Comprehensive sexuality education (CSE), including critical reflection on gender norms and unfavourable power relations, has been theorised to affect various health and social outcomes among adolescents. This systematic review aimed to synthesise evidence on the effectiveness of school-based CSE addressing gender and power topics on adolescents' sexual and reproductive health (SRH) and relationships outcomes. We screened six databases for evaluations of school-based CSE programmes. We included outcome evaluations of interventions addressing SRH, gender, and power through a critical reflection and empowerment approach. Intervention effects were synthesised in effect direction plots. We identified 12 articles evaluating 11 interventions in four countries. Positive effects were found for most healthy relationships outcomes and for outcomes related to adolescents' SRH knowledge, attitudes, and intentions. Effects on SRH behaviours were more mixed. CSE programmes addressing gender and power appeared more effective than sexuality education without this content. Gender roles and norms play a crucial role in shaping adolescents' relationships and should be addressed as part of a comprehensive approach to sexuality education. However, in the light of some inconclusive outcomes, CSE with gender and power content needs to be more rigorously evaluated than hitherto in more diverse social and cultural contexts.
Bali et al. (Wed,) studied this question.