Meta Analysis of the Effect of School-Based Sexual Education on the Risk of Pregnancy and Human Immunodeficiency Virus Infection in Adolescents


  • Jatu Kartika Akmala Masters Program in Public Health, Universitas Sebelas Maret
  • Eti Poncorini Pamungkasari Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret
  • Hanung Prasetya Health Polytechnics, Ministry of Health Surakarta


Background: Adolescent behavior is current­ly worrying, many adolescents have risky sexual behavior that can lead to pregnancy and HIV. School-based sexual education is given to adolescents to provide knowledge, understand­ing and prevention of sexual and reproductive health, including pregnancy and HIV among adolescents. The purpose of this study was to estimate the effect of school-based sexual education on the risk of pregnancy and HIV in adolescents based on the results of previous studies.

Subjects and Method: This study is a syste­matic and meta-analysis study. Article is ana­lyzed by using a randomized controlled trial study design. Several databases were used, including PubMed, Science Direct, BMJ and Google Scholar. The keywords for the article search were “school-based sexual education” OR “school-based sex education” AND “human immunodeficiency virus” AND “unwanted pregnancy” OR “unintended pregnancy” AND adolescent AND “randomized controlled trial”. This study is a full-text article with a rando­mized-controlled trial design. Articles were collected using PRISMA Flow diagrams. Articles that met the inclusion criteria were analyzed using the Review Manager 5.3 application.

Results: There were 12 articles that fulfilled the criteria for a meta-analysis with 9 studies which showed the effect of school-based sexual education on increasing pregnancy prevention behavior by 1.04 times higher compared to non-school based sexual education (RR = 1.04; 95% CI= 0.95 to 1.13; p= 0.42) and 7 studies showed the effect of school-based sexual education on increasing HIV prevention beha­vior by 1.02 times higher compared to non-school based sexual education (RR= 1.02; 95% CI= 0.94 to 11; p=0.60).

Conclusion: School-based sexual education affected the behavior of preventing pregnancy and HIV among adolescents.

Keywords: School-based sexual education, pregnancy, HIV, adolescents.

Correspondence: Jatu Kartika Akmala. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email:

Journal of Health Promotion and Behavior (2021), 06(01): 67-79


Abdella ADNH, Abd-Elhalim A, Fathy Attia DAM (2016). The body mass index and menstrual problems among adolescent students. IOSR J Nurs Health Sci. 05(04): 13–21.

Campbell MA, Mcgrath PJ (1997). Use of medication by adolescents for the management of menstrual discomfort. Arch Pediatr Adolesc Med. 151(9): 905-13.

Castillo-Martínez L, López-Alvarenga JC, Villa AR, González-Barranco J (2003). Menstrual cycle length disorders in 18- to 40-y-old obese women. Nutr. 19(4): 317–320.

Center for Evidence Based Management. (2014). Critical appraisal checklist for cross-sectional study.

Chang PJ, Chen PC, Hsieh CJ, Chiu LT (2009). Risk factors on the menstrual cycle of healthy Taiwanese college nursing students. Aust N Z J Obstet Gynaecol. 49(6): 689–694.

Chavez-MacGregor M, Elias SG, Onland-Moret NC, Van DSYT, Van GCH, Monninkhof E, Grobbee DE, Peeters PHM (2005). Postmenopausal breast cancer risk and cumulative number of menstrual cycles. Cancer Epidemiol Biomarkers Prev. 14(4): 799–804.

Diaz A, Laufer MR, Breech LL (2006). Menstruation in girls and adolescents: Using the menstrual cycle as a vital sign. Pediatr. 118(5): 2245–2250.

Ganesan DK, Krishnan GK, Chitharaj RR, Boopathirajan R (2019). A cross-sectional study on relationship between body mass index and menstrual irregularity among rural women in Tamil Nadu. Int J Community Med Public Health. 6(11): 4635.

Kementerian Kesehatan RI (2019a). Profil Kesehatan Indonesia. Kementerian Kesehatan Republik Indonesia.

Kementerian Kesehatan RI (2019b). Remaja Putri yang Obesitas Berisiko Depresi (Obese Teenage Girls are at Risk for Depression). Kementerian Kesehatan Republik Indonesia.

Kumar S, Kelly AS (2017). Review of childhood obesity: From epidemiology, etiology, and comorbidities to clinical assessment and treatment. Mayo Clinic Proceedings. 92(2): 251–265.

Lin HT, Lin LC, Shiao JSC (2007). The impact of self-perceived job stress on menstrual patterns among Taiwanese nurses. Industrial Health. 45(5): 709–714.

Moreno LA, Mesana M, González-Gross M, Gil CM, Ortega FB, Fleta J, Wärnberg J, et al. (2007). Body fat distribution reference standards in Spanish adolescents: The AVENA Study. Int J Obesity. 31(12): 1798–1805.

Murti, B. (2018). Prinsip dan Metode Riset Epidemiologi (Edisi V) (Principles and Methods of Epidemiological Research (V). (Universitas Sebelas Maret (ed.); V). Bintang Fajar Offset.

Nath A, Garg S (2008). Adolescent friendly health services in India: A need of the hour. Indian J Med Sci. 62(11): 465–472.

Palm-Fischbacher S, Ehlert U (2014). Dispositional resilience as a moderator of the relationship between chronic stress and irregular menstrual cycle. J of Psychosom Obstet Gynecol. 35(2): 42–50.

Rad M, Sabzevary TM, Dehnavi MZ (2018). Association between menstrual disorders and obesity-related anthropometric indices in female high school students: A cross-sectional study. Int J School Health. 5(2): 1-8.

Rafique N, Al-Sheikh MH (2018). Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences. Saudi Med J. 39(1): 67–73.

Rakhmawati A, Dieny FF (2013). Hubungan obesitas dengan kejadian gangguan siklus menstruasi pada wanita dewasa muda (The relationship between obesity and the incidence of menstrual cycle disorders in young adult women). J Nutr Coll. 2(1): 214–222.

Reavey JJ, Duncan WC, Brito-Mutunayagam S, Reynolds RM, Critchley HOD (2020). Obesity and menstrual disorders. In Obesity and Gynecology. INC.

Seif MW, Diamond K, Nickkho-Amiry M (2015). Obesity and menstrual disorders. Best Prac Res: Clin Obstet Gynaecol. 29(4): 516–527.

Septian R, Ahaddini, Widyastuti N, Probosari E (2017). Konsumsi fitoestrogen, persen lemak tubuh dan siklus menstruasi pada wanita vegetarian (Phytoestrogen consumption, percent body fat and menstrual cycle in vegetarian women). J Nutr Coll. 6(2): 180-190.

Sommer M, Phillips-Howard PA, Mahon T, Zients S, Jones M, Caruso BA (2017). Beyond menstrual hygiene: Addressing vaginal bleeding throughout the life course in low and middle-income countries. BMJ Global Health. 2(2): 1–7.

Wei S, Schmidt MD, Dwyer T, Norman RJ, Venn AJ (2009). Obesity and menstrual irregularity: Associations with SHBG, testosterone, and insulin. Obesity. 17(5): 1070–1076.

WHO (2020). Obesity and overweight.

Xueyu Chen, Tang Y, Chen Y, Feng H, Zhu C, Tong M, Chen Q (2020). Is body mass index associated with irregular menstruation: A questionnaire study? BMC Women’s Health. 20(1): 4–9.

Yamamoto K, Okazaki A, Sakamoto Y, Funatsu M (2009). The relationship between premenstrual symptoms, menstrual pain, irregular menstrual cycles, and psychosocial stress among Japanese college students. J Physiol Anthropol. 28(3): 129–136.

Zhou X, Yang X (2020). Association between obesity and oligomenorrhea or irregular menstruation in Chinese women of childbearing age: a cross-sectional study. Gynecol Endocrinol. 36(12): 1101-1105.




How to Cite

Akmala, J. K., Pamungkasari, E. P., & Prasetya, H. (2021). Meta Analysis of the Effect of School-Based Sexual Education on the Risk of Pregnancy and Human Immunodeficiency Virus Infection in Adolescents. Journal of Health Promotion and Behavior, 6(1), 67–79. Retrieved from




Most read articles by the same author(s)

1 2 3 4 5 6 > >>