The goal of this randomized controlled trial is to learn if comprehensive sexuality education (CSE) and access to mobile sexual and reproductive health (SRH) services in secondary schools can improve short- and long-term health, well-being, social and economic outcomes among adolescents and young people in two districts of Sierra Leone. The main questions it aims to answer are:
1. How do CSE and mobile SRH services (individually and combined) change adolescent SRHR, well-being and socioeconomic outcomes in the short term and in the longer term (over 3 years)? 2. What are the economic costs of providing CSE and mobile SRH services? 3. How cost-effective is the provision of CSE and mobile SRH services, given its potential impact on health, socioeconomic, and well-being outcomes? 4. To what extent are CSE and mobile SRH services being implemented according to the original plan and timeline?
Researchers will compare schools receiving CSE and mobile SRH services to schools not receiving these services, to see if adolescent SRHR, well-being and socioeconomic outcomes are better in those schools that received the services. The trial will compare four groups of schools, each with 60 participating schools:
1. No additional services (control schools) 2. Only CSE 3. Only mobile SRH services 4. CSE and mobile SRH services
The implementation of these services will be led by Marie Stopes Sierra Leone (MSSL) in collaboration with the Ministry of Education. MSSL will ensure that participating schools:
* Attend teacher training on the CSE curriculum before the study starts, followed by yearly refresher training during the study * Have sufficient time allocated to CSE in the weekly school schedule * Have adequate teaching materials \& equipment to teach CSE * Have guidance counsellors in each school who will monitor the implementation of CSE * Have a designated "safe space" which adolescents can access for menstrual products and care. * Have access to mobile SRH services (provided by MSSL staff) on the school premises 3 times per school year
Aged 12 to 17 at baseline
Enrolled in the lowest grade (JSS1) of one of the junior secondary schools selected for the study in September 2026
Provided assent to participate in the research
Individuals unable to provide assent due to cognitive impairment or severe mental illness
Individuals whose guardians opted them out
Factorial
Comprehensive Sexuality Education
BehavioralFor junior secondary schools in the "CSE only" and "CSE+mobile SRH services" intervention arms, at baseline at the start of the school year, MSSL will train teachers who teach subjects in which CSE topics are included, using a standard teaching training curriculum to help mitigate the risk of variability in the quality of CSE implementation across schools. Teachers will then implement the CSE curriculum in their classes throughout the duration of the study. MSSL will provide yearly refresher teacher training throughout the study. In each school, guidance counselors will be tasked with monitoring implementation of the intervention. MSSL will provide all materials and equipment needed to teach CSE. Each school will create a "safe space" where students can go for menstrual hygiene and care.
Mobile SRH services
BehavioralFor junior secondary schools in the "Mobile SRH services only" and "CSE+mobile SRH services" intervention arms, MSSL will utilize three mobile clinical teams to provide direct, comprehensive SRHR services on-site at schools. Each team will be composed of two service providers trained to provide youth-friendly services, one data imputer, and a transport assistant. The team will visit each school once per quarter (3 times during the school year). A comprehensive range of youth-friendly SRH services, including contraceptive counseling, provision of LARC (implants and IUDs), short-term methods (pills, injectables and emergency contraception), condom promotion, STI services, and referrals to health facilities if needed, will be available to all students through the mobile visits.
Proportion of Adolescent Girls and Young Women (AGYW) Using (or Whose Partner Uses) a Modern Contraceptive Method (mCPR)
Proportion of female respondents who use, or whose partners use, modern contraceptive methods (female/male sterilization, IUD, implant, injectable, pill, emergency contraception, male/female condom, and modern fertility-awareness-based methods). Aggregated as a proportion at each round; between-arm effect estimated via difference-in-differences.
Proportion of AGYW Whose Contraceptive Use or Non-Use Is Concordant with Their Fertility Preferences (Preference-Aligned Fertility Management)
Proportion of female respondents classified as preference-concordant by the Preference-Aligned Fertility Management (PFM) indicator: using contraception and wanting to be, or not using and not wanting to be.
Proportion of AGYW with Decision-Making Autonomy over Family Planning
Proportion of female respondents who report being able to make their own decisions regarding the use of family planning, as opposed to needing permission from a parent, partner, healthcare provider, or other household authority figure.
Proportion of AGYW and Adolescent Boys and Young Men (ABYM) Who Have Dropped Out of School
Proportion of the baseline (JSS1-enrolled) cohort of female and male respondents no longer enrolled in / attending school at a given follow-up round. Baseline enrollment is universal by eligibility, so dropout is measured longitudinally across rounds.
Unintended Pregnancy Incidence Rate Among AGYW
Proportion of female respondents who reported a new pregnancy that was unwanted or mistimed since the previous round, based on pregnancy history and retrospective wantedness.
Proportion of Sexually Active AGYW and ABYM Who Used a Condom at Last Sexual Intercourse
Among female and male respondents who report having had sex in last 6 months, proportion who report that a condom was used at last intercourse.
Proportion of AGYW with Unmet Need for Modern Contraception
Modified unmet-need indicator: Proportion of sexually active non-pregnant female respondents who wish to delay or avoid pregnancy but are not using a modern contraceptive method.
Proportion of Female Contraceptive Users Who Are Satisfied With Their Method
Proportion of female contraceptive users who are satisfied with their method
Average Number of Comprehensive Sexuality Education Topics Reported by AGYW and ABYM as Covered in Class
Average number of CSE topics covered in class during the current school year as reported by female and male respondents
Proportion of AGYW and ABYM Reporting That Comprehensive Sexuality Education Classes Have Been Useful
Proportion of female and male respondents who report that CSE classes have been useful or very useful in helping them in their personal life, by trial arm
Proportion AGYW and ABYM Who Received School-Based Mobile SRH services
Proportion of female and male respondents who report having attended mobile SRH services at their school or a neighboring school during the current school year
Mean Score on Person-Centered Contraceptive Counseling (PCCC) Scale for AGYW
Mean score on validated PCCC scale for female respondents who attended mobile SRH services at their school or a neighboring school during the current school year, based on 4 items
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Guttmacher Institute
Lead sponsor
Innovations for Poverty Action
Collaborator
Marie Stopes Sierra Leone
Collaborator
MSI Reproductive Choices
Collaborator
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