“Not just the consequences, but also the pleasurable sex”: a review of the content of comprehensive sexuality education for schooling early adolescents in Rwanda.

Abstract Background: Responding to adolescents' educational needs in sexual and reproductive health and rights is central to their sexual health. In 2016, Rwanda introduced the Competence-based curriculum (CBC) that integrated comprehensive sexuality education (CSE). However, globally, the content of CSE is sometimes dissimilar, and little evidence surrounds its scope in many settings. This study aimed to assess major topic areas of the school-based CSE for early adolescents, analyse how this CSE correlates with international guidelines, and make recommendations accordingly.Methods: We reviewed the CBC and conducted semi-structured interviews with key informants concerned with sexuality education to map sexuality education contents and related CSE competences for pre-primary, primary and lower secondary levels. We selected eleven of the 23 CBC documents for the final review. We manually extracted data using a standard form in Microsoft Excel. We conducted a descriptive analysis (frequency tables and charts) of review data and a thematically analysed interviews in NVivo 11 for Windows using the International Technical Guidance of Sexuality Education (ITGSE).Findings: Overall, we found 58 CSE competences from the CBC. CSE competences increased with school grades: 4/58 (6.9%) in pre-school, 5/58 (8.6%) in lower-primary, 17/58 (29.3%) in upper-primary, and 32/58 (55.2%) in lower-secondary levels. Subjects of Kinyarwanda (13/58, 22.4%), Biology (10/58, 17.2%), and Social studies (9/58, 15.5%) abounded in CSE. Four ITGSE key concepts abounded most in CSE competences: Sexual and reproductive health (13/58, 22.4%); Human body and development (11/58, 19%); Values, rights, and sexuality (9/58, 15.5%); and Understanding gender (8/58, 13.8%). The CBC CSE covered least the area of Violence and staying safe (2/58, 3.4%). Six of 27 ITGSE topics had only one CSE competence, and eight ITGSE topics were not represented in the CBC. Recommended additional contents are sexual pleasure, sexual orientation, sexual desire and modern contraceptive methods such as condoms.Conclusion: CSE for early adolescents is delivered mainly in three subjects and aligns, to some extent, with the international guidelines for sexuality education. CSE intensifies with school grades and emphasises more on some topics than others that are equally important. The study recommends additional topics for CSE for this age group.