Factors influencing adolescent sexual behaviour and reproductive health

Introduction

According to Nnachi (2013), sex education, which is sometimes called sexuality education or sex and relationships education, is the process of acquiring information and forming attitudes and beliefs about sex, sexual identity, relationships and intimacy. Sex education is also about developing young people’s skills so that they make informed choices about their behaviour, and feel confident and competent about acting on these choices.

It is widely acceptable that young people have a right to sex education. This is because it is a means by which they are helped to protect themselves against abuse, exploitation, unintended pregnancies, sexually transmitted disease (Kulkarni, 2008). Providing an effective sex education helps to meet young people’s rights to information about matters that affect them, their right to have their needs met and to help them enjoy their sexuality and the relationships that they form. To contribute to adolescent’s full social and economic potential, young people need the knowledge and skills to make choices about when to have sex and how to protect themselves from infection and unintended pregnancies (Moronkola, 2010).

Okonkwo and Eze (2014) stated that sex education that works also helps to equip young people with the skills to be able to differentiate between accurate and inaccurate information, and to discuss a range of moral and social issues and perspectives on sex and sexuality, including different cultural attitudes and sensitive issues like sexuality, abortion and contraception.

Akerele (2009) stated that for young people to attain the highest standard of health, they must first be empowered to exercise choice in their sexual and reproductive lives; they must feel confident and safe in expressing their own sexual identity. Providing information through sex education is therefore about finding out what young people already know and adding to their existing knowledge and correcting any misinformation they may have. For example, young people may have heard that condoms are not effective against human immunodeficiency virus (HIV) or that there is a cure for acquired immunodeficiency syndrome (AIDS). It is important to provide information which corrects mistaken beliefs. Without correct information young people can put themselves at greater risk. Information is also important as the basis on which young people can developed well informed attitudes and views about sex and sexuality.

Young people need sexually related information such as the physical and emotional changes associated with puberty and sexual reproduction, including fertilization and conception, as well as sexually transmitted diseases and HIV. Sex education is a widely used approach to prevent sexually transmitted infection and reproductive health promotion. Comprehensive sex education is effective at assisting young people to make healthy decisions about sex and to adopt healthy sexual behaviours (Garber & Brooks, 2012).

Conceptual framework

According to Mueller (2008), sex education is the acquisition of knowledge that deals with human sexuality. It consists of instruction on the development of an understanding of the physical, mental, emotional, social, economic and psychological phases of human relations as they are affected by sex. In other words, sex education involves providing children with knowledge and concept that will enable them make informed and responsible decisions about sexual behaviours at all stages of their lives.

In the opinion of Durojaiye (2015), since adolescents’ characteristics predispose them to high risky sexual activities, behavioural interventions such as sex education is needed to reduce their at risk sexual behaviours. Sex education is needful and necessary for our young ones. Being mindful of the exposure given to our young ones in school, in the media and among their peers.

Sex education teaches our young ones not only about sexual intimacy, but also enlightens them on their reproductive systems, birth control, and sexually transmitted diseases. It also exposes them to their gender identity, gender role, family role, body images, sexual expression (what it entails and how to time it), intimacy and the marriage relationship. Kraus (2014) stated that in sex education, relevant important and accurate information about sexuality in both boys and girls are given depending on their age. It will be unfair and criminal to ignore or push aside the fact that they are aware of their sexuality; in whatever stage or state they are. Sex education should naturally be integrated into their lives as they grow up both by the parents, teachers and the society in a very mature way. Parents should answer their children’s questions properly and information according to their level of exposure and maturity. It will not be appropriate to look embarrassed or pretend sex never exists.

Importance of sex education

According to Kim and Ward (2015), sex is a natural part of life, and it happens with or without sex education. It is a fundamental part of being human; just because we refuse to talk about sex does not mean it is just going to go away. Based on this, it is important that everyone get all the information they can, and then make a decision about their own values.

Busari (2013) stated that sex education is important. It is been proven time and time again. Students who receive formal sex education in schools are shown to first have sexual intercourse later than students who have not had sex education. Sex education does not encourage teenagers to have sex, it does quite the opposite.  Adegoke (2010) noted that there is an obvious increase in unwanted teen pregnancies, miscarriages, abortions and spread of Sexually transmitted diseases (STDs). This evidence proves how unaware the youth are in terms of risking their lives. Precautionary measure is the need of the hour. Sex education will also expose them to their gender identity, family responsibility, body images, sexual expression, intimacy and the marriage relationship.

International Planned Parenthood Foundation (2008) stated that youngsters usually derive information on sex and related subjects from sources like friends, books, the media comprising advertising, television, magazines and the Internet. The problem is that these sources may or may not really provide them with correct and accurate information. As such, sex education will help in transferring authentic information and in the process also correct any misinformation that they may have apart from adding to their already existing knowledge.

International Planned Parenthood Foundation (2008) stated that:

• Sex education imparted through schools can prove to be a significant and effective method of bettering the youngster’s sex-related knowledge, attitude and behavior.
• Sex education in school is important because many parents are shy about talking /teaching their children on this subject.
• Educating children on sex related issues also requires one to know how to broach the subject, what information to impart and what to hold back. All these can be carefully handled by a trained sex educator.
• It is a fact that more and more teens these days are engaging into premarital sex. This further underscores the need for sex education to students. This will help them make better informed decisions about their personal sexual activities.
• Many argue that sex education also helps to lessen risk behaviors in teenagers like engaging in unprotected sex which result in unwanted pregnancies and STDs.

Factors that influence adolescent sexual behaviour and reproductive health

Sprecher (2008) noted that several factors influence adolescent sexual behaviour and reproductive health. Although their degree of influence may vary at different points, they all shape how young people experience the transition from childhood to adulthood.

1. Biological factor: Biological and physiological changes, such as physical growth, the development of secondary sex characteristics, and menarche, occur during puberty and early adolescence. They, in turn, can influence an adolescent’s psychological development, self-image, and peer and other relationships, plus the social expectations placed on adolescents (Sprecher, 2008).
2. Emotions: The emotional aspects of a young person’s development include the role feelings play in motivating behavior, how youth feel about themselves in relation to their peers and others, how they view their bodies, and what their interpersonal relationships are. These emotions can manifest as excitement, optimism, change, and growth from the perspective of adolescents; however, circumstances can sometimes defeat those very positive emotional characteristics (Sprecher, 2008).

• Cognition: As development progresses, enhanced thinking skills enable an adolescent to move from concrete to abstract thought. This process has an impact on the way information is perceived and understood. Consequently, it has implications for how information, education, and communication (IEC) materials and counseling and reproductive health services should be designed and delivered (Sprecher, 2008).
• Identity: Above all, adolescence is a time for discovering “Who am I?” The development of identity—largely determined by culture and tradition—is also linked to family and peer relationships, values, and the meaning of being male or female in a given society. Girls are particularly vulnerable to negative reproductive health outcomes because they are often assigned roles that limit and constrain their independence and decision making, placing them at greater reproductive health risk. Although attitudes vary, most cultures expect young women to abstain from premarital sex while tolerating, or sometimes even encouraging, it for males (Sprecher, 2008).
• Family: In most cases, adolescent development takes place within the context of the nuclear or extended family. The degree to which this developmental period results in family tension and conflict rather than support and celebration will vary. Societal and familial expectations and the nature of family relationships, as well as significant events such as births, deaths, and separation, all affect how young people develop. Family stability can be especially critical, and disruptions, including death, divorce, or separation, can have a lasting effect on adolescent behavior and development. In addition, some adolescents are institutionalized, are fighting wars, are living on the streets, are orphaned, or have married or formed other partnerships (Sprecher, 2008).
• Sexuality: Sexuality includes a range of emotions, thoughts, and behaviors and is not limited to sexual intercourse. It involves the individual’s physiological, psychological, and emotional state; sexual expression and gender roles; and expectations (Sprecher, 2008).

• Society: Adolescent development also takes place within the context of the adolescent’s social environment. The healthy development of social skills is reflected in interpersonal and group relationships and in the balance between healthy group interaction, individuality, and independence (Sprecher, 2008).
• Ethics and morality: A sense of ethical standards and morality, or values, helps an individual distinguish between right and wrong and shapes decisions about individual behavior. That sense is evident in an awareness of broader issues affecting not only the individual, but also the family, the community, and the society. Because of these factors, adolescence, especially in its early stages, is an optimal time to influence the development of healthy gender roles as well as positive and productive goal setting. Data confirm that adolescents do listen to adults and that positive relationships with adults can reduce some of the potential hazards associated with adolescence and can increase positive behaviors. Outlined in this tool are intervention strategies that focus on prevention. These strategies hold special promise for younger adolescents. Sexual thoughts, feelings, and behaviours, present throughout life, are often accentuated during adolescence (Sprecher, 2008).

Parental attitude towards impacting sex education

Kim and Ward (2015) noted that parents have a unique position when it comes to sex education because parents are the earliest socialization agents in children’s lives. Many parents actually want to teach and talk to their children about sex but they often doubt their skills and competency to impart that knowledge. It is important to note though parents can influence their children’s beliefs and attitudes about sex more than, they may not necessarily pass down specific messages related to sex. There are certain positive benefits to parents opening up communication with their children about sex. There are indirect effects on the sexual health of adolescents, such as prompting them to have more open talks with their partners and increasing their knowledge of HIV, and even reduce the chances of sexually risky behavior. However, parents’ communication is usually centralized on a few topics, such as health, risks, and safety issues, rather than on pleasure, orgasm, etc. This is contrasted from findings based on existing studies of family sex communication, that preventative measures are rarely talked about; and the focus of parental communication is on negative consequences of having sex.

Durojaiye (2015), observed that in most African homes, parents are not fully equipped to answer questions on sexual matters usefully. Even those who try to, pass on faulty information to their children. The whole subject thus becomes surrounded by secrecy and the children now become too embarrassed to discuss these matters with their parents. The results of study showed that even though parents claim to be communicating to their children about sex and birth control, those topics are usually discussed within the contexts of the moral concerns surrounding sexual activity. In addition, the more frequently the parents attended church, there were fewer discussions on sex and birth control and more discussions on moral issues. In addition, it seems that parents are unable to develop the content of their communication. It seems to be rather difficult for the parents to heighten the maturity level of their conversation as their children become older and more mature.

Afifi (2008) pointed out that parents are generally also shy and embarrassed to talk about such a topic. Parents are unsure about the right timing to approach their children with such discussions, and they fear that they may lack adequate knowledge and thus misinform their children. When parents do profess to be open about sex communication, they are reactive rather than proactive, meaning that they will only talk about it when the issues arise or when their children approach them with questions. From the adolescents’ point of view, discussing about sex is what they would avoid the most when it is related to their parents. Embarrassment is a factor for them as well, and so is feeling uncomfortable and unwilling to taint their parents’ image of them or have them think that they are sexually active. Paradoxically, adolescents, at the same, desire more sex communication with their parents. Further investigation into how adolescents reacted during certain styles of communication revealed that adolescents become avoidant and anxious when parents used fear, used restrictive and moralistic behaviors, to pressure adolescents to remain abstinent.

However, if parents would create an environment for communication where adolescents are welcomed to present their views and opinions without being judged, then more disclosure and thus more communication would take place between adolescents and their parents. Research also covered religion’s role in sex communication. Interestingly, religious parents and adolescents were more comfortable talking about sex than nonreligious families. On the other hand, adolescents in the study said that they were comfortable because there was nothing to talk about. As the researchers explored that the mothers did not have frequent “sex talk” with their daughters, the mothers said that sex was not an interest for their daughters; and therefore, it was not a matter for discussions. According to some adolescents, sex was a taboo topic in their families. In families where sex was discussed, boys received more information about STDs and safer sex practices, whereas girls were simply told to avoid men and situations that may be sexually tempting.

Sprecher (2008) stated that since sex education is rarely received from parents, adolescents look to other sources for knowledge. Adolescents learn more about sex from peers, specifically dating partners and same-sex friends, than from any other sources. In a 16-year longitudinal study on university students’ perception of their sources of sex education, observed that overall, young people received sex information from peers, professionals, and the media. In addition, throughout the years, youth increasingly communicated more with professionals. Siblings, though often overlooked, are also important sex knowledge communicators. The media is a powerful agent in sex education. When it comes to media messages about sex, they can be either inaccurate, thus harmful, or can be informative and educational.

Factors affecting sex education in Nigeria

There are several factors affecting sex education in Nigeria. According to Meshike (2012), the following are factors affecting sex education in Nigeria:

1. Sexuality education is a sensitive issue: Due to the sensitive nature of sexuality education and the fear from parents and society that teaching it to young people could make them sexually adventurous create a barrier to its proper implementation (Meshike, 2012).
2. Inadequate and/or lack of political will: The government of Nigeria through the Federal Ministry of Education has over the years shown commitment to roll out its implementation. However, this is not the case in many states of the federation, where in some places, no political will and in some areas, the commitment is grossly inadequate. There is apathy and unwillingness on the part of some state governments to allow robust discussion and dialogue that will lead to policy reform for the proper take-off of sexuality education (Meshike, 2012).
3. Inadequate human and financial resources: In many schools especially public schools, fewer teachers are providing teaching support to all the subjects. Adding sexuality education provides additional burden in an already overstretched environment. Funding related to sexuality education such as training of teachers, supply of instructional materials, effective monitoring and evaluation of its implementation is grossly inadequate from the part of government due to lack and/or inadequate political will, as explained above (Meshike, 2012).
4. Donor dependency: The Non-governmental organizations providing technical and advocacy support to the implementation of sexuality education largely depend on International Development Partners, so also the HIV/AIDS unit of the Federal Ministry of Education. This is a barrier to the sustainability of sexuality education implementation in Nigeria (Meshike, 2012).
5. Systemic problems within the education sector: Challenges in integrating sexuality education into existing curriculum are still a barrier to its effective implementations. In many schools and settings, it is being taught as just sexuality education or HIV/AIDS and Family Life Education (Meshike, 2012).
6. Inadequate capacity and knowledge of teaching staff: Experience has shown that many teachers are not properly trained and taught to handle sexuality education. Some could not respond to students questions as they relate to anatomy and physiology of human body. Some are not matured enough to handle sexuality issues (Meshike, 2012).
7. Over crowded curricula: The curriculum is view by many as too large to be covered under the circumstances that there are many other curricula to also taught and couple with fewer trained staff (Meshike, 2012).
8. Over blowing issues out of proportion by the media: The media that is supposed to educate and enlighten the public and allay fears of the society, in the early time of introducing sexuality education in Nigeria had not only exaggerated its perceived negative effects, but added to the controversy and opposition by religious leaders (Meshike, 2012).
9. Top bottom approach: The introduction of the sexuality education took the approach of top–down approach, federal government and NGOs more or less dumping it on the state governments that were not prepared and ready (Meshike, 2012).
10. Opposition to the implementation by religious group: Many religious groups both Muslims and Christian have shown stiff opposition to the implementation of the sexuality curriculum due to perceived fear that it would create immorality among young people (Meshike, 2012).

Measures to promote sex education in Nigeria

In other to promote sex education in Nigeria there should be a holistic approach by the school and the family. Nnachi (2013) suggest the following measures to promote sex education in Nigeria:

1. Advocacy and social mobilisation and consensus building: The federal government in collaboration with NGOs and organised Media should intensify high level advocacy and social mobilisation across the federation to various relevant stakeholders. Groups like National and State Legislative Assemblies, Ministries of Finances, Executive Governors, Traditional and Religious Leaders as well as parents. Well tailored advocacy will lead to improved financial resources as well as building consensus on effective implementation of sexuality education.
2. Capacity building and provision of sexual/reproductive health services: More teachers need to be recruited and well trained to provide quality sexuality education as well as build a strategic monitoring and evaluation plan to be measuring performance and impact. Apart from teaching sexuality education, sexual/reproductive health services need to be available to ensure that young people have access to friendly services when in need , especially issues to do with sexuality transmitted infections including HIV/AIDS and coping with adolescent sexual health problems.

Kirby (2017) suggested that sex education should be inculcated in the school curriculum. The following are some of his suggestions to the form in which the curriculum should be structured:

• Sex education should be inculcated in the school curriculum. This should be implemented in private and government schools with a carefully knitted syllabus covering all the aspects of sex education for youth.
• Various risky behaviours among youth, such as forced sex, indulging in pornography, physical abuse can lead to early pregnancies. This should form the vital part of the curriculum helping the youth to understand the unethical and inhuman aspect of such behaviours.
• It should also provide the knowledge of contraceptives and the difference between various contraception methods, such as morning pills, contraceptives, condoms and finally abortion. This should also include the time duration for taking these precautions. Many girls from varied age groups do not have access to this information and give birth to stillborn babies or even encounter death.
• Colleges and schools can hold debates and discussions on the importance of sex education and sensitise teachers and students.
• A major section of the Indian society lives below the poverty line, therefore, in order to attract the attention of this social stratum, alternate methods of education must be approached. Film screenings and visual media showing the intensity of STDs and life-taking diseases are a few suggestions. Apart from that, free health camps should also be set up that supply condoms and regular health checkups for the underprivileged.
• Make the youth understand, through intensive training programmes, the importance of self worth. Random sexual acts can cause irreparable damage to the human body. Every individual should learn to understand the worth of life.
• Another important point within sex education is to teach the youth about personal hygiene.
• The youth must not allow the generation gap they have with their parents come in the way. Consultation with parents, guardians or trusted authorities can be the best way to put one’s anxieties to rest.
• Prejudice and biases prevent one from understanding the importance of sex education. Every youth must undertake this venture as a responsibility and not just as curriculum.

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