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Good adolescent sexual health is the cornerstone of future healthy families and is essential for the development of optimal intimate and social relations including gender equality.1 Investing in adolescents’ sexual health may consolidate early gains, or offer a second chance to those who missed out during childhood.2 The right to access age-appropriate sexuality education at home and in school, and to tailored services for sexual and reproductive health, should be granted to all adolescents.3 Such services should be confidential, that is, without the obligation to inform parents or partners, should be delivered in a non-judgemental manner, and should include actual access to contraceptives and treatment of sexually transmitted infections (STIs). Comprehensive sexuality education, that is, the provision of information and guidance tailored to different cultural and socioeconomic backgrounds on physical and emotional aspects of growing up and starting relationships,4 has shown to effectively delay onset of sexual activity, reduce the frequency of sexual activity and number of sexual partners, increase condom and contraceptive use and reduce the experience of negative sexual health outcomes such as teenage pregnancies and infections with HIV or STIs.5 ,6 Several frameworks using evidence-based standards and criteria offer guidance on how to set up comprehensive or holistic sexuality education.2 ,7 Implementation requirements are known to be complex and need sufficient attention to avoid repetition of previous failures.8 Thus, the issue rather lies in the implementation and scaling-up of evidence-based strategies known to effectively improve adolescent sexual health. Implementation has lagged behind globally, as sexual health is typical a field driven by normative rather than evidence-based policies.
The highest burden of poor adolescent sexual health is found in low-income countries.9 Especially, vulnerable are adolescents who lack the basic school or home support (eg, out-of-school adolescents with no …