Scaling up, sustaining, and enhancing school-based sexuality education programs in resource-constrained and conservative contexts: Replicable lessons from positive-deviant countries

Despite considerable efforts, progress in the implementationof sexuality education (SE) has been uneven. This study identi-fied six “positive-deviant” low- and middle-income countries,i.e., countries that had scaled up, sustained and enhancedtheir SE programs when many others—in similar social, cul-tural and economic circumstances—were not able to do so. Inother words, they were significantly and consistently moresuccessful than the norm. Countries were shortlisted using avalidated framework and were analyzed using three other vali-dated frameworks on political priority setting, scaling up, andstakeholder engagement. The study found that India, Pakistan,Nigeria, Senegal, Mexico, and Uruguay had scaled up (eithernationwide or in some states/provinces), sustained andenhanced their SE programs in very different contexts. In allsix, SE was a political priority, the national or state/provincelevel SE scale up effort had been carefully planned and man-aged, and a mix of methods were used to build support and/or to overcome resistance. The study points to what needs tobe done better/more energetically/differently in research, pro-gram support-tool development, and policy and program sup-port to change the status quo