Obstacles to intergenerational communication in caregivers’ narratives regarding young people’s sexual and reproductive health and lifestyle in rural South Africa

Abstract

Background: Statistics from South Africa show the world's highest HIV prevalence with an estimated seven million people living with the virus. Several studies have pointed to communication about sexuality between parents/ caregivers and children as a protective factor. However, communication between generations has been described as problematic, especially due to discomfort in discussing sexual matters. The aim of this study was to explore how caregivers in a poor, rural part of South Africa talked about young people in general, their sexuality, and their lifestyle practices. A particular interest was directed towards central discourses in the caregivers' narratives and how these discourses were of importance for the caregivers to function as conversation partners for young people. Methods: In this qualitative study convenience sampling was used to select and invite participants. Information was collected from nine one-on-one interviews conducted with caregivers from rural areas within South Africa. The interview guide included nine main questions and optional probing questions. Each interview took place in an uninterrupted setting of choice associated with the caregivers' home environment. The interviews were transcribed and analyzed using discourse analysis. Results: Interview narratives were characterized by three central discoursesdemoralized youths in a changing society, prevailing risks and modernity and a generation gap. The youths were discursively constructed as a problematic group relating to specific prevailing risks such as early pregnancies, modern technologies, STI/HIV and contraceptives. The interview narratives illustrated that caregivers tried to impose their views of a respectable lifestyle in young people. At the same time caregivers expressed a morality of despair mirroring a generation gap which counteracted their ability to communicate with their children and grandchildren.

‘I can't go to her when I have a problem’: sexuality communication between South African adolescent girls and young women and their mothers

“…Linked to AGYW outcome expectancies described above, when AGYW view their parents’ attitudes as inflexible, outdated and irrelevant, and expect that engaging parents in SRH discussions will be fruitless or reactionary, AGYW avoid such interactions. Interventions for AGYW SRH in South Africa need to be sensitive towards socio-cultural norms, the traditional morals, and expectations of the older generation, while emphasising the importance of communication across generational boundaries (Nilsson, Edin, Kinsman, Kahn, & Norris, 2020 ).…”

“…In order to address barriers relating to parents’ self-efficacy, it would be beneficial for interventions to include strategies that provide parents/caregivers with a knowledge base and skill-set, to enhance their motivation and confidence in communicating around SRH topics with their adolescents, and create opportunities for communication and collaboration among parents/caregivers (AVAC, 2018 ; Guilamo-Ramos et al, 2008 ; Seif et al, 2018 ). The provision of knowledge to parents is one key ingredient, but must be combined with efforts to empower parent/caregivers, validating and addressing their potential discomfort towards talking about sex, and working to build their courage in discussing SRH, which will in turn increase their ability to be responsive to the needs of adolescents and support them to make safe and informed decisions about sex (Grossman et al, 2017 ; Nilsson et al, 2020 ).…”

“…Within South African cultural frameworks, maternal figures are expected to play the role of sexuality socialising agents of appropriate behaviours to girl-children, and are thus in a position to provide accurate SRH information to their daughters, and equip them with the knowledge and skills necessary for safe-sex competence, empowering them with the ability to make informed decisions regarding the engagement in protective behaviours (Mastro & Zimmer-Gembeck, 2015 ; Mudhovozi & Ramarumo, 2012 ). Interventions need to be designed and implemented in a manner that recognises the importance of communication across generational boundaries, is sensitive to generational norms, culturally and linguistically appropriate, and works to address socio-cultural norms and religious beliefs that may create resistance to open, inter-generational communication around sex (Nilsson et al, 2020 ). Further in-depth research to enrich understanding of how sexuality communication should best be included in SRH interventions in the South African context would be beneficial.…”

Combination prevention package of interventions for reducing vulnerability to HIV among adolescent girls and young women in Nigeria: An action research

“…An important consideration for program design is to create programs that target parent/caregiver-adolescent pairs as there is PLOS ONE some evidence that they are effective [49]. The interventions that mediate the intergenerational gaps between parents and adolescents by finding a common ground for them are likely to be effective interventions as such gaps have been implicated in poor parent-adolescent communications [50]. Some interventions may be presented via traditional and social media in order to bring them to scale.…”

‘A difficult conversation’: community stakeholders’ and key informants’ perceptions of the barriers to talking about sex and HIV with adolescents and young people in KwaZulu-Natal, South Africa

“…In addition, cultural and religious structures, personal knowledge and discomfort also affect parent's ability to have these conversations (Vilanculos and Nduna 2017). Research with adults in a rural South African context has shown that adults perceive their children to be modern, and themselves to be traditional, making intergenerational communication about issues of sex and lifestyle difficult (Nilsson et al 2020). Other research focused on maternal HIV disclosure has found that mothers felt a lack of capacity to have conversations with their children about sex-related issues but knew it was necessary, while not being sure how to initiate and conduct these discussions (Mkwanazi, Rochat, and Bland 2017).…”