Ethiotime1
This study was conducted to assess parent to adolescent discussion about SRH issues from parents’ perspective including knowledge, reasons and associated factors.
In this study 25.7% (95% CI: 22.48%, 29.19%) parents reported that they had discussion on two or more topics in the last 6 months prior to the study about SRH issues with their adolescent children. This finding is similar to findings from other different regions of Ethiopia like Awabel Woreda in East Gojjam/Western Ethiopia (25.3%), Harar (28.7%) and Benishangul Gumuuz (28.9%). Similar findings were reported from China [27] which showed that the discussion rarely occurs despite accepting its importance. The results of this study are relatively higher than studies from Zeway, Ethiopia (20%) [28] and Lesotho (20%) [29]. This difference could have been due to the time gap as improvement in accessing SRH information may have occurred. This result is also lower than the findings in Mekele (57.6%) and Alamata (68.2%). The difference might be due to difference in measurement tools as study in Mekele considered discussion on one topic enough as compared to this study where at least two topics were used as cutoff. Similarly, different results from the study in Alamata may be due to the fact that, they considered discussions between sisters, brothers and health personals as parental discussion [13, 30]. When compared to results from studies in other continents the results were much lower. For example Mexico reported 83.1% parents have spoken to their children about SRH issues [11]. A study from New York, Alabama reported about the proportion to be 70.6% [9]. This might be due to difference in educational level of parents, knowledge, skill of communication and accessing sexual and reproductive health information which is better in Mexico and New York, Alabama compared to Ethiopia.
In this study discussion about puberty was 8.3%, which is similar to previous study done in Ziway (10.6%) [28]. However, this result was much lower than in the result reported from Yirgalem, southern Ethiopia (39.7%). This difference may be a result of difference in measuring tool as they considered one topic enough to constitute parental discussion. In addition time period was not restricted, which may have resulted in increased proportion [31]. The discussion about sexual intercourse (23.9%) was similar to study done in Debremarkos (27.6%) but much lower than the studies done in Yirgalem (33.5%), Bullen woreda of Benishangul Gumuuz (42.2%) and Harar (50.02%). This may be due to different in measurement criteria. In Bullen, discussion with teachers, friends, sisters and brothers was considered as being part of having parental discussion [21, 23, 31, 32].
Only 7% participants in this study reported discussion on contraception. This is lower than reported by other studies done in different parts of Ethiopia, including in Debremarkos (25.9%), Harar (26.39%), Yirgalem (36.1%) and Bullen woreda of Benishangul Gumuuz (41.3%). The difference may similar to as reported above, being difference in measurement criteria [21, 23, 31, 32]. Only 3.7% of the participants from this study discussed condom use and the result is far lower than other studies done in Ethiopia [21, 31, 32].
One fifth (21.1%) participants of this study discussed about STI and HIV/AIDS. This is lower than the study in Bullen woreda of Benishangul Gumuuz, Ethiopia (78.6%). This may be due to difference in study population and that they considered discussions between teachers, friends, sisters and brothers as parental discussion [32]. Eighteen percent of the respondents discussed about unintended pregnancy which is similar to the study from Ziway (20.7%) but much lower than other studies in Debremarkos (28.5%), Yirgalem (36.1%), Harar (42.59%) and in Bullen Benishangul Gumuuz (54.1%) This may be due to difference in measurement tools and study population [21, 23, 28, 31, 32].
Parents also indicated various reasons why they do not discuss sexual and reproductive health issues with their adolescents. Among the major reasons, cultural norms (54.2%) was mentioned which is in line with the study done in Ziway (54%) but greater than other studies done in Yirgalem, Harar and Bullen woreda of Benishangul Gumuuz [21, 23, 28, 31, 32].This shows existence of extensive cultural taboos throughout the country. Fear of discussion (41.5%) was also mentioned as one of the major reasons this is in line with many other researches [18, 23, 31, 33]. This may be due to the taboo nature of discussion about SRH issues in many Ethiopian settings.
Thirty-six percent of the respondents do not discuss due to lack of communication skills. This result is consistent with many studies done in different parts of Ethiopia and from abroad [18, 23, 31, 33, 34] indicating a gap in communication skills among parents. Belief that discussion would initiate sex (34%) was also mentioned as a reason, which is similar to the study done in Debremarkos (33.1%) and Harar (33.8%) where parents perceive that discussing sexual matters with their adolescents might encourage the children to engage in premarital sex [21, 23]. Some of the participants also mentioned lack of knowledge (20.8%) as a reason for no discussion. This result is similar to the study done in Wollega and Benishangul Gumuuz [32, 33]. This may be due to parents’ perspective that the adolescents know more than them.
Majority of the participants had good knowledge about SRH issues (72.4%) (95% CI: 68.91%, 75.76%). This is greater than the studies done in different parts of Ethiopia like, Harar (67.38%) and Debremarkos (57.3%). This difference may be due to time gap between the studies which may have resulted in improvements in available resources [21, 23].
The result of multiple logistic regression models revealed that parents who had no formal education were less likely to discuss about SRH issues when compared to those parents who had primary education (AOR 3, 95% CI: 1.1, 7.7), secondary education (AOR 9, 95% CI: 3.87, 20.64) and diploma and above (AOR 22.33, 95% CI: 9.49, 32.56).This result is consistent with different previous studies [23, 33,34,35,36]. This may be due to educated parents have better information about SRH issues and communication skills, so that they are more likely to discuss than those with no formal education. Knowledge leads to the development of desirable attitude and builds confidence in parents to shoulder the matter.
Parents who reported a monthly income of above 2000 Ethiopian Birr were 2.4 times more likely to discuss SRH issues with their adolescents (AOR 2.4, 95% CI:1.3, 4.55) compared to parents with a monthly income of less than 1000 Birr. This is similar to the study done in Harar [23]. Parents who had good SRH knowledge had a two fold increase in the odds of discussing SRH issues with their adolescents (AOR 2, 95% CI: 1.14, 3.5) than their counterparts. This result was consistent with previous findings [23, 33, 34, 36]. This may be due to respondents who had good knowledge were eager to discuss and their knowledge may initiate discussion and they may have interest to share their knowledge. The odds of discussion on SRH issues were 4 times higher among parents who had positive attitude than their counterparts (AOR 4, 95% CI: 1.57, 10).This result was also consistent with previous findings [23, 33, 34, 36]. This may be due to their perceived importance of discussion for their adolescents.
Strengths and limitations of the study
This study is community based and conducted from parents’ perspective unlike many researches done from adolescent perspective. However, the study was based on self-reporting and responses might be affected by social desirability bias because of the sensitive nature and cultural barriers for reporting. Since the study design was cross sectional, cause and effect relationship could not be established. The presumption that discussion is positive, when in reality, some discussions can be quite negative and harmful is limitation of the study. Another limitation is that only adults were interviewed. It would have been interesting to get the adolescents’ perspective and see if it aligned with the parents.
Research policies and implications
As a primary socializing agent, and as live model, parents are very important in shaping the current and the future lives of their adolescents. Indeed, this study provides important programmatic implications for amending policies and programs which address cultural and social factors that influence parental discussion about SRH issues.
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