Sex education strategies and adolescent sexual behaviour in Ghanaian schools.

Abstract

School-based sex education is meant to equip adolescents with knowledge and skills to make healthy sexual decisions, yet adolescent sexual risk-taking remains high in Ghana. This study examined the influence of different sex education strategies on in-school adolescents’ sexual behaviour in the Bosomtwe District of Ghana. A mixed-methods approach was employed, surveying 489 senior high school students (aged 14–21) and conducting focus group discussions (FGDs) with students and teachers. Quantitative data (questionnaires) were analyzed for descriptive and inferential patterns, including chi-square tests of association between exposure to sex education content and sexual behaviour outcomes. Qualitative data from FGDs were thematically analyzed to contextualize and support the quantitative findings. The majority of students had been exposed to abstinence-focused education (85%) and sexual refusal skills training (88%), while contraceptive education was less emphasized. Over half (57%) of the adolescents were sexually active, with a median age of sexual debut around 15 years. Many engaged in unprotected sex; condom use, while relatively high at first sexual encounter, dropped in more recent encounters as some students cited decreased pleasure with condoms. A considerable proportion had multiple sexual partners, including transactional relationships. Chi-square analyses found no significant association between exposure to school sex education (in any form) and age at first sex or number of partners (p>0.3). There was a slightly positive association between abstinence-focused education and ever-use of contraception (p≈0.04), but overall, the current curriculum exposure did not markedly alter risky behaviours. These findings suggest that the present abstinence-centric and piecemeal sex education approach in Ghanaian schools has limited impact on adolescents’ sexual behaviour. A comprehensive sexuality education strategy that goes beyond abstinence — including practical contraceptive knowledge, skill-building for negotiation, and addressing motivational factors such as peer pressure and desire for pleasure, is recommended. Such an approach could better equip adolescents to delay sexual initiation, reduce risky practices, and make informed, safer choices regarding their sexual health.