CSE implementation at regional and country levels

Different regions have shown leadership in the implementation of CSE, from demonstrating increased political will, to developing and investing in CSE programming:

  • Western Europe pioneered the introduction of school-based sexuality education programmes 50 years ago. Countries such as Sweden, Norway, and the Netherlands, with long-standing sexuality education programmes in schools, have significantly lower adolescent birth rates than countries in Eastern Europe and Central Asia, where open discussion of issues related to sexuality and sexual and reproductive health and rights (SRHR) in schools remains more sensitive.
  • Within Europe, the WHO Regional Office produced Standards for sexuality education in Europe, which provides a framework to support policy-makers, education and health authorities, and other stakeholders in implementing quality standards for sexuality education across the region.
  • The Ministerial Commitment on comprehensive sexuality education and sexual and reproductive health services for adolescents and young people in Eastern and Southern Africa (ESA) has been endorsed by 21 countries in the Eastern and Southern Africa region.
  • In Latin America and the Caribbean, ministers of health and education declared their commitment to sexuality education through the Preventing through Education Declaration signed in 2008. Governments committed to integrating strategies and ensuring interdepartmental coordination and agreed to implement and strengthen ‘multi-sectoral strategies of comprehensive sexuality education and promotion of sexual health, including HIV/STI prevention’. More information on CSE in Latin America and the Caribbean is described in the report Políticas educativas, jóvenes y sexualidades en América Latina y el Caribe: las luchas feministas en la construcción de la agenda pública sobre educación sexual [in Spanish].
  • The Asia-Pacific region has traditionally had a favourable policy environment towards implementing HIV education, with most countries integrating broader sexuality education into national HIV strategies. The commitment from the Asian and Pacific Population and Development Conference in 2013 focused on ensuring SRHR for all, particularly the poorest and most marginalized populations, and recognized the need for sufficient resources for sexuality education programmes.
Regional CSE policies


  • Asia-Pacific: 21 out of 25 countries’ national HIV strategies/plans referenced the role of education; most targeted in-school young people, mentioned capacity development of teachers and promoted HIV and life skills education. Cambodia and Papua New Guinea have established HIV policies for the education sector.
  • Eastern Europe and Central Asia: All countries covered in the assessment had national policies supporting CSE – with the exception of Uzbekistan, Kazakhstan and the Russian Federation – providing a cornerstone for the delivery of life skills-based health education, with HIV and SRH education being central.
  • West and Central Africa: Most countries in the assessment have an education sector policy on HIV and AIDS, completed by a strategy that creates an enabling environment for the delivery of life skills-based HIV and sexuality education. SERAT studies show that 12 out of 13 countries have a plan that supports the implementation of a sexuality education programme.
  • Latin America and the Caribbean: In 2008 health and education ministers signed a declaration affirming a mandate for national school-based sexuality and HIV education, as well as endorsing the increased availability of adolescent-friendly reproductive health services.
  • Eastern and Southern Africa: Ministers of health and education from 20 countries affirmed and endorsed the Ministerial Commitment on CSE and SRH services for adolescents and young people in December 2013, setting specific targets to ensure access to high-quality, comprehensive, life skills-based HIV and sexuality education and appropriate youth-friendly health services for all young people. The Commitment was reaffirmed and expanded in December 2021, endorsed by 21 countries.

In late 2018, with the support of UNFPA, Ghana issued guidelines on comprehensive sexuality and reproductive health education in school- and community-based programmes, aimed at enabling teachers to deliver these programmes ‘with confidence and empathy’. Significant changes in the economic and social context, including the growing role of social media, prompted the development of these guidelines, which consist of 9 modules and 60 topics organized by grade and age. These modules can be taught through a standalone subject or can be integrated into different subjects in primary, lower secondary and upper secondary education.
The preparation of these guidelines was preceded by a review of the curriculum in Ghana and selected other countries, interviews, validation exercises and extensive consultation. The government and UNFPA have also reached out to the media to communicate the guidelines to the wider public and urge journalists to provide more responsible coverage of issues related to adolescent girls. 
In recognition of the country’s religious leaders as key stakeholders on issues of sexual and reproductive health, a national summit was organized in 2018 that also addressed the introduction of the guidelines. The summit concluded with their commitment to strengthen knowledge sharing and advocacy efforts for comprehensive sexuality education.
Source: Ghana Education Service (2018), UNFPA (2018a; 2018b).

[Source: GEM Report Team. 2019. Facing the facts: the case for comprehensive sexuality education, p.12.]

Scotland has mainstreamed comprehensive sexuality education as part of an emphasis on health and well being. Scotland has developed a policy framework that puts health and well-being at the centre of the school curriculum and at the heart of children’s learning, alongside literacy and numeracy. The framework is supported by legislation and policies including the Children and Young People (Scotland) Act 2014, which sets out to improve the well-being of children and young people through systematic and consistent recognition of their rights, in accordance with the United Nations Convention on the Rights of the Child. Under the Curriculum for Excellence, all teachers, regardless of subject, and all non-teaching staff are expected to reflect health and well-being, literacy and numeracy in their lessons and work practices.
The health and well-being curriculum covers relationships, sexual health and parenthood. Its use is guided by eight well-being indicators: safe; healthy; achieving; nurtured; active; responsible; respected, and included. Because each child is unique, there is no set ‘level’ of well-being children should achieve. Instead, the indicators aim to be responsive to pupil needs and fully personalized, while ensuring consistency in how teachers consider the quality of each pupil’s life. This allows teachers to respond not only to the local context but also to students’ unique circumstances.
The Scottish Education Authority recognizes that there will inevitably be variation in teaching from school to school, as the Curriculum for Excellence is based on learner needs at a local level and takes local health and well-being priorities into account. While there are clear expectations about how children should progress, teachers, headteachers and education professionals are given the authority to decide what is taught and how content is delivered.
Source: O’Neill (2017).

[Source: GEM Report Team. 2019. Facing the facts: the case for comprehensive sexuality education, p.13.]