Socioecological analysis of determinants of early adolescent sexuality in Benin: a qualitative study

Introduction: early adolescent sexuality is associated with an increase in risky sexual behaviour, unwanted pregnancies, and the occurrence of sexually transmitted infections. However, despite the efforts of governments and their partners, the implementation and effectiveness of appropriate and adapted services to improve adolescent sexual and reproductive health are lagging. Therefore, this study aimed to document determinants of early adolescent sexuality in the central district of Tchaourou in Benin based on a socio-ecological approach. Methods: an explorative and descriptive qualitative study was conducted using focus groups and individual interviews based on the socio-ecological model. Participants included adolescents, parents, teachers, and community leaders in Tchaourou. Results: the number of participants in each focus group was 8 (32). There were 20 girls and 12 boys aged 10-19 years, of whom 16 were students (7 females and nine males) and 16 were apprentice dressmakers and hairdressers. In addition, five participants attended individual interviews (two community leaders, one religious' leader, one teacher and one parent). Four themes were identified that influence early sexuality among adolescents and grouped into individual determinants related to knowledge about early sexuality; interpersonal determinants related to adolescents' function, including the influence of family and peers; community and organizational determinants related to where harmful sociocultural norms; political determinants comprising the disadvantaged socioeconomic status of the communities where adolescents live. Conclusion: many factors at multiple social levels influence early adolescent sexuality in the commune of Tchaourou in Benin. Therefore, interventions directed at these various levels are needed urgently.

Challenges on sexual health communication with secondary school learners, Limpopo province

A conversation about sexuality is most likely to encourage healthy and positive sexual practices while reducing risky sexual behaviour among adolescents. Traditionally, sexuality is discussed in hushed tones in proverbs and is reserved for adults. On the other hand, adolescents must be well informed about their sexuality to assist them to make informed decisions about their sexual behaviour.Objectives: The study determined parents' views regarding challenges of sexual health communication among secondary school learners in the Limpopo province.Method: A qualitative, exploratory-descriptive and contextual approach was employed for the study. Fifty-six parents were purposively selected, resulting in five focus group discussions that had 8­12 members. One central question was asked, and based on the participants' responses, probing questions followed. Data were analysed using thematic analysis. Trustworthiness and ethical considerations were ensured.Results: Three themes, namely communication concerns, role shifting in imparting sexuality education and poor parent­child relationships, and eight subthemes emerged from the data.Conclusion: This study identified that communication concerns influence parent­child dialogue on sexuality education. Therefore, there is a need to address factors hindering communication such as cultural barriers, role shifting in imparting sexuality education and poor parent­child relationships. This study suggests that parents should be empowered in dealing with children's sexuality.Contribution: Parents should be equipped with reproductive knowledge to enable them to talk freely about sexuality with their children. This should be complemented with broader programmes aimed at promoting sexual health education within the traditional family institution

Exploring the effects of programmatic intervention on family planning health literacy and contraceptive utilization in eastern Uganda

Uganda Village Project (UVP) implemented the Healthy Village Initiative (HVI) and conducted household surveys to assess the effects of the initiative. This data adds to the limited body of knowledge regarding the efficacy of community health interventions for reproductive health in rural east Africa. As part of the HVI, UVP surveys rural Ugandan households before and after a 3-year programmatic intervention to assess changes in family planning health literacy, and contraception utilization. Results showed that there was an increase in contraceptive utilization, an increase in family planning health literacy, and a decrease in unmet need for contraception. Community-based outreaches led by community members and health workers can contribute to improving access to contraception, utilization of contraception, and health literacy surrounding contraception. (Afr J Reprod Health 2022; 26[4]: 15- 21).

Challenges to ethical integration of reproductive health education in schools of Tshwane District, South Africa

The Integrated School Health Policy was set to ensure the incorporation of a multi-disciplinary approach to health care in South African schools. However, the implementation of sexuality and reproductive health teaching and learning has not been without problems. Central to sexuality and reproductive health education is the common ethical application of the subject in teaching. School sexuality and reproductive health education have proved to be a sensitive issue across a socio-cultural environment. Compliance with ISHP programs in sexuality and gender orientation is related to the inclusion of a more comprehensive education for learners to cover human rights and sexual diversity. This paper aims to reflect on the ethical challenges related to the integration of reproductive health education and teaching in schools in the City of Tshwane. This study applied a descriptive exploratoryquantitative research design. Data was collected using a survey questionnaire and a checklist, and applied stratified random sampling to select schools that participated in the study. Data were analysed using descriptive statistics which included frequencies and percentages (%). The results show that the absence of health care values in organisational strategies will challenge the ethical dimension relating to sexuality and reproductive health education. The ethical dilemma of teaching sexual and reproductive health in schools can prove to be a challenging exercise since its a sensitive issue in most societies. Sexuality and reproductive health education is compounded by a lack of clear guidelines in the ISHP programs and the diversity of stakeholders that do not hold a common or standardised ethical framework. Furthermore, lack of sufficient teacher preparation adds to the ethical dilemma in managing school ethical issues in general. (Afr J Reprod Health 2022; 26[4]: 75-81).

Religion and non-marital fertility: A qualitative study of the perspectives and experiences of South African Muslim women

In light of the rising number of children born outside of formal marriage, there is increasing concern about the well-being of these mothers and children, especially since they mostly come from disadvantaged populations. This study aims to determine the role religion plays in the experience of non­marital fertility. This study draws on data from ten in-depth interviews with women in Durban, South Africa. The study found that women did not anticipate the negative impact of non­marital fertility prior to experiencing their first birth. The main reason contributing to the experience of non­marital fertility was the lack of sex education.Many women believed that Islam allowed only married women to use contraceptives because unmarried women are expected to practice celibacy and their religion advocates for a two-parent household. As a result, unmarried women with children found themselves often ostracised from their community. The study recommends a comprehensive sexual education regime to address the challenges associated with non-marital fertility. (Afr J Reprod Health 2022; 26[7]: 49-58).

Behavioural intervention for adolescent uptake of family planning: a randomized controlled trial, Uganda

Objective:To evaluate the impact of a peer-referral and clinic welcome programme for reducing barriers to adolescents' uptake of family planning services in Uganda. Methods: We developed an intervention using behavioural design and carried out a stratified, randomized controlled evaluation of the intervention in girls aged 15­19 years. Sexual and reproductive health clinics were randomized into control (56 clinics) and intervention groups (60 clinics). All intervention clinics received the core intervention (materials to create an adolescent-friendly environment and referral cards to give to friends), while a subset of clinics additionally received training in youth-friendly service provision. We collected clinics' routine data on monthly numbers of visits by adults and adolescents over a 15-month baseline and 6-month intervention period, 2018­2020.Findings:In multivariate regression analysis we found significant effects of the intervention on primary outcomes in the pooled intervention group compared with control. Mean monthly visits by adolescents increased by 45% (incidence rate ratio, IRR: 1.45; 95% confidence interval, CI: 1.14­1.85), or over five additional adolescent clients per clinic per month. The mean adolescent proportion of total clients improved by 5.3 percentage points (95% CI: 0.02­0.09). Within treatment arms, clinics receiving the training in youth-friendly service provision showed the strongest effects: a 62% increase (IRR: 1.62; 95% CI: 1.21­2.17) in adolescent clients, or over seven additional adolescents per clinic per month, relative to the control group.Conclusion: A behavioural change intervention designed to target identified barriers can increase adolescents' uptake of family planning counselling and services.

Challenges of including sex education in the life orientation programme offered by schools: the case of mahikeng, north west province, south Africa

Teenage pregnancy and the prevalence of HIV among school girls are very high in South Africa, despite the introduction of sexuality education in schools since 2002. A qualitative approach of inquiry was used to investigate challenges faced by schools offering sexuality education in Mahikeng, South Africa. Four school principals, seven teachers and 39 learners were interviewed. The curriculum on sexuality education indicates that sexual matters are introduced to learners only when they reach Grade 8, whereas pregnancy is already common among girls as early as Grade 3. Participants from all groups represented in the study revealed that Life Orientation was not taken seriously in schools compared to other subjects. Although learners are very much interested in the subject matter, there were no qualified teachers and the content of the curriculum is very shallow. In addition, schools paid very little attention to this subject since it is not considered for admission into tertiary institutions. There is need, therefore, for the South African government to revise the curriculum content and presentation of Life Orientation to ensure the improvement of sexuality education in schools. The appropriate age-specific topics on sexual matters for learners should also be revised and the qualification of teachers considered

Adolescent sex education: prevalence, sources and perspective among senior secondary school students in Obio/Akpor Local Government Area of Rivers State

Background: Adequate sex education is an essential tool for all adolescents. The purpose of this study was to determine the proportion of adolescents who have had access to sexuality education, their source and their perspective to sexuality education in Obio/Akpor local government area (LGA) of Rivers State. Methods: This is a cross sectional descriptive school based study. A multistage sampling method was used to select four secondary schools (two public and two private) in Obio/Akpor LGA of Rivers State. The study participants were recruited by simple balloting from the senior secondary classes. The study instrument was a pretested semi-structured self-administered questionnaire. Data were analysed with Epi Info version 7.2.2.16 statistical programme. In all cases, a value of P < 0.05 was statistically significant. Results: One thousand one hundred and ten participants were recruited for the study, ages ranged from 13 to 19 years with a mean age of 15.5 ± 1.6 years. Majority (91.9%) of the participants have been taught sex education. More males and students from public schools had not been taught sex education. Sources of sex education were school (58.3%) and parents (13.5%). Most (74.0%) of the students preferred a school-based sex education taught by their teachers and 96.5% supports sex education to be incorporated into the school curriculum. Furthermore, majority of the students acknowledged that sex education will help them prevent sexually transmitted infection and HIV/AIDS, pregnancy and help them relate better with the opposite sex.Conclusion: It is concluded that every child irrespective of the gender, school type be given access to adequate sex education. Parents and teachers are encouraged to ensure that the appropriate age-specific information is given to the children to prevent them from accessing wrong information from unreliable sources. There is need to incorporate sex education into the secondary school curriculum

'They tell you about the risks': exploring sources of sexuality education among very young adolescents in rural Mpumalanga

Background. Early adolescence (ages 10 - 14) is a crucial stage of development. The importance of early intervention in improving adolescent sexual and reproductive health (SRH) is increasingly acknowledged. Yet, school-based sexuality education largely focuses on older adolescents, leaving very young adolescents to contend with conflicting information from different sources. This study responds to the need for contextually nuanced research with very young adolescents, which can inform policy and programmes aimed at improving their SRH outcomes. Objectives. To explore very young adolescents' sources of SRH knowledge and investigate the implications of both formal school-based sexuality education and informal sources of information for their SRH rights. Methods. This research was conducted with schoolgoing adolescents (aged 10 - 14) from the Gert Sibande district in rural Mpumalanga. Data were collected qualitatively using individual interviews and group-based participatory workshops, all conducted with the same participants. Transcribed data were analysed using thematic analysis. Results. Findings indicate that while formal transfer of SRH information takes place through school-based sexuality education, learners' sexual knowledge is also shaped by informal sources, including household observations and sexual play. We identify three themes that cut across sources of SRH knowledge and position young adolescents in contradictory ways: prohibitive messaging, the notion of childhood innocence and everyday sexual learning. Conclusion. Recommendations are made for comprehensive sexuality education that is responsive to this age group's needs, draws on their everyday lived experiences and optimises the opportunities offered by foregrounding agency, while remaining cognisant of structural constraints

Maternités des adolescentes au Centre Hospitalier Universitaire de Conakry en Guinée. Profil socio-démographique et obstétrical

But : Etudier le profil sociodémographique et le pronostic obstétrical des adolescentes de 18 ans et moins à la maternité Donka du Centre Universitaire de Conakry.Méthodes : Etude rétrospective descriptive, d'une durée d'un an (1er janvier au 31 décembre 2014). La population d'étude était constituée par les adolescentes de 18 ans et moins ayant accouché à 28 semaines d'aménorrhée (SA) et plus. L'adolescente était définie par un âge maternel inférieur ou égal à 18 ans révolu. Les caractéristiques sociodémographiques, obstétricales et néonatales ont été étudiées. Résultats : Sur 6.782 accouchements réalisés à la maternité Donka, 186 (2,74%) étaient des adolescentes. Le profil était celui d'une adolescente mariée (74,2%), non-scolarisée (54,8%), sans emploi (51,7%). La majorité (67,2%) avait un mauvais suivi prénatal. L'accouchement par voie basse était réalisé dans la majorité des cas (71%) et la césarienne dans 29% des cas. Parmi les nouveau-nés, 16,4% avaient un petit poids pour l'âge gestationnel dont 10% de prématurés. Le taux de mort in-utero et intra-partum était de 10%. Conclusion : Notre étude suggère la mise en place de mesures permettant aux adolescentes de bénéficier d'une plus longue scolarisation, d'un accès à l'information et aux services de santé de la reproduction, ce qui leur permettraient de mieux protéger leur santé et d'éviter les complications liées aux grossesses non-désirées

Love grows with sex: teenagers negotiating sex and gender in the context of HIV and the implications for sex education

How do teenagers located in the KwaZulu-Natal province of South Africa, the epicentre of the HIV pandemic, give meaning to sexuality? This paper examines teenage black Africans investments in sex and sexuality and the gendered dynamics through which sexuality is articulated. Whilst unequal gender relations of power continue to feature prominently within relationship dynamics fuelling the gendering of HIV, attention to the micro-processes through which relationships are forged remain significant in illustrating the complex connections between love, sex and gender. Drawing on empirical findings with teenagers between the ages of 16 and 17 years old, the paper shows how relationships are conceptualised based on discourses of love. Love is inextricably bound up with sex and when teenagers talk about love and sex they also talk about condom use, multiple sexual partners and gender inequalities. What teenagers were interested in for their sexual relationships was not raised in sex education programmes at school. Implications for addressing teenage constructions of sexuality are discussed in the conclusion

Impact of Parental Sex Education on Child Sexual Abuse among Adolescents

Background: Parental sex education of children is an often overlooked issue in pediatrics; especially in our society where talking about issues concerning sex is regarded as a taboo.Objectives: The objective of this study is to determine the impact of sex education on child sexual abuse among adolescents attending secondary schools in south east Nigeria.Methods: This is a cross-sectional study that was carried out among children in three secondary schools in Enugu and Ebonyi states of Nigeria. Five hundred and six adolescents who met inclusion criteria were consecutively recruited into our prospective study between June and October; 2014.Results: Eighty (80%) of respondents were educated by parents on sex abuse. Of those educated majority was by mother (46.2%) and both parents (45.2%). Most (72.1%) were not informed that family members or family friends can abuse children and 73.8% were not told to inform adults if it happens to them. A lower proportion (37.9%) of those educated by parents at home was abused. Those educated by parents were 1.23 times less likely to be abused than those not educated. There was significant difference in sex abuse between males and females (p=0.014) while there were no significant difference for age (p=0.157) and social class (p=0.233).Conclusion: Children educated by parents on sexual abuse were less likely to be sexually abused than those not educated. There is no link between socioeconomic class and child sexual abuse among adolescents

Challenges Faced by Older Women in Botswana in Accessing Services that Address Sexual and Reproductive Health; and Family Planning Needs; in Botswana

Objective: This study explored the challenges that older women from selected sites in Botswana face in accessing services that address sexual and reproductive health (SRH) and family planning (FP) needs. Design; setting and subjects: Two rural and two urban health districts were randomly selected for the study. A statistically determined sample of 454 older women was allocated to the different districts (strata); using probability proportional to size. Outcome measures: The study estimated the percentage use of sexual and reproductive health services (including family planning services); unmet need for family planning and factors inhibiting use of these services. Results: The study revealed that 25 of the older women used some type of FP method. Of this number; 67.9 were aged 50-59 years; 17.4 60-69 years; 10.1 70-79 years; and 72 had unmet needs for FP. The older women used natural FP methods mainly. The main SRH services used by them were screening for human immunodeficiency virus/acquired immune deficiency syndrome; sexually transmitted infections and cervical cancer. Obstacles to accessing SRH and FP services were found to include illiteracy; lack of education; financial constraints; a perception that healthcare planners limited SRH needs to antenatal and obstetrical services; a cultural reluctance to discuss SRH in public and domestic issues.Conclusion: The study recommends comprehensive public health education for older women on human sexuality and fertility; contraceptive use; access to services; effective training programmes for healthcare providers on how to deal with older women's issues and better access to STI and cervical cancer screening services

'Every Teacher is a Researcher!': Creating Indigenous Epistemologies and Practices for HIV Prevention through Values-Based Action Research

Since gender is an undisputed driver of HIV infection; teachers concerned with HIV prevention education should ideally encourage critical awareness of and culturally sensitive practices around gender inequalities. Many interventions and programmes have been developed for teachers to enable them to do this; however most have met with limited success. This article proceeds from the viewpoint that for HIV-prevention interventions to be sustainable and effective; teachers should be actively engaged in their design; implementation and evaluation. It outlines how teachers in an HIV prevention programme utilised an action research design to explore their own gender constructs as a necessary first step to the creation of more gender-sensitive school climates and teaching practices. This values-based self-enquiry moved the teachers to action on two levels: first; to adopt a more gendersensitive approach in their own personal and professional lives and second; to take action to challenge gender inequalities within their particular educational contexts. Evidence is presented to justify the claim that action research of this genre helps teachers to generate indigenous epistemologies and practices that not only are effective in creating sustainable and empowering learning environments for HIV prevention education; but also for teaching and learning in general

'Checkmating HIVetAIDS': Using Chess to Break the Silence in the Classroom

In this article; I give an account of my 'Checkmating HIVetAIDS' action research project; which was an attempt to break the 'culture of silence' concerning HIVetAIDS and sex and sexuality in my classroom. In this project; I focused specifically on one code of sport; namely chess; and I point out and discuss the potential of using chess as an educational tool in addressing HIVetAIDS. It was found that learners enjoy playing chess and that it can be used in the Life Orientation classroom to promote HIVetAIDS awareness. This type of alternative awareness is relevant as learners in most schools were becoming fatigued by HIVetAIDS information overload. The project portrays the role of the teacher as a researcher and critical change agent in an HIVetAIDS-challenged society

Teenagers' Experiences of Sexual Health Dialogue in the Rural Villages of the Vhembe District; Limpopo Province

Dialogue with teenagers about sexual health is of global concern; as it is found mostly to be minimal; if not absent. This limitation is influenced by the cultural values; beliefs and norms of teenagers. To a great extent; culture influences which and how sexual health issues can be discussed between teenagers and adults. The purpose of this study was to explore and describe teenagers' experiences of sexual health dialogue in the rural areas of the Vhembe district in Limpopo province; South Africa. A qualitative; explorative; descriptive and contextual research approach was used. Data were collected by means of in-depth; individual interviews and focus-group discussions. A purposive sampling method was used to select the 57 participating teenagers; based on criteria that were set. The findings of the study indicated that there was minimal dialogue between adults and teenagers about sexual health. Most teenagers reported that they learned about issues related to sexual health from friends; the media; initiation schools and relatives who; most often; were aunts. It was also noted with concern that the teenagers always equated sexual health to the act of intercourse and that no attention was paid to other aspects of sexual health. Recommendations to improve the current situation were made

Mothers Perception of Sexuality Education for Children

Sexuality education is the process of acquiring information and forming attitudes and beliefs about sex; sexual identity; relationships and intimacy. It develops young people's skills so that they make informed choices about their behaviour; and feel confident and competent about acting on these choices. It also equips children to face developmental challenges and empowers them against the ills of abuse; exploitation; unwanted pregnancies amongst others. Mothers who are the primary caregivers should be well informed about sexuality issues. The objective of the study is to determine mothers' perception of sexuality education in children; in Port Harcourt.A structured; anonymous and selfadministered questionnaire; used as instrument for data collection; was distributed amongst a convenient sample of women attending a Christian women's convention in Port Harcourt.One hundred and fifty eight women participated in the study. Most of them were married (80.4); and belonged to the 30-49 years age bracket. Seventy one (44.9) of the respondents had tertiary education. Over 80agreed that children needed sexuality education but only 15 women (9.5) had a good knowledge of the concept of sexuality education. One hundred and eleven (70.2) believed it was the responsibility of both parents to educate their children and over 70acknowledged that the home was the best place for such education. 64 (40.5) believed that 6-10 years was the ideal age for starting sex education while 49thought that the ideal age was 11-15 years. 65of respondents discussed sexuality issues with their children at least occasionally; the content mostly involved description of body parts and reproductive organs. The average age of menarche amongst respondents was 14.0. One hundred (63) of the women had prior knowledge of menstruation before menarche. About half of them had received information from their mothers. The study highlights the need for enlightenment of women on sexuality education to enable them empower their children against the ills of child abuse