Adolescents’ World: Know One Tell One against Unsafe Sexual Behaviours, Teenage Pregnancies and Sexually Transmitted Infections Including Chlamydia

Abstract

Addressing adolescents’ sexual and reproductive health (SRH) matters using multidisciplinary pedagogical innovations may assure the proper development and well-being of adolescents so that they reach the adulthood stage healthy and strong enough to produce for their future investment. This is in response to sustainable development goal number 3, target 3.7, and SDG4, target 4.7 in particular emphasizes the universal availability and accessibility of sexual information and education among people and knowledge and skills for gender equality, human rights and sustainable lifestyles by 2030, respectively. Yet, the innovative strategies may respond to a call stated by SGD5 (gender equality), target 5.3 which advocates the elimination of child, early, and forced marriages, and target 5.6 which focuses on ensuring universal access to SRH and rights to all by 2030.

1. Introduction

This chapter has been informed and validated by several published reports, literature, relevant international organizational publications, country-based materials, and ongoing initiatives (between 2017 and 2022 years). The reviewed documents included those related to young people’s sexual and reproductive health against sexually transmitted infections (STIs) including human immunodeficiency virus (HIV), chlamydia, and teenage pregnancies among adolescents around the globe. Search engines for published research articles, reports, web pages, books, and or conferences preceding included google, google scholar, WBMED, and/or PUBMED. The criteria for the articles were set at not <2017 year of publications, and or only articles that addressed issues around STIs among young people. The review started by analysing the concept of adolescents, the global trend of unsafe sexual behaviours among young people, followed by the global trend of STIs/HIV, chlamydia, teenage pregnancies, factors linked with unsafe sexual behaviours, and the global trend of various strategies against STIs among adolescents.

2. Findings

2.1 The global trend of adolescents

Addressing adolescents’ sexual and reproductive health (SRH) matters using multidisciplinary pedagogical innovations may assure the proper development and well-being of adolescents so that they reach the adulthood stage healthy and strong enough to produce for their future investment [1, 2]. This is in response to sustainable development goal number 3, target 3.7, and SDG4, target 4.7 in particular emphasizes the universal availability and accessibility of sexual information and education among people and knowledge and skills for gender equality, human rights and sustainable lifestyles by 2030, respectively [3]. Yet, the innovative strategies may respond to a call stated by SGD5 (gender equality), target 5.3 which advocates the elimination of child, early, and forced marriages, and target 5.6 which focuses on ensuring universal access to SRH and rights to all by 2030.

From the point of view of human life history theory, adolescence marks the beginning of a young individual’s journey into sexual development, which can be an exciting, worrying, and/or difficult period. Adolescence is a stage of socio-sexual maturation and the construction of social and economic skills, which may increase reproductive success during later life. It is acknowledged through global statistics that adolescents determines a huge opportunity to transform the social and economic fortunes of any nation if they are formed properly during the early years of their lives [4, 5]. The proper formation here means developing adolescents with safe, good, and age-appropriate personal characters, identities, and social responsibilities for healthy adulthood [6].

Reports have defined adolescence as a transition period from childhood to adulthood [7]. The adolescence stage has been categorized into three stages including early adolescents (10–12 years), middle adolescents (13–16 years), and late adolescents (17–19 years) [8]. All stages are reported to be characterized by a tremendous amount of changes including biological, pubertal, and neuro-behavioural changes [9]. The term ‘biological changes’ here means physical growth and intellectual maturity milestone from childish to adulthood behaviours; while ‘pubertal change’ is a series of significant releases of sex hormones that influence physical maturity and emotional fluctuation [10]. Neuro-behavioural changes are deliberated to encompass all adolescent-related characteristics including an increase in risk-taking, attention-seeking, trial and error, violence, and or injuries [11].

Scholars have defined adolescence as a period whereby adolescents experience changes in social responsibilities that need close parental guidance, monitoring, and social support toward their life potential [12, 13]. Social responsibilities are defined here as a person’s concern for self, others’ welfare, sense of duty, avoidance of destructive behaviours, civil involvement, and responsible attitudes towards others [14]. Timely and age-appropriate sexual and reproductive health (SRH) information and education among adolescents are closely linked with healthy adolescence stages. As described by Denno et al. [15], the adolescence stage is always considered to be a healthy period when nurtured in ethical standards and acceptable socio-cultural norms. It is impressive to note that the number of adolescents keeps on increasing around the globe, which is perceived as a result of good parenthood demonstrated by parents, relatives, and other people.

The 2010 data shows that about 55% of the total global adolescents live in Asia and the Pacific with 29% in South Asia and India, 26% in East Asia, and the Pacific including China. Contrariwise, adolescents in Sub-Saharan Africa account for 16% of the world’s total adolescent population with equal distribution between Eastern, Western, Southern, and Central Africa. Referring to the UNFPA [16] report, the adolescent population distribution is predicted to decline by 18% in Asia and the Pacific while in Sub-Saharan Africa, adolescents aged 10–17 years old will significantly rise to about 23% by 2030. Data indicate that the largest national increase in adolescent girls will mostly happen in the Sub-Saharan African countries including Tanzania which encompasses about 90%, the highest being Zambia (99%) followed by Malawi (93%).

Adolescents aged 10–19 years are of school age which is authoritatively well-defined at the country level for secondary and tertiary education [16, 17]. Updated data on adolescents by [18] estimates that of the 7.2 (higher than that reported in 2010) billion world population, 42% (over 3 billion) are younger than 25 years, while 18% (1.2 billion) are adolescents aged 10–19 years. About 88% of adolescents live in developing countries whereby Sub-Saharan Africa (SSA) constitutes 18%. It is also projected that between 2010 and 2030 the adolescent population in Sub-Saharan Africa will increase to 1.3 billion [19]. Tanzanian adolescents aged between 10- and 19 years account for 11,858,193 (23%) of the country’s population (N = 51,557,365). Early adolescents (10–14 years) make up 13%, while late adolescents (15–19 years) make up 10% of the total population, respectively [20, 21, 22].

The global view holds the belief that, if adolescents are nurtured well, and the rearing process, parental control, and social scaffolding are assured to them they will one day be young professionals, entrepreneurs, farmers, teachers, social workers, engineers, nurses, doctors, technicians, politicians, designers, good parents, and new brave thinkers [23, 24]. However, adolescents at the adolescence stage may feel that they are old enough to start sexual activities, which need future-oriented parenting styles to assure proper character, good social responsibilities, and future investments [10, 25].

Although their sexual freedom and activity patterns differ markedly according to geographical, cultural, and religious backgrounds, it is acknowledged that they need continuous parental and academic guidance to reach their adulthood with good health and strong enough to produce to contribute to the socio-economic prosperity of their nations [26, 27]. Effective support, particularly on sexual education interventions for adolescents who are about to begin their sexual lives appears to have potential and long-lasting effects in enhancing their academic and behavioural outcomes.

2.2 The global trend of unsafe sexual behaviours among adolescents

A healthy adolescence stage is argued to determine strong and healthy adulthood, which is associated with increased job market opportunities that are believed to increase productivity rates in reproductive health and economic aspects, respectively [28]. Increased productivity rates are argued by scholars to have the potential of promoting economic growth and prosperity at individual, family, and national levels in response to the sustainable development goal number 1 (SDG1) of no poverty in the world [29, 30]. However, the literature argues that most adolescents are not developed appropriately in their characters, identity, and social responsibilities to contribute to economic opportunities [31].

Aristotle [32] notes that adolescents often live out of their control with a sense that they are always right to their desires and acts, regardless of how beneficial or hazardous they are to live. Literature has demonstrated that adolescents in their early years of life are driven by a sense that they are mature enough, and thus, they are obsessed with impulses to interact with diverse people and the largest social networks that constantly require them to be socially competent [33, 34]. Sometimes they demonstrate attention-seeking and reckless behaviours including disputes with their parents, peers, teachers at schools, and other people in society, and unsafe sexual behaviours that expose them to sexual exploitation [35].

Unsafe sexual behaviours among adolescents aged between 10 and 19 years, for example, have become the most prevailing problem around the globe [36, 37, 38]. Unsafe sexual behaviours include such manners as; early initiation, unsafe sexual behaviours, incorrect and inconsistent usage of contraceptive methods, having multiple sexual partners, frequent sexual intercourse, drug abuse before, or while having sexual activity, and or engaging in sexual intercourses for money or materials gain [36, 39]. Early initiation of unsafe sexual behaviours among adolescents is considered a problem as it is often associated with early and unintended teenage pregnancies and or new sexually transmitted infections (STIs) such as syphilis, gonorrhoea, chlamydia, and/or human immunodeficiency virus (HIV) just to mention a few [40, 41].

Reports such as that by UNICEF [42] indicate that 11 and 6% of girls and boys, respectively claim to have had sex before the age of 15 years. They reported early sexual debut, being involved in a sexual partnership with older men, and having unprotected sexual intercourse in their lives. Almost 57% of young women and 48% of young men across the world report having had sexual intercourse by the age of 18 years [43]. An estimate of unsafe sexual behaviours among young people in Tanzania shows that approximately 57 and 48% of young women and men, respectively, report having had sex by the age of 18 years [20]. These pieces of data show that unsafe sexual behaviours among adolescents are still a public concern around the globe.

Available data may indicate that despite the effect of the existing strategies, there might be a need to rethink, adapt and test other pedagogies that aim at empowering young people with soft skills against unsafe sexual behaviour. Participatory and collaborative sexual education pedagogies among teachers and health workers that involve adolescents in the first position may become a sustainable solution in addressing unsafe sexual behaviours among adolescents. Addressing unsafe sexual behaviours among them may promise a fruitful fight against STIs/HIV, teenage pregnancies, and school dropouts among adolescents.

Unintended pregnancies in the adolescence stage for example are also linked with several adverse health outcomes associated with childbearing such as obstetric complications before, during, and after delivery including eclampsia, post-partum haemorrhage, fistula, and or premature deaths [37, 44]. Children born from an adolescent girl are at risk of higher potential deaths, and low birth weights [45]. Unintended teenage pregnancies from unsafe sexual behaviours are more often associated with educational outcomes such as interrupting schooling leading to school dropouts [46, 47]. Early and unintended teenage pregnancies are linked with social and economic outcomes including endangering their future economic opportunities such as reduced job market opportunities that would contribute to the economic growth and prosperity at an individual, family, and national level at large [15].

Although sexual behaviours may be seen as emotional involvement, for some adolescents it may start as a commercial endeavour that may lead to emotional (or vice versa) and health, educational and socioeconomic consequences [48]. Adolescents who are empowered with sexual and reproductive health (SRH) knowledge, and soft skills (self-esteem, and assertiveness skills) are believed to be able to demonstrate self-control over the urges to engage in sexual relationships, marry young, and or have children at young ages [49]. However, different reports on sexual education in developing countries claim that adolescents are not well empowered with the necessary soft skills for safe sexual behavioural change [50, 51].

Needless to say, scholars such as Envuladu et al. [39] and Kaale et al. [37] disclose that unsafe sexual behaviours among adolescents are very obvious with misinformation about SRH matters and poor self-regulation of sexual emotions and behaviour at an early age, something that may need to be addressed accordingly. Tallying with a belief of the current study, poor self-regulation among adolescents is reported to be proximal to sexual risk-taking and might have more sexual partners later in their lives [45, 52].

The majority of adolescents tend to fail to make informed and reasoned decisions about sexual activities early in their lives when they encounter sexual pressures, dilemmas, and or temptations from peers, adults, or strangers [53]. Mlyakado [54, 55] exposes that most adolescents have less negotiating power over sexual pressures and coercions on safer sexual behaviour. To embark on the situation, Chilisa et al. [56] argue that by improving their SRH knowledge and soft skills, adolescents may be able to abstain from sexual intercourses and hence decide to delay sexually aroused relationships, intend to reduce the number of sexual partners if any and or negotiate for consistent and accurate use of condoms for safe sexual activities.

2.3 A global trend of STIs/HIV among adolescents

Reports have provided pieces of evidence, which demonstrate that sexually transmitted infections have increased to >1 million newly infected people on daily basis. An estimate made by the World Health Organization [57] indicates that about 376 million people were newly infected with chlamydia (127 million), gonorrhoea (87 million), syphilis (6 million), and trichomoniasis (150 million) while 500 million people were infected with genital herpes, respectively. Being at young ages, many adolescents engage in unsafe sexual behaviours, which are commonly associated with incidences of sexually related infections [37].

Adolescents’ health problems, for example, have been connected to the prevalence of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) infections which account for 60 and 69% of global and Sub-Saharan Africa, respectively [58]. STIs such as gonorrhoea, syphilis, trichomoniasis, HIV, chlamydia, and/or genital herpes among the cohort of adolescents are prevailing at the global, regional, and national levels [59, 60]. The HIV report by UNAIDS [61], for example, has informed that although trends of new global HIV infections have continued to decline from 3.4 million in 1996 to 1.8 million in 2017, the UNAIDS report published online in 2021 has reported 38,000,000 people are living with HIV, up from 30.7 million in 2010.

Approximately 690,000 died of AIDS-related causes in 2019, a decrease (37%) from 1.1 million in 2010; of which, an estimated 600,000 deaths occurred among adults and 95,000 deaths among children <15 years [62]. Available reports uncover that about 76 million people have been infected with HIV since the beginning of the HIV epidemic [63]. However, the current UNAIDS report has exposed that there were still 1.7 million new HIV infections in 2019, which is equivalent to about 5000 new HIV infections per day [62]. Sums of 1.5 million people are adults while 150,000 are adolescents. Approximately, 250,000 young people of school age were newly HIV-infected whereby about 182,599 (73%) of them were residing in Sub-Saharan [64].

The overall global HIV decline progress rate (including that of young people) has been counted in the report to be slower than the requirement to reach a decline to 500,000 new infections by 2020. Needless to say, like other developing countries, Tanzania has 4.8% of people living with HIV of which there has been a remarkable increase in the prevalence from 1.3 million in 2010 to 1.7 million in 2019 [65]. However, it is worth noting that deaths associated with acquired immunodeficiency syndrome (AIDS) have decreased from 52,000 people in 2010 to 27,000 in 2019. The same decline in the trend of HIV/AIDS has been reported in Zanzibar whereas, the prevalence is low with only 6990 people living with HIV while the number of new HIV infections has decreased from 82,000 in 2018 to 77,000 in 2019.

Despite the decrease in HIV prevalence among adolescents and adults (15–49 years) from 5.1% in 2014 to 4.8% in 2019 in Tanzania, 5.8% (N = 104,400) of the adolescents who are living with HIV in the globe (N = 1,800,000), are in Tanzania [65]. Almost 8600 new HIV infections occur among children between the ages of zero and the middle adolescent stage (0–14 years); whereas 93,000 children of the same age range live with HIV. Out of the 27,000 estimated AIDS-related deaths in the country, 5900 deaths occur among children (0–14 years).

Approximately, 99,000 adolescents aged between 10 and 19 years are living with HIV; of whom about 57,000 are adolescent girls. It is estimated that out of the 77,000 new HIV infections occurring in the country, 10,000 are adolescents aged between 10 and 19 years. Despite some improvements in reducing the rate of new STIs/HIV among adolescents, the reported trend may imply that the existing strategies are either not sustainable, not reaching a large and appropriate age group of adolescents, or something is missing, be it in their design, implementation, or evaluation.

2.4 A global trend of chlamydia infections among adolescents

By considering its significance not only in this book but also in the promotion of sexual and reproductive health among young people, reports have uncovered that chlamydia infections among others have become to be the most diagnosed STI with an incidence of 1.6 million in 2020, which is equivalent to 481 per 100,000 population regardless the existing strategies to lower down its burden [66, 67]. Nevertheless, the report has demonstrated that of the infected individuals with STIs, 53% were young people between 15 and 24 years adolescents inclusive. It may feel upsetting to find that 62% of STIs were incidences of chlamydia among adolescents in the year 2020.

Such a piece of data may imply that despite all good and positive initiatives against STIs at the global, regional and national levels, it appears that the trend of chlamydia infections among you people including adolescents is critical and may need to be prioritized by engaging them in the front line against it. Although the uptake of chlamydia screening is keeping in a high race, an international organization such as the Centers for Disease Control and Prevention (CDC) has demonstrated the intent to boost it to 77% by 2030 [66].

Sometimes STIs may be counted to be less fatal in peoples’ health but, chlamydia can result in reproductive tract morbidities including but not limited to ectopic pregnancies (to females), infertility, pelvic inflammatory diseases particularly in women of reproductive age, and new-borns morbidity and mortality health outcomes [68, 69]. Additionally, the health burden of chlamydia infection may be linked with someone feeling shame after acquiring it, being faced with different forms of maltreatment from stigma, the reluctance of young people to talk about SRH matters, exposure to active sexual relationships and or engage in the productive activities [70].

The increasing trend of chlamydia infection among young people including adolescents may be used as an alert to the respective authorities for special collaborative efforts to be given appropriate weight to reach them [71]. Tallying to the existing initiatives against chlamydia infections among young people, mounting the scope of SRH preventive interventions such as screening programs, and education programs may be crucial to the proper development of the young generation towards a healthy adulthood [72].

A strong and healthy generation is believed to have the appropriate social responsibilities and fuel economic fortunes for the prosperity of regions and nations around the globe [28, 44]. Needless to say, the trend compels the need for increased collaborative initiatives that will focus on reaching and bringing out the forgotten and hidden young cohort so they to be provided with rehabilitative services such as timely and right health treatments, counselling, and extra-curricular activities [73]. It appears to be timely for the higher authorities such as policymakers and ministry, schools, health facilities, religious facilities, parents/caregivers, and other stakeholders to unite and advocate for young people against chlamydia.

2.5 A global trend of teenage pregnancies among adolescents

Apart from the trend of STIs/HIV among adolescents, adolescents aged between 15 and 19 years face the challenge of getting unplanned pregnancies [74]. Although WHO [75] estimated a high (16 million) number of girls aged 15–19 years give birth each year, the number declined to 12 million girls in 2019 [76]. WHO [76] has reported a decline in the adolescent fertility rate from 56 births per 1000 adolescent women in 2000 to 45 births in 2015 and 44 births in 2019.

Despite the decline of the fertility rate in the globe, the level has remained high (19.3%) in Sub-Saharan Africa whereby, adolescent fertility accounts for 101 births per 1000 adolescent women. Owing to the high adolescent fertility rate, an estimated 21 million girls (15–19 years) become pregnant every year, while 12 million of them give birth and approximately 2.5 million (12%) of them become mothers by the age of 16 years. The prevalence appears to be high in East Africa (21.5%) and low (9.2%) in Northern Africa [33, 52].

Reports about teenage pregnancies in East African regions show that the highest percentage exists in Uganda (23.8%) and Tanzania (22.8%). Rwanda (7.3%) and Ethiopia (12.4%) have the lowest rate as compared to other African regions. Currently, the adolescent fertility rate in Tanzania, in particular, has reached 128 pregnancies per 1000 women against the target of fewer than 100 pregnancies per 1000 women by 2020 [20]. MoHCDGEC [77] reports that 27% of adolescents in Tanzania get underage pregnancies. Adolescents are always blamed for the current trend as their fault as perceived by parents and the community at large [78].

The trend of teenage pregnancies among adolescents is perceived by what has commonly been reported to be due to poor parenting, and sexual masculinities which are linked to sociocultural norms, migrations, social media, drug abuse, peer pressure, poverty, and or the existence of sugar daddy and sugar mommy [79]. The trend is also linked to inadequate implementation and evaluation of health policy and co-related health strategic plans and lack of health-seeking behaviour (to access the available SRH services) among adolescents [74]. However, the most forgotten aspect, which, if addressed to its maximum, might change the current trend of teenage pregnancies, would be soft skills, which are believed to enhance informed and reasoned decisions over an act among people.

2.6 Factors associated with trends of unsafe sexual behaviours among adolescents

Scholars such as Wolinsky [80] have argued that nothing under the earth occurs without a cause. Figure 1 shows the bioecological concepts that root in the ecological system of human life, which demonstrate factors that potential in determining adolescents’ SRH [81]. The theory believes that an individual’s behaviour is shaped by several factors ranging from biological, social, cultural, and technological to politics. The theory stipulates that the environment where a child is put affects the shaping of a child’s behaviour, and thus, needs to be structured into layers or systems as important building blocks to their development.

Figure 1.

Bioecological correlates of adolescents’ sexual behaviours. Source: Dr. Walter C. Millanzi (PhD).

The five recommended systems by the theory include microsystem (child’s proximal interaction with family, school, neighbourhood, or childcare environment); and mesosystem (indirect child’s interaction with the microsystem structures such as child’s teacher and parents, and parents with neighbours). Other systems consist of the exosystem (child’s distal interaction with society to feel positive or negative outcomes to the microsystem such as parents’ work schedules or community-based resources). “A child interacts outside of his/her system via the macro-system” (the outermost layer of a child including cultural values, customs, and laws that can also influence the mesosystem and exosystem).

On the other hand, the review of existing documents, interventions, projects, policies, and guidelines revealed that the RH content focuses more on biological contents such as definitions of concepts, biological changes in human beings’ health, diseases and their causes, effects of the disease on health, and the preventive measures of diseases. However, issues around the emotional and psychological aspects (soft skills: critical thinking and reasoned judgment, resilience, self-esteem, assertiveness skills, and negotiation skills) were less addressed in the RH contents for adolescents.

Most programs, and or projects have been reported to depend on external funding to work [82]. Depending on external funding from program donors may open new avenues for Non-governmental Organizations (NGOs) to decide and prioritize what, why, when, and how to facilitate SRH learning among adolescents. The content scenarios, problems, stories, and examples in the existing SRH lesson materials, for example, appear to be more of western styles than African situations. Adopting and implementing western styles for facilitating SRH learning among African countries’ adolescents without considering the input factor to adolescents’ behaviours predicts the permanent mismatch between what is supposed to be provided, the right dosage, timing, and frequency among them, and the real-life events in low-resource countries.

The review of the existing documents exposed that despite the RH lesson materials borrowing western styles, conventional pedagogies are commonly used to facilitate SRH learning in adolescents. If the RH lesson materials and its associated pedagogical knowledge mismatch continue, adolescents will not only continue to be formed in a conventional style but also lack soft skills to solve social and economic problems in their real-life phenomena. With this brief review, this chapter disseminates a need to address the gap by adopting ecological systems of human life theory to help shape the materials by considering important factors to be addressed too during the development and implementation of integrated RH lesson materials in PBP. Figure 1 illustrates the concept.

Literature [10, 52, 83, 84, 85] claims that factors such as age, sex, religious influence, and unsafe sexual behaviours among adolescents contribute greatly to teenage pregnancies amongst adolescents. Furthermore, limited education and employment, drug abuse, exposure to media, low self-esteem, and inability to refuse sexual temptations catalyse the trend of unsafe sexual behaviour among adolescents resulting in STIs/HIV, teenage pregnancies, and school dropouts [86, 87]. Factors such as socio-cultural, economic, and environmental factors including peer influence, coerced sexual relations, and sexual intercourse with adults have been linked to the early onset of adolescents’ unsafe sexual behaviour [36, 88].

Similarly, unequal gender power relations, the pressure to marry and bear children early, poverty, lack of parental counselling and guidance, and inadequate comprehensive sexuality education have been mentioned as contributing to the persistence of the trend [89]. Still, health services related to factors such as inadequate and unskilled health workers, lack of youth-friendly comprehensive sexuality education at health facilities, costs of contraceptives, and long waiting times at clinics have been associated with adolescents’ unsafe sexual behaviour [28]. The detailed trend of STIs/HIV, teenage pregnancies, and school dropouts among adolescents with co-related factors presented above, for example, has been linked closely with the early onset of unsafe sexual behaviours [90]. This may be the case because, as argued by previous studies, sexual emotions and abilities to make reasoned and informed decisions develop gradually at young ages [91].

Sexual emotions here include the desire for intimacy, friendship, and belonging, which at this age translate into temptations to sexual acts at an age when they have little understanding of their consequences [92]. Indeed, suggested data from Schiller [93] on neuroscience is that changes in affective processing during adolescence may be critical to understanding unsafe behaviour in this age period. Christopher et al. [94] unfold that adolescents with poor self-regulation of sexual emotion and behaviour at an early age are more prone to sexual risk-taking and might have more sexual partners later in their lives. In that regard, it appears that although sexual behaviour may be seen as emotional involvement, for some adolescents it may start as a commercial endeavour that may lead to emotional (or vice versa) and health, educational and socio-economic consequences.

2.7 Global response to adolescents’ SRH

The reviewed reports and literature indicate a remarkable need to rethink innovative, sustainable, and multidisciplinary pedagogical strategies to enhance the proper formation of the right personality and character leading to social responsibility among adolescents [95]. Initiatives have been in place to develop adolescents with good personalities and characters for social responsibilities and their future investment through multidisciplinary strategies to enhance their sexual selves [96]. The initiatives are rooted in the sustainable development goals 3 (SDGs3) target 3.7 (universal accessibility of sexual information and education among people by 2030) and SDG4 target number 4.7 (knowledge and skills for gender equality, human rights and sustainable lifestyles by 2030) [30].

Various health policies and SRH guidelines have been developed to be adopted and implemented across the world including low and middle-income countries Tanzania inclusive [97]. The policies and guidelines seem to work better in ensuring that sexual and reproductive health rights and associated services (such as menstrual hygiene education and pads, and contraceptives) are available and accessible among adolescents in health facilities and schools. Owing to the presence of political and health policies in middle and low-income countries, whereby, for example, adolescents are advocated against sexual abuses and exploitations towards preventing teenage pregnancies, STIs/HIV, and school dropouts that are linked with teenage pregnancies [98, 99].

Several interventions include, but are not limited to, building boarding schools, enrolment of students to stay at school hostels, policy and legislation reinforcement by the government, sexual education clubs, large-scale reproductive and family planning methods campaigns, projects, and sexual health education training among teachers are being implemented to address unsafe sexual behaviour among adolescents [20, 100]. The National School Health Program provides adolescents with many healthcare services such as SRH information and its associated services and counselling support to address their SRH challenges [20].

Although the SRH content varies widely across nations and schools, the Ministry of Education and Vocational Training has tried to integrate sexual education and STIs/HIV education into the national school curriculum [101, 102, 103, 104]. Scholars’ works [105, 106] reveal that parents, teachers, and or health workers have a positive attitude towards STI screening and the implementation of school-based sexual educational syllabi among adolescents. However, they claim to experience trouble when they try teaching the social and physiological parts of it by using conventional pedagogies such as lectures, discussions, demonstrations, and storytelling, and or initiating communication with adolescents about SRH matters.

However, the outcry among stakeholders links the permanent use of conventional pedagogies with the permanence facilitation of biological than psychological SRH contents among adolescents [107, 108]. Topics such as the human reproductive system and sexual health behaviour are taught in the classrooms with great care and respect; taking into consideration the prevailing socio-cultural sensitive issues. School teachers and health workers who are invited to facilitate SRH learning among adolescents in schools, tend to make their own decisions regarding what, how, and when to implement it, which is commonly facilitated by using didactic pedagogies [100].

The SRH lesson materials are claimed to adopt more western lifestyle contents, problems, and scenarios, which hardly reflect the existing contexts of adolescents [109]. The noted SRH pedagogical situation may indicate that there is no formal guideline with pedagogical prescriptions to guide teachers, health workers, and other facilitators in facilitating SRH learning among adolescents [82, 110]. Furthermore, as it has been exposed by literature the existing guidelines seem to lack robust prescriptions about the coverage, dosage, timing, frequency, and associated pedagogies to facilitate comprehensive and age-appropriate SRH lesson materials among adolescents [111].

Findings by Bilinga and Mabula [100], for example, have noted that teachers and or health workers implement the existing curriculum materials using conventional teaching and assessment approaches as pedagogical bases in facilitating SRH learning among adolescents. Pressures on schools to demonstrate the effective inclusion of comprehensive SRH issues alongside innovative pedagogical approaches open new avenues for educators to decide what, why, when, and how to facilitate SRH learning among adolescents [82]. The permanent use of conventional pedagogies in school curricula, project, interventions, and other programs is argued here to lead to pedagogical inadequacies when facilitating SRH learning among adolescents [111].

To continue implementing SRH education programs via conventional pedagogies may imply that teachers, health workers, and or other facilitators might continue experiencing challenges in assisting adolescents to develop self-control over sexual temptations, harassment, and peer/parental sexual pressure when they resort to using didactic pedagogies [112]. Developing adolescents under conventional pedagogies may imply that they will grow up misinformed about comprehensive SRH information, and its consequences will remain common [109]. To facilitate the empowerment of adolescents on their SRH matters, information about sex, pubertal development, teenage pregnancy, STIs/HIV, and contraception; multidisciplinary strategies, which advocate participatory, collaborative, and age-appropriate pedagogies are proclaimed [113].

Scholars and practitioners [114, 115, 116, 117, 118, 119] encourage basic education to adopt and implement participatory and collaborative pedagogies in facilitating sexual and reproductive health learning among adolescents. The implementation of collaborative and participatory pedagogies has also been supported by some literature to be timely as they enhance, not only inquiry learning but also active engagement in learning and the development of hands-on skills in solving real-life problems among adolescents [6, 45, 83, 120]. Moreover, most projects advocate extra-curricular activities among adolescents such as farming, gardening, games, and or entrepreneurship works. Extra-curricular activities are believed to promote adolescents’ hard skills more than soft skills, which they need to make informed, conscious, reasoned, and responsible decisions over sexual behaviours.

Yet, scholars [2, 13] have argued that if comprehensive sexual and reproductive health education is facilitated by using participatory and collaborative pedagogies, the interaction and communication about sensitive SRH topics among teachers, healthcare workers, and other facilitators become very easy. Amidst the existing efforts, most of the existing strategies focus more on adolescents’ empowerment in life skills than the pedagogical issues prescribed in school curricula. The projects are argued to not advocate multidisciplinary strategies in facilitating SRH learning to adolescents including education and health fields [121]. Some projects are claimed to be unsustainable because they largely depend on external funding along with the prescribed curricula, which are more of a conventional style and have adopted western styles that do not blend with the African context [122, 123].

2.8 Sexual information and education versus sexual behaviours among adolescents

Adolescents’ behaviours have been described by medical, psychosocial, and educational scientists as being malleable owing to internal and external stressors [120, 124, 125]. Owing to globalization, changes in social roles and responsibilities, and migrations, the current situation has plenty of sources of sexual information and education among adolescents including schools, healthcare professionals, parents, religious facilities, media, and peers [6, 83, 126]. These sources are expected to enhance the sexual well-being of adolescents by developing them with good SRH knowledge, and soft skills and thus, shape their safe sexual behaviours. However, literature has critiqued some of the sources to be not valid enough to provide accurate and age-appropriate SRH information and education among adolescents such as media and peer groups [121].

Most social media including television, radio, online music, movies, cinema, and peer groups, just to mention a few, are currently disseminating SRH health information and education without considering the sociocultural, age, and gender differences contexts of the consumers. Sources, including parents, healthcare professionals, and religious facilities are reported to be rarely available to sit and educate their children about SRH [23, 46]. The duty of providing accurate and age-appropriate SRH information and education among adolescents seems to fall on schools [127]. However, the identification of factors that determine adolescents’ biological changes, neurobehavioral changes, and social maturation to pursue their roles and responsibilities in society needs to be given priority during the development of SRH lesson materials [5]. Based on this context scholar appear in the frontline in advocating innovative interventional researches to address the informative contextual gap observed in this chapter for the well-being of young people to contribute to the socio-economic prosperity of nations, regions and the globe at large [128].

3. Conclusion

Although the uptake of chlamydia screening and treatment is keeping in the high race, its incidence among young people remains high. With this regard to the knowledge disseminated in this chapter, there seems to be a need for establishing a multidisciplinary pedagogical guideline for teachers, health workers, and or other facilitators of SRH learning for adolescents, especially in middle and low-income countries.