Authorization from the school head was obtained before entering any school to field the surveys, and further authorization to survey students was obtained from each head; some heads solicited consent from school boards where deemed necessary. To ensure equal representation of each school within its region, the number of sampled students per school was proportionate to school size. Scope of this report Reviews of policies and curricula pertaining to sexuality education have shown that while many countries have established curricula, little is known about their use in schools—the degree of implementation, the mode and quality of the instruction, the existence of program monitoring and evaluation tools, the adequacy and quality of teacher training, the level of support for or opposition to the subject, and the effectiveness of existing programs in achieving desired knowledge and behavioral outcomes among students. The topics considered in this study reflect a broad approach that could reasonably be expected in Ghana, given cultural contexts. Informants included Ministry of Education staff involved in the development of policies and curricula related to SRH education, as well as national stakeholders and individuals with international agencies and NGOs involved in implementation. Using various international guidelines, we identified five topic categories as key components of a comprehensive program Box 2. Defining comprehensive sexuality education The terminology used to describe sexuality education varies across countries; in Ghana, the term sexual and reproductive health education is widely employed, and we therefore use that terminology when referring specifically to Ghana throughout this report. There are also two main co-curricular programs that offer additional activities outside of the regular curriculum, either during or after school: Teachers reported challenges to teaching SRH topics effectively, including lack of time, lack of appropriate skills and inadequate teaching materials.
Following the selection of the regions and schools, letters were sent to the three regional directors of education, informing them about the survey and requesting their support. Topics such as communication and interpersonal skills, which are imperative for adolescent development, are included in the management in living elective curriculum and the HIV Alert module, and contraception topics are included in management in living and biology electives, but neither of these subjects is taken by all students. Despite efforts targeting young people, recent studies suggest a persistent need for SRH information and services, further emphasizing the need for high-quality sexuality education. Informed consent was sought from all participants. In-depth interviews with key informants. There are also two main co-curricular programs that offer additional activities outside of the regular curriculum, either during or after school: Ethical clearance for the study was obtained from the institutional review boards of the University of Cape Coast and the Guttmacher Institute. The Ministry of Education and the Ghana Education Service have collaborated with key agencies, notably the Ministry of Health and the Ghana Health Service, to provide sexuality education in schools. While a major aim of the overall study is to compare all four countries, this report presents findings only for Ghana. Survey of schools Selection of regions. The regional director in Greater Accra did not respond to the letter, but the heads of schools in that region were shown the permission letter from the Director-General, which was sufficient to allow entry into their schools. One was a private, all-male seminary school in the Northern region that did not allow questions about sexuality to be asked, and one was a public school in Greater Accra that refused because it had not received a letter from the regional director of education. Southern regions that have coastal strips: For example, we did not include topics such as sexual pleasure or desire, which are not culturally appropriate in the country setting. One region was selected from each zone. Because of scheduling issues, for one school in the Greater Accra region, the survey was conducted in June , and a few opinion leaders in the Northern and Greater Accra regions were interviewed in September of that year. There is also evidence that adolescents are particularly vulnerable to having unintended pregnancies that result in abortions. The presence or absence of the topics in each category was used to measure comprehensiveness in the range of topics offered. To ensure that all estimates were representative at the regional level, sample weights were applied to account for the different probabilities of a school, student, teacher or head being selected to participate. Summaries of key findings are presented at the ends of Chapters 3—7. Fourteen percent of all adolescents in Ghana have begun childbearing i. We did not, however, include these concepts in our measure of comprehensiveness in the range of topics. Characteristics of samples In the 82 sampled schools, we surveyed 78 school heads, teachers and 2, students. Improving and systematizing teacher training, and diversifying teaching approaches to encourage active student participation and promote practical skills, confidence and agency, are essential if SRH education is to be delivered accurately and effectively. We defined three levels:
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