Evaluating the impact of the Programa Saúde na Escola on adolescent sexual and reproductive health in Brazil: A quasi-experimental analysis using propensity score matching

Abstract

Promoting access to knowledge about sexual and reproductive health in schools is important for adolescents' development, serving as a protective factor against risky sexual behaviors. Therefore, the objective of the study is to evaluate the impact of the Programa Saúde na Escola (PSE) on sexual- and reproductive-health indicators, such as condom use and knowledge on the topic, using data from Pesquisa Nacional de Saúde Escolar (PeNSE) from 2019. The study is designed to provide representative results of students regularly enrolled in public and private schools across the entire national territory, using a probabilistic sample of Brazilian students. After adjustments, the final sample totaled 6.663 observations of students from public schools. In a quasi-experimental approach, a propensity score matching model is used, to compare students attending schools that participate in the program (treatment group) with those attending non-participating schools (control group). The results show that students from schools participating in the PSE report receiving more guidance on preventing pregnancy, sexually transmitted infection, and how to obtain free condoms. Furthermore, students at schools participating in the program start their sexual life slightly earlier. Significant results are found for the total sample and for girls. The variables related to effective condom use are not significant in any specification. These findings suggest that although access to information has increased, no changes in behavior are perceived, which opens space to consider improvements in the implementation of the program, such as strengthening partnerships with basic health units. A sensitivity analysis using the Rosenbaum limits test indicates no bias in the sample.

Keywords: Adolescents; Brazil; Impact evaluation; Programa Saúde na Escola (PSE); Propensity score matching; Quasi-experimental design; School; Sexual education; Sexual health.