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

Abstract

Background: Early adolescence (ages 10-14) is a critical period of physical, cognitive, social and emotional development, which affect sexual and reproductive health and rights. Yet, little is known about positive or healthy aspects of sexuality development during this period of life, especially in South East Asia where sexual norms remain restrictive. The objective of this study is to assess the prevalence and correlates of sexual wellbeing among early adolescent girls and boys ages in Indonesia.Methods: Data for this cross-sectional study were collected as part of the Global Early Adolescent Study via a school-based survey in three Indonesian urban sites in 2018 (N=4309). We assessed the prevalence of multiple indicators of sexual wellbeing (e.g. sexual and reproductive health knowledge and communication, gender attitudes, body satisfaction, self-efficacy, freedom from violence) and tested for differences by gender using Chi-square, Student t-test, and Wilcoxon rank-sum test. Multivariable logistic regression models were used to assess the adjusted odds ratio of selected indicators in relation to sociodemographic factors, romantic and sexual experiences. Results: The mean age of students was 12 years (53% girls); 90% had started puberty. Sexual and reproductive health knowledge and communication was low overall, but higher among boys than girls. Boys were more likely than girls to report high body satisfaction, less feelings of sexual guilt, but also to experience physical peer violence. In contrast, girls were more likely to hold gender equal attitudes, greater self-efficacy to say no, and to report being bullied by boys. In multivariable models, romantic experiences, perceived voice (boys and girls) and decision-making (girls) were associated with three or more indicators of sexual wellbeing. Conclusions: While young adolescents in Indonesia score high on some aspects of sexual wellbeing, misconceptions, feelings of guilt and uncertainties related to sexuality are common, with clear gender differences. These findings confirm the need for comprehensive sexuality education that begins early in adolescence.

“Such conversations are not had in the families”: a qualitative study of the determinants of young adolescents’ access to sexual and reproductive health and rights information in Rwanda

“…A recent scoping review concluded that young adolescents in low-and middle-income countries have inadequate SRHR knowledge, especially in terms of puberty and menstruation [40]. Young adolescents' SRHR knowledge in Rwanda is inadequate, as in many other settings such as Sub-Saharan Africa [30,41], Guangzhou City in China [42], Korea [43] and Indonesia [11]. The age of initiating sexuality education was another perceived determinant of access to SRHR information by young adolescents.…”

“…Early adolescence provides a window of opportunity to intensify the delivery of such SRHR information [9,10]. Through this socialisation process, young adolescents become significantly aware of their bodies, gender and sexuality [11]. Family members, media, and social institutions teach young adolescents appropriate behaviours [12,13] and norms for interacting, forming relationships, and engaging in social and sexual behaviours [14].…”

“…While the global developmental agenda focuses on enabling universal access to SRH information [3,5], extant literature does not have sufficient evidence on this aspect among young adolescents. Generally, research involving young adolescents in low-and middle-income countries, including Rwanda, is scant [11,26]. Studies involving young adolescents have focused on gender norms [9,27,28] and attitudes [14].…”

“…Studies involving young adolescents have focused on gender norms [9,27,28] and attitudes [14]. Assessing sexual wellbeing during early adolescence, Kagesten et al found that SRHR knowledge and communication were generally low in urban Indonesia [11]. Koenig et al assessed SRH communication patterns in early adolescence and found that socioecological factors such as older age and pubertal onset are associated with SRH communication [29].…”