Abstract
Background:
Sexuality and reproductive health have remained a topic of taboo and disgust in India, owing to its deep-rooted cultural, traditional and religious practices. Lack of right sources of information and negligible communication about sexual and reproductive health (SRH) with trusted adults encourages adolescents to rely on unsafe sources, both online and offline, which could lead to detrimental consequences on their physical and mental health.
Methods:
This study utilizes a qualitative descriptive design to explore the factors influencing parent-adolescent communication on SRH. It focuses on mothers of adolescent children (10–19 years) from Urban Bengaluru. Data is collected through in-depth interviews of mothers and thematic analysis is performed on the data collected.
Results:
The qualitative analysis identified five core themes: Knowledge about SRH and gender-based needs, cultural and traditional influences, role of family, role of partner and inhibition of children. The perspectives of parents provided scope for what could be done to facilitate healthy and open communication.
Conclusion:
This study portrays the factors that hinder free communication between parents and adolescents about SRH. Suggestions for breaking the taboo pertaining to sexuality conversations and future studies have also been mentioned.
Introduction
Adolescence is a critical time of development for all individuals, primarily involving risk-taking and experimentation. Adolescence is the period of life where a child passes through sexual and psychological maturity. 1 The onset of puberty with gradual sexual maturity makes them curious about exploring their body, resulting in risky sexual behaviors. 2 They are prone to exploring various activities like drugs, alcohol, sex etc. and are strongly influenced by peers and self-assessed role models which could lead to conflicts. 3 There have been increasing trends worldwide for teenage pregnancies, high-risk sexual behaviors, early initiation of sexual activities in teenagers, and a decrease in safe sexual practices. 4
An important means to improve sexual health outcomes for adolescents is to provide them with information. 5 Conversations between parents and adolescents about their sexuality in particular are often difficult for both parents and adolescents. 6 Talking about sexual topics is a complicated issue for parents, 7 which can be attributed to the enormous diversity and cultures of India, most of which oppose discussions on sexuality. 8 The limited attitudes could also stem from the fact that India, for most of it, is a collectivist, orthodox traditional society where open discourse on “Sex” is a taboo and is meant only for married couples. Thus, there is hardly any communication about sex and sexuality directly between parents and children, and children are often ill-prepared to deal with sex and sexuality issues. 9
Parental communication is extremely essential in transmitting the right knowledge and attitudes about sexuality even though schools are potential sources in various countries. 10 Parents are an important source of SRH-related information, particularly because school-based sexual health education is highly controversial and is not widely offered in India,8,11,12 in spite of the Adolescent Education Programme (AEP) launched by the government in 2010. Therefore, even discussing such aspects, knowledge, and information about sex often leads to humiliation and is regarded as a taboo, so it is mainly discouraged, even in schools. 13
It has been found that adolescents rely more on media and peers to gain information on sex and sexuality rather than on parents. 14 This is an alarming scenario, for one cannot rely on peers and media as absolute sources of the right information. Previous studies have also shown that parents can indeed influence sexual decision-making of adolescents, 15 which makes it necessary to have appropriate parental conversations and interventions regarding the same. A report published by UNICEF 16 claims that in the year 2016, the presence of comprehensive and correct knowledge about HIV among male and female adolescents aged 15–19 years in India was highly limited with 28.2% and 18.5%, respectively. This disturbing statistic coupled with the high rates of unmarried adolescents seeking abortion (38.6% of them between 17 and 19 years of age) 17 makes parental communication about sexuality with their adolescents the urgent need of the hour.
The meta-analysis conducted across a span of over three decades by Widman and team in 2016 18 on over 25000 adolescents concluded upon a small but substantial link between parent-adolescent SRH communication and safer sexual behavior and choices among adolescents. Sanjana 4 in her review of several studies mentions that a substantial proportion of young adolescents (17%–87%) often report that they have not discussed sexual topics with a parent ever. A study conducted by Anna et al. 19 on 338 adolescents (N = 338) in Kerala deduced that just 19.8% of the adolescents had good SRH communication with their parents. The feeling of shame, cultural unacceptability, and lack of communication skills in parents were perceived as significant barriers to communication in the same study. Another study conducted by Kumar et al. 20 states that around 35% female and 23% male adolescents (N = 586) have not ever communicated SRH topics or issues with parents. A similar study conducted by Sandra Byers et al. 21 on 78 mothers and 91 fathers of adolescents concluded that parents reported limited sexual communication with their children, having only talked occasionally or generally.
Most of the previous studies focus on adolescents and the issues they have in communicating SRH needs and issues with parents. Some of them also delve into the perception of adolescents about parents engaging in healthy conversations about sexuality. Very limited studies, however, focus on the issues faced by parents with respect to their levels of awareness, societal and familial biases and support systems in communicating SRH needs with their adolescent children. This study aims to focus on this aforementioned aspect and dive deeper into understanding and exploring the factors that hinder healthy discussions on SRH between parents and adolescents from a parents’ perspective. The study utilizes the Rommetveit and Blakar Model of Communication in order to understand how parents’ communication can directly affect the sexual choices of adolescents and The Theory of Planned Behavior which looks into the attitude and perception of parents toward sex and sexuality which in turn has an impact on the behavior of adolescents.
Objectives
Understand and explore the possible factors influencing the communication between parents and their adolescents about SRH.
Understanding issues and challenges faced by parents in communicating SRH needs with adolescents.
Designing/Suggesting strategies to improve adolescents’ access to sexual and reproductive health (SRH) information through reliable and safe sources.
Methodology
This study is qualitative in nature. In-depth interviews were used to collect the data from mothers to understand the various factors that could influence SRH-related communication with their wards. They are an effective means to encourage people to talk about personal feelings, opinions, and experiences, and offer insights into how people interpret and organize their worlds. 22 Telephonic in-depth interviews were conducted by the author in different phases. In the first phase, rapport was built with the participants to establish a smooth relationship. The second phase encompassed detailed conversations pertaining to the topic under study. The interviews were completed across a span of two sessions, which extended to three for a few. An overall time of 45–60 minutes was taken for the interviews. Certain interviews were held in Kannada since the participants were more comfortable to communicate in the regional language.
Confidentiality of information shared was guaranteed to all participants by the author beforehand. The participants were also assured that the information provided would only be used for official research purposes and not elsewhere. Participants were also encouraged to not answer any of the questions if they felt uncomfortable and to opt out of the interview as per their will and wish. Permission to record the interviews over call were also taken from the participants before the start of each interview. The participants were thoroughly informed about the intention, objectives and potential implications of the study beforehand and the interviews were only conducted after informed consent was taken from all participants.
The interview format was semi-structured and included both open and closed-ended questions. 23 The interview schedule was carefully designed to answer the objectives aforementioned. The guide comprised socio-demographic information followed by a structured outline of the topics to be covered. Referring to the previous research conducted and the gaps identified, the interview guide was meticulously designed so as to extract maximum information from the participants. The core areas of the guide included the extent of knowledge that the participants themselves had about SRH, the various levels of communication practiced with wards, the obstacles encountered in healthy communication practices and their suggestions, if any. The guide was primarily prepared by the author during the last quarter of 2023 which was validated by other experts in the field of sexuality and child safety from Enfold Proactive Health Trust, Bengaluru. Inputs and suggestions from experienced researchers and facilitators were considered and incorporated to enhance the quality and authenticity of the interview guide before the interviews were conducted.
Snowball sampling was used to collect data and thematic analysis was undertaken. The data collected over call was transcribed using online software. The interviews held in the regional language were translated into English before being transcribed. Thorough reading of all the transcripts were undertaken to arrive at common themes after analyzing repeating data patterns. Coding of the data and division into themes was done manually after reading over the transcripts multiple times. The most common and repeating ideas, beliefs and statements of the participants are encapsulated and analyzed under one common theme. The themes that emerged from pattern recognition in the data were the categories for analysis. The findings of the study throw more light into the themes identified and what they imply and indicate. Certain verbatims from participants have also been added to add more credibility and enforce the statements and analysis of the author
Mothers’ whose children are in the phase of adolescence (10–19 years) were considered for the study. Mothers’ who were diagnosed with any kind of neurological or intellectual disorders were omitted. All mothers included in this study were between 30 and 50 years of age and belonged to an urban community (Bengaluru).
Findings
Participant 1 stated that the use of right vocabulary and terms pertaining to SRH is a significant barrier in communication with the kids about the same.
Participant 1 said, “….I didn’t know the right words or vocabulary to communicate about all this….I knew about the changes that were happening. I knew that he would get erections and wet dreams but I didn’t know how to put it out to him.”
Participant 4 said that there is no scope of thought about genitals and other things when SRH is spoken about.
Participant 4 said, “…..Keeping aside an educational perspective, nothing of that sort, like private parts and all that come to my mind when I hear of SRH……”
Participants 1 and 5 believe that the needs of SRH are different for boys and girls. They stated that the needs are different because of the natural biology of the bodies.
Participant 1 said, “….it is different for boys and girls, because the biology of a boy is very different from that of a girl, the libido is also high compared to girls. Girls need more emotional intimacy, and boys want more physical intimacy, so it is definitely different……”
Participant 5 said, “……. I think girls definitely need menstrual products…..otherwise I don’t think there is any other difference…..I believe that Physical and mental health correlates with sexual health…….”
Participant 2 stated that there is no difference in the SRH needs of the different genders as all human beings are born sexual creatures.
Participant 2 said, “……so irrespective of the gender, everybody will have sexual needs until and unless that person does not feel sexually attracted to anyone. Both genders will have needs, but I do not know how different it is, because at the end of the day, all boys and girls will have sexual desires. How they express it might be different, and I do not know how differently they put it across….”
Participant 3 expressed concern that SRH awareness is majorly directed toward girls and boys are left with no one to fall back on for guidance and no authentic sources of information as well.
Participant 3 said, “… If the husbands are well informed and want to take initiative, they will talk to the sons about all this. Fathers tell girls, mothers also tell the girls….. There is nobody to talk to the boys about these kinds of things ….”
Participants 1 and 5 stated that culture and tradition play a very big role in influencing their thought process and thereby communication about SRH with their children.
Participant 1 said, “……even in our religion, nobody talks about this. Nothing is mentioned or spoken about this even in our place of worship. They feel it is wrong to talk about sex and sexual needs of a human being openly. They believe that adolescents do not have sexual needs and urges. They believe that only when a man gets married, his sexual drive will become active……..”
Participant 5 said, “….. Even though I am a Christian, I have not put my children into Christian schools … . because I was worried where they would be influenced by that thought process when it comes to sexuality and body image and all that……”
Participant 3 said that culture and traditional practices prevent them from speaking their mind out about SRH issues since it has been the conventional method for generations. Participant 3 also stated that they were hesitant to talk about SRH issues in front of their partner since it was not allowed in their tradition.
Participant 3 said, “……. My husband is there right now, and so no other kind of thoughts come to my mind about this, because our practices and tradition say so ….”
Participants 1, 2, and 5 clearly state that family dynamics and presence is a strong inhibiting factors in discussing SRH concerns and matters directly and freely with their adolescents.
Participant 1 said, “……In my family, this topic is a big taboo, so we do not get much opportunity to sit and discuss at home or in front of other family members. In front of other family members, I do not want to talk about all this and they are also not comfortable. My husband’s family is from rural regions, and for them, spelling the word S-E-X is a big sin. Talking about masturbation and all is a big sin…..”
Participant 2 said, “……I would not be comfortable talking about all this in front of my family because they have told me that you should not be talking about certain things to your son…..”
Participant 5 said, “….No way!! I have tried…They just get up and walk away….”
All participants rightly acknowledged that the other partner plays a very pivotal role in engaging free and open conversations about SRH with the kids.
Participant 4 said, “… it is important because both husband and wife should be on the same page. If one person hesitates to express, the other person may also step back. They need to understand that it’s not for them but it’s for the kids.…… ”
Participant 1 said, “…..it is important because the boy would look up to the father as a male role model….. Same goes for the girls with their mothers……”
Participant 2 said, “……Both the partners should be aligned with respect to anything when it comes to a child. If one thinks one way and the other thinks the opposite way……then the childhood is really going to get affected ….it’ll give them more scope and opportunities to sway either way……”
Participants also stated that they receive very little or no support from their partner in communicating SRH needs with their children which is leading to drawbacks and inhibitions on the part of the parents and adolescents.
Participant 1 said, “…. When I asked my husband to talk to my son about the changes, he said that there’s no need to speak and boys will learn and figure it out on their own…..”
Participant 5 said, “….I receive no support at all…..My partner very clearly told me one day….By talking openly about these things to my kids….I am corrupting them as a mother…..and I am not doing the right thing….”
Participants 1, 3, and 5 clearly state that the children themselves are hesitant to engage in conversations around SRH. This further prevents this topic from being discussed within the family. The participants believe that this inhibition from the children could be due to peer influences and the general stigma and taboo associated with the topic.
Participant 3 said, “……I feel hesitant to talk about this to my daughter….she also feels that I talk cheaply……she thinks that I talk in a third class way……Whenever I speak all this, she asks me if I am mad to be talking all this cheap stuff…..”
Participant 5 said, “….When I wanted to speak about menstruation, my son was initially not comfortable to speak about it…..I understood that it was because of the peer pressure…..His friends behave like that so he also has to behave like that……”
Participants also mention the fact that their children feel shy to talk about this topic with parents.
Participant 1 said, “……I have not spoken about menstruation to my son because Whenever I want to speak, he does not want to listen. I feel he is very shy…….”
Participant 5 said, “…. My daughter was also very uncomfortable talking about all these things….she would say, Ma, why are you speaking about all these yucky things?! I don’t want to know so much!!……They did feel uncomfortable that it’s coming from my mouth…”
Discussion
This study highlights several crucial factors that impact communication between parents and their adolescent children regarding SRH needs and concerns. Understanding what SRH entails and its various dimensions is vital for parents to engage in constructive dialogues with their children on this subject. Similar research by Ashcraft and Murray 24 supports the notion that a lack of knowledge about SRH results in a misunderstanding of adolescence and its physical and emotional characteristics, leading to inaccurate or insufficient information being provided to adolescents. Parents who possess comprehensive knowledge about SRH comprehend the importance of communicating it effectively to their children at appropriate stages of development. The verbatims and responses of parents also highlight the correlation between awareness levels of SRH and comfort and confidence in communicating the same with their children.
Moreover, awareness of the specific SRH needs of both boys and girls significantly influences communication. Participants in the study emphasized the importance of imparting SRH-related information to all genders. Persson et al.’s research 25 underscores the neglect of men’s sexual health due to societal norms portraying them as strong and capable, coupled with a lack of awareness and education. Participants echoed similar sentiments, expressing concerns about the absence of discussions regarding SRH with boys, as parental attention tends to be primarily focused on girls. This oversight could lead adolescent boys to seek information from unreliable sources, potentially placing them at risk. Participants also emphasized that desires and sexual urges are universal among adolescents, underscoring the importance of equal SRH awareness across all genders.
Cultural and traditional norms exert significant influence in impeding parental discussions about SRH with adolescents. Rooted deeply in religion, culture, and orthodox systems, these beliefs create barriers for parents to initiate open and comfortable dialogues about SRH, often deeming the topic taboo. Participants have candidly expressed how their religious faith and cultural backgrounds hinder free communication about SRH, preventing the establishment of conducive environments for such discussions. Shilpi 9 and Das 8 echo similar sentiments, highlighting inhibitions arising from the socio-cultural setup of the society regarding SRH communication. Additionally, participants note the impact of educational institutions in shaping children’s attitudes toward sex and related topics. Ismail’s research 13 in educational settings corroborates participants’ experiences, revealing how discussions on sexuality and reproductive health remain taboo and stigmatized, even within educational environments, leading to minimal engagement with these crucial subjects. A sense of awkwardness was also noticed in the participants, where they know that engaging in appropriate communication about SRH with their children is essential, but the cultural roots and customs they are accustomed to prevent them from doing so. They seem to be caught between traditionality and technicality of the issue, with some participants openly expressing that they do not want to follow the orthodox practices in their respective religion or faith, but find it better to follow the herd rather than stand out.
The familial structure is a crucial factor in comprehending communication dynamics between parents and their children regarding SRH. Participants emphasize how family dynamics can impede open discussions about sexuality, with the mere mention of the word “SEX” often viewed as taboo and sinful within familial and religious contexts. Factors such as family background, geographical location, educational qualifications, and belief systems significantly influence the level of stigma associated with discussing SRH, a notion supported by Sanjana et al.’s study. 4
Moreover, the role of the partner is essential in fostering healthy SRH communication. Participants unanimously agree that both partners must be aligned to engage in open discussions, yet many express a lack of desired support from their respective partners. This lack of support is often attributed to upbringing and adherence to traditional customs, thus underscoring the influence of cultural and religious beliefs on SRH communication, as elucidated by the findings of Shilpi 9 , Das 8 in their respective studies.
Rachel’s study 3 delves into the myriad changes adolescents undergo, characterized by confusion and peer influence. It also addresses how adolescence is a period marked by experimentation, including in choices and sexual impulses, which, if not appropriately guided, can adversely affect individuals’ physical and mental health. Participants in the study align with these findings, noting that adolescents often feel reticent and uneasy discussing SRH topics with their parents, possibly due to peer influence. The prevailing stigma surrounding these subjects further contributes to this inhibition. The study of Anna et al. 19 also corroborates the aspects of shame, taboo and guilt in addressing topics pertaining to sexuality.
The research highlights numerous factors influencing communication between parents and adolescents regarding SRH issues. However, it emphasizes the vital importance of providing SRH-related information to adolescents to help them develop healthy relationships, practice safe sexual behavior, and make informed decisions. Educational institutions can collaborate with governments and civil society organizations to conduct awareness sessions for parents, caregivers, and community stakeholders, focusing on reducing stigma and promoting respectful discussions about SRH topics. Policymakers need to enact robust policies to implement Comprehensive Sexuality Education (CSE) from the grassroots level, ensuring coordinated implementation and effective monitoring of its impact over time. Additionally, parents and adolescents should actively work to challenge traditional taboos and stigma surrounding SRH topics, fostering open and friendly conversations. Only through collaborative efforts across institutions can the stigma surrounding SRH dissipate, leading to a more liberated, open, and safer society. Adolescents can support their parents in understanding prevailing customs and norms and work toward bringing about a holistic understanding surrounding the associated stigmas across all sections of society. This in turn can enable and support adolescents in making wise sexual choices which can create a positive impact on their physical and mental health in the long run.
Conclusion
In conclusion, this study underscores the multifaceted nature of factors influencing communication between parents and their adolescent children regarding SRH needs and issues. A critical takeaway is the pivotal role of parental knowledge about SRH, which, when lacking, can result in inadequate or incorrect information being provided to adolescents. The study also emphasizes the importance of gender-inclusive SRH education addressing societal norms and stereotypes. The study suggests a need for collaborative efforts from various stakeholders, including educational institutions, policymakers, parents, and adolescents themselves. It advocates for awareness sessions to dismantle the stigma surrounding SRH, CSE from grassroots levels, and stringent policies to ensure effective implementation.
While the study provides a comprehensive overview of the challenges faced by the participants, it has certain limitations. It was conducted solely in an urban setting, thus not accounting for diverse beliefs, traditions, and norms. Additionally, all participants were mothers, limiting the study’s ability to capture perspectives from other genders. Future research could benefit from a larger and more diverse sample size drawn from various regions to explore region-specific factors and broader perceptions influencing discussions on SRH. Furthermore, extended research could involve interviewing fathers to gain insights into their perspectives and approaches toward communicating SRH topics with their children. Employing mixed methods in future studies could enhance the comprehensiveness of findings by providing both quantitative data for impact measurement and qualitative data to contextualize and enrich numerical findings.
Footnotes
Acknowledgements
The author would like to acknowledge the participants from various parts of Bengaluru for taking part in this study. The author also would like to sincerely thank Enfold Proactive Health Trust, Bengaluru for guiding and supporting in completing this study.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Ethical Approval
The contents of this article have not been published or submitted for publication elsewhere, except as a brief abstract in the proceedings of a scientific meeting or symposium.
Funding
The author received no financial support for the research, authorship and/or publication of this article.
Informed Consent
Informed Consent was obtained from all participants before data collection. The participants were free to withdraw consent at any time during the interview and opt out.