The first thematic section presents economic analyses of school-based sexuality education programmes. There are numerous SBSE implementation guidelines for policy makers and programme managers. However, they are often left in the dark on budget implications and efficient design of SBSE programmes. The thesis addresses this by providing cost analyses and -comparisons of six real-world SBSE programmes in India, Indonesia, Kenya, Nigeria, Estonia and the Netherlands, by identifying efficient SBSE programme types and conducting an exploratory cost-effectiveness analysis on one the programmes.

This thesis suggests that SBSE programmes are potentially cost saving and cost-effective in their public health objective to reduce unintended pregnancies, STIs and HIV infections. However, these outcomes are dependent on programme characteristics and context. The thesis demonstrates that SBSE programmes can be produced at low cost per student, when implemented as large scale intra-curricular programmes. It recommends countries to invest in scalable comprehensive intra-curricular SBSE programme models, that have demonstrated their effectiveness in similar context.

Moreover, the thesis shows that a context where sexuality is a sensitive issue increases costs and reduces potential impact of SBSE programmes. Opposition has consequences for how and the pace at which SBSE programmes can be introduced and scaled-up, and for the content of sexuality education, i.e. comprehensive versus abstinence-only. Advocacy plays a key role in the success of implementation of SBSE programmes. Advocacy appears to be a significant cost component, throughout all implementation phases, in many SBSE programmes. Despite this, advocacy is often not budgeted. Therefore, the thesis advices policy makers and programme managers to consider advocacy as a necessary and continuous investment. Lastly, a combination of SBSE and YFSRH services appears to be particularly effective.