Background <p>Comprehensive Sexuality Education is crucial for equipping young people with the knowledge and skills necessary to make informed decisions about their sexual health and well-being. We explored stakeholders’ perspectives on Comprehensive Sexuality Education in Sierra Leone through a critical theory lens, emphasising the power structures, economic conditions, and cultural norms that shape educational realities. Specifically, we asked how power relations, gender norms, economic vulnerability, and institutional authority shape stakeholders’ perceptions and implementation of Comprehensive Sexuality Education.</p> Methods <p>A qualitative research design was employed, utilising purposive sampling to capture diverse viewpoints from 127 key informant interviews and 61 focus group discussions involving 366 participants across 11 schools in various provinces. Focus group discussions were conducted in sex-disaggregated groups so that male and female students’ perspectives were captured equally. Data analysis incorporated deductive and inductive thematic analysis, revealing how social norms, economic factors, and power relations affect educational practices and policies.</p> Results <p>Our findings reveal that educational authorities in Sierra Leone often adopt a conservative approach to Comprehensive Sexuality Education, prioritising traditional frameworks over comprehensive, reality-based instruction. While stakeholders recognise the importance of sexual and reproductive health education, there is widespread concern that practical methods, such as condom demonstrations, could encourage inappropriate behaviours. Gender dynamics play a crucial role, with a disproportionate focus on female students, who are seen as responsible for managing sexual risks, thereby marginalising male students and perpetuating traditional gender roles. Additionally, economic conditions complicate Comprehensive Sexuality Education implementation, as financial hardships influence students’ sexual decision-making, often leading to risky behaviours. The successful implementation of Comprehensive Sexuality Education depends on teacher training, community engagement, societal attitudes, and policy support, but societal stigmas surrounding sexual health discussions remain significant barriers, underscoring the need for initiatives that foster open dialogue.</p> Conclusion <p>Our study underscores the need for a transformative approach to Comprehensive Sexuality Education in Sierra Leone that addresses power dynamics, gender disparities, and economic influences, ultimately fostering a more equitable and effective educational environment for all students.</p>