All young people need comprehensive sex education for health, while others also need sexual health services. Young people who are at disproportionate risk of sexual health inequalities may also need targeted measures specifically aimed at developing self-efficacy and freedom of choice. In addition, administrators and other policy makers need to recognize that there is evidence that structural determinants, socio-cultural factors and cultural norms have a significant impact on the sexual health of young people and that they need to be addressed in order to truly address sexual inequalities fuelled by social inequalities. Comprehensive sex education has been seen as incompatible with local culture and religious values, as it is confronted with local conceptions of sexual morality. Some issues were too sensitive, as they were believed to promote pre-marriage and casual sex among learners. We are a Christian country, so the message is not for us a sex before marriage (IDI, Professor 9). In Canada, a federal report found that LGBT communities have less access to health services and face broader health challenges than the general population. The Comprehensive Health Education Workers (CHEW) project was established in October 2014 due to a lack of support for the LGBT population. Its goal is to inform the LGBT community on topics such as gender identity, sexually transmitted infections (STIs), healthy social relationships and depression. They do so through workshops, art projects and one-on-one interviews. The CHEW project is aimed exclusively at the LGBT community to create a safe environment in which LGBT youth can earn resources for sex education.  In addition, the themes of the ESC were not reflected in the common work pattern that all schools in the county were to teach: once the programs were completed, we simply found that we accidentally omitted a complete sex education (IDI, Professor 1). The study examined teachers` interpretations of their role in teaching sexuality, romantic relationships and contraception during the early phase of the implementation of the CSE in rural Zambia.
We found that what, when and how to teach depends on the decisions of each teacher. Consistent with Lipsky`s requirement  the need to move beyond the top-down approach to political analysis and to take into account other contextual realities that shape policy implementation, our study strongly demonstrates how attitudes within schools where the CSE framework was implemented have influenced the way teachers have made decisions about the curriculum , and then on the model and how the CSE is implemented. The results of this study showed that the confused clarity within the framework of the ESC, the way in which ESC teaching is integrated into existing subjects, coupled with contextual challenges, has left teachers participating in the ESC with a great deal of discretion.