Assessing Comprehensive Sexuality Education Programs in the Democratic Republic of the Congo: Adolescents’ and Teachers’ Knowledge, Attitudes and Practices towards Contraception

Introduction: Improving teenagers’ knowledge on sexual and reproductive health (SRH) is important to prevent unintended pregnancies. We aimed to assess comprehensive sexuality education (CSE) programs and knowledge, attitudes and practices of adolescents and teachers towards contraception. Methods: Based on the reasoned action theory and CSE guidelines, a qualitative study was conducted with seven teachers and 62 adolescents aged 15 - 19. The data were collected through six focus groups (FG) of adolescents and seven semi-structured interviews of teachers. The program of the family life education course (FLEC) was assessed. The Atlas Ti software helped to analyze the data, using a deductive approach. Results: The periodic abstinence, male condoms and pills were the most known contraceptive methods. Adolescents and teachers were reluctant to use artificial contraceptive methods, apart from the male condom which they used irregularly. Girls especially preferred natural contraceptive methods, fearing side effects, such as the risk of infertility. Almost all adolescents wanted to be informed on SRH and family planning in school. However, they estimated that the content of the FLEC was insufficient and criticized the teachers’ lack of openness. Their main sources of information were peers, siblings and the internet. Mothers were an important source of information for girls, unlike fathers considered to be indifferent or even frightening. Conclusion: Adolescents’ and teachers’ knowledge are weak;and their attitudes unfavorable towards contraception. Misconceptions about contraception lead to the use of ineffective practices to prevent unwanted pregnancies. To improve knowledge, a teacher training program should be developed and the content of the FLEC improved, formalized and regulated.

Assessment of Policies, Laws, and Regulations Affecting the Contraceptive Needs of Adolescents in the Democratic Republic of the Congo

Background: Poor regulation is a barrier to adolescents’ accessing family planning (FP) services. We aimed to assess policies, laws, and regulations according to the contraceptive needs of adolescents in the Democratic Republic of the Congo (DRC). Methods: A mixed method study was conducted in 74 structures, including 13 administrative structures and 61 facilities offering FP. Data were collected through semi-structured interviews and document review. Using a health policy analysis framework, we analyzed the types of policies;their availability at the delivery points;the actors and the context of the policy formulation process. The content of policies was analyzed on the basis of WHO recommendations to ensure respect for human rights in the provision of contraceptive information and services. Results: Of the policies targeting the sexual and reproductive health (SRH), 18 were mainly focused on the FP of which 5 were the standards and directives;5 implementing documents;3 guidelines;3 laws and 2 policies. Twelve documents were classified “important” for the FP extension. However, a few targeted adolescents and were translated into operational instructions for providers. Of 9 WHO recommendations, one was fully and two partially integrated into FP policies. Adolescents and FP providers were less involved in the policy formulation process. Conclusion: The FP regulation remains problematic in the DRC. FP policies are unsuitable to adolescents’ expectation;they do not guarantee a secure and unrestricted access to FP services. The ministry of health should put in place evidence-based regulations to improve access to SRH services by adolescents.