Parent-Adolescent Sexual and Reproductive Health Communication in South-Eastern Nigeria: a qualitative study

With the backdrop of 44% of marriages before age 18 in Nigeria, early sexual debut, poor uptake of contraceptives, and a high birth rate, the recent directive from the Ministry of Education to cease delivery of the Comprehensive Sexuality Curriculum (November 2022) further highlights the critical role of parents in adolescent sexual socialisation. Extant knowledge of parent-adolescent sex communication (PASC) is largely derived from mothers and girls’ perspectives missing the voices of fathers and boys as identified from a qualitative literature review in the Sub-Saharan context. Parents’ and adolescents’ experiences and preferences on PASC and the complexities and dynamics of adolescents’ sexual socialisation leave a major gap. I provide new insight into the voices, processes, and contradictions of PASC and the relevance of other multi-level sexual and reproductive health (SRH) sources for adolescents’ sexual socialisation. I use an inductive qualitative research approach with focus group discussions and in-depth interviews to explore adolescents’ and parents’ views (n=67) supplemented by interviews with high-level decision makers (n=8), for instance, an adolescent health analyst for the United Nations Population Fund (UNFPA), an Imo state health ministry staff, and a clergy member. The socio-ecological model of communication and behaviour change and Hofstede’s cultural dimensions theory provided frameworks for conceptualising and interpreting the data. Adolescents are keen to learn about sexual and reproductive health (SRH) issues from parents perceived as trusted and experienced sources, but for parents, religious beliefs, safety concerns and cultural norms dominate. Optimal timing, frequency and content are critical for effective PASC as adolescents appear to mirror parental ideologies. Gender normative roles are changing, with fathers more involved in PASC than previously and PASC is now more inclusive of boys. SRH service utilisation targets and current services do not meet need. I contribute empirically a theoretically informed framework for understanding the rationale for the timing and frequency of PASC, which provides insight into gender differences. The political, socio-ecological and technological domains, and micro- to macro-contextual factors exert opposing and facilitating forces that must be considered when designing adolescent sexual and reproductive health (ASRH) policy and interventions

Parent-adolescent communication on adolescent sexual and reproductive health in sub-Saharan Africa: a qualitative review and thematic synthesis

Background Improving adolescent sexual and reproductive health continues to be a global public health need. Effective parent–adolescent communication on sexual health issues has been cited as a factor that could influence adolescents towards adopting safer sexual behaviour. The current review synthesises qualitative literature to understand the nature and relevance of parent–adolescent sexual and reproductive health communication and the barriers to effective communication in sub-Saharan Africa. Methods We systematically searched and synthesised qualitative literature published between 1st January 1990 to December 2019 and searched from CINAHL, PsycINFO, MEDLINE, Global Health, EMBASE, PubMed, and Google Scholar. We assessed the methodological quality of included studies using the Critical Appraisal Skills Programme (CASP) checklist. We thematically analysed qualitative data from the included primary studies. Results Fifteen studies were included. Social and physiological events act as triggers for initiating discussions. Fear of personal, social, and economic consequences of high-risk sexual behaviours act as drivers for communication but also carry a negative framing which hinders open discussion. Lack of parental self-efficacy and cultural and religious norms create an uncomfortable environment leaving peers, media, teachers, and siblings as important and sometimes preferred sources of sexual health information. Conclusions While mothers recognise their own role in adolescent sexual and reproductive health and school-based interventions can act as useful prompts for initiating discussion, fathers are mainly absent from home-based dialogue. Fear dominates the narrative, and the needs of adolescents remain unarticulated