State of collaborative implementation of comprehensive sexuality education to address adolescent SRHR needs in rural communities in Zambia: A Reproductive Justice analysis

Abstract Background Comprehensive Sexuality Education (CSE) is designed to equip young people with accurate, age-appropriate information and life skills related to sexuality, relationships, and reproductive health. It plays a critical role in addressing adolescent sexual and reproductive health and rights (ASRHR), which remain significantly challenged in Sub-Saharan Africa. This study sought to explore the state of collaborative implementation of CSE to address adolescent SRHR needs in rural communities in Zambia using a reproductive justice lens. Methods We conducted a qualitative case study in Chongwe District of Zambia, guided by Emerson et al.’s collaborative governance framework (system context, government regime, and collaborative dynamics). Data collection included five focus group discussions with adolescents and peer educators, 12 key informant interviews with district officials, health workers, teachers, Non-Governmental Organisations (NGOs), and religious leaders, and seven in-depth interviews with learners and community members. Thematic analysis was conducted using NVivo. Results Key systemic barriers included limited awareness of SRHR policies, minimal incorporation of RJ concepts into educational materials, and persistent economic and cultural obstacles leading to school dropout, early marriage, and limited access to youth-friendly services. District and community health leaders supported sensitisation and youth engagement initiatives, but these were hampered by inadequate capacity strengthening, weak policy enforcement, and poor intersectoral coordination. Although collaborative efforts such as school-based programs and peer-led initiatives facilitated increased engagement, these activities remain fragmented and under-resourced, with persistent stigma. Conclusion Integrating RJ principles into CSE is both feasible and necessary to address entrenched ASRHR inequities in rural Zambia. Effective integration requires explicit RJ content in curricula, sustained district leadership, ongoing mentorship for teachers and service providers, expansion of adolescent-friendly services, and more vigorous community-level enforcement of girls’ rights. These findings inform policy reforms and coordinated strategies to advance reproductive justice and empower adolescents in resource-limited settings. Policy Implications There is a need to increase stakeholders' awareness of existing SRHR-related policies and improve the integration of RJ principles into the CSE framework, which is critical to reducing school dropout due to unintended pregnancies and child marriages. Enhance district leadership capacity and mandate in implementing CSE, increase teachers', healthcare providers', and police capacity to collectively sensitise communities, and collaborate in the enforcement of child protection laws.