Abstract

Sexuality education remains contested yet essential for adolescent health promotion in low- and middle-income countries (LMICs), where cultural norms and religious beliefs strongly shape policy and classroom practice. This systematic review synthesizes empirical evidence on how sociocultural and religious factors influence the design, content, delivery, and outcomes of secondary school sexuality education across LMICs. Guided by PRISMA principles, peer-reviewed qualitative, quantitative, and mixed-methods studies published between 2005 and 2023 were identified from major academic databases and screened against predefined eligibility criteria. Across studies, cultural expectations around modesty, gender roles, and premarital abstinence consistently narrowed curriculum scope, with many programmes emphasizing biological reproduction and abstinence while avoiding contraception, consent, sexual diversity, and gender-based violence prevention. Religious doctrines commonly expressed through faith-based school policies, parental pressure, and advocacy in curriculum debates often reinforced these limits and contributed to resistance against comprehensive sexuality education. Teachers’ personal beliefs and fear of backlash further shaped implementation, leading to selective teaching, omission of sensitive topics, and reliance on moralistic messaging rather than skills-based instruction. At the same time, evidence shows that socioreligious contexts can be engaged constructively. Culturally sensitive framing, collaboration with respected religious leaders, and the use of values-based language sometimes improved acceptance without abandoning public health goals. Programmes that involve parents, respect local belief systems, and emphasize life skills, health protection, and future aspirations tended to report stronger feasibility and student engagement. However, restrictive environments were repeatedly linked to misinformation, limited participation, and inequitable access especially for girls. Overall, sociocultural and religious determinants function as dynamic forces that can hinder or enable sexuality education depending on how they are navigated. Effective approaches in LMIC secondary schools require context-responsive frameworks that balance cultural and religious sensitivities with adolescents’ rights to accurate, comprehensive, and age-appropriate sexual and reproductive health information, supported by inclusive stakeholder dialogue, teacher capacity building, and culturally grounded curriculum adaptation.