School-based Comprehensive Sexuality Education for Prevention of Adolescent Pregnancy: A Scoping Review

Abstract

Abstract Background Adolescent pregnancy is a global public health problem. Comprehensive Sexuality Education (CSE) aims at increasing contraceptive use to prevent adolescent pregnancy. Numerous approaches for CSE delivery in schools have been implemented around the world. Previous reviews did not follow the International Technical Guidance on Sexuality Education (ITGSE) and because this subject is very diverse in terms of population, interventions, settings and outcomes. We conducted this scoping review to identify and map the evidence of school-based CSE for prevention of adolescent pregnancy with emphasizing on adolescents’ contraceptive use, unintended pregnancy and abortion.Methods We searched PubMed, CENTRAL, Scopus, ISI Web of Science, CINAHL, and WHO ICTRP to identify potential eligible studies from their inception to 12th May 2022. We included randomized controlled trials (RCTs) and non-RCTs of CSE implemented in public or private schools for adolescents. CSE was defined as a multi-session intervention in school that covered topics including contraception, pregnancy, abortion, and HIV/STI. School-based interventions were the main intervention that may be either stand-alone or multicomponent. There was no limitation on study’s geographical area, but only English-language studies were considered. Two reviewers selected and extracted data independently, discussed for consensus or consulted the third reviewer if there are discrepancies for final conclusion. Data were presented using figures, map and table.Results Out of 5,342 records, 75 studies (97 reports) were included in this review. Most studies were conducted in the United States and other high-income countries in secondary or high schools with cluster RCTs. All studies included participatory methods. Almost all studies included Sexual and Reproductive Health which is the eighth concept of CSE. The number of concepts, duration and providers varied across the included studies. However, none of the interventions identified in this scoping review adhered to the ITGSE recommended approach. Condom use was the most common reported outcome.Conclusions Our scoping review shows gaps in school-based CSE implementation in terms of completeness of concepts, providers, duration and outcomes recommended by ITGSE.