Talking to young people about sex and sexuality does not increase their sexual activity. Rather, it provides them with the knowledge, understanding and skills to make informed decisions that affect all aspects of their lives.

In fact, as current research suggests, when provided with comprehensive sexual and reproductive health education, adolescents delay having sex, and when they do, they are more inclined to use protection (UNESCO. 2009, International Technical Guidance on Sexuality Education: An evidence-informed approach for schools, teachers and health educators. Volume 1: The rationale for Sexuality Education).

Conversely, a lack of sexuality education and the perception among parents that sexual intercourse is a taboo subject is a significant contributor to teenage pregnancy.

Various complex social factors also contribute to youth pregnancy including peer pressure, intimate partner violence, a lack of knowledge about sexual and reproductive health education and barriers to contraception (Child Gauge, 2015). According to Statistics South Africa, 3,261 girls children aged between 10 and 14 were registered as mothers in 2018. Apart from major health and education risks associated with teenage pregnancy such as maternal health problems, infant mortality, unsafe abortions, poor education outcomes and school dropout, there is much evidence of the burden that teenage pregnancy places on the health, education and economic systems of the country.

Mental health barriers, particularly among girls, trans and non cisgender youth, are directly linked to societal norms and pressures, with the result that many non-binary young people are marginalised by patriarchal patterns that prevail across all social systems including schools. The very high gender-based violence rate in South Africa is a reality, as is the fact that girls in schools, and LGBTQIA+ youth are often made vulnerable by predators who groom and then abuse. Femicide is on the rise: between 2015 and 2016/17 the murder rate of women increased by 117% (Statistics South Africa) and the number of women who experienced sexual offences also increased by 53% during the same period.

A greater focus on sexuality education is critical to youth well-being, as stated in the South African Integrated School Health Policy (ISHP, DBE, 2012) – this being an example of the government’s efforts to promote youth health and well-being in schools.

In addition to the provision of basic health services, the policy emphasises the importance of sexual and reproductive health education as part of the Life Orientation curriculum. However, many Life Orientation teachers feel ill equipped, and in some cases morally and/or religiously opposed to teaching sexuality education. Sexual and reproductive health education is therefore still highly contentious in certain contexts, and, because school-governing bodies must, according to the policy, agree to the provision of sexual and reproductive health services, the effectiveness, degree and impact of such programmes is variable.

Given the complex relationship between socioeconomic status, patriarchy, gender-based violence and sexual behaviour, there is no doubt that a diverse approach to sexual and reproductive health education is needed, and that school health programmes should be multidimensional, integrated and holistic.

Successful implementation of such programmes requires strong, enduring partnerships between schools, health sectors and community organisations (World Health Organisation (1996) Recommendations of the WHO Expert Committee on Comprehensive School Health Education and Promotion. Geneva). Universities also have a key role to play in partnering with schools and community-based organisations. This is crucial in addressing equity gaps, in helping youth reach their full potential and in minimising the risk of mental health issues at tertiary level and beyond. Cross-sector partnerships are critical drivers of change, and it is this multi-stakeholder, systemic approach to health that informs the Schools Wellness Centre – one of the key programmes of the Schools Improvement Initiative in the Schools Development Unit at UCT.

The vision of the Wellness Centre has from the start been to develop a model of excellence in school-based well-being by offering psychosocial support to learners through strong interdisciplinary and community-based collaboration. In realising this vision, the university has worked hand-in-hand with Metro-East Education District, Khayelitsha-Eastern Substructure Metro District Health Services, community-based organisations – and, critically, the school communities. Through multi-stakeholder collaboration the Schools Wellness Center has introduced a range of interventions to build youth capacity and to create safer, more enabling environments for all learners to thrive. In partnership with the Khayelitsha Site B Youth Clinic for example, trained staff in mobile clinics administer screening for pregnancy, sexually transmitted diseases and HIV/AIDS.

Fostering caring, healthy and equitable relationships among schoolgoing youth has been a key focus of the Schools Wellness Centre since it began in 2016. Developing strategies that build resilience and develop agency to shift negative behavioural patterns is another key focus.

To this end the wellness centre facilitates sexual agency and assertion of confidence so that learners understand consensual versus predatory sexual behaviour. This does not pertain to girls only. In many cases the trauma of male rape and the social stigma associated with diminished masculinity results in them resorting to silence. Research suggests that experiences of male rape, and that of non-gender conforming youth, mirror experiences of female rape in terms of shame, humiliation and self-blame. However males are less likely to report a rape incident. Fears among victims of sexual assault, being punished, doubted or victim-shamed in turn lead to isolation, depression and higher incidents of suicide.

Through the Schools Wellness Centre, opportunities are provided in safe, protected spaces for young people to break the silence that all too often masks the challenges they face. Psychosocial support is offered together with a range of interventions including topic-based classroom discussions. Empowering girls through the Future You (sanitary pad project), in partnership with the Department of Health and community organisations is one such example. Girls are given sanitary pads, and the social worker holds discussions with them about physical and emotional development and the types of challenges they experience.

Discussions have also been introduced for boys, the aim being to shift traditionally held narratives, disrupt patriarchal attitudes and prevent harmful sexual behaviour. Male learners and non-cisgender youth are also vulnerable to the challenges of puberty and to bullying, addiction and abuse.

Role models from the community are invited to help expose learners to alternative narratives. The South African women’s rugby captain Babalwa Latsha, from Khayelitsha for example, spoke about her experiences relating to gender bias and misrepresentation. The powerful impact of personal stories reflecting the violence of internalised sexism, misogyny and homophobia has resulted in these discussion forums being extended to reach many more learners in different grades.

Empowering parents/guardians and teachers with information that assists them in understanding their children is also critical to the work of the Wellness Centre. A central theme underpinning these workshops is the importance of healthy communication between parents/guardians and their children.

The work of the Schools Wellness Centre is closely aligned to the Global strategy for women’s, children’s and adolescents’ health (2016-2030) which highlights three objectives:

• Survive: end preventable mortality;

• Thrive: promote health and well-being;

• Transform: expand enabling environments

Promoting heath and well-being in our schools is critical for learners to thrive, and fundamental in creating safe, enabling environments. Working towards gender equity is an urgent priority for transformation so that our youth, particularly women, children and non gender conforming people can enjoy healthy, respectful relationships. And so that all South Africans can contribute towards creating social, political and economic justice. DM

Patti Silbert (PhD) is project manager of the Schools Improvement Initiative in the Schools Development Unit, UCT. She specialises in university-school-community, whole-school improvement and school organisational development.

Tembeka Mzozoyana is a social worker in the Schools Improvement Initiative. As coordinator of the Schools Wellness Centre her focus is psychosocial, developmental and physical well-being.