Pregnancy, Unwanted

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

Transgender and gender-diverse young people who were assigned female at birth (AFAB), including transgender boys, nonbinary youth, and others, face real sexual health disparities. Existing pregnancy and HIV prevention programs are designed for cisgender girls and do not meet the needs of AFAB trans youth, leaving this group without programs that speak to their lives. #TranscendentHealth is a text messaging sexual health program developed specifically for AFAB transgender and gender-diverse youth ages 14 to 18. It builds on Girl2Girl, a program shown to improve sexual health behaviors in LGB+ cisgender girls, and updates the content to reflect the identities, relationships, and health needs of AFAB trans youth. The study has two parts. In the first part, AFAB trans youth help shape the program through focus groups, Content Advisory Teams (youth review panels that give feedback on program messages), and a small pilot test. In the second part, a national randomized controlled trial enrolls 467 AFAB transgender youth ages 14 to 18 across the United States. Participants are randomly assigned to receive either #TranscendentHealth or a general sexual health text messaging program. Both programs are delivered entirely by text message over 5 months, with no in-person visits required. Youth complete short online surveys at the start of the program, at program end (5 months), and at 3 and 6 months after the program ends. The study's main goals are to determine whether #TranscendentHealth improves rates of condom-protected sex, use of other birth control methods (such as the pill, shot, or IUD), and HIV/STI testing. Secondary goals include reducing unintended pregnancy, increasing PrEP uptake among eligible participants, and improving intentions to use sexual health services.