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. Author manuscript; available in PMC: 2022 Oct 31.
Published in final edited form as: Sex Med Rev. 2022 Oct;10(4):554–566. doi: 10.1016/j.sxmr.2022.04.001

Parent-Adolescent Sexuality Communication in the African Context: A Scoping Review of the Literature

Anthony Senanu Agbeve 1, Daniel Yaw Fiaveh 1, Martina Anto-Ocrah 2
PMCID: PMC9620762  NIHMSID: NIHMS1843536  PMID: 36210094

Abstract

Introduction:

Young people constitute a critical mass in Africa south of the Sahara (SSA) yet lack adequate information on sexuality education essential for their health and development.

Objectives:

Guided by two sociological perspectives on socialization, that is, structural functionalism and conflict perspective, our study had 2 aims: 1) to identify and analyze studies investigating parent-adolescent sexuality communication (ie, triggers/contents) and 2) to identify and discuss barriers to sexuality-related communication between parents and adolescents.

Methods:

The scoping review was conducted according to the Arksey and O’Malley framework and used PRISMA reporting guidelines for scoping reviews. We searched three databases (Scopus, PubMed, and Google Scholar) for relevant articles published in English in the last decade −2011 to 2021 and analyzed the data using a qualitative content analysis approach.

Results:

A total of 1045 studies were identified. After abstract review, we identified 58 papers, and after full-text review, 16 studies were included in the final review. Aim 1a) Discussions of sexuality-related conversations were triggered by parents/caretakers due to pubertal/physical changes and adolescents’ “inapt” behaviors (eg, engaging in sex). Aim 1b) Our results showed that contents of sexuality education de-emphasized/avoided sensitive sexuality-related topics (such as condom use/contraception) that did not fit within the sociocultural norms/expectations, characterized by threats, cautions, and wrought with moralistic and religious views that evaded practical information regarding sex, contraception, and other critical sexual information. Aim 2: Two themes emerged as barriers that impede sexuality-related discussions, including whose responsibility it is to discuss sexuality-issues with adolescents and the gender differences/discordance of parent-adolescent dyads.

Conclusion:

Sexuality education for adolescents in SSA is not comprehensive due to structured power relations. Thus, parent-adolescent sexuality communication falls short of the value of sexuality education for young people for whom accurate and complete sexual health information is critical for making informed decisions as they emerge into adulthood. Agbeve AS, Fiaveh DY, Anto-Ocrah M. Parent-Adolescent Sexuality Communication in the African Context: A Scoping Review of the Literature. Sex Med Rev 2022;10:554–566.

Keywords: Sexuality Education, Parenting, Sub-Saharan Africa, Socialization, Sexuality, Adolescents

INTRODUCTION

Sexuality education involves the process of “teaching and learning about the cognitive, emotional, physical and social aspects of sexuality”.1 Sexuality education across various societies in SSA occurs through socialization and usually begins at home. Adolescence, characteristically defined as occurring between ages 10−19-years,2 is a period of human development marked by immense physical, emotional, cognitive, and sexual maturation.3 The socialization process reflects several aspects of adolescent development. For instance, classical and contemporary theorists argue that socialization includes the development of sexual attitudes and the acquisition of sexual knowledge, skills, and values,4−7 a term synonymously described by some scholars as sexual socialization.8,9 For structural functionalists like Parsons,5 young people’s socialization is a critical component of society as a whole to adhere to and continue a society’s established norms, beliefs, and expectations. However, for structural conflict approaches such as Marxism,10 socialization, rather than emphasizing social cohesiveness, results in “conflict” induced by power differences and competing groups’ social status, such as parents and adolescents. Regardless of theoretical alignment, the consensus remains that significant other such as parents, caretakers, guardians, teachers, and respected adults within the community play a meaningful role in the socialization process of adolescents, thus, helping shape their behavior and providing them with the requisite skills and knowledge needed for their growth and development.8,11

Sexuality education encompasses more than the act of “sex”1,12 and is intended to equip adolescents with the knowledge and skills to make informed decisions about their sexual health and wellbeing. Appropriate and complete sexuality education contributes to advancing and attaining the World Health Organization’s sustainable development goals of good health and wellbeing, quality education, and gender equality,13 critical in transitioning from childhood to adulthood. Sexuality education plays a critical role in preventing adverse reproductive health outcomes such as early or unwanted pregnancy, unsafe abortions, and sexually transmitted infections.1,13 In SSA, adolescents constitute a significant component of the global demographic block, making up about 23 percent of the total population.14 Despite adolescents’ documented needs and the urgency for sexuality-related information,13,15 reports from various SSA countries’ Demographic and Health Surveys show an increasing trend in early sexual debut among adolescent boys and girls over the last decade.16,17 These statistics, combined with the fact that 71% of all new HIV infections occur in SSA,18 emphasize the vulnerability of the youth and how critical sexuality education is in this part of the world.

The need for sexuality education for the youth of SSA has been emphasized through several initiatives over the years, including the International Conference on AIDS and sexually transmitted infections (STIs) in Africa − 2011; Colombo Declaration on Youth − 2014; Our Rights, Our Lives, Our Future (O3 Programme) − 2019; and the African Union’s Agenda − 2063,19−22 all of which have led stakeholders to scale up efforts at improving access to sexuality education for the youth across SSA. Despite these efforts, adolescents across the region still face numerous challenges accessing information regarding their sexual and reproductive health needs and rights; and the continent lags behind many parts of the world. Parents influence and have responsibility for their wards and can impart young people with appropriate sexual norms/values that fit the sociocultural context they find themselves in. In this scoping review, we review and synthesize the literature on parent-adolescent sexuality communication in SSA. We build upon the existing literature by; specifically, i) identifying studies investigating parent-adolescent sexuality communication (Aim 1); categorized into two broad themes: (Aim 1a) triggers of sexuality-related conversations and (Aim 1b) content of parent-adolescent sexuality conversations, and (Aim 2) identifying barriers to sexuality-related communication that influence complete and appropriate sexuality education for adolescents and youth in the SSA region. Throughout the paper, we refer to parents/caretakers/guardians/respected adults as parents.

METHODS

We conducted a scoping review of the literature on parent-adolescent sexuality communication in SSA in the last decade −2011 to 2021 when we saw a “scaling up” of sexuality education efforts.19−22 We employed the guidelines for conducting scoping reviews outlined by Arksey and O’Malley23 and the Joanna Briggs Institute24 as outlined below:

Step 1: Identifying the Research Question

The main objective was to review and synthesize the literature on parent-adolescent sexuality communication in SSA over the last decade (2011−2021) to answer the following research questions and achieve the aims, framed as Aim 1a) What are the triggers of sexuality-related conversations? Aim 1b) what is the content of parent-adolescent sexuality conversations? And Aim 2) What are the barriers to sexuality-related communication between parents and adolescents?

Step 2: Identifying Relevant Studies

We conducted a comprehensive search for articles from the following databases: Scopus, PubMed, and Google Scholar using the search terms shown in Appendix A. Boolean terms such as “AND” and “OR” were combined with search terms such as: “sexuality education,” “sociocultural,” “adolescent,” “reproductive health,” and “sexual information” to produce broader results. These search terms were matched with “sub-Saharan Africa” to specifically include studies relevant to the sub-region. Studies included in the search were restricted to publications in the English language published between 2011 and 2021 to capture a decade’s long period of “scaled up” sexuality education initiatives across the SSA region, as previously explained. The choice of selecting studies published in English was because all authors are English speakers. We also searched the bibliographies of the studies retrieved to identify additional articles that matched our search strategy. Relevant studies extracted from the database were managed in the Zotero reference management software.

Step 3: Study Selection

The first author screened the titles and abstracts of all records retrieved from the database to determine if the published papers met the eligibility criteria. After that, all duplicate articles retrieved from the search were removed. A full text of the selected article was retrieved and scrutinized to sort out published studies that did not meet the eligibility criteria.25 Relevant studies included in this scoping review were considered using the following inclusion criteria: 1) primary research papers focused on sexuality/sexual and reproductive health education, 2) employed qualitative, quantitative, or mixed-method approaches and included adolescents, parents, or caretakers as study population, 3) published in the English language, and 4) focused on sub-Saharan Africa. We excluded 1) secondary research papers (ie, systematic reviews, scoping reviews, and narrative reviews), 2) studies that focused mainly on contraception and sexually transmitted infections, 3) studies published in languages other than English, and 4) studies conducted outside sub-Saharan Africa. After the full-text review, in consensus with the co-authors, the studies to be included in the final review were approved. The first author did a final review of the selected articles before charting the data using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Review (PRISMA-ScR).25 To minimize the risk of bias assessment and reporting, a full-text screening of eligible studies was conducted by the first and second author, with the third author acting as an arbiter where discrepancies existed about the eligibility of an article. To ensure objectivity in the assessment process, authors did not review eligible studies they authored.

Step 4: Charting the Data

In this scoping review, we conducted a charting process to organize and map out relevant information from selected studies retained for the review. The studies retrieved were sorted into various categories to classify the data retrieved. We identified categories such as year of publication, author(s), country, aims or objectives, study approach, study population, research design, and findings. The information obtained from eligible studies was summarized and mapped in chart forms by the first author. He carried out the data charting iteratively to ensure that all relevant information retrieved was captured accurately. The co-authors reviewed the data charts to ensure accuracy as a form of inter-coder reliability to ensure consistency and validity.

Step 5: Collating, Summarizing, and Reporting the Results

We synthesized the data from the selected articles extracted using the content analysis approach. Content analysis involves categorizing, interpreting, and coding textual information to determine patterns or trends used in a text, the relationship, and its frequency.26 Studies reviewed were summarized based on the year of publication, study objective, study approach, study population, and findings. We used the PRISMA guidelines for reporting scoping reviews to report the reviews extracted from the selected studies.25 The data was analyzed manually guided by themes developed from the content analysis of the reviewed studies based on the specific objectives of this scoping review. The themes include (triggers/content of parent-adolescent sexuality-related conversations) and barrier factors (ie, cultural norms/values and gender disparities) that influence complete and appropriate sexuality education for young people in SSA.

Study Limitations

This scoping review has some challenges that should be noted in terms of the coverage of data and the methodological paradigm adopted. The inclusion and exclusion criteria and the search strategy may have impacted the choice of literature and could nuance the analysis, particularly from non-English speaking countries in SSA. The majority of such literature employed a qualitative approach focusing on adolescents and parents. Even though keywords and queries were used to identify and retrieve relevant information on sexuality education in three key databases (Scopus, PubMed, and Google Scholar), only 16 articles were included in the final review. Therefore, caution should be exercised when interpreting the results in light of the available data at the time of the scoping review.

RESULTS

As shown in Figure 1, the initial search identified 1045 relevant studies. After removing 459 duplicate studies, 586 studies were screened for eligibility. After title and abstract screening, 528 studies were excluded because they did not meet the eligibility criteria. A full-text review of 58 articles was conducted in the first round of review. A total of 16 studies fulfilled our eligibility criteria and were included in the final review. Details of the 16 studies are shown in Table 1. The following SSA countries were represented as shown in Figure 2: Ghana (n = 5), Ethiopia (n = 5), Zimbabwe (n = 1), Uganda (n = 1), South Africa (n = 1), Rwanda (n = 1), Kenya (n = 1), and Nigeria (n = 1). The majority of the studies (n = 10) utilized qualitative methods, while the remaining studies utilized the quantitative method (n = 5) and (n = 1) utilized the mixed-method. The population for the studies reviewed included parents/caretakers and adolescents. About half of the studies (n = 8) reviewed focused on parent-adolescent (10−24 years) dyads. Six studies focused on parents/caretakers who had adolescents within the age range of 10−24 years, while the remaining two focused exclusively on adolescents. The sample size for the qualitative studies reviewed ranged from 20 to 149 participants, 796 participants for quantitative studies, and 790 participants in mixed-method studies.

Figure 1.

Figure 1.

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Flow diagram of steps used in selecting relevant studies.

Table 1.

Summary of studies on sexuality education in Africa south of the Sahara

Author(s) Years Country Study objective Study approach Study population Main findings
Manu, Mba, Asare, Odoi-Agyarko, & Asante. (2015).27 Ghana To explore parent-child sexual communication and sexual topics discussed by parents. Quantitative A cross-sectional study of 790 parent-child dyads through a two-stage cluster sampling. Sexual communication by parents focused on topics such as menstruation for girls, physical/puberty development, and stressed on abstinence. Gender differences among parent-adolescent dyads also influenced the content and frequency of sexual communication between boys and girls.
Baku, Agbemafle, Kotoh, & Adanu. (2018).28 Ghana To explore the experiences of parents discussing sexuality topics with adolescents. Qualitative A qualitative exploratory study using focus group discussions (FGDs) and in-depth interviews (IDIs) of 44 parents. Parents’ sexual discussions focused on less sensitive sexual topics such as physical changes, personal hygiene, abstinence, abortion, and saying “no” to forced sex. Parental fear, inadequate knowledge gender, and age disparities are barriers to effective sexual communication by parents.
Ayalew, Mengistie, & Semahegn, (2014).29 Ethiopia To determine adolescent-parent communication on SRH issues among students. Quantitative A simple random sampling technique using a cross-sectional study of 695 students from grades 9 to 12. Cultural taboos, fear of exposing young people to early sex, shame, and lack of communication skills by parents were barriers to effective communication on sexual topics. Adolescents preferred their peers as sources of sexual information due to sociocultural restraints and misconceptions.
Ayehu, Kassaw, & Hailu, (2016).30 Ethiopia To assess young people’s parental discussion about SRH issues and its associated factors. Quantitative A cross-sectional study of 781 adolescents aged 10 −24 using a multistage sampling technique. Parents’ lack of interest and awareness, cultural notions, and misconceptions regarding adolescent sexuality deterred young people from discussing sexual issues with their parents. Feeling ashamed and fearing being misconstrued as engaging in sex were barriers to parent-adolescent sexuality conversations.
Baku, Adanu, & Adatara. (2017).31 Ghana To explore the sociocultural factors affecting parents’ role in the sexuality education of their young children. Qualitative A qualitative exploratory study of 44 parents using focus group discussions (FGDs) and in-depth interviews (IDIs). Parents’ religious beliefs, cultural norms, taboos, and misconceptions regarding sexuality issues were inhibitions to sexual communications. Sexual discussions emphasized abstinence-only messages while paying less attention to other critical sexual topics such as contraception, relationship, and dating.
Bushaija, Sunday, Asingizwe, Olayo, & Abong’o, (2013).32 Rwanda To explore the factors that hinder parents from communicating with their adolescents on sexual matters. Quantitative A descriptive, cross-sectional study of 388 parents/caretakers with adolescents. Cultural norms and values, parental attitudes, religious values and associations, and sociodemographic factors such as lower levels of education and lower-income levels hindered parent-adolescent communications on sexual and reproductive health issues.
Kumi-Kyereme, Awusabo-Asare & Darteh. (2014).33 Ghana To explore the views of adults on adolescent sexual and reproductive health. Qualitative A qualitative study of 60 purposively sampled adults (ie, parents, teachers, health workers). Various challenges, including parental resistance due to sociocultural norms, notions of exposing young people to early sex, communication barriers, and adolescents’ attitudes, influenced sexual and reproductive health discussions.
Mudhovozi, Ramarumo, & Sodi. (2012).34 South Africa To explore mothers’ perspectives on adolescent sexuality within their cultural prism. Qualitative A qualitative study using 44 purposively sampled mothers of adolescent girls aged 12−19 yrs. Cultural taboos, religious norms and values, and socialization context influenced sexual issues discussed by parents. Misconceptions and fear of exposing young people to early sexual activities were barriers to sexual communication among mothers and daughters.
Svodziwa, Kurete, & Ndlovu. (2016).35 Zimbabwe To explore parent-adolescent barriers to communication on SRH issues. Qualitative A descriptive exploratory study with 52 parents purposively sampled. Cultural barriers, religion, educational levels, and gender differences hinder parents from discussing sexual issues with their wards. Sexual communication by parents was not comprehensive and emphasized less sensitive sexuality issues.
Yadeta, Bedane, & Tura. (2014).36 Ethiopia To assess factors that affect parent-adolescent discussion on RH issues with their adolescents. Qualitative A cross-sectional survey of 751 randomly selected parents/youths using one-on-one and focus group discussion. Sociocultural norms, lack of information, limited skills, negative parental notions, and unsupportive environments influenced parent-adolescent sexual communications. Adolescents preferred sexual discussions with their peers due to the negative parental attitudes/reactions toward sexual matters.
Yibrehu & Mbwele, (2020).37 Ethiopia To assess the challenges of Parent-adolescent communication on SRH practices. Qualitative A qualitative cross-sectional study of 40 parent-adolescent dyads using in-depth interviews and focus group discussions. Sexual communication was rare and was discussed after adolescents had engaged in sexual activity or deviant behaviors. Misconceptions from cultural taboos, fear of exposing adolescents to early sexual activities, gender differences, and parental uncertainties are barriers to parent-adolescent sexual communication.
Fentahun, Assefa, Alemseged & Ambaw. (2012).38 Ethiopia To explore the perception and attitude of parents, teachers, and students toward sex education. Mixed method A cross-sectional quantitative/qualitative study randomly selected 386 students, 94 teachers, and 10 parents. Content of sexuality discourse should be based on adolescents’ age and maturity levels. Thus, sexuality education for in-school adolescents should include abstinence-only messages for younger adolescents in primary school and abstinence-only plus for older adolescents in secondary schools.
Agbeve, (2020).39 Ghana To explore SRH discussions among families and how it has empowered young people. Qualitative An exploratory qualitative study of 20 purposively sampled parents and their wards. Sexual communication by parents was limited to less sensitive topics while neglecting contraception, dating, and relationships. Gendered socialization scripted on cultural norms/values and misconceptions regarding sexuality education were barriers to young people’s access to SRH information.
Muhwezi et al., (2015).40 Uganda To explore perceptions, sexual issues discussed, and factors that influence sexual discussions Qualitative Exploratory qualitative study using 149 participants: parents, adolescents, and school administrators Parent-adolescent discussions were gendered; mothers were cordial and more open. Fathers, were strict, intimidating, and unapproachable. Sexual discussions were triggered by the onset of menstruation among adolescent girls and suspicion of deviant behaviors among adolescents.
Maina, Ushie, & Kabiru.(2020).41 Kenya To explore the nature and content of parent-child communication about SRH issues. Qualitative A qualitative study of 32 parents and 30 adolescent boys and girls using narrative interviews. Parent-child communication on sexual issues was influenced by gender. Parental attitude toward sexual discussions influenced the nature and content of sexual topics discussed. Sexuality-related discussions were mainly reactive, authoritarian, one-sided, and often initiated by parents.
Aliyu, Aransiola, (2021).42 Nigeria To investigate factors associated with parent-adolescent communication on SRH issues in Nigeria. Quantitative A quantitative study of 796 parent-adolescent dyads using structured questionnaires. Parent-adolescent communication on sexual issues is characterized by threats, warnings, caution, vague warnings. Age, gender, marital status, educational levels, and religion influenced sexual discussions among parent-adolescent dyad.
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RH, reproductive health; SRH, sexual and reproductive health.

Figure 2.

Figure 2.

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Map depicting countries represented in scoping review.

Aim 1: Parent-Adolescent Sexuality Communication

Studies investigating parent-adolescent sexuality-related communication were categorized into two broad themes: triggers of sexuality-related conversations and content of parent-adolescent sexuality conversations.

Triggers of Sexuality Communication.

Shown in Table 1, four studies27,37,39,40 explored factors that triggered sexuality-related discussions among parents and adolescents. The narratives revealed that parents voluntarily initiated such discussions when they identified the development of certain biological and behavioral features among their adolescents. For instance, a qualitative study in Ethiopia and Ghana found that the onset of menstruation with girls, puberty, and physical development among adolescents were common triggers for parents’ initiation of sexuality-related conversations.37,39 The review found that sexuality-related conversations were incident or behaviorally driven and reactionary (from a functionalist lens) and of a snowballing effect (conflict-driven). For example, parents used negative experiences of other adolescents who had engaged in risky behaviors such as early sexual debut due to unsafe sexual practices, that is, lower levels of condom use, chances of unintended pregnancy, and risk of contracting STIs.39 Similar studies in Ethiopia, Uganda, and Ghana also found that sexuality-related conversations were triggered due to parents’ suspicion of adolescents being involved with the opposite sex or already engaged in sex.27,37,40 In another study from Uganda, parents began sexuality-related dialogues when an undesirable incident such as unplanned pregnancy involving a teenager or their ward had occurred.40 Other triggers of sexuality-related conversations identified among some Ghanaian and Ugandan families were coming home late at night, associating with bad friends, and exposure to sexually explicit material from the television and media phone39,40 in the form of video, photography, and other creative writings.

Adolescents shared similar views expressed by parents on common triggers of sexuality-related conversations. For adolescent girls, such discussions are only triggered by parents when the colleagues (girls) within their community become pregnant. In such instances, parents employ reactionary tactics to initiate and discuss sexuality-related issues with them. This also qualifies for a snowballing effect where parents refer their wards to the deviant behaviors of their colleagues they consider as not being well brought up girls and the need to disassociate from ‘bad’ friends. On the other hand, adolescent boys indicated that the commonest trigger of sexuality-related discussions was when they were seen to be associating with the opposite sex.39,40 Some adolescent boys from Ugandan study in their narratives, indicated, “our mothers started telling us about these issues because they see us moving in the company of girls in the village. They tell us that we should not engage in sex with girls but just be friends with them”.40 The emphasis was largely about teaching the ethics and values of society to guide adolescent behavior. As noted by Dery et al43 and Arnfred7 and Parsons,5 the pervasive nature of these norms/values influences the sexual socialization of young people. It restricts them to sexualities considered appropriate by society. Thus, this affects “how,” “what,” and “who” young people can discuss sexuality-related issues with. Such an approach can be a source of conflict for some young people who may want to explore their sexuality which can be empowering even if the repercussions can be dire.

Content of Sexuality Communication.

Ten studies reported data on the contents of sexuality topics discussed among parents and adolescents.27,28,31,33,35,38−42 Two studies, one from Zimbabwe and Ghana, found that parent-adolescent discussions on sexuality-related issues were not comprehensive and focused on less sensitive and less specific sexuality topics. This includes personal hygiene, physical development, menstrual hygiene for girls, and the consequences of pre-marital sex (ie, teenage pregnancy).27,35 A comparative trend analysis of adolescents in Ghana and Ethiopia found that parents were silent on sensitive, experiential sexual topics such as dating and relationships, contraception, and condom use.27,36 Findings from Nigeria and Ethiopia also showed that while abstinence and consequences of engaging in early sex (eg, teenage pregnancy and unsafe abortion) were discussed, such discussions were characterized by threats and cautions to emphasize the need for abstinence.38,42 Overall, sexuality-related conversations tended to be shrouded in the broader context of personal hygiene, morality, and young people focusing on their education.40 Abstinence-only messages remained central.27,28,36,38 Parents stated that they discussed less sensitive sexuality-related topics and focused on abstinence because they did not want to undermine cultural/religious norms.31,33

Across the studies reviewed, a greater number of adolescents revealed that parental discussions on sexuality-related issues resorted to threats, warnings, and scare tactics that emphasized the need for abstinence, though they felt the need for comprehensive information on sexuality-related issues.40 Adolescents expressed dissatisfaction with abstinence-only messages that focused on self-control, avoiding association with the opposite sex, and calls to abstain from sex.31,40 For the adolescents, sexuality-related information given by parents seemed to be in line with prevailing socio-cultural norms and perceptions often broached with issues of morality, negative consequences of engaging in sex, and the implications for the outlook of the future.39,40

Aim 2: Barriers to Sexuality-Related Communication

Two broad themes emerged under this theme as barriers that impede sexuality-related discussions between parents and adolescents. These include sociocultural norms/values and gender differences among parent-adolescent dyads.

Sociocultural Barriers.

A total of fifteen studies reported sociocultural norms as barriers that influence sexuality-related conversations among parents and adolescents.27−37,39−42 The studies reviewed found that sexuality-related issues are ‘tabooed’ and considered ‘sacred’ issues that should not be discussed with young people.31,34,36 Among the various religious groupings − Christianity, Islam, and African traditional religion, sexuality-related discussions outside the confines of marriage were tabooed and considered a sin.35,41 Thus, sexuality-related conversations often take on a moralistic approach that stresses the need for abstinence,31,34 aligning with religious doctrines and promoting “moral education”.32 Such religious norms governed and hindered the initiation of sexuality discussions for both parents and adolescents. For instance, studies from Uganda40 and Ghana39 found that feeling ashamed and fearing being misconstrued as engaging in sex were drawbacks to adolescents initiating sexuality-related conversations with their parents.

Similarly, some parents deemed it “shameful” to discuss sexual issues with their wards.28,37,40 Parents stated they discussed less sensitive sexuality-related topics and focused on abstinence because they did not want to undermine cultural/religious norms.35 A parent said, “No, I can’t talk with my child of any sex issues of puberty because my traditional norms prohibit me as a father. It is an insult for me as a parent to discuss issues like these”.35 Another barrier noted was parents’ concerns about the maturity and readiness of the adolescents. In Nigeria42 and Ghana,39 parents were concerned that sexuality-related discussions would encourage sexual experimentation. Some parents revealed that the assertiveness of some children could make them over-zealous and curious as they may want to “test” and experience the actualities of the information given to them.39

Other norms that prohibited parent-adolescent sexuality-related discussion was a question of “whose responsibility, is it?” In Rwanda, for example, uncles and aunties are expected to provide sexuality-related information to adolescents, not the parents.35 About 32% of Rwandan parents in a cross-sectional study32 indicated sexuality-related discussions with young people were the role of aunts and uncles, not them as parents. Thus, parents were hesitant to initiate conservations with their wards, as it was not “their role.” However, for adolescents, fear of embarrassment, timidity, and shyness were drawbacks to sexuality-related discussions with parents. For instance, some adolescents feared that asking questions on sexuality-related issues could make parents angry and violent, including fear of being punished for openly discussing sexuality-related issues.40

Gender Barriers.

Parent/adolescent gender differences (discordance) emerged as a significant barrier to effective sexuality-related conversation. Seven studies27,28,35,37,39,41,42 identified gender differences as factors that influence the content of sexuality topics discussed. Stereotypical gender roles and notions portrayed some sexuality-related issues as topics best discussed by mothers or fathers; hence, some parents do not discuss sexual issues with children of the opposite sex.35,39 For instance, fathers prefer discussing sexuality-related issues with their sons and mothers with their daughters. Several studies28,39,41 documented that parent-adolescent communication on sexual issues occurred more with adolescent girls than boys. Emphasis on girls stems from the notion that girls disproportionately bear the consequences of sexual risk behaviors such as unplanned pregnancy and unsafe abortions.29

Moreover, mothers tended to take on the role of “sex educators” more than fathers.27,31,39,42 A cross-sectional study of parents in Rwanda found that about 53% of fathers do not discuss sexual issues with their wards compared to 47% of mothers.32 Similarly, in Uganda40 and Ghana,39 fathers were not expected to discuss sexuality-related issues with adolescent girls, but mothers could discuss such issues with both genders. Although some fathers had discussions with their wards, such discussions did not emphasize sensitive sexuality issues such as contraception and condom use but rather acceptable behaviors expected of young people.39,40 Some fathers also expressed their discomfort, citing sexual topics such as menstruation, physical and puberty development in girls as feminine subjects best discussed by mothers.39

When focusing on adolescent preferences, however, we found that most preferred sexuality discussions with their same-sex parents (ie, boys discuss issues with their fathers (not their mothers) and girls discuss with their mothers).39 Adolescent girls indicated they share similar experiences with their mothers, making them relate more to sexual discussions by mothers.39 Despite these preferences, studies show that adolescents prefer peers as sources of sexuality-related information.30,33,40 In a cross-sectional study of 781 Ethiopian adolescents, over half (58%) preferred sexual discussions with their peers than their parents.30 For instance, as vocalized by an adolescent girl from Ghana, “my father does not discuss such issues into detail like my mother. For my mum, I think that because I am a girl, she takes her time to do this with me”.38 This narrative expression exemplifies why adolescents prefer sexuality-related discussions with their same-sex parents.

DISCUSSION

The review has attempted to synthesize existing evidence on parent-adolescent sexuality communication in SSA and argues that young people’s access to sex education in Africa is challenged by complex multiple interwoven factors which are structural in nature. The review found that the tendency for adolescent boys and girls to openly and frequently discuss sexuality-related issues with their parents was less likely to occur, as evident in studies from Ethiopia, Ghana, and Uganda.29,35,39 This review has shown that parents’ failure to educate adolescents on sexuality-related issues rather makes them prone to risky sexual outcomes. This can partly be due to the proliferation of the new media, which has made sexuality-related information readily accessible to young people.

The findings demonstrate that the content of sexuality-related issues discussed between parents and adolescents across the sub-region is functional in nature and focus mainly on abstinence from sex, physical and puberty development, sexually transmitted infections (STIs), and reactionary notions of the consequences of sexual behaviors appropriate of adolescent development. A comparative analysis of studies from Ghana, Ethiopia, Nigeria, and Uganda identified similar factors (ie, abstinence from sex) as a prominent feature of sexuality-related discussions. However, sensitive sexuality issues such as contraception and condom use are not emphasized, highlighting how value systems can dislocate young people’s sexuality education and promote structured social inequality.10 This was consistent with studies from Ghana, South Africa, Nigeria, and Ethiopia30,33,34,42 which report that adolescents who receive abstinence-only messages are predisposed to risky sexual outcomes such as unplanned pregnancy and unsafe abortions compared to adolescents who receive comprehensive sexuality education.44 Ineffective sexual communication characterized by threats and cautions makes young people susceptible to unreliable sources of sexuality-related information.36 Thus, parents are prompted to initiate sexual discussions upon suspicion or after adolescents have engaged in sexual risk behaviors.27,40 This negative parental attitude borne out of restrictive sociocultural norms and the unbalanced power relations among parents and adolescents, as suggested by some African feminists scholars such as Stella Nyanzi and co,4,7 puts young people in a disadvantaged position of not having adequate access to sexuality-related information27; and ironically, leaving them even more vulnerable to adverse sexual outcomes.

The review identified a broad social, cultural, and religious context that defines the boundaries surrounding sexuality education in SSA as cited in studies from Ghana, Nigeria, Kenya, Ethiopia, Zimbabwe, Rwanda, Uganda, and South Africa. Historical factors that undergird the socialization process of young people shape sexuality-related discussions in SSA, and families are predisposed to building and instilling a set of behavioral habits among young people through ‘reinforcement,’ a process where desired behavior regarding young people’s sexuality is reinforced,5−7 rather than behavioral norms that can enhance young people’s knowledge and skills. Over time, these dispositions become the standard for reinforcing sociocultural notions on young people’s sexuality. For example, evidence from West Africa (ie, Ghana and Nigeria) shows that parent-adolescent communications were mainly geared toward adolescent girls than boys,39,42 thus reinforcing gender stereotypes. These findings are similar to evidence from East Africa (ie, Ethiopia and Kenya)29,41 and parts of Southern Africa (ie, South Africa and Zimbabwe).34,35 This indicates that adolescent boys may miss out on vital sexuality-related information which may be useful to their sexual health. This puts boys at greater risk for HIV and other STIs and may de-emphasize their role in unwanted pregnancies. It also puts more pressure, blames, and stigma on adolescent girls, negatively impacting sexuality-related conversations. Interventions that address these gender inequities in adolescent sexual health education are needed to ensure that both females and males receive comprehensive sexual health education.

Religious beliefs also hinder sexuality-related discussions among parents and adolescents. Conservative religious norms and values portray sexuality-related discussions as subjects limited to the confines of marriage, as argued by Foucault.45 This makes sexuality-related conversations beyond the confines of marriage inappropriate, which could constitute grounds for the subjugation of young people’s sexuality in an attempt to maintain an unequal status quo.10 Parents fear that having such discussions will contest religious norms and values; hence, they are faced with the difficult task of determining what they perceive young people need to know and what young people actually need.43 This uncertainty makes young people susceptible to inappropriate and unreliable sexuality-related information. Evidence from studies across the sub-region (ie, Western, Eastern, and Southern Africa) shows that lack of adequate sexuality-related information by parents creates an uncomfortable environment for young people making it difficult for them to discuss sexual issues with their parents and vice versa.29,32,34,46 Thus, parents employ scare tactics to discourage their children from being interested in sexuality-related issues,46 avoiding “the elephant in the room” and instead insisting that they focus on their education. Human development continues; however, the physiological demands of adolescence rage on. Interventions that foster positive attitudinal and behavioral changes in parents toward their developing children are needed to diminish the indirect, vague warnings, threats, and cautions toward sexuality-related discussions during such a critical period of human development for the child. Programs such as Uganda’s Straight Talk campaign47 and Families Matter in Kenya48 have been shown to shift parental attitudes and general willingness toward sexuality-related discussions with their children.

The role of extended family relations like aunts and uncles in some cultures poses a significant challenge to parent-adolescent sexuality-related discussions in cultures in SSA. As revealed in previous studies,5,8,11 parents play an essential role in shaping the behavior and attitude of their children in an attempt to ensure conformity to the social and cultural norms.5 However, due to cultural norms, their inability and non-involvement in sexuality discussions could mean that children may miss out on critical sexuality-related issues during their formative years. This may lead to the youth relying on their peers and social media as sources of sexual health information, though they may be unreliable. Irrespective of whose responsibility norms dictate, someone needs to take on the responsibility of helping adolescents understand their changing bodies. This review suggests that cultural norms around who that someone is may need revisiting.

Given the role of parents in shaping young people’s attitudes and behavior, there is a need to improve their communication on sexuality-related issues with their adolescent wards. Interventions that support parents in recognizing and being responsive (not reactionary) to the sexual needs of their developing adolescent children are needed.

CONCLUSION

This scoping review demonstrates gaps in the extant literature regarding parent-adolescent communication on sexuality issues in SSA. The sociocultural factors and barriers influencing sexual communications are largely similar across the sub-region and are structurally driven. Future studies could engage in a review of studies on peer-taught adolescent education in SSA in order to interrogate young people’s agency to self-aware sex education.

Funding:

This work was supported by grants from the International Society for the Study of Women’s Sexual Health (ISSWSH), and the Ghana Studies Association (GSA).

APPENDIX A. SEARCH TERMS

Database Search term
Google Scholar “sexuality education,” “sexuality,” “sociocultural,” “cultural factors,” “adolescent,” “young people,” “parents,” “guardians,” “sexual information,” “sexual discussion,” “sexual communication,” “sexual health” “reproductive health,” “barriers,” “sub-Saharan Africa,” sexuality education OR sexuality AND sociocultural OR cultural factors AND adolescent OR young people AND parents OR guardians AND sexual information OR sexual discussion OR sexual communication AND sexual health OR reproductive health AND barriers AND sub-Saharan Africa, sexuality education, sexuality, sociocultural, adolescent, parents, sexual information, sexual discussion, sexual communication
Scopus sexuality education OR sexuality, sociocultural OR cultural factors, adolescent OR young people, parents OR guardians, sexuality education, Africa, sexual reproductive health education, barriers, Africa, sexuality education, AND sub-Saharan Africa
PubMed sexuality education OR sexuality AND sociocultural OR cultural factors AND adolescent OR young people AND parents OR guardians AND sexual information OR sexual discussion OR sexual communication AND sexual health OR reproductive health AND barriers AND sub-Saharan Africa sexuality education AND sub-Saharan Africa, sexuality education, Africa, sexual reproductive health education, barriers, Africa
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Footnotes

Conflict of Interest: The authors report no conflicts of interest.

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