Adolescents’ and young people’s perspectives on school- based sexuality education in low- and middle-income countries: A scoping review

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In low- and middle-income countries (LMICs), research has raised concerns about the availability and sub-optimal implementation of sexuality education, yet few studies address these concerns considering AYP’s views. This limits insights for developing relevant and effective sexuality education programmes that can support AYP in their journey to adulthood. This review explores AYP’s perspectives on school-based sexuality education in LMICs. Methods A scoping review search was conducted across five academic databases and key stakeholder websites, identifying studies published between 2013 and 2024 in English. Following screening and systematic data extraction, 66 studies were included. Findings on characteristics of studies, AYP’s perspectives on needs, experiences and preferences related to sexuality education content and delivery, as well as socio-ecological influences were synthesized using a narrative approach. Results The review finds that while AYP across LMICs generally express high needs for school-based sexuality education, these often remain unmet. AYP consistently reported dissatisfaction with sexuality education as they wish for education that extends beyond cognitive learning about biology and negative implications of sexuality, to include more comprehensively its emotional, physical, and social aspects. Participants’ age, gender and urban or rural residence influence delivery preferences. Gaps in participatory, inclusive, and empowering education approaches reinforce gender norms, exclude diverse identities, and fail to address the specific needs of adolescent girls, young women, and marginalized youth. The review underscored the scarcity of research on AYP’s perspectives regarding age- and context-appropriateness, inclusivity of content, and regarding delivery formats. Studies from certain geographic regions and focusing on younger adolescents, youth with diverse social identity markers and those living in rural areas are especially underrepresented. Conclusions For the first time, this article synthesizes direct AYP perspectives on school-based sexuality education, while also pointing to remaining knowledge gaps when capturing views of AYP in LMICs. Concerted efforts are needed to diversify research, calling for more rigorous, inclusive and youth-participatory research efforts to inform sexuality education policies and programmes that are responsive to AYP’s needs. Sexuality education health and wellbeing school-based programmes education policy adolescent and youth perspectives youth participation low- and middle-income countries Figures Figure 1 Plain Summary Sexuality education is essential for adolescents’ and young people’s health, well-being, and rights. While recognized in policies worldwide, gaps remain in its implementation. This review explores youth perspectives on school-based sexuality education in low- and middle-income countries to understand their needs, experiences, and preferences. A scoping review was conducted across five academic databases and key stakeholder websites, identifying 66 relevant studies published between 2013 and 2024. The review found strong support for school-based sexuality education but noted that many programmes fail to meet adolescents’ and young people’s needs. Current curricula often emphasize biology and risks including early and unintended pregnancy and sexually transmitted infections while neglecting emotional, physical, and social aspects of sexuality. Teaching approaches are frequently not fullyinclusive, and marginalized groups—such as adolescent girls, youth with disabilities and LGBTIQ+ youth—face additional barriers. Many young people want more interactive and engaging teaching methods. The review also highlighted a lack of research on how learners perceive the appropriateness and inclusivity of sexuality education content and delivery. Certain groups, including younger adolescents, youth with diverse identities, and those in rural areas, remain underrepresented in studies, particularly in some geographic regions. More inclusive, youth-participatory research is needed to inform policies and programmes that better reflect the needs and realities of all adolescents and young people. Background With the global youth population at an all-time high, adolescents and young people (AYP) aged 10–24 face a myriad of social, health, economic and environmental challenges in the 21st century ( 1 – 3 ). The role of sexuality education in advancing towards AYP’s health and social development is increasingly recognised in policy and legal frameworks worldwide ( 4 ). Comprehensive sexuality education (CSE) is a curriculum-based process of teaching and learning that covers the cognitive, emotional, physical and social aspects of sexuality, aiming to equip AYP with knowledge, skills, attitudes and values that will empower them to realise their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and understand and ensure the protection of their rights throughout their lives ( 5 ). Acknowledging that reaching consensus on what can be deemed as ‘comprehensive’ may neither be possible nor desirable ( 6 ), that many countries do not implement fully comprehensive sexuality education and that countries use different terms and curricula to implement programmes, this paper refers to sexuality education as a broad umbrella term while employing context-specific terminology when discussing individual studies. When designed and implemented appropriately, sexuality education has been shown to reduce risk factors for poor sexual and reproductive health and rights (SRHR) such as early and unintended pregnancy (EUP) as well as sexuality transmitted infections (STIs) including HIV/AIDS, foster gender equality, help create safer learning environments and decrease discrimination and violence ( 5 , 7 – 10 ). The development of social-emotional and other transferable skills furthermore shapes healthy and productive citizens ( 9 ). However, in practice, research has shown that sexuality education is not always effective due to inadequate facilitator training and skills, limited resources, rigid curricula, weak integration of gender and power dynamics, resistance from cultural and political stakeholders, a narrow focus on biological risks over psychosocial factors, and/or lack of participatory teaching methods ( 11 – 14 ). Marginalised AYP experience additional barriers to receiving sexuality education that meets their needs. These barriers often related to access, stigma, sociocultural taboos, discrimination, violence and bullying ( 15 ), and the lack of policies and curricula to address relevant content, for example, related to sexual orientation, gender identity and expression ( 16 ), HIV status ( 17 ) or disability ( 18 ). While significant research has been conducted on the effectiveness of sexuality education, existing literature is often outcome-centered rather than focused on AYP's first-hand accounts of their needs, experiences and preferences. Centering youth perspectives in sexuality education research is essential for designing policies and programmes that reflect their realities and respond to their needs. Recognizing their opinions will not only ensure that sexuality education is evidence-based and context-appropriate but might also challenge adult-driven assumptions about what is relevant in sexuality education. Reviews directly centering youth voices draw largely on high-income contexts ( 19 – 22 ), some of which focus exclusively on qualitative studies ( 19 , 20 ). Given the distinct sociocultural, political, economic, and institutional contexts of low- and middle-income countries (LMICs) ( 23 ), it is important to better understand AYP’s perspectives on sexuality education in these settings. Sexuality education in LMICs is often influenced by international funding streams and policy agendas, which can contribute to both opportunities and resistance ( 24 ). While such support facilitates programme implementation, it may also fuel opposition, particularly from actors who perceive it as an externally imposed agenda. In many LMICs, there remains a noticeable gap between adolescent and youth perspectives and policy-making, primarily due to systemic, socio-cultural and financial barriers that hinder meaningful youth engagement and can contribute to intergenerational misunderstandings of AYP’s needs and interests ( 25 ). These dynamics highlight the importance of capturing AYP’s own voices and perspectives to ensure that sexuality education policies and programmes are not only evidence-based but also contextually relevant and responsive to their lived realities. This review addresses the question: What does the existing literature reveal about the needs, experiences, and preferences of AYP regarding school-based sexuality education in LMICs, and what knowledge gaps remain for future research? Specifically, it examines adolescent and youth perspectives on both content and delivery of sexuality education in formal education, as schools provide a structured and accessible platform for reaching large numbers of learners. While beyond the scope of this study, we acknowledge the importance of out-of-school approaches in ensuring inclusive and contextually relevant sexuality education that leaves no one behind. Methods Scoping reviews have emerged as a suitable method for providing a comprehensive synthesis of the available evidence related to a relatively broad question in a rigorous and transparent way, and – as applied in this study – are being used to explore key concepts, data and evidence gaps as well as to inform future research priorities ( 26 , 27 ). Search strategy Given the multidisciplinary nature of the topic and with the aim of comprehensive coverage of recent literature, the search was conducted in five databases, namely PsycInfo, Medline, ERIC, Web of Science Core Collection and SocINDEX. The search included documents in English published between 2013 and December 2024 1 . Scientific studies, qualitative, quantitative or mixed-methods in nature, and grey literature, such as research reports and evaluations produced outside scientific publishing channels were included. The review focused on the perspectives of AYP aged 10–24 on school-based sexuality education in LMICs, following the World Bank Open Data Catalog classifications of 2023. The search focused on studies capturing sexuality education that was delivered in schools—integrated into core subjects, offered as standalone courses, or provided through extracurricular activities by the government or non-governmental organisations (NGOs). The scoping review did not focus on outcomes or impact, but rather on AYP’s perceptions of school-based sexuality education, shedding light on perceived quality and recommendations for improvement. To answer the research question, documents had to include findings related to at least one of the components related to AYP perspectives, namely self-reported needs, experiences, preferences or recommendations. Older studies, books, documents without firsthand youth perspectives or focusing on AYP from high-income countries, or studies that did not disaggregate adolescent and youth perspectives from those of adult stakeholders such as teachers or parents; as well as studies relating to sexuality education outside the school system were excluded. The search was adjusted per search engine, applying a comprehensive set of search terms across four key concepts: ( 1 ) sexuality education, ( 2 ) AYP’s perspectives, ( 3 ) LMICs, and ( 4 ) school-based education. The search strategy combined controlled terms (e.g., MeSH terms such as "sex education/") and free-text keywords (e.g. youth perspectives), using Boolean operators (AND/OR) and proximity operators (e.g. ADJ7). The full search strategy, including all terms and filters, is detailed in Additional File 1. The search yielded 1.536 results, and as illustrated in Fig. 1 , after deduplication the review considered 865 results. Informed by initial screening against the inclusion criteria on the basis of title and abstract or document summary using Rayyan, 798 documents were excluded. The remaining 67 studies were successfully retrieved and assessed for eligibility. An additional 7 studies were added resulting from hand search, including a grey literature search via key stakeholders’ websites, including UN agencies, international NGOs, and civil society. As the full texts of 74 documents were read, 8 studies were excluded. Details can be found in Fig. 1 . Studies were not excluded based on quality, as the review aimed to capture the broad range of available literature. The search, screening and eligibility assessment were undertaken jointly by one author and a librarian. This resulted in the inclusion and data extraction of a total of 66 studies (see Additional File 2), including 60 scientific peer-reviewed articles and 6 grey literature reports. Data extraction A structured data extraction approach was employed to systematically capture key characteristics of and findings from studies. Three authors co-created and piloted the data extraction sheet on 15 studies, with refinements made following discussions. Remaining data extraction was conducted by a single author. The extraction sheet included study details (publication year, country setting of sexuality education implementation, study type, design and methods), participant demographics (age, sex, social identity markers and school status), and educational context (urban/rural setting, sexuality education terminology, and curriculum details). Drawing from concepts 2 and standards highlighted in the UN International technical guidance on sexuality education (ITGSE) ( 15 ), AYP's perspectives concerning sexuality education content were assessed along preferred topics as well as perceived relevance, comprehensiveness, age- and context-appropriateness, inclusivity, gender sensitivity, and rights-based premises. Related to sexuality education delivery, categorisations of AYP’s experiences and preferences used included stand-alone vs. integrated curriculum; timing and frequency of programmes; teaching methods and set-up; the role of the educator, including their knowledge, attitudes and skills; confidentiality, privacy and safe environments; and the teaching and learning materials used ( 15 ). Finally, acknowledging that curricula and implementation are embedded in wider socio-ecological contexts ( 28 , 29 ), the role of school environments including parental engagement, socio-cultural and political influences on AYP perspectives were documented. While scoping reviews do not traditionally assess study quality, a brief appraisal of study limitations was conducted. Given the heterogeneity of study designs and data types, a narrative synthesis approach was applied to summarize key findings and to identify common themes, gaps, and contextual variations in AYP perspectives on school-based sexuality education in LMICs. Results Characteristics of included studies [Table 1 larger than one A4 to be inserted here – see end of the document text file] Table 1 to be placed at beginning of results section # of studies % of studies Studies Region Sub-Saharan Africa 42 63.6% ( 32 – 36 , 38 , 40 – 43 , 45 , 47 – 50 , 52 , 54 – 58 , 64 , 66 , 67 , 69 , 71 – 73 , 75 , 76 , 78 , 79 , 83 , 85 – 87 , 90 – 93 , 95 , 120 ) Asia-Pacific 17 25.8% ( 30 , 36 , 39 , 46 , 51 , 59 , 61 , 63 , 65 , 68 , 81 , 82 , 88 , 96 , 97 , 120 , 121 ) Latin America and the Caribbean 7 10.6% ( 36 , 50 , 53 , 70 , 74 , 80 , 120 ) Middle East and Northern Africa 3 4.5% ( 44 , 60 , 84 ) Eastern Europe and Central Asia 1 1.5% ( 37 ) Study designs Qualitative 43 65.2% ( 31 – 35 , 38 – 43 , 45 , 47 , 52 – 55 , 60 , 63 – 72 , 74 , 76 , 78 , 79 , 85 – 88 , 90 – 93 , 95 , 96 , 120 ) Quantitative 12 18.2% ( 37 , 49 , 56 , 58 , 59 , 61 , 70 , 75 , 81 – 84 ) Mixed-methods 11 16.7% ( 30 , 36 , 44 , 46 , 48 , 50 , 51 , 62 , 73 , 80 , 97 ) Use of creative and participatory research methods 9 13.6% ( 30 – 38 ) Involvement of youth as co-researcher 7 10.6% ( 32 , 36 , 38 – 42 ) Participant characteristics Currently in (primary or secondary) school 49 74.2% ( 30 – 34 , 41 – 45 , 48 , 50 – 59 , 62 – 67 , 70 – 76 , 78 – 80 , 83 – 86 , 88 , 90 – 93 , 95 – 97 ) Retrospective reporting 6 9.1% ( 35 , 39 , 60 , 81 , 82 , 87 ) Mix of educational backgrounds 6 9.1% ( 37 , 38 , 40 , 46 , 61 , 68 ) Educational background not specified 3 4.5% ( 36 , 69 , 120 ) Aged 10–12 18 27.3% ( 30 , 31 , 33 , 34 , 40 , 47 – 49 , 57 , 58 , 64 , 70 , 76 , 78 – 80 , 84 , 97 ) Aged 13–15 49 74.2% ( 30 – 37 , 40 – 44 , 47 – 51 , 53 , 56 – 59 , 61 , 63 , 64 , 66 – 68 , 70 – 73 , 75 , 76 , 78 – 81 , 83 – 85 , 88 , 90 – 92 , 95 – 97 ) Aged 16–19 60 90.9% ( 30 , 31 , 34 – 56 , 58 – 63 , 65 – 78 , 80 – 88 , 90 – 93 , 95 , 97 ) Aged 20–24 20 30.3% ( 35 – 39 , 45 , 46 , 51 , 53 , 60 , 75 , 77 , 80 , 81 , 85 , 87 , 88 , 91 , 93 , 97 ) Male and female participants 57 86.4% ( 30 – 33 , 37 , 38 , 40 – 42 , 45 – 49 , 51 – 54 , 56 , 57 , 59 – 67 , 69 – 78 , 80 – 88 , 90 – 93 , 95 – 97 ) Female participants only 3 4.5% ( 34 , 43 , 44 ) Male participants only 1 1.5% ( 39 ) Sex not specified 6 9.1% ( 35 , 36 , 50 , 55 , 68 , 79 ) Reporting on at least one additional social identity marker (disability, ethnic identity, socio-economic status, religion, ethnic or racial identity, sexual orientation and gender identity, record of abduction, pregnancy, HIV status, living situation, relationships status and/or parents’ background characteristics) 42 63.6% ( 30 , 32 – 34 , 36 , 38 , 39 , 41 , 42 , 44 – 57 , 59 – 77 ) Urban setting 16 24.2% ( 43 , 45 , 51 , 52 , 58 – 60 , 63 , 65 , 68 , 69 , 74 , 75 , 79 , 81 , 82 ) Semi-urban setting 2 3.0% ( 34 , 48 ) Rural setting 4 6.1% ( 71 , 78 , 90 , 95 ) Participants from mixed settings 22 33.3% ( 30 , 33 , 39 – 41 , 44 , 47 , 50 , 54 – 57 , 61 , 64 , 70 , 73 , 76 , 80 , 83 , 85 , 92 , 97 ) Setting not specified 22 33.3% ( 31 , 32 , 35 – 38 , 42 , 46 , 49 , 53 , 62 , 66 , 67 , 72 , 77 , 84 , 86 – 88 , 91 , 93 , 96 ) Sexuality education programme Ministry of Education-led 39 59.1% ( 30 , 32 , 34 , 35 , 40 – 42 , 45 , 47 , 48 , 50 – 55 , 57 , 59 , 63 – 66 , 68 , 69 , 71 – 73 , 76 , 78 , 79 , 82 , 85 – 87 , 91 , 92 , 96 , 97 ) School-based NGO-led 9 13.6% ( 33 , 38 , 56 , 57 , 62 , 67 , 90 , 93 , 95 ) Mix of programmes 4 6.1% ( 31 , 39 , 43 , 80 ) Curriculum not specified 14 21.2% ( 32 , 36 , 37 , 44 , 46 , 49 , 58 , 60 , 61 , 75 , 77 , 81 , 84 , 88 ) AYP’s perspectives on specific components of school-based sexuality education Overall attitudes toward school-based sexuality education 33 50% ( 33 , 37 – 39 , 42 , 43 , 45 – 47 , 51 , 55 – 62 , 65 , 66 , 73 , 74 , 77 – 85 , 87 , 88 ) Specific sexuality education topics 33 50% ( 30 , 31 , 38 , 41 , 43 – 45 , 48 , 50 – 53 , 55 , 58 , 60 , 65 – 68 , 73 – 76 , 78 , 80 , 82 , 83 , 85 – 88 , 90 , 97 ) Comprehensiveness and/or relevance of content 52 78.8% ( 30 , 32 – 36 , 38 – 40 , 42 – 50 , 53 – 55 , 57 , 58 , 60 – 62 , 66 – 70 , 73 – 85 , 87 , 88 , 90 – 93 , 95 , 97 ) Gender-sensitivity, inclusivity and/or rights-based premises of content 21 31.8% ( 32 , 34 , 35 , 39 – 43 , 45 , 48 , 52 , 54 , 55 , 67 – 70 , 74 , 85 , 87 , 88 ) Age- and/or context-appropriateness of content 7 10.6% ( 34 , 51 , 65 , 70 , 71 , 74 , 93 ) Modality (Stand-alone vs. integrated, sex-segregated vs. mixed classroom, location of delivery, timing and frequency) 22 33.3% ( 14 , 33 , 41 , 42 , 50 , 57 , 58 , 60 , 64 , 66 , 69 , 73 , 74 , 76 , 78 – 80 , 84 , 85 , 88 , 92 , 96 ) The educator (Characteristics, knowledge, attitudes, skills) 43 65.2% ( 31 – 33 , 37 , 39 , 41 – 57 , 61 , 63 , 64 , 66 , 68 – 73 , 76 , 77 , 79 , 80 , 85 , 86 , 88 , 90 , 93 , 95 , 96 ) Learning environment (Interactions in the classroom, safety, confidentiality) 31 47.0% ( 30 – 32 , 41 , 43 , 44 , 47 , 50 , 52 , 54 , 55 , 57 , 61 , 63 – 65 , 69 , 71 – 74 , 76 , 77 , 80 , 81 , 85 , 88 , 90 , 95 – 97 ) Table 1 Descriptive characteristics of included studies (n = 66) As illustrated in Table 1 , the analysis reveals a strong geographical bias in the reviewed studies, likely affected by the search conducted in English language only. Sub-Saharan Africa (n = 42) —particularly because of 14 studies from South Africa— is overrepresented, followed by Asia-Pacific (n = 17). Latin America and the Caribbean (n = 7) see limited coverage, while the Middle East and Northern Africa (n = 3) as well as Eastern Europe and Central Asia (n = 1) remain severely underrepresented. The review includes 43 qualitative, 12 quantitative, and 11 mixed-methods studies, although AYP perspectives in three of the latter mainly draw on the quantitative component. Most studies applied ‘traditional’ methods, i.e. focus group discussions and individual interviews or questionnaires, with only nine studies reporting on creative and participatory methods such as drawing ( 30 – 32 ), storytelling ( 33 ), dialogic engagement ( 34 , 35 ), co-creation ( 36 ) or surveys ( 37 ) using digital platforms or the use of a ‘Pleasuremeter’ tool ( 38 ). Only seven of 66 studies reported on the involvement of youth researchers, in authorship ( 39 ), participatory action research ( 32 ), co-design approaches ( 36 ), as data collectors ( 38 , 40 , 41 ) or with recognition as collaborators ( 42 ). Most AYP were in (primary or secondary) school during data collection (n = 49). The review shows that most studies center the voices of learners of 16–19 years (n = 60), while adolescents aged 10–12 are least represented (n = 18). The majority of studies included male and female participants (n = 57), with few focusing specifically on adolescent girls or young women( 34 , 43 , 44 ) or adolescent boys and young men ( 39 ). Two thirds of studies reported on at least one other social identity marker of participants, regarding AYP’s disability ( 45 – 47 ), ethnic identity ( 46 , 48 – 51 ), racial background ( 34 , 42 , 52 – 55 ), religion ( 41 , 48 , 49 , 56 – 64 ), socio-economic status ( 32 , 34 , 41 , 51 , 53 , 57 , 60 , 61 , 64 – 67 ), sexual orientation and gender identity ( 30 , 46 , 55 , 68 ), HIV status ( 33 , 38 , 69 ), migration status ( 46 , 70 ), ever being pregnant( 71 – 74 ) or current relationship status ( 73 ), living situation ( 56 , 75 , 76 ), ever been abducted( 73 ) or diverse parental background characteristics ( 39 , 44 , 46 , 70 ). Overall, few offered disaggregated/comparative analysis based on these characteristics, while some focused exclusively on specific groups such as AYP living with HIV ( 69 ), lesbian, gay, bi, trans, intersex and queer (LGBTIQ+) learners ( 55 , 68 , 77 ), young parents ( 32 , 74 ), racial minority learners( 54 ) and AYP with intellectual( 45 ) or physical disabilities ( 47 ). Out of the studies reporting on location (n = 44), most included urban and rural settings (n = 22), while four times as many studies focused specifically on urban youth (n = 16) compared to rural AYP (n = 4). The majority of studies (n = 39) reported that the Ministry of Education designed, and teachers delivered the curriculum, while nine studies reported on NGO-led curricula in schools and four included a mix of programmes. The review shows that the majority of studies centering AYP voices focus on aspects related to the comprehensiveness and relevance of sexuality education content (n = 52), educators’ characteristics, knowledge, attitudes, and skills (n = 43), as well as overall attitudes toward school-based sexuality education or experiences with specific sexuality education topics (n = 33 each). Additionally, teaching methods and materials (n = 30) and the learning environment (n = 31) also receive notable attention. However, significant gaps exist in research on the age- and context-appropriateness of content (n = 7). Furthermore, studies addressing AYP perspectives on experiences and preferences regarding gender sensitivity, inclusivity, and rights-based premises of sexuality education (n = 21) as well as delivery modality (n = 22) remain relatively limited. AYP’s strong demand for school-based sexuality education Findings across studies and countries demonstrate a strong demand for school-based sexuality education among AYP from LMICs, with many perceiving it as essential for their well-being, decision-making or future opportunities ( 33 , 37 , 38 , 42 , 51 , 60 , 66 , 70 , 74 , 78 – 81 ). Learners commonly associated sexuality education with staying in school, avoiding early marriage, and preventing unintended pregnancies, highlighting its perceived role in supporting educational attainment and preventing negative sexual and reproductive health (SRH) outcomes. Only one quantitative study from China reported that college students had mixed attitudes about school-based sexuality education, with some fearing it could encourage earlier sexual activity, others disagreeing, and the majority remaining uncertain ( 82 ). Studies also found that AYP who had received sexuality education were significantly more likely to recognize its importance and advocate for its provision compared to their peers who had not received such education ( 56 , 73 , 83 , 84 ). At the same time, a qualitative study from South Africa found that students became increasingly resistant and disinterested in sexuality education when they felt it failed to provide meaningful learning, as it remained too simplistic—focusing on biological facts like virus transmission rather than advancing their knowledge holistically ( 41 ). This suggests that while exposure to sexuality education may increase awareness of its relevance and importance, a curriculum that fails to provide meaningful education could lead to disengagement among students. Variation in perceived needs for sexuality education is further influenced by several demographic factors. With regards to school level, adolescents in Nigerian senior secondary schools, Tanzanian secondary schools or Lebanese middle schools were more likely to express a strong need for sexuality education compared to those in junior secondary school ( 56 , 83 ), primary school ( 58 ) and lower grades ( 84 ) respectively, possibly due to their increasing exposure to relationships and social pressures. While studies from Ecuador and South Africa reported on similar support for sexuality education among urban and rural participants ( 74 , 85 ), a quantitative study from Nigeria ( 83 ) found that rural adolescents expressed a greater need for school-based SRH interventions than their urban counterparts, which could reflect disparities in access to information and services. Findings from India reported no gender differences regarding perceived need for Family life education ( 61 ), while a qualitative study from Ethiopia observed girls demonstrating higher levels of engagement and valuing sexuality education more than boys, as reflected in their consistent attendance, participation, and advocacy for sessions ( 43 ). While the reviewed studies concur that AYP express a need for and support of school-based sexuality education, several studies indicate that these needs were largely unmet due to insufficient or non- existent implementation ( 39 , 55 , 61 , 65 , 73 ). The following sections explore how specific experiences with the content and delivery of sexuality education shape to what extent AYP’s needs are met or remain unmet. AYP’s perspectives on sexuality education content This section explores AYP’s experiences and preferences regarding the content of sexuality education, grouped for this analysis according to the ITGSE concepts ( 15 ): Relationships; Values, Rights, Culture and Sexuality; Understanding Gender; Violence and Staying Safe; Skills for Health and Wellbeing; The Human Body and Development; Sexuality and Sexual Behaviour; and Sexual and Reproductive Health. It also reflects their perspectives on the overall comprehensiveness, relevance, inclusivity, and the extent to which programmes are gender- and rights-based, as well as age- and context-appropriate. Sexuality education is perceived to emphasize biology and abstinence over relationships, rights, gender, and diversity According to AYP from LMICs, the most consistently covered areas in school-based sexuality education are topics related to The Human Body and Development such as sexual and reproductive anatomy, physiology, menstruation and personal hygiene and puberty ( 30 , 31 , 36 , 43 , 48 , 50 , 65 , 78 ). Other commonly highlighted topics included those related to Sexual and Reproductive Health such as pregnancy and pregnancy prevention ( 30 , 53 , 86 ) — although often with an emphasis on abstinence following the ABCD (Abstain, Be faithful, Use a Condom Delay sexual initiation) model ( 43 , 47 , 54 , 58 , 59 , 61 , 75 , 84 , 94 ). Across studies, perceived coverage of the topics related to STIs and HIV/AIDS transmission and prevention varied between frequent in Brazil, Ghana, Nigeria and South Africa ( 48 , 53 , 76 , 87 ) and low in Guatemala and Thailand ( 31 , 50 ). Discussions on Skills for Health and Well-being such as self-esteem, decision-making, and communication skills were noted only in a mixed-methods study from Nigeria ( 48 ). Understanding gender, including gender norms, gender equality and gender-based violence also appeared inconsistently covered ( 43 , 50 ) or as de-emphasized ( 46 ). Topics related to Relationships, such as self-esteem, love, friendship and family relationship ( 46 , 48 ) as well as to Values, rights and culture ( 46 ) further seem to be minimally covered. Some studies pointed out notably absent or underrepresented topics, related to Sexuality and Sexual Behaviour including pleasure ( 50 , 67 , 75 , 86 ), LGBTQ + identities( 31 , 67 , 75 , 86 ) and risk-related topics such as drugs, alcohol and abuse ( 33 ), diverse body images including physical disabilities ( 31 ), and the role of digital media in sexualities ( 31 , 48 ). AYP would prioritize learning about navigating relationships, consent and safety as well as sexuality; with preferences shaped by age, gender and other social identity markers While The Human Body and Development tends to be the most reported concept covered, some studies also stressed that AYP would like to learn more about puberty and pubertal changes ( 40 , 68 , 83 ). Other key areas of interest for additional or more in-depth learning expressed by AYP included contraception and safe sex practices ( 35 , 38 , 50 , 62 , 83 , 88 ), including STI prevention ( 83 , 88 ), particularly emphasizing the practical guidance on contraceptive use and accessing services. While sexuality education programmes in LMICs seemingly tend to avoid direct teaching on sexuality and sexual behaviours, AYP from several studies voiced their curiosity about these topics, such as engaging in sexual activities ( 38 , 68 , 85 , 89 ), including specific topics such as premarital sex ( 44 , 90 ), transactional sex ( 91 ), masturbation and porn ( 35 , 38 ), pain during sex ( 40 ) and diverse sexual orientations ( 40 , 54 , 55 , 68 ). In several studies, AYP suggested discussions on topics related to Relationships ( 38 , 40 , 50 , 90 ) and emotions ( 85 ). The preferences on topics regarding Skills for Health and Well-being, particularly on navigating consent and negotiating safe sex ( 35 , 40 , 50 , 55 ) were frequently mentioned in direct connection with Violence and Staying Safe. Another commonality was that many participants highlighted their curiosity to learn about staying safe from violence and coercion ( 36 , 45 , 46 , 67 , 70 , 74 , 80 , 83 , 88 , 91 ). A mixed-methods study from Nigeria, India, the US and El Salvador further highlighted that AYP whose age at first sex was below 10 years were reported to be 2.3 times more likely to be interested in learning about how to say no ( 36 ). In a mixed-methods study in the Dominican Republic and qualitative studies from China and South Africa, AYP highlighted a need to address mental health and emotional support, particularly for pregnant adolescents ( 80 ), AYP living with HIV ( 69 ) and in relation to social media pressure and self-esteem ( 88 ). While few studies discussed specific interests around Understanding gender, adolescent males aged 10–14 years interviewed in Ghana were interested in perceived gender-based disparities, such as favoritism toward girls in schools and at home ( 40 ), pointing to gaps in critical gender literacy among AYP. AYP’s sexuality education interests varied by demographic background and identity markers. Studies showed that older adolescents generally prioritized a broader variety of topics, for instance when comparing responses of 10–13-year-olds with adolescents aged 14–16 regarding gender roles, sexual health and rights, relationships, diversity, and violence prevention in Ecuador ( 70 ). In a Nigerian study, younger adolescents (11–13 years) reported more support for abstinence-only teaching than respondents aged 14–19 years; ( 58 )( 49 ) and older youth among interviewees 15–24 years (no age specification provided) reported being more interested in improving sexual relationships and performance, as well as hiding or enhancing their gender or sexual identity in Thailand ( 68 ). This suggests that cognitive and identity development as well as social exposure shape adolescents’ preferences for sexuality education topics. In Ecuador, female secondary school learners generally expressed higher needs for learning about CSE compared to boys surveyed ( 70 ). In contrast,girls in Tanzania were less likely than boys to prioritize discussions on pleasure and decision-making ( 58 ). While in Uganda, male secondary school learners expressed a need for self-control and refusal skills to abstain from sex, girls interviewed were more concerned about sexual harassment and pressure from boys to engage in sex ( 91 ). Additionally, in Thailand, cis-gender young men prioritised clear and unambiguous sexual knowledge, straight young women focused on relationships and attractiveness, and LGBTQ + youth wanted to learn more about navigating identity and societal barriers ( 68 ). Primary and secondary school learners with varied disabilities (visual, hearing, speech, physical, intellectual, and developmental) interviewed in a multi-country study including Botswana, Eswatini, Ghana, Malawi, Uganda and Zambia particularly stressed a need for content addressing self-esteem, the desire to feel accepted, and risks of sexual exploitation, abuse, and coercion ( 47 ). These variations highlight how gendered social expectations, power imbalances and experiences of stigma, and differing levels of agency in sexual decision-making might affect AYP’s preferences for sexuality education content. Incomplete and ‘out of touch’ with AYP’s realities: A call for more comprehensive, accurate and practical sexuality education The review shows that while school-based sexuality education can successfully increase awareness and be considered informative by AYP, mostly in relation to education about human development and SRH ( 43 , 61 , 92 ), it has frequently been described as incomplete ( 39 , 40 , 42 , 48 , 53 , 54 , 62 , 63 , 67 , 75 , 76 , 80 , 85 , 86 , 89 , 91 ). Selective information, misinformation, and knowledge gaps risk leaving adolescents uncertain about their SRHR and well-being ( 42 ). Framing it as a “discourse of disconnect”( 87 ) or “out of touch” ( 34 ), adolescents from China, the Gambia, Nigeria and South Africa experienced their sexuality education largely as irrelevant to, or unhelpful in, their lives ( 32 , 48 , 82 , 85 , 89 ). Even within HIV/STI prevention and contraception education, students seem to be more likely to learn factual information rather than practical skills needed to handle sexual pressures and real-life situations (e.g., how to use contraceptives or negotiate safer sex) ( 48 , 50 ). That learning is often perceived as inadequate has specifically been expressed amongst marginalized AYP, such as adolescents living with HIV in Uganda( 78 ) and LGBTIQ + youth in South Africa and Thailand ( 55 , 68 ). Few studies offered qualitative insights of AYP positively assessing their sexuality education. AYP from Madagascar appreciated that the programme content complemented other sources of information about SRH while they considered the CSE programme covered this information in more depth, and at the opportune time ( 93 ). Chinese students interviewed and AYP from Botswana, Eswatini, Malawi, Uganda, Zambia found the topics relevant to their needs, suggesting broad support for the curriculum ( 47 , 88 ) – although the latter multi-country study distinguished that learners from Ghana felt that the content was not detailed enough to fully address their knowledge aspirations ( 47 ). These experiences underscore that perceived relevance and in-depth learning enhance sexuality education’s perceived effectiveness. Consequently, the review found a strong demand from AYP from LMICs for more comprehensive ( 33 , 40 , 42 , 43 , 50 , 58 , 67 , 70 , 73 , 85 , 88 ), accurate ( 40 , 42 , 91 ) and applicable ( 50 , 74 ) sexuality education. Concerns raised about fear-based and stigmatizing messages, gender bias, heteronormativity and structural inequalities in sexuality education AYP reported that sexuality education teaching, particularly in relation to topics like abortion, sex and sexual diversity, and STIs including HIV, were predominantly framed in negative, problem-based, or risk-focused terms across countries ( 30 – 32 , 35 , 42 , 55 , 67 , 75 , 76 , 87 ). Few studies have focused on comparative analysis, however, a qualitative study from South Africa found that urban schools placed greater emphasis on broader sexuality issues, while rural schools focus more on HIV/AIDS education, reflecting a narrower, disease-prevention approach in rural areas ( 85 ). Another prominent concern raised by AYP is the sexual gendered double standards embedded in sexuality education. Participants across a variety of study contexts, majority female, recalled moralist and prescriptive sexuality education teaching ( 30 , 39 , 41 – 43 , 48 , 54 , 74 , 86 , 87 ), reinforcing gendered social and moral restrictions on adolescent sexuality. Examples include stereotypical framing of male and female sexuality, such as men having uncontrollable sexual urges and entitlement to sex and women as passive recipients of male sexual advances in Ethiopia ( 67 ) or the “onus of abstinence” falling mainly on girls in South Africa ( 42 ). Male participants from Nigeria and South Africa reported lower access to sexuality education at schools ( 48 , 85 ), reflecting gendered norms that position girls as needing protection and boys as sexually autonomous. Some AYP shared that lessons on gender equality helped them break down stereotypical attitudes toward relationships, marriage, and domestic responsibilities - particularly among boys in China ( 88 ). A South African study stressed adolescents’ accounts on sexuality education that framed sexuality in simplistic and deviant ways ( 41 ). Adolescent girls interviewed in Ethiopia criticized that sexuality education primarily focused on violence in the home, making school-based violence harder for students to recognize and report ( 43 ). The heteronormativity of sexuality education content has particularly been documented in studies with an intentional focus on LGBTIQ + youth perspectives from South Africa ( 34 , 52 , 54 , 55 ) and Thailand ( 30 , 68 ). A qualitative study from China suggested that young people’s sexuality education experiences were shaped by class-based school divisions, meaning that students in vocational schools perceived receiving less comprehensive and more stigmatizing sexuality education than their peers in other educational tracks ( 65 ). Also, a qualitative study from South Africa concluded that Life Orientation classes missed to critically engage with how race and class shape experiences of sexuality, beauty, and empowerment ( 34 ). This highlights the underused transformative power of sexuality education, as it often fails to address intersecting oppressions that shape AYP’s experiences and opportunities. Few studies included AYP’s specific first-hand recommendations, some calling for a more gender-responsive approach to sexuality education ( 40 ), that reflects diverse identities and experiences in non-judgmental ways ( 55 , 68 ) and frames sexuality in a sex-positive and empowering way ( 40 , 42 , 70 , 94 ). The latter has also specifically been voiced by AYP living with HIV in Tanzania ( 69 ) and learners with intellectual disabilities in Kenya ( 45 ). Limited evidence on AYP’s views on age- and context-appropriate sexuality education Few studies have examined how AYP perceive the appropriateness of content covered in their sexuality education classes. A qualitative study in Botswana, Eswatini, Ghana, Malawi, Uganda and Zambia found that some primary school learners felt the content was too advanced and would be more appropriate for secondary school students ( 47 ). Some students (14–19 years) from South Africa indicated feeling uncomfortable discussing sexuality-related topics with adults, which the authors of this study interpreted in relation to internalized parental views that they are too young for such discussions ( 72 ). In contrast, adolescents (13–17 years) in a mixed-methods study from Myanmar emphasized that they did not think they were too young to know or learn about sexuality; and that they believed that all teaching was appropriate for their age ( 51 ). Learners from the Gambia emphasized their preference for a staggered approach, recommending that some topics, such as puberty and menstruation, should be introduced in lower basic school, while broader sexuality education should continue in upper basic school to ensure age-appropriate learning ( 66 ). These differences underscore the importance of phased and developmentally appropriate sexuality education that considers individual readiness. Notably, given the influence of international actors in shaping sexuality education policies in LMICs, an important research gap emerges as existing studies have largely overlooked how learners perceive the contextual appropriateness of such education. AYP’s perspectives on the delivery of sexuality education This section synthesizes AYP’s perspectives on how sexuality education in LMICs is delivered in schools, including reflections on the modality of delivery, the role and characteristics of the educator, the school-based learning environment, and the teaching methods used. AYP’s views on timing and frequency, subject integration, gender segregation and prioritisation of sexuality education While the above section on age-appropriateness of content showed that AYP did not always feel comfortable with some topics, some AYP expressed concerns about the late introduction of sexuality education. Students from Uganda lamented that sexuality education was only taught in senior classes, excluding younger adolescents who might benefit from early exposure before real-life situations arise ( 78 ). When it comes to preferences, 76% of Tanzanian primary school students and 66% of secondary school students surveyed believed that Sex and Relationships Education should begin in primary school, with Class 4 (around age 10) being the most frequently suggested starting point ( 58 ). Tanzanian learners in another qualitative study proposed initiating sexuality education when puberty is reached( 79 ) and Gambian learners emphasized a need before sexual debut ( 66 ). These findings suggest AYP’s preference for earlier, more timely sexuality education delivery. Some studies highlighted AYP’s challenges with sexuality education’s integration into broader subjects. More than 40% of Bosnian and Herzegovinian and about 26% of Ugandan learners surveyed suggested sexuality education to be implemented as a standalone subject ( 37 , 67 ). These studies listed several possible improvement options beyond delivery modality, and thus do not indicate how many remaining learners preferred integration; rather they reflect that a substantial share of AYP interviewed argued sexuality education deserves the same weight as other school courses. Some learners from Nigerian and South African qualitative studies also recommended that sexuality education should be a standalone subject ( 42 , 92 ). Students widely felt that too little time was allocated to sexuality education, often being overshadowed by other subjects or implemented with limited frequency ( 42 , 47 , 50 , 63 , 66 , 74 , 80 ), calling for longer and frequent sessions. A mixed-methods study from Ghana and a qualitative study from Indonesia emphasized that the limitedly available number of lessons may restrict the depth of content, leading to superficial coverage of key topics and leaving students feeling that they have not learned enough ( 62 , 63 ). In contrast, having a dedicated on-site educator who engages with students regularly, reportedly created opportunities for deeper discussions, follow-ups, and trust-building ( 64 ). There is also concern that sexuality education is not taken seriously in schools due to the lack of formal assessments ( 41 ), with some South African and Zambian AYP even advocating for its inclusion in final exams ( 85 , 95 ). Overall, research on AYP’s delivery preferences remains limited. Preferences on delivery approaches varied— with 44% of Lebanese adolescents (11–16 years) surveyed, some Sierra Leonan students (10–14 years) and most Tanzanian (12–14 years) and Gambian learners interviewed (15–19 years) favouring mixed-gender discussions for inclusivity ( 33 , 57 , 84 , 89 ), while learners from China (from grade 8 and 9, presumably 13–15 years) preferred single-gender sessions for comfort( 88 ) and a multi-country study involving primary and secondary school students from Sub-Saharan Africa showing mixed results ( 47 ). The latter study found that in rural schools in Zambia, girls preferred sex-segregated classes, whereas in peri-urban and urban schools, girls and boys were comfortable to be taught together. That these preferences across and within studies differed underlines students’ comfort being conducive to their learning as well as the importance of tailoring delivery to context. AYP’s perspectives on educators’ age, gender, expertise, attitudes and skills The review shows that the role of the educator has a strong effect on AYP’s satisfaction with sexuality education delivery, with varying findings regarding educators’ age, gender, professional background, and lived experiences. Younger educators tend to be seen as relatable, fostering trust and engagement ( 37 , 64 , 80 ), whereas older educators were valued for experience ( 95 ). Gender dynamics also play a role, with students often favouring same-sex educators, particularly for sensitive topics ( 44 , 51 , 57 , 90 ) and in rural areas, as a study from Iran suggests ( 44 ). A study from South Africa emphasized “cross-gender relatability”, challenging this widespread preference for same-sex teachers by showing that – when implemented with care - students can also connect with educators of a different gender ( 41 ). Some studies highlighted the empowering effect that sexuality education teachers’ supportive attitudes can have on AYP ( 41 , 69 , 80 , 93 , 95 ). A qualitative study from Madagascar illustrated that relatable, inclusive, and caring educators who communicate sensitive sexuality education topics in a direct and engaging manner fostered stronger student connections and created a more effective learning environment ( 93 ). In South Africa, positive relationships with Life Orientation educators were reportedly built on trust, confidentiality, consistency between values and behaviour, and the use of supportive, non-punitive discipline strategies that encouraged open discussions on sexuality education ( 41 ). Expertise, approachability, and inclusivity were also highlighted as positive educator traits in another South African and a Myanmar study ( 51 , 55 ). Several studies highlight AYP’s appreciation for diverse perspectives, including guest speakers and individuals who share personal stories, as these approaches made lessons more engaging and relevant ( 41 , 42 , 64 ). Students from Ghana, Myanmar, South Africa, Tanzania and Uganda expressed a preference for educators with expertise in SRH, such as healthcare professionals, over schoolteachers, citing their specialized knowledge and approachability ( 51 , 64 , 72 , 73 , 76 , 85 ), particularly in contexts where teachers are perceived as making them feel uncomfortable or to be judgmental, as documented in some South African schools ( 55 ). Many students interviewed in another South African study, however, ultimately preferred Life Orientation educators over civil society organisation facilitators due to their teaching experience and ability to maintain order in the classroom ( 64 ). This shows that students value thematic expertise as well as effective teaching and classroom management skills in educators. Several studies highlight that educators were perceived as judgmental ( 42 , 43 , 48 , 66 , 71 ), contributing to unsafe or uncomfortable learning environments. Many participants reasoned that teachers' religious and cultural beliefs ( 42 , 47 , 50 , 53 , 63 , 71 ), discomfort ( 33 , 38 , 47 , 63 , 69 , 71 , 73 , 92 , 96 ) and lack of knowledge ( 66 , 68 ) influenced their teaching. Students who expressed lack of trust in their educators often cited moralising attitudes ( 42 , 48 , 55 , 66 )—particularly towards girls ( 43 , 53 , 90 ), non-normative sexualities ( 55 ), and students returning after pregnancy ( 55 ). Adolescent voices from a qualitative study from Brazil further highlighted that some teachers reproduced racial biases within the classroom, reinforcing inequities and influencing their perceptions of self-worth and appearance ( 53 ). Language style and educators’ communication skills affect student receptiveness to sexuality education. In Nigeria and South Africa, students found formal, outdated, or overly direct terminology uncomfortable, limiting engagement ( 69 , 92 ). In Botswana, vernacular use was sometimes perceived as inappropriate ( 47 ), while in the Dominican Republic, students valued clear, respectful, and example-based delivery ( 77 ). Learners with disabilities interviewed from Botswana, Eswatini, Ghana, Malawi, Uganda and Zambia overall expressed appreciation for their schools for providing specialized teachers who could communicate with students with different disabilities and enable them to learn about sexuality education concepts, but that they often lacked key communication skills, such as sign language and braille, creating barriers for students with disabilities ( 47 ). Challenges to safe, healthy and inclusive learning environments for sexuality education AYP believed that some educators failed to create safe, inclusive learning spaces due to insufficient training ( 48 , 71 , 74 , 77 , 85 , 92 ) and highlighted perceived power imbalances and teachers enacting harsh authority or favouritism ( 30 , 54 , 93 ). Feeling unsafe in the classroom, in return, can affect learners’ willingness to ask questions and participate ( 43 , 69 ). Peer pressure and teasing can create discomfort ( 43 , 54 , 57 , 71 , 72 , 90 ). These factors contribute to many AYP reportedly feeling shy and embarrassed ( 43 , 54 , 71 , 73 , 74 , 76 , 90 ) during sexuality education. One study furthermore highlighted disruptive behaviour, particularly by boys, such as laughter and side conversations, hindering engagement ( 47 ). Gender-biased classroom dynamics limit opportunities for equal learning and discussion. Female participants in qualitative studies from Ethiopia, Iran and South Africa expressed fear of being labeled negatively if they participated openly ( 43 , 54 , 90 ). Girls living in Iranian villages experienced greater fear of being labeled than urban girls, highlighting geographical and cultural differences in how stigma affects engagement with sexuality education ( 44 ). Finding relatively low satisfaction rates overall, only a survey with Chinese adolescents suggests that girls (56.62%) felt safer and more comfortable for puberty discussions at school, compared to boys (42.9%) ( 97 ). Some studies also touched upon confidentiality concerns and a risk for distress during sexuality education classes, particularly for survivors of sexual violence ( 71 ) and those navigating LGBTIQ + identities ( 55 ). Learners recommended that educators should receive training and support that enables them to teach sexuality education confidently and with an open mind ( 66 , 68 , 85 , 92 ). Other suggestions to promote safer learning environments included smaller discussion groups ( 31 ) as well as to increasing trust-based relationships between students and educators ( 33 , 66 ). Moving beyond lectures: AYP call for adequate, interactive and inclusive sexuality education methods and materials AYP from a variety of LMICs overwhelmingly critiqued traditional, lecture-based sexuality education methods as passive, adult-centric, and disengaging ( 30 , 31 , 53 , 68 , 74 , 76 , 92 ) and that educators often failed to use practical teaching strategies ( 31 , 68 , 71 , 85 , 97 ). Conversely, students expressed preferences for interactive, student-centered approaches ( 38 , 42 , 47 , 74 , 88 , 95 ). Accounts on positive learning experiences from Zambia suggest the effectiveness of methods such as group discussions and role-playing ( 95 ), which encourage active participation and reflection. The use of videos and films depicting real-life scenarios seems particularly valued ( 68 , 71 , 85 , 95 ), as they not only capture learners’ interest but also foster emotional engagement with sensitive topics. A mixed-methods study from Asia-Pacific concluded that AYP respondents who reported receiving sexuality education through participatory methods appeared to be “more satisfied” with the sexuality education they had received than those who did not ( 46 ). Similarly, female and male participants in a Madagascan study highlighted that the programme’s learner-centred, participatory approaches diminished their shyness and gradually built their self-confidence ( 93 ). However, particularly in unsafe learning environments, shy and introverted participants might struggle to engage with such approaches, preferring teaching methods that feel less exposing ( 31 , 71 ). Peer education ( 44 ) and digital learning platforms ( 41 , 88 ) have also been suggested as useful tools to complement classroom instruction, possibly offering accessible and youth-friendly alternatives to traditional learning. While few studies include direct recommendations from AYP in this regard, it seems that AYP advocate for a sexuality education pedagogy that effectively addresses topics in an engaging and inclusive manner ( 38 ) and reflective of their lived realities with practical demonstrations ( 68 , 71 ). AYP’s perspectives on the wider school environment, school leadership and parental involvement A persistent challenge that extends beyond sexuality education delivery is the availability and quality of teaching materials in schools in LMICs. Students from African, Asian and Latin American countries reported a lack of textbooks and educational materials ( 33 , 47 , 57 , 66 , 68 , 73 , 74 , 79 , 92 , 96 ). Only a mixed-methods study from China reported on widespread availability of learning materials, with over 90% of students stating to have access to some sexuality education materials, including textbooks, flyers, handouts, and videos ( 97 ). Inadequate or outdated curricula can further limit the comprehensiveness of sexuality education ( 33 , 42 , 68 , 96 ), particularly regarding LGBTIQ + topics, sex and pleasure, HIV positive learners and gender diversity ( 38 , 68 ). For students with disabilities, the absence of adapted teaching tools, such as sign language guides and braille materials, further exacerbates exclusion ( 38 , 47 ). Safety and discrimination concerns go beyond the sexuality education classroom and need to be addressed at school-level. A study from South Africa stressed that schools reinforce cis- and heteronormativity through disciplinary violence and social policing, marginalizing LGBTIQ + youth and silencing allies who challenge exclusion ( 55 ). A study focusing on gender dimensions of sexuality education in Ethiopia also highlighted that implementation failed to address critical school environment concerns, leaving girls feeling unsupported and vulnerable to harassment and exclusion ( 43 ). Experiences of racial discrimination at school, from either classmates or teachers, in Brazil reveal the burden of structural inequalities reproduced at school affecting Black adolescents’ education, particularly girls’ ( 53 ). Also the reported disconnect between schools’ overall curriculum and the lived experiences of marginalized students (in the case of South Africa, for instance, the so-called "day girls" coming from working-class backgrounds and from black townships), underscores the need for schools to better support learners’ diverse socio-economic, cultural, and sexual health challenges in order to provide effective sexuality education ( 34 ). AYP from several studies stressed that their parents are an important source of sexuality education ( 48 , 67 , 95 ). Conflicting messages between home and school can create uncertainty, as parents may promote narratives that clash with sexuality education curricula ( 32 , 41 , 79 ), more evident in rural communities than urban settings in a South African study ( 85 ). A study from China highlights the varying extent to which AYP discuss school-based sexuality education with their parents, with girls (86.84%) engaging substantially more in these conversations compared to boys (46.1%) ( 97 ). Students from Lebanon who discussed reproductive health topics with their parents, and learners from Myanmar who had a parent with a positive behavioural intention for CSE, were more likely to support in-class sexuality education ( 51 , 84 ). In a study from Nigeria, parent/guardian support to access SRH services at health facilities was significantly higher among the intervention group (79.9%) compared to the non-intervention group (69.7%) with p = 0.009, which authors attributed to sensitization activities with parents in addition to the school-based interventions with AYP ( 56 ). This shows that actively involving parents in school-based sexuality education can be a means to enhance AYP’s support for sexuality education as well as their SRH outcomes and parent-child communication. Socio-cultural and religious norms shape AYP’s engagement with sexuality education Socio-cultural norms may not only affect educators’ and schools’ approaches to sexuality education but also shape how AYP themselves engage with it. Many AYP internalize these norms, with girls questioning their own sexual agency and impeding their participation in class, while boys more openly discuss sexuality at school ( 40 , 43 , 63 ). Self-reported cultural resistance toward sexuality education among AYP varied. While only 3.9% of (n = 827) respondents in a Ugandan study worried that adolescent SRH education could breach cultural norms ( 73 ), 22% of ( 120 ) Tanzanian learners interviewed acknowledged that culture plays a significant role in shaping behaviours and attitudes toward family life education ( 79 ). Some Bangladeshi AYP interviewed expressed that schools should not provide sex education at all, adhering to the culturally perceived as dominant discourses of sex as natural, private and taboo ( 39 ). There is limited research on how religious differences could further influence attitudes toward sensitive topics, with only one quantitative study from Tanzania reporting on disaggregation of AYP’s views on sexuality education components ( 58 ). Discussion This scoping review aimed to map the existing literature on AYP’s perspectives on sexuality education in LMICs. It identified an overall scarcity of information in English language from Latin America and the Caribbean, Middle East and Northern Africa as well as Eastern Europe and Central Asia. Little focus is given to the perspectives of adolescents aged 10 to 12, a common limitation across the literature on education for health and well-being ( 98 ). There is limited research in rural study settings as well as insufficient data disaggregation by AYP’s social identity markers. Key data gaps include AYP’s perspectives on the age- and context-appropriateness of content, delivery formats, and the integration of gender-sensitive, inclusive, and rights-based approaches, highlighting the need for future studies to pay particular attention to exploring how these elements can be better tailored to AYP’s needs in LMICs. The heterogeneity of contexts, curricula and research methodologies of the reviewed studies makes it difficult to draw overall conclusions. Yet, some commonalities cut across settings and studies. Critically, findings highlight a strong need for, and widespread support of, sexuality education among AYP, but gaps in content and delivery must be addressed to ensure it meets their expectations, prevents disengagement and provides a safe, comfortable, and empowering learning experience. While school-based sexuality education reportedly tends to focus on cognitive learning about human biology and developmental aspects, abstinence and negative implications of sexuality, AYP have clearly expressed that they expect such education to meet all their needs - social, emotional, cognitive and physical ( 99 ) - and cover a comprehensive breadth of topics. In particular, they emphasize the importance of including affective and social-relational dimensions, such as communication, consent, and navigating relationships, as well as skills-based learning that supports their everyday lived experiences. These insights from AYP first-hand accounts align with broader evidence on the effectiveness of sexuality education, which highlights similar gaps. A review of available systematic reviews ( 100 ) underscored persistent limitations in evaluations capturing the effectiveness of sexuality education programmes on outcome areas related to critical thinking and decision-making skills as well as understanding of cultural aspects and human-rights frameworks related to sexuality. As a result, existing evaluations often fail to capture AYP's capabilities to express their feelings, articulate their needs, and develop their own gender and sexual identities. Long-term outcomes - such as AYP’s experience of sexuality as pleasurable and the promotion of a more tolerant, respectful social climate toward diverse sexualities, lifestyles, attitudes, and values - remain underexplored ( 100 ). AYP from many LMICs voiced that sexuality education failed to challenge heteronormative and patriarchal gender norms, and in fact, the delivery more often reproduced them. Moralist teachings disproportionately burden girls with sexual responsibility, expecting them to maintain moral boundaries while boys are afforded greater freedom to explore their sexuality. These patterns highlight a critical gap, especially considering that sexuality education programmes that address gender or power have been found to be five times more likely to be effective in reducing STIs and unintended pregnancies than those that did not ( 101 ). AYP identifying with a minority group highlighted in this review—such as those with diverse sexual orientations, gender identities, disabilities, racial minorities, living with HIV, from lower socio-economic status or adolescent mothers—felt that sexuality education was not inclusive or responsive to their lived realities. Although AYP may interpret inclusivity in different ways, findings consistently indicate that existing curricula often neglect the specific needs and experiences of AYP who do not conform to dominant norms. While this exclusion is partly shaped by restrictive social, legal, and political environments—limiting, for example, teachers' ability to speak about LGBTIQ + rights—it also reflects deeper systemic issues rooted in the political economy of international development and education programming. Notably, few studies applied an intersectional lens ( 102 ) to AYP’s perspectives, often treating marginalized identities in isolation rather than examining how overlapping social identity markers interact to shape their experiences and needs in relation to sexuality education. Findings related to experiences and preferences concerning delivery were inconclusive, as fewer studies discussed these and findings varied among settings. One common thread identified was that AYP generally preferred participatory methods to learn about sexuality, which might allow for more personalized and adaptive learning; and promotes critical thinking ( 103 ). This has important implications for policymakers, curriculum developers and educators. In many LMICs, participatory approaches face challenges such as large or mixed-age class sizes, limited teacher capacity, and a lack of emphasis on participatory methods in pre-service training ( 104 ). Combined with this review’s findings on AYP’s calls for education to better reflect their lived realities, these considerations underscore the need for context-specific, participatory pedagogies that align with LMIC contexts. Preferences for mixed-gender versus single-gender instruction differed across studies, with some learners valuing inclusivity and open discussion, while others, particularly in rural and more conservative settings, preferred gender-segregated sessions for comfort and privacy. While the findings indicate that AYP value the early introduction of sexuality education, gaps in age-appropriate content may lead to delivery that feels uncomfortable or irrelevant for learners. The review stresses that educators are essential in fostering safe learning environments for sexuality education. Many AYP favoured health professionals and external educators for their expertise and neutrality, while others preferred schoolteachers for their continuity, trust, and teaching skills. This highlights AYP’s preference for knowledgeable, approachable, and respectful educators who facilitate open, stigma-free discussions. That AYP’s perspectives on pedagogical methods differ more strongly could be explained by the variety of settings included in the review, as well as the potential influence of culture on human behaviour and thus preferences around teaching methods and interactions between learners and educators ( 105 ). Knowing and learning about sexuality is central to human development and addressing social inequalities and goes beyond preventing adverse health and social outcomes ( 106 , 107 ). In reality, however, implementation is hindered by strained school systems and contexts of violence, including gender-based violence ( 12 ) and compounded by socio-cultural norms, politics and the broader dynamics of international development that shape sexuality education ( 108 , 109 ). Sexuality education requires supportive education systems, including enabling policies, safe and inclusive learning environments, human resource development, and engagement with community structures and parents ( 110 , 111 ). Youth-participatory approaches create space for the development of democratic governance structures (112–114), can enhance youth empowerment, civic engagement, and organizations’ capacity to institutionalize meaningful involvement as well as youth-sensitive SRH interventions ( 94 ). While limited evidence is available on the effects of youth-participatory research on sexuality education or SRHR specifically, there are indications that it not only empowers youth researchers themselves ( 115 ), but also that it contributes to enhanced research quality ( 115 – 117 ). In light of this, it is concerning that only seven out of 66 studies reviewed explicitly acknowledged employing a youth-participatory research design and nine mentioned applying youth-friendly creative methods. Future research should prioritize the meaningful and engaging involvement of AYP in studies about their lives, ensuring that their perspectives—particularly those from diverse backgrounds—are adequately represented and integrated into the evidence base. Moreover, debates on the effectiveness of sexuality education often prioritize predefined behavioural and health outcomes, while process evaluations and studies on the acceptability of sexuality education are largely lacking from scientific literature ( 100 ). Rethinking effectiveness through AYP’s needs and satisfaction levels could offer a more responsive and meaningful framework for assessing sexuality education’s impact. Lastly, several limitations of this review should be acknowledged. Restricting our search to English-language sources has likely led to the underrepresentation of certain regions and may reflect analytical frameworks and discourses shaped by English-language academic traditions, potentially differing from insights found in literature published in other languages. For future systematic reviews, we recommend incorporating literature in multiple languages as well as to consider a broader scope beyond school-based programmes, acknowledging their potential for more effective and inclusive curricula outside the classroom ( 118 ). This scoping review included studies with variations in methodological rigor, sample sizes and reporting transparency, which may affect the validity of findings. Conclusions Understanding AYP's perspectives is essential for developing relevant, effective and culturally sensitive sexuality education programmes that can support them in their journey to adulthood. The scoping review presented in this article centralised, for the first time, first-hand AYP accounts on their needs, experiences and preferences related to school-based sexuality education, while also pointing to the remaining knowledge gaps when capturing views of AYP in LMICs. This scoping review showed that AYP from LMICs concur with adolescent and youth perspectives from previous studies that largely focused on high-income context in viewing sexuality education as often inadequate, overly biological, heteronormative, and lacking inclusivity ( 19 , 21 , 22 , 119 ). This study also reinforces existing findings that AYP advocate for comprehensive, sex-positive sexuality education and prefer trained, nonjudgmental professionals over regular teachers due to discomfort and perceived bias. It extends the discussion by offering a more nuanced analysis of how access, sociocultural norms, and school infrastructure influence the availability and perceived quality of sexuality education in LMICs. Additionally, this study explicitly maps the intersections between sexuality education and broader social inequalities, including gender, sexual orientation, socio-economic status, disability, and HIV-related stigma. Without more rigorous research into the diverse needs, experiences, and preferences of AYP across different countries, age groups, genders, and intersecting social identities, there is a risk of amplifying only the voices of dominant youth groups. Targeted and inclusive research efforts and greater data disaggregation are essential to ensure that sexuality education reflects the realities of AYP in all their diversity. Abbreviations AYP Adolescents and Young People LMICs Low- and Middle-Income Countries LGBTIQ+ Lesbian, Gay, Bisexual, Transgender, Intersex, Queer/Questioning, and other diverse identities CSE Comprehensive Sexuality Education SRH(R) Sexual and Reproductive Health (and Rights) EUP Early and Unintended Pregnancy STIs Sexually Transmitted Infections HIV/AIDS Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome NGOs Non-Governmental Organizations UN United Nations UNESCO United Nations Educational, Scientific and Cultural Organization UNFPA United Nations Population Fund ITGSE International Technical Guidance on Sexuality Education Declarations Ethics approval and consent to participate Ethics approval was not required for this project because the scoping review examined and summarized publicly available data. Data Availability N/A. Consent for publication N/A. Competing interests The authors declare no competing interests. Funding Time for HK, MLM, and MK was partially supported by a UNESCO-commissioned study. KC and LW's contributions were covered within their employment with UNESCO, with financial support from Norway. The contents of this manuscript are the sole responsibility of KIT Institute and UNESCO, and can in no way be taken to reflect the views of the Government of Norway. Author Contributions Statement HK, MLM, MK, KC, LW and HB participated in the conceptualisation of the scoping review. HK, MK and MLM led the development of the study protocol. HK led the literature search, screening and data extraction and MK and MLM participated in data extraction and discussions on key findings. HK led the data analysis, interpretation and writing of the manuscript. All authors contributed and reviewed the draft of the manuscript and have agreed to the final text. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6733942","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":469860389,"identity":"feb34bb8-6597-4f5d-b187-33e4bb7dc0d3","order_by":0,"name":"Hannah Kabelka","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvUlEQVRIie3RsQrCMBCA4QMhXVpcDyL6CimBqtiHsUtcO3ZwCAh9hrr4LIFAuvQBlDp3LjgKYtzcem4O+ceD7zg4gFDoDxPAYAawERDVYPxgQSUoIHZgvIl/IKgASGQNrHiUFcr5eSjsCPdpstXM8qbDDHtl/GED4TATaZ7UmEN/0J5YEjk9kxfmq1tLJszxRGMmrswQiWVq1ziUaaf2phMU0tayL495emmdHKvKLifJ5ynfG6ZBKBQKhQi9AeS+PF8hUHTZAAAAAElFTkSuQmCC","orcid":"","institution":"KIT Institute","correspondingAuthor":true,"prefix":"","firstName":"Hannah","middleName":"","lastName":"Kabelka","suffix":""},{"id":469860390,"identity":"4322f92c-9bbd-4ce2-aa76-f52a9f07a3e8","order_by":1,"name":"Maryse Kok","email":"","orcid":"","institution":"Liverpool School of Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Maryse","middleName":"","lastName":"Kok","suffix":""},{"id":469860391,"identity":"e0ec1f52-33fb-471d-87b9-dcfead881192","order_by":2,"name":"Kathleen Chau","email":"","orcid":"","institution":"UNESCO","correspondingAuthor":false,"prefix":"","firstName":"Kathleen","middleName":"","lastName":"Chau","suffix":""},{"id":469860392,"identity":"bb48ea39-bf80-4d43-86ca-4328314bc539","order_by":3,"name":"Leonie Werner","email":"","orcid":"","institution":"UNESCO","correspondingAuthor":false,"prefix":"","firstName":"Leonie","middleName":"","lastName":"Werner","suffix":""},{"id":469860393,"identity":"0d1316cb-0e1b-4f9f-b17c-27c5697c0e03","order_by":4,"name":"Henny Bos","email":"","orcid":"","institution":"University of Amsterdam","correspondingAuthor":false,"prefix":"","firstName":"Henny","middleName":"","lastName":"Bos","suffix":""},{"id":469860394,"identity":"77f74a99-091f-4a8d-a236-4e97ab24ca83","order_by":5,"name":"Marielle Le Mat","email":"","orcid":"","institution":"KIT Institute","correspondingAuthor":false,"prefix":"","firstName":"Marielle","middleName":"Le","lastName":"Mat","suffix":""}],"badges":[],"createdAt":"2025-05-23 14:53:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6733942/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6733942/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12978-025-02124-9","type":"published","date":"2025-10-21T16:17:10+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":84689487,"identity":"42070cfa-5949-4873-addf-dd79cd6dc4f5","added_by":"auto","created_at":"2025-06-16 09:30:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":261565,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA Flow Diagram\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6733942/v1/bfa19dc915d4ffb482760ddc.png"},{"id":94490644,"identity":"b701d0dd-61c4-403f-a552-8109030dff4e","added_by":"auto","created_at":"2025-10-27 17:13:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1988285,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6733942/v1/24d9a45f-28e5-487c-8167-e1332177e579.pdf"},{"id":84689483,"identity":"102513f0-3596-4b57-ba56-477e4ddd94e7","added_by":"auto","created_at":"2025-06-16 09:30:35","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":126663,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile12.docx","url":"https://assets-eu.researchsquare.com/files/rs-6733942/v1/e67157ef79ece168e06cf57b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adolescents’ and young people’s perspectives on school- based sexuality education in low- and middle-income countries: A scoping review","fulltext":[{"header":"Plain Summary","content":"\u003cp\u003eSexuality education is essential for adolescents\u0026rsquo; and young people\u0026rsquo;s health, well-being, and rights. While recognized in policies worldwide, gaps remain in its implementation. This review explores youth perspectives on school-based sexuality education in low- and middle-income countries to understand their needs, experiences, and preferences.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA scoping review was conducted across five academic databases and key stakeholder websites, identifying 66 relevant studies published between 2013 and 2024. The review found strong support for school-based sexuality education but noted that many programmes fail to meet adolescents\u0026rsquo; and young people\u0026rsquo;s needs. Current curricula often emphasize biology and risks including early and unintended pregnancy and sexually transmitted infections while neglecting emotional, physical, and social aspects of sexuality. Teaching approaches are frequently not fullyinclusive, and marginalized groups\u0026mdash;such as adolescent girls, youth with disabilities and LGBTIQ+ youth\u0026mdash;face additional barriers. Many young people want more interactive and engaging teaching methods.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe review also highlighted a lack of research on how learners perceive the appropriateness and inclusivity of sexuality education content and delivery. Certain groups, including younger adolescents, youth with diverse identities, and those in rural areas, remain underrepresented in studies, particularly in some geographic regions. More inclusive, youth-participatory research is needed to inform policies and programmes that better reflect the needs and realities of all adolescents and young people.\u0026nbsp;\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eWith the global youth population at an all-time high, adolescents and young people (AYP) aged 10–24 face a myriad of social, health, economic and environmental challenges in the 21st century (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR146\" class=\"CitationRef\"\u003e1\u003c/span\u003e–\u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The role of sexuality education in advancing towards AYP’s health and social development is increasingly recognised in policy and legal frameworks worldwide (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Comprehensive sexuality education (CSE) is a curriculum-based process of teaching and learning that covers the cognitive, emotional, physical and social aspects of sexuality, aiming to equip AYP with knowledge, skills, attitudes and values that will empower them to realise their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and understand and ensure the protection of their rights throughout their lives (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Acknowledging that reaching consensus on what can be deemed as ‘comprehensive’ may neither be possible nor desirable (\u003cspan citationid=\"CR133\" class=\"CitationRef\"\u003e6\u003c/span\u003e), that many countries do not implement fully comprehensive sexuality education and that countries use different terms and curricula to implement programmes, this paper refers to sexuality education as a broad umbrella term while employing context-specific terminology when discussing individual studies.\u003c/p\u003e \u003cp\u003eWhen designed and implemented appropriately, sexuality education has been shown to reduce risk factors for poor sexual and reproductive health and rights (SRHR) such as early and unintended pregnancy (EUP) as well as sexuality transmitted infections (STIs) including HIV/AIDS, foster gender equality, help create safer learning environments and decrease discrimination and violence (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e–\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The development of social-emotional and other transferable skills furthermore shapes healthy and productive citizens (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, in practice, research has shown that sexuality education is not always effective due to inadequate facilitator training and skills, limited resources, rigid curricula, weak integration of gender and power dynamics, resistance from cultural and political stakeholders, a narrow focus on biological risks over psychosocial factors, and/or lack of participatory teaching methods (\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e–\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Marginalised AYP experience additional barriers to receiving sexuality education that meets their needs. These barriers often related to access, stigma, sociocultural taboos, discrimination, violence and bullying (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and the lack of policies and curricula to address relevant content, for example, related to sexual orientation, gender identity and expression (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), HIV status (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) or disability (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile significant research has been conducted on the effectiveness of sexuality education, existing literature is often outcome-centered rather than focused on AYP's first-hand accounts of their needs, experiences and preferences. Centering youth perspectives in sexuality education research is essential for designing policies and programmes that reflect their realities and respond to their needs. Recognizing their opinions will not only ensure that sexuality education is evidence-based and context-appropriate but might also challenge adult-driven assumptions about what is relevant in sexuality education. Reviews directly centering youth voices draw largely on high-income contexts (\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e–\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), some of which focus exclusively on qualitative studies (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Given the distinct sociocultural, political, economic, and institutional contexts of low- and middle-income countries (LMICs) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), it is important to better understand AYP’s perspectives on sexuality education in these settings. Sexuality education in LMICs is often influenced by international funding streams and policy agendas, which can contribute to both opportunities and resistance (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). While such support facilitates programme implementation, it may also fuel opposition, particularly from actors who perceive it as an externally imposed agenda. In many LMICs, there remains a noticeable gap between adolescent and youth perspectives and policy-making, primarily due to systemic, socio-cultural and financial barriers that hinder meaningful youth engagement and can contribute to intergenerational misunderstandings of AYP’s needs and interests (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). These dynamics highlight the importance of capturing AYP’s own voices and perspectives to ensure that sexuality education policies and programmes are not only evidence-based but also contextually relevant and responsive to their lived realities.\u003c/p\u003e \u003cp\u003eThis review addresses the question: What does the existing literature reveal about the needs, experiences, and preferences of AYP regarding school-based sexuality education in LMICs, and what knowledge gaps remain for future research? Specifically, it examines adolescent and youth perspectives on both content and delivery of sexuality education in formal education, as schools provide a structured and accessible platform for reaching large numbers of learners. While beyond the scope of this study, we acknowledge the importance of out-of-school approaches in ensuring inclusive and contextually relevant sexuality education that leaves no one behind.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eScoping reviews have emerged as a suitable method for providing a comprehensive synthesis of the available evidence related to a relatively broad question in a rigorous and transparent way, and – as applied in this study – are being used to explore key concepts, data and evidence gaps as well as to inform future research priorities (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSearch strategy\u003c/p\u003e\u003cp\u003eGiven the multidisciplinary nature of the topic and with the aim of comprehensive coverage of recent literature, the search was conducted in five databases, namely PsycInfo, Medline, ERIC, Web of Science Core Collection and SocINDEX. The search included documents in English published between 2013 and December 2024\u003csup\u003e1\u003c/sup\u003e. Scientific studies, qualitative, quantitative or mixed-methods in nature, and grey literature, such as research reports and evaluations produced outside scientific publishing channels were included. The review focused on the perspectives of AYP aged 10–24 on school-based sexuality education in LMICs, following the World Bank Open Data Catalog classifications of 2023. The search focused on studies capturing sexuality education that was delivered in schools—integrated into core subjects, offered as standalone courses, or provided through extracurricular activities by the government or non-governmental organisations (NGOs).\u003c/p\u003e\u003cp\u003eThe scoping review did not focus on outcomes or impact, but rather on AYP’s perceptions of school-based sexuality education, shedding light on perceived quality and recommendations for improvement. To answer the research question, documents had to include findings related to at least one of the components related to AYP perspectives, namely self-reported needs, experiences, preferences or recommendations. Older studies, books, documents without firsthand youth perspectives or focusing on AYP from high-income countries, or studies that did not disaggregate adolescent and youth perspectives from those of adult stakeholders such as teachers or parents; as well as studies relating to sexuality education outside the school system were excluded.\u003c/p\u003e\u003cp\u003eThe search was adjusted per search engine, applying a comprehensive set of search terms across four key concepts: (\u003cspan citationid=\"CR146\" class=\"CitationRef\"\u003e1\u003c/span\u003e) sexuality education, (\u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e2\u003c/span\u003e) AYP’s perspectives, (\u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e3\u003c/span\u003e) LMICs, and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) school-based education. The search strategy combined controlled terms (e.g., MeSH terms such as \"sex education/\") and free-text keywords (e.g. youth perspectives), using Boolean operators (AND/OR) and proximity operators (e.g. ADJ7). The full search strategy, including all terms and filters, is detailed in Additional File 1.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003eThe search yielded 1.536 results, and as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, after deduplication the review considered 865 results. Informed by initial screening against the inclusion criteria on the basis of title and abstract or document summary using Rayyan, 798 documents were excluded. The remaining 67 studies were successfully retrieved and assessed for eligibility. An additional 7 studies were added resulting from hand search, including a grey literature search via key stakeholders’ websites, including UN agencies, international NGOs, and civil society. As the full texts of 74 documents were read, 8 studies were excluded. Details can be found in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Studies were not excluded based on quality, as the review aimed to capture the broad range of available literature. The search, screening and eligibility assessment were undertaken jointly by one author and a librarian. This resulted in the inclusion and data extraction of a total of 66 studies (see Additional File 2), including 60 scientific peer-reviewed articles and 6 grey literature reports.\u003c/p\u003e\u003cp\u003eData extraction\u003c/p\u003e\u003cp\u003eA structured data extraction approach was employed to systematically capture key characteristics of and findings from studies. Three authors co-created and piloted the data extraction sheet on 15 studies, with refinements made following discussions. Remaining data extraction was conducted by a single author.\u003c/p\u003e\u003cp\u003eThe extraction sheet included study details (publication year, country setting of sexuality education implementation, study type, design and methods), participant demographics (age, sex, social identity markers and school status), and educational context (urban/rural setting, sexuality education terminology, and curriculum details). Drawing from concepts\u003csup\u003e2\u003c/sup\u003e and standards highlighted in the UN International technical guidance on sexuality education (ITGSE) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), AYP's perspectives concerning sexuality education content were assessed along preferred topics as well as perceived relevance, comprehensiveness, age- and context-appropriateness, inclusivity, gender sensitivity, and rights-based premises. Related to sexuality education delivery, categorisations of AYP’s experiences and preferences used included stand-alone vs. integrated curriculum; timing and frequency of programmes; teaching methods and set-up; the role of the educator, including their knowledge, attitudes and skills; confidentiality, privacy and safe environments; and the teaching and learning materials used (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Finally, acknowledging that curricula and implementation are embedded in wider socio-ecological contexts (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), the role of school environments including parental engagement, socio-cultural and political influences on AYP perspectives were documented. While scoping reviews do not traditionally assess study quality, a brief appraisal of study limitations was conducted.\u003c/p\u003e\u003cp\u003eGiven the heterogeneity of study designs and data types, a narrative synthesis approach was applied to summarize key findings and to identify common themes, gaps, and contextual variations in AYP perspectives on school-based sexuality education in LMICs.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eCharacteristics of included studies\u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e larger than one A4 to be inserted here \u0026ndash; see end of the document text file]\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eto be placed at beginning of results section\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e# of studies\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e% of studies\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStudies\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSub-Saharan Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan additionalcitationids=\"CR33 CR34 CR35\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan additionalcitationids=\"CR41 CR42\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR45\" 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citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan additionalcitationids=\"CR86\" citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan additionalcitationids=\"CR91 CR92\" citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsia-Pacific\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e, \u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e121\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLatin America and the Caribbean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle East and Northern Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEastern Europe and Central Asia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStudy designs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan additionalcitationids=\"CR32 CR33 CR34\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39 CR40 CR41 CR42\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan additionalcitationids=\"CR53 CR54\" citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan additionalcitationids=\"CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71\" citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan additionalcitationids=\"CR86 CR87\" citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan additionalcitationids=\"CR91 CR92\" citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan additionalcitationids=\"CR82 CR83\" citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed-methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of creative and participatory research methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan additionalcitationids=\"CR31 CR32 CR33 CR34 CR35 CR36 CR37\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvolvement of youth as co-researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39 CR40 CR41\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParticipant characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrently in (primary or secondary) school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan additionalcitationids=\"CR31 CR32 CR33\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan additionalcitationids=\"CR42 CR43 CR44\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan additionalcitationids=\"CR51 CR52 CR53 CR54 CR55 CR56 CR57 CR58\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan additionalcitationids=\"CR63 CR64 CR65 CR66\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan additionalcitationids=\"CR71 CR72 CR73 CR74 CR75\" citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan additionalcitationids=\"CR79\" citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan additionalcitationids=\"CR84 CR85\" citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan additionalcitationids=\"CR91 CR92\" citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan additionalcitationids=\"CR96\" citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetrospective reporting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMix of educational backgrounds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational background not specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAged 10\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan additionalcitationids=\"CR48\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan additionalcitationids=\"CR79\" citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAged 13\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan additionalcitationids=\"CR31 CR32 CR33 CR34 CR35 CR36\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan additionalcitationids=\"CR41 CR42 CR43\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan additionalcitationids=\"CR48 CR49 CR50\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan additionalcitationids=\"CR57 CR58\" citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan additionalcitationids=\"CR67\" citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan additionalcitationids=\"CR71 CR72\" citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan additionalcitationids=\"CR79 CR80\" citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan additionalcitationids=\"CR84\" citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan additionalcitationids=\"CR91\" citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e, \u003cspan additionalcitationids=\"CR96\" citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAged 16\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan additionalcitationids=\"CR35 CR36 CR37 CR38 CR39 CR40 CR41 CR42 CR43 CR44 CR45 CR46 CR47 CR48 CR49 CR50 CR51 CR52 CR53 CR54 CR55\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan additionalcitationids=\"CR59 CR60 CR61 CR62\" citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan additionalcitationids=\"CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74 CR75 CR76 CR77\" citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan additionalcitationids=\"CR81 CR82 CR83 CR84 CR85 CR86 CR87\" citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan additionalcitationids=\"CR91 CR92\" citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAged 20\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan additionalcitationids=\"CR36 CR37 CR38\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale and female participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan additionalcitationids=\"CR31 CR32\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan additionalcitationids=\"CR46 CR47 CR48\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan additionalcitationids=\"CR52 CR53\" citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan additionalcitationids=\"CR60 CR61 CR62 CR63 CR64 CR65 CR66\" citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan additionalcitationids=\"CR70 CR71 CR72 CR73 CR74 CR75 CR76 CR77\" citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan additionalcitationids=\"CR81 CR82 CR83 CR84 CR85 CR86 CR87\" citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan additionalcitationids=\"CR91 CR92\" citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan additionalcitationids=\"CR96\" citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale participants only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale participants only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex not specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReporting on at least one additional social identity marker (disability, ethnic identity, socio-economic status, religion, ethnic or racial identity, sexual orientation and gender identity, record of abduction, pregnancy, HIV status, living situation, relationships status and/or parents\u0026rsquo; background characteristics)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan additionalcitationids=\"CR45 CR46 CR47 CR48 CR49 CR50 CR51 CR52 CR53 CR54 CR55 CR56\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan additionalcitationids=\"CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74 CR75 CR76\" citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban setting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan additionalcitationids=\"CR59\" citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSemi-urban setting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural setting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants from mixed settings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan additionalcitationids=\"CR55 CR56\" citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSetting not specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan additionalcitationids=\"CR36 CR37\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan additionalcitationids=\"CR87\" citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexuality education programme\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinistry of Education-led\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan additionalcitationids=\"CR51 CR52 CR53 CR54\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan additionalcitationids=\"CR64 CR65\" citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan additionalcitationids=\"CR72\" citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan additionalcitationids=\"CR86\" citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool-based NGO-led\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMix of programmes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurriculum not specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAYP\u0026rsquo;s perspectives on specific components of school-based sexuality education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall attitudes toward school-based sexuality education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan additionalcitationids=\"CR78 CR79 CR80 CR81 CR82 CR83 CR84\" citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecific sexuality education topics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan additionalcitationids=\"CR51 CR52\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan additionalcitationids=\"CR66 CR67\" citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan additionalcitationids=\"CR74 CR75\" citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan additionalcitationids=\"CR86 CR87\" citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComprehensiveness and/or relevance of content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan additionalcitationids=\"CR33 CR34 CR35\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan additionalcitationids=\"CR43 CR44 CR45 CR46 CR47 CR48 CR49\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan additionalcitationids=\"CR54\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan additionalcitationids=\"CR61\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan additionalcitationids=\"CR67 CR68 CR69\" citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan additionalcitationids=\"CR74 CR75 CR76 CR77 CR78 CR79 CR80 CR81 CR82 CR83 CR84\" citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan additionalcitationids=\"CR91 CR92\" citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender-sensitivity, inclusivity and/or rights-based premises of content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan additionalcitationids=\"CR40 CR41 CR42\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan additionalcitationids=\"CR68 CR69\" citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge- and/or context-appropriateness of content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModality (Stand-alone vs. integrated, sex-segregated vs. mixed classroom, location of delivery, timing and frequency)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan additionalcitationids=\"CR79\" citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe educator (Characteristics, knowledge, attitudes, skills)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan additionalcitationids=\"CR42 CR43 CR44 CR45 CR46 CR47 CR48 CR49 CR50 CR51 CR52 CR53 CR54 CR55 CR56\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan additionalcitationids=\"CR69 CR70 CR71 CR72\" citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearning environment (Interactions in the classroom, safety, confidentiality)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan additionalcitationids=\"CR64\" citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan additionalcitationids=\"CR72 CR73\" citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e, \u003cspan additionalcitationids=\"CR96\" citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003eDescriptive characteristics of included studies (n\u0026thinsp;=\u0026thinsp;66)\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAs illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the analysis reveals a strong geographical bias in the reviewed studies, likely affected by the search conducted in English language only. Sub-Saharan Africa (n\u0026thinsp;=\u0026thinsp;42) \u0026mdash;particularly because of 14 studies from South Africa\u0026mdash; is overrepresented, followed by Asia-Pacific (n\u0026thinsp;=\u0026thinsp;17). Latin America and the Caribbean (n\u0026thinsp;=\u0026thinsp;7) see limited coverage, while the Middle East and Northern Africa (n\u0026thinsp;=\u0026thinsp;3) as well as Eastern Europe and Central Asia (n\u0026thinsp;=\u0026thinsp;1) remain severely underrepresented.\u003c/p\u003e \u003cp\u003eThe review includes 43 qualitative, 12 quantitative, and 11 mixed-methods studies, although AYP perspectives in three of the latter mainly draw on the quantitative component. Most studies applied \u0026lsquo;traditional\u0026rsquo; methods, i.e. focus group discussions and individual interviews or questionnaires, with only nine studies reporting on creative and participatory methods such as drawing (\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), storytelling (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), dialogic engagement (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), co-creation (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) or surveys (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) using digital platforms or the use of a \u0026lsquo;Pleasuremeter\u0026rsquo; tool (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Only seven of 66 studies reported on the involvement of youth researchers, in authorship (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), participatory action research (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), co-design approaches (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), as data collectors (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) or with recognition as collaborators (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMost AYP were in (primary or secondary) school during data collection (n\u0026thinsp;=\u0026thinsp;49). The review shows that most studies center the voices of learners of 16\u0026ndash;19 years (n\u0026thinsp;=\u0026thinsp;60), while adolescents aged 10\u0026ndash;12 are least represented (n\u0026thinsp;=\u0026thinsp;18). The majority of studies included male and female participants (n\u0026thinsp;=\u0026thinsp;57), with few focusing specifically on adolescent girls or young women(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) or adolescent boys and young men (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Two thirds of studies reported on at least one other social identity marker of participants, regarding AYP\u0026rsquo;s disability (\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e), ethnic identity (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan additionalcitationids=\"CR49 CR50\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), racial background (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan additionalcitationids=\"CR53 CR54\" citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e), religion (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan additionalcitationids=\"CR57 CR58 CR59 CR60 CR61 CR62 CR63\" citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e), socio-economic status (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65 CR66\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e), sexual orientation and gender identity (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e), HIV status (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e), migration status (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e), ever being pregnant(\u003cspan additionalcitationids=\"CR72 CR73\" citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e) or current relationship status (\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e), living situation (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e), ever been abducted(\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e) or diverse parental background characteristics (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e). Overall, few offered disaggregated/comparative analysis based on these characteristics, while some focused exclusively on specific groups such as AYP living with HIV (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e), lesbian, gay, bi, trans, intersex and queer (LGBTIQ+) learners (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e), young parents (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e), racial minority learners(\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e) and AYP with intellectual(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) or physical disabilities (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Out of the studies reporting on location (n\u0026thinsp;=\u0026thinsp;44), most included urban and rural settings (n\u0026thinsp;=\u0026thinsp;22), while four times as many studies focused specifically on urban youth (n\u0026thinsp;=\u0026thinsp;16) compared to rural AYP (n\u0026thinsp;=\u0026thinsp;4). The majority of studies (n\u0026thinsp;=\u0026thinsp;39) reported that the Ministry of Education designed, and teachers delivered the curriculum, while nine studies reported on NGO-led curricula in schools and four included a mix of programmes.\u003c/p\u003e \u003cp\u003eThe review shows that the majority of studies centering AYP voices focus on aspects related to the comprehensiveness and relevance of sexuality education content (n\u0026thinsp;=\u0026thinsp;52), educators\u0026rsquo; characteristics, knowledge, attitudes, and skills (n\u0026thinsp;=\u0026thinsp;43), as well as overall attitudes toward school-based sexuality education or experiences with specific sexuality education topics (n\u0026thinsp;=\u0026thinsp;33 each). Additionally, teaching methods and materials (n\u0026thinsp;=\u0026thinsp;30) and the learning environment (n\u0026thinsp;=\u0026thinsp;31) also receive notable attention. However, significant gaps exist in research on the age- and context-appropriateness of content (n\u0026thinsp;=\u0026thinsp;7). Furthermore, studies addressing AYP perspectives on experiences and preferences regarding gender sensitivity, inclusivity, and rights-based premises of sexuality education (n\u0026thinsp;=\u0026thinsp;21) as well as delivery modality (n\u0026thinsp;=\u0026thinsp;22) remain relatively limited.\u003c/p\u003e \u003cp\u003eAYP\u0026rsquo;s strong demand for school-based sexuality education\u003c/p\u003e \u003cp\u003eFindings across studies and countries demonstrate a strong demand for school-based sexuality education among AYP from LMICs, with many perceiving it as essential for their well-being, decision-making or future opportunities (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan additionalcitationids=\"CR79 CR80\" citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e). Learners commonly associated sexuality education with staying in school, avoiding early marriage, and preventing unintended pregnancies, highlighting its perceived role in supporting educational attainment and preventing negative sexual and reproductive health (SRH) outcomes. Only one quantitative study from China reported that college students had mixed attitudes about school-based sexuality education, with some fearing it could encourage earlier sexual activity, others disagreeing, and the majority remaining uncertain (\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudies also found that AYP who had received sexuality education were significantly more likely to recognize its importance and advocate for its provision compared to their peers who had not received such education (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e). At the same time, a qualitative study from South Africa found that students became increasingly resistant and disinterested in sexuality education when they felt it failed to provide meaningful learning, as it remained too simplistic\u0026mdash;focusing on biological facts like virus transmission rather than advancing their knowledge holistically (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). This suggests that while exposure to sexuality education may increase awareness of its relevance and importance, a curriculum that fails to provide meaningful education could lead to disengagement among students.\u003c/p\u003e \u003cp\u003eVariation in perceived needs for sexuality education is further influenced by several demographic factors. With regards to school level, adolescents in Nigerian senior secondary schools, Tanzanian secondary schools or Lebanese middle schools were more likely to express a strong need for sexuality education compared to those in junior secondary school (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e), primary school (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e) and lower grades (\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e) respectively, possibly due to their increasing exposure to relationships and social pressures. While studies from Ecuador and South Africa reported on similar support for sexuality education among urban and rural participants (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e), a quantitative study from Nigeria (\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e) found that rural adolescents expressed a greater need for school-based SRH interventions than their urban counterparts, which could reflect disparities in access to information and services. Findings from India reported no gender differences regarding perceived need for Family life education (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e), while a qualitative study from Ethiopia observed girls demonstrating higher levels of engagement and valuing sexuality education more than boys, as reflected in their consistent attendance, participation, and advocacy for sessions (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile the reviewed studies concur that AYP express a need for and support of school-based sexuality education, several studies indicate that these needs were largely unmet due to insufficient or non- existent implementation (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e). The following sections explore how specific experiences with the content and delivery of sexuality education shape to what extent AYP\u0026rsquo;s needs are met or remain unmet.\u003c/p\u003e \u003cp\u003eAYP\u0026rsquo;s perspectives on sexuality education content\u003c/p\u003e \u003cp\u003eThis section explores AYP\u0026rsquo;s experiences and preferences regarding the content of sexuality education, grouped for this analysis according to the ITGSE concepts (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e): Relationships; Values, Rights, Culture and Sexuality; Understanding Gender; Violence and Staying Safe; Skills for Health and Wellbeing; The Human Body and Development; Sexuality and Sexual Behaviour; and Sexual and Reproductive Health. It also reflects their perspectives on the overall comprehensiveness, relevance, inclusivity, and the extent to which programmes are gender- and rights-based, as well as age- and context-appropriate.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSexuality education is perceived to emphasize biology and abstinence over relationships, rights, gender, and diversity\u003c/h2\u003e \u003cp\u003eAccording to AYP from LMICs, the most consistently covered areas in school-based sexuality education are topics related to The Human Body and Development such as sexual and reproductive anatomy, physiology, menstruation and personal hygiene and puberty (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e). Other commonly highlighted topics included those related to Sexual and Reproductive Health such as pregnancy and pregnancy prevention (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e) \u0026mdash; although often with an emphasis on abstinence following the ABCD (Abstain, Be faithful, Use a Condom Delay sexual initiation) model (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e). Across studies, perceived coverage of the topics related to STIs and HIV/AIDS transmission and prevention varied between frequent in Brazil, Ghana, Nigeria and South Africa (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e) and low in Guatemala and Thailand (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). Discussions on Skills for Health and Well-being such as self-esteem, decision-making, and communication skills were noted only in a mixed-methods study from Nigeria (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Understanding gender, including gender norms, gender equality and gender-based violence also appeared inconsistently covered (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e) or as de-emphasized (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Topics related to Relationships, such as self-esteem, love, friendship and family relationship (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e) as well as to Values, rights and culture (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) further seem to be minimally covered.\u003c/p\u003e \u003cp\u003eSome studies pointed out notably absent or underrepresented topics, related to Sexuality and Sexual Behaviour including pleasure (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e), LGBTQ\u0026thinsp;+\u0026thinsp;identities(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e) and risk-related topics such as drugs, alcohol and abuse (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), diverse body images including physical disabilities (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), and the role of digital media in sexualities (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eAYP would prioritize learning about navigating relationships, consent and safety as well as sexuality; with preferences shaped by age, gender and other social identity markers\u003c/em\u003e \u003c/p\u003e \u003cp\u003eWhile The Human Body and Development tends to be the most reported concept covered, some studies also stressed that AYP would like to learn more about puberty and pubertal changes (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e). Other key areas of interest for additional or more in-depth learning expressed by AYP included contraception and safe sex practices (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e), including STI prevention (\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e), particularly emphasizing the practical guidance on contraceptive use and accessing services.\u003c/p\u003e \u003cp\u003eWhile sexuality education programmes in LMICs seemingly tend to avoid direct teaching on sexuality and sexual behaviours, AYP from several studies voiced their curiosity about these topics, such as engaging in sexual activities (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e), including specific topics such as premarital sex (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e), transactional sex (\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e), masturbation and porn (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), pain during sex (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) and diverse sexual orientations (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). In several studies, AYP suggested discussions on topics related to Relationships (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e) and emotions (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e). The preferences on topics regarding Skills for Health and Well-being, particularly on navigating consent and negotiating safe sex (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e) were frequently mentioned in direct connection with Violence and Staying Safe. Another commonality was that many participants highlighted their curiosity to learn about staying safe from violence and coercion (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e). A mixed-methods study from Nigeria, India, the US and El Salvador further highlighted that AYP whose age at first sex was below 10 years were reported to be 2.3 times more likely to be interested in learning about how to say no (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). In a mixed-methods study in the Dominican Republic and qualitative studies from China and South Africa, AYP highlighted a need to address mental health and emotional support, particularly for pregnant adolescents (\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e), AYP living with HIV (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e) and in relation to social media pressure and self-esteem (\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e). While few studies discussed specific interests around Understanding gender, adolescent males aged 10\u0026ndash;14 years interviewed in Ghana were interested in perceived gender-based disparities, such as favoritism toward girls in schools and at home (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), pointing to gaps in critical gender literacy among AYP.\u003c/p\u003e \u003cp\u003eAYP\u0026rsquo;s sexuality education interests varied by demographic background and identity markers. Studies showed that older adolescents generally prioritized a broader variety of topics, for instance when comparing responses of 10\u0026ndash;13-year-olds with adolescents aged 14\u0026ndash;16 regarding gender roles, sexual health and rights, relationships, diversity, and violence prevention in Ecuador (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e). In a Nigerian study, younger adolescents (11\u0026ndash;13 years) reported more support for abstinence-only teaching than respondents aged 14\u0026ndash;19 years; (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e)(\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e) and older youth among interviewees 15\u0026ndash;24 years (no age specification provided) reported being more interested in improving sexual relationships and performance, as well as hiding or enhancing their gender or sexual identity in Thailand (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). This suggests that cognitive and identity development as well as social exposure shape adolescents\u0026rsquo; preferences for sexuality education topics.\u003c/p\u003e \u003cp\u003eIn Ecuador, female secondary school learners generally expressed higher needs for learning about CSE compared to boys surveyed (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e). In contrast,girls in Tanzania were less likely than boys to prioritize discussions on pleasure and decision-making (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). While in Uganda, male secondary school learners expressed a need for self-control and refusal skills to abstain from sex, girls interviewed were more concerned about sexual harassment and pressure from boys to engage in sex (\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e). Additionally, in Thailand, cis-gender young men prioritised clear and unambiguous sexual knowledge, straight young women focused on relationships and attractiveness, and LGBTQ\u0026thinsp;+\u0026thinsp;youth wanted to learn more about navigating identity and societal barriers (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). Primary and secondary school learners with varied disabilities (visual, hearing, speech, physical, intellectual, and developmental) interviewed in a multi-country study including Botswana, Eswatini, Ghana, Malawi, Uganda and Zambia particularly stressed a need for content addressing self-esteem, the desire to feel accepted, and risks of sexual exploitation, abuse, and coercion (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). These variations highlight how gendered social expectations, power imbalances and experiences of stigma, and differing levels of agency in sexual decision-making might affect AYP\u0026rsquo;s preferences for sexuality education content.\u003c/p\u003e \u003cp\u003e \u003cem\u003eIncomplete and \u0026lsquo;out of touch\u0026rsquo; with AYP\u0026rsquo;s realities: A call for more comprehensive, accurate and practical sexuality education\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe review shows that while school-based sexuality education can successfully increase awareness and be considered informative by AYP, mostly in relation to education about human development and SRH (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e), it has frequently been described as incomplete (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e). Selective information, misinformation, and knowledge gaps risk leaving adolescents uncertain about their SRHR and well-being (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFraming it as a \u0026ldquo;discourse of disconnect\u0026rdquo;(\u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e) or \u0026ldquo;out of touch\u0026rdquo; (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), adolescents from China, the Gambia, Nigeria and South Africa experienced their sexuality education largely as irrelevant to, or unhelpful in, their lives (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e). Even within HIV/STI prevention and contraception education, students seem to be more likely to learn factual information rather than practical skills needed to handle sexual pressures and real-life situations (e.g., how to use contraceptives or negotiate safer sex) (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). That learning is often perceived as inadequate has specifically been expressed amongst marginalized AYP, such as adolescents living with HIV in Uganda(\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e) and LGBTIQ\u0026thinsp;+\u0026thinsp;youth in South Africa and Thailand (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFew studies offered qualitative insights of AYP positively assessing their sexuality education. AYP from Madagascar appreciated that the programme content complemented other sources of information about SRH while they considered the CSE programme covered this information in more depth, and at the opportune time (\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e). Chinese students interviewed and AYP from Botswana, Eswatini, Malawi, Uganda, Zambia found the topics relevant to their needs, suggesting broad support for the curriculum (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e) \u0026ndash; although the latter multi-country study distinguished that learners from Ghana felt that the content was not detailed enough to fully address their knowledge aspirations (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). These experiences underscore that perceived relevance and in-depth learning enhance sexuality education\u0026rsquo;s perceived effectiveness. Consequently, the review found a strong demand from AYP from LMICs for more comprehensive (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e), accurate (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e) and applicable (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e) sexuality education.\u003c/p\u003e \u003cp\u003e \u003cem\u003eConcerns raised about fear-based and stigmatizing messages, gender bias, heteronormativity and structural inequalities in sexuality education\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAYP reported that sexuality education teaching, particularly in relation to topics like abortion, sex and sexual diversity, and STIs including HIV, were predominantly framed in negative, problem-based, or risk-focused terms across countries (\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e). Few studies have focused on comparative analysis, however, a qualitative study from South Africa found that urban schools placed greater emphasis on broader sexuality issues, while rural schools focus more on HIV/AIDS education, reflecting a narrower, disease-prevention approach in rural areas (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnother prominent concern raised by AYP is the sexual gendered double standards embedded in sexuality education. Participants across a variety of study contexts, majority female, recalled moralist and prescriptive sexuality education teaching (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e), reinforcing gendered social and moral restrictions on adolescent sexuality. Examples include stereotypical framing of male and female sexuality, such as men having uncontrollable sexual urges and entitlement to sex and women as passive recipients of male sexual advances in Ethiopia (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e) or the \u0026ldquo;onus of abstinence\u0026rdquo; falling mainly on girls in South Africa (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Male participants from Nigeria and South Africa reported lower access to sexuality education at schools (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e), reflecting gendered norms that position girls as needing protection and boys as sexually autonomous.\u003c/p\u003e \u003cp\u003eSome AYP shared that lessons on gender equality helped them break down stereotypical attitudes toward relationships, marriage, and domestic responsibilities - particularly among boys in China (\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e). A South African study stressed adolescents\u0026rsquo; accounts on sexuality education that framed sexuality in simplistic and deviant ways (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Adolescent girls interviewed in Ethiopia criticized that sexuality education primarily focused on violence in the home, making school-based violence harder for students to recognize and report (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). The heteronormativity of sexuality education content has particularly been documented in studies with an intentional focus on LGBTIQ\u0026thinsp;+\u0026thinsp;youth perspectives from South Africa (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e) and Thailand (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA qualitative study from China suggested that young people\u0026rsquo;s sexuality education experiences were shaped by class-based school divisions, meaning that students in vocational schools perceived receiving less comprehensive and more stigmatizing sexuality education than their peers in other educational tracks (\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e). Also, a qualitative study from South Africa concluded that Life Orientation classes missed to critically engage with how race and class shape experiences of sexuality, beauty, and empowerment (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). This highlights the underused transformative power of sexuality education, as it often fails to address intersecting oppressions that shape AYP\u0026rsquo;s experiences and opportunities.\u003c/p\u003e \u003cp\u003eFew studies included AYP\u0026rsquo;s specific first-hand recommendations, some calling for a more gender-responsive approach to sexuality education (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), that reflects diverse identities and experiences in non-judgmental ways (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e) and frames sexuality in a sex-positive and empowering way (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e). The latter has also specifically been voiced by AYP living with HIV in Tanzania (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e) and learners with intellectual disabilities in Kenya (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLimited evidence on AYP’s views on age- and context-appropriate sexuality education\u003c/h3\u003e\n\u003cp\u003eFew studies have examined how AYP perceive the appropriateness of content covered in their sexuality education classes. A qualitative study in Botswana, Eswatini, Ghana, Malawi, Uganda and Zambia found that some primary school learners felt the content was too advanced and would be more appropriate for secondary school students (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Some students (14\u0026ndash;19 years) from South Africa indicated feeling uncomfortable discussing sexuality-related topics with adults, which the authors of this study interpreted in relation to internalized parental views that they are too young for such discussions (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e). In contrast, adolescents (13\u0026ndash;17 years) in a mixed-methods study from Myanmar emphasized that they did not think they were too young to know or learn about sexuality; and that they believed that all teaching was appropriate for their age (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). Learners from the Gambia emphasized their preference for a staggered approach, recommending that some topics, such as puberty and menstruation, should be introduced in lower basic school, while broader sexuality education should continue in upper basic school to ensure age-appropriate learning (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e). These differences underscore the importance of phased and developmentally appropriate sexuality education that considers individual readiness. Notably, given the influence of international actors in shaping sexuality education policies in LMICs, an important research gap emerges as existing studies have largely overlooked how learners perceive the contextual appropriateness of such education.\u003c/p\u003e \u003cp\u003eAYP\u0026rsquo;s perspectives on the delivery of sexuality education\u003c/p\u003e \u003cp\u003eThis section synthesizes AYP\u0026rsquo;s perspectives on how sexuality education in LMICs is delivered in schools, including reflections on the modality of delivery, the role and characteristics of the educator, the school-based learning environment, and the teaching methods used.\u003c/p\u003e\n\u003ch3\u003eAYP’s views on timing and frequency, subject integration, gender segregation and prioritisation of sexuality education\u003c/h3\u003e\n\u003cp\u003eWhile the above section on age-appropriateness of content showed that AYP did not always feel comfortable with some topics, some AYP expressed concerns about the late introduction of sexuality education. Students from Uganda lamented that sexuality education was only taught in senior classes, excluding younger adolescents who might benefit from early exposure before real-life situations arise (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e). When it comes to preferences, 76% of Tanzanian primary school students and 66% of secondary school students surveyed believed that Sex and Relationships Education should begin in primary school, with Class 4 (around age 10) being the most frequently suggested starting point (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). Tanzanian learners in another qualitative study proposed initiating sexuality education when puberty is reached(\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e) and Gambian learners emphasized a need before sexual debut (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e). These findings suggest AYP\u0026rsquo;s preference for earlier, more timely sexuality education delivery.\u003c/p\u003e \u003cp\u003eSome studies highlighted AYP\u0026rsquo;s challenges with sexuality education\u0026rsquo;s integration into broader subjects. More than 40% of Bosnian and Herzegovinian and about 26% of Ugandan learners surveyed suggested sexuality education to be implemented as a standalone subject (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e). These studies listed several possible improvement options beyond delivery modality, and thus do not indicate how many remaining learners preferred integration; rather they reflect that a substantial share of AYP interviewed argued sexuality education deserves the same weight as other school courses. Some learners from Nigerian and South African qualitative studies also recommended that sexuality education should be a standalone subject (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudents widely felt that too little time was allocated to sexuality education, often being overshadowed by other subjects or implemented with limited frequency (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e), calling for longer and frequent sessions. A mixed-methods study from Ghana and a qualitative study from Indonesia emphasized that the limitedly available number of lessons may restrict the depth of content, leading to superficial coverage of key topics and leaving students feeling that they have not learned enough (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e). In contrast, having a dedicated on-site educator who engages with students regularly, reportedly created opportunities for deeper discussions, follow-ups, and trust-building (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e). There is also concern that sexuality education is not taken seriously in schools due to the lack of formal assessments (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), with some South African and Zambian AYP even advocating for its inclusion in final exams (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e). Overall, research on AYP\u0026rsquo;s delivery preferences remains limited.\u003c/p\u003e \u003cp\u003ePreferences on delivery approaches varied\u0026mdash; with 44% of Lebanese adolescents (11\u0026ndash;16 years) surveyed, some Sierra Leonan students (10\u0026ndash;14 years) and most Tanzanian (12\u0026ndash;14 years) and Gambian learners interviewed (15\u0026ndash;19 years) favouring mixed-gender discussions for inclusivity (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e), while learners from China (from grade 8 and 9, presumably 13\u0026ndash;15 years) preferred single-gender sessions for comfort(\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e) and a multi-country study involving primary and secondary school students from Sub-Saharan Africa showing mixed results (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). The latter study found that in rural schools in Zambia, girls preferred sex-segregated classes, whereas in peri-urban and urban schools, girls and boys were comfortable to be taught together. That these preferences across and within studies differed underlines students\u0026rsquo; comfort being conducive to their learning as well as the importance of tailoring delivery to context.\u003c/p\u003e\n\u003ch3\u003eAYP’s perspectives on educators’ age, gender, expertise, attitudes and skills\u003c/h3\u003e\n\u003cp\u003eThe review shows that the role of the educator has a strong effect on AYP\u0026rsquo;s satisfaction with sexuality education delivery, with varying findings regarding educators\u0026rsquo; age, gender, professional background, and lived experiences. Younger educators tend to be seen as relatable, fostering trust and engagement (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e), whereas older educators were valued for experience (\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e). Gender dynamics also play a role, with students often favouring same-sex educators, particularly for sensitive topics (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e) and in rural areas, as a study from Iran suggests (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). A study from South Africa emphasized \u0026ldquo;cross-gender relatability\u0026rdquo;, challenging this widespread preference for same-sex teachers by showing that \u0026ndash; when implemented with care - students can also connect with educators of a different gender (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSome studies highlighted the empowering effect that sexuality education teachers\u0026rsquo; supportive attitudes can have on AYP (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e). A qualitative study from Madagascar illustrated that relatable, inclusive, and caring educators who communicate sensitive sexuality education topics in a direct and engaging manner fostered stronger student connections and created a more effective learning environment (\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e). In South Africa, positive relationships with Life Orientation educators were reportedly built on trust, confidentiality, consistency between values and behaviour, and the use of supportive, non-punitive discipline strategies that encouraged open discussions on sexuality education (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Expertise, approachability, and inclusivity were also highlighted as positive educator traits in another South African and a Myanmar study (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral studies highlight AYP\u0026rsquo;s appreciation for diverse perspectives, including guest speakers and individuals who share personal stories, as these approaches made lessons more engaging and relevant (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e). Students from Ghana, Myanmar, South Africa, Tanzania and Uganda expressed a preference for educators with expertise in SRH, such as healthcare professionals, over schoolteachers, citing their specialized knowledge and approachability (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e), particularly in contexts where teachers are perceived as making them feel uncomfortable or to be judgmental, as documented in some South African schools (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). Many students interviewed in another South African study, however, ultimately preferred Life Orientation educators over civil society organisation facilitators due to their teaching experience and ability to maintain order in the classroom (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e). This shows that students value thematic expertise as well as effective teaching and classroom management skills in educators.\u003c/p\u003e \u003cp\u003eSeveral studies highlight that educators were perceived as judgmental (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e), contributing to unsafe or uncomfortable learning environments. Many participants reasoned that teachers' religious and cultural beliefs (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e), discomfort (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e) and lack of knowledge (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e) influenced their teaching. Students who expressed lack of trust in their educators often cited moralising attitudes (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e)\u0026mdash;particularly towards girls (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e), non-normative sexualities (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e), and students returning after pregnancy (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). Adolescent voices from a qualitative study from Brazil further highlighted that some teachers reproduced racial biases within the classroom, reinforcing inequities and influencing their perceptions of self-worth and appearance (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLanguage style and educators\u0026rsquo; communication skills affect student receptiveness to sexuality education. In Nigeria and South Africa, students found formal, outdated, or overly direct terminology uncomfortable, limiting engagement (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e). In Botswana, vernacular use was sometimes perceived as inappropriate (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e), while in the Dominican Republic, students valued clear, respectful, and example-based delivery (\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e). Learners with disabilities interviewed from Botswana, Eswatini, Ghana, Malawi, Uganda and Zambia overall expressed appreciation for their schools for providing specialized teachers who could communicate with students with different disabilities and enable them to learn about sexuality education concepts, but that they often lacked key communication skills, such as sign language and braille, creating barriers for students with disabilities (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eChallenges to safe, healthy and inclusive learning environments for sexuality education\u003c/h3\u003e\n\u003cp\u003eAYP believed that some educators failed to create safe, inclusive learning spaces due to insufficient training (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e) and highlighted perceived power imbalances and teachers enacting harsh authority or favouritism (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e). Feeling unsafe in the classroom, in return, can affect learners\u0026rsquo; willingness to ask questions and participate (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e). Peer pressure and teasing can create discomfort (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e). These factors contribute to many AYP reportedly feeling shy and embarrassed (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e) during sexuality education. One study furthermore highlighted disruptive behaviour, particularly by boys, such as laughter and side conversations, hindering engagement (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGender-biased classroom dynamics limit opportunities for equal learning and discussion. Female participants in qualitative studies from Ethiopia, Iran and South Africa expressed fear of being labeled negatively if they participated openly (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e). Girls living in Iranian villages experienced greater fear of being labeled than urban girls, highlighting geographical and cultural differences in how stigma affects engagement with sexuality education (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Finding relatively low satisfaction rates overall, only a survey with Chinese adolescents suggests that girls (56.62%) felt safer and more comfortable for puberty discussions at school, compared to boys (42.9%) (\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e). Some studies also touched upon confidentiality concerns and a risk for distress during sexuality education classes, particularly for survivors of sexual violence (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e) and those navigating LGBTIQ\u0026thinsp;+\u0026thinsp;identities (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLearners recommended that educators should receive training and support that enables them to teach sexuality education confidently and with an open mind (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e). Other suggestions to promote safer learning environments included smaller discussion groups (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) as well as to increasing trust-based relationships between students and educators (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMoving beyond lectures: AYP call for adequate, interactive and inclusive sexuality education methods and materials\u003c/h2\u003e \u003cp\u003eAYP from a variety of LMICs overwhelmingly critiqued traditional, lecture-based sexuality education methods as passive, adult-centric, and disengaging (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e) and that educators often failed to use practical teaching strategies (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e). Conversely, students expressed preferences for interactive, student-centered approaches (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e). Accounts on positive learning experiences from Zambia suggest the effectiveness of methods such as group discussions and role-playing (\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e), which encourage active participation and reflection. The use of videos and films depicting real-life scenarios seems particularly valued (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e), as they not only capture learners\u0026rsquo; interest but also foster emotional engagement with sensitive topics. A mixed-methods study from Asia-Pacific concluded that AYP respondents who reported receiving sexuality education through participatory methods appeared to be \u0026ldquo;more satisfied\u0026rdquo; with the sexuality education they had received than those who did not (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Similarly, female and male participants in a Madagascan study highlighted that the programme\u0026rsquo;s learner-centred, participatory approaches diminished their shyness and gradually built their self-confidence (\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e). However, particularly in unsafe learning environments, shy and introverted participants might struggle to engage with such approaches, preferring teaching methods that feel less exposing (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). Peer education (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) and digital learning platforms (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e) have also been suggested as useful tools to complement classroom instruction, possibly offering accessible and youth-friendly alternatives to traditional learning.\u003c/p\u003e \u003cp\u003eWhile few studies include direct recommendations from AYP in this regard, it seems that AYP advocate for a sexuality education pedagogy that effectively addresses topics in an engaging and inclusive manner (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) and reflective of their lived realities with practical demonstrations (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAYP\u0026rsquo;s perspectives on the wider school environment, school leadership and parental involvement\u003c/p\u003e \u003cp\u003eA persistent challenge that extends beyond sexuality education delivery is the availability and quality of teaching materials in schools in LMICs. Students from African, Asian and Latin American countries reported a lack of textbooks and educational materials (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e). Only a mixed-methods study from China reported on widespread availability of learning materials, with over 90% of students stating to have access to some sexuality education materials, including textbooks, flyers, handouts, and videos (\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e). Inadequate or outdated curricula can further limit the comprehensiveness of sexuality education (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e), particularly regarding LGBTIQ\u0026thinsp;+\u0026thinsp;topics, sex and pleasure, HIV positive learners and gender diversity (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). For students with disabilities, the absence of adapted teaching tools, such as sign language guides and braille materials, further exacerbates exclusion (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSafety and discrimination concerns go beyond the sexuality education classroom and need to be addressed at school-level. A study from South Africa stressed that schools reinforce cis- and heteronormativity through disciplinary violence and social policing, marginalizing LGBTIQ\u0026thinsp;+\u0026thinsp;youth and silencing allies who challenge exclusion (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). A study focusing on gender dimensions of sexuality education in Ethiopia also highlighted that implementation failed to address critical school environment concerns, leaving girls feeling unsupported and vulnerable to harassment and exclusion (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Experiences of racial discrimination at school, from either classmates or teachers, in Brazil reveal the burden of structural inequalities reproduced at school affecting Black adolescents\u0026rsquo; education, particularly girls\u0026rsquo; (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). Also the reported disconnect between schools\u0026rsquo; overall curriculum and the lived experiences of marginalized students (in the case of South Africa, for instance, the so-called \"day girls\" coming from working-class backgrounds and from black townships), underscores the need for schools to better support learners\u0026rsquo; diverse socio-economic, cultural, and sexual health challenges in order to provide effective sexuality education (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAYP from several studies stressed that their parents are an important source of sexuality education (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e). Conflicting messages between home and school can create uncertainty, as parents may promote narratives that clash with sexuality education curricula (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e), more evident in rural communities than urban settings in a South African study (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e). A study from China highlights the varying extent to which AYP discuss school-based sexuality education with their parents, with girls (86.84%) engaging substantially more in these conversations compared to boys (46.1%) (\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e). Students from Lebanon who discussed reproductive health topics with their parents, and learners from Myanmar who had a parent with a positive behavioural intention for CSE, were more likely to support in-class sexuality education (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e). In a study from Nigeria, parent/guardian support to access SRH services at health facilities was significantly higher among the intervention group (79.9%) compared to the non-intervention group (69.7%) with p\u0026thinsp;=\u0026thinsp;0.009, which authors attributed to sensitization activities with parents in addition to the school-based interventions with AYP (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e). This shows that actively involving parents in school-based sexuality education can be a means to enhance AYP\u0026rsquo;s support for sexuality education as well as their SRH outcomes and parent-child communication.\u003c/p\u003e \u003cp\u003eSocio-cultural and religious norms shape AYP\u0026rsquo;s engagement with sexuality education\u003c/p\u003e \u003cp\u003eSocio-cultural norms may not only affect educators\u0026rsquo; and schools\u0026rsquo; approaches to sexuality education but also shape how AYP themselves engage with it. Many AYP internalize these norms, with girls questioning their own sexual agency and impeding their participation in class, while boys more openly discuss sexuality at school (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e). Self-reported cultural resistance toward sexuality education among AYP varied. While only 3.9% of (n\u0026thinsp;=\u0026thinsp;827) respondents in a Ugandan study worried that adolescent SRH education could breach cultural norms (\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e), 22% of (\u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e) Tanzanian learners interviewed acknowledged that culture plays a significant role in shaping behaviours and attitudes toward family life education (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e). Some Bangladeshi AYP interviewed expressed that schools should not provide sex education at all, adhering to the culturally perceived as dominant discourses of sex as natural, private and taboo (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). There is limited research on how religious differences could further influence attitudes toward sensitive topics, with only one quantitative study from Tanzania reporting on disaggregation of AYP\u0026rsquo;s views on sexuality education components (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis scoping review aimed to map the existing literature on AYP\u0026rsquo;s perspectives on sexuality education in LMICs. It identified an overall scarcity of information in English language from Latin America and the Caribbean, Middle East and Northern Africa as well as Eastern Europe and Central Asia. Little focus is given to the perspectives of adolescents aged 10 to 12, a common limitation across the literature on education for health and well-being (\u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e). There is limited research in rural study settings as well as insufficient data disaggregation by AYP\u0026rsquo;s social identity markers. Key data gaps include AYP\u0026rsquo;s perspectives on the age- and context-appropriateness of content, delivery formats, and the integration of gender-sensitive, inclusive, and rights-based approaches, highlighting the need for future studies to pay particular attention to exploring how these elements can be better tailored to AYP\u0026rsquo;s needs in LMICs.\u003c/p\u003e \u003cp\u003eThe heterogeneity of contexts, curricula and research methodologies of the reviewed studies makes it difficult to draw overall conclusions. Yet, some commonalities cut across settings and studies. Critically, findings highlight a strong need for, and widespread support of, sexuality education among AYP, but gaps in content and delivery must be addressed to ensure it meets their expectations, prevents disengagement and provides a safe, comfortable, and empowering learning experience.\u003c/p\u003e \u003cp\u003eWhile school-based sexuality education reportedly tends to focus on cognitive learning about human biology and developmental aspects, abstinence and negative implications of sexuality, AYP have clearly expressed that they expect such education to meet \u003cem\u003eall\u003c/em\u003e their needs - social, emotional, cognitive and physical (\u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e) - and cover a comprehensive breadth of topics. In particular, they emphasize the importance of including affective and social-relational dimensions, such as communication, consent, and navigating relationships, as well as skills-based learning that supports their everyday lived experiences. These insights from AYP first-hand accounts align with broader evidence on the effectiveness of sexuality education, which highlights similar gaps. A review of available systematic reviews (\u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e) underscored persistent limitations in evaluations capturing the effectiveness of sexuality education programmes on outcome areas related to critical thinking and decision-making skills as well as understanding of cultural aspects and human-rights frameworks related to sexuality. As a result, existing evaluations often fail to capture AYP's capabilities to express their feelings, articulate their needs, and develop their own gender and sexual identities. Long-term outcomes - such as AYP\u0026rsquo;s experience of sexuality as pleasurable and the promotion of a more tolerant, respectful social climate toward diverse sexualities, lifestyles, attitudes, and values - remain underexplored (\u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAYP from many LMICs voiced that sexuality education failed to challenge heteronormative and patriarchal gender norms, and in fact, the delivery more often reproduced them. Moralist teachings disproportionately burden girls with sexual responsibility, expecting them to maintain moral boundaries while boys are afforded greater freedom to explore their sexuality. These patterns highlight a critical gap, especially considering that sexuality education programmes that address gender or power have been found to be five times more likely to be effective in reducing STIs and unintended pregnancies than those that did not (\u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e101\u003c/span\u003e). AYP identifying with a minority group highlighted in this review\u0026mdash;such as those with diverse sexual orientations, gender identities, disabilities, racial minorities, living with HIV, from lower socio-economic status or adolescent mothers\u0026mdash;felt that sexuality education was not inclusive or responsive to their lived realities. Although AYP may interpret inclusivity in different ways, findings consistently indicate that existing curricula often neglect the specific needs and experiences of AYP who do not conform to dominant norms. While this exclusion is partly shaped by restrictive social, legal, and political environments\u0026mdash;limiting, for example, teachers' ability to speak about LGBTIQ\u0026thinsp;+\u0026thinsp;rights\u0026mdash;it also reflects deeper systemic issues rooted in the political economy of international development and education programming. Notably, few studies applied an intersectional lens (\u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e) to AYP\u0026rsquo;s perspectives, often treating marginalized identities in isolation rather than examining how overlapping social identity markers interact to shape their experiences and needs in relation to sexuality education.\u003c/p\u003e \u003cp\u003eFindings related to experiences and preferences concerning delivery were inconclusive, as fewer studies discussed these and findings varied among settings. One common thread identified was that AYP generally preferred participatory methods to learn about sexuality, which might allow for more personalized and adaptive learning; and promotes critical thinking (\u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e). This has important implications for policymakers, curriculum developers and educators. In many LMICs, participatory approaches face challenges such as large or mixed-age class sizes, limited teacher capacity, and a lack of emphasis on participatory methods in pre-service training (\u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e104\u003c/span\u003e). Combined with this review\u0026rsquo;s findings on AYP\u0026rsquo;s calls for education to better reflect their lived realities, these considerations underscore the need for context-specific, participatory pedagogies that align with LMIC contexts. Preferences for mixed-gender versus single-gender instruction differed across studies, with some learners valuing inclusivity and open discussion, while others, particularly in rural and more conservative settings, preferred gender-segregated sessions for comfort and privacy. While the findings indicate that AYP value the early introduction of sexuality education, gaps in age-appropriate content may lead to delivery that feels uncomfortable or irrelevant for learners.\u003c/p\u003e \u003cp\u003eThe review stresses that educators are essential in fostering safe learning environments for sexuality education. Many AYP favoured health professionals and external educators for their expertise and neutrality, while others preferred schoolteachers for their continuity, trust, and teaching skills. This highlights AYP\u0026rsquo;s preference for knowledgeable, approachable, and respectful educators who facilitate open, stigma-free discussions. That AYP\u0026rsquo;s perspectives on pedagogical methods differ more strongly could be explained by the variety of settings included in the review, as well as the potential influence of culture on human behaviour and thus preferences around teaching methods and interactions between learners and educators (\u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eKnowing and learning about sexuality is central to human development and addressing social inequalities and goes beyond preventing adverse health and social outcomes (\u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e, \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e). In reality, however, implementation is hindered by strained school systems and contexts of violence, including gender-based violence (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and compounded by socio-cultural norms, politics and the broader dynamics of international development that shape sexuality education (\u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e, \u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e). Sexuality education requires supportive education systems, including enabling policies, safe and inclusive learning environments, human resource development, and engagement with community structures and parents (\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eYouth-participatory approaches create space for the development of democratic governance structures (112\u0026ndash;114), can enhance youth empowerment, civic engagement, and organizations\u0026rsquo; capacity to institutionalize meaningful involvement as well as youth-sensitive SRH interventions (\u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e). While limited evidence is available on the effects of youth-participatory research on sexuality education or SRHR specifically, there are indications that it not only empowers youth researchers themselves (\u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e), but also that it contributes to enhanced research quality (\u003cspan additionalcitationids=\"CR116\" citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e117\u003c/span\u003e). In light of this, it is concerning that only seven out of 66 studies reviewed explicitly acknowledged employing a youth-participatory research design and nine mentioned applying youth-friendly creative methods. Future research should prioritize the meaningful and engaging involvement of AYP in studies about their lives, ensuring that their perspectives\u0026mdash;particularly those from diverse backgrounds\u0026mdash;are adequately represented and integrated into the evidence base.\u003c/p\u003e \u003cp\u003eMoreover, debates on the effectiveness of sexuality education often prioritize predefined behavioural and health outcomes, while process evaluations and studies on the acceptability of sexuality education are largely lacking from scientific literature (\u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e). Rethinking effectiveness through AYP\u0026rsquo;s needs and satisfaction levels could offer a more responsive and meaningful framework for assessing sexuality education\u0026rsquo;s impact.\u003c/p\u003e \u003cp\u003eLastly, several limitations of this review should be acknowledged. Restricting our search to English-language sources has likely led to the underrepresentation of certain regions and may reflect analytical frameworks and discourses shaped by English-language academic traditions, potentially differing from insights found in literature published in other languages. For future systematic reviews, we recommend incorporating literature in multiple languages as well as to consider a broader scope beyond school-based programmes, acknowledging their potential for more effective and inclusive curricula outside the classroom (\u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e). This scoping review included studies with variations in methodological rigor, sample sizes and reporting transparency, which may affect the validity of findings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eUnderstanding AYP's perspectives is essential for developing relevant, effective and culturally sensitive sexuality education programmes that can support them in their journey to adulthood. The scoping review presented in this article centralised, for the first time, first-hand AYP accounts on their needs, experiences and preferences related to school-based sexuality education, while also pointing to the remaining knowledge gaps when capturing views of AYP in LMICs.\u003c/p\u003e \u003cp\u003eThis scoping review showed that AYP from LMICs concur with adolescent and youth perspectives from previous studies that largely focused on high-income context in viewing sexuality education as often inadequate, overly biological, heteronormative, and lacking inclusivity (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e). This study also reinforces existing findings that AYP advocate for comprehensive, sex-positive sexuality education and prefer trained, nonjudgmental professionals over regular teachers due to discomfort and perceived bias. It extends the discussion by offering a more nuanced analysis of how access, sociocultural norms, and school infrastructure influence the availability and perceived quality of sexuality education in LMICs. Additionally, this study explicitly maps the intersections between sexuality education and broader social inequalities, including gender, sexual orientation, socio-economic status, disability, and HIV-related stigma.\u003c/p\u003e \u003cp\u003eWithout more rigorous research into the diverse needs, experiences, and preferences of AYP across different countries, age groups, genders, and intersecting social identities, there is a risk of amplifying only the voices of dominant youth groups. Targeted and inclusive research efforts and greater data disaggregation are essential to ensure that sexuality education reflects the realities of AYP in all their diversity.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAYP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAdolescents and Young People\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLMICs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLow- and Middle-Income Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLGBTIQ+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLesbian, Gay, Bisexual, Transgender, Intersex, Queer/Questioning, and other diverse identities\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComprehensive Sexuality Education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSRH(R)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSexual and Reproductive Health (and Rights)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEUP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEarly and Unintended Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSTIs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSexually Transmitted Infections\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHIV/AIDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHuman Immunodeficiency Virus / Acquired Immunodeficiency Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNGOs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNon-Governmental Organizations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnited Nations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUNESCO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnited Nations Educational, Scientific and Cultural Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUNFPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnited Nations Population Fund\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eITGSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInternational Technical Guidance on Sexuality Education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval was not required for this project because the scoping review examined and summarized publicly available data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN/A.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN/A.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTime for HK, MLM, and MK was partially supported by a UNESCO-commissioned study. KC and LW\u0026apos;s contributions were covered within their employment with UNESCO, with financial support from Norway. The contents of this manuscript are the sole responsibility of KIT Institute and UNESCO, and can in no way be taken to reflect the views of the Government of Norway.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHK, MLM, MK, KC, LW and HB participated in the conceptualisation of the scoping review. HK, MK and MLM led the development of the study protocol. HK led the literature search, screening and data extraction and MK and MLM participated in data extraction and discussions on key findings. HK led the data analysis, interpretation and writing of the manuscript. All authors contributed and reviewed the draft of the manuscript and have agreed to the final text.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Janneke Staaks, librarian at the University of Amsterdam, for her support with the literature search and screening.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003ePatton G, Azzopardi P, Kaoma N, Sabet F, Sawyer S. Adolescent health. In: Detels R, editor. Oxford Textbook of Global Public Health [Internet]. 7th ed. Oxford Academic; 2021 [cited 2025 Feb 23]. pp. 1\u0026ndash;7. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://academic.oup.com/book/36249/chapter/316177727\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSundler AJ, Bergnehr D, Haffejee S, Iqbal H, Orellana MF, Del Vergara A et al. 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Cult Health Sex. 2014;16(9):1097\u0026ndash;112.\u0026nbsp;\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Footnotes","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e The search was originally conducted in 2023, covering a 10-year time scope (2013\u0026ndash;2023) to capture the most recent research. In 2024, the search was updated to ensure the inclusion of the latest findings.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e The eight key concepts include Relationships; Values, Rights, Culture and Sexuality; Understanding Gender; Violence and Staying Safe; Skills for Health and Well-being; the Human Body and Development; Sexuality and Sexual Behaviour; and Sexual and Reproductive Health (15).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sexuality education, health and wellbeing, school-based programmes, education policy, adolescent and youth perspectives, youth participation, low- and middle-income countries","lastPublishedDoi":"10.21203/rs.3.rs-6733942/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6733942/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSexuality education plays a crucial role in supporting adolescents\u0026rsquo; and young people\u0026rsquo;s (AYP\u0026rsquo;s) health, well-being and gender equality and is increasingly recognised in global policies. In low- and middle-income countries (LMICs), research has raised concerns about the availability and sub-optimal implementation of sexuality education, yet few studies address these concerns considering AYP\u0026rsquo;s views. This limits insights for developing relevant and effective sexuality education programmes that can support AYP in their journey to adulthood. This review explores AYP\u0026rsquo;s perspectives on school-based sexuality education in LMICs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA scoping review search was conducted across five academic databases and key stakeholder websites, identifying studies published between 2013 and 2024 in English. Following screening and systematic data extraction, 66 studies were included. Findings on characteristics of studies, AYP\u0026rsquo;s perspectives on needs, experiences and preferences related to sexuality education content and delivery, as well as socio-ecological influences were synthesized using a narrative approach.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe review finds that while AYP across LMICs generally express high needs for school-based sexuality education, these often remain unmet. AYP consistently reported dissatisfaction with sexuality education as they wish for education that extends beyond cognitive learning about biology and negative implications of sexuality, to include more comprehensively its emotional, physical, and social aspects. Participants\u0026rsquo; age, gender and urban or rural residence influence delivery preferences. Gaps in participatory, inclusive, and empowering education approaches reinforce gender norms, exclude diverse identities, and fail to address the specific needs of adolescent girls, young women, and marginalized youth. The review underscored the scarcity of research on AYP\u0026rsquo;s perspectives regarding age- and context-appropriateness, inclusivity of content, and regarding delivery formats. Studies from certain geographic regions and focusing on younger adolescents, youth with diverse social identity markers and those living in rural areas are especially underrepresented.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eFor the first time, this article synthesizes direct AYP perspectives on school-based sexuality education, while also pointing to remaining knowledge gaps when capturing views of AYP in LMICs. Concerted efforts are needed to diversify research, calling for more rigorous, inclusive and youth-participatory research efforts to inform sexuality education policies and programmes that are responsive to AYP\u0026rsquo;s needs.\u003c/p\u003e","manuscriptTitle":"Adolescents’ and young people’s perspectives on school- based sexuality education in low- and middle-income countries: A scoping review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-16 09:30:31","doi":"10.21203/rs.3.rs-6733942/v1","editorialEvents":[{"type":"communityComments","content":1},{"type":"decision","content":"Revision requested","date":"2025-07-08T14:37:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-08T13:24:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-01T12:39:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210070673710215856769658501856043870442","date":"2025-06-16T09:30:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"262749645103961858879770592247631341861","date":"2025-06-13T16:58:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266268277957808955764740927673980498287","date":"2025-06-11T13:49:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-11T08:04:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-28T00:01:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-27T23:59:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Reproductive Health","date":"2025-05-23T14:39:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"61ed676b-c480-4001-acef-7016fef92764","owner":[],"postedDate":"June 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-27T16:41:59+00:00","versionOfRecord":{"articleIdentity":"rs-6733942","link":"https://doi.org/10.1186/s12978-025-02124-9","journal":{"identity":"reproductive-health","isVorOnly":false,"title":"Reproductive Health"},"publishedOn":"2025-10-21 16:17:10","publishedOnDateReadable":"October 21st, 2025"},"versionCreatedAt":"2025-06-16 09:30:31","video":"","vorDoi":"10.1186/s12978-025-02124-9","vorDoiUrl":"https://doi.org/10.1186/s12978-025-02124-9","workflowStages":[]},"version":"v1","identity":"rs-6733942","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6733942","identity":"rs-6733942","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}