Ethics approval and consent to participate
This study received ethical review and independent ethical approvals from Population Council’s Institutional Review Board (IRB), 1 Dag Hammarskjold, New York, NY 10017, USA; as well as the Zambia National IRB ERES CONVERRGE, Joseph Mwilwa Road, Lusaka 10100. We declare that all study methods were carried out in accordance with the respective IRB guidelines and regulations. The Ministry of General Education (Lusaka, Zambia) and Parent Teacher Associations from each participating school, provided approvals for the study. All study participants provided informed consent if they were age 18 years and older; assent following prior guardian or parental consent was obtained from all study participants under age 18. Consenting participants individually responded to study questionnaires on demographic data, CSE knowledge, and utilization of health services. Data on annual numbers of pregnancies were obtained from end of year de-identified school records, which are collated annually and submitted to the Ministry of Education by all schools.