Delivering sexuality education: A review of teaching pedagogies within South African schools

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Introduction
Sexuality education programmes are widely recognised as key in challenging negative assumptions in respect of HIV and AIDS, gender-based violence and unwanted pregnancy, and in promoting safer, equitable and non-violent sexual practices (Shefer & Macleod, 2015).Sexuality education delivered in schools aims to reduce risky sexual practices, thereby contributing to the reduction of HIV incidence among youth and adolescents (Mavedzenge et al., 2011); which is an outcome of the Sustainable Development Goals (SDGs) (UN General Assembly, 2014) and South Africa's National Strategic Plan for HIV, STIs and TB 2017-2022(South African National AIDS Council, 2017).Apart from promoting the development of young peoples' sexual knowledge, school-based life skills programmes may also potentially help develop maturity, self-confidence, communication skills and well-rounded personalities (Goldman, 2006).
The HIV and AIDS Life Skills education programme has been implemented in all schools via the Life Orientation (LO) learning area from 2000/2001.While the LO learning area continues to function as the primary vehicle for the delivery of sexuality education, including reproductive health (Bhana et al., 2005;Shefer & Mcleod, 2015), translation of this knowledge into improved prevention behaviour has been somewhat inconclusive (Department of Education, 2006;Reddy, James & McCauley, 2005;Visser, 2005).South African studies have suggested that LO efforts may often not lead to healthier sexual attitudes and behaviour (Hendricks & Tanga, 2016).LO is falling short of its goals and often appears to be failing to impact positively on youth sexual practices and experiences (Sedibe, 2014;Shefer & Mcleod, 2015).Even though a theoretical understanding exists of the goals and objectives of the LO programme, there are knowledge gaps regarding the extent to, and conditions under which the programme is delivered (Tucker et al., 2016).

Educators' challenges in delivering sexuality education
The efficacy of sexuality education in South Africa is wedged within a triad of policy, personal and community values (Francis, 2011).Frequent changes in the LO curricula over the past two decades, as well as limited detail or departmental guidance for teaching practice and pedagogy, have left LO educators feeling overwhelmed by the complex nature of the subject (Diale, 2016;Francis, 2010;Goldman, 2010).This is concerning, as many LO educators across South African schools lack uniformity in professional training and come from a diverse range of fields, which do not always adequately equip them for delivering sexuality education confidently and effectively (Francis, 2011;Rooth, 2005).Effective pedagogical strategies are missing to create a dynamic classroom atmosphere for LO lesson delivery that incorporates cultural diversities (Prinsloo, 2007).Engaging youth as legitimate sexual subjects who can provide input into what is being taught (Francis, 2010), while paying attention to students' personal biographies and life-histories -sexuality issues, opinions and experiences -is crucial to the realisation of the programmes objectives (Timmerman, 2009).
Educators' individual experiences and personality affect their pedagogical and didactic approach, including their ability to address practical knowledge about relationships and issues of gender and desire (Francis, 2010;Timmerman, 2009).South African educators have reported a lack of confidence in embodying the role of effective instructors and modellers of life-skills, rendering LO a daunting task for many of them (Wood & Olivier, 2007).Models to increase educator's self-efficacy beliefs have proven effective in enhancing their confidence in the teaching of this learning area (Wood & Olivier, 2007).
Operational research is needed to understand the factors contributing to an effective delivery of sexuality education, particularly in under-resourced and culturally diverse contexts to "bridge the gap" between good curricula and positive sexual and reproductive health (SRH) outcomes in adolescents' lives.As such, research in the education arena should move beyond solely critiquing the content of sex education programmes, towards scrutinising "how" these curricula are being delivered in developing contexts, and by whom (Diale, 2016;Yankah & Aggleton, 2008).In so doing, not only structural and individual barriers but also local (South African) value systems ought to be taken into consideration (Prinsloo, 2007).This paper examines educators' views of LO delivery and if pedagogic strategies and use of resources, favour the development of learners as capable, self-efficacious decisionmakers.It is the intention of this research to assist LO educators in identifying and anchoring pedagogies in approaches that are more structured and theoretically geared towards greater levels of understanding and behaviour change.Bandura's (1986) social cognitive theory (SCT) conceptualises individuals as agents, proactively engaged in their personal development.Upon processes of reflection, the self is regulated in a dynamic interplay of cognitive, behavioural and environmental influences, as noted in Figure 1 below.This conceptualisation of humans as self-efficacious represents a move away from theories understanding the individual as mostly reactive to their environments.Bandura's (1986) understanding of reciprocal determinism instead finds self-regulations to be a product resulting from a process of triadic reciprocality, including interactions between (a) personal factors in the form of cognition, affect and biological events, (b) behavioural competencies and (c) environmental influence.Concerning SCT, this paper highlights the cognitive and behavioural factors underpinning LO educators' competence in teaching LO, as well as the key environmental factors that shape LO lesson delivery, thereby positively or negatively influencing learners' engagement with and application of SRH information.

Methodology
A cross-sectional research design was used to explore factors affecting the implementation of LO programmes, specifically the sexuality education sub-component, in public secondary schools across select districts in three provinces in South Africa (George et al., 2013).In the original study, focus-group sessions were held with grade 9 and 11 learners, typically representing our 14-18 year old adolescent group, while in-depth interviews were conducted with LO educators, LO Heads of Department (HODs), departmental LO subject advisors and coordinators for non-governmental organisations involved in school-based life skills education (Tucker et al., 2016(Tucker et al., , 2017)).This paper focuses on teaching practices with an emphasis on the views expressed by LO educators and LO HODs.These views are supplemented with classroom observational data.

Sampling
The participating schools in the study were sampled across three districts in South Africa: the Umgungundlovu district in KwaZulu-Natal, the North Tshwane district in Gauteng and the Bohlabela district in Mpumalanga.The purposive selection of these districts was geared towards developing a better understanding of LO programmes across varying educational contexts.North Tshwane and Bohlabela represented the best performing and worst performing districts for the 2010 National Senior Certificate (NSC) examinations, with matriculant pass rates of 85.6% and 40.1% respectively (Department of Basic Education, 2011).The bulk of the research was conducted in the Umgungundlovu district in KwaZulu-Natal.The grade 12 pass rate for KwaZulu-Natal (70.7%) was closest to the national average of 67.8% for the 2010 NSC (Motshekga, 2010), while Umgungundlovu recorded the highest HIV prevalence among pregnant women across all districts within KwaZulu-Natal (45.7% in 2008) (Department of Health, 2009).
Poverty quintile rankings (PQs) were also taken into consideration as national indicators for poverty and infrastructure.PQ communities 1, 2 and 3 represent more under-resourced and non-fee paying schools compared to PQ 4-5 communities (Department of Basic Education, 2013).Stratified random sampling was employed across districts and PQs, resulting in a final sample of 16 schools, comprising nine PQ 1-3 schools and seven PQ 4-5 schools.

Data collection
The Humanities and Social Science Research Ethics Committee at the University of KwaZulu-Natal and the National Department of Basic Education (DBE) granted permission and ethical approval for the study.Fieldwork was conducted between July 2011 and mid-October 2011.Across the sixteen sampled schools, 45 semi-structured interviews were conducted with LO educators (n = 30) and LO HODs (n = 15)1.Written, informed consent was obtained from participants regarding the audio recording of interviews and the understanding of confidentiality, anonymity and voluntariness of participation.
Interviews lasted approximately 45 minutes and were conducted in a private office or area on the school grounds.Educators were interviewed during free lesson periods, break times or after school, by trained fieldworkers proficient in an interview language of choice (English, Zulu or Tsonga).In addition to recording basic demographic data, participants responded to various open and closed questions about their teaching position, their qualifications and experience, enjoyment of teaching LO, lesson preparation, teaching pedagogies, staff and student relationships and other community-level issues and services.
Thirty-two LO classroom observations were performed in the sixteen schools, one per grade 9 class and grade 11 class in each school.Opportunistically, an additional three classroom observations were conducted, bringing the total observations for analysis to thirty-five.One trained fieldworker was tasked with conducting lesson observations to improve evaluation consistency across sites.The observation questionnaire contained questions designed to assess several dimensions of LO lessons, including teaching methods and activities, teaching resources and materials, as well as learner participation and engagement in LO lessons.Questions were primarily in the form of numeric rating tables with only a few open-ended, qualitative questions covering LO lessons and the educators' approach to discipline and classroom management.The observation questionnaire was piloted in two Durban secondary schools prior to the formal research activities.

Data analysis
After the recorded interviews were transcribed, the qualitative data was thematically analysed.Analysis was guided by the conventions proposed by Gibbs (2007), Boyatsiz (1998) and Bazely (2007).Transcripts were analysed using the qualitative software, Nvivo (version 9) and coded according to themes and sub-themes relating to how LO is taught at the 16 schools sampled.During analysis and interpretation of the data, narratives from different groups of participants were triangulated with one another as well as with findings from the LO lesson observations to examine commonalities and discrepancies.Where applicable, frequency counts were used to document the demographic information of respondents and their responses to closed questions regarding teaching experiences and preferences.Pseudonyms were used to protect the identities of schools and the interviewees.

Results
Hereinafter, LO educators are profiled, based on the information obtained during the structured interviews.This is followed by an overview of perceived LO educator competence and selfefficacy in relation to the cognitive, behavioural and environmental features that negatively or positively influence the delivery of LO content.

Profile of LO educators
Demographic information was obtained from the 30 LO educators within the sample, as noted in Table 1 below.LO educator ages were evenly distributed between 23 to 56 years, with an average educator age of 37 years.There were more female educators (70% n=21) than male educators (30% n=9).When questioned about their desire to teach LO, 20 educators (66.7%) reported that it was their preference, while 10 educators (33.3%) indicated that it was not their first subject choice.
A review of teaching responsibilities reveals that most of the LO educators teach one other subject in addition to LO (58.6%.n=17), while six educators taught two subjects in addition to LO (20.7%.n=6).Educators within lower PQ schools in this sample appear to have a more diverse teaching portfolio by covering a greater number of subject areas in addition to LO, while educators in high PQ schools were more likely to appoint specialist LO educators.Most LO educators in the sample were responsible for teaching LO to two grades within their schools (38%.n=11).The number of individual LO classes assigned to educators ranged from one class to 20 classes, with two classes most frequently reported (41.4%.n=12).The reported number of classes, lessons and the duration of teaching periods were calculated to ascertain the contact time that LO educators share with their learners.Contact time reported by educators varied considerably.The most frequently reported contact times were four (17.2%.n=5) or six hours (13.8%.n=4) within a five or ten-day timetable.The greatest overall contact time for teaching LO in a week was reported at 28 hours for a specialist LO educator teaching LO to classes across four grades.
The qualified teaching experience of educators within the sample ranged from 0 years to 33 years, with the former indicating an absence of a formal teaching qualification.The years of experience for teaching LO ranged from less than 1 year to 9 years, with some respondents including their experience facilitating pre-LO school subjects such as career guidance.Nearly half the educators (43.3%.n=13) reported having less than one year experience teaching LO as a subject within their current school, while eight educators reported having less than one year experience teaching LO at any level (26.7%).

Cognitive: Knowledge, expectations and attitudes
LO educators' levels of knowledge regarding LO themes and lesson content, and their perceptions of and general attitudes towards the subject, are important factors shaping competence for LO lesson delivery.Understanding the expression of these ideas and values in class is critical, as learners' judgement of their own knowledge and the ways in which this information becomes encoded, is rooted in their observations of educators as role models.
More than two thirds of the educators in the study preferred teaching LO to other subjects but also covered other subject areas, with only higher PQ-levelled schools having dedicated specialist LO educators.LO educators frequently had little teaching experience and lacked training.This affected classroom management and attitudes towards sexuality education.
Nearly every educator expressed belief in the importance of teaching learners about HIV and AIDS, sex and sexuality and acknowledged learners' needs for related information.A responsibility to tell learners the "truth" about sensitive topics such as HIV and AIDS and sex was highlighted, meaning that learners ought to know the consequences of their behaviour.However, this often resulted, particularly within PQ 1-3 schools, in simplistic and prescriptive warnings, designed to deter learners from having sex, rather than discussing values, knowledge and developing skills to make healthy and informed sexual and reproductive health choices, as exemplified in the following two excerpts: Interviewer: Is that why it is very important to teach learners about sexual issues?2019: 37(1) Yes, so that they know the risks of engaging in sex, especially unsafe sex.Because when you take risks, you will die from AIDS, and you will give birth to an HIV positive child who will die as well (LO educator, PQ 2 school, Umgungundlovu district).
You must just ask them, "Do you know what sex is?" Then some they'll say "We know", some will say "We don't know", and I said, "It's good for you if you don't know because sex is very dangerous, because you are going to fall pregnant, you're going to get HIV, you're going to have babies with no fathers" (LO educator, PQ 1 school, Bohlabela district).
While many educators found LO important and put effort into conveying lesson content, there were concerns regarding the perceived value and recognition of LO within the academic context: There's that stigma that life orientation is just a subject where we talk about everything, so it's an "easy subject".So, "Can we have your period now?We can use them for something more important".Though they [other educators] don't say it like that but if you are an adult, you can read between the lines ... Sometimes they don't understand the importance of it (LO educator, PQ 4 school, Umgungundlovu district).
If it was according to me, we could have been doing away with this subject because, though it is important, as important as it is, it is not being recognised by the learners and even us as the teachers because the score for life orientation is not considered for admission at universities, that is another serious problem.So why must we waste our time by allocating this thing in the timetable, in a composite timetable, whereas it's not taking the learner anywhere?(HOD, PQ 2 school, Umgungundlovu district).
As the previous quote illustrates, perceptions of LO credibility at the individual-level in the context of a schooling system cannot be divorced from the broader environmental influences related to institutional policies like university accreditation.

Behavioural: Skills for practice
Internalisation of LO content and the skills learners develop, also hinge on the various pedagogical approaches used by LO educators to covey sensitive subjects.The expressed comfort of the majority of educators in teaching these topics largely stemmed from individual factors, including background training in Psychology or Nursing; personal characteristics such as confidence, open-mindedness and having frequently been exposed to information on HIV and AIDS.However, there also appeared to be insecurities about handling classroom situations, as the following educator statement highlights: Now if you go deep into that (HIV and AIDS and sexuality topics) and there are those older boys who now are like, "Yes ma'am, please tell us more, tell us more", they make it personal now.They ask you, "Ma'am, when did you start to engage in sex?What can be done, how can we do it?"Now, they digress, they take the lesson in a bad direction.

That's why I feel that you mention it, you don't have to actually go deep and explain how it happens, but if you say that, "Girls don't sleep with boys. Boys don't sleep with girls!" I think that is generally understood (LO educator, PQ 4 school, Umgungundlovu district)
Classroom observations revealed three major trends in educator-learner interactions.Half the observed lessons (48.6%.n=17) supported a democratic atmosphere in which educators and learners shared equal participation and retained a focus on the subject material.Fourteen lessons (40%) were formal and educator-dominant with a one-way transmission of information from educator to learner and little opportunity for learners to participate.In a few cases (11.4%.n=4), this power dynamic was inverted whereby learners were reluctant to follow the educator's instructions and failed to complete tasks.
Even though learner participation was prized within lessons covering sensitive thematic areas, educators reported a need to ensure an even stricter control of classroom discipline in order to prevent inappropriate comments or questions from learners that may offend peers affected by the lesson content.In contrast, educators from PQ 5 schools largely felt that their learners were tired of hearing about HIV and AIDS, given that they had been exposed to HIV prevention messages and lessons since primary school.Their primary education approach was dedicated to piercing through a perception of invulnerability to HIV infection that learners had developed: Regarding the HIV specifically, I have a feeling that, that it's, old news, it's "flogging a dead horse".The learners have had this on primary school, in every grade, and in different subjects also, they do it in the languages, in essays, or in comprehension tests, or whatever.They are bored with the subject, on the one side.The other side, we must keep on doing it because there are still a lot of myths and lack of information out there and personally I don't know how to bridge that gap."It will not happen to me", sort of, "It happens to Black people or to poor people.It won't happen to me.So I don't listen in class to what the teacher says".I don't know how to bridge that gap.If somebody can discover that tool.(LO educator, PQ 5 school, North Tshwane district)

Environmental: Social norms and resources
In the previous themes and excerpts, it is suggested that educators' individual views of LO and the ways in which it is internalised by learners, is influenced by how the subject is facilitated across broader institutional levels.Educator accounts reveal how institutional sentiment shapes curriculum time, as well as staff and other resource allocations.Many educators and HODs in the sample acknowledged that insufficient time is allocated to LO in curriculums, reinforcing a perception of LO as unimportant relative to other learning areas.This was seen as compromising teaching quality, either through reliance on didactic teaching to progress quickly through content, or through a vague and superficial teaching approach that failed to cover curriculum material and formal department assessments.The allotment of educators to LO was not only described as secondary to other subjects, but also as a form of penalty for under-performing educators: They think that life orientation is an easy subject because it's not examinable.That is why I was saying that when a teacher is absent a lot they give them life orientation.When a teacher has got ill health, they give them life orientation.When a teacher did not perform well in grade 12 results, they switch them to teaching grade 8 and also give him life orientation.That's the problem that we are facing.(HOD, PQ 1 school, Bohlabela district).
Most of the educators were utilising and closely following the work plans provided to them by the DBE subject advisor and their LO textbooks in preparing LO lessons.Apart from educators in PQ 5 schools who routinely held meetings to confer about lesson content, activities and pace of delivery, LO educators from other poverty quintiles tended to prepare their own class content independently from fellow LO educators in that same grade.While educators in PQs 4 and 5 consulted multiple textbooks and relied heavily on alternate sources to diversify the information for their lessons, educators in PQs 1-3 had access to only one LO textbook per grade as reference material, which was said to contain insufficient information.Creative methodologies like role-plays and debates, as well as project activities were largely absent from LO lessons.The use of technology through PowerPoint slideshows was observed in six lessons (17.1%) and solely within PQ 5 schools.One significant resource constraint challenging the use of participatory activities, which was observed and reported by respondents, was the overcrowding of classrooms (ranging from 90-120 learners in PQ 1 schools to 38-45 learners in PQ 5 schools).Educators who acknowledged difficulties with large class sizes recalled using a more didactic approach in lessons to manage learner misbehaviour and ensure the covering of the volume of work outlined in the curriculum.
Furthermore, a lack of internet access and school libraries in all but six schools (PQ 4-5) and long distances to community libraries and facilities made it particularly difficult for learners and educators in poorer, rural communities to source information and conduct independent research tasks.Nevertheless, there was evidence of motivated LO educators assisting learners in sourcing external information, including the provision of transport to community locations and improvising with lesson materials:

Discussion
The LO subject is designed to enhance personal growth, to develop the self in society and form a sense of responsibility for oneself and others, including learning to make healthy choices.Thus, LO lessons ought to be geared towards learner's notions of self-efficacy; an ability to influence aspects affecting their lives.Through the lens of LO educator accounts, as outlined in the findings, this section discusses potential intersections of LO educator's pedagogic approaches and learner self-efficacy.Firstly, the socio-structural frameworks of LO lesson delivery will be discussed further.Secondly, the section will elaborate on how educators within these structures respond to learners' experiences and information needs regarding sexuality and health, as this forms a crucial part in the reciprocal interplay between the personal, behavioural and environmental factors (see Bandura, 1986).

Socio-structural frameworks
The finding that LO as a subject area was lacking acknowledgement is in line with other research conducted across South Africa (Sedibe, 2014;Tucker et al., 2016;Shefer & McLeod, 2015).Standards of LO delivery vary considerably across different PQ-levelled schools, highlighting the hampering effects of structural inequality on the quality of sexuality education.However, there remain motivated educators who provide learners with additional material, even in contexts with limited or absent internet and library access.
While educators of all PQ levels emphasised the potential of participatory teaching strategies, only PQ 5 educators used creative and innovative activities in their LO lessons.PQ 5 educators, equipped through additional meetings, greater access to LO resources including specialist educators and smaller classes, used a less didactic and more participatory pedagogic approach.The simplistic and prescriptive warnings about HIV and sexual behaviour shared by many PQ 1-3 educators coincide with fewer resources, less training, over-crowded classrooms and having to deal with learners' issues.Limitations regarding training resources, as reported by LO educators in lower PQ schools, resulted in LO staff having to rely heavily on their individual skills and judgments, requiring them to be at ease teaching sexuality education content.Even though most educators expressed comfort in teaching LO, the close following of the department work plan and the often disciplinary pedagogies used may indicate insecurities in conveying sexuality education messages.The lack of communication between educators in non-PQ 5 schools prevent a potentially helpful exchange of experiences and may perpetuate the treating of sexuality as a taboo subject.

Responses to learner information needs
In line with Bandura's (1986) theory, learners' perceptions of their own self-efficacy depend on how their information needs are responded to.LO educators ensuring a strict control of classroom discipline in order to prevent "inappropriate" and possibly offensive comments or questions from learners pose a considerable challenge in conveying sexuality education messages successfully, which hinder skills-building and self-reflective activities, as do oversimplistic and prescriptive warnings.
The most passionate and well-trained educators emphasised the importance of approaching lessons on sex, sexuality and sexual health with great sensitivity and care.The comments of LO educators in our study describing sex as quintessentially dangerous, particularly for girls, posits a strong indicator for gender bias, which is likely to permeate through LO lessons.
The disciplinary and authoritative character of LO lessons and gender bias indicate that learners are only, to limited degrees, encouraged to cultivate abilities to self-reflect, regulate their actions and make responsible choices on their own account.Such prescriptive teaching approaches potentially reproduce discourses shaping unequal gendered sexual practices, including coercive, unsafe and inequitable sexual intimacies (see Shefer & Mc Leod, 2015).

Conclusion and recommendations
Our findings suggest that the majority of LO educators recognise the importance of their role and responsibility in teaching learners about sex, sexuality and potential risks.However, the success of LO education depends on a range of overlapping cognitive, behavioural and environmental aspects.In the study contexts, many of these aspects did not favour such education goals.Insufficient resource allocation for the LO subject area (especially in lower PQ-levelled schools), the lack of training and experience of LO educators, and crowded classrooms, overlapped with prescriptive teaching pedagogies, limiting educators from engaging learners as legitimate sexual subjects who can provide input into what is being taught.
Concerning formal training and knowledge development amongst educators, our findings suggest it would be beneficial to: (1) enhance educators' knowledge about HIV and AIDS, sex and sexuality, and increase their proficiency and skill in teaching this content.(2) Educators need to be provided with the skills and knowledge to deliver participatory lessons and implement classroom management strategies that will channel learner interest and energies into productive forms of engagement.(3) Educators should be assisted in teaching and managing learners who are personally affected by sensitive topics in order to minimise trauma and emotional distress.(4) Finally, to enhance educators' personal development by interrogating and creating awareness of personal belief systems, cultural worldviews and attitudes that have bearing on the way LO is delivered, and how they position themselves and learners in that process.In order for the subject to be transformative, there is a need for LO educators to pay attention to learners' personal biographies and life histories (Timmerman, 2009) and adopt exploratory, discussion-based and reflective pedagogies in addressing their abilities to act self-efficaciously (Matseke, 2011).
Future educator training opportunities should include pedagogic and personal development workshops; providing knowledge and skills required to deliver HIV and AIDS and sexuality education by using participatory activities and a rights-based framework, and creating awareness of educators' internalised beliefs, attitudes and biases.It is acknowledged that the DBE HIV strategy (2012)(2013)(2014)(2015)(2016) and the DBE National Policy on HIV, STIs and TB (2017) address these needs, with the latter policy advocating for the use of scripted lesson plans to unpack the sexuality curricula and provide educators with the tools to deliver sexuality content more effectively.Future research should evaluate the progress against these and other relevant strategies.

Figure 1
Figure 1 Bandura's social cognitive theory (Adapted by the Authors)

Table 1 : Profile of LO educators
I'm feeling comfortable except the PET, although I'm flexible to use whatever material that I have.For instance here, during PET time, we need to have changing rooms, we don't have changing rooms, even the material we don't have the equipment but if you are an educator you need to be creative.You need to use whatever is in front of you.You can't just say, or being lazy, there's no material at work.You need to improvise (LO educator, PQ 3 school, Umgungundlovu district).