Considering Culture and Countering Mistrust: Organisation Perspectives for Adapting Comprehensive Sexuality Education in Ghana

IntroductionComprehensive sexuality education (CSE) is heralded as an effective solution to reduce acute sexual and reproductive health (SRH) issues, particularly for young people. In Ghana, from 2019 to 2020, a co-ordinated campaign against implementing revisions to the CSE curriculum by national and international parties generated a polarising debate resulting in government pull-back from actioning the revisions. Whilst mainstream reporting predominantly focuses on political voices that either promote or discredit the CSE curriculum, formally documented perspectives of those working within service delivery are limited in Ghana.MethodsTo address this gap, in February 2020, an exploratory qualitative study was conducted using 16 key-informant semistructured interviews with practitioners from organisations delivering SRH in Accra, Ghana, to answer the question: In what ways might CSE be adapted to enhance SRH education delivery for young people in Ghana? Participants were asked their perspectives on the barriers and enablers of CSE implementation in Ghana.ResultsUtilising a rights-based approach as a theoretical frame for analysis, a hybrid thematic analysis approach revealed three overarching themes: (1) "It's not anything strange": The need to normalise young people's sexual wellness; (2) cultural considerations and countering mistrust; and (3) suggested adaptations.Conclusions and Policy ImplicationsKey informants described seeing the need for CSE in Ghana alongside cultural resistance to content within the curriculum. They called for CSE implementations to consider engaging multiple stakeholders in training to develop content clarity and suggested pathways for incremental delivery and adaptations at government and community levels to continue addressing issues of sexual wellness for the country's growing youth population.