Promoting responsible sexual behaviour among school-going adolescents in Mpumalanga province in South Africa

Abstract

Background

Irresponsible sexual behaviour among school-going adolescents is a major concern among different stakeholders in South Africa. In 2019, among 106 383 registered live births among adolescents in South Africa, 10% were in the Mpumalanga Province.

Objective

This article explores and reports on the challenges that school-going adolescents face in achieving responsible sexual behaviour and aims to develop effective recommendations to promote safer sexual behaviours.

Methodology

This article was an extract from the main study that employed a qualitative inquiry using an exploratory and descriptive phenomenological approach. The main study was conducted between 2021 and 2022. The current study explores and describes challenges school- going adolescents aged 15 to 19 years face in achieving responsible sexual behaviours. The data were collected via focus group discussions in high schools in one of the townships in the Mpumalanga Province in South Africa. Non-probability sampling using snowballing from the sample of school-going adolescents who previously participated in the main study’s quantitative strand enabled the selection of a sample of 14 school-going adolescents who were able to contribute meaningful information to the study. Qualitative data were analysed manually using Creswell’s thematic analysis, with emerging themes, subthemes and categories.

Findings

Six themes emerged from the inductive manual thematic analysis: Overwhelming pressures to engage in unsafe sexual behaviours; diffused parental role in awareness and support around adolescents’ sexual and reproductive health (SRH); poor sexual and reproductive health knowledge ; immaturity, lack of self-control and curiosity; poor access, acceptability and utilisation of SRH services and financial constraints in the relationship were reported as challenges adolescents faced to achieving safer sexual well-being.

Conclusions

The findings revealed that adolescents face many challenges to achieve responsible sexual behaviour. Actionable recommendations were devised to overcome these challenges and these are: involving peer educators who share SRH information, guide, and promote behaviour change. Adolescents must utilise role models, parental and adolescent support groups whom they can emulate from healthy sexual behaviours. Adolescents must seek strong parental support when utilising SRH services like contraceptive use. Campaigns that encourage parents to be role models of good values, morals and social skills should be initiated. Peer adolescents should promote access, acceptability and utilisation of adolescents’ SRH services. Media platforms like links and websites where correct sexual and reproductive health knowledge should be accessible by adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-26086-6.

Background

Adolescence is a time of sexual exploration that is natural and part of growing up [1]. However, some adolescents’ sexual exploration result in unsafe sexual behaviours resulting in negative consequences such as unplanned pregnancies. For example, in Mpumalanga Province learners fell pregnant [2]. Pregnant adolescents may not be able to pursue rewarding careers, and future ambitions [3]. Safe sexual behaviour is defined as a socially desirable and deliberative pattern of behaviours that protects an individual’s sexual health by managing risk and respecting sexual partners in the context of their community [3–5]. The qualities of safe sex include abstinence [4], being well informed about sexual and reproductive health (SRH), maintaining healthy relationships. Good communication, supporting each other, maintaining equality and fairness, trust, honesty, mutual respect, spending quality time in a relationship, and consistent contraceptive and condom use promote safer sexual behaviours [3]. However, in Mpumalanga Province, some sexually active adolescents face challenges to maintain these qualities by engaging in sexual behaviours that place them at high risk of unplanned pregnancies [2], human immune deficiency virus infection (HIV) and other sexually transmitted infections (STIs) [6]. For instance, in 2022, a survey explored consistency of condom use with the most recent sexual partners. Among the participants, 20% were adolescents aged 15 to 19 years from Mpumalanga Province. The evidence revealed that 32.4% (%) of adolescents never used condoms, 32% sometimes used condoms, 11% used condoms almost every time while 24.6% used condoms every time [26, 27]. Hence, the inconsistent condom use increased the risk of new HIV and STI infections among adolescents [3, 4, 6, 7]. In Mpumalanga News, it was reported between 2021 and 2022, the province recorded about 8643 pregnancies among adolescents 15 to 19 years and 297 pregnancies among 10-14years [2].

In a study carried out in Mpumalanga Province, the findings revealed that most adolescents became sexually active at a young age despite being affiliated to religion that discouraged premarital sex and promoted abstinence [8, 13, 14]. Abstinence is a 100% safe, free and effective practice that prevents pregnancy, HIV and STI infections. A number of studies have shown that adolescents who abstain from sex are more likely to graduate from high school and attend tertiary education than sexually active adolescents [6, 7, 11, 12, 16]. However, the reliance on religion only has proven ineffective with some adolescents in Mpumalanga Province as they ultimately engaged in sexual intercourse without being properly oriented to the reality of the implications of unprotected sexual intercourse [10–13]. There is evidence that some religious adolescents who did not take contraceptives got unwanted pregnancies and contracted sexually transmitted infections (STIs), including human immune deficiency virus (HIV) [13, 18]. Studies showed that some adolescents could not stay with one and same partner once they had sex at a young age. The reasons vary with individuals: the adolescent’s brain which may still be developing particularly in the regions related to impulse control, decision making, and lack emotional maturity to navigate complex relationships leading to disappointment, and lack of commitment to long term relationships [11, 12]. Peer pressure, family dynamics and social norms can encourage casual relationships among adolescents contributing to having different partners, thus increasing the risk of unwanted pregnancies, termination of education, unsafe and illegal abortions and multiple sexual partners [9]. Early sexual debut predisposed adolescents to HIV or STI infections [14, 17, 19, 27, 28]. Interpersonal or legal conflicts, stress, myths and misconceptions of sexual and reproductive health [12]. Hence, the Mpumalanga Department of Education remained concerned even when one learner got pregnant, hence the it continued to sensitise adolescents and communities of consequences of adolescent pregnancy [Mpumalanga News] [28, 29].

Inconsistent condom usage and having unprotected sex either anal or oral sexual intercourse with multiple partners is common among adolescents in South Africa [9, 20–22] due to age disparate sexual relationships, as a result adolescents are not in a favourable position to negotiate safe sex predisposing them to HIV and STI infections [7]. Practising irregular or transactional sex or engaging in sex under and/or with a drug user or a person under the influence of drugs (psychoactive substances) and alcohol is dominant in Mpumalanga Province [7, 23–25]. Contraceptive use is low among adolescents despite widespread freely available contraceptives, the dissemination of reproductive health education [36, 37], progressive reproductive laws and structures in South Africa and awareness campaigns run by public health and non-governmental organisations (NGOs) like Love Life [18, 28, 29]. Given that most adolescents still do not adhere to safer sexual behaviours, negative sexual experiences among adolescents are rife.

Methods

Study design and theory

The study design utilised was a qualitative inquiry using an exploratory and descriptive phenomenological approach, wherein the aim was to explore the adolescents’ lived experiences of their sexual behaviours. The theory of planned behaviour (TPB) guided the study by suggesting that a person makes an intentional decision to engage in specific behaviours guided by a combination of attitude, subjective norms and perceived behavioural control [30]. The theory of planned behaviour was appropriate for the study of adolescents’ sexual behaviour as adolescents are developing their critical thinking skills, thus making TPB’s focus on attitudes, norms and perceived control relevant. Social influence plays a significant role in shaping adolescents’ attitudes and behaviours aligning with TPB’s subjective norms. Furthermore, TBP acknowledges that adolescents’ decisions about sexual behaviour are influenced by their perceived control over their actions and TPB helped to explain why adolescents intended to engage in safe sexual practices but failed due to various factors.

Study setting

A qualitative study was carried out in one of the townships in the Mpumalanga Province in South Africa. Mpumalanga Province was one of the provinces with a high incidence of HIV infection and STIs among adolescents in 2017. Adolescents in townships of Mpumalanga Province were more affected than those living in towns, which made it an ideal setting for this study [32, 33]. Two schools were selected in the township for the site of the study. The main study was carried out between 2021 to and 2022.

Study population and recruitment

This article was extracted from the main study comprising of school-going adolescents, aged 15 to 19 years, who resided in the selected township (name withheld due to the sensitivity of the topic). At the school level, permission was obtained from the principals first who allocated Life orientation teachers to assist with recruitment. Two schools participated in the study. The principal researcher and Life orientation teachers engaged students in class about the study. The principal researcher educated the students about what the study was about and allowed them to ask questions, which were answered. Parents of participants less than 18 years were also informed and educated of the aim of study. Informed assent consent to participate were obtained from the parents of underage participants and school-going adolescents aged 18 and above gave their consent. For reaching a hard-to- access population within a school setting, the researcher selected participants utilising snowball non-probability sampling. The recruitment took two months [34]. A sample of 14 school-going adolescents participated in two focus group discussions (FGDs), each with seven male and female participants combined.

The eligibility criteria to participate was as follows: Both male and female adolescents, aged 15–19 years, who had participated in the main study, living and attending school in one of the high schools in the township were eligible. Adolescents who spoke and understood English at a basic level were ideal given that at this stage, adolescents are considered mature and understand the subject of sexuality and English language, hence were able to provide required information for the study. Schools in the township were eligible because they are a place to impart knowledge, and all schools in the township used English as the medium of instruction.

Data analysis

A structured discussion guide created by the authors, guided the FGDs through a series of questions delved on sexual experiences of adolescents and challenges they faced to achieve safer sexual well-being (see Annexure A, attached). The main question and probing questions of the focus group discussions captured components of the TPB namely the attitudes towards sexual behaviour, whether favourable or unfavourable, subjective norms and pressures to perform or not to perform risk sexual behaviour and perceived control regarding challenges to achieving safe sexual behaviours. Expectations, actions of important persons (like adolescents’ partners, peers, parents, teachers, and health professionals) and the adolescents’ motivation to comply were explored by seeking to understand adolescents’ perceived power/control beliefs related to safe sexual behaviours. (Ajzen 2012:18). The FGDs were mixed sex. The female principal investigator facilitated the FGDs. To overcome barriers to open discussions about sex, the facilitator established a comfortable and private classroom environment where both boys and girls felt secure, introduced herself and explained the purpose of the study, ensured confidentiality and showed genuine interest in the topic. The discussion was non-judgmental, open communication was encouraged and the facilitator listened actively. All participants were allowed to ask questions to seek clarifications. The focus group discussions were carried out in English language. Both FGDs were 45 and 60 min in duration and on average the FGDs lasted 53 min. FGDs were audio recorded, moderated and supplemented by note taking of the key points by the principal researcher. The main question posed was “What are the challenges school-going adolescents face in achieving safer sexual behaviour? The researcher probed further to get rich information from participants, to understand more about safer sexual encounters and to clarify whether there were misunderstandings. Manual Creswell’s thematic data analysis approach was utilised [31]. Themes and patterns taking into consideration, the TPB components were identified. The principal researcher PS transcribed the data by immersing herself in the data through listening to the audio recordings, reading and re-reading the transcript and writing down initial ideas in cooperating written notes into the transcription. An inductive method was used to generate codes which were grouped into probable themes based on components of TPB: attitudes, norms and perceived control. The themes were further grouped into categories and sub-categories. These were reviewed by supervisor FH and three participants, to check if the themes were appropriate in relation to the codes extracted and if they represented what adolescents truly wanted to say. Data collection was discontinued when saturation was reached. Professor FH supervised the principal investigator PS in data analysis process [31].

Ethical considerations

In accordance with the Declaration of Helsinki where the study involved human participants, ethical clearance was obtained from the Research Ethics Review Committee of the Department of Health Studies, UNISA with reference number REC-012714-039 (NHERC). Based on this clearance, ethical approval was obtained from relevant authorities in the Mpumalanga Provincial Department of Education, at the district, and circuit level in the Mpumalanga Province. Permission to conduct the study was granted through official letters from the Ethics Committee to Sub District Offices and then to the management of selected and participating schools. Participants were informed about the purpose of the study, reporting of study results and interview recordings. Written informed consent were obtained from participants before data collection. Participation was voluntary. I explained that even after consenting, participants could withdraw from the study at any time without penalty if they so wished. Participants were kept anonymous by giving them code numbers instead of names. The information was kept confidential and kept under lock and key. Only the principal researcher and her supervisor had access to the information.

Theory of planned behaviour

The theory of planned behaviour emerged from Theory of Reasoned Action, which explains the of a person to engage in a particular behaviour through six constructs [30]. Three beliefs namely behavioural intention, normative beliefs and control beliefs, shape a person’s attitude, subjective norms, and perceived behavioural control which influences an individual’s intention to perform behaviour [30]. Henceforth, the TPB constructs guided the researcher to explore strategies to promote safe sexual behaviours based on deeper understanding of the intentions behind the adolescents’ sexual behaviour. Contextually, behavioural intention refers to the factors that strengthen or weakens the intention to perform the behaviour giving growth to attitude towards certain behaviour and influenced by its outcomes [30]. Normative beliefs take into context the cultural context centered around the behaviour which influence an adolescent’ subjective norm to seek approval from their peers and people they value. Control beliefs refers to the factors that influence the performance of the behaviour and the adolescents’ control over each of those factors giving rise to the perceived behavioural control of the adolescent depending on the degree of difficulty in carrying out the behaviour [30]. The theoretical framework will be explained further in the results section.

Result

Socio-demographic profile

Fourteen adolescents aged 15 to 19 participated in two focus groups, with seven participants in each group. Six participants were male (43%), and eight participants were female (57%). The majority of adolescents (43%) were between 17 and 18 years and attending grades 11 and 12. Fewer sampled adolescents were in grade 10. Most mature adolescents were more eager to participate than young adolescents, and they provided more in-depth knowledge that contributed meaningfully to the study. Table 1 below shows their demographic data:

Table 1.

Demographic data of participants

Demographic variables	Frequency	Percentage (%)
Gender
- Male	6	43%
- Female	8	57%
Age range
- 15–16 years	5	36%
- 17–18 years	6	43%
- 18–19 years	3	21%
Level of schooling
- Grade 10	3	21%
- Grade 11	6	43%
- Grade 12	5	36%

Table 1 extracted from “Strategies to promote responsible sexual behaviour among school-going adolescents in Mpumalanga Province in South Africa 2022: 153

Six themes emerged from the inductive manual thematic analysis. The results were unpacked as themes, categories and sub-categories. Each of these will be unpacked in Table 2 below:

Table 2.

.

	Themes	Category	Sub-category
Behavioural beliefs and attitudes	Theme 1: Access, acceptability and utilisation of SRH services	Poor access, acceptance and use of SRH services	Lack of transport money Lack of time. Lack of preferred contraceptives Lack of will-power to access the SRH services. Lack of acceptable youth friendly services, lack of confidentiality and privacy. Judgmental and rude health care providers. Some schools were not well-equipped to provide complicated SRH services
	Theme 2: Financial constraints in relationships	In a relationship male partners are supposed to take care of females financially.	Dumping of poor male partners. Multiple sexual partners
Normative beliefs and subjective norms	Theme 3: Overwhelming Pressures due to expectations	Adolescents faced too many expectations from significant others.	Peer pressure Pressure from parents to maintain virginity. Intimate partner pressure Peer stigmatisation
	Theme 4: Diffused parental role in adolescents’ sexual and reproductive health	Parents’ absent role in adolescent’ life and parents’ sexual behaviours.	Culture as a barrier to SRH communication. Lack of parental involvement Parents’ convictions. Lack of adequate adult supervision during and after school. Parents’ sexual misbehaviour. Lack of family structure. Lack of activity after school, and lack of adult supervision.
Control beliefs and perceived behavioural control	Theme 5: Poor sexual and reproductive health knowledge	Heavy reliance on media fallacies regarding SRH.	Not listening to elders’ SRH advices Choosing wrong SRH information from media.
	Theme 6: Immaturity, Lack of self-control and curiosity	Transition from childhood to adulthood	Immaturity. Lack of self-control. Curiosity. Males did not have the patience to wait. Lack of commitment to long term relationships. Short moments of joy and one night stands. Curiosity.

Table 2 extracted from “Strategies to promote responsible sexual behaviour among school-going adolescents in Mpumalanga Province in South Africa 2022: 147

Behavioural beliefs and attitudes

Adolescents’ negative feelings towards sexual and reproductive services led to poor access, poor acceptability and poor utilisation of SRH services. Furthermore, financial constraints in the relationship were contributing factors to negative attitude towards safe sexual behaviour practices.

Theme 1: Access, acceptability and utilisation of SRH services

This theme was discussed into three sub-themes namely poor access, acceptance and use of SRH services and these will be discussed below utilizing different sub-categories:

Some adolescents faced difficulties in accessing SRH services due to lack of transport money to go to clinic. “Sometimes we fail to have even R20 to catch a local taxi to clinic.” (Female,15years).

Some adolescents lacked will-power to access the SRH services despite knowing where the SRH services are. “…we getting them there [contraceptives] but we are lazy.” (Female, 18 years).

Given that the public clinics in the area provide fragmented SRH services, there is lack of acceptable youth friendly services, lack of confidentiality and privacy which made accessibility difficult as other adolescents were uncomfortable given that there was a chance of meeting a person whom they knew. Hence, adolescents feared stigmatisation and that parents might know that they are sexually active.

“Preventing its sensitive because neighbour will talk about me to my parents or other people [if they see me]. Then everyone will know that I now have sex].” (Female, 17 years).

Judgmental and rude health care providers deterred adolescents from accessing SRH services, “Nurses judge us not straight forward but by their actions are rude”. (Male, 19 years).

The unavailability of preferred contraceptives caused poor use of SRH services by some adolescents predisposing them to unplanned pregnancies.

“Most of us we use injections. Sometimes we do find one type or all of them out of stock. We are forced to take that which is available. This disturbs our periods.” (Female, 16 years).

“…then we stop contraceptives… that’s how I got pregnant”. (Female, 17 years)

The findings revealed that some adolescents did not have time to visit clinics due to commitments to their schoolwork, especially those in grade 12 as they go to school every day. Lack of time jeopardised their chances of utilising contraceptives to prevent unwanted pregnancies.

“I do have problems with time, I am always at school for me to go to clinic.” (Female, 18 years).

The findings revealed that some adolescents preferred Life orientation sessions at school to get valuable SRH information. However, some schools were not well-equipped to provide this school-based SRH services. For instance, adolescents felt that teachers are few and some were inexperienced and not trained in managing the number of adolescents who need complicated SRH services. This created SRH knowledge gaps among adolescents pre-disposing them to risky sexual behaviours.

“There are less teachers to teach us. Just imagine one teacher teaching more than 200 students of LO?” (Female 18). -.

Theme 2: financial constraints in relationships

The responses revealed that female adolescents still believed that in a relationship male partners are supposed to take care of them financially. Failure to do so, led to dumping. This is an indirect sexual exchange for money most adolescents did not acknowledge as a predisposing factor to multiple sexual partners.

“…we dump them if they are not able to look after me” (Girl, 16 years).

“[females]… they are not reliable they can abandon you anytime [if there is no money].” (Male, 19 years).

Negative attitude emerged when male school-going adolescents were pressured by girlfriends to level up economically with working-class males. Otherwise, males risked being dumped or to be shared with another partner and this led to risky sexual practices like poor and unsafe relationships and multiple sexual partners.

” I can-not wait for these small boys to grow up and be financially stable” (Girl,16 years).

Normative beliefs and subjective norms

Intense social pressure from peers and romantic partners were drivers to unsafe sexual behaviours. In addition, lack of parental guidance on sexual and reproductive health reflected weaker expectations from parents for adolescents to practice safe behaviours.

Theme 3: overwhelming pressures due to expectations

Adolescents faced too many expectations from peers, parents, and intimate partners. For instance, the findings revealed that some peers shaped adolescents’ sexual behaviours by luring others with flashy materials bought by partners which their parents could not afford. Some adolescents intentionally rode on free transport from boyfriends to and from school putting pressure on adolescents who practiced abstinence to initiate sexual encounters with boyfriends with cars to have free transport benefit. Thus imposing themselves to risky behaviours.

“Adolescents wants nice things parents cannot buy. Friends dress nicely and do not use Avanza (public local transport) (Female, 17 years).

The findings revealed that male adolescents feared peer stigmatisation or being ostracized if they were not involved with many girls.

…On the other hand, boys want status among other boys by having many girlfriends… otherwise they will be laughed at if they don’t have” (Male, 18 years).

Some school-going adolescents felt overwhelmed by parents’/guardian’s pressure to maintain virginity. This created curiosity, tension and rebellion among some adolescents leading them to engaging in irresponsible sexual behaviour. The following excerpts from participants illustrate the challenges adolescents faced:

“I do not see the reason why our parents want us to remain virgins… I have already tested the forbidden fruit… Laughs”. (Female,18 years).

Intimate partners pressurised adolescents to have sex by threatening to leave or by forcing adolescents to prove their virginity. For fear of being left out for another girl, adolescents gave in to sexual behaviour which they were not ready for.

“We are pressurised by our boyfriends to have sex. For example, when you tell him that you are not ready they leave you for the next weak girl because they do not get what they want… (Female,15 years).

Some adolescents were not believed in by peers and their partners when they indicated that they were still virgins. Hence, due to peer pressure some adolescent girls gave in by giving away their virginity, placing them at high risk of unsafe sexual behaviour.

“…and they do not believe any girl is a virgin” (Female,15 years).

The findings revealed that religion promoted healthy sexual behaviours among some adolescents by promoting sexual abstinence. However, those who practiced abstinence, found it very difficult to commit to lasting relationships due to stigma from peers. The following excerpt reveals the challenge,

“…if it happens that they know that you are a virgin and follow church teachings, they laugh at you, stigmatise you and call you holier than thou….” (Female 16 years).

Theme 4: diffused parental role in adolescents’ sexual and reproductive health

The sub-themes that emerged were: cultural barrier to SRH communication, lack of parental involvement, parent convictions in adolescent sexual health and lack of adult adequate supervision during and after school.

Culturally, adolescents were not free to talk about sexuality as it was considered culturally taboo for adolescents to have sex-related discussions with their parents and vice versa.

“It has always been taboo for a child to feel free to talk about sex with your parents. This acts as a barrier for us to learn through parents who are most trusted sources of information… (Male 19 years).

Parent convictions such as principles, cultural, religious beliefs and values hindered most parents to discuss sexual and reproductive health with adolescents.

“It is not just on for my parent to talk to me about sex.” (Female,16 years).

“Maybe they think that it feels embarrassing to know that my child is doing it.” (Female, 16 years).

Parents avoided sexual related discussions, and had the belief that it is not the right time to have the discussions with adolescents, this created a wide information gap between parents’ and adolescents’ SRH and these predisposed adolescents to risky sexual behaviour. The following except revealed the challenges:

“Because they think they are giving too much information to the child which would lead us to misbehaviour”. (female 19 years).

Some parents’ sexual misbehaviour lacked respect. For example, having sexual encounters in front of adolescents and having multiple sexual partners led some adolescents to copy this misbehaviour predisposing them to unsafe sexual practises.

“Our parents no longer respect us, they have unbecoming sexual behaviour in front of us, and what do we learn from them? misbehaviours also… (Male 17 years).

Lack of family structure among some adolescents led to poor sexual and reproductive health advice and lack of good values and morals instilled by both parents predisposing adolescents to risky behaviours. These challenges are represented below:

“our parents stay separately, this boyfriend girlfriend arrangement thing…we want proper family to learn from [about right and wrong of sexuality…” (Male, 19 years.

“Some [parents] even choose to leave us for a boyfriend then where do we run to. They lack commitment to their partners and many lack intact family life…” (Male, 19 years).

Adolescents living without parents faced difficulties in getting safe SHR information leading adolescents to engage in unsafe behaviours. The challenge is represented in the following excerpt: “Even though I have so many sources of information, I am safe when it is coming from my parent.” (Male 19 years).

Other sub-categories that emerged were lack of activity after school, and lack of adult supervision. Adolescents revealed that most schools in the township closed at 2 o’clock, and they lacked extra-curricular activities after school or did not participate in available ones. Most adolescents remained idle and lacked supervision after school because their parents were at work. A lack of adult supervision after school meant school-going adolescents ended up spending time with their boyfriends unsupervised, and this often led to them engaging in sex. “When we are alone with our boyfriends we enjoy ourselves, we romance and end up having sex even when did not plan it. Sometimes it even happens in our homes.” (Female, 17years).

Control beliefs and perceived behavioural control

Poor sexual and reproductive health knowledge; immaturity, lack of self-control and curiosity drove adolescents to practising unsafe sexual behaviours.

Having idle time gave adolescents opportunities to indulge in risky behaviours such as taking alcohol and drugs. Given that alcohol and drugs impair judgement, this might have led to poor decision making, reduced inhibition, distorted reality, miscommunication, misunderstanding and reduced memory. This made it hard for some adolescents to discuss boundaries, consent and protection leading to risky sexual encounters predisposing adolescents to HIV and other STIs.

‘There is too much time for us and as a result we have time for alcohol consumption, drug use and sex throughout the week.” (Male, 19 years).

Theme 5: poor sexual and reproductive health knowledge

With regard to this theme, this category came out: heavy reliance on media fallacies regarding SRH. The study revealed that most school-going adolescents’ sources of information were social media like Tiktok, other unscientific sources and some adolescents chose not to listen to elders’ advices. This created tension and rebellion between family members, further predisposing them to risky sexual behaviour. “…I have media…I do not have time for outdated talks, I have media…”” (Female, 17 years).

The challenges happened when adolescents selected wrong SRH information leading to risky sexual behaviours. Participants’ responses revealed that media fallacies led to ignorance, believing in myths and misconceptions regarding adolescents’ SRH.

We know about these things [risky sexual practices] through different platforms such as tiktok, and dating sites…” (Male, 15 years).

Some responses revealed that adolescents chose unsafe SRH information from media. Given that adolescents did not have effective skills to select the correct SRH information, and most followed SRH information that pleased them, which is often misleading and risky.

“We learn about things like spiking of drinks at parties, using drugs and other behaviours such as one night stands, twosome and three some through media (Male 15 years).

Theme 6: Immaturity, lack of self-control and curiosity

This theme revealed immaturity, lack of self-control and curiosity as challenges to achieving safe sexual behaviour among adolescents. Some adolescents were immature to handle the hormonal changes and did not see the consequences of unsafe sexual practices. Instead they blamed the effects of hormones on sexual urge.

“It is not our fault to have sex, just do not pressurise or force us not to have it… Kumnanzi (it feels nice)” (Female, 16 years).

Most males did not have the patience to wait for a boring and immature partner. Some adolescents ended up having many sexual partners predisposing them to risk of acquiring HIV and STIs.

“I cannot wait for a partner’s time when the girl is not ready physically and emotionally to have sex. (Male, 17 years).

Increased hormones influenced adolescents’ self-control. Many adolescents, both males and females revealed difficulties to regulate emotions and sexual desires leading to some adolescents engaging in unplanned and risk sexual behaviours. The above are represented in the below excerpts:

…its nice and we just follow nature and my hormones… [even when we know it’s risky] (female 16 years).

“Majita hawakhoni kutiphatsa when they are sexually aroused” (Boys find it difficult to control themselves…). (Male, 17 years).

The lack of self-control resulted in inability for adolescents to wait for the right time to have sex and the right partner promoting multiple sexual partners as adolescents moved from one person to another predisposing them to risky sexual behaviours.

“I would rather pick and drop whenever I like.” (Male, 18years).

Being young resulted in lack of commitment to long term relationships among adolescents as adolescents considered themselves as having time and space to experiment.

“We are still young, adventurous and meet different characters and tastes. I am too young to commit.” (Male, 16 years).

On the other hand, young male and female adolescents’ sexual encounters were short moments of joy, and some were heartbroken as nothing tangible came out from these relationships. These kind of relationships promoted multiple sexual partnerships which are high risk. “Once boyfriends have sex with girls they dump them and go for the next girls…boys they just want what they want (sex)…we are left heartbroken” (Female, 16 years).

Some adolescents revealed that they had impulsive one-night stands, especially at parties where alcohol and drugs were involved. Given that alcohol and drugs prevent a person to make informed and safe sexual decisions predisposing a person to HIV and other STIs if no protection is used.

“when we are at parties we drink a lot… we work up in someone’s bed not remembering how I got there…what happened.” (Male, 19 years).

Adolescents engaged in sexual relationships for the wrong reasons. For instance, a need for material things from older boyfriends thus exposing them to greater risks like multiple partners, HIV and STIs infections. This is represented in the below excerpt:

“An adolescent girl would have a boyfriend for different reasons such as one [each boyfriend] is for airtime, pocket money, jewellery or other luxuries. (Female, 17 years)

The adolescents engaged in unsafe sexual behaviours out of curiosity and an urge to experiment. Given that adolescents were curious this might have led to sex without proper protection and consent. This challenge is indicated in the following excerpt:

“We want to know what is it that parents do not want us to know”. (Female, 15 years).

Discussion

Challenges to achieve safer and healthy sexual behaviours among school going adolescents aged 15 to 19 years in Mpumalanga Province in South Africa were analysed with Theory of Planned Behaviour framework [30]. Overwhelming pressures were found to influence sexual behaviours negatively; diffused parental role in awareness and support around adolescents’ sexual and reproductive health (SRH); poor sexual and reproductive health knowledge; immaturity, lack of self-control and curiosity, poor access, acceptability and utilisation of SRH services and financial constraints in the relationship were reported as challenges adolescents faced to achieving safer sexual well-being.

Overwhelming pressures to engage in unsafe sexual behaviours

Overwhelming pressure from peers negatively affected adolescents’ capability to achieve safe sexual behaviour consistent with recent studies like Maharajh and Haffejee’s research that revealed that drinking alcohol before sex results in risky sexual behaviours like inadequate condom use and multiple sexual partners. These studies suggested the need for sexual behaviour changes targeted at peers [12, 13, 19, 29].

Peer and partner pressure were found to influence maintenance of abstinence negatively. Some adolescents reported being pressurised and stigmatised to give up their virginity. Abstinence is 100% safe, consistent with a study in Gillespie et al. [34]. Some adolescents were pressurised by parents to follow the religious doctrine to maintain virginity. However, these parents did not teach adolescents how to practice safe sex in case of sexual encounters leaving adolescents at risk. Hence, some studies cautioned against over reliance on religion for SRH information. Some church-going adolescents had unprotected sex and became pregnant even behind the strictest parent’s back [3, 12, 13, 20].

Diffused parental role in awareness and support around adolescents’ sexual and reproductive health (SRH)

The participants of our study illustrated parental role in awareness and support around adolescents’ sexual and reproductive health (SRH): Some parents’ culture predisposed adolescents to engage in unsafe sexual behaviours [12, 13]. Culture works as a barrier to SRH communication. Consistent with our study, some adolescents possessed myths and misconceptions regarding adolescent SRH services due to lack of guidance from parents hindered by culture [35].

Parental involvement, adequate adult supervision during and after school and respectful parents might promote safe sexual behaviour among adolescents, consistent with our studies’ findings, many adolescents needed their parents in their sexual lives [10]. Greater parental supervision or monitoring systems reduce adolescents’ sexual risk taking [13]. However, factors like community context, norms and values, back up parents’ monitoring skills [13]. Community context either positively or negatively affect adolescents’ intention to engage in sex early [9]. Frequency of sexual encounters, number of sexual partners, and risky sexual activities were found to directly affect sexual behaviours of adolescents [6, 10]. Parents should have time with their children and avoid leaving adolescents alone to guess their way through sexual transition without guidance and good leadership [10]. Adolescents should be free to talk about sexual and reproductive health with parents. Normally, parents are considered as reliable sources of SRH information [12, 13] to prevent exposing adolescents to unsafe sexual behaviours due to lack of SRH information.

Consistent with other studies our study’s participants advocated for a family consisting of father and mother living together with their children [14, 32]. Previous studies found out that a good family structure instils good morals and values among adolescents [12] and that good examples of sexual behaviours of parents gave their adolescents a platform to learn from them through seeing and doing [5, 9, 12, 14, 15]. In our study, adolescents revealed that parent monitoring prevent adolescents from engaging in unsafe behaviours such drinking alcohol and consuming drugs. Consisitent with previous studies, too much alcohol has been shown to increase vulnerability to risky sexual behaviours like non-use of condoms during sex [9, 19, 20]. Hence, acts of sexual intercourse performed without the use of condoms predispose adolescents to contracting HIV and other STIs, and the HIV/AIDS. The HIV and AIDS pandemic continues to threaten and kill adolescents [5, 14].

Poor sexual and reproductive health knowledge

Evidence showed that schools provide valuable SRH information [15]. However, our study found out that SRH teachers were not enough and some lacked enough knowledge to deal with complicated SRH issues [15]. Some adolescents intentionally turn to media for acquisition of sexual knowledge. However, wrong information predisposes adolescents to consequences like HIV and STIs infections [18, 20].

Immaturity, lack of self-control and curiosity

Consistent with recent studies, inability of some adolescents to handle the hormonal changes due to immaturity, lack of self-control and curiosity. This led to inability to practice safer sex, increased rate of multiple sexual partners and promoted high risk of acquiring HIV and STIs [9, 16]. Our study revealed gender differences in sexual behaviours whereby males were often impatient and hoped from one partner to another predisposing them to risk sexual consequences [5, 9]. On the other hand, some females felt used as short moments of joy instead of long term commitment to relationships. Heartbreak with no tangible outcomes resulted. Consistent with recent, some adolescents want to wait for the right time to have sex but this is often perceived as boring by impatient intimate partners [5, 9]. Consistent with other studies, in young age, impulsive one-night stands, especially at parties where alcohol and drugs are involved are common drivers to risky sexual behaviours [18–20]. Therefore, restrictions to alcohol and drugs consumption among adolescents should be enforced as these predispose a person to HIV and other STIs if no protection is used [16, 21]. Curiosity and an urge to experiment lead to early sexual debut, without proper protection and consent, and lack of commitment to long term relationships, consistent with past studies [5, 9].

Poor access, acceptability and utilisation of SRH services

The lack expertise in dealing with confidentiality and privacy among health care workers drove adolescents away from utilising contraceptives which prevent unplanned pregnancies [35–37]. Lack of enough supply of SRH resources and money to buy and for transport to health care facilities deterred adolescent from utilising SRH services predisposing them to unplanned pregnancies, this finding is in agreement past studies [35–37]. The above findings are consistent with findings in Xiong et al. and Baker et al. [25, 26].

Financial constraints

Money drove adolescents to engage in risky sexual practices like having multiple sexual partners. Often, these adolescents are vulnerable to poor SRH outcomes like HIV and STIs infections [34–38].

Contribution of the study

The study contributes by providing recommendation support to adolescents to develop resilience and confidence in managing peer pressure and making informed decisions about sexual behaviour. It provides recommendations for guidance for parents, teachers, and peer educators to strengthen communication, life skills and sexual health education in schools. The findings also encourage health and education departments, community and religious organisations to promote safer behaviours among adolescents while fostering positive parental involvement.

Limitations of the study

The current study describes the challenges that influence adolescents’ achievement and promotion of safer sex. However, the results of this phenomenological study should be treated with caution due to small sample size of school-going adolescents got in only one township of the Mpumalanga Province. Hence, the findings offer context- specific, in-depth insights into adolescents’ experiences, and should be interpreted within the scope and setting of the study.

The current study involved sensitive matters of sex among adolescents, social desirability bias could have happened due to fear of judgement, repercussions and adolescents wanting to present a positive image.

The study utilised snowball sampling method whereby the researcher did not have control over some participants’ traits during selection. Hence, the quality of sample was limited to the social network of the referring participants.

Conclusion

Our study aimed to understand the challenges adolescents face to achieve safe sexual behaviour and to develop strategies to promote safer sexual behaviours. Based on the adolescents’ responses we identified these challenges: overwhelming pressure from peers, partners, and parents; immaturity, lack of self-control and curiosity; poor sexual and reproductive health knowledge; Diffused parental role in awareness and support around adolescents’ sexual and reproductive health (SRH), poor utilisation, accessibility and acceptability of SRH services by adolescents; and financial constraints. Recommendations to promote the practice of safer sexual behaviours among adolescents were devised below.

Recommendations

The current study can be interpreted as working together of people mentioned in adolescents’ responses namely peers, intimate partners, parents, schools and nurses to promote safe sexual behaviour among adolescents. The above mentioned stakeholders should work together to combat the challenges identified by adolescents to maintain safer sexual behaviours among adolescents in South Africa.

Overwhelming pressures to engage in unsafe sexual behaviours

A resilient, self-esteemed and self-confidant adolescent conquers all the behavioural and sexual challenges despite all the obstacles the adolescent may face. Adolescents themselves are key actors in shaping their own responsible sexual behaviours.

Action for adolescents:

• Join support groups to build resilience physically, emotionally, mentally and socially.

• Avoid stigmatising each other’s relationships or sexual choices. Seek information on tough sex-related issues.

• Respect cultural differences in a relationship and communicate openly with a partner about expectations.

• Be confident around peers, and not get swayed. Learn to say no and do not do what you do not believe in.

• Seek help from important significant others like peer role models if overwhelmed.

Diffused parental role in awareness and support around adolescents’ sexual and reproductive health (SRH)

Parents did not have time to discuss sex-related issues with their adolescents and adolescents regarded it is taboo to have sex related discussions with parents and this created cultural sexual boundaries that did not allow exchanges of SRH ideas between parents and children. Some parents exhibited unsafe sexual behaviour, exposing adolescents to unsafe sexual behaviour.

Action plan for parents:

• Build a strong relationship with adolescents: create a health bond A close bond with adolescents for open communication about sexual responsibility. Impart SRH knowledge: start when the child enters puberty, sharing both positive and negative real-life messages.

• Communicate correct information about sex. Provide accurate information about sex avoiding lies that mislead the child. Use practical examples to reinforce the SRH messages with real-life examples.

• Correct a child with love using understanding instead of threats to create understanding and agreement between the parent and the child.

• Reinforce positive knowledge by stressing the importance of sexual responsibility. Break cultural, sexual boundaries that do not allow exchanges of SRH ideas between parents and children and teach the consequences of premarital sex.

• Set aside time with adolescents to teach and train them spiritually and physically on managing sexual temptations and building self-control.

• Responsible actors: parents, peer educators and teachers.

Poor sexual and reproductive health knowledge

The education department is a responsible actor for improving adolescents’ sexual and.

reproductive health knowledge:

• Encourage clear and specific educational goals for adolescents noting further schooling reduces early pregnancy chances and support school-based sex education.

• Target SRH training for life orientation teachers at teaching colleges and universities.

• Reduce teachers’ workload by hiring adolescent health experts and equip teachers with sufficient resources for comprehensive SRH teaching (safer sex, not just abstinence.

• Guide adolescents to access media’s SRH information cautiously via social platforms like WhatsApp, YouTube, Twitter, Facebook, and Tiktok to select important messages that promote responsible sexual behaviour.

Immaturity, lack of self-control and curiosity

The majority of adolescents face the challenges of immaturity, curiosity, lack of self-control, alcohol and drug use, excessive partying and are not faithful to one partner leading to risky behaviours like unprotected sex and multiple sexual partners. Furthermore, adolescents lack a commitment to long-term relationships, leading to exposure to STIs and HIV infection. Adolescents themselves are key actors in shaping their own responsible sexual behaviour.

Action for adolescents:

• Adolescents should stay away from bad company or youth with deviant behaviour and should acknowledge good morals and practice them and stop drinking alcohol or drink responsibly.

• Adolescents must stop substance use during adolescence’ since drugs permit a person to indulge in risky sexual behaviour like unprotected one-night stands and encourage supervised parties or parties without alcohol.

• Adolescents must exercise restraint when drinking alcohol with or without a partner and drink in an open space where there are other people to prevent temptations.

• Commit to rehabilitation and join support groups against substance and alcohol abuse.

Poor access, acceptability and utilisation of SRH services

Most adolescents faced challenges to attending public clinics because of a lack of confidentiality, lack of privacy and appropriate contraceptives, most adolescents could not afford to go to private facilities for SRH services and the majority complained of rude nurse-patient relationships. The Ministry of health in collaboration with NGOs should improve availability, affordable contraceptives and accessibility at private and public health institutions, avoid judgements, stigmatisation and harassment.

• The health care workers should ensure they afford privacy and confidentiality every step of the way, not only in consulting rooms. In addition, good nurse-patient relationship should be maintained.

Financial constraints in the relationship

Some adolescents engage in risky sexual practices including transactional sex and accepting gifts and money from partners exposing them to STIs, HIV infection and unplanned pregnancies. To address these risks and their impacts on adolescents, various stakeholders need to be involved.

Action for adolescents, social services, parents and community:

• The government’s social services department should provide for adolescents’ needs and empower adolescents through self-sustaining methods like entrepreneurship, which is integral to meeting adolescents’ needs.

• Community based organisations should encourage vulnerable adolescent mothers to enrol for the government child support grants.

• Parents should use the child support grant wisely to meet the child’s needs.

Author’s contributions

Doctor PRICILLA SHUPIKAYI MUDZANA conducted the study and prepared the manuscript for publication under close supervision and guidance of Professor Faniswa Honest Mfidi. Professor Faniswa Honest Mfidi reviewed the manuscript and approved it for submission to the journal for publication.

Funding

The study is part of a PhD study financed by the UNISA NSFAS BURSARY.

Data availability

The data and materials are available from the University of South Africa repository 2023 www.unisa.ac.za./library.

Declarations

Ethics approval and consent to participate

In accordance with the Declaration of Helsinki where the study involves human participants, ethical clearance was obtained from the Research Ethics Review Committee of the Department of Health Studies, UNISA with reference number REC-012714-039 (NHERC). Based on this clearance, ethical approval was obtained from relevant authorities in the Mpumalanga Provincial Department of Education, at the district, and circuit level in the Mpumalanga Province. Permission to conduct the study was granted through official letters from the Ethics Committee to Sub District Offices and then to the management of selected and participating schools.

Consent for publication

Informed consent was obtained from adolescents who were 18 years and above. informed parental consent was obtained from parents of minors and minors signed the informed assent form.

Competing interests

The authors declare no competing interests.