Building Support for Adolescent Sexuality and Reproductive Health Education and Responding to Resistance in Conservative Contexts: Cases From Pakistan

Background: Despite international recommendations and supportive evidence, there are few examples of scaled-up and sustained programs to provide adolescents with sexuality education. Moreover, despite acknowledgment that building community support and responding to resistance are key challenges, there is a lack of detailed discussion on specific programmatic strategies to address these issues. Objectives: This article reviews the work of 2 organizations-Aahung and Rutgers Pakistan-that are successfully implementing large-scale sexuality education programs in Pakistan, collectively reaching more than 500,000 students. This review aims to answer the following questions: (1) How did Aahung and Rutgers Pakistan work to understand Pakistani society and culture and shape their programs to build community support? (2) How did Aahung and Rutgers Pakistan overcome resistance to their efforts? Methods: We reviewed program documents and publications, synthesized key themes, identified questions of interest, and engaged key informants from Aahung and Rutgers Pakistan's leadership. Results: The success of Aahung and Rutgers Pakistan was grounded in their readiness to understand the nuanced context within the communities, collaborate with groups of stakeholders-including parents, school officials, religious leaders, media personnel, and adolescents themselves-to ensure support, and stand up to forces of resistance to pursue their goals. Specific strategies included working with communities to select content, tactfully selecting and framing issues with careful consideration for sensitivities, engaging adolescents' influencers, strengthening media presence, showcasing school programs to increase understanding and transparency, and choosing opportune times to introduce messages. Conclusion: The successful strategies used by Aahung and Rutgers Pakistan to promote adolescent sexual and reproductive health through sexuality education can inform programs worldwide. Additionally, the programmatic weaknesses identified can guide future planning and action by Aahung and Rutgers Pakistan. We call on other programs to continue sharing challenges, specifically related to resistance, with sexuality education programs in order to develop a toolbox of additional strategies for community uptake.