Myanmar Health Sciences Research Journal
Original Articles :
Myanamr Health Research Registration 2020; 32(2): 125-131.
DOI: DOI: https://doi.org/10.34299/mhsrj.00992

Parents’ Perception On Sex Education Towards Their Adolescent Children in Twantay Twonship, Yangon Region

Tun Win Lat, Nan Hkawn Pan, Thiha Than, Nay Lynn Htet, Aung Kyaw Soe, Kyaw Phyo Paing, Thandar Tun, Swe Mar Myint Lwin

Myanmar Health Sciences Research Journal, 2020; 32(2): 125-131

ABSTRACT

Most of the parents in many cultures are reluctant to discuss with their adolescent children about sexual and reproductive health information leading to increased incidence of sexually transmitted infections, adolescent pregnancy, unsafe abortion and child marriages. This study was carried out to explore the parents’ perception of sexual education towards their adolescent children from February to May 2018.As a qualitative study, ten fathers and ten mothers from Twantay Township were selected according to the attitude scores which were interviewed to 216 parents in quantitative survey for attitude question and in-depth interview was done by using IDI guideline. According to the finding results, it was noticed that most of the parents agreed to include sex education in the school curriculum and teach the students according to their age. And it was also revealed that most common barriers for parents on giving sexual health education were gender difference and age of children. The respondents in this study want to suggest that other parents should give sex education with examples, talking with interactive conversations, talking gently and frankly to their adolescents. Programs for giving sexual and reproductive health information to the parents should be initiated and the sexual education topics in the school curriculum should be taught effectively.


RESULT
Goto

After analysis, there were six themes that influence the parents’ perception on their adolescents, namely(1)understanding reproductive health,(2) advantages of sexual and reproductive health education to adolescents, (3) disadvantages of sexual and reproductive health education to adolescents,(4)barriers to give sexual and reproductive health education to adolescents,(5) ways to overcome barriers and(6) peers’ pressure in giving sexual and reproductive health education to adolescents.According to the qualitative results of parents’ perception on reproductive health and advantages and disadvantages of giving sexual and reproductive health education to adolescents, most parents did not understand the meaning of the sexual and reproductive health. Some mentioned it only as the relationship between men and women and the process of conception. A 44 years old, middle school-educated mother of an adolescent girl expressed reproductive health as follows.

“About the reproductive health, I think it as the healthy methods for reproduction. As for me, I understand reproductive health education means being good health of mother and child. ”

“မျိုးဆက်ပွားကျန်းမာရေးဆိုတာသားသမီးရအောင်လုပ်တယ်။ကလေးတွေရော၊မိခင်ရောကျန်းမာရေးကောင်းအောင်လုပ်တယ်။”

And almost all parents thought that sexual health education should be given to their adolescents in order to prevent their adolescent children from getting risky sexual problems such as unwanted pregnancies and sexually transmitted diseases. But they accepted it as a good practice. Most of the parents perceived that teaching sexual health education to adolescents has advantages such as preventing from unwanted pregnancy and premarital sex as well as can have disadvantages like misusing of contraceptives. Very few parents perceived teaching sexual health as harmful because the adolescents may take risky sexual experiments when they got knowledge and information on sexual health. Almost all parents thought that teaching sexual education at school is good, but most of them thought it should be started when the school children enter the adolescent hood (that is middle or high school). Some parents thought that teaching sexual education leads the adolescent children to be more interested in sexual behaviors and more sexually active.

According to the qualitative results of parents’ barriers to give sex education to their adolescent children,some respondents said they have no practice on giving sexual health education to their adolescents. Some respondents said that they gave sexual health education to their adolescent children and mentioned that there is no barrier while some respondents pointed out barriers such as embarrassment, being difficult to choose suitable words, being thought that their children were too young to be taught and gender difference between parents and children (that is father feels more convenient to talk about sexual health to his son rather than to his daughter). A 40 years old, middle school educated mother who had a boy and a girl adolescents expressed her barriers in giving sexual and reproductive health education to her son and daughter as follows.

“When I told my son and daughter about sexual health, they told me that they felt shy to hear about it.”

“တခါတလေ ကျမပြောပြရင် သူတို့က ‘အမေက ဘာဖြစ်လို့ အဲ့ဒါတွေလာပြောနေတာလဲ။ သမီးတို့ ရှက်တယ်’လို့ ပြောကြတယ်။”

According to the qualitative results of parents’ ways to overcome the barriers to give sex education to their adolescent children, most respondents suggested the ways to overcome these barriers like giving sexual health information with examples, talking with interactive conversations, talking gently and frankly. In IDI results, some respondents suggested that other parents of adolescent children to get knowledge about sexual health information and to teach sexual health education to their adolescents. They advised to teach sexual education gently and wisely to adolescents so that they can understand and they will listen to. Some parents taught their adolescent children about sexual health by giving examples. But very few respondents thought sexual education should not be taught to adolescents.
A 49 years old, middle school-educated father of an adolescent boy expressed his way to educate his son as follows.

“When I talk about sexual and reproductive health education to my son, he says 'yes, I know' and listen to me well. We talk about it with laugh.”

“ကျွန်တော့်အနေနဲ့ကတော့လိင်ပိုင်းဆိုင်ရာ အကြောင်း ရှင်းပြရင်သားတွေက ‘ဟုတ်ကဲ့သူတို့သိတယ်’ ဆိုပြီးပြောတာကို နားထောင်တယ်။သားအဖတွေရယ်ရယ်မောမောပဲပြောဖြစ်ကြပါတယ်။”

And a 40 years old, middle school-educated mother who had a boy and a girl adolescents expressed her way to educate his son as follow.

“I want to advise other parents to tell gently and wisely when they get trouble in giving sexual health education to their children.”

“တခြားမိဘတွေကိုအကြံပေးချင်တာကတော့ကလေးတွေကို မျိုးဆက်ပွား ပညာပေးတဲ့အခါ သူတို့လေးတွေ နားထောင်လာအောင် ညင်ညင်သာသာနဲ့ ပါးပါးနပ်နပ် ပေးသင့်တယ်။”

According to the qualitative results of peers’ pressure in giving sexual and reproductive health education to adolescents, most thought their neighbors would have positive opinion on teaching sexual education to their dolescents but some parents thought their neighbors might blame them of teaching it in aspect of cultural issues. A 36 years old, primary school-educated mother of an adolescent girl expressed her opinion on peers’ perception in giving sexual and reproductive health education to adolescents as follows.

“The family, relatives and neighbors may comment on me as shameless to talk about sexual health to my children.”

“ကိုယ်ကသင်ပေးရင် မိသားစုတွေ၊ အမျိုးတွေနဲ့ အိမ်နီးချင်းတွေကကိုယ့်ကိုမကောင်းတဲ့သူ လို့မြင်ကြမှာပေါ့။သားသမီးကို ဒါမျိုးပြောတယ်။အရှက်မရှိဘူးလို့ပြောကြမှာပေါ့။”


INTRODUCTION
Goto

Adolescent is a transition period of growth, exploration and experimentation, as well as a time of rapid development towards mature forms of thought, emotion and behavior during which young people face many new situations and challenges.1 Healthy development of adolescents is depending on many complex factors such as the environment in which they live and grow, the family they are living with, and the peers they are communicating with. The family plays a critical role in healthy adolescent development because it is a task of adolescence to achieve independence from parental care.2 Generally, most  of the parents in many cultures are reluctant to discuss with their adolescent children about sexual and reproductive health information which are being considered as taboo. These may lead to increased incidence of sexually transmitted infections, adolescent pregnancy, unsafe abortion and child marriages. Even when parents have discussions with their children on sexual health issues, they tend to be more protective and focus on abstinence from sex and the negative outcomes of sexual experiences for girls.But for boys, parents often address issue related to condom use and protection or the conse-quences of sexually transmitted infection.3 Parentchild communication about sex is a strong determinant in increasing the age of sexual initiation, increased contraceptive use and negative attitude to early pregnancy in teenagers.4 Female adolescents between ages of  15-19years are two times likely to die during pregnancy or childbirth compared to women over 20 years of age. Female adolescents under 15 years of age are five times more likely to die during pregnancy or childbirth. Additionally, adolescent mothers are more likely to have low birth weight babies who are at risk of malnourishment and poor development. Infant and child mortality is also highest among children born to adolescent mothers.5 Teenage pregnancy is one of the consequences of unprotected sexual intercourses and a common occurrence around the world. World Health Organization stated that an estimated14 million adolescents aged 15 to 19 years gave birth each year between 1995 and 2000, with 12.8 million of those occurring to teenagers in developing countries.1Unsafe abortion is a serious problem in many developing countries. Around 18.5 million unsafe abortion cases are reported each year in developing countries, and 14% of all unsafe abortions in developing countries related to young women (19 and younger).1 Every year, about 1 million girls under 15 give birth;mostly in low and middle-income countries and some 3 million girls aged 15 to 19 undergo unsafe abortion. Every day, there are 39000 child marriages. Between2011 and 2020, more than 140 million girls will become child brides, according to United Nations Population Fund.1

Adolescent pregnancy and child birth is one of the major public health problems in SEA region. Maternal mortality (deaths related to pregnancy and child birth) ranks second among cause of death among 15 to 19-year-old girls in the SEA region. Much of adolescent pregnancy is related to early marriage of girls in some countries in the region. Early marriage among girls  (below 18 years age) is common in some countries in SEA region. The proportion of currently married adolescents aged  15-19 years is 46% in Bangladesh, 27% in India and 32% in Nepal.1 Adolescent pregnancy and child birth can reduce women’s educational employment opportunities. In Myanmar, 6% of women aged 15-19 have begun childbearing: 5% have begun birth, and an additional 1% is pregnant with their first child. The percentage of women who have begun child bearing increases with age from 1% at age 15 to 18% at age 19. The percentage of teenagers who have begun child bearing is lowest at 2% in Mandalay Region and is highest at 11% each in Kachin State, Chin State and Shan State.5

Parents are important role models in their adolescents' lives because they can directly or indirectly transmit values, traditions and lifestyles to their children. They also play an integral role in the overall development of adolescents, especially mental and social development.6 Since parents can play major role in contributing towards positive reproductive health outcomes of adolescents by means of  creating a favorable environment of communication, it is necessary to sensitize parents on the way they com- municate reproductive health issues with their adolescents and encourage them to seek information on adolescent reproductive health and sexuality issues.6

There is growing recognition of the importance of addressing sexual and reproductive health of adolescents.1Twantay Township was purposively selected because in which 31% of total population were less than 15 year of  age among 220,351 of total population (urban population of 38,120 and rural population of 182,231). This study found out how parents from rural and urban areas  in Twantay Township deal with issues of teenage sexuality and perception and barriers they faced when giving sex education to their adolescents. A Myanmar study suggested the need to strengthen the involvement of parents in existing adolescent reproductive health programs and design interventions focusing on parents.6By knowing the perception and barriers of parents concerning on giving sexual health education to their adolescent children, the effective interventions can be carried out to offer the sex education and promotion of sex education from parents to adolescent children thoroughly and efficiently. Based on these findings of survey, the results can be applied in setting future health education policy  and practice for adolescents.


SUPPLEMENTARY MATERIAL
Goto

Study and study design

This study was conducted at Twantay Township, Yangon Region from first week of February to last week of May 2018. The township had 6 rural health centers and 1 urban health center. Sequential explanatory method mixed design was conducted concurrently to generate a holistic understanding to aid in drawing conclusions.

Sample size and study population

A sample size of 20 parents (10 male and 10 female) from both urban and rural area were determined for the survey. Study population was parents of adolescents who gothigh attitude score and low attitude score according to their getting marks from questions of quantitative survey from both urban and rural were included in this study.

Sampling procedure

This was qualitative study where data collection was conducted only after quantitative data had been collected to generate a holistic understanding to aid in drawing conclusions. In this study, 20 parents (10 male and 10 female) from both urban and rural area were chosen according to their altitude scores based on 6 key altitude questionnaires. Firstly, respondents were scored at the end of each data collection day both for rural and urban area separately. Secondly, respondents were classified and listed into high and low score groups categorized by using 75 percentile value of total score as cut-off point ‘22’ because the researchers assumed that only those who had 75 percentiles of total attitude scores should be supposed as good attitude holders. Thirdly, well-communicated and well-responsive respondents who were commented by interviewers were purposively selected to meet required sample size.
Finally, 4 respondents from urban area (2 participants with high score, 2 participants with low score) and 16 respondents from rural area (8 participants with high score, 8participants with low score). Total 20 respondents were selected both from rural and urban areas and then they were invited again, informed consents were taken and interview was conducted.

Data collection methods and tools

Qualitative data was collected through in-depth interview with IDI guidelines concerning parent’s perception on giving sexual health education to their adolescents, barrier and ways to solve the barrier they faced when giving education to their adolescents. Before data collection, pretesting was done so as to ensure that a collection tool valid. The purposes of study, procedure, voluntary nature of participation and confidentiality issues were explained to all participants (both fathers and mothers) who were involved in the study. Respondents’ confidentiality and anonymity was assured. Only those who had given the consents to participate were recruited in the study.Another consent was also asked to record interview before IDIs. All in-depth inter-views were done inside the room with privacy.The recordings were kept under strict confidentiality and destroyed one year after the research.

Data management and analysis

Interviews were transcribed in verbatim and the full transcripts were coded and organized from field notes on the basis of guidelines and topics. Thematic analysis were performed by using QDA (Qualitative Data Analysis) software. Qualitative data analysis was done in Myanmar language and only selected coded transcripts were translated into English. Qualitative findings were explored by texts, quotations and dialogue boxes.

Ethical consideration

Ethical approval was obtained from University of Public Health, Yangon, Institutional Review Board,(UPH-IRB).


DISCUSSION
Goto

Most of the respondents did not understand the reproductive health. They thought that sexual health education can prevent some risky sexual behaviors and sexually transmitted diseases but not all parents had given their children about sexual health. Almost all parents thought that teaching sexual health education at school is relevant. Some respondents said that they gave sexual health education to their adolescent children and pointed out some barriers in doing so. Most parents thought their neighbors would have positive opinion but some parents thought their neighbors might blame them of teaching education to their adolescents.

In this study, it was explored that few participants thought sexual education for adolescents must be initiated by parents because they accepted that parents are the first teachers for children. This finding agrees with that of the qualitative study done in Iran on mothers with adolescent daughters in 2017and a study done in Myanmar adolescents’ parents in 2011.7,6 But in this study, some parents thought that sexual health should not be taught to children because it might be harmful to them. This finding totally agrees with the study done in India adolescents’ mothers in 2012.8 It indicates that parents have the major roles in educating sexual and reproductive health information and should be considered to establish sexual and reproductive health education program for parents who have adolescents.In this study, it was explored that most common barriers for parents on giving sexual health education were gender difference and age of children. Fathers did not want to talk about sexual health to their daughters and some parents thought that their children were too young to be taught about sexual health. These results coincide with that of a qualitative study done in parents of pre-teenage children from United States in 2007and a study done in Kenya adolescents and mothers in 1996.9,10

It shows parents had preferences in splitting gender roles while doing reproductive health discussions with their adolescent children and found difficulties for giving comprehensive sexual and reproductive health education to their adolescents. Therefore, other proper and available channels should be considered for effective education program for adolescents.

This study explored that almost all of the parents accepted teaching their children about sexual and reproductive health education at school is relevant. This finding is consistent with that in the study about Nigeria parents’ perception in 2015.11 It indicates that in behavioral change communication point of view, school is a good entry point with multi-advantages and the school teachers are gate-keepers to shape the children’s knowledge, attitude and practice and influence to parents.

Therefore, specific strategies, capacities, activities and resources should be considered for effective and comprehensive sexual education (CSE) program implementation in schools. This study revealed that some parents thought their neighbors might blame them of teaching it in aspect of cultural issues. It agrees with the finding in the study done in the parents of pregnant adolescents in South Africa in 2015.12 This finding highlights the influence that culture has on the perceptions of parents concerning sex education to their adolescents. It signals that the parent education program should be culturally sensitive.

Conclusion

Almost all parents perceived that sexual health education should be given to their adolescents to prevent their adolescent children from getting risky sexual problems such as unwanted pregnancies and sexually transmitted diseases. The main barriers for doing so are embarrassment, being difficult to choose suitable words, being thought that their children were too young to be taught and gender difference between parents and children. Therefore, most of the parents in the study wanted to add the sexual education in the school curriculum. In school curriculum, sex education program for adolescent school children should be strengthened. Training and culture sensitive education programs for parents concerning sex education and ways of teaching this to their adolescents should be provided. Further studies to assess the perceptions and practices of adolescents on sexual education among adolescents and school teachers and other regions where adolescent pregnancy is high are strongly recommended.



ACKNOWLEDGMENT
Goto

Our deepest appreciation, gratitude and love also goes to all those, our rector, professors, all teachers and supervisor in University of Public Health, Yangon and Regional and township health authorities, basic health staffs, volunteers, local authorities, local community, all participants and everybody who professionally, energetically, actively and interestedly participated in this study. without whom this study would not be accomplished. External Grant Committee from Department of Medical Research supported partially research grant for data collection in this study. The funding agency had no role in data collection, analysis, or interpretation of the data, the writing of the report, or

the decision to submit for publication.


CONFLICT OF INTEREST
Goto

The authors declared that there was no conflict of interest.


REFERENCES
Goto

  1. World Health Organization. Preventing Early Pregnancy and Poor Reproductive Outcomes. Geneva, WHO, 2011.
  2. Hyde A, Carney M, Drennan J, Butler M, Lohan M & Howlett E. Parents’ Approaches to Educating their Pre-adolescent and Adolescent Children about Sexuality. Belfast, University College Dublin and Queen’s University, 2009; 88-97.
  3. Nyarko K, Adentwi KI, Asumeng M & Ahulu LD. Parental attitude towards sex education at the lower primary in Ghana. International Journal of Elementary Education 2014; 3(2):21-29.
  4. Muhwezi WW, Katahoire AR, Banura C, Mugooda H, Kwesiga D, Bastien S, et al. Perceptions and experiences of adolescents, parents and school administrators regarding adolescent-parent communication on sexual and reproductive health issues in urban and rural Uganda. Reproductive Health 2015; 12: 110.
  5. Ministry of Health and Sports & ICF. Myanmar Demographic and Health Survey 2015-16. MOHS & ICF, 2017; 56-67.
  6. Yin Thet Nu Oo Ko Ko Zaw, Kyu Kyu Than, Thae Mg Mg, Kyi Kyi Mar & San San Aye. Do parents and adolescents talk about reproductive health? Myanmar adolescents’ perspective. South East Asia Journal ofPublic Health 2011; 1: 40-45.
  7. Shams M, Parhizkar S, Mousavizadeh A & Majdpour M. Mothers’ views about sexual health education for their adolescent daughters: A qualitative study. Reproductive Health 2017; 14(1): 1-6.
  8. Soletti AB, Burnette D, Sharma S,Leavitt S & Mccarthy K. Parent-adolescent communication about sex in rural India : U. S .– India collaboration to prevent adolescent HIV. Qualitative Health Research 2012 Jun; 22(6): 788-800. doi:10.1177/1049732311431943.
  9. Wilson EK, Dalberth BT, Koo HP & Gard JC. Parents’ Perspectives on talking to preteenage children about sex. Perspectiveson Sexual and Reproductive Health2010; 42(1): 56-63.
  10. Kiragu K, Obwaka E, Odallo D & Van Hulzen C. Communicating about sex: adolescents and parents in Kenya. AIDS Health Promotion Exchange 1996; 3: 11-13.
  11. Esohe KP & Peterinyang M. Parents perception of the teaching of sexual education in secondary schools in Nigeria. International Journal of Innovative Science Engineering and Technology 2015; 2(1): 89-99.
  12. Phiri CM, Lebese RT & Maputle MS. Parents’ perceptions regarding sex education of their adolescent children: Perspectives from a community in Mopani District, South Africa. 27th International Congress on Nursing and Primary Health Care; 2015 October 5-7; San Francisco, USA.