Adolescent-parent communication about sexual and reproductive health among junior high school students in five areas with the highest prevalence of HIV in Indonesia: A qualitative study

Situational context of home-based sexual education in urban slums of Ibadan, Nigeria-evidence from a qualitative study

This study explores the influence of situational context on parent-adolescent communication about sexual and reproductive health (SRH) issues in the urban slums of Ibadan, Nigeria. A qualitative exploratory study was conducted in the Southeast and Northeast LGAs of Ibadan. Eight (8) vignette-based focus group discussions (FGDs) with parents and adolescents of both sexes were conducted in addition to four (4) key informant interviews (KIIs) with community and women's leaders. Interviews were tape-recorded, transcribed, and translated into English. Thematic analysis was adopted using ATLAS Ti 9 software. Findings portray SRH meanings and experiences, intergenerational cultural norms, and expectations for SRH, gender double standards in SRH discussion, streetwise SRH knowledge, and social media exposure as contexts that interfere with parent-adolescent communication on SRH issues. The findings show that despite understanding the need for SRH discussion, parents and adolescents lack effective communication on SRH issues due to the interference of unfiltered streetwise SRH knowledge and social media exposure. Also, SRH conversation between parents and adolescents promotes gender inequalities as different information is passed to adolescent girls and boys. Interventions that take into account situational occurrences must be geared towards enabling parents to give their adolescents early exposure to relevant, context-specific SRH knowledge.

Using the behaviour change wheel to examine facilitators and barriers to assertive contraception-use conversations for Indonesian women

Contraception-use communication between sexual partners is important to reduce unwanted pregnancies and protect sexual and reproductive health. There is a dearth of research focused on developing countries where sexual and reproductive health conversations are often considered taboo. Using the Behaviour Change Wheel, this qualitative study examines the facilitators and barriers to having assertive contraception-use conversations with a male partner for Indonesian women and then identifies behaviour change techniques as potential intervention strategies. Semi-structured interviews were conducted with ten Indonesian women aged 18 to 29 years who had been sexually active and were currently in a committed dating relationship with a male partner. Using thematic analysis, 13 themes were identified. Facilitators of assertive contraception-use communication include knowledge about sexual and reproductive health and contraception, communication skills, closeness of the relationship with one's partner, other people's experiences of sex and contraception, and social media norms concerning the open discussion of sex and contraception. Fear of initiating the conversation about contraception was a barrier. Partner's attitude towards having contraception-use conversations and the taboos surrounding contraception in Indonesian culture acted as both facilitators and barriers. Suggested strategies to promote contraception-use communication include using social media to break the stigma surrounding sexual and reproductive health matters, normalising assertive conversations about contraceptive use with sexual partners, empowering women to be more assertive about their preferences for contraception, and teaching strategies to promote assertive contraception-use communication among young women and men in Indonesia.

Level of Knowledge on Sexual and Reproductive Health Rights Among the Teenage Mothers and Their Parents in Rwanda: A Comparative Cross-Sectional Study

Background

Parents are the primary caregivers and influential figures in adolescents' lives. They play a crucial role in shaping their children's attitudes, beliefs, and behaviors regarding sexual reproductive health. A vast difference in knowledge between adolescents and their parents indicates failure in knowledge translation and is associated with sexual and reproductive consequences, such as teenage pregnancies.

Methods

In this cross-sectional study between December 2020 and December 2021, 834 teenage mothers and their parents/guardians (n = 861) were enrolled from all five provinces of Rwanda. Knowledge of sexual reproductive health (SRH) rights was assessed, and the differences between the understanding of parents and their children were analyzed using Chi-square tests.

Results

There were statistically significant differences for all the assessed aspects of SRH knowledge rights between parents and their teenagers (ie, on the age of consent, safe abortion, right to education for teenage mothers, understanding of financial responsibilities, and perceptions of legal consequences).

Conclusion

There is a significant knowledge difference between the two generations regarding their understanding of SRH rights. It is recommended that future programming should devise innovative ways that bring together parents and their children to discuss sexual reproductive health rights, which will result in empowered children and teenagers in Rwanda. Also, awareness programs are needed to improve the knowledge gaps regarding SRH in the public by policymakers, NGOs, and educators.

Open Communication about Reproductive Health is Associated with Comprehensive HIV Knowledge & Non-stigmatizing Attitude among Indonesian Youth: Cross-sectional Study

Objectives

Human immunodeficiency virus (HIV) prevention among youth seems under-prioritised compared to other key populations. HIV knowledge and stigma are important parts of HIV prevention. To inform HIV prevention among youths, this study quantitatively analysed the associations between open communication regarding sexuality and sexual health, comprehensive HIV knowledge, and non-stigmatising attitudes in Indonesia.

Methods

This study used data from the Indonesian Demographic and Health Survey (IDHS) 2017. The analysis included unmarried men and women aged 15–25 years old. Comprehensive HIV knowledge and a stigmatising attitude were defined according to the IDHS 2017. Open communication about sexuality and sexual health was defined as the number of people with whom participants could openly discuss these topics in their direct network of friends, family, and service providers, with a scale ranging from 0 to a maximum of 7. Primary analysis used binomial logistic regression with weighting adjustments.

Results

The final analysis included 22 864 respondents. Twenty-two percent of youth had no one in their direct network with whom to openly discuss sexual matters, only 14.1% had comprehensive HIV knowledge, and 85.9% showed stigmatising attitudes. Youth mostly discussed sex with their friends (55.2%), and were less likely to discuss it with family members, showing a predominant pattern of peer-to-peer communication. Multivariate analysis showed that having a larger network for communication about sexuality and sexual health was associated with more HIV knowledge and less stigmatising attitudes.

Conclusions

Having more opportunities for open sex communication in one’s direct social network is associated with more HIV knowledge and less stigmatising attitudes.

Sexual wellbeing in early adolescence: a cross-sectional assessment among girls and boys in urban Indonesia

Background

Early adolescence (ages 10–14) is a critical period of physical, cognitive, social and emotional development, which affect sexual and reproductive health and rights (SRHR). Yet, little is known about positive or healthy aspects of sexuality development during this period of life, especially in South East Asia where sexual norms remain restrictive. The objective of this study is to assess the prevalence and correlates of sexual wellbeing among early adolescent girls and boys ages 10–14 years in Indonesia.

Methods

Data for this cross-sectional study were collected as part of the Global Early Adolescent Study via a school-based survey in three Indonesian urban sites in 2018 (N = 4309). We assessed the prevalence of multiple indicators of sexual wellbeing (e.g. SRHR knowledge and communication, gender attitudes, body satisfaction, self-efficacy, freedom from violence) and tested for differences by sex using Chi-square, Student t-test, and Wilcoxon rank-sum test. Multivariable logistic regression models were used to assess the adjusted odds ratio of selected indicators in relation to sociodemographic factors, romantic relationship status, and sexual activities.

Results

The mean age of students was 12 years (53% girls); 90% had started puberty. SRHR knowledge and communication was low overall, but higher among boys than girls. Boys were more likely than girls to report high body satisfaction, less feelings of guilt in relation to sexuality, but also to have experienced physical peer violence. In contrast, girls were more likely to hold gender equal attitudes, greater perceived self-efficacy to say ‘no’, and to report being bullied by boys. In multivariable models, romantic relationship experiences, perceived voice (boys and girls) and decision-making (girls) were associated with three or more indicators of sexual wellbeing.

Conclusions

While young adolescents in Indonesia score high on some aspects of sexual wellbeing, misconceptions, feelings of guilt and uncertainties related to sexuality are common, with clear gender differences. These findings confirm the need for comprehensive sexuality education that begins early in adolescence.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01199-4.

Ages 10–14 years, known as early adolescence, is a fundamental time when young people become increasingly aware of their bodies, gender and sexuality. Yet, little is known about positive or healthy aspects of sexuality development during this period of life, as most studies tend to focus on risky outcomes such as teenage pregnancy and sexually transmitted infections. In this study, we conducted a survey with primary school students aged 10–14 years in Indonesia, asking them about sexual wellbeing from a broad sense, such as their body image and knowledge about sexual and reproductive health and rights. We analyzed responses from 4309 participants using statistical methods and compared the results between boys and girls. We found that misconceptions, feelings of guilt and lack of knowledge related to sexual and reproductive health were common, with clear differences between boys and girls. Our study provides new information about healthy sexuality development in an Asian setting where young people’s sexual and reproductive health is often considered taboo. The results can be used to guide programs and research to improve sexual and reproductive health and rights in Indonesia and other low-income settings. In particular, comprehensive sexuality education may play an important role to support sexual wellbeing by providing factual and age-appropriate information as young people grow up.