While school-based comprehensive sex education (CSE) is effective in HIV prevention among young people ages 10–24 years, Ghana’s national sexual and reproductive health education policy promotes abstinence. Meanwhile, the Ministry of Health’s HIV prevention programs provide more comprehensive school-based education. This qualitative study evaluated the HIV/AIDS education program in the Lower Manya Krobo Municipality to assess the perspectives of students and educators in 10 schools on school-based sexual and reproductive health programs, including HIV/AIDS education and conflicting HIV/AIDS sex education policies. HIV prevalence in the Lower Manya Krobo Municipality of Ghana was more than twice the national average at 5.64% in 2018, and prevalence among youth in the municipality aged 15–24 was the highest in the nation at 0.8%. Educators have mixed feelings regarding abstinence-based and CSE approaches. However, students generally endorse abstinence and describe the limitations of condom use. Ambiguity in overarching policies is identified as a factor that could influence the orientation of school-based health educators, create disharmony in sex education interventions, introduce confusing sex education messages to young people, and create a potentially narrow curriculum that limits the gamut of HIV/AIDS sex education to exclude young people’s risky sexual behaviours and diverse teaching and implementation strategies. Policies and the scope of sex education should be realigned to ensure the transparent implementation of HIV/AIDS sex education programs in Ghana.

Background: Condom education campaigns that aim to prevent early and unintended pregnancies can be undermined by local gender norms, religious edicts and ineffective sexuality education policies. In some schools in Ghana, both condom education and abstinence only education run concurrently. Methods: This study explored community attitudes towards condom education in a context of competing messages about sexuality education. The study adopted a qualitative case study approach involving three schools in the Komenda-Edina-Eguafo-Abrem Municipality of the Central Region of Ghana. Data were collected from in-depth interviews with pupils and educators. They were analysed by (1) template analysis and (2) using the Health Promoting Schools framework, which emphasises links between schools and communities in sexuality education programming. Findings: In the case study schools, condom education was implemented alongside abstinence education through partnerships between schools and the local community. Attitudes varied in the community – with some members rejecting condom education, while others encouraged their daughters into consensual relationships and contraception. The (Methodist) church locally also rejected condom education. The interplay between poverty and gender power relations puts young women at a disadvantage in decision-making about sex, including condom use. Simultaneously, cultural taboos and religious norms limit condom use and place 11- to 15-year-olds at risk of early and unintended pregnancy. Conclusion: Future policy must account for local gender norms, poverty and gender power relations, alongside prevailing religious beliefs that affect sexual health interventions. Unlike the current fragmented picture, a coherent sexuality education framework could effectively address these local factors, leading to better outcomes for sexuality and condom education programmes, with health and educational benefits for young people.

Female Genital Mutilation/Cutting (FGM/C) as a form of gender-related violence continues to thrive within communities and across borders, with (under)reported prevalence among communities in the diaspora. Reports of FGM/C among communities in the diaspora speak to the socio-cultural and religious factors which promote its prevalence. Successful interventions offer alternatives such as rites of passage to the socio-cultural-religious prospects offered by FGM/C to practicing communities. This suggests the need for a critical approach to research methods that engage intimately with the worldview of communities practicing FGM/C while inferring implications for designing health-promotion interventions in specific contexts. This paper draws on the insider and outsider approach to positionality to assess the factors accounting for the prevalence of FGM/C in Pusiga (3.8% nationally and 27.8% in Pusiga) in the Upper East Region of Ghana while inferring lessons for designing health promotion interventions. Applying a phenomenological qualitative design guided by focus groups and interviews, we draw on the insider approach to present a contextually and culturally sensitive report of five survivors, five non-survivors, and ten religious leaders on factors that account for the prevalence of FGM/C. Next, we assume an outsider approach to infer implications based on participants’ perspectives for designing health promotion interventions to curb FGM/C. The findings suggest shifting from socio-cultural-religious factors to economic undertones underpinning FGM/C. Inter-generational differences also vary attitudes toward FGM/C. We recommend a systematic approach to health promotion that addresses FGM/C’s deep socio-cultural and economic, religious underpinnings of FGM/C in Pusiga. The insider–outsider continuum in feminist research provides a powerful approach to producing knowledge on contextual factors that account for FGM/C in particular settings.

Adolescence represents a vital transitional phase during which young people actively explore and engage with their sexual identity and expression. However, in Sub-Saharan African contexts, such as Ghana, prevailing socio-cultural norms can inhibit the recognition of young people as sexual beings, thereby restricting their ability to engage with their sexuality. It is essential to examine structural interventions, particularly sexual and reproductive health initiatives, to understand how they can better address the challenges within the Ghanaian context, where the conceptualization of young people’s sexuality remains problematic, because socio-cultural norms recognize only adults, and not young people, as sexual beings. This narrative review evaluates existing SRH policies in Ghana and analyzes evidence from schools, communities, and families to discern how young people’s sexuality is perceived. An overview of overarching policies shows a fragmented intersectoral approach, emphasizing an abstinence-based curriculum, while incorporating some elements of comprehensive sexuality education like condom use. Investigation into community, school, and home interventions reveals ambivalent attitudes toward young people’s sexuality, with a mix of acceptance and rejection of their sexuality, moral support for abstinence, and varying views on contraception. Further analysis using the sociology of childhood suggests that the incoherent framework for young people’s sexual and reproductive health, identified through this study’s reviews, is inadequate for a comprehensive understanding of young people’s sexuality. The existing sexual and reproductive health framework may not effectively challenge negative cultural norms and socio-cultural contexts that sustain the perception of young people as asexual beings. Therefore, implementing existing structural interventions within a comprehensive sexuality education framework is crucial to effectively tackle negative cultural norms and the contexts that marginalize young people’s sexuality.

Background: Condom education campaigns that aim to prevent early and unintended pregnancies (EUPs) can be undermined by local gender norms, religious edicts, and ineffective sex education policies. This study explored community attitudes towards condom education in the context of either comprehensive sexuality education or abstinence forms of sex education in three schools in Ghana. Methods: The study adopted a qualitative case study approach informed by in-depth interviews with programme managers and students. Findings: Findings show that condom education is implemented alongside abstinence education through partnerships between the school and the community. The community largely rejected condom education, while some parents encouraged their daughters into consensual relationships and contraception. The church also rejected condom education, contradicting parental encouragement for contraception use for young women in consensual relationships. The interplay between poverty and gendered power dynamics puts young women at a disadvantage in decision-making on sexual practice condom use. At the same time, cultural taboos and religious norms limit condom use and put 11-15-year-olds at risk of early and unintended pregnancy (EUPs). Conclusion:It is essential to recognise the impact that local gender, cultural and religious norms have in shaping how sexual health education is delivered and how sexual health outcomes are produced.