Asian Journal of Pregnancy and Childbirth

Adolescent sexual and reproductive health (ASRH) remains a critical global public health concern, particularly in low- and middle-income countries, where early sexual debut, unintended pregnancies and sexually transmitted infections (STIs) are prevalent. School-based sexual health programmes have emerged as a promising strategy to address gaps in adolescents’ knowledge, attitudes and behaviours related to sexual and reproductive health. This paper explores the implementation, effectiveness and challenges of such programmes, drawing on evidence from diverse settings. This study employed a mixed-methods design and targeted adolescents aged 12 to 18 years. A total of 20 schools participated, comprising approximately 4,500 students. Quantitative data were collected using pre- and post-intervention surveys, while qualitative data were gathered through focus group discussions and semi-structured interviews with students, teachers and programme facilitators. Statistical analyses were performed using descriptive and inferential techniques. Paired t-tests and chi-square tests compared pre- and post-intervention survey responses, while multivariate regression analyses examined associations between demographic factors and behavioural outcomes. The majority of students reported living with both parents (62.1%), while 25.4% lived with a single parent and 12.5% resided with guardians or extended family. Sexual activity was reported by 18% of participants, with a higher prevalence among older adolescents aged 16–18 years (27%) than among those aged 12–15 years (11%). Scores for self-efficacy in negotiating sexual decisions increased significantly from a mean of 2.8 to 4.1 on a 5-point Likert scale (p < 0.001). Participation in voluntary counselling and testing services increased from 18% at baseline to 52% post-intervention, suggesting enhanced engagement with reproductive health services. Thematic analysis identified key success factors, including high-quality facilitation, culturally relevant content and repetition of core messages. Parental involvement and school leadership support were essential in sustaining learner engagement. Comprehensive sexual health education within schools has been shown to improve knowledge about contraception, delay sexual initiation, reduce risky sexual behaviours and promote healthy decision-making. Despite these benefits, limited resources, inadequate teacher training, cultural resistance and variable policy support hinder widespread implementation. By bridging knowledge and service gaps, school-based sexual health programmes contribute to improved reproductive health outcomes, reduced adolescent pregnancy rates and the empowerment of young people to make informed decisions about their sexual and reproductive health. Future research should focus on longitudinal assessments, adaptation to local contexts and strategies for scaling successful interventions sustainably. Overall, integrating evidence-based sexual health education into school curricula represents an important step towards promoting adolescent well-being globally.