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Comprehensive sexuality education for partner violence prevention: a school-based evaluation in Mexico City

Understanding how gender-transformative sexuality education can reduce partner violence among young people in Mexico, and exploring better ways to evaluate complex interventions. 

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The project

This co-produced evaluation in Mexico City was carried out by LSHTM, Mexfam, and IPPF/WHR. We explored how Mexfam’s gender transformative sexuality education programme contributed to more equitable and less violent relationships for young people.

We were awarded the 2019 Development Marketplace Award for Innovations in Gender-based Violence from the Sexual Violence Research Initiative and World Bank Group. ​We also received funding from IPPF/WHR through a private donation from Mr. Stanley Eisenberg, and from the Advancing Learning and Innovation on Gender Norms (ALIGN) Research Fund (2018).

The co-principal investigators of this study are Shelly Makleff and Professor Cicely Marston from the DEPTH research group at LSHTM.


Our co-produced evaluation resulted in outputs for different audiences. We wrote peer-reviewed publications for academic audiences, and developed policy briefs and blog posts in English and Spanish to communicate our findings to programmatic teams, policymakers and donors.

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The intervention
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Comprehensive sexuality education may help prevent intimate partner violence, but this has rarely been explored or measured in evaluations. We evaluated a comprehensive sexuality education programme with a violence-prevention component in Mexico. 
The course is delivered in a classroom in weekly sessions by young health educators – aged under 30 years – who are staff at Gente Joven, Mexfam’s youth programme. Each health educator facilitates the intervention for a group of approximately 20 students between 14 and 17 years of age. The course content is specified in a manual. Topics include gender, sexuality, sexually transmitted infections, unintended pregnancy, violence, and relationship skills, in addition to information on where and how to access health services. The curriculum takes a “gender-transformative” approach, promoting critical thinking around social norms about gender with the aim of reducing power differentials based on gender, in order to increase gender equality. The curriculum uses participatory techniques to reinforce key course messages, particularly those related to gender and partner violence, through self-reflection and group discussion. 
We evaluated the course in a state-run technical secondary school in Tlalpan, an area in the south of Mexico City. We used a longitudinal quasi-experimental design. Data collection methods included in-depth interviews, repeat interviews, direct observation, and focus group discussions with students, teachers, and health educators.

You can learn more in our publications and other dissemination materials.

Peer-reviewed publications
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Our project publications are free and open access.

Evaluating Complex Interventions Using Qualitative Longitudinal Research: A Case Study of Understanding Pathways to Violence Prevention

Evaluating social change programs requires methods that account for changes in context, implementation, and participant experience. We present a case study of a school-based partner violence prevention program with young people, where we conducted 33 repeat interviews with nine participants during and after an intervention and analyzed participant trajectories. We show how repeat interviews conducted during and after a social change program were useful in helping us understand how the intervention worked by providing rich contextual information, elucidating gradual shifts among participants, and identifying aspects of the intervention that appear to influence change. Long- term effects of social change interventions are very hard to quantify or measure directly. We argue that a qualitative longitudinal approach provides a way to measure subtle changes that can serve as proxies for longer term impacts.

Makleff S, Garduño J, Zavala RI, Valades F, Barindelli F, Cruz M, Marston C. Qualitative Health Research (2021).

Applying a social complex adaptive systems approach when evaluating implementation of a school-based intervention for intimate partner violence prevention: A case study in Mexico.

Despite calls for evaluation practice to take a complex systems approach, there are few examples of how to incorporate complexity into real-life evaluations. This article presents the case for using a complex systems approach to evaluate a school-based intimate partner violence-prevention intervention. We analysed data in relation to complexity concepts particularly relevant to schools: ‘diverse and dynamic agents’, ‘interaction’, ‘unpredictability’, ‘emergence’ and ‘context dependency’. The data—two focus groups with facilitators and 33 repeat interviews with 14–17-year-old students—came from an evaluation of a comprehensive sexuality education intervention in Mexico City, which serves as a case study for this analysis. We show that an intervention comprises multiple dynamic and interacting elements, all of which are unlikely to be consistent across implementation settings. Interpersonal interactions, group dynamics, the core messages of the course, and intervention context will impact the intervention process, often in unpredictable ways. This gender-transformative intervention appeared to disrupt pervasive gender norms and reshape beliefs about how to engage in relationships. A social complex adaptive systems approach is well-suited to the evaluation of gender-transformative interventions and can help identify how such interventions disrupt the complex social systems in which they are implemented to address intractable societal problems.

Makleff S, Billowitz M, Garduño J, Cruz M, Silva Marquez VI, Marston C. Health Policy and Planning (2020).

  • Accompanied by podcast discussing the article.

Preventing intimate partner violence among young people – a qualitative study examining the role of comprehensive sexuality education.

It seems likely that comprehensive sexuality education may help prevent intimate partner violence, but few studies have examined this. In this article, we explore the ways that a “gender-transformative” comprehensive sexuality education course in Mexico City may help prevent intimate partner violence. We conducted in-depth interviews and focus groups with students ages 14 to 17 as well as their teachers and health educators. The data suggest that the comprehensive sexuality education course helped young people develop strategies to prevent and respond to partner violence. We found four elements of the course that seem central to violence prevention. First, encouraging young people to reflect about romantic relationships, which helped them question whether jealousy and possessive behaviors are signs of love; second, helping them develop skills to communicate about sexuality, inequitable relationships and reproductive health; third, encouraging care-seeking behavior; and fourth, addressing norms around gender and sexuality, for example demystifying and decreasing discrimination towards sexually diverse populations. The results suggest that this promising and relatively short-term intervention should be considered as a school-based strategy to prevent and respond to partner violence.

Makleff S, Garduño J, Zavala RI, Barindelli F, Valades J, Billowitz M, Silva Márquez VI, Marston C. Sexuality Research and Social Policy (2020).

See our other project outputs.

Other outputs
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We developed materials in English and Spanish to communicate the policy- and programme-relevant findings of this project to diverse audiences. These outputs include a briefing paper, a series of policy briefs, and blog posts.

Briefing paper

The three organisations wrote a briefing paper for programmatic audiences. The document describes the programme in detail and shares preliminary qualitative and quantitative evaluation findings.

Briefing paper: “Preventing intimate partner violence among young people – The role of comprehensive sexuality education.” Advancing Learning and Innovation on Gender Norms (ALIGN) (2019).

Policy briefs

We developed a series of three short policy briefs in English and Spanish to outline emerging evidence about comprehensive sexuality education as a prevention strategy for partner violence.

Blog posts by research partners

We wrote a series of blogs to reflect on various aspects of programme implementation and research methodology. These reflect the perspectives and experiences of different members of our project team from Mexfam, IPPF/WHR and LSHTM.

See our peer-reviewed articles.