saves nine by helping young people navigate reproductive health challenges that could jeopardize their attainment of the highest level of socio-economic development.

III – How is CSE misrepresentation in Africa?

CSE has been framed and understood in diverse ways across countries and cultures. The subject has been misrepresented due to the believe that it is a one-size-fits-all without any consideration of cultural diversity and values. Although the discourse and misrepresentations vary between different African countries and communities, there are some common frames through which the misrepresentation of CSE can be regarded;

Firstly, there is a misconception that CSE promote or increase sexual activity among young people by showing explicit or inappropriate content not suitable for their age, leading to fears of moral corruption. Some of the topics such as  abortion and LGBT+ (lesbian, gay, bisexual, or transgender, and to people with gender expressions outside traditional norms) are particularly contentious and elicit significant controversy and debate among local stakeholders. According to some cultural and religious opposition, CSE is a form of cultural imperialism that teaches western values and upbringing that undermines traditional practices and religious teachings such as abstinence. Informing adolescents about condoms and how to prevent sexually transmitted diseases and unwanted pregnancies could make them experiment sex leading to promiscuity. By talking about sex in schools, we are also promoting it as part and parcel of teenage life while making those who practice abstinence to feel abnormal.

Secondly, CSE is perceived as a threat to parental authority in making decisions in matters of sexual education for their children. Some parents may have specific religious, cultural, or moral values that they want to instil in their children and the provision of CSE in schools might interferes with their right to pass on their beliefs to their children. Such criticism affect the way teachers deliver lesson on CSE as most of them watered down or modified the content, thereby diffusing the message.

Thirdly, the misrepresentation of CSE in Africa is also blamed  on the pressure from external donors from the global North whose approach is perceived to be promoting specific agenda that may not align with local norms, thereby creating tensions and misconceptions about the goals of CSE programs. For instance, in 2023, the government of Cameroon through a letter to the French Ambassador blocked France’s LGBT+ rights ambassador from travelling to the country to hold a conference on gender and sexual identity[7]. The perception is that he was coming to encourage youths to practice LGBT+. Also, international pressure and discussion regarding LGBT+ in Africa is a topic that is generally perceived with a negative attitude. Therefore, placing topics such as LGBT+ in front of CSE instil resistance before action.

Lastly, political interest groups are exploiting the sensitive nature of the topic to mobilize support against their opposition, using misinformation to shape public opinion for political gains. Thus, some political leaders may shy away from addressing issues related to sexuality due to fears of backlash or losing support. For instance, in Ghana, lawmakers requested to decide on the bill of LGBT+ via a secret ballot, because of the fear that they could be witch-hunted politically by the opposition[8].

IV – How can the misrepresentation of CSE in Africa be changed or replaced?

Changing or replacing the misrepresentation of CSE in Africa requires sustained, multifaceted effort and long-term commitment, focusing on advocacy, capacity building, community engagement and collaboration with policy-makers and the community, including adolescents, the media, religious and traditional leaders. Various approaches can be employed in tandem to identify common ground to integrate CSE within the cultural and religious contexts of African communities and the approach should include advocacy with civil society organizations, youth groups, and educational institutions to provide accurate information that is culturally appropriate and context-specific. Also, using workshops, conferences, and community forums, constructive conversations can be used to foster dialogue and collaboration among policy-makers, educators, parents, and religious organizations, including youth representatives to ensure their voices are heard and their perspectives are considered.

Furthermore, introducing capacity-building programs and training can equip parents, educators and health professionals with the necessary knowledge, skills, and resources to teach CSE in a culturally sensitive manner. Additionally, there is a need to engage with media outlets leveraging social media platforms and digital channels to disseminate accurate and balanced information on CSE, dispelling myths using media campaigns and testimonials from educators, parents, and young people who have benefited from CSE. Lastly, effort should be  made to conduct studies in collaboration with policy-makers to generate evidence on the positive outcomes and impact of CSE tailored to Africa. This will help to develop and implement CSE policies that are evidence-based, inclusive and specific to the continent and countries in line with international human rights standards.

Conclusion

It is important to note that Africa is a vast and culturally diverse continent, and the perspectives on CSE  differ significantly from that of the global north and therefore should not be one-size-fits-all. In some communities in Africa, discussing CSE is considered a taboo because it challenges tradition, religion and the power dynamics that legitimizes male hegemony or dominant position in the society. Therefore, it is critical to recognize that CSE in Africa requires a multi-sectoral collaboration with all relevant stakeholders and it is a long-term process that requires sustained commitment, funding, and political will that is based on local evidence and not internationally motivation.

Recommendations

  • All key stakeholders, including parents, teachers, community leaders, religious leaders, and policy-makers must be involved in the development and implementation of comprehensive sexuality education programs in Africa.
  • CSE in Africa should be adapted to local, cultural, social and religious contexts of each country or community
  • There is a need to provide comprehensive training for teachers to equip them with the knowledge, skills, and confidence to deliver effective sexuality education.
  • Effort should be made to ensure that the curriculum is evidence-based, medically accurate, and addresses the needs of different age groups.

Advocate for supportive policies at the national level that endorse and prioritize comprehensive sexuality education

Dr Valery Ngo
+ posts

Dr. Ngo Valery Ngo is a Medical Doctor and a Senior Health Researcher at Nkafu Policy Institute, a think tank at the Denis & Lenora Foretia Foundation in Yaoundé, Cameroon. Before his appointment, he was a volunteer research assistant under Professor Bright Nwaru at the Krefting Research Centre in Gothenburg, Sweden, during which he conducted various researches in global health and contributed to various systematic reviews to synthesize existing evidence on major global health issues.

Regina Sinsai
+ posts

Regina Sinsai holds a Bachelor of Arts Degree in Psychology from the United States International University – Africa, in Nairobi and an HND in General Nursing from the Humanity Health Professional Training Center (HHPTC) in Yaoundé.

Solange Dabou
+ posts

Solange DABOU holds a Master of science in Clinical Biochemistry from the University of Dschang and have followed a distance learning training in epidemiology and health statistics from Aix Marseille University.

Evrard Kepgang
+ posts

Kepgang Evrard is a young research and humanitarian passionate. He holds a master’s degree in Public health and epidemiology at the University of Dschang.

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