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School-based CSE is a critical building block for preparing adolescents to lead healthy and fulfilled sexual and reproductive lives. This technical brief aims to analyse and document classroom implementation of CSE curricula and bottlenecks encountered in four lower and middle income countries: Kenya, Peru, Guatemala and Ghana. Based on this learning, this paper presents seven recommendations, which are applicable beyond these four countries, for overcoming common bottlenecks in LMICs and thereby improving CSE implementation.