“Change It, Change It” Barriers for Parent–Adolescent Communication about Contraceptives in Bahir Dar City, North West, Ethiopia, 2023
Abstract
Background. The rising prevalence of risky behavior among East African adolescents places an additional strain on them, their families, and society. Adolescents in this area are particularly vulnerable to sexual and reproductive health (SRH) issues such as sexually transmitted infections, unexpected pregnancies, unsafe abortions, sexual abuse, and rape. This is believed to be due to the lack of communication between most parents in this region and their adolescents about SRH issues, such as contraceptives. This study explored barriers to parent–adolescent communication about contraceptives. Materials and Methods. A qualitative study with a phenomenological approach was used. Participants in the study were purposefully selected parents and adolescents who lived in the city of Bahir Dar, Ethiopia. An in-depth interview guide was prepared and used to collect the data. ATLAS.ti software was used for coding, and thematic analysis was subsequently performed. Results. Thirty adolescents and 20 parents participated in the in-depth interviews. Five main themes and 14 subthemes were identified. The main barriers to parental-adolescent communication about contraceptives were cultural and religious factors, the knowledge gap, parents’ busyness, age, and the media as a source of information. Conclusions and Recommendations. To improve communication with very young adolescents (ages 10–13), parents should have sufficient and accurate knowledge about contraception as well as efficient communication techniques. To involve all stakeholders, including parents, in the deconstruction of sociocultural norms surrounding the SRH of adolescents, it is important to strengthen and spread campaigns that raise awareness of parental-adolescent communication.
1. Background
The World Health Organization (WHO) defines adolescents as people between 10 and 19 years of age [1], and these individuals represent approximately 16% of the world’s population [2].
Adolescence is the transition phase between childhood and adulthood. It is a time of much physical, social, mental, and emotional change. Adolescents start having sex earlier in life before they are emotionally ready for an intimate relationship. Peer pressure and inadequate parental direction can lead to sexual experimentation and feelings of helplessness among many adolescents. Consequently, the prevalence of HIV (Human immune deficiency virus) and other sexually transmitted infections (STIs) has increased [3]. For adolescents to have better sexual and reproductive health (SRH) outcomes, they must have timely access to SRH information and services [4]. Previous research has indicated that adolescentsʼ primary sources of SRH information were their peers and the media. However, inaccurate information from peers and the media could lead to exposure to several risks, including the triple tragedy of STIs, including HIV/AIDS, unwanted teenage pregnancy, and unsafe-induced abortion [5].
A review of research conducted in sub-Saharan African countries revealed that cultural norms, taboos, and a lack of knowledge and skills are the main barriers to parent–adolescent communication [5]. Furthermore, several studies have shown that parental characteristics such as “lack of time with children,” “parents not willing to listen,” and “embarrassment to parents,” along with inaccurate or low self-efficacy that is socially unacceptable and unsettling, can make it difficult for some parents to have frank and comfortable discussions with their adolescents about contraceptives [6, 7, 8].
Contraceptive-related topics are rarely discussed in Ethiopian communities, especially with parents and adolescents [9, 10]. Some parents find it challenging to talk to their adolescents about contraception because they believe that it promotes promiscuity, while others believe that adolescents are better knowledgeable than parents about it [3, 11]. Different generational gaps are the main source of communication barriers between parents and teenagers. Parents misunderstand their adolescents because they are often unable to keep up with their rapidly evolving social and technical development. Adolescents, on the other hand, believe that their parents have a very traditional point of view, making it difficult for them to understand [12]. Additional factors influencing parent–adolescent conversations about SRH include social structure, culture, communication abilities, parents’ views, attitudes, and knowledge about SRH [13, 14]. In Ethiopia, currently, there is a paucity of literature to elucidate the constraints on parent–adolescent communication about contraceptives. The aim of this study was to assess barriers to parent–adolescent communication about contraceptives in Bahir Dar City, Ethiopia. Furthermore, the study will contribute to the development of general suggestions needed to reduce current communication barriers and, as a result, improve the SRH of adolescents in the area.
2. Materials and Methods
2.1. Study Design and Setting
The data were collected between November and December 2023. We used a qualitative research design to gain a deeper understanding of the barriers to parent–adolescent communication about contraceptives in Bahir Dar City, Ethiopia.
2.2. Study Participants and Procedures
Participants, in this study, were parents of adolescents and adolescents, aged 10–19. Thirty adolescents (men and women) were purposively sampled from 15 schools in the city of Bahir Dar, Ethiopia. Thus, 15 schools were randomly selected out of 34 schools. Then, the school administrators were met and informed about the study, and they offered assistance by providing name lists of adolescents aged 10–19 years. To be included in the study, adolescents had to be residents of Bahir Dar City for more than 6 months and between 10 and 19 years old, and their parents provided informed consent for the adolescent to participate in the study.
The parents in this study were biological mothers, fathers, or female or male caregivers of the adolescent who must have lived continuously with the adolescent for at least 1 year prior to data collection. Through the assistance of the health extension worker, 25 parents were identified. They were contacted and briefed on the nature of the study, and 20 agreed to participate in it. The other parents who did not participate cited having a busy schedule as the prime rejection reason. Parents were eligible to participate if they had an adolescent aged 10–19 years who had been a resident of Bahir Dar City for more than 6 months and who expressed a willingness to participate in the study.
2.3. Data Collection Tools and Procedures
Participant selection was performed in such a way that it represented variation in the phenomenon of interest. To achieve maximum variation, heterogeneity of participants was ensured through selection, which adhered to differences in age and sex. IDIs were held with 10 mothers and 10 fathers, whereas for adolescents, they were held with 15 male adolescents and 15 female adolescents. Before data collection, participants were informed about the purpose of the study. Each purposely selected respondent interview was conducted by the principal investigator in the morning at the time and venue of their preference.
The interview guides were structured and did not contain any leading questions. Probing questions were asked on the basis of participants’ responses. The interviews were conducted in Amharic, a language all the participants are fluent in. Trained research assistance moderated the IDI, as did taking notes during the discussions. The interviews lasted for approximately 40 min.
All the interviews were audiotaped and transcribed (those conducted in Amharic were transcribed directly into English) by two bilingual transcribers. Twenty percent (10) of the transcripts were randomly selected, and the precision of the audio recordings was verified by the lead author and principal investigator for quality assurance before analysis. The data were collected and analyzed until no new information was forthcoming to enrich the identification of the relevant themes.
2.4. Data Quality and Reliability (Trustworthiness)
Quality assurance was integrated throughout the research process. To ensure credibility, different activities were performed, including triangulation, iterative questioning, prolonged participation, peer debriefing, and member checking. The principal investigator and the research assistant were familiar with the cultural and social backgrounds of the study participants. Different groups of participants, including parents (fathers and mothers) and adolescents (men and women), were included to obtain triangulated data. Training was provided to the research assistants and supervisors for 2 days. Training was focused on the aim of the study, how to conduct IDIs, the role of research assistants, and the topics to be discussed. Before the data were collected, the interview guides for the IDIs were pretested using three adolescents and two parents residing in Bahir Dar city. The results of the preliminary findings were presented by the PI in member checkup sessions. After the pretest, the tool was strengthened further, especially in line with the objectives. Specific questions on what parents and adolescents think about the barriers to parent–adolescent contraceptive communication.
The tape recordings were separately transcribed by the PI, and the research assistants and their scripts were compared. The transcriptions were compared, and portions that differed significantly from each other were retranscribed by listening to those portions of the tape recording again to reduce the effect of investigator bias (confirmability). The use of a tape recorder, careful probing, and interviewing up to data saturation were some of the activities that were performed to ensure dependability.
2.5. Data Processing and Analysis
After the data were collected and before the audio was transcribed, the audio recordings were repeatedly listened to. The transcription of the recorded Amharic version was conducted by the principal investigators and research assistants. The Amharic versions were translated into English by the PI and research assistants to maintain the consistency of the data and avoid bias from the principal investigator. The analysis was carried out using ATLAS.ti (Scientific Software, Berlin; version 7) and followed the inductive approach, where the researchers first examined all transcripts and identified emerging quotations about barriers to parent–adolescent communication about contraceptives, which were then labeled with a code. Codes were reviewed to identify and resolve coding discrepancies. Where necessary and upon discussion among the members of the research team, the codes were merged or separated. Finally, the codes were classified into themes and subthemes. Using the developed codebook, a second level of coding was performed. Thematic analysis was used to analyze our data. In the analysis, we triangulated the data from male and female adolescents and their parents. Differences in themes and subthemes were discussed among the team members. Our results are organized in such a way that participants’ responses about barriers to parent–adolescent communication about contraceptives are summarized. To explain each theme, a range of relevant quotes have been included in Section 3.
3. Results
The following themes emerged from the qualitative data as barriers to parent–adolescent contraceptive communication: cultural and religious factors, knowledge gaps, the busyness of parents, age, and media (Table 1).
| Sn | Theme | Subthemes |
|---|---|---|
| 1 | Cultural and religious factors |
|
| 2 | Knowledge gap |
|
| 3 | Busyness of parents |
|
| 4 | Age |
|
| 5 | Media as a source of information |
|
3.1. Cultural and Religious Factors
Communication regarding contraception between parents and adolescents was hampered by cultural and religious factors.
3.1.1. Cultural Norms
Cultural norms were the most frequently reported barrier to contraceptive conversations between parents and children. Therefore, frank discussions about contraception between parents and adolescents became unacceptable. Numerous statements from adolescents revealed that they do not openly communicate with their parents because they fear that they will be ashamed because it is culturally seen as a disgrace. Parents also mentioned that cultural norms impeded discussion between parents and adolescents about contraception.
“One of the things is our own culture of upbringing. It is considered taboo to talk about such things. Our culture is where we grew up. It keeps us from discussing such issues with our children” (a 38-year-old mother).
“Our culture considers sexual discussion immoral and unacceptable. Here, we grew up. Children have sex in secret. When they do it in secret, they get into trouble. I lost my sister due to the lack of discussion and clarity about this issue. If the family accepted this discussion and the culture was not bad, her sister would not die by secret abortion. This is what happens at the age of a teenager” (a 40-year-old mother).
“Due to this outdated cultural thinking, there are toxic parents in some places who see this kind of discussion as unnecessary. They often come up with ideas that will stunt their childrenʼs thinking abilities. It has a profound effect on our generation because it is where they grew up. This idea is out of date. Kids, you cannot know about this; you cannot do this. Every time we are told that we cannot know about contraceptives, this is a toxic idea. We see many adolescents being mothers when they are still young adolescents” (13-year-old female adolescent).
“Most of the time, when a movie is seen, when a romantic film is made up of a man or a woman, the movie (the parents) may change the channel. I do not understand why they say, Change it, change it. As long as a movie is made for a purpose, you might think that it can be ruined in the beginning, but we have to wait until the end to judge. Instead of saying, “Change it, change it,” change the channel when we see it; they (parents) should advise us what is wrong and what is right. If it is wrong, they should be aware of the problem rather than blindly saying that it is not our culture” (16-year-old male adolescent).
3.1.2. Religious Norms
It is assumed that religious beliefs prohibit parents from discussing contraceptives with their adolescent children. Due to societal religious beliefs, parents were discouraged from talking to their children about issues related to contraception.
“There is a trend to avoid such a discussion since it is believed that contraception is inherently undesirable from a religious perspective” (a 39-year-old father).
“Such discussions with adolescents are prohibited by religion. However, I disagree with this viewpoint. I believe we should discuss contraception with our teens. Spirituality will be restored through repentance. But nothing can be fixed once our children’s lives have been lost as a result of abortion, as was the case with my sister, and only grief remains. Thatʼs all” (a 40-year-old mother).
3.1.3. Feeling of Shame
Adolescents expressed that they avoid having open conversations with their parents because they are afraid of embarrassing themselves in front of their strict parents, whom they believe are culturally inappropriate.
“When we watch TV ads like Sensation (a condom) together with our parents, eh, they are embarrassed before us to change the channel” (a 15-year-old female adolescent).
“When I determined that my mother was using contraception, she did not tell me clearly. I just found that out in my way. I have seen that she inserted the Implanon. I saw the implanon insertion site tied to plaster. When I asked her after seeing that she had inserted the implanon, she did not tell me the truth; she could hide the insertion site. Parents are ashamed to talk to their children about such issues (a 19-year-old female adolescent).
3.1.4. Gender Differences
Gender is also another cultural barrier that hinders parental-adolescent contraceptive communication. The parents also expressed that this discussion was based on the same sex. Fathers are more likely to talk to their sons than their daughters are, and mothers are more likely to talk to their daughters than their sons are.
“Our relationship with Him (the father) is to take and receive orders. In addition, I take what he says as a command. We are not even friendly. Dads often become bosses, so I don’t think I can talk to my dad about this. Ehh, he did not think that women’s issues concerned him. He doesn’t even want to know when I am menstruating, so if he doesn’t want this, I don’t think he will talk to me about contraceptives” (19-year-old female adolescent).
“Taking such an issue with my father is so embarrassing…laughter… It is unthinkable. I think she (the mother) can explain everything openly because she is like me; she is a woman” (16-year-old female adolescent).
“I have a son and daughter, but I often talk about this with only my sons. Eh, most of the time, it is not common for girls to talk to fathers about this issue, and I give my advice through her mother” (a 39-year-old father).
3.2. Knowledge Gap
3.2.1. Lack of Knowledge about Contraceptives
It was difficult for parents to start conversations with their adolescents about contraceptives because they thought that they lacked the necessary knowledge, appropriate skills, and approaches. Parents reported that this lack of knowledge created a lack of confidence, making it difficult to find the courage to start a discussion with their adolescents. Consequently, parents faced difficulties speaking confidently about topics they were not familiar with. Adolescents also claimed that because their parents were uneducated, they did not have the opportunity to learn these things from them.
“Most of us lack knowledge about this issue; therefore, we do not open the door for this conversation. We think we cannot effectively respond to the question raised by our adolescents” (40-year-old father).
“There is a lack of knowledge to discuss contraceptives openly in our community, even among those who wish to be open about it.” (13 years old, female adolescent).
3.2.2. Parent Thinks about Its Unnecessary Topic
“I think the parent–adolescent contraceptive discussion was not of any importance for male adolescents because girls are exposed to unwanted pregnancy” (47-year-old mother).
“They may perceive this issue as necessary when I get married, not now… Our parents learned about this in their marriage in this way. They think, I will learn everything from my marriage” (15 years old, a woman adolescent).
3.2.3. Sexual Experimentation Ideology
Due to the knowledge gap, some parents expressed that it is difficult to have discussions about contraceptives with their children because they fear that the discussion might make sexual activities attractive. Parents expressed concerns that discussing contraception with their adolescents could encourage them to have sex. Similarly, many adolescents did not discuss this issue with their parents because they feared being misinterpreted or perceived as sexually active. A good example of this perception is illustrated in the following extract.
“When we ask parents about contraceptives, they think that we are starting to have sex. In addition, instead of asking, we (adolescents) try to keep quiet” (15-year-old female adolescent).
“Laugh…. I think talking about condoms with children is like telling children to act. If contraceptive discussions between parents and adolescents become common, they can lead to unnecessary sexual desire” (40-year-old father).
3.3. Busyness of Parents
3.3.1. Lack of Time to Spend Together
The amount of time parents could spend with their children depended on their jobs. Parents increasingly prioritized the demands of work over child care. According to numerous participants, parents were too busy to spend time discussing contraception with their adolescents.
“I do not have time for this discussion because I am so tired when I get home from work. There are numerous issues that need to be discussed. Numberous economic challenges, a high cost of living, and social concerns preoccupy our attention more than the contraceptive discussion with our children” (38-year-old father).
“My parents leave work in the morning, and I also go to school. We will meet after dark. At that point, we are fatigued and want to sleep. They lack time to talk to me about this matter” (14 years old, male adolescent).
3.3.2. Lack of Closeness between Parent and Adolescent
Some adolescents expressed that they were not close enough to their parents to talk about contraceptives.
“Most Ethiopian fathers are never close to their children… Most of them (the fathers) come to work at night and just talk with their wives. This makes children never close to their parents. Therefore, we lack the courage to ask our parents about such issues” (18-year-old male adolescent).
3.4. Age
3.4.1. Parent Thinks That Adolescent is Young
The age of adolescents is also another barrier to parent–adolescent contraceptive communication. Some parents believe that their children are not yet mature enough to grasp the concept of contraception. Parents thought that their children were still too young to know about contraceptives.
“Even if they raise the contraceptive issue, they do not think it will involve me. They do not think I am old, but parents need to know the age of their children. If children are teenagers, parents should know that they have grown up” (19 years old, female adolescent).
“Parents think that I am young. They think I need to know such an issue slowly and calmly laugh; when I say something about contraceptives, they (the parents) say, How could you know? Where did you hear it? “Where did you know it?” (17 years old, female adolescent).
“We hide everything from them; they treat us like children and don’t believe we know this kind of thing” (14-year-old female adolescent).
3.4.2. Presence of Younger Siblings at Home
Another barrier to not discussing contraceptives was the presence of younger siblings.
“Our conversations with my mother at home are frequently interrupted by my brother, who is 8 years old. Even if my mother and I had brought up the subject of contraception, if my brother entered the room, we would immediately stop talking about it and switch to another subject” (16-year-old female adolescent).
3.5. Age Difference between Parents and Adolescents
Adolescents expressed that the age difference between parents and children was a communication barrier.
“First, there is a difference in age. If you tell your friend, she will understand you. Your closest sister or brother will understand you. However, the parents will never understand us because of the age differences between us. However, they were the ones who should have told us. They had many life experiences. I have never discussed these contraceptive issues with my parents” (15 years old, female adolescent).
“Due to the difference in age, the parents did not understand us. If I talk to them about this, they think of something else. If I ask them that, they will wonder why I asked” (13 years old, female adolescent).
“How can I talk about this issue with the parent if they (the parents) are angry with me not only for talking about such an issue but also for thinking about it? Due to the age difference, they (the parents) did not understand us” (14 years old, female adolescent).
3.6. Media as a Source of Information
3.6.1. Parents Think that Adolescents Know about Contraceptives from School and the Internet
It was discovered that parents thought that their children had the necessary knowledge of contraception from school and other media. Some adolescents claimed that their parents did not discuss contraception with their children because they believed that their children learned everything through sophisticated science and technology and through education.
“They (parents) do not want to explain about contraceptives because they know that we know… they think you have a phone, you go to school, you study, you know.” (15-year-old female adolescent).
3.6.2. Adolescent Google Preference
Some adolescents indicated that they preferred to use Google rather than ask their parents about contraceptives.
“We (adolescents) don’t want to ask the parents about this; we just want to search Google for what we want to know” (14-year-old female adolescent).
“I have wifi at home, so a simple search can provide me with a wealth of knowledge about this type of issue” (13-years old, female adolescent).
4. Discussion
Our qualitative interviews highlighted barriers to contraceptive communication between parents and adolescents. The findings of this study showed that participants perceived that the barriers that affect communication about contraceptives between parents and adolescents arise from both parents and adolescents.
We found that prominent parental factors were linked to a strong cultural barrier: parents do not talk about contraceptives with their adolescents. Due to their various social roles, parents and adolescents have different worldviews. Parents are tightly bound to cultural norms that prevent them from having conversations with their adolescents about contraceptives. Open conversations on SRH, especially sex-related issues, are highly scripted and veiled in mystery in most African societies, including Ethiopia [3, 15]. Similarly, open university training modules have shown that Ethiopian parents tend to consider such communications as nonmoral activities when raising adolescents [16]. Cultural norms do not offer a friendly environment in which contraceptive issues can be honestly and openly discussed. As a result, adolescents lack vital and beneficial contraceptive information and guidance.
As a communication barrier, religion also plays a role. Religious belief often stands as a stumbling block to communication between parents and adolescents on contraceptive issues. Parents said that when talking to their adolescents, their religious beliefs serve as guidance. Like in other parts of the world, common and major religions are found in Ethiopia, with the largest number of believers being Christian and Muslim. Both religions prohibit their followers from committing adultery before marriage, practicing abortion, or using contraceptive methods such as condoms. It was extremely difficult for parents from these religious backgrounds to recommend the use of contraceptives to their adolescents. These findings are also consistent with those of other studies [14].
Gender played an influential role when effective parent–adolescent interaction occurred with respect to contraceptive communication. We found that mothers frequently communicate with daughters and fathers with boys. Surprisingly, most fathers think it is not their responsibility, but it can be done at school. Moreover, parents were more likely to discuss contraceptives with their female adolescents than with their male adolescents. Similarly, it was evident that male adolescents, in general, communicated less with anyone on contraceptive issues. This sex difference was similarly reported in a cross-sectional study in Dire Dawa, eastern Ethiopia [17]. This gender disparity may result from the belief that adolescent girls are disproportionately more likely to experience the negative consequences of early sexual activity, such as unintended pregnancies, unsafe abortions, coercion, sexual violence, dropping out of school, and early marriage [18].
The age of the adolescent was also identified as the most common barrier to communication about contraceptives. Some parents think that their adolescent is too young to have this type of conversation. Parents have been reported to feel more comfortable discussing contraceptives with their adolescents as their age increases. These findings are similar to those of a previous study, which showed that parents speak less to younger adolescents [10, 11, 12, 13] years because they believe it is not yet appropriate to talk about contraceptives at such a young age [19].
Parents initiate communication only as a means of protection once they discover that adolescents are sexually active. It was also noted that adolescents felt more comfortable talking to their peers about concerns related to contraception. This strategy was inspired by the fact that peers generally adopt a more friendly stance, creating an atmosphere that allows people to be free and freely discuss delicate subjects. Unfortunately, studies have shown that the information obtained from these sources is incorrect or false [5]. This is a major cause of early sexual activity and, consequently, a high rate of unwanted pregnancies and unsafe abortions among adolescents [20]. Adolescents believe that their parents are unapproachable and that they worry about being misinterpreted and having their personal affairs questioned. Parents are an important source of information, and these issues may increase the difficulty for enablers to connect with them effectively. Consequently, this approach reduces the importance of parents as the main information providers. The responsibility is relegated to other sources that are too characterized by information gaps. Many parents lacked confidence in their ability to discuss contraceptives with their adolescents, which was attributed to their lack of relevant knowledge and to their low level of educational achievement. Others had incorrect knowledge, while others did not know what to tell the adolescent, which limited what they could communicate.
Due to the knowledge gap, some parents stated that it is difficult to have conversations about contraceptives with their adolescents because they are afraid that the discussion might make sexual activities seem attractive. These findings are similar to those of a previous study that showed that some parents denied their responsibility to communicate with their adolescents because they feared that communicating with their adolescents would perpetuate early sex practices and were embarrassed by the process [3, 21]. Premarital sexual activity, especially among adolescents, is strongly discouraged in many SSA settings [13, 22].
Another major barrier to parent–adolescent communication in this study was parentsʼ busy schedules due to work pressures, which hindered interaction between parents and children [23]. A previous study by Mmbaga et al. [24] also confirmed that busy schedules hindered SRH discussions between parents and secondary school adolescents aged 16–19 years in Tanzania. Plausible explanations for this could be as follows: Most parents leave very early in the morning for work, and many return late at night. Absent parents are less likely to have a close and trusting relationship with their adolescents, which affects the communication process, as documented by other studies in SSA [20, 24].
Furthermore, some parents added that they did not communicate with their adolescents about contraceptives because they thought that their adolescents knew more about contraceptives than themselves. This finding is similar to the finding from a study by Bethilhem Wubet and Abeje [14] performed by Bahir Dar, which showed that parents felt that their role was no longer valuable, as young people knew more about contraceptives than they did.
In addition, parents claimed that they did not talk about contraceptives with their adolescents because they thought that adolescents preferred to obtain information about contraceptives from the media, such as television and the Internet. These findings are similar to previous findings [25].On the part of the adolescents, they were of the opinion that parents were not sufficiently friendly and that they were not sure what their parents would think of them if they continued to ask questions about contraceptives. This finding is also consistent with the study of Guilamo-Ramos et al. [26]. These authors showed that both boys and girls were afraid to ask their parents questions about sex, as they did not want their parents to discover that they were already sexually active.
5. Conclusion
This study revealed that cultural and religious factors, the knowledge gap, parental busyness, age, and the media as a source of information were themes that emerged as barriers to parent–adolescent contraceptive communication. Findings from this research suggest that adolescents are interested in talking about contraceptives with their parents. However, contraceptives were one of the rarely discussed SRH topics.
The Ethiopian government has developed a national reproductive health strategy, but the role of parent–adolescent discussion contraceptives is not well addressed yet. Parents must be empowered and motivated to communicate with their adolescents about contraceptives. This is because many of them are uncomfortable talking to their own children about SRH issues such as condoms.
Community-based campaigns by hospital outreach programs and community health workers targeting parentʼs knowledge, attitudes, and practices to initiate Parent-Adolescent contraceptives communication are needed. Empowering adolescents with contraceptive knowledge can improve their self-efficacy in negotiating safe sex practices. To achieve this goal, there is a need for consistent and coordinated access to contraceptive information at all levels, including home, school, and community.
Sensitization campaigns about parent–adolescent communication should be strengthened, and messages should be disseminated to create an opportunity for all stakeholders, including parents, to deconstruct sociocultural norms around the SRH of adolescents, to sensibilize and develop parents’ capacity, to encourage the initiation of contraceptive discussions at an early age, and to integrate parent–adolescent communication into parenting interventions as potential strategies to decrease adolescent pregnancy, unsafe abortions, and complications during pregnancy and childbirth.
Abbreviations
-
- AIDS:
-
- Acquired immune deficiency syndrome
-
- HIV:
-
- Human immune deficiency virus
-
- IDI:
-
- In-depth interview
-
- SRH:
-
- Sexual and reproductive health
-
- STI:
-
- Sexually transmitted infection
-
- WHO:
-
- World Health Organization.
Ethical Approval
Ethical approval was obtained from the Institutional Review Board of the Bahir Dar University College of Medicine and Health Science (IRB) with the Ethics Consent Letter Ref. No. 443/2022. A letter of cooperation was obtained from the Amhara Public Health Institute and the Bahir Dar town health office. Participants were explicitly informed about the purpose, benefits, risks, discomfort, and right to refuse or even withdraw at any time during the interview.
Consent
Written informed consent was obtained from adolescents aged ≥18 years. The consent of parents/guardians and assent of adolescents aged <18 years were also obtained. To ensure the confidentiality of the information, personal identifiers were not used throughout the study.
Conflicts of Interest
We have no competing interests.
Authors’ Contributions
Bethilhem Wubet developed the idea, planned the original study, collected the data, and performed the analysis with guidance from Taye Zeru, Gizachew Worku, and Gedefaw Abeje. Bethilhem Wubet and Taye Zeru led the analysis, and Gizachew Worku and Gedefaw Abeje subsequently verified the analysis. Bethilhem Wubet drafted the manuscript, which was reviewed repeatedly. Taye Zeru, Gizachew Worku, and Gedefaw Abeje contributed to and approved the final manuscript. The authors read and approved the final manuscript.
Acknowledgments
The author offers special thanks to all the authors listed on the reference page. Additionally, I would like to express my sincere gratitude to all the study participants and supervisors for their genuine dedication and effort during the data collection.
Open Research
Data Availability
All data generated or analyzed during this study are included in this article. The data that support the findings are also available from the corresponding and primary authors upon reasonable request.
