From policy to practice: Implementation of the Integrated School Health Policy and the provision of sexual and reproductive health services for adolescent girls in KwaZulu-Natal, South Africa

Introduction: Adolescent girls and young women (AGYW) in South Africa continue to experience poor sexual and reproductive health (SRH) outcomes, such as early and unintended pregnancies, and sexually transmitted infections. The Integrated School Health Policy (ISHP) aims to enhance the health and well-being of school-going AGYW by promoting SRH and providing services. This study examined the implementation of SRH services for school-going adolescent girls within KwaZulu-Natal, South Africa. Methods: A qualitative research design was employed, gathering triangulated data from six focus group discussions (FGDs) with school-going AGYW (n=54), key informant interviews (KIIs) with learner support agents (n=3), a school-based support team member, district-based support team members (N=8), and provincial-level ISHP stakeholders (n=2). All FGDs and KIIs were audio-recorded, transcribed, and thematically analysed. Results: Our findings highlight several upstream challenges in providing SRH services for school-going AGYW. Gatekeeping from school governing bodies and difficulties in obtaining parental consent were identified as key obstacles for promoting SRH and providing contraceptive services. Additionally, cultural norms that supported early adolescent pregnancies among learners were reported to be a key challenge. Psychosocial support remains inadequate, particularly for young women who have experienced sexual violence and/or are adolescent mothers. Delivering age-appropriate sexuality education remains a challenge in South African schools because of the age disparities within the same school grades. Conclusions: Policies and the provision of SRH services need to be responsive to cultural norms, which may be at odds with a rights-based approach to the provision of SRH services. Parents and school governing bodies need to be meaningfully engaged through awareness-raising efforts and education on the short and long-term benefits of SRH support for learners.