Bridging the gap: exploring students’ needs, knowledge, and preferences for delivering comprehensive sexuality education in Sierra Leone

Abstract

Background

Sierra Leone, like many developing countries, faces challenges in providing comprehensive sexuality education to its students. Despite the growing recognition of the importance of comprehensive sexuality education in promoting sexual health and well-being, there is a lack of standardised and accessible programs in many parts of the country. This study examined the disconnect between students’ needs (both perceived and real), their knowledge, and their preferences for delivering comprehensive sexuality education in Sierra Leone.

Methods

This qualitative study, which was part of a broader research initiative by the Institute for Development and funded by the UK Foreign Commonwealth Development Office, explored the delivery of comprehensive sexuality education in Sierra Leone. Using purposive sampling, the study engaged students, educators, school administrators, community leaders, and parents/guardians from 11 diverse schools across four provinces (Northern, Northwestern, Southern, and Western Area) in Sierra Leone. Data were collected through gender-separated focus group discussions and semi-structured interviews, conducted in schools and community settings, with protocols tailored to ensure cultural sensitivity and participant comfort. Thematic analysis was employed to identify patterns and themes related to students' comprehensive sexuality education knowledge, preferences, and contextual challenges.

Results

Our study reveals a hostile educational environment, with reports of male teachers making inappropriate advances and harassing female students, creating unsafe learning conditions. Economic challenges force many rural students to relocate to urban areas, where financial instability drives them into relationships for survival, often exacerbated by parental encouragement for economic gain. Girls engaged in hawking face heightened risks of sexual abuse. Students demonstrate some knowledge of sexual and reproductive health, including family planning and contraceptives, but gaps remain, particularly in understanding puberty and menstrual health. Information sources are varied, including digital platforms, traditional media, and community figures, but often lack reliability. Preferences for comprehensive sexuality education delivery differ by gender and marginalised groups, with female students favouring confidential, female-led discussions, while male students seek structured, community-based approaches. Marginalised groups, including students with disabilities and pregnant students, emphasise the need for inclusive, non-judgemental support.

Conclusion

The findings underscore the need for safe, inclusive, and culturally sensitive comprehensive sexuality education in Sierra Leone. Addressing teacher harassment and creating safe learning environments are critical, alongside tackling economic vulnerabilities that push students into exploitative relationships through financial support mechanisms. Bridging knowledge gaps on puberty and menstrual health requires improved curricula and teacher training, while reliance on informal sources highlights the need for accurate, youth-friendly information through trusted channels like female teachers and digital platforms. Tailored approaches for marginalised groups, such as students with disabilities and pregnant students, are essential, emphasising inclusive strategies like visual aids and community-based support.

Introduction

Comprehensive sexuality education (CSE) is a critical component of public health and education systems worldwide, particularly in developing countries where informed decision-making regarding sexual health is paramount [1]. In Sierra Leone, a nation with high rates of adolescent pregnancy, sexually transmitted infections (STIs), and limited access to reproductive health services, the implementation of CSE is essential [2]. Evidence demonstrates that CSE positively impacts a wide range of sexual and reproductive health (SRH) outcomes, including delayed sexual initiation, reduced rates of STIs and unintended pregnancies, and improved knowledge and attitudes toward SRH [3, 4], underscoring its relevance to addressing Sierra Leone’s SRH challenges.

Understanding student preferences for CSE delivery is vital, as effective education must resonate with its audience to foster engagement and retention [5]. In Sierra Leone, where cultural norms and societal attitudes towards sexuality can be conservative, it is crucial to investigate how various factors influence student receptivity to different educational methods [2]. Moreover, engaging students in discussions about their preferences empowers them and ensures that the education is relevant and culturally sensitive [6, 7]. By prioritising student input, we can better address misconceptions and stigma surrounding sex education, ultimately leading to healthier attitudes and behaviours.

In Sierra Leone, CSE is undergoing a period of gradual reform, though it remains characterized by challenges such as limited resources, inadequate training for educators, and a lack of fully operationalized policies [8]. In 2018, the President pledged to reintroduce Family Life Education in schools, a commitment that has since prompted the Ministry of Basic and Senior Secondary Education (MBSSE) to establish a Child and Adolescent Health and Life Skills (CAHLS) task force [9]. This body coordinates activities and strategies among various partners and advises the government on issues pertaining to youth health, life skills, and the radical inclusion of women and girls into national development processes. Notably, CAHLS has emerged as the preferred term in Sierra Leone, as the explicit inclusion of the word “sexuality” has not been culturally acceptable to certain stakeholders. A dedicated syllabus is now being piloted, with plans for CAHLS content to be delivered in junior and senior secondary schools and integrated in up to seven core subjects including 1.Language Arts 2. Social Studies 3. Integrated Science 4. Religious and Moral Education 5. Physical and Health Education 6. Home Economics and 7. Mathematics. At senior secondary school level, there are also plans for CALHS to be embedded in the instruction of critical thinking skills. Five government partners have begun implementing CAHLS in a limited number of schools across select districts, signaling early but promising steps toward a more comprehensive and accessible approach to sexuality education. Building on this evolving framework, this study aims to analyze the persisting challenges in implementing CAHLS while providing evidence-based recommendations to enhance its delivery, with a focus on aligning with student preferences and needs. By doing so, we aim to enrich the ongoing discourse on effective health and life skills education in resource-limited settings.

Methods

Study design

The study utilised a qualitative research to get specific, contextual knowledge via direct participant interactions. This study was a component of comprehensive research conducted by the Institute for Development (IfD) to guide the formulation of the second phase of the countrywide Secondary School Education Improvement Project (SSEIP2), financed by the UK Foreign Commonwealth Development Office (FCDO) and executed by Mott MacDonald. The research examined school violence, the influence of social norms on the marginalisation of specific student groups, and stakeholders’ views on comprehensive sexuality education. The qualitative design was selected to investigate the intricate social dynamics and power linkages affecting educational experiences and outcomes for marginalised groups(students with disabilities, pregnant students, student mothers, and students living apart from their families)within Sierra Leone’s educational systems.

Sampling strategy

Participants were chosen using purposive sampling to ensure a broad representation of social, economic, and cultural backgrounds. The study encompassed stakeholders including students, educators, school administrators, community leaders, and parents/guardians from 11 schools spanning four provinces (Northern, Northwestern, Southern and Western Area) of Sierra Leone. The selected schools comprised both junior and senior secondary institutions, Christian, Muslim, secular, single-sex, and coeducational to capture a wide range of perspectives. By deliberately targeting such a wide range of participants and school types, the study captured perspectives from different demographic, religious, and institutional contexts, thereby enhancing the diversity and richness of the viewpoints represented.

Sierra Leone follows a 6-3-3-4 education system, whereby children typically enter primary school at age six, then progress through three years of junior secondary school (JSS) and three years of senior secondary school (SSS). Under ideal circumstances, JSS students are around 12–14 years old, while SSS students are approximately 15–17 years old. However, late school enrollment and grade repetition mean that actual ages can vary, and some participants were older than the typical range. Some of the student participants had been exposed to some form of CSE within their respective schools or communities, though the degree and content of this exposure varied. Lastly, parents/guardians in the study were those of students currently attending these schools, ensuring that their insights were directly relevant to the research questions.

Data collection

Data were gathered through focus group discussions with students, which were organized by gender to ensure diverse perspectives. As part of a larger study, educators, school administrators, community leaders, and parents/guardians were also consulted; however, the findings from these groups are not included in this paper, which focuses solely on the data collected from students.To ensure a focused and relevant discussion, genders were always separated during these sessions to encourage open and uninhibited contributions from all participants. This separation was crucial in exploring sensitive topics and gathering candid responses, especially regarding SRH.

The semi-structured interview and FGD protocol, developed specifically for this research, is outlined in the supplementary file in English. However participants were able to have the interview in the language of their choice. Interviews with educators, school administrators, and students were conducted on school grounds, ensuring a formal setting conducive to discussing professional and educational experiences. In contrast, interviews with community leaders and parents/guardians took place in community spaces or at their residences, settings that likely made participants feel more at ease when discussing personal and community issues. The structure of the interview guide (attached in the supplementary file) was directly aligned with the results section themes, focusing on SRH knowledge, contextual realities affecting SRH education, and preferred modes of delivery.

Before data collection, participants were apprised of the study’s objectives: to comprehend stakeholders’ perspectives on delivering comprehensive sexuality education to adolescents and young individuals. Participants were informed that the outcomes of this research would be disseminated to relevant stakeholders through published reports, peer-reviewed publications, posters/presentations and workshops to assist the Ministry of Basic and Senior Secondary Education in enhancing the approach schools use to overcome exclusion. Given the sensitive nature of CSE in the African context and the potential stigma associated with supporting its implementation, strict measures were taken to ensure participants’ confidentiality and anonymity. Participants were informed prior to data collection that their identities would remain protected, with pseudonyms or identification codes used in place of real names during recording, transcription, and analysis. Data were securely stored in password-protected files accessible only to the research team, and interviews or focus group discussions were conducted in private, neutral settings to ensure comfort and privacy. These steps created a safe environment for participants to share their views without fear of stigma or repercussions.

Training and pre-testing

Before data collection, researchers underwent extensive training to familiarize themselves with the theoretical framework, ethical considerations, and sensitivities surrounding gender-based violence and sexual and reproductive health rights. The Social Ecological Model (SEM) was chosen as the guiding framework for this study because it provides a comprehensive lens for understanding how individual behaviors, preferences, and access to information are shaped by the interaction of multiple levels of influence. These include personal, interpersonal, organizational, community, and societal factors [10]. The SEM is particularly relevant for studying the delivery of CSE, as it allows for an in-depth analysis of how contextual realities such as economic challenges, gender norms, and community structures intersect with students’ knowledge, preferences, and access to SRH information. By using the SEM, this study was able to capture the complexity of these interactions and generate insights that are not only theoretically grounded but also actionable for designing multi-level interventions to improve CSE delivery in Sierra Leone.The training of the researchers also included mastering qualitative data collection methodologies. To ensure the research instruments were culturally appropriate and effective, the interview guides and focus group discussion protocols were pilot-tested in a school/community near Freetown. The pilot study revealed several issues, including the use of certain terms and phrases that were either unclear or culturally sensitive, which risked causing discomfort or misunderstanding among participants. Additionally, some questions were found to be too broad, leading to responses that lacked depth, while others were overly complex, making them difficult for participants to comprehend. Based on these findings, the instruments were revised to include clearer and more culturally sensitive language, as well as more focused and accessible questions. These modifications ensured that the tools were better suited to the cultural context and capable of generating meaningful and relevant data.

Data analysis

Transcriptions and data coding from semi-structured interviews and focus groups were conducted using thematic analysis [11]. The analysis was performed manually in Microsoft Word, with researchers organising, coding, and identifying patterns and themes within the data collection. The researchers commenced with an extensive familiarisation process of the data, encompassing interview transcripts and observational notes. Subsequently, the team structured the data into manageable chunks, classifying responses according to principal themes about current knowledge and sources of information on sexual reproductive health, influential factors in sex and relationships, and student’s preferences for delivering CSE. Each researcher was allocated distinct segments of the dataset, facilitating concentrated investigation and encouraging varied interpretations of the results. The coding procedure entailed recognising key phrases, concepts, and patterns within the data. The researchers jointly created a coding framework that encapsulated the subtleties of the participants’ perspectives. This framework was progressively enhanced as new insights surfaced, ensuring the analysis remained adaptable and sensitive to the data. The researchers assembled to deliberate on their findings upon completing the initial coding. This interactive debate enabled the discovery of predominant themes and patterns throughout the dataset. To enhance the validity and robustness of the findings, the researchers employed a triangulation method, systematically cross-referencing the identified themes with established literature on CSE. This methodological approach ensured a multi-faceted validation of the results by integrating diverse perspectives from existing academic research. By situating the findings within the broader research framework in Sierra Leone and similar contexts, the triangulation process not only confirmed the reliability of the results but also enriched the analysis. This deliberate linking to established research strengthened the study’s credibility, relevance, and alignment with the wider academic discourse.

Results

Our study included 61 FGDs with 6 participants per FGD among the 366 participants in total. Table 1 below shows the breakdown of interviews per district and school.

Table 1 Summary of interview participants by district

Understanding students’ concerns and influential factors in sex and relationships for effective CSE

Our findings highlight the pressing need for a deep understanding of the multi-faceted concerns and influences on students’ decisions and behaviours regarding sex and relationships to develop and provide effective CSE.

Concerns arise from within the educational environment itself, where some male teachers are reported to make inappropriate advances toward students. According to reports from a female student in Koinadugu district, “Teachers in this school like to make advances on intelligent girls just to have sex with them. When a girl refuses their request, they will punish her every day.” This behaviour undermines the educational experience and contributes to a hostile and unsafe learning environment. Moreover, there are reports of physical harassment where a female student stated,“some male teachers are in the habit of touching our buttocks, and they like to tell us some inappropriate words about sex.”

Many students from rural areas are compelled to relocate to larger towns to access secondary education, as their villages lack such facilities. This transition often places them in a precarious economic situation, as the earning power of their parents back in the village seldom meets their needs in urban settings. A female student from Karene Junior Secondary School in Karene explained the dilemma: “For the girls that are coming from the village, most of them need to have boyfriends so that they will be able to survive in the big town; otherwise, they will not be able to survive because their parents are not here. Their eyes are more open in the street than in the big town.” This highlights how economic necessity drives these students to depend on boyfriends for financial support to afford basic necessities like school lunches.

Even in cases where students find supportive carers in these larger towns, they often face additional challenges such as managing relationships with the carers’ own biological children. A female student described this complex situation: “The thing that worries me most about sex and relationships is the stress we get from the people we are residing with. Some of our carers don’t have a problem helping us with schooling and basic needs, but their children are so jealous that when they give us money, they [children of the carers] will take the money away from us. To avoid the embarrassment, that is why we engage in sexual relationships, at least our boyfriends can’t give us money and collect it from us.” This indicates the intricate dynamics involved when living with non-family members and how these circumstances influence students’ decisions to enter relationships that offer a more reliable source of financial support.

Furthermore, some parents actively push their daughters into these relationships for economic benefits. A distressing account from a female student revealed, “Some parents actively contribute to their daughters getting pregnant by advising them to find a boyfriend and take care of themselves, even suggesting that the boyfriend take care of the parents as well. This encouragement leads some girls into relationships with boys. Some parents even deliberately withhold lunch, compelling their daughters to seek support elsewhere.” This testimony underscores the dire economic conditions that not only prompt students to seek financial stability through relationships but also involve parental encouragement, adding another layer of complexity to the students’ socio-economic challenges.

Amidst the economic and familial challenges, another deeply concerning aspect involves the vulnerability of girls engaged in hawking. Often separated from their biological parents, these girls confront not only the hardships associated with child mobility (living away from their biological parents) but also significantly increased risks of sexual abuse. The nature of their work selling goods in public spaces exposes them to male customers or bystanders who may exploit these interactions. Disturbingly, some men take advantage of the supposed commercial exchange to commit acts of violence. Testimonies from Koinadugu and Karene districts illustrate the severity of this threat. One female student from JSS-Koinadugu recounted a chilling scenario: “Sometimes, the men will call you into their room to sell; when you enter their room, that is when they will rape you.”

Students’ current knowledge and sources of information on CSE

Female students demonstrated a clear understanding of family planning, viewing it both as a mutual agreement between couples regarding their desired number of children and a method to prevent unintended pregnancies, thus preparing them for future responsibilities. They perceive birth spacing as a strategy for better parental care for each child. In terms of contraceptives and other preventative measures, female students were aware of various methods like implants (locally known as Captain Band), condoms, pills, coils, and injections (Depo). They also acknowledged traditional methods, such as tying a rope around the waist to prevent pregnancy.

They emphasised the importance of cleanliness, especially during menstruation, to avoid unpleasant odours; as one female student from Karene noted: “If you are experiencing your menstrual cycle and, in the morning, you do not wash your body and you go where your colleagues are, they will get the bad smell from my body.” However, there seems to be a gap in comprehensive knowledge about puberty, as there was lack of discussion from researchers about the menstrual cycle itself its phases, hormonal changes, and physiological implications.

In relationships, female students value mutual respect and have a conceptual understanding of what a good relationship should look like, as noted by a female student in Western Area Urban: “Students are aware of what a good relationship should look like—mutual respect between spouses.”

Male students also recognised the concept of family planning and birth spacing, primarily through a functional understanding, as something to guide them. Their knowledge of contraceptives includes condoms and implants, indicating a practical awareness of available preventative options. However, it is noteworthy that a male student from Koinadugu expressed a commonly-held opinion among male participants, stating that “male students are not listened to when they ask questions on the topic of sex,” suggesting a gendered disparity in engagement and information delivery in educational settings.Sources of information about sex and relationships for students are varied and come from multiple platforms, as highlighted by participants:

• Digital Platforms: Female students shared that they often access information through social media platforms such as TikTok, Facebook, Instagram, and WhatsApp. One female student remarked, “I learn about relationships and sex mostly from TikTok videos and WhatsApp groups where my friends share posts.” Male students, on the other hand, specifically mentioned the use of explicit internet content, with one male student stating, “We watch videos on the internet to understand more about sex.”

• Traditional Media:Participants highlighted movies, television, and radio as other sources of information. For instance, one female student noted, “I listen to radio programs on Sierra Leone Broadcasting Cooperation that talk about health and relationships,” while another added, “We watch Africa Young Voices television programs that discuss issues about sex and relationships.”

• Educational and Social Environments: Both male and female students acknowledged schoolteachers and biology classes as key sources of information. One male student shared, “Our biology teacher explains reproductive health in class, but not all questions are answered.” Additionally, NGOs were frequently mentioned for their contributions through life skills sessions, community outreach, and assembly talks. A participant explained, “The NGO workers come to our school to talk about life skills and relationships, and they teach us things we don’t learn in class.” Government initiatives, such as community sensitization programs, were also cited as important channels.

• Community and Family: Students noted that community health workers, health professionals, and family members provide information. For example, a female student stated, “The health workers in our community talk to us about sex education during their visits,” while another mentioned, “My aunt talks to me about relationships and how to avoid problems.”

Both genders showed gaps in knowledge on fundamental areas like puberty, indicating a common need for enhanced educational interventions. Furthermore, students relied on informal and potentially unreliable sources of information like sex videos or peer advice.

Students’ preferences for content and delivery of CSE

Students’ preferences for the delivery of CSE provide crucial insights into optimal approaches for teaching about sex and relationships, ensuring these methods respect their needs and cultural contexts. Notably, preferences differ significantly between genders and are particularly distinct among marginalized groups.

Female students, for instance, express a strong preference for receiving information from trusted, confidential sources. They appreciate discussing sensitive topics with individuals who are considered discreet and supportive, favouring communication with female teachers and older sisters, which reflects their comfort with authoritative yet personally relatable figures. One female student from JSS-Koinadugu articulated this preference clearly: “We prefer…people that can keep a secret. For example, Female teacher (Aunty Mary, Miss Conteh, Mrs Mansaray) and older sisters.” Moreover, in regions such as Bo, Karene, and Koinadugu, female students trust not only their immediate family parents, guardians, siblings but also other older women in the community and health professionals like nurses.

This preference highlights the critical role of supportive, understanding, and relatable communicators who can offer both information and reassurance in a confidential environment. However, this ideal is challenged by the reality in some schools, such as one in Karene, where there is a notable shortage of female teachers, which complicates the delivery of CSE tailored to the preferences and comforts of female students. As one female student explained, “We feel more comfortable talking to female teachers about these topics because they understand us better.” This highlights the importance of addressing the shortage of female teachers to meet students’ preferences effectively. Male students have articulated a clear and specific interest in learning more about family planning and sexual intercourse, underscoring a broader curiosity and desire for comprehensive sexual health education. Their requests reflect an intent to understand effective strategies for managing family size and responsibly planning for their future. For instance, during a focus group discussion, a male student from Bo expressed, “I want more information about family planning because I want to learn how to plan my family.” Additionally, their eagerness extends to gaining a better understanding of sexual intercourse, indicating a need for detailed and accurate information that goes beyond the basics, as another student noted, “I also want to learn how to have sexual intercourse.”

However, despite their clear interest, there are challenges in the current educational environment that hinder their full participation in these discussions. For example, a JSS male student in Koinadugu, noted that “male students are not always listened to when they ask questions about sex”, suggesting a need for more open and responsive communication channels within educational settings.

Expanding on their educational preferences, male students suggest more structured and communal approaches for the delivery of CSE. They recommend that community health workers, health professionals, and biology teachers serve as the primary providers of this information. Moreover, they advocate for the dissemination of sex and relationship education through community meetings, radio discussions, and sessions conducted by teachers and parents. This preference for formal and broadly accessible formats indicates that male students might value a more public and perhaps less personalized approach to learning about sexual health, yet it is crucial that these forums also provide a space where their questions are welcomed and addressed effectively.

Meanwhile, students from marginalized groups including those with disabilities, those living away from their biological families, pregnant students, and student mothers have highlighted a distinct set of preferences for the delivery of CSE. They pointed towards NGOs, health centers, religious leaders (imams or pastors), and teachers as trusted and ideal channels for providing SRH information. Students with disabilities expressed a preference for communication methods that cater to their specific needs, such as the use of visual aids, sign language interpretation, and accessible learning materials. One male student with a physical disability shared, “Sometimes, they forget about us when teaching these things. We need pictures or examples we can understand easily.” Similarly, students living away from their biological families emphasized the importance of community-based support, with one female student stating, “NGOs and health centers are better because they understand our struggles and can help us without judging us.”

Pregnant students and student mothers highlighted the need for safe, non-judgmental spaces where they could access CSE and support tailored to their unique challenges. A pregnant student commented, “We need help from health workers who can teach us about our bodies and how to take care of ourselves without making us feel bad for being pregnant.” Another student mother added, “It is hard to go to school and take care of my baby. If they could come to us in the community, it would be easier to learn.”

Additionally, practical needs were a recurring theme among marginalized students. A female student living away from her biological family in a secondary school in Bo stated, “For us, the girl child, it is important they help us with pads in school because I remember the time I saw my time when I was in school, and I was not having a pad, so I had to go home before the normal time and lost some lessons for that day.” These preferences underscore the need for diverse and inclusive approaches that integrate educational content with practical and community-based support structures, ensuring that the unique circumstances and challenges faced by marginalized students are adequately addressed.

Discussion

The results from our study reveal that CSE among students involves diverse levels of understanding, various information sources, and distinct preferences for CSE delivery. Applying the SEM framework in our study highlights the complexity of students’ CSE knowledge, concerns, and preferences, while underscoring the need for multi-level interventions to deliver effective CSE.

At the individual level, female students strongly understand family planning as a mutual decision and preventative measure, suggesting effective communication about its role in life planning. However, gaps in knowledge about puberty highlight deficiencies in foundational biological education essential for SRH, echoing findings by Neema et al. [12], who reported similar trends among adolescent girls in Uganda. Students’ reliance on informal sources of information, such as social media platforms like TikTok and WhatsApp, reflects a gap in accessible, accurate, and comprehensive SRH education. This is consistent with existing literature that identifies adolescents’ use of digital media as a key strategy for filling knowledge gaps, albeit one fraught with risks of misinformation [13,14,15]. Addressing this issue requires equipping students with media literacy skills and ensuring that formal education provides evidence-based, age-appropriate, and engaging content to counteract unreliable sources.

At the interpersonal level, gendered differences in students’ preferences for CSE delivery reveal the influence of social relationships and cultural norms on learning. Female students’ preference for private discussions with female teachers, older sisters, or other trusted women underscores the importance of safe and confidential spaces for addressing sensitive topics. This finding aligns with research emphasizing the role of trusted interpersonal relationships in fostering open communication about SRH, particularly for girls [16, 17]. However, the shortage of female teachers in certain regions, as noted in this study, limits the ability to meet these preferences. Interventions at this level must focus on strengthening interpersonal networks by training female mentors, community health workers, and peer educators to deliver SRH education in a culturally sensitive manner. For male students, the preference for group-based learning formats, such as community meetings or radio discussions, highlights the importance of fostering collective engagement. However, the reported lack of responsiveness to male students’ questions in schools indicates a need to challenge traditional gender norms that discourage open dialogue about male SRH concerns.

At the community level, socio-economic pressures and cultural dynamics play a significant role in shaping students’ decisions and behaviours related to sex and relationships. The findings reveal that rural-to-urban migration for secondary education often places students, particularly girls, in precarious economic situations, leading to reliance on transactional relationships for financial support. This is consistent with literature documenting the intersection of poverty and gender inequality as key drivers of risky sexual behaviours [18, 19]. Additionally, the role of parents in encouraging daughters to seek financial support through relationships highlights the influence of community norms and economic hardship on SRH outcomes [20, 21]. Addressing these challenges requires community-level interventions, such as poverty alleviation programs, economic empowerment initiatives for families, and community sensitization campaigns to challenge harmful norms and practices. Furthermore, the vulnerability of girls engaged in hawking that is selling goods on the streets or in public spaces, often to support their families becomes evident in their limited access to education and increased exposure to exploitation and abuse. This underscores the need for targeted protections against sexual exploitation, including stricter enforcement of child protection laws and community-based monitoring systems.

At the organizational level, schools and NGOs emerge as critical platforms for delivering CSE, yet challenges persist in ensuring inclusivity and accessibility. The findings indicate that while biology teachers and NGO workers provide valuable SRH information, gaps remain in addressing students’ specific concerns, particularly for marginalized groups such as students with disabilities, pregnant students, and student mothers. This aligns with research highlighting the importance of tailoring CSE programs to meet the diverse needs of students, particularly those facing additional barriers to education [1, 22, 23]. Schools must adopt inclusive policies, such as providing menstrual hygiene products and creating safe spaces for pregnant students, to ensure that all learners can participate fully in SRH education. Partnerships with NGOs and health centers can further enhance the reach and effectiveness of CSE programs, particularly in underserved communities.

Finally, at the societal level, structural inequalities and systemic challenges create barriers to effective CSE delivery. The findings highlight issues such as the economic pressures driving transactional relationships, the shortage of female teachers, and the normalization of sexual harassment by male teachers, which undermine students’ ability to access a safe and supportive learning environment. These challenges reflect broader societal issues, including gender inequality, poverty, and weak enforcement of child protection policies, which are well-documented in the literature [24, 25]. Addressing these systemic issues requires coordinated efforts at the policy level, including increased investment in education, the recruitment and training of female teachers, and the implementation of strict accountability mechanisms to address sexual harassment in schools. Additionally, integrating SRH education into broader development initiatives, such as poverty reduction and gender equality programs, can help create an enabling environment for students to thrive.

Implications of the study

To enhance CSE in Sierra Leone, a multi-faceted approach tailored to the specific needs of students across different contexts is essential. The implications of this study are directed toward policymakers in government and its development partner donors including NGO implementing partners, educators, community leaders, and other stakeholders involved in both school-based and out-of-school CSE programs. First, school-based CSE programs must ensure that educational content is enriched to cover the biological aspects of sexual and reproductive health, including detailed discussions on puberty, menstruation, and reproduction, to provide students with a strong scientific foundation. Interactive teaching methods, such as group discussions and peer-led activities, should be adopted to better engage male students, while integrating digital literacy into the curriculum will help students critically evaluate online information and discern credible sources from misinformation. Confidential and empathetic communication channels, such as counseling services and safe spaces, should be prioritized within schools to foster open discussions about sensitive topics, particularly for female students.

Out-of-school CSE programs, delivered by NGOs, community health workers, and local leaders, should complement school-based efforts by focusing on marginalized and hard-to-reach groups, ensuring accessibility and cultural sensitivity. For example, community-focused delivery methods, such as public awareness campaigns and collaboration with local leaders, can effectively engage male students and broaden the reach of CSE beyond formal educational settings. Programs targeting marginalized groups, including students with disabilities, pregnant students, and those involved in hawking, must address their unique vulnerabilities through tailored interventions, such as teaching self-defense, legal rights, and resources for seeking help in cases of abuse. Both school-based and out-of-school programs should address socio-economic factors driving transactional sex by providing education on financial literacy and linking students to available support services.

To ensure complementarity between school-based and out-of-school CSE, there must be strong collaboration among stakeholders. Schools should partner with NGOs and health centers to deliver life skills sessions, community outreach, and assembly talks that reinforce classroom learning. Additionally, strict policies are necessary to safeguard students from educator misconduct, including regular training on professional boundaries and the establishment of robust reporting systems. Addressing peer influence and misinformation should be a shared focus, with both school-based and out-of-school programs incorporating scenario-based learning to equip students with critical thinking skills. By fostering coordination among educators, policymakers, community leaders, and health professionals, these recommendations can ensure a comprehensive and effective CSE delivery that meets the diverse needs of all students in Sierra Leone.

Strengths and limitations of the study

Our study on student preferences for the delivery of CSE in Sierra Leone showcases several strengths and limitations. A key strength is its qualitative design, which employs purposive sampling to capture diverse perspectives, allowing for a rich and nuanced understanding of students’ knowledge and preferences regarding CSE. However, the reliance on self-reported data could lead to social desirability bias, where participants may not disclose their true feelings or experiences regarding sexual health. We also recognize that the sampling method, which relied on purposive sampling within selected schools and districts, may not yield findings that are fully representative of the entire country. Furthermore, the findings of this research are context-specific to Sierra Leone. However, these experiences could reflect young people in different contexts with similar sociocultural and economic circumstances.

Conclusion

The study highlights gaps in knowledge and understanding of sexual and reproductive health among students in Sierra Leone, revealing a pressing need for CSE that is tailored to the diverse preferences and needs of both female and male students. Female students favour confidential discussions with trusted figures, while male students prefer more formal, communal settings for information delivery. To address these disparities, CSE programs should incorporate a multi-faceted approach that includes training female teachers to foster a supportive discussion environment while leveraging digital and traditional media to reach students effectively. Additionally, the curriculum must address socio-economic factors influencing students’ decisions and incorporate strategies to mitigate risks, particularly for vulnerable groups. By ensuring that CSE is accessible, inclusive, and sensitive to the unique challenges faced by marginalised students, educational initiatives can empower young people to make informed decisions about their sexual health and relationships, ultimately promoting a safer and more informed generation.