Associations Between Agency and Sexual and Reproductive Health Communication in Early Adolescence: A Cross-cultural, Cross-sectional Study

Abstract

Purpose To assess the extent to which adolescents aged 10–14 have communicated about sexual relationships, pregnancy, and contraception and how agency in the form of voice and decision-making along with an enabling socioecological environment are associated with sexual and reproductive health (SRH) communication. Methods Using data from the Global Early Adolescent Study, we included 1,367, 697, and 1,424 adolescents in Kinshasa, Cuenca, and Shanghai, respectively. Patterns of SRH communication and agency levels were described by site and sex. Multivariable logistic regressions assessed odds of SRH communication first in relation to socioecological characteristics and second with levels of agency, after adjustment for social environmental factors. Interaction terms tested sex differences in associations. Results Experiences of SRH communication ranged from one in ten in Kinshasa to about half in Cuenca. Pregnancy was the most discussed SRH topic. Socioecological factors consistently related to SRH communication included older age and pubertal onset, while others varied by context. In multivariable analyses, voice was linked to all forms of SRH communication in Kinshasa and Cuenca with adjusted odds ratios ranging from 1.6 to 2.2, but not in Shanghai. In Cuenca, decision-making was associated with a 50% and 60% increase in odds of communication about pregnancy and contraception, respectively. In Kinshasa, a stronger association between voice and pregnancy discussions was observed for girls than boys. Conclusions Developmental characteristics and voice were linked to communication about SRH among young adolescents across two contexts. Results suggest agency may play a role in shaping antecedents, like communication, to sexual behaviors.

Sexual Wellbeing in Early Adolescence: A Cross-sectional Assessment Among Girls and Boys in Urban Indonesia

“…Speci cally, we found that girls reported lower SRHR knowledge, poorer body satisfaction, more feelings of guilt, and lower selfe cacy to prevent pregnancy than boys. Voice and decision-making seemed to be especially linked with sexual wellbeing for girls, similar to how research with 10-14-year-olds in other urban poor settings have found perceived agency to correlate with SRH communication [25]. In contrast, boys were more likely to hold gender stereotypical attitudes, less self-e cacy to "say no", and to report having experienced bullying and violence, while simultaneously reporting lower educational aspirations and parental connectedness -both of which were associated with sexual wellbeing.…”

Sexual wellbeing in early adolescence: a cross-sectional assessment among girls and boys in urban Indonesia

“…Specifically, we found that girls reported lower SRHR knowledge, poorer body satisfaction, more feelings of guilt related to sexuality development, and lower self-efficacy to prevent pregnancy than boys. Voice and decision-making seemed to be especially linked with sexual wellbeing for girls, similar to how research with 10–14-year-olds in other urban poor settings have found perceived agency to correlate with SRHR communication [ 25 ]. In contrast, boys were more likely to hold gender stereotypical attitudes, less self-efficacy to ‘say no’, and to report having experienced bullying and violence, while simultaneously reporting lower educational aspirations and parental connectedness—both of which were associated with sexual wellbeing.…”

Understanding Sexual Agency. Implications for Sexual Health Programming

“…Additionally suggested in the literature is the need for the creation of personal narratives, as they are necessarily "the site where agency emerges" [71]. Koenig et al [72] found the extent to which young adolescents have communicated about sex-related issues (relationships, pregnancy, and contraception) to be positively related to aspects of agency, such as voice and decision making (although not consistently across all contexts). Munford and Sanders [40] also recommended the articulation of needs and feelings and giving young people a voice.…”

“…Parenting programs are indispensable in SRHR programming and have indeed already been shown to be able to positively impact SRHR outcomes [78]. These programs enhanced parents' own knowledge and self-confidence to discuss SRH issues with their children-an important building block for subsequent communication and support, which in turn is an important building block for young people's creation of personal narratives related to their sexuality as a crucial site for their sexual agency [72].…”