A qualitative study exploring parent–daughter approaches for communicating about sex and transactional sex in Central Uganda: Implications for comprehensive sexuality education interventions

Abstract

Introduction: Ugandan adolescent girls and young women are disproportionately impacted by human immunodeficiency virus, and this is largely driven by their engagement in transactional sex. Globally, parent-daughter communication about sex is associated with increased contraceptive use and delayed/decreased sexual activity, but research on parent-daughter communication about transactional sex is lacking. This paper elucidates local perspectives on, and experiences of parent-daughter communication about sex and transactional sex, to inform family-level comprehensive sexuality education interventions. Methods: We conducted a secondary, thematic analysis of 13 focus group discussions (n = 119) and 30 in-depth interviews collected between 2014 and 2015 with adolescent girls and young women aged 14+, and men and women in Kampala and Masaka. Results: We found that parents used three approaches to discuss sex and transactional sex with their daughters: (1) frightening their daughters into avoiding sex; (2) being "strict"; and (3) relying on mothers rather than fathers to "counsel" daughters. Mother-daughter communication about transactional sex was common, but frequently unidirectional. Adolescent girls and young women bringing home gifts sparked conversations about the risks of transactional sex, although less in poorer households. Mothers felt they lacked control over their daughters' sexual behaviors and thus restricted their movements and friendships to try to prevent them from having sex. In contrast to previous research, we found some evidence of mothers encouraging condom use and father-daughter communication about sex. Conclusions: Family-level comprehensive sexuality education interventions targeting parent-daughter communication about sex could further highlight the role that fathers might play, and emphasize communication about the inequitable power dynamics in transactional sex and condom negotiation skills, while reducing fear surrounding parent-daughter communication.

A mixed-methods, exploratory, quasi-experimental evaluation of a radio drama intervention to prevent age-disparate transactional sex in Tanzania

“…At endline some caregivers gained a more nuanced understanding of the long-term consequences of adolescent engagement in these relationships compared to baseline. Caregivers also reported increased knowledge of the challenges their daughters faced, promoting caregiver support for adolescent girls and encouraging parent-daughter connectedness, which has been found to help prevent agedisparate transactional sex (38,39).…”

Parent-Adolescent Communication on Sexual and Reproductive Health: Perceptions and Experiences of Out-Of-School Adolescent Mothers in the East Gonja Municipality, Ghana

“…In Muhwezi et al (2015) study, adolescents from rural-based schools expressed some level of dissatisfaction with the content of parent-child SRH communications. Parents' failure to teach "sex positive" behaviours and condom negotiation skills (Pichon et al, 2022) could have contributed to the pregnancies noticed among adolescents in the current study and has an important implications for SRH policy development in the near future.…”

“…Also, in a systematic review of 15 outcome studies, Usonwu et al (2021) noted that parents often used negative tones including threats, warnings and misinformation to deliver SRH information to adolescents. Although these approaches (cautioning) adopted for parentadolescent SRH communications may help to instill some fear and discipline in the adolescent girl, it has the potency to further dampen adolescents' confidence in sharing important SRH information with their parents and the effect can be very detrimental to their health (Pichon et al, 2022).…”

“…Adolescence is a special developmental period often associated with diverse sexual and reproductive health (SRH) risks (Pichon et al, 2022). The World Health Organization (WHO) defines an adolescent as an individual aged 10 to 19 years (Bekele et al, 2022), and describes this period as a rapid and formative phase of human development (Malango et al, 2022).…”

“…sex, sexuality, contraception, and sexually transmitted infections (STIs)) at an early age are more likely to learn or adopt safe sexual behaviors, including abstinence and protective behaviors that prevent pregnancy and STIs (Bekele et al, 2022). In a recent study, good parentadolescent SRH communication was found to have a positive correlation with good adolescent mental health, educational, and developmental outcomes (Pichon et al, 2022). However, in many homes and community settings in Ghana, parents still overlook this important social responsibility.…”