Promising Practices For The Design and Implementation of Sexuality Education Programmes For Youth in India A Scoping Review

Sexual and Reproductive Health Matters
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/zrhm21
Promising practices for the design and

implementation of sexuality education
programmes for youth in India: a scoping review
Niveditha Pattathil & Amrita Roy
To cite this article: Niveditha Pattathil & Amrita Roy (2023) Promising practices for the design
and implementation of sexuality education programmes for youth in India: a scoping review,
Sexual and Reproductive Health Matters, 31:1, 2244268, DOI: 10.1080/26410397.2023.2244268
To link to this article: https://doi.org/10.1080/26410397.2023.2244268
© 2023 The Author(s). Published by Informa

UK Limited, trading as Taylor & Francis
Group
View supplementary material
Published online: 15 Sep 2023.
Submit your article to this journal
Article views: 1000
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=zrhm21
REVIEW
Promising practices for the design and implementation of

sexuality education programmes for youth in India: a scoping
review
Niveditha Pattathil,a Amrita Roy b,c
a Medical Student, Faculty of Health Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada
b Assistant Professor, Department of Family Medicine, Queen’s University, Kingston, ON, Canada
c Assistant Professor (cross-appointed), Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada.
Correspondence: [email protected]
Abstract: Sexual violence and HIV/AIDS are major public health concerns in India. By promoting bodily
autonomy, wellbeing, and dignity through knowledge and skills, comprehensive sexuality education for
young people can help prevent adverse sexual and reproductive health outcomes. While there is increased
recognition globally regarding young people’s need for sexuality education, translating this recognition into
accepted programmes in India has been challenging. This scoping review aims to examine recommendations
for promising practices for the design and implementation of sexuality education programmes and resources
aimed at youth in India. A systematic search and review of the literature was conducted from June to August
2020. Of the total 5312 citations identified and screened, 622 advanced to full-text screening, and 39 were
included in the final analysis. Promising practices include the need to: tailor content to serve the needs of the
specific youth population being targeted; use engaging and participatory methods to teach sexual health
content; work in partnership and collaboration with local experts and organisations; address potential
barriers to participation and work to mitigate those barriers for marginalised youth; be youth friendly,
flexible and convenient; and to be developmentally and culturally appropriate for the Indian youth context.
Sexuality education programmes should integrate into existing community services and link with local
reproductive health services to help provide youth with access to the services they may need. Continued work
and efforts are required to address the interrelated and broad structural factors, including political,
financial, social, and cultural factors that affect youth sexual health and wellbeing. DOI: 10.1080/
26410397.2023.2244268
Keywords: Sexuality education, health promotion, reproductive health, comprehensive sexuality
education, youth, India
Introduction transmitted infections (STIs), HIV/AIDS and unin-

Properly-designed and properly-executed compre- tended pregnancies.1 Contrary to popular myths,
hensive sexuality education (CSE) programmes and it does not hasten the onset of sexual activity in
resources for youth are an important component youth but rather has a positive impact by promot-
in sexual health promotion and in public health ing the adoption of safer sexual behaviours and
efforts to combat the global AIDS epidemic.1 CSE can even delay sexual debut.2,3 A 2014 review of
“imparts critical information and skills for life. school-based sexuality education programmes
These not only include knowledge on pregnancy found that students demonstrated increased HIV
prevention and safe sex, but also understanding knowledge, increased self-efficacy related to refus-
bodies and boundaries, relationships and respect, ing sexual activities, increased contraception and
diversity and consent” (p. 7).1 CSE has a positive condom use, a lower number of sexual partners
impact on sexual and reproductive health, notably and delayed onset of sexual activity and inter-
in contributing to reducing rates of sexually course.4 CSE is also important for effectively
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group 1
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://
creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in
any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting
of the Accepted Manuscript in a repository by the author(s) or with their consent.
N Pattathil, A Roy. Sexual and Reproductive Health Matters 2023;31(1):1–30
addressing issues such as sexual and gender-based awareness regarding freely available antiretroviral
violence, gender-based discrimination, as well as therapies.14
homophobia/ transphobia.3 In addition to indi- Sexual violence is also a prevalent issue in
vidual and population health, CSE is integral to India, especially rape and sexual violence against
the human rights upheld in United Nations instru- women.15 According to UN Women, 35% of
ments including the International Covenant on women worldwide have experienced either phys-
Economic, Social and Cultural Rights,5 the Conven- ical or sexual violence at some point in their
tion on the Elimination of Discrimination Against lives.15 However, this value increases dramatically
Women,6 and the Convention on the Rights of the across various states in India, reaching a stagger-
Child.7 Comprehensive sexuality education: ing 88.95% in certain areas.15–17 In concert with
patriarchal gender norms, the effective lack of
“… enables young people to protect and advocate
open discussion in Indian society about healthy
for their health, well-being and dignity by providing
sexuality, consent in sexual activity, and sexual
them with a necessary toolkit of knowledge, atti-
assault contributes to these overwhelming
tudes and skills. It is a precondition for exercising
numbers.16,17
full bodily autonomy, which requires not only the
Adolescent pregnancy and its consequences
right to make choices about one’s body but also
also present a major challenge. Pregnancy at an
the information to make these choices in a mean-
early age can put both the mother and the baby
ingful way.” 8
at risk for many related health complications.18,19
While there is increased recognition at a global The social consequences of adolescent pregnancy
level regarding young people’s need for sexuality can include dropping out of school, lower edu-
education, translating this recognition into cational attainment, decreased social and employ-
nationally accepted and implemented pro- ment opportunities, reduced lifetime earnings,
grammes in India is difficult to do.3,9 Many and even violence via suicide or homicide in
young people find that they are often unable to some cases.18 The WHO Guidelines on Preventing
access basic information regarding sexual and Early Pregnancy and Poor Reproductive Outcomes
reproductive health and rights.3,9–11. Among Adolescents in Developing Countries high-
This scoping review aims to examine rec- lights the key role of sexuality education in achiev-
ommendations for promising practices for the ing its goals.20
design and implementation of sexuality education
programmes and resources aimed at youth in Comprehensive sexuality education and the
India. Indian context
India was a signatory to the Programme of Action
Sexual and reproductive health in India (PoA) of the 1994 International Conference on
India has the third largest HIV epidemic in the Population and Development (ICPD) where the
world, with over 2.1 million people living with sexual and reproductive health needs of youth
HIV.12 The epidemic is concentrated among key as a group were officially articulated and ident-
affected populations, including sex workers, men ified as an area for further action. The PoA from
who have sex with men, people who inject the ICPD states in paragraph 7.47: “Governments,
drugs, transgender people, migrant workers, and in collaboration with non-governmental organiz-
truck drivers.12 However, other strata of society ations, are urged to meet the special needs of ado-
are also affected. Notably, rates are growing lescents and to establish appropriate programmes
among married, monogamous, heterosexual to respond to those needs.”21 India’s efforts to
women who are infected by their husbands enga- operationalise the PoA began with the launching
ging in extramarital or paid sex; in this regard, of the Reproductive and Child Health Programme
there is a noted intersection with intimate partner in 1997. In 2000, adolescent reproductive and sex-
violence.13 HIV incidence, prevalence and AIDS- ual health was recognised as a top priority in the
related death rates remain among the highest in National Population Policy of 2000 and in the
the world, and a number of issues limit further Reproductive and Child Health II programme of
progress, including HIV-linked stigma, low levels 2005.22
of education regarding HIV among people living In India, a two-pronged approach is being used
with the illness, limited awareness about sexual to implement sexuality education. For youth that
health and prevention of HIV, and limited are currently enrolled in school, the national
2
Adolescent Education Programme (AEP) is being serve to provide counselling, life skills training,
delivered in school, reaching students between and recreational activities; awareness campaigns
the ages of 13-18.23 The AEP was launched in and counselling through Accredited Social Health
2005 by the Ministry of Human Resource Develop- Activists; and teen clubs to provide youth with
ment and the National AIDS Control Organization life skills experiential learning and education on
(NACO).23 The AEP seeks to provide accurate, age- reproductive and sexual health.23,25 In 2014, the
appropriate and culturally-relevant information Government of India started a national pro-
regarding sexual health, gender, sexuality, com- gramme entitled “Rashtriya Kishor Swathya Kar-
munication skills, and navigating relationships. yakram.” The aim of the programme is to
Unfortunately, serious reservations have been expand outreach to youth and their communities,
expressed in India about the sexuality component especially the most vulnerable and at-risk, includ-
of the programme.24 Following the pushback, ing adolescents not enrolled in schools. The pro-
efforts were made by several stakeholders, includ- gramme includes the establishment of
ing governmental departments, the NACO, the adolescent-friendly health clinics, nutritional sup-
National Council of Educational Research, and plementation, peer education programmes, and
civil society organisations, to review the original menstrual product provision.26
curriculum and generate support for the The reach and the quality of sexuality edu-
implementation of the programme in general. cation programmes, however, are questionable.
They provided states flexibility to modify the exist- Open discussion of sexuality remains largely
ing curriculum if necessary, while reiterating the taboo in India, due partially to Victorian-era
need to keep the AEP overall.23 The revised curri- mores inserted into society during British colonial
culum consisted of four sections: (a) changes from rule. In the present day, conservative attitudes
childhood to adolescence; (b) adolescent repro- towards sexuality are framed as intrinsic to Indian
ductive and sexual health; (c) mental health and cultural identity.9,11 As of 2019, there is a ban on
substance misuse; and (d) life skills and HIV pre- the AEP in at least five states across India due to
vention.23 The AEP has been widely implemented mass outrage about the notion of teaching youth
in high schools in partnership with state and about sexuality. Moreover, there is no uniformity
national educational organisations as well as in how the subject is approached across the
civil society organisations.23 country, with actual content regarding sexuality
There are other programmes that have been frequently diluted or absent due to parental and
designed to provide sexual health education to community concerns about teaching youth
youth, including the School Health Programme about sexuality, and due to teacher embarrass-
under the National Rural Health Mission; Red Rib- ment or discomfort.9,11,27 Generally, implemen-
bon Clubs under the National AIDS Control Pro- tation of the AEP is uneven and reach remains
ject; the University Talk AIDS Program; the limited. There is also limited follow-through,
Youth Unite for Victory on AIDS campaign; and monitoring, and evaluation of adolescent health
Yuva, which is a network of seven youth organisa- programmes across India.23,28,29
tions working to provide youth with sexual health
education and life skills training in partnership Research question, objectives, and definitions
with the Ministry of Youth Affairs and Sports and This research sought to answer the following ques-
NACO.23 tion: What are promising practices for the design
There is no formal programme for educating and implementation of sexuality education pro-
youth that are not enrolled in school, but infor- grammes aimed at youth in India?
mation and counselling are available through In this research project, we engaged with a defi-
the adolescent health clinics created through the nition of “promising practices” as practices
Ministry of Health and Family Welfare’s Reproduc- described by programmes that report successful
tive, Maternal, Newborn, Child and Adolescent outcomes. Promising practices are differentiated
Health initiative.1 There are also several key pro- from best practices as there is not yet enough
grammes run by the National AIDS Control Pro- research evidence to definitively establish the
gram and the Ministry of Health and Family practice as the standard guideline for effective
Welfare, including the Village Talk AIDS Program implementation across all settings.30
which is an educational programme designed for There are several articles that have assessed
out-of-school youth; Red Ribbon Clubs which sexuality education programmes in other
3
countries and even “developing countries” as a identity is defined as the romantic and/or sexual
whole.31–37 They advocate for and present guide- orientation that an individual identifies with.40
lines for comprehensive sexuality education, Sexual and reproductive health refers to the
including elements such as curricular objectives, state of overall physical and emotional well-
guidance on topic inclusion, the development of being in relation to sexuality, including positive
activities, and the process of developing edu- relationships free from coercion or violence.20
cational resources. However, in this review, the
focus is on youth sexuality education programmes
based out of India only. By looking at programmes Methods
carried out within the Indian context only, we A scoping review aims to map out key concepts
hope to identify characteristics of successful pro- and knowledge in a particular area, by looking
grammes that are specific to the Indian setting at the “extent, range and nature” of work done,
and the youth living within this environment. to “summarize and disseminate” what is known,
There is a myriad of micro- and macro-level and to identify gaps for further research or action.
upstream factors that can contribute to adverse The methodological framework of Arksey and
sexual health outcomes for youth. Micro-level fac- O’Malley41 was drawn upon to guide the scoping
tors include influences on an individual level that review process, based on five main stages: (a)
can affect choices youth make, such as family tra- identifying the research question, (b) identifying
ditions, local community norms, and economic relevant articles, (c) article selection, (d) charting
circumstances. Macro-level factors can include the data, and (e) summarising and analysing the
regional or national norms, laws, policies, and results. After the focused research question was
overarching culture. Legal and regulatory frame- identified and developed (namely: What are
works can facilitate or hinder these choices and promising practices for the design and implemen-
behaviours made by youth, such as the enforce- tation of sexuality education programmes aimed
ment of laws concerning child marriage, harm at youth in India?), the selected relevant articles
reduction, human trafficking, sexual exploitation, were examined in order to analyse the field, sum-
intimate partner violence, and sexual assault.38 marise and report results, as well as identify gaps
Micro- and macro-levels provide a framework for and areas for further research.
understanding socioeconomic determinants of A systematic search of the literature was con-
health that can impact the sexual health and over- ducted. The inclusion criteria were articles dis-
all wellbeing of youth. Each of these levels inter- cussing and examining programmes for youth
acts with and influences the others, and they based in India that sought to improve their repro-
can be visualised as being linked together via a ductive and sexual health knowledge, published
feedback loop in which changes at one level will from the year 1995 onwards. This threshold was
influence events at another level.39 In order to chosen as this year marked the landmark decision
promote the wellbeing of youth, changes are within the field to officially include youth sexual
required at these local, regional, and national health in the ICPD’s Programme of Action21 and
levels by different sectors to bring about lasting the subsequent signing of the Programme by
improvement in outcomes and promote healthy India, officially marking youth sexual and repro-
practices.18 In this review, we endeavoured to ductive health as a national area for further
analyse the selected papers through this lens, action. Articles published in English from peer-
with a focus on the social determinants and reviewed sources and grey literature, were
upstream factors that influence youth health, included. The following databases were searched:
which include socioeconomic and cultural factors, MEDLINE, EMBASE, PsychINFO, COCHRANE,
as well as the characteristics of social spaces and CINAHL, ProQuest (Sociology, Nursing & Allied
physical environments. Health), and Google Scholar. References of
In the research presented in this paper, we selected papers, and websites of relevant non-gov-
engaged with definitions of key constructs. We ernmental organisations (NGOs) and other groups,
engaged with a definition of gender as the social were also scanned to identify additional potential
identity that encompasses the norms, behaviours papers that could be included.
and roles with which an individual identifies. We used various combinations of keywords and
While this can correlate with biological sex all possible associated terms in English. The search
assigned at birth, it does not need to. Sexual terms are listed in Table 1. The complete search
4
strategy is provided in the online Supplemental conclusions reported by the authors of the indi-
Material. Our search strategy was validated by a vidual studies.
librarian from the Health Sciences Library at
Queen’s University. All selected documents were
saved in Covidence software.42 Results
The initial search process picked up many Our search strategy yielded a total of 5312 cita-
duplicates, reinforcing the completeness of the tions. That number was reduced to 3275 after
search. To add to the rigour of the search strat- excluding 2037 duplicate records. 626 of these
egy, two reviewers independently conducted an moved onto full-text screening on the basis of
initial title-abstract screening of all articles; their titles and abstracts. A final set of 35 articles
results were compared and any discrepancies met all inclusion criteria and were included in
were reviewed to derive a clear and reproduci- our scoping review. Figure 1 is our PRISMA chart
ble protocol. All articles that passed this screen- of the selection process and Table 2 includes the
ing moved onto full-paper screening. The search characteristics of the programmes of the selected
and review process started in June 2020 and papers. Key themes are presented below.
ended in August 2020. Articles were excluded if
they were not specific to India, did not include Programmes vary greatly across India
any youth, were not discussing a specific pro- There is wide diversity in interventions and inter-
gramme or intervention that was conducted, vention-delivery mechanisms. Programmes were
did not include any promising practices or les- conducted either at the individual level, small-
sons learned for sexuality education pro- group level, or community/village wide. They
grammes, or were not available in full-text were either implemented within the context of a
versions despite contacting authors to request school environment (majority of programmes –
full text. Data from the final set of papers 24/35), or within a local community (10/35), or both
included in the review were extracted and (1/35). Overall, there is a great variety in the types
recorded in an Excel spreadsheet. The pro- of programmes that have been developed across
grammes described in the final included papers the Indian context to provide sexual and reproductive
were sorted and mapped according to the health education to youth; no clear consensus was
location, target population, type of programme, found across articles reviewed on which type of pro-
elements/components of the programme, and gramme or programme components should be
subjects covered within the programme. Promis- implemented within a specific setting.
ing practices were identified from the Most programmes included a central didactic
teaching component. There were differences
across programmes in who taught the pro-
gramme, with most programmes having health
Table 1. Search terms utiliseda worker-led programming (19/35); 5 programmes
were teacher-led, 5 were peer educator-led, 3 pro-
1. (teen* OR adolescent OR youth OR young adult OR grammes were health worker and peer-led, 2 pro-
college student OR students) grammes were peer and teacher-led, and 1
2. AND (India) programme was health-worker and teacher-led.
Some programmes included a peer education
3. AND (intervention OR best practices OR component as the main method of information
development OR program development OR program delivery (5/35), and a few included peer education
evaluation OR program or Practice Guidelines as a as an additional supplement to their central deliv-
Topic) ery method through teachers or health pro-
4. AND (*Sex Education OR *Sexual Health). fessionals (5/35).
In our review, we charted the subjects covered
a
Note: The above search terms represented the start- by the included programmes. Certain topics were
ing point in tailoring our search strategy according to widely included in most programmes, such as:
each database’s features and processes. Subject anatomy and physiology of male and female
headings, truncation and keywords specific to each reproductive systems, changes during adoles-
database were employed under the guidance of a cence/puberty, sexual maturity, personal sexu-
university research librarian.
ality, navigating relationships, menstruation,
5
Figure 1. PRISMA diagram
591
35
pregnancy and family planning, STIs, and HIV/

AIDS. Other topics were not as commonly that included each individual topic is shown in
included, such as: gender equity (9/35 pro- Table 3.
grammes), gender-based violence (4/35), com-
munication and personal skills development (7/ Diverse methods for delivering information
35), and societal pressures faced by youth (3/35). increase programme success
In certain regions, local myths and misconcep- Programmes that included time for group discus-
tions were addressed and debunked in the teach- sions found that attendees found the discussions
ing, such as: popular myths surrounding STIs (gupt beneficial, regardless of whether it was a struc-
roga), nocturnal emissions (swapnadosh), the sex tured focus group discussion or a more informal
determination of the fetus, and culturally specific group discussion. Group discussions were reported
conditions like koro.* The number of programmes to be a good opportunity to share personal experi-
ences, ask questions, engage in conversation over
*Koro is a psychiatric culture-bound syndrome characterised by retract into the body. It has been found to be most prevalent
intense fear that the sexual organs (i.e. penis, breasts) will in populations within South Asia and South East Asia.
6
Table 2. Characteristics of individual sexual health education programmes for youth conducted in India
Location in Teaching
# India Target audience Setting delivery Components of programme Subjects covered in programme
1 Impact of health education on knowledge and practices about menstruation among adolescent school girls of rural part of district Ambala, Haryana. Arora
et al, 201243
Haryana Adolescent School-based Health- Structured teaching programme with: Menstruation (Physiology of
females of classes worker menstruation, role of hygiene,

. Lectures
IXth and Xth of led myths in society about
. A/V aids
government menstruation)
. Question and answer sessions conducted
secondary schools
afterwards
2 The acceptability, feasibility, and effectiveness of a population-based intervention to promote youth health: an exploratory study in Goa, India. Balaji et al,
201144
Youth aged 16-24 Community- Peer and “Yuva Mitr” programme: Communication skills, decision-
based teacher- making skills, violence, general
. Peer education, teacher delivered education
led sexual and reproductive health,
and counselling, community peer education menstruation, sexual abuse
. Distribution of health information materials
distributed to youth through house to house
visits
. Street plays
. Posters in prominent locations
3 Participatory Approaches to Message Design: “Jeevan Saumbh,” a Pioneering Radio Serial in India for Adolescents. Bhasin & Singhal, 199845
India- wide Older adolescents Community Health- Radio series Teenage sexuality, gender bias,
based (radio worker puberty, masturbation,
. 13 episodes of radio series, which addressed menstruation, reproductive
programme) led
various problems faced by adolescents, physiology, homosexuality, STDs,
discuss solutions
commercial sex, self-confidence,
. Utilised participatory message design (used social norms, peer pressure,
the actual “voices” of the youth, parents,
relationships with the opposite sex,
health experts; high degree of involvement unplanned pregnancy inter-
and feedback from listeners) generational conflicts, career
. Interactive exercises: parallel interaction
choices, personality development
programmes, quiz contests, awards, Q&A
7
8

4 Talking about love and sex in adolescent health fairs in India. Capoor & Mehta 199546
Gujarat Adolescents aged Community- Health Adolescent health “mela” or fair organised by Myths and misconceptions about
11-18 based worker- NGO (CHETNA) adolescent reproductive and sexual
led health, personal experiences with
. Ice-breakers and rapport building exercises sexual activity, puberty,
. Small group learning in individual “stalls” menstruation, abortion, STDs,
with trained facilitators contraception
. Interactive exercises (ex. songs, games, Q&A,
case studies, role play, skits, group
discussions)
. Learning materials provided (ex. charts,
puppets, cartoon books and exhibits)
5 What did it take to scale up and sustain Udaan, a school-based adolescent education programme in Jharkhand, India? Chandra-Mouli et al, 201847
Jharkhand Youth in grades 9 School-based Teacher- Structured teaching programme entitled Communication skills, interpersonal
and 11 led “Udaan” relationships, puberty,
masturbation, menstruation, sexual
. Teacher led education
maturity, myths and
. “Udaan clubs” for life skills activities misconceptions about sexual
. Interactive group activities (ex. poster health, dating, friendships, sexual
competitions, group/panel discussions,
abuse, domestic violence, rape,
games, case studies, brainstorming exercises, gender roles, gender equity, early
field visits, storytelling, debates, poster
marriage, sexual decision-making,
creation, role playing) marriage, parenthood, STIs, HIV/
. Larger campaigns and events to raise AIDS
awareness
6 Adaptation of an alcohol and HIV school-based prevention programme for teens. Chhabra et al, 201048
Himachal Youth aged 13-16 School-based Peer-led STEP (School-based Teenage Education Program) HIV/AIDS, communication skills,
Pradesh programme alcohol abuse, social pressures,
social skills, self-confidence,
. Sessions taught by trained peer educators
individual values, assertiveness
. Included visual aids
training, coping skills.
. Created a community advisory board for their
(Acknowledged need to introduce
ongoing feedback. gender roles as a topic in future
. Conducted quality and attendance recording
programmes.)
throughout the programme to make sure the
programme was being implemented
correctly.
7 PRACHAR: Advancing Young People’s Sexual and Reproductive Health and Rights in India. Daniel et al, 201349
Bihar Adolescents aged Community- Health “PRACHAR” structured teaching programme Reproductive health, family
12-19 based worker- planning, STIs, HIV/AIDS, puberty,
. Trained governmental frontline health
led menstruation, personal hygiene,
workers to deliver educational sessions, myths surrounding contraception
group discussion, interactive skill-building and conception, gender norms,
activities, narrative/dialogue-based exercises
delaying early marriage, societal/
. Community wide initiatives (ex. street parental pressures, communication
theater, wall paintings, puppet shows,
and negotiation skills, personal

distribution of educational materials, agency
community meetings, home visits)
8 The effect of community- based health education intervention on management of menstrual hygiene among rural Indian adolescent girls. Dongre & Garg,
200750
Maharashtra Adolescent Community- Health Group based teaching programme Awareness of menstruation,
females aged 12- based worker- importance of its acceptance as a
. Pre-tested flip book containing needs-based
19 years led normal biological process,
key messages on the management of menstrual hygiene
menstrual hygiene distributed to youth
. Education delivered by trained healthcare
professionals at monthly village group
meetings
. Participants encouraged to share their
knowledge and recruit more village youth
9 Sexual Behaviour of Rural College Youth in Maharashtra, India: An Intervention Study. Ghule & Donta, 200851
Maharashtra Youth aged 18-24 School-based Teacher Structured teaching programme Self-awareness, decision-making,
and peer- general reproductive health
. Trained teachers and peer educators
led
delivered education, counselling
. Programme included group discussions, AV
aids, posters, flipcharts, street plays,
demonstrations of contraception products,
Q&A sessions, distribution of print health
education materials
. Large-scale exhibitions during “AIDS Week”
. Creation of “Youth Friendly Center” staffed by
trained counsellors in college for education,
counselling, referrals to health services
9
10 Impact of reproductive health education on the knowledge of mid adolescents boys of urban population of India. Jadon, 201752
10

Haryana Adolescent males School-based Health Structured teaching programme Puberty and changes during
aged 14-16 in worker- adolescence, attraction to others,
. Included AV aids, interactive lecture sessions, male and female reproductive
grades 9, 10, 11 led
group discussions, Q&A sessions
system, menstrual cycle, marriage,
pregnancy, motherhood, newborn
health, family planning,
contraception, night emissions,
masturbation, HIV/AIDS
11 Catalysing change: Improving youth sexual and reproductive health through DISHA, an integrated programme in India. Kanesathasan et al, 200853
Bihar and Youth aged 10-24 Community- Peer and “DISHA” programme Changes during adolescence, gender
Jharkhand based health and sexuality, fertility awareness,
. Partnered with local NGOs
worker- contraception, HIV/AIDS, safe
. Trained peer educators provided education,
led motherhood, reproductive health
counselling, referrals services
. Group discussions, livelihood component
aimed to create income-generating
opportunities
. Large-scale activities: street plays, wall
writings, thematic fairs, rallies, mobile health
clinics, sporting events
. Establishment of youth groups and youth
resource centres with youth-friendly services
. Trained healthcare professionals and youth
depot holders to provide confidential
counselling, contraception education, and
other services
12 Seeds of prevention: the impact on health behaviors of young adolescent girls in Uttar Pradesh, India, a cluster randomised control trial. Kapadia-Kundu
et al, 201454
Uttar Adolescent School-based Teacher- “Saloni” pilot intervention Physical health, nutrition, daily
Pradesh females aged 10- led genital hygiene, menstruation,
. Delivered by trained teachers, sessions
14 years menstrual hygiene, legal age at
conducted in groups marriage, childbearing, and family
. Utilised AV aids, posters, personal journaling planning
and reflection, interactive exercises (ex. role
play, group discussions)
. Promotion of adolescent health services
provided at the school level
13 Efficacy of focused group discussion on knowledge and practices related to menstruation among adolescent girls of rural areas of RHTC of a medical
college: An interventional study. Kokiwar & Nikitha, 202055
Telangana Adolescent Community- Health Structured teaching programme General knowledge on

females aged 10- based worker- Menstruation, hygienic practices
. Didactic session with AV aids
19 led during menstruation
. Interactive focused group discussion in small
groups
14 A psychosocial resilience curriculum provides the “missing piece” to boost adolescent physical health: A randomised controlled trial of Girls First in India.

Leventhal et al, 201656
Bihar Adolescent School-based Peer-led “Girls First” intervention Personal goal-setting, emotional
females aged 9-18 awareness, assertive
. Facilitated peer support group sessions and
communication, conflict resolution,
facilitated peer support group sessions problem solving, self-esteem,
. Trained local leaders to facilitate group
opposing violence, personal
sessions confidence, gender constructs, the
. Sessions combined didactic learning, peer-led reproductive system, menstruation
discussions, and problem-solving exercises
and hygiene, relationships, physical
intimacy, gender-based violence
15 Knowledge and attitude about reproductive health among rural adolescent girls in Kuppam Mandal: An intervention study. Malleshappa et al, 201157
Andhra Adolescent School-based Health Structured teaching programme Anatomy and physiology of male
Pradesh females aged 14- worker- and female reproductive system,
. Didactic lecture
19 years led physical and psychological changes
. Interactive sessions with group discussion during puberty, conception, various
. Utilised AV aids, videos, charts, posters methods of contraception, STDs
including HIV/AIDS
16 An educational intervention study on adolescent reproductive health among pre-university girls in Davangere district, South India. Manjula et al, 201258
Karnataka Pre-university School-based Teacher- Structured teaching programme Growth and development during
adolescent led adolescence, puberty, pregnancy,
. Delivered by teachers
females (XI and XII STIs, HIV/AIDS, communication and
. Utilised AV aids, posters, printed health
standard) relationship management skills
education materials, flip charts, overhead
projections
. Group discussions with students conducted
11
12

17 Effectiveness of a community based intervention to delay early marriage, early pregnancy and improve school retention among adolescents in India.
Mehra et al, 201859
Uttar Youth aged 10-24 Community- Peer-led Peer education programme General reproductive health and
Pradesh and years based rights, gender and sexuality, early
. Trained local youth conducted peer
Bihar marriage, early pregnancy,
education sessions in small groups importance of completing school
. Posters, games, picture cards education, learning vocational
. Development of “Youth Information Centre”
skills, delaying marriage and
to facilitate peer communication, monthly pregnancy
activities, group sessions, access referrals,
counselling
18 Preparing girls for menarche. Minimol, 200360
Karnataka Pre-adolescent School-based Teacher- Structured teaching programme Female reproductive system,
females led menstrual cycle, menstrual hygiene
. Delivered by teachers practices, management of pain
. Utilised AV aids during menstruation
19 Effectiveness of a reproductive sexual health education package among school going adolescents. Nair et al, 201261
Kerala Adolescents aged School-based Health Structured teaching programme Puberty, changes when growing up,
13-17 years worker- nutrition, reproductive and sexual
. Led by trained project leaders
led health hygiene, body image,
. Utilised interactive discussion format
sexuality and risk taking behaviour,
. Q&A sessions gender and interpersonal
. School-wide exhibitions and quizzes
relationships, STIs and HIV/AIDS, life
conducted related to sexual health education skill development and scholastic
achievement
20 Effectiveness of video assisted teaching module on knowledge of adolescent girls regarding polycystic ovarian syndrome in Gayatri Women’s + 2 Science
College, Berhampur Ganjam, Odisha. Nayak, 201762
Odisha Adolescent School-based Health Structured teaching programme Polycystic ovary syndrome
females aged 16- worker- (symptoms, diagnosis, treatment),
. Delivered by healthcare professionals
19 years led importance of maintaining healthy
. Assisted with video modules
lifestyle habits
. Included health education module, manual,
printed materials
21 Reproductive health education intervention trial. Parwej et al, 2005
Chandigarh Adolescent School-based Peer and Bi-pronged structured teaching programme Anatomy and physiology of male
females of classes health and female reproductive system,
. Didactic teaching by public health nurse
X, XI, XII worker- physical and sexual changes during
. Distribution of print health education
led adolescence, menstrual cycle,
materials conception, contraception, child
. Peer education delivered by trained peer marriage, abortion, laws regarding
educators
reproductive rights, STDs, HIV/AIDS
. Group and individual counselling available

22 Improving Adolescent Health: Learnings from an Interventional Study in Gujarat, India. Patel et al, 201863
Gujarat Adolescents aged Community Teacher Structured teaching programme General sexual and reproductive
11-18 years and school- and health, nutrition, substance abuse,
. Delivered by trained teachers, social health communication skills, gender
based health
activists, health workers, Anganwadi workers,
worker- equality, menstrual cycle and
led local mentors menstrual hygiene practices,
. Peer education delivered by trained peer adolescent pregnancy, changes
educators
during adolescence, HIV/AIDS, STDs
. Development of health resource centres
. “Adolescent Health Days” organised for wide-
spread awareness, physical check-ups,
referrals, counselling
23 Effectiveness of interventional reproductive and sexual health education among school going adolescent girls in rural area. Phulambrikar et al, 201964
Maharashtra Adolescent School-based Health Structured teaching programme Mental and social changes taking
females from 9th- worker- place during adolescence, changing
. Didactic presentations using AV aids, videos, relationships, peer pressure, values
12th standard led
health education print materials
and attitudes, decision-making,
. Q&A sessions conducted body image, reproductive anatomy
and physiology in both males and
females, puberty, physiology of
menstruation, ways to maintain
menstrual hygiene, common
menstrual disorders, seeking
medical help, myths about
menstruation, human reproduction,
contraception, legal age of
marriage, STDs including HIV/AIDS
13
14

24 Impact of planned health education programme on knowledge and practice regarding menstrual hygiene among adolescent girls studying in selected high
school in Puducherry. Premila et al, 201565
Puducherry Adolescent School-based Health Structured teaching programme Menstruation, physiology and
females in grade 8 worker- anatomy of female reproductive
. Didactic lecture, included use of AV aids
and 9 (aged 13-15 led system, menstrual cycle, menstrual
. Group discussions
years) hygiene
. Q&A sessions
25 School health promotion programmes in India: a casebook. Rajaraman, 201566
Rajasthan Youth in grades 7- School-based Teacher- “DRISHTI” structured programme Communication skills, healthy
8 led relationships, resolving conflicts,
. Education provided by trained teachers physical hygiene, STDs, HIV/AIDS,
. Included fact sheets and posters
gender roles and stereotypes
. Interactive activities such as case studies,
field visits, debates, panel discussions,
storytelling, role play, games, worksheets,
projects
. Community wide initiatives such puppet
shows, rallies and fairs (mela)
26 The acceptability, feasibility and impact of a lay health counsellor delivered health promoting schools programme in India: a case study evaluation.
Rajaraman et al, 201267
Goa Youth aged 9-17 School-based Health “SHAPE” structured school programme Physiological and sexual and
years, in grades 5- worker- reproductive health, STI/STDs, HIV/
. Class-level: structured teaching sessions by
12 led AIDS, general physical hygiene,
trained school health counsellors, promotion conflict resolution, mental health,
of skills-based education,interactive puberty, changes associated with
exercises, counselling
adolescence
. School-wide initiatives: school mapping and
needs assessment, screening camps, “speak-
out box” for Q&A, health camps, workshops
27 Effectiveness of reproductive health education among rural adolescent girls: a school-based intervention study in Udupi Taluk, Karnataka. Rao et al,
200868
Karnataka Adolescent School-based Health Structured teaching programme Reproductive health, contraception,
females aged 16- worker- ovulation, menstruation, menstrual
. Didactic lecture followed by interactive
19 years led hygiene practices, pregnancy,
sessions, Q&A
fertilisation, antenatal care
. AV aids, charts, posters and video films used
28 Health awareness of rural adolescent girls: an intervention study. Sharma et al, 200969
Himachal Adolescent School-based Health Structured teaching programme Changes during puberty, menstrual
Pradesh females aged 14- worker- cycle, pain during menstruation,
. Didactic lecture followed by interactive
18 led childbearing, immunisations, family
sessions size, birth spacing, family planning
. Group discussions, narrative-based teaching,
methods, safe birthing practices
storytelling
. xxx

29 The development and pilot testing of a multicomponent health promotion intervention (SEHER) for secondary schools in Bihar, India. Shinde et al, 201770
Bihar Adolescents in School-based Peer and “SEHER” structured school programme Social skills, decision-making
secondary school health processes, sexual health, gender,
. Class-level: peer group education, interactive gender-based violence,
worker-
workshops, counselling, referrals
led reproductive health
. School-wide initiatives: school mapping and
needs assessment, cleanliness drive, skit
presentations, wall-magazines, extra-
curricular competitions, “speak-out box” for
Q&A, school assemblies, debates, storytelling,
panel discussions, role playing, monthly
competitions
30 Study of the effect of information, motivation and behavioural skills (IMB) intervention in changing AIDS risk behaviour in female university students.
Singh, 200371
Delhi Female youth School-based Health Structured multicomponent intervention HIV/AIDS, misconceptions
aged 18-22 years worker- associated with sex, safer sex
. Didactic lecture
led practices, personal attitudes and
. AV aids, slide shows, take home booklets, social norms that hinder preventive
videos
practices, communication skills,
. Interactive exercises: demonstration and negotiation skills
practice with contraceptive methods, role
playing, skits
. Group discussions
15
16

31 Impact assessment of school-based sex education programme amongst adolescents. Thakor and Kumar, 200072
Gujarat Adolescents aged School-based Health Structured teaching programme Anatomy and physiology of the
15-18 years worker- reproductive systems, STDs and how
. Trained healthcare professionals delivered
led to prevent them, myths about sex,
curriculum to small groups sexual behaviour, contraception,
. Group discussion time
conception, HIV/AIDS
. Q&A sessions
32 Effectiveness of a health educational package for AIDS prevention among adolescent school children. Tilak & Bhalwar, 199873
Pune Youth in classes IX School based Health Structured teaching programme HIV/AIDS: transmission, prevention,
to XII worker- treatment, common misconceptions
. Didactic lecture
led
. AV aids, overhead projections, video
showings
. Group exhibition
. Q&A session
33 Empowering the people: Development of an HIV peer education model for low literacy rural communities in India. Van Rompay et al, 200874
Tamil Nadu Youth (ages not Community Peer-led Structured teaching programme HIV/AIDS, masturbation, safe sex
reported) based practices, sexual anatomy,
. Peer education delivered by NGO outreach reproductive physiology, STDs,
workers, peer educators of women’s groups, proper contraception use
barbers
. Peer educators given “Health Education Kits”
with flipcharts, info booklets, fact sheets,
pamphlets, stickers, condoms, referral slips,
reporting forms
. Distribution of printed educational materials
adapted to match needs of community
. Referrals offered for diagnosis and treatment
of HIV/AIDS and other STDs
. Community wide: street theatre productions,
songs, folk dances, humorous skits,
awareness rallies
34 Promoting gender equity as a strategy to reduce HIV risk and gender-based violence among young men in India. Verma et al, 200875

Maharashtra Male youth aged School based Peer-led “Yaari-Dosti” programme Gender norms, IPV, gender and
and Uttar 15-24 years sexuality, STDs, HIV/AIDS, violence,
. Peer-led group education sessions
Pradesh reproductive system, alcohol and
. Interactive exercises: role playing, games, risks, stigma and discrimination
discussion, debate, critical thinking exercises
. Lifestyle social marketing campaigns
. Community wide: street plays, posters,
pamphlets, comic strips, community- based
discussions, T-shirts
. Creation of mobile booth as distribution
centre for condoms, communication
materials
35 Health Training Programme for Adolescent Girls: Some Lessons from India’s NGO Initiative. Visaria & Mishra, 201776
Gujarat Adolescent Community Health Structured teaching programme Menstruation (symptoms, cause,
females based worker- menstrual hygiene), unsafe sex,
. Trained instructor delivered education in
led contraception, reproductive tract
groups infections, family planning,
. Inclusion of AV aids, pamphlets reproductive health
. Group discussions
. Guest lectures from medical professionals
17
Table 3. Topics covered by the included programmes

Number of programmes
Subject covering topic
Anatomy and physiology of male and female reproductive system 28
Changes during adolescence/puberty (physical, sexual, mental, emotional) 27
Menstruation (physiology, symptoms, hygienic practices) 22
HIV/AIDS (transmission, prevention, treatment, common misconceptions) 19
STI/STDs (transmissions, prevention, risky behaviours) 18
Pregnancy and family planning (conception, pregnancy, contraception, abortion, 18

childbearing, birth spacing, antenatal care)
Sexual maturity (masturbation, navigating sexual situations and feelings, 14

navigating personal sexuality)
Relationships and friendships (communication skills, navigating dating, healthy 12

relationships, resolving conflicts)
Gender equity (gender norms/stereotypes, gender inequality, gender 9

discrimination, reproductive rights)
Personal skills and life skills training (personal confidence, goal setting, 7
individual values, personal skill development)
Physical hygiene practices (for males and females) 6
Addressing local myths/misconceptions about: 6

. STDs/STIs (Gupt roga)
. Koro
. Nocturnal emissions (Swapnadosh)
. Sex determination of the fetus
Violence (intimate partner violence, sexual violence/abuse, gender-based 4
violence)
Societal/parental pressures faced by adolescents 3
Polycystic ovary syndrome (symptoms, diagnosis, treatment) 1
Immunization (purpose, schedules, vaccines for newborns) 1
similar experiences, and learn from learned.44,47,59 Another important component

others.33,47,50,52 Successful programmes also that was found to be very appreciated by youth
included visual aids, such as posters, diagrams, was the inclusion of some form of “question and
drawings and videos.2,60,64,66 Interactive and par- answer” period; this could be through a formal
ticipatory exercises such as demonstrations, role- discussion session or an anonymous submission
playing exercises, creating skits in groups, playing box with answer provision sessions later on.2,43
trivia games, and engaging in debates on relevant Successful programmes also had the inclusion of
topics were also found by youth to be helpful in take-home handouts or pamphlets to reinforce
consolidating information they had learning and potentially help extend the learning
18
process to family members at home.67,74,75,77 programme funding, employees, duration of pro-

Lastly, several programmes included the option gramme activities, needed equipment/supplies,
of booking individual counselling sessions with and facilities) and programme outputs (i.e. stu-
trained counsellors or healthcare professionals dent knowledge, skills developed, feedback
for any personal concerns or topics they wanted received).47,48,66,70 Evaluation is the process of
to discuss in private.44,59,67 examining whether the programme’s objectives
Programmes that addressed a larger audience, have been achieved. Evaluation processes, typi-
such as a community as a whole, employed sev- cally conducted at the conclusion of the pro-
eral elements to impart educational messaging. gramme delivery, provided valuable information
Some programmes included a large health “fair” on longer-term impacts of the programme and
or “mela,” youth health camps or festivals, rallies feedback for future iterations or expansion of pro-
or parades to engage large groups of gramme delivery. Thorough assessment and
people.46,53,66 Successful programmes, similar to evaluation of programme delivery provide infor-
the smaller programmes, included interactive mation on who was actually reached by the curri-
and participatory exercises such as community culum and the measurable impact made, such as
plays, puppet shows, and street shows to engage changes in knowledge, attitudes, and skills among
youth and share information.66,70 Several pro- participants, through methods such as document
grammes included visual aids such as posters, analysis, participant interviews, focus group dis-
flyers, T-shirts, badges, and buttons to spread cussions, and surveys.33,59,67,70
awareness throughout the community.44,49,66,74,75
A few programmes included home-to-home visits Resources and time allocated by educators
to provide education and counselling on a more make a difference
personal level, and others also set up youth health There is a great diversity in the educators that lead
clinics in order to serve as a designated space for the programmes identified in our review, includ-
youth to access accurate information, connect ing community members, youth group leaders,
with healthcare services, and discuss sexual health peer educators, and formal school teachers.
topics in a confidential setting.53,63,78 There are benefits and drawbacks for each type
of instructor choice, and there is no established
Monitoring and evaluation is critical to preferred option in the literature. Drawing on
programme success and sustainability existing staff resources, such as school teachers,
We also identified several recommendations from ensures sustainability and allows for rapid
the reviewed articles regarding the development implementation and potential scale-up of activi-
of all programmes, regardless of type. The impor- ties. At the same time, if the educators delivering
tance of preliminary assessment of knowledge the programme have another primary responsibil-
levels and needs of youth in the target community ity, the effectiveness of the programme may be
prior to the development of the programme was compromised. A major recommendation that
emphasised by all programmes. Including con- emerged from the literature was making sexuality
tinuous quality monitoring and evaluation of pro- education a core subject within the regular school
gramme delivery was very important to ensure curriculum.47,52,64,66 This would help emphasise
that the programme curriculum was being deliv- the importance of sexual health and reproductive
ered correctly.66 Through the process of monitor- health education for youth, ensure that adequate
ing, programmes were able to determine whether time and resources are allocated to its teaching,
a certain curriculum was making progress towards and could allow students to study the topics cov-
its specific goals and objectives. Furthermore, by ered without worrying about sacrificing study
checking-in with programme educators, pro- time for their other classes.66
grammes were able to address educator feedback, Some programmes delivered their programme
provide them with support and answer any ques- through health professionals and health counsel-
tions or concerns they may have as these come lors. Since these educators were solely assigned
up.48,56 In some programmes, refresher training to the programme delivery, their time to dedicate
sessions were conducted for educators at set inter- to the programme was protected and was greater
vals during the programme duration.48,53,63,66,67 than programmes that relied on school teachers,
Other components of monitoring included assess- for example. The “SHAPE” programme was deliv-
ment of inputs and required resources (i.e. ered by school health counsellors67 and the
19
“SEHER” programme utilised lay counsellors for involvement of a greater range of stakeholders,
the delivery of their intervention activities.70 wider awareness through mass media and local
Both programmes found that one of the greatest channels, as well as advocacy for greater social
strengths of counsellor-led delivery was the issues can be established.79
focused time and coverage they were able to pro- Several programmes established partnerships
vide. However, the “SEHER” programme noted with local organisations and community leaders
that there was an increased cost associated with to provide feedback, assist in the programme
the hiring and training of counsellors in their development, and monitor implemen-
delivery model compared to a teacher-led tation.56,59,63,64,70 Certain programmes even
programme.70 established a formal advisory board composed
Several successful programmes have also uti- of local stakeholders, local organisation leaders
lised peer-led education as their primary method and community representatives to provide con-
of delivery. Peer educators may require consider- tinuous feedback on a regular basis throughout
able training before they have the knowledge and programme implementation.44,48,67,74 Establish-
skills to implement an educational programme. ing community support can help to promote sus-
Overall, the evidence on the utility of peer educators tainability and increased engagement from
is mixed.79 Youth may be more receptive and open community members.48 Several programmes con-
to peer educators given the similarity in age and ducted needs assessments and consulted with
stage in life. Peer education can be helpful in local stakeholders such as parents and teachers
terms of promoting peer-to-peer support and an during the development process.43,50,58,60,67,69
open environment for the discussion of sensitive However, consultation with local youth is
topics.80 One systematic review of literature from especially important, as youth perspectives can
the Indian context found overall mixed results for often be overlooked in decision-making pro-
peer education and its effects on behaviour, but processes.9 Youth themselves can play an integral
posed that, while it has its limitations, it can be a role in identifying and advocating for their own
valuable component of sexual health education needs.79 Among the 35 individual programmes,
efforts.77 Peer education may be most beneficial only 4 reported consulting with local youth in
when it is included as a part of a multicomponent, the development and initiation of their pro-
holistic intervention for youth.78,81 grammes. For example, in the “DISHA” pro-
gramme, a confidential access point for
Community and youth involvement increase individualised counselling and provision of con-
the acceptability of programmes traceptive products was established based on
The importance of fostering and engaging local input from youth.53
organisations and community resources was Furthermore, partnerships with local NGOs and
emphasised across the reviewed literature as a health centres were found to play a significant
key component for ensuring success and longevity role in ensuring buy-in from diverse stakeholders
of the implemented programme and curriculum in 13/35 of the reviewed programmes. They were
within the Indian context. Engaging community also found to help programmes liaise with various
leaders, community stakeholders and local school systems, communities, villages, agencies,
experts in the creation, development and and institutions. These organisations provided
implementation process were vital to the success valuable assistance in the development of tools
and feasibility of all programmes.79 Programmes and systems for the implementation, monitoring,
that included local leaders such as principals, and evaluation of educational programmes. Fur-
school teachers, village council leaders and local thermore, partnering with local health services
NGOs or organisations were able to develop and helped to strengthen community and youth access
run programmes effectively and were well- to sexual health information and clinical
received by the community with which they services.49,51,53
were working in partnership. Fostering a suppor-
tive and receptive environment is critical for the Access to high-quality education enhances
successful initiation and continuation of sexuality reproductive health outcomes
education programmes. By working with and Limitations of school-based sexuality education
mobilising the community, empowerment of par- provision include the underlying assumptions
ticipants, support for programme expansion, the that (1) all or most youth we are trying to reach
20
are in fact attending school and have been able to making and bangle decoration. The programme
attend school uninterrupted since childhood, and also linked youth to micro-saving and credit
(2) their education up to this point has been of sat- groups.53
isfactory quality, and has provided them with the
opportunity to develop the required literacy, Reaching vulnerable youth requires out-of-
numeracy, critical thinking and communication school programming
skills necessary to build a solid foundation in sex- For an intervention to have an impact on youth
ual health decision-making and navigating knowledge and behaviour, it must be able to
relationships. Several articles in the reviewed lit- reach them. A significant proportion of Indian
erature raised concerns about the applicability youth, especially those who are most marginalised
of school-based approaches to promoting sexual or vulnerable, are not being reached by interven-
and reproductive health because of these limit- tions intended for them. These groups include:
ations.82 One working paper published by the youth with disabilities, youth engaged in sex
Population Council found that the implemen- work, youth experiencing homelessness, youth
tation of sexual health education programmes with low literacy levels, migrant youth, and
has little impact in Indian schools where teachers youth involved in the justice system. Most existing
require more training and where students have programmes focus on youth enrolled in schools
not attained basic skills such as literacy and and colleges rather than those outside the school
numeracy. The authors also found a strong over- system. Within our review 24/35 programmes
lap between youth most at-risk for poor health were primarily school-based in their delivery. In
outcomes and youth who were most disadvan- India, there are higher rates of drop-out from
taged educationally. They postulated that for school in girls than boys, and in those belonging
many of these students, improvement in their to socioeconomically disadvantaged households
basic literacy and numeracy skills may itself be over advantaged households. As a result, the
the most significant and promising intervention most vulnerable youth are often not enrolled in
in terms of their reproductive health outcomes.82 school or involved in youth groups, so it can be
Access to schooling itself can play a great role in difficult to reach them through these standard
sexual health outcomes for youth and young routes.23,78 For example, youth living in slum
adults. Prevention of early marriage, in particular, areas are less likely to be in school, are more likely
is important in ensuring continued access to to have significant stressors in their life, and they
schooling for youth, especially for women and may live within a social system unique to slum
girls in India. Keeping Indian youth enrolled in communities (e.g. council of Elders, workers at
school is an effective way to prevent early mar- Anganwadi rural childcare and community health
riage, as many studies completed in the Indian centres). Therefore, it is important to reach them
context and across the world have shown that by developing and implementing interventions
youth enrolled in school are less likely to be mar- that involve and empower the existing community
ried at an early age.18 They are more likely to con- structure, local NGOs and available health ser-
tinue their post-secondary studies, apply for vices. For this reason, some programmes have
employment, and become financially indepen- tried unconventional delivery methods like pro-
dent. It is important to ensure access to high-qual- viding education through barber-shops, wine
ity education for all youth, and provide economic shops, and radio shows.45,74,83
and social support for families to help prevent
child marriage. One example of this was con- Addressing gender inequality is essential to
ducted through the Indian “DISHA” programme, mitigating violence
where in addition to providing education on sex- While there is a growing body of work on pro-
ual health to youth, the programme introduced grammes specifically focused on gender-related
“livelihood groups” to address some of the socio- topics that are making targeted efforts to engage
economic barriers that youth face. The livelihoods youth in understanding gender-based inequity,
component set up income-generating opportu- inclusion of this topic into comprehensive sexu-
nities for youth along with training in employ- ality education is limited. Only one of the pro-
ment-oriented skills. Some examples included grammes included in the review incorporated
training youth in skills such as pottery, tailoring, gender equity and gender-based violence into
vegetable cultivation, rice production, candle- their comprehensive sexual health curriculum.
21
The programme consisted of peer-led group edu- educational and vocational attainment, in
cation activities, and participatory activities such addition to socioeconomic security and social
as role-playing, debates, and critical thinking supports.38 Along with sexuality education pro-
exercises. The programme was supported by grammes aimed at increasing personal knowl-
monthly meetings where facilitators, field super- edge and related skills, interventions
visors, as well as experts in the field of gender addressing these broader factors are concur-
equity, met to discuss programme progress and rently required, in order to also increase employ-
implementation.75 While many sexual health ment, school retention, financial security, and
education programmes have acknowledged the social support for youth. Integrated programmes
importance of including discussion about gender like these result in better outcomes and greater
inequity, gender-based norms, reproductive impact. For example, in the “Saloni” pilot pro-
rights, LGBTQ+ rights and gender-based violence gramme, multiple upstream preventative health
as part of their curriculum, resistance from indi- interventions for adolescents were introduced
viduals such as local school officials and parents, through the school system that addressed mul-
combined with the general taboo surrounding tiple areas of youth health including nutritional
such topics, can make implementation diffi- deficiencies, reproductive health, and physical
cult.46,84 Furthermore, the persistence of gen- hygiene. The “Saloni” programme included 10
der-based or sexuality-based inequity, especially in-school sessions and take-home activities for
if explicitly visible among staff at school or within their participants. The study team reported
the local environment, can undermine the utility approximately 65% of the girls in the interven-
of many sexual and reproductive health tion group had adopted 13 or more new positive
programmes. preventative health behaviours in the areas of
One extensive review and analysis of a wide nutrition, hygiene and reproductive health, by
variety of evaluation studies of comprehensive the end of the programme compared to 4.5% in
sexuality education programmes from different the control group and 5% at baseline.54
global contexts and settings, including India,
found that programmes that included gender
and gender-based rights in their curriculum Discussion
were more successful in improving sexual health This review has demonstrated that there is a wide
outcomes for youth than “gender-blind” pro- variety of interventions and programmes that
grammes. They also found that youth who adopt have been developed and implemented to
more egalitarian stances on gender and gender- address the need for sexuality education for
based norms, are more likely to have a delayed youth in India. There are many different types of
sexual debut and use protection during sexual programmes and there is no consensus within
activity, and are less likely to be involved in inti- the literature with regard to which are the most
mate partner violence.10 On a nation-wide scale, successful with youth, although what is most feas-
there is a need for greater inclusion, open discus- ible and useful is likely driven by the specific con-
sion, and teaching of these topics in programmes text and needs of the population being targeted.
for youth. The main take-aways are summarised in Figure
2. We found that successful programmes required
Supportive environments for comprehensive a diverse team to support development, including
sexuality education are crucial for delivery experts in sexuality education, local community
Interventions related to the upstream factors leaders, parents, youth, NGOs, and community
influencing youth health can be challenging to organisations. Prior to programme debut, it was
evaluate and develop. Barriers related to individ- important to complete a needs assessment of
ual behaviour can be at the household, school, the target population in order to create a person-
local community, regional or national level. alised programme tailored to meet the needs of
Socioeconomic capital, access to required the community. With regards to curricular devel-
resources, healthcare service delivery, school opment, it was important to develop specific
and educational systems, social capital and objectives for the programme, and to deliver pro-
social norms can all influence the sexual health gramming using culturally appropriate messaging
of youth. It is important for youth to have a sup- that was also tailored to the literary and develop-
portive environment that supports their mental level of the participants. Having a variety
22
Figure 2. Main take-aways for programme development and implementation
23
of methods for delivering information was also important in the Indian context, due to unique
highlighted, for example: the use of visual aids, sociocultural settings of various communities
interactive exercises, participatory activities, reflec- across the country. The vast diversity in sociocul-
tion exercises, group projects, and community/vil- tural norms, language, religious, financial, and
lage-wide activities and events. Providing youth economic conditions necessitates that new pro-
with follow-up by way of connection to local sexual grammes are developed specifically for the indi-
health services and/or take-home resources was vidual setting for which they are planned.
also found to be helpful for youth. Implementation Specific areas of focus unique to India for new
of the programme should be delivered over a suffi- sexuality education programmes include the
cient length, duration, and level of intensity via topics of gender-based equity, gender-based vio-
well-trained educators with ongoing monitoring lence, as well as local culture-bound syndromes
and support for their performance. Overall, such as koro. Both the UNESCO guidelines and
engagement in continuous ongoing feedback and our review support the importance of consulting
quality monitoring of the programme is vital for stakeholder groups, establishing a local steering
the understanding of programme impact, assessing committee supported by community organisa-
the potential for long-term continuation and/or tions, conducting an assessment of local youth
expansion, and developing further partnerships needs, determining focused and measurable pro-
and collaborative linkages with related organisa- gramme goals and outcomes, and developing a
tions and stakeholders. framework for curricular activity based on the
Few programmes identified in the scoping population reference values and existing edu-
review explicitly addressed gender inequity and cational resources. As stated in the UNESCO guide-
gender-based violence in their content. Gender – lines, and also confirmed by the studies in our
a societal construct - can permeate all aspects of review, after the development of the programme,
youth health, especially sexual and reproductive it is key to pilot test before launching the pro-
health. In ancient Indian society, women were gramme, and then continue to monitor and evalu-
treated and valued as having equal status to ate the programme on an ongoing basis to assess
men.85 Patriarchy entered Indian society in the outcomes and scale-up as possible. Both UNESCO
post-Vedic era, with Victorian gender norms and and our review also found that the programme
puritanical principles notably imposed by the itself should be specific to the needs of the com-
colonial rule of Britain, including the penal munity, with use of participatory teaching
code. Youth of all genders are impacted by limited methods, targeting risk and protective factors
access to sexual health information, and by that may be present while also providing youth
societal norms that dissuade open dialogue on with practical skills and scientifically accurate
sexual violence, consent, and respect in intimate information about sexual and reproductive
relationships; however, the impact is arguably health.3 As previously discussed, providing youth
more pronounced for women, who face enhanced with practical skills is especially important in the
gender-based oppression through the patriarchal Indian context, where providing youth with prac-
norms of post-Vedic Indian society and are corre- tical skills that they can leverage to improve
spondingly more likely to face sexual violence. their socioeconomic status is key in breaking the
When comparing the promising practices ident- cycle of lower educational attainment, decreased
ified in our review with the globally-defined best social and employment opportunities, and nega-
practices for CSE established by the United Nations tive sexual and reproductive health outcomes.
Educational, Scientific and Cultural Organization
(UNESCO), we found many similarities between Areas of paucity and goals for the future
the two, and no contradictions. Our review corro- We aim for the results of this paper to help guide
borated several practices also recommended by educators and public health organisations in the
UNESCO. Specifically, the UNESCO guidelines also creation, implementation, and evaluation of CSE
emphasise the importance of sufficient prep- programmes for youth within the context of
aration and groundwork within the target com- India but also any other similar settings. Our
munity before implementation, with the work also provides an example of a framework
development of links to existing community for evaluating sexuality education programmes
resources and partners in order to support future and provides a comprehensive overview of factors
sustainability of the programme. This is especially that are important to consider in the development
24
and assessment of these initiatives. This review effectiveness, will be important for decisions on
offers educators, programme planners, and policy how to allocate resources for programmes for
makers an in-depth look into the current state of health promotion. Longer-term tracking of health
sexuality education programmes in India, and var- and social outcomes for the participants of a pro-
ious strengths, weaknesses, and key lessons gramme is also important, as many of the potential
learned by these various groups in their endea- benefits may not be measurable in the short term.2
vours to deliver sexuality education for youth. Standardised and validated outcome measures
Sexuality education must be shaped by awareness should be utilised to allow for effective comparabil-
of what works for youth and be adaptable accord- ity between programmes. Research should be con-
ing to the changing needs of young people. For ducted across a wide variety of sociocultural
example, we identified the specific need for contexts to identify feasible and effectual pro-
greater incorporation of education surrounding grammes that work among youth to reduce nega-
gender-based stereotyping and prevention both tive sexual health outcomes, especially in
on the individual and community level for the resource-limited settings.86 Evidence-based and suc-
prevention of gender-based violence within the cessful programmes should be scaled up, delivered
Indian context. with adequate intensity and sustained long-
We identified several gaps and areas for future term.2,78,89
work and research in the literature. There is a
need to generate more robust and standardised
data on the outcomes of sexuality education pro- Conclusion
grammes. Much of the global literature on inter- Personal knowledge and skills development
ventions to promote sexual and reproductive related to sexuality is an important determinant
health among youth has noted a need for more of health during adolescence and young adult-
rigorous and theory-based research to evaluate hood. As part of a broader sexual health pro-
the effectiveness of interventions in improving motion strategy addressing both downstream
youth knowledge and changing health behaviours and upstream determinants of healthy sexuality,
and outcomes.78,86–88 the delivery of CSE for young people has a signifi-
One of the limitations of our review is the cant impact on promoting overall wellbeing. It
restricted ability to accurately compare pro- serves as a crucial prevention tool for adverse sex-
grammes across different settings and target popu- ual and reproductive health outcomes, including
lation groups. Even within the context of India unwanted pregnancy, unsafe abortions, sexually
alone, there is a huge diversity across programmes transmitted infections, HIV/AIDS, and sexual vio-
in the types of activities, components, curricula, lence. Moreover, CSE is an integral prerequisite
outcomes measured and methods of implemen- to full-body autonomy and thus intimately tied
tation. Due to this variety in the outcomes and to human rights.
reported measurement methods, it is understand- In this scoping review, we endeavoured to
ably difficult to draw accurate conclusions about identify components and characteristics of suc-
the field and cross-compare between different pro- cessful sexuality education programmes, to
grammes. There is currently no consensus on inform promising practices for the development
whether teacher-taught, peer-taught, counsellor/ of programmes for youth in India. CSE pro-
health worker-taught programmes are all effective grammes, in combination with access to sexual
or if one of these methods is better in a given con- health services, are vital for providing youth
text, largely because of lack of meaningful evalu- with comprehensive knowledge on the topic as
ation approaches that are standardised while also well as providing youth with the skills to navi-
context-specific. Similarly, there is no consensus gate sexual and reproductive health-related
currently on which programme length, duration decisions. The Indian context is very diverse,
of sessions, or number of sessions is most effective and not all identified promising practices may
in a given context, although it has been shown that be applicable for all locales and populations.
any type of intervention when delivered piecemeal It is important for existing programmes and
or with inadequate dosage is not as those looking to develop new programmes to
successful.2,53,78 tailor their content to serve the needs of the
Further research on the costs and benefits, using specific youth population being targeted; to
validated and context-specific measures of work in partnership with local experts and
25
organisations; to address potential barriers to Natalie DiMaio assisted in the citation screen as
participation and work to mitigate those bar- the second reviewer.
riers for marginalised youth; to be youth-
friendly, flexible and convenient; and be devel- Disclosure statement
opmentally and culturally appropriate for the No potential conflict of interest was reported by the
Indian youth context.51 author(s).
A myriad of micro- and macro-level factors can
lead to negative sexual health outcomes among Funding
youth and young adults, from family and commu- N. Pattathil received summer studentship funding
nity pressures, social norms and expectations, to from the Department of Medicine at Queen’s Uni-
educational attainment and financial constraints. versity and the Dr. Samuel S. Robinson Charitable
Continued efforts are required by different sectors Foundation to conduct this research.
and stakeholders to address the interrelated and
broad structural factors, including political, finan-
cial, social, and cultural, that affect youth sexual Supplemental data
health and wellbeing. Supplemental data for this article can be accessed
online at https://do.org/10.1080/26410397.2023.
2244268.
Acknowledgements
Sandra Halliday from Bracken Health Sciences ORCID
Library at Queen’s University provided guidance in Amrita Roy http://orcid.org/0000-0001-6624-
developing and implementing the search strategy. 3644
References
1. Shahbaz S. Comprehensive Sexuality Education (CSE) in 7. Convention on the Rights of the Child [Internet]. OHCHR.
Asia: a regional brief. Asian-Pacific Resource and Research [cited 2022 Oct 22]. Available from: https://www.ohchr.
Centre for Women (ARROW); 2018. org/en/instruments-mechanisms/instruments/convention-
2. Kirby D, Laris BA, Rolleri L. Impact of sex and HIV education rights-child.
programs on sexual behaviors of youth in developing and 8. Comprehensive sexuality education [Internet]. United
developed countries. Family Health International, Nations Population Fund. [cited 2022 Oct 23]. Available
YouthNet Program Durham, NC; 2005. from: https://www.unfpa.org/comprehensive-sexuality-
3. UNESCO. Emerging evidence, lessons and practice in education.
comprehensive sexuality education: a global review. 9. Roy A, Roy R. Bengali youth speak out for change:
UNESCO Paris; 2015. knowledge and empowerment of youth in West Bengal,
4. Fonner VA, Armstrong KS, Kennedy CE, et al. School based India. In: S Bastien, HB Holmarsdottir, editors. Youth’at the
sex education and HIV prevention in low-and middle- margins’. Rotterdam: Brill Sense; 2015. p. 123–151.
income countries: a systematic review and meta-analysis. 10. United Nations Population Fund. The evaluation of
PloS one. 2014;9(3):e89692. doi:10.1371/journal.pone. comprehensive sexuality education programmes [Internet].
0089692 2015 [cited 2021 Apr 12]. Available from: /publications/
5. International Covenant on Economic, Social and Cultural evaluation-comprehensive-sexuality-education-
Rights [Internet]. OHCHR. [cited 2022 Oct 22]. Available programmes.
from: https://www.ohchr.org/en/instruments-mechanisms/ 11. Roy A, Roy R. “There is a lot of embarrassment”:
instruments/international-covenant-economic-social-and- reflections of students and educators on sex education in
cultural-rights. West Bengal, India. Clin Investig Med. 2015;38(6):
6. Convention on the Elimination of All Forms of E335–E336.
Discrimination against Women New York. [Internet]. 12. Paranjape RS, Challacombe SJ. HIV/AIDS in India: an
OHCHR; 18 December 1979. [cited 2022 Oct 22]. Available overview of the Indian epidemic. Oral Dis. 2016;22:10–14.
from: https://www.ohchr.org/en/instruments-mechanisms/ doi:10.1111/odi.12457
instruments/convention-elimination-all-forms- 13. Silverman JG, Decker MR, Saggurti N, et al. Intimate
discrimination-against-women. partner violence and HIV infection among married Indian
26
women. Jama. 2008;300(6):703–710. doi:10.1001/jama. https://www.mohfw.gov.in/sites/default/files/24%

300.6.703 20Chapter%20496AN2018-19.pdf.
14. Ekstrand ML, Bharat S, Srinivasan K. HIV stigma is a barrier 28. Ram U, Mohanty SK, Singh A, et al. Youth in India:
to achieving 90-90-90 in India. Lancet HIV. 2018;5(10): situation and needs 2006–2007. International Institute
e543–e545. doi:10.1016/S2352-3018(18)30246-7 for Population Sciences (IIPS) and Population Council;
15. World Health Organization. Global and regional estimates 2010.
of violence against women: prevalence and health effects 29. Sivagurunathan C, Umadevi R, Rama R, et al. Adolescent
of intimate partner violence and non-partner sexual health: present status and its related programmes in India.
violence. World Health Organization; 2013. Are we in the right direction? JCDR. 2015;9(3):LE01.
16. Raj A, McDougal L. Sexual violence and rape in India. 30. Public Health Agency of Canada. Canadian best practices
Lancet. 2014;383(9920):865. doi:10.1016/S0140-6736 Portal [Internet]; 2015 [cited 2021 Nov 26]. Available from:
(14)60435-9 https://cbpp-pcpe.phac-aspc.gc.ca/interventions/search-
17. Saravanan S. Violence against women in India. New Delhi: interventions/.
Institute of Social Studies Trust; 2000. 31. Beyers C. Sexuality education in South Africa: A
18. Chandra-Mouli V, Camacho AV, Michaud PA. WHO sociocultural perspective. Acta Acad. 2011;43(3):192–209.
guidelines on preventing early pregnancy and poor 32. Braeken D, Cardinal M. Comprehensive sexuality education
reproductive outcomes among adolescents in developing as a means of promoting sexual health. Int J Sex Health.
countries. J Adolesc Health. 2013;52(5):517–522. doi:10. 2008;20(1–2):50–62. doi:10.1080/19317610802157051
1016/j.jadohealth.2013.03.002 33. Dei Jnr LA. The efficacy of HIV and sex education
19. Patton GC, Coffey C, Sawyer SM, et al. Global patterns of interventions among youths in developing countries: a
mortality in young people: a systematic analysis of review. Scient Acad Publ. 2016;6(1):1–17.
population health data. Lancet. 2009;374(9693):881–892. 34. Huaynoca S, Chandra-Mouli V, Yaqub Jr N, et al. Scaling up
doi:10.1016/S0140-6736(09)60741-8 comprehensive sexuality education in Nigeria: from
20. World Health Organization. WHO guidelines on preventing national policy to nationwide application. Sex Educ.
early pregnancy and poor reproductive health outcomes 2014;14(2):191–209. doi:10.1080/14681811.2013.856292
among adolescents in developing countries. World Health 35. Parker R, Wellings K, Lazarus JV. Sexuality education in
Organization; 2011. Europe: an overview of current policies. Sex Educ. 2009;9
21. United Nations. Population and development: programme (3):227–242. doi:10.1080/14681810903059060
of action adopted at the international conference on 36. Yankah E. International framework for sexuality education.
population and development, Cairo, 5–13 September Evidence-based approaches to sexuality education: a
1994. Vol. 1. New York: United Nations, Department for global perspective. New York: Routledge; 2016, p. 17–32.
Economic and Social Information and … ; 1995. 37. Vanwesenbeeck I, Westeneng J, de Boer T, et al. Lessons
22. Barua A, Chandra-Mouli V. The Tarunya Project’s efforts to learned from a decade implementing comprehensive
improve the quality of adolescent reproductive and sexual sexuality education in resource poor settings: the world
health services in Jharkhand state, India: a post-hoc starts with me. Sex Educ. 2016;16(5):471–486. doi:10.
evaluation. Int J Adolesc Med Health. 2016;29(6). doi:10. 1080/14681811.2015.1111203
1515/ijamh-2016-0024 38. Hardee K, Gay J, Croce-Galis M, et al. What HIV programs
23. Jejeebhoy SJ, Santhya KG. Sexual and reproductive health work for adolescent girls? JAIDS J Acquir Immune Defic
of young people in India: a review of policies, laws and Syndr. 2014;66:S176–S185. doi:10.1097/QAI.
programmes; 2011. 0000000000000182
24. Chakravarti P. The sex education debates: teaching ‘Life 39. World Health Organization. Innovative care for chronic
Style’ in West Bengal, India. Sex Educ. 2011;11 conditions: building blocks for actions: global report. World
(4):389–400. doi:10.1080/14681811.2011.595230 Health Organization. 2002.
25. Ministry of Youth Affairs and Sports (MOYAS). Annual 40. Chrisler JC, Johnston-Robledo I. The (un)healthy body.
Report 2010–2011. New Delhi: MOYAS, Government of Woman’s embodied self: feminist perspectives on identity
India; 2011. and image. Washington, DC: American Psychological
26. Kansara K, Saxena D, Puwar T, et al. Convergence and Association; 2018, p. 123–140.
outreach for successful implementation of Rashtriya Kishor 41. Arksey H, O’Malley L. Scoping studies: towards a
Swasthya Karyakram. Indian J Community Med. 2018;43 methodological framework. Int J Soc Res Methodol. 2005
(Suppl 1):S18. Feb 1;8(1):19–32. doi:10.1080/1364557032000119616
27. Ministry of Health and Family Welfare. Annual Report 42. Covidence systematic review software. Veritas Health
2018-2019: National AIDS Control Organization (NACO) Innovation, Melbourne, Australia. Available from: www.
[Internet]; 2019 [cited 2020 Mar 24]. Available from: covidence.org.
27
43. Arora A, Mittal A, Pathania D, et al. Impact of health menstruation among adolescent girls of rural areas of
education on knowledge and practices about menstruation RHTC of a Medical College: an interventional study. Indian
among adolescent school girls of rural part of district J Community Med. 2020;45(1):32–35. doi:10.4103/ijcm.
Ambala, Haryana. Indian J Community Health. 2013;25 IJCM_134_19.
(4):492–497. 56. Leventhal KS, DeMaria LM, Gillham JE, et al. A
44. Balaji M, Andrews T, Andrew G, et al. The acceptability, psychosocial resilience curriculum provides the “missing
feasibility, and effectiveness of a population-based piece” to boost adolescent physical health: a randomized
intervention to promote youth health: an exploratory study controlled trial of girls first in India. Soc Sci Med.
in Goa, India. J Adolesc Health. 2011;48(5):453–460. 2016;161:37–46. doi:10.1016/j.socscimed.2016.05.004
doi:10.1016/j.jadohealth.2010.07.029 57. Malleshappa K, Krishna S. Knowledge and attitude about
45. Bhasin U, Singhal A. Participatory approaches to message reproductive health among rural adolescent girls in
design: ‘Jeevan Saumbh’, a pioneering radio serial in India Kuppam mandal: an intervention study. Biomed Res.
for adolescents. Media Asia. 1998;25(1):12–18. doi:10. 2011;22(3):305–310.
1080/01296612.1998.11726544 58. Manjula R, Kashinakunti SV, Geethalakshmi RG, et al. An
46. Capoor I, Mehta S. Talking about love and sex in educational intervention study on adolescent reproductive
adolescent health fairs in India. Reprod Health Matters. health among pre-university girls in Davangere district,
1995;3(5):22–27. doi:10.1016/0968-8080(95)90078-0 South India. Ann Tropical Med Public Health. 2012;5
47. Chandra-Mouli V, Plesons M, Barua A, et al. What did it (3):185. doi:10.4103/1755-6783.98612
take to scale up and sustain Udaan, a school-based 59. Mehra D, Sarkar A, Sreenath P, et al. Effectiveness of a
adolescent education program in Jharkhand, India? Am J community based intervention to delay early marriage,
Sex Educ. 2018;13(2):147–169. doi:10.1080/15546128. early pregnancy and improve school retention among
2018.1438949 adolescents in India. BMC Public Health. 2018;18(1):1–13.
48. Chhabra R, Springer C, Leu CS, et al. Adaptation of an doi:10.1186/s12889-018-5586-3
alcohol and HIV school-based prevention program for 60. Minimol G. Preparing girls for menarche. Nurs J India.
teens. AIDS Behav. 2010;14(1):177–184. doi:10.1007/ 2003;94(3):54.
s10461-010-9739-3 61. Nair MK, Paul MK, Leena ML, et al. Effectiveness of a
49. Daniel EE, Hainsworth G, Kitzandtides I, et al. PRACHAR: reproductive sexual health education package among
advancing young people’s sexual and reproductive health school going adolescents. Indian J Pediatr. 2012;79(Suppl
and rights in India. Watertown (MA): Pathfinder; 2013. 1):S64–S68. doi:10.1007/s12098-011-0433-x.
50. Dongre AR, Deshmukh PR, Garg BS. The effect of 62. Nayak M. Effectiveness of video assisted teaching module
community-based health education intervention on on knowledge of adolescent girls regarding polycystic
management of menstrual hygiene among rural Indian ovarian syndrome in Gayatri Women’s +2 Science College,
adolescent girls. World Health Popul. 2007;9(3):48–54. Berhampur Ganjam, Odisha. i-Manager’s J Nurs. 2017;7
doi:10.12927/whp.2007.19303 (2):27–31.
51. Ghule M, Donta B. Sexual behaviour of rural college youth 63. Patel P, Puwar T, Shah N, et al. Improving adolescent
in Maharashtra, India: an intervention study. J Reprod health: learnings from an interventional study in Gujarat,
Contracept. 2008;19(3):167–189. doi:10.1016/S1001-7844 India. Indian J Commun Med Official Publ Indian Assoc
(08)60020-6 Prevent Social Med. 2018;43(Suppl 1):S12.
52. Jadon G. Impact of reproductive health education on the 64. Phulambrikar RM, Kharde AL, Mahavarakar VN, et al.
knowledge of mid adolescents boys of urban population of Effectiveness of interventional reproductive and sexual
Haryana. IP Int J Med Paediatr Oncol. 2018;4(1):20–32. health education among school going adolescent girls in
53. Kanesathasan A, Cardinal LJ, Pearson E, et al. Catalyzing rural area. Indian J Community Med. 2019;44(4):378–382.
change: improving youth sexual and reproductive health doi:10.4103/ijcm.IJCM_155_19
through DISHA, an integrated program in India. 65. Premila E, Ganesh K, Chaitanya BL. Impact of planned
Washington (DC): International Center for Research on health education programme on knowledge and practice
Women; 2008. regarding menstrual hygiene among adolescent girls
54. Kapadia-Kundu N, Storey D, Safi B, et al. Seeds of studying in selected high school in Puducherry. Asia Pacific
prevention: the impact on health behaviors of young J Res. 2015;1(25):154–162.
adolescent girls in Uttar Pradesh, India, a cluster 66. Rajaraman D, Shinde S, Patel V. School health promotion
randomized control trial. Soc Sci Med. 2014;120:169–179. programmes in India: a casebook. New Delhi: Byword
doi:10.1016/j.socscimed.2014.09.002 Publications; 2015.
55. Kokiwar PR, Nikitha P. Efficacy of focused group 67. Rajaraman D, Travasso S, Chatterjee A, et al. The
discussion on knowledge and practices related to acceptability, feasibility and impact of a lay health
28
counsellor delivered health promoting schools programme 79. Senderowitz J. A review of program approaches to
in India: a case study evaluation. BMC Health Serv Res. adolescent reproductive health. Arlington (VA): US
2012;12(1):1–11. doi:10.1186/1472-6963-12-127 Agency for International Development Bureau for
68. Rao RS, Lena A, Nair NS, et al. Effectiveness of reproductive Global Programs/Population Technical Assistance
health education among rural adolescent girls: a school Project; 2000.
based intervention study in Udupi Taluk, Karnataka. Indian 80. Swartz S, Deutsch C, Makoae M, et al. Measuring change
J Med Sci. 2008 Nov;62(11):439–443. doi:10.4103/0019- in vulnerable adolescents: findings from a peer education
5359.48455 evaluation in South Africa. SAHARA-J: J Social Aspects of
69. Sharma S, Nagar S, Chopra G. Health awareness of rural HIV/Aids. 2012;9(4):242–254. doi:10.1080/17290376.
adolescent girls: an intervention study. J Soc Sci. 2009;21 2012.745696
(2):99–104. doi:10.1080/09718923.2009.11892758 81. Michielsen K, Beauclair R, Delva W, et al. Effectiveness of a
70. Shinde S, Pereira B, Khandeparkar P, et al. The peer-led HIV prevention intervention in secondary schools
development and pilot testing of a multicomponent health in Rwanda: results from a non-randomized controlled trial.
promotion intervention (SEHER) for secondary schools in BMC Public Health. 2012;12(1):1–11. doi:10.1186/1471-
Bihar, India. Glob Health Action. 2017;10(1):1385284. 2458-12-729
doi:10.1080/16549716.2017.1385284 82. Lloyd C. The role of schools in promoting sexual and
71. Singh S. Study of the effect of information, motivation and reproductive health among adolescents in developing
behavioural skills (IMB) intervention in changing AIDS risk countries poverty. Gender and Youth Working Paper;
behaviour in female university students. AIDS Care. 2007.
2003;15(1):71–76. doi:10.1080/095401202100039770. 83. Sivaram S, Johnson S, Bentley ME, et al. Exploring “wine
72. Thakor HG, Kumar P. Impact assessment of school- shops” as a venue for HIV prevention interventions in
based sex education program amongst adolescents. urban India. J Urban Health. 2007;84(4):563–576. doi:10.
Indian J Pediatr. 2000;67(8):551–558. doi:10.1007/ 1007/s11524-007-9196-0
BF02758475. 84. Jejeebhoy S, Sebastian M. Actions that protect: promoting
73. Tilak VW, Bhalwar R. Effectiveness of a health educational sexual and reproductive health and choice among young
package for AIDS prevention among adolescent school people in India. Reproductive Health [Internet]; 2003.
children. Med J Armed Forces India. 1998;54(4):305–308. Available from: https://knowledgecommons.popcouncil.
doi:10.1016/S0377-1237(17)30590-7. org/departments_sbsr-rh/528.
74. Van Rompay KK, Madhivanan P, Rafiq M, et al. 85. Ray S. Understanding patriarchy. Human Rights Gender
Empowering the people: development of an HIV peer Environ. 2006;1(1):1–21.
education model for low literacy rural communities in 86. Kasedde S, Kapogiannis BG, McClure C, et al. Executive
India. Hum Resour Health. 2008;6(1):1–11. doi:10.1186/ summary: opportunities for action and impact to address
1478-4491-6-6 HIV and AIDS in adolescents. JAIDS J Acquir Immune Defic
75. Verma RK, Pulerwitz J, Mahendra VS, et al. Promoting Syndr. 2014;66:S139–S143. doi:10.1097/QAI.
gender equity as a strategy to reduce HIV risk and gender- 0000000000000206
based violence among young men in India; 2008. 87. Denno DM, Hoopes AJ, Chandra-Mouli V. Effective
76. Visaria L, Mishra RN. Health training programme for strategies to provide adolescent sexual and reproductive
adolescent girls: some lessons from India’s NGO initiative. health services and to increase demand and community
J Health Manag. 2017;19(1):97–108. doi:10.1177/ support. J Adolescent Health. 2015;56(1):S22–S41. doi:10.
0972063416682586 1016/j.jadohealth.2014.09.012
77. Siddiqui M, Kataria I, Watson K, et al. A systematic 88. Schunter BT, Cheng WS, Kendall M, et al. Lessons learned
review of the evidence on peer education programmes from a review of interventions for adolescent and young
for promoting the sexual and reproductive health of key populations in Asia pacific and opportunities for
young people in India. Sex Reprod Health Matters. programming. JAIDS J Acquir Immune Defic Syndr.
2020;28(1):1741494. doi:10.1080/26410397.2020. 2014;66:S186–S192. doi:10.1097/QAI.
1741494 0000000000000185
78. Chandra-Mouli V, Lane C, Wong S. What does not work in 89. Salam RA, Faqqah A, Sajjad N, et al. Improving
adolescent sexual and reproductive health: a review of adolescent sexual and reproductive health: a systematic
evidence on interventions commonly accepted as best review of potential interventions. J Adolescent
practices. Glob Health Sci Pract. 2015;3(3):333–340. Health. 2016;59(4):S11–S28. doi:10.1016/j.jadohealth.
doi:10.9745/GHSP-D-15-00126 2016.05.022
29
Résumé Resumen
La violence sexuelle et le VIH/sida sont des problè- La violencia sexual y el VIH/SIDA son graves pro-
mes majeurs de santé publique en Inde. En pro- blemas de salud pública en India. Al promover
mouvant l’autonomie corporelle, le bien-être et la autonomía corporal, el bienestar y la dignidad
la dignité par le biais des connaissances et des por medio de conocimientos y habilidades, la
compétences, l’éducation complète à la sexualité educación integral en sexualidad para las perso-
des jeunes peut contribuer à prévenir les effets nas jóvenes puede ser útil para evitar los resulta-
néfastes sur leur santé sexuelle et reproductive. dos adversos de la salud sexual y reproductiva.
S’il est de plus en plus admis dans le monde Aunque cada vez hay más reconocimiento a
que les jeunes ont besoin d’une éducation sex- nivel mundial de la necesidad de las personas
uelle, il s’est révélé difficile de traduire cette jóvenes de recibir educación en sexualidad, ha
prise de conscience dans des programmes sido un reto traducir este reconocimiento a pro-
acceptés en Inde. Cette étude de portée vise à gramas aceptados en India. Esta revisión de
examiner les recommandations relatives à des alcance pretende examinar las recomendaciones
pratiques prometteuses pour la conception et la de prácticas prometedoras para el diseño y la eje-
mise en œuvre de programmes et de ressources cución de programas de educación en sexualidad
d’éducation sexuelle à l’intention des jeunes en y recursos dirigidos a jóvenes en India. Entre junio
Inde. Une recherche et un examen systématiques y agosto de 2020, se realizó una búsqueda y revi-
des publications ont été menés entre juin et août sión sistemáticas de la literatura. Del total de 5312
2020. Sur les 5312 citations totales identifiées et citas identificadas e investigadas, 622 avanzaron a
examinées, 622 sont parvenues à l’examen du la revisión del texto completo y 39 se incluyeron
texte intégral et 39 ont été incluses dans l’analyse en el análisis final. Entre las prácticas promete-
finale. Parmi les pratiques prometteuses, il convi- doras se encuentran la necesidad de: adaptar el
ent de citer la nécessité: d’adapter le contenu contenido para atender las necesidades de la
pour répondre aux besoins de la population de población específica de jóvenes bajo estudio; uti-
jeunes spécifique visée; d’utiliser des méthodes lizar métodos interesantes y participativos para
engageantes et participatives pour enseigner le enseñar contenido sobre salud sexual; trabajar
contenu relatif à la santé sexuelle; de travailler en alianza y colaboración con expertos y organiza-
en partenariat et en collaboration avec des organ- ciones locales; abordar las posibles barreras a la
isations et experts locaux; d’éliminer les obstacles participación y trabajar para mitigar esas barreras
potentiels à la participation et de s’employer à para jóvenes marginados; tener en cuenta las
atténuer ces obstacles pour les jeunes margina- necesidades de la juventud y ser flexible y conve-
lisés; d’être adaptées aux jeunes, souples et pra- niente; y ser adecuado para el desarrollo y la cul-
tiques; et d’être appropriées du point de vue du tural del contexto de la juventud de India. Los
développement et de la culture au circonstances programas de educación en sexualidad deben
de la jeunesse indienne. Les programmes d’éduca- integrarse en los servicios comunitarios existentes
tion à la sexualité doivent s’intégrer dans les ser- y vincularse con los servicios locales de salud
vices communautaires existants et établir des reproductiva para ayudar a proporcionar a la
liens avec les services locaux de santé reproduc- juventud acceso a los servicios que podrían nece-
tive pour aider à fournir aux jeunes l’accès aux sitar. Es imperativo continuar el trabajo y los
services dont ils peuvent avoir besoin. Il faut pour- esfuerzos por abordar los factores interrelaciona-
suivre le travail et les activités afin de traiter les dos y estructurales generales, entre ellos factores
facteurs structurels d’ensemble interdépendants, políticos, financieros, sociales y culturales, que
notamment de nature politique, financière, afectan la salud sexual y el bienestar de las perso-
sociale et culturelle, qui influent sur la santé et nas jóvenes.
le bien-être sexuels des jeunes.
30

Promising Practices For The Design and Implementation of Sexuality Education Programmes For Youth in India A Scoping Review

Uploaded by

Copyright:

Available Formats

Promising Practices For The Design and Implementation of Sexuality Education Programmes For Youth in India A Scoping Review

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Promising Practices For The Design and Implementation of Sexuality Education Programmes For Youth in India A Scoping Review

Uploaded by

Copyright:

Available Formats

Sexual and Reproductive Health Matters

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/zrhm21

Promising practices for the design and

Niveditha Pattathil & Amrita Roy

To link to this article: https://doi.org/10.1080/26410397.2023.2244268

© 2023 The Author(s). Published by Informa

View supplementary material

Published online: 15 Sep 2023.

Submit your article to this journal

Article views: 1000

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

Promising practices for the design and implementation of

Introduction transmitted infections (STIs), HIV/AIDS and unin-

Figure 1. PRISMA diagram

pregnancy and family planning, STIs, and HIV/

N Pattathil, A Roy. Sexual and Reproductive Health Matters 2023;31(1):1–30

N Pattathil, A Roy. Sexual and Reproductive Health Matters 2023;31(1):1–30

N Pattathil, A Roy. Sexual and Reproductive Health Matters 2023;31(1):1–30

N Pattathil, A Roy. Sexual and Reproductive Health Matters 2023;31(1):1–30

Telangana Adolescent Community- Health Structured teaching programme General knowledge on

N Pattathil, A Roy. Sexual and Reproductive Health Matters 2023;31(1):1–30

N Pattathil, A Roy. Sexual and Reproductive Health Matters 2023;31(1):1–30

18 Preparing girls for menarche. Minimol, 200360

N Pattathil, A Roy. Sexual and Reproductive Health Matters 2023;31(1):1–30

N Pattathil, A Roy. Sexual and Reproductive Health Matters 2023;31(1):1–30

25 School health promotion programmes in India: a casebook. Rajaraman, 201566

N Pattathil, A Roy. Sexual and Reproductive Health Matters 2023;31(1):1–30

N Pattathil, A Roy. Sexual and Reproductive Health Matters 2023;31(1):1–30

N Pattathil, A Roy. Sexual and Reproductive Health Matters 2023;31(1):1–30

Table 3. Topics covered by the included programmes

Anatomy and physiology of male and female reproductive system 28

Changes during adolescence/puberty (physical, sexual, mental, emotional) 27

Menstruation (physiology, symptoms, hygienic practices) 22

HIV/AIDS (transmission, prevention, treatment, common misconceptions) 19

STI/STDs (transmissions, prevention, risky behaviours) 18

Pregnancy and family planning (conception, pregnancy, contraception, abortion, 18

Sexual maturity (masturbation, navigating sexual situations and feelings, 14

Relationships and friendships (communication skills, navigating dating, healthy 12

Gender equity (gender norms/stereotypes, gender inequality, gender 9

Physical hygiene practices (for males and females) 6

Addressing local myths/misconceptions about: 6

Societal/parental pressures faced by adolescents 3

Polycystic ovary syndrome (symptoms, diagnosis, treatment) 1

Immunization (purpose, schedules, vaccines for newborns) 1

similar experiences, and learn from learned.44,47,59 Another important component

process to family members at home.67,74,75,77 programme funding, employees, duration of pro-

Figure 2. Main take-aways for programme development and implementation

women. Jama. 2008;300(6):703–710. doi:10.1001/jama. https://www.mohfw.gov.in/sites/default/ﬁles/24%

You might also like