COMMUNICATION BETWEEN MOTHERS AND THEIR ADOLESCENT DAUGHTERS ON THE SUBJECT OF SEXUALITY AND HIV/AIDS IN UGANDA
Abstract: In this study, the researcher intended to investigate the role played by mothers in providing information to their adolescent daughters on the subject of sexuality and HIV/AIDS. Specifically, the researcher wanted to establish the content, context and frequency of communication between mothers and their adolescent daughters in recognition of the emerging important role parents have to play in providing safe sex education to their children.
The World Health Organization (WHO) 30 cluster 7 quota sampling method was used to select households of the respondents. In all, 210 households, consisting of 210 mothers and 210 daughters, were sampled equally from Rubaga and Kabulasoke study areas.
Closed and open-ended questionnaires and focus group discussions were employed to collect quantitative and qualitives data, respectively. Data, entry and analysis was done using the EpiInfo-version 6 statistical computer package.
Results
75.8% (138/182) mothers revealed that they talked to their daughters on the subject of sexuality and HIV/AIDS while 24.2% (44/182) reported that they did not discuss with them.
67.9% (125/184) daughters acknowledged their mothers' having talked to them about sexuality and HIV/AIDS. However, 32.1% (59/184) or a third of the daughters reported their mothers had never talked to them about sexuality and HIV/AIDS. The mean age of daughters at which mothers reported they initiated the discussion did not significantly differ from that reported by daughters (p= 0.923). Significant differences were, however, noted on the frequency of communication as reported by mothers and their daughters (p= 0.008942). The content of the messages given or received as reported by mothers and their daughter were more or less similar.
In Uganda today, the number of sexually active adolescents is on the increase. Indeed, many parents, especially in this era of the deadly AIDS epidemic, are perplexed about what to do for their children. The general breakdown of society's moral values brought about by social strife since independence, coupled with the breakdown of the social infrastructure, including schools and health services, rural-urban migration, have changed adolescent sexual behaviour considerably. Today, it is no longer valued and necessary for a bride to be a virgin as it used to be in Ugandan tradition. Pre-marital sex has become much more common. Traditionally, adolescent girls received sex education from a female family member, mostly an adult auntie or a grandmother. The event that led to this sex educational conversation was often the first menstruation. Girls would then get instructed on female hygiene, abstinence during menstruation, on how to please a man sexually and finally on the sexual act itself. Any sexual activity was only allowed after the girl got married. Tradition obliged women to keep their virginity until marital vows had been taken. Therefore girls had their first sexual experience at a much later age than nowadays.
The AIDS Control Program estimates that as of June 1993, women constituted 51.9% of AIDS cases. Another consequence of this has been deteriorating trends in infant mortality rates, in spite of aggressive efforts to immunize children, which can be attributed to the AIDS epidemic and the corresponding vertical transmission from mother to child. Article 12 of the Convention on Elimination of all forms of Discrimination Against Women (CEDAW 1995) committed state parties to intensify efforts in dissemination of information to increase public awareness of the risk of HIV infection and AIDS among women, and to the factors relating to the reproductive roles of women and their subordinate position in some societies, which makes them vulnerable to HIV. The article emphasized active participation of women in primary health care and aimed to enhance their role in health education and communication in the prevention of HIV/AIDS among others.
However, up to today, communication between parents and their children about sex and the risks involved has always been limited, partly because it is seen as a "taboo subject" and partly because parents do not see it as their duty to inform their children. In the past, it was seen as a duty of the members of the extended family. However, with the breakdown of strong extended family ties today, it has increasingly become necessary for the mothers to assume the role of providing sex education to their adolescent girls in particular and children in general.
Sexual health problems ranging from early pregnancies, abortions, sexually transmitted diseases and HIV/AIDS are among the major health problems affecting adolescent girls in Uganda today (Lubega et al. 1989). Risky sexual practices are common among adolescents with mean age for first sexual intercourse at 15.7 years for girls (Sentumbwe 1993). The incidence rate of HIV/AIDS has risen most rapidly among adolescents of the age group 15-19 years, especially girls. Adolescent girls have six times higher risk of getting infected with HIV than boys of their age . Almost 30% of girls between 15-21 years have reported to having an abortion (Agyei et al. 1990). The Beijing Declaration and Platform for Action (1995) recognized that adolescent girls need, but often do not have access to necessary health information and educational services as they mature. Counselling and access to sexual and reproductive health information and services for adolescents girls has been inadequate or lacking completely, and a young woman's right to privacy, confidentiality, respect and informed consent has often not been considered. Adolescent girls are both biologically and psycho-socially more vulnerable than boys to sexual abuse, violence and prostitution, and to the consequences of unprotected and premature sexual relations. The trend towards early sexual experience combined with a lack of information and services increases the risk of unwanted and early pregnancy, HIV infection and other sexually transmitted diseases, as well as unsafe abortions.
Because of their high risk to sexual health problems and HIV/AIDS, there was need to explore the role mothers could play in providing information to the adolescents on the subject of sexuality and HIV/AIDS. There was also a need to establish the content; context and frequency of communication between mothers and their adolescent daughters in recognition of the emerging important role parents have to play in providing safe sex education to their children. This study investigated these issues.
This study was designed to answer the following research questions:
· What role did mothers play in providing information to their adolescent daughters about sexuality and HIV/AIDS? In Which ways could this be improved to meet the desired goals?
· What is the content, context and frequency of communication between mothers and adolescent daughters about sexuality and HIV/AIDS?
· What factors impeded effective and harmonious communication about sexuality and HIV/AIDS between mothers and daughters?
· What were the other different sources of information about sexuality and HIV/AIDS for the adolescent girls?
· How did they differ in the kind of message that the different sources conveyed? Especially, what difference existed in the content and context of message between sources within the family and sources outside the family?
· Who are the other trusted persons and various potential sources of reliable information about sexuality and HIV/AIDS that could provide good sex education to adolescent girls?
1.4.1 Purpose
This study had both basic and applied purposes. As basic research, the theoretical findings aimed to add knowledge on how mothers and their daughters communicated on the subject of sexuality and sex education as it relates to HIV/AIDS. Intellectuals, policy makers and service providers could use the empirical findings. By establishing the role communication between mothers and daughters on the subject of sexuality and HIV/AIDS contributed to knowledge and adolescent sexual behaviour, the study attempted to situate the research within the imperative of policy and program analysis and would contribute towards policy and program formulation to improve on the benefits of effective communication between mothers and daughters.
1.4.2 Specific Objectives
· To establish how communication between mothers and their adolescent daughters about sexuality and HIV/AIDS contributes to sex education as a whole, and especially education about HIV/AIDS.
· To establish the content, context, occasion and frequency of communication between mothers and daughters about sexuality and HIV/AIDS
· To identify barriers to effective and harmonious communication between mothers and daughters, and how this could be improved.
· To identify the different sources from which adolescent girls obtain information about the subject of sexuality and HIV/AIDS.
· To determine the different (moral) messages which the different sources convey and establish the differences that might exist in the content and context of messages between sources within family and sources outside family.
· To identify other possible trusted persons who could give sex education, and education about sexuality and HIV/AIDS to girls, and the various other potential sources of reliable information on sex education.
Over the years, there have been changes in societal values and attitudes. Some of the consequences of these changes have been that the age at which girls have their first sexual contact has gone down, with certain drastic consequences concerning the subject of sexuality and HIV/AIDS. Several factors have contributed to this; the most conflicting ideas about pre-marital sex, the increasing urbanization, emergence of migrant labour, and the phenomena of "sugar daddies" and westernisation among others.
Urbanization has led to looser family ties. Complete families no longer live close together. The implication to these recent developments has been that traditional sexual educators are not always in the close vicinity to give children advice on sexually related subjects. The grandmothers and aunties are no longer there to pass on traditional values about sex and sexuality. The consequence has been increased morbidity and mortality from sexual health problems among adolescents, including HIV/AIDS.
This study focused on daughters because they are more vulnerable to HIV/AIDS than their male counterparts for various reasons. First, women have less access to information on HIV/AIDS and STDs. They are less educated than men, and have higher illiteracy levels. At the same time they are over-burdened with work and have little or no access to meetings or programs about good health-seeking behaviour. Second, biologically, women are more vulnerable to HIV/AIDS, and younger girls more so than mature women. STD/HIV/AIDS intervention strategies worldwide created awareness but did not consider women vulnerability. Neither have strategies to solve women's' issues been considered. This research thus explored new innovative ways, which have emerged, to give access to young women and the girl child to HIV information and sex education within and out of their families to bridge this information gap. The study further examined the role mothers could play in communicating issues about sexuality and HIV/AIDS to their daughters.
Several KAP and behavioural studies have been done on the subject of sexuality and HIV/AIDS among adolescents and youth in Uganda (Lubega et al. 1989), Ankrah (1987), Bagarukayo (1990), Sentumbwe et al. (1993). However, most of these studies have focused on establishing statistical and factual biomedical knowledge (Kristiansen 1991) without seeking in-depth knowledge and sources of information. Most of these studies have focused on the subject of HIV/AIDS as an isolated problem paying little attention on how integral HIV/AIDS infection is to the whole subject of sexuality and sex education.
Many of these studies have sought quantitative data without seeking the more qualitative in-depth information such as the content and context in which this information is received (Kristiansen 1991). The traditional extended family system has been weakened and as such, the information and knowledge for adolescent girls from traditional sources such as aunties and grandmothers has also weakened. However, no research had been done to establish the new emerging role, mothers (and fathers) could play in communicating with their daughters (or children) on the subject of sexuality and HIV/AIDS now days. There was also a need to seek for more qualitative in-depth information by use of triangulation, that is, several methods of investigation like Focus Group Discussions and participant observation.
Previous studies reported the common sources of information about sexuality as being friends/peers (46%), parents/guardians (14%), teachers (12%), radio (11%), health workers (5%) and other sources constituted 60% (Sentumbwe et al. 1993). However, the studies did not give details on the actual information given, the content, context, occasion and frequency of information from those sources. Most studies contended on the need to include AIDS education in School Health Education (Ankrah et al.. 1989; Abaho et al. 1991) and to improve teachers' ability to teach health education (Bagarukayo 1990). However, none of these studies examined the need and the role that could be played by mothers communicating to their daughters. According to the study by Sentumbwe et al. (1993), only 5% of the adolescents mentioned having ever discussed sexual matters with their parents. Mostly adolescents discussed such matters with friends (60%), other relatives (10%) while 25% did no discuss with any one. In most of these studies, parents were generally in favour of more education of their children about AIDS (Ankrah 1987), but had a negative attitude towards expanding the amount of sex education. This, therefore, suggested the need to study what information parents thought was useful to give to their children and under what circumstances.
As regards current patterns of sexual behaviour among adolescents, studies by Agyei et al. (1990) and Lubega et al. (1989) revealed that the majority of adolescents began their sexual activities at quite an early age. Premarital sexual experiences were common and the mean age at the first sexual intercourse was 15.1 years for males and 15.5 years for females. Almost one third of female respondents between 19 and 20 years had had an abortion. However, the observed knowledge about sexuality and STDs was not utilized for the prevention to any significant extent - either through sex abstinence or condom use (Lubega et al. 1989). Similar studies by Sentumbwe et al., (1993) among rural youth and Makerere University students (1996) revealed similar findings. All these findings confirmed that risky sexual behaviours were prevalent among adolescents.
In an answer to why this was so, Faul-Doyle (1990) gave the best explanation. She contended that the danger of using schools to disseminate sex and AIDS information lay in the very nature of the formal education system, which put strong emphasis on paper qualification. Thus, the formal education system had either stagnated or been financially incapable. The only objective of parents, teachers and pupils alike, was to pass exams and gain qualification (Sentumbwe et al 1996). In this regard, issues of sexuality and HIV/AIDS, on which they were not examined, raised little interest. The implication to this was that a communication and information gap existed where children could not receive sex education in its right content and context.
Studies about communication between parents and their children concerning sex and the risks involved with it had been few. A study among rural parents revealed that only 16% of the respondents had talked about HIV/AIDS with their children. This reflected the traditional norm in Uganda that parents did not communicate with their children about sexual matters. However, with increasing urbanization and the resulting loosening of the extended family ties, there was need to examine the role mothers could play in communicating to their daughters about sexuality and HIV/AIDS. There was also a need to examine differences that may exist in the different sources of information within family, and sources out of the family, in order to identify communication and information gaps for improvement.
