Towards More Helpful and Satisfactory Sexuality Education: First-Hand Accounts from Adolescents and Young People in Low- and Middle-Income Settings

Abstract Introduction Sexuality education is increasingly recognised as essential for adolescents’ and young people’s well-being, yet their own perspectives on its relevance and delivery remain underexplored. This mixed-methods, youth-participatory study examined adolescents’ and young people’s perceptions of school-based sexuality education across diverse low- and middle-income contexts. Methods A global online survey with 9,288 respondents aged 16–24, complemented by qualitative research with 405 participants in Burkina Faso, Cameroon, Colombia, the Kyrgyz Republic, and Trinidad and Tobago, explored associations between perceived helpfulness of and satisfaction with sexuality education and content received, delivery methods, perceived classroom safety, and sociodemographic factors. Results While most respondents identified schools as their preferred learning space, only about half felt that sexuality education had prepared them for real-life relationships and sexual and reproductive health decisions. Only selected topics independently predicted perceived helpfulness: HIV/STIs were positively associated, while anatomy was negatively associated, and that the perceived value of relational or sensitive topics depended on pedagogical conditions rather than coverage alone. Perceived classroom safety was the strongest predictor of both helpfulness and satisfaction, and participatory delivery methods were consistently associated with higher helpfulness and satisfaction. Older respondents and those outside Sub-Saharan Africa reported lower satisfaction with school-based sexuality education. Conclusion The study underscores that effectiveness of sexuality education should be assessed through learners’ perceptions of quality and responsiveness to their needs. Policy implications Policies should prioritise culturally grounded, skills-based curricula delivered through participatory pedagogy, alongside systemic investment in teacher training, classroom safety, accountability mechanisms, and institutionalised youth feedback systems.