Associations Between Agency and Sexual and Reproductive Health Communication in Early Adolescence: A Cross-cultural, Cross-sectional Study

Agency and role models: do they matter for adolescent girls' sexual and reproductive health?

Despite recent declines in early childbearing in Ethiopia, improved sexual and reproductive health continues to elude many adolescent girls, partially due to constrained agency and role models. This study examined the relationship between agency, role models and two sexual and reproductive health outcomes, ideal age at childbirth and attitude towards gender-differentiated parental control, among adolescent girls in Ethiopia. Agency and role model presence were positively associated with ideal age at childbirth (β = 0.23, p < .01 and β = 0.77, p < .001, respectively). Having family members, friends or famous individuals as role models was significantly associated with an increase of 1.45 years (p < .01), 1.32 years (p < .05) and 1.01 years (p < .01) in ideal age at childbirth, respectively, compared to having no role model. Agency was positively associated with attitude towards gender-differentiated parental control of adolescent behaviors (OR = 1.18, p < .001). This study highlights the need for interventions aimed at increasing agency and providing role models for adolescent girls.

"Such conversations are not had in the families": a qualitative study of the determinants of young adolescents' access to sexual and reproductive health and rights information in Rwanda

Background

Access to sexual and reproductive health and rights (SRHR) information during adolescence has become a global concern. This study explored factors that enable or prevent young adolescents from accessing to SRHR information from the perspective of the key informants in Rwanda.

Methods

We conducted a qualitative study using semi-structured interviews with 16 purposively selected key informants from public and private institutions in Rwanda. This selection was based on their positions and expertise in delivering SRHR information to adolescents. The interview guide questions were designed based on the social-ecological theoretical framework of adolescent health. The interview transcripts were recorded, transcribed, translated and thematically analysed in Nvivo 11.

Results

The study reflected that multiple enablers and barriers at the individual, relationship, community and societal levels determined young adolescents’ access to SRHR information. These determinants include information-seeking behaviour and age of starting sexuality education at the individual level; and parents’ limited communication with young adolescents due to taboos, lack of skills, limited parental availability, beliefs, lack of appropriate language and peer norms at the relationships level. Enablers and barriers at the community level were the diversity of SRHR sources, the scope of sexuality education programmes, and cultural and religious beliefs. Finally, the perceived enablers and barriers at the societal level consisted of inadequate resources, inappropriate SRHR policy-making processes and unfriendly SRHR laws.

Conclusion

Enabling access to SRHR information requires addressing multiple factors within the social-ecological environment of young adolescents. Addressing these factors may facilitate improved access to SRHR information for this age group.

Sexual and reproductive health experiences of adolescent girls and women in marginalised communities in Bangladesh

Participatory research was conducted with adolescent girls and women in three isolated rural communities of Bangladesh to assess their perspectives and the role of social and gender norms on the construction of knowledge regarding menstruation, pregnancy and abortion. Norms of privacy and silence, local beliefs and a culture of shame held that the human body is 'natural' and does not require formal sexual and reproductive health care. Instead, participants sought out traditional healers and used herbal plants as natural remedies. Participants reported being restricted in performing religious activities, cooking and food consumption during menstruation. Because sanitary protection was expensive, women used old cloths to soak up menstrual blood and used them repeatedly without washing with soap or drying in the open air, due to shame and the fear of evil spirits. The local incidence of child marriage was high, which also limited women's agency and voice. Contraceptive use was irregular and inappropriate; none of participants or their husbands used contraceptives, resulting in unwanted pregnancy often followed by unsafe abortion. Programmes and interventions are needed that engage with women's experiences within the sociocultural context of studied communities.

How Do Iranian Men Perceive Their Sexual and Reproductive Health Situation? A Qualitative Content Analysis

Background

Males' viewpoint about sexual and reproductive health (SRH) and their situation are essential components of men's and women's health in the community. Men have been overlooked in reproduction health, especially with reproductive issues such as contraception, sexually transmitted infections (STIs), infertility, and sexual function. This study aimed to investigate the males' perceptions of their SRH situation in Iran.

Methods

A qualitative study was conducted from May 2016 to April 2017 on data retrieved through semi-structured interviews with 19 adult males aged 18 to 59 years. The participants were purposefully recruited from among populations of health centers in Alborz province, Iran. Conventional content analysis in OneNote software version 2016 was used for data analysis.

Results

Three main themes and nine categories emerged including 1) Perceived SRH needs, including "need to increase men's awareness about SRH", "need to have an accessibility to SRH services", and "need to have a high-quality sexual relationship"; 2) perceived SRH responsibilities, including "health-seeking behaviors", "sexual skills", "childbearing responsibilities", and "ethical commitment", and 3) Men' perception of trends of social and cultural norms, including "changing SRH priorities" and "changing marital prototype".

Conclusion

In this study, men perceived SRH as an important issue due to the changes in social and cultural trends, and many of their SRH needs have not yet been addressed. Hence, along with socio-economic changes, the policymakers of the health system should develop strategies and interventions to meet these needs.

Enabling Young People from Informal Urban Communities to Exercise Their Right to Sexual and Reproductive Health: A Practice-Based Study

This qualitative study explores how comprehensive sexuality education located within a broader positive youth development approach informed transformations among young people from informal urban communities in India. A thematic analysis of data obtained from the young people, their parents, and frontline workers revealed that securing the cooperation of families was possible for the program because sexual and reproductive health education was not a stand-alone intervention, but a part of a larger approach seeking to build capacities of young people. The strategic introduction of sexual and reproductive health communication helped the participants to overcome inhibitions about the topic. Enhanced awareness of gender, pubertal changes, gender-based violence, and child sexual abuse was evidenced post participation. Improved agency was manifest through decision making, critical thinking, confidence, mobility, and articulation, especially among girls. Program interventions to enhance sexual and reproductive health awareness of parents and communities and to improve health services and facilities were bolstered through youth engagement. Such contribution by the young reinforced their knowledge and skills, strengthened agency, and cemented family and community support. A holistic program situated within the positive youth development approach thus seemed a pragmatic vehicle to promote comprehensive sexuality education for young people in vulnerable urban communities.

Understanding Sexual Agency. Implications for Sexual Health Programming

Debates on human agency, especially female and sexual agency, have permeated the social scientific literature and health educational practice for multiple decades now. This article provides a review of recent agency debates illustrating how criticisms of traditional conceptions of (sexual) agency have led to a notable diversification of the concept. A comprehensive, inclusive description of sexual agency is proposed, focusing on the navigation of goals and desires in the wider structural context, and acknowledging the many forms sexual agency may take. We argue there is no simple relation between sexual agency and sexual health. Next, we describe the implications of such an understanding of sexual agency for Comprehensive Sexuality Education (CSE) and for sexual health and rights (SHR) programming more generally. We put forward validation of agentic variety, gender transformative approaches, meaningful youth participation, and multicomponent strategies as essential in building young peoples’ sexual agency and their role as agents of wider societal change. We also show that these essential conditions, wherever they have been studied, are far from being realized. With this review and connected recommendations, we hope to set the stage for ongoing, well-focused research and development in the area.

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.