Sri Lankan mothers with adolescent girl children have agreed that they need to be equipped with the knowledge and necessary skills to discuss adolescent sexual and reproductive health (SRH)-related matters with their daughters effectively.

These findings were made in an article on “Mothers’ perceptions and concerns over sharing SRH information with their adolescent daughters: A qualitative study among mothers of adolescent girls aged 14-19 years in the developing world, Sri Lanka” which was authored by D. Mataraarachchi, G. Ariyadasa, C. Wijemanne, I. Gunatilake, I. Nupahewa, A. Gunasoma and P.V.S.C. Vithana (all seven attached to the Health Ministry's Family Health Bureau), P.K.B. Mahesh (attached to the Ministry's Health Department), and T.E.A. Pathirana (attached to the Panadura Base Hospital), and published in the BMC Women's Health's 23rd Volume in May, 2023.

In Mataraarachchi et al.'s study, a group sample of 64 biological mothers of unmarried, adolescent girls aged 14-19 years in six purposively selected Medical Officer of Health areas in the Kalutara District (considering the geographic variation with 10-12 mothers purposively selected from each public health midwife area to participate) was spoke to from November 2019 to February 2020. 

The mean age was 43.5 years. The majority was above 40 years (81.2%). All participants were Sinhalese and 53/82.8% were Buddhists, while 11/17.2% were Catholic or Christian. A total of 40/34.1% were educated above the Ordinary Level, while 21/32.8% were employed.

SRH issues are common to adolescent girls

Mothers identified issues related to puberty and romantic relationships, and exposure to sexual violence as the main SRH concerns during adolescence. They understood that sudden physiological changes during this time can be distressful to an adolescent girl. They also understood how important body image can be. Most talked about the difficulties a girl could be facing due to puberty. Among these, menstruation played a major role. 

“My younger daughter attained puberty at the age of 12. Then, she didn’t get her period for some time. When she started bleeding, she was worried about it. She was scared of blood that was coming out of her body. I told her that this is normal to any girl of her age, and then, with time, she learned to accept the event.” 

“My daughter complains of pain in the upper and lower limbs, and head and stomach ache during this time. She even ignores watching television (TV) and falls asleep the whole day. She loses interest in food and hates to go out of the house during this time.” 

“During this phase, they undergo bodily changes like breast enlargement and increased growth of body hair that might be distressful.”

Many did not want their daughters to be involved in romantic relationships, since they feared the chance of intimacy. They were more concerned about the chastity of their daughters. This is largely explained by the cultural beliefs in the study setting, where virginity is given importance at the time of marriage. “We are scared that our girls might get involved in love affairs.” 

“Love affairs can have a harmful impact on an adolescent girl if her parents do not properly monitor them.” 

“Girls will have difficulty getting into marriage if they get themselves into sexual relationships during this time.”

Mothers were careful to use the word “sexual abuse” or “forced sex” to describe sexual relationships that happen during adolescence. This could partly be attributed to the fact that those mothers were reluctant to accept that their adolescent children are willingly engaging in sexual activity. The finding can also be explained by the fact that the mothers in the study setting regarded their teenagers as small children and did not want to admit that they have sexual desires. “Pregnancies can happen during this time, mostly by forced sex.” 

“The young girls of this age are more at risk of getting sexually abused.” 

“If a female child gets coerced into sex once, she gets marginalised from the society and might face recurrent abuse. This may even push her to prostitution.”

Mothers had fairly good knowledge about from whom their children could get sexually coerced and the consequences of being subjected to sexual violence. They even had knowledge about the new ways that a child can get sexually coerced such as through the Internet and social media. “Now, there are other ways from which a girl can be put into trouble such as by posting pictures on social media without permission.”

Factors contributing to adolescent girls’ SRH issues

Adolescent girls’ reluctance to share SRH-related matters with a trustworthy adult was identified by the mothers as a contributing factor for SRH problems. Some mothers worried that girls were not opening up to their parents but to their peers. “They tend to share their thoughts and feelings with friends but don't want to share those with me. If they tell us their problems, we can help them out.”

Mothers believed that the lack of love and protection from the family can push a teenage girl into trouble. “Parents should give adequate love and care to children. Otherwise, they would go in search of love and affection from others.” 

“Most of the time, when the mother doesn’t act as a friend to the adolescent daughter, there is a high chance that children face such issues.”

Mothers knew that sudden changes in hormone levels can cause increased sexual desire during this age which might put them in trouble. “When body appearance changes with the maturation of the sexual organs, a young girl might feel as if they are adults. This will probably make them try out adult behaviours, perhaps sexual behaviours.”

The participants pointed out that poor SRH knowledge is one major reason for SRH issues in adolescents. “I feel that my daughter is not very knowledgeable about these things. Sometimes, I fear that she may fall into risks.” 

“If the girls know the sexual risks around them, they will try to protect themselves.”

They blamed school teachers for not providing their children with proper sexuality education.

Mothers also believed that children are exposed to sexual material that is published via the TV. “Sexual content is very common on TV and YouTube nowadays. They will be influenced to practise sex after watching these.”

Sources of SRH info for adolescent girls

Many mothers believe that parents are a good source of sexual health information for adolescent girls. “I think that parents are the best persons to deliver SRH information to young girls. Parents know what to tell their children and what not to. Also, if the parents talk to their children about these topics, the children will also open up themselves to the parents.”

However, some mothers said that school teachers are a better source of sexual health information as they know how to deliver these messages to children in the most appropriate way. “Teachers know how to teach these to the children.”

Some mothers would like healthcare workers to talk to their children regarding these matters. “Schools should invite a doctor to teach this chapter so that the children will learn things better because doctors know what to say to a teen girl and how to properly communicate the matters.”

Importance of providing SRH info to adolescent girls

Many mothers were not satisfied with the sexuality education in schools. They complained about the fact that many teachers avoid teaching the SRH chapter in schools. “SRH education is there in the textbook. However, most of the teachers don’t teach but give questions and ask the children to find out answers on their own after reading the book.”

Many mothers believed that it is important to provide sexual health information to their offspring. “Giving sexual health information at an early age will minimise the curiosity of adolescents to go after sex related content.” 

“If provided with information, she will be able to protect herself from any danger that she might face during this time. She will also develop the capacity to solve issues that she might face.”

However, almost all mothers preferred “abstinence only” sexuality education over “abstinence-plus” or “comprehensive” sexuality education. Instead, they wanted to make their girls aware of the consequences of premarital sex and the importance of keeping bodily boundaries until marriage. “It is important to provide them information about the consequences of engaging in sex during this time. If the children are made aware of these consequences, they will not engage in any unwanted relationships before marriage.”

Nevertheless, there were some mothers who thought that sexual education is not an essential requirement for the child. They feared that providing sexual health information may aggravate the child’s curiosity to explore more, putting her at more risk of sex during adolescence. “I feel that giving knowledge at an early age may arouse the curiosity of the child to explore these things more. I feel that it’s good to let the child learn these things little by little, naturally, with time, rather than feeding her a big chunk of information at once.”

Mother has a role to play

All mothers accepted that the mother should maintain a healthy relationship with their daughter/s. “We should always be a friend to our daughters, so that they will communicate their issues to the mother. A daughter is always close to her mother. If the mother keeps the habit of talking to her daughter about every day information, she will not hesitate to open up with any of her confidential matters to the mother.”

Communicating SRH matters with daughters

The majority realised the importance of making their children aware of sexual health matters and were trying to communicate appropriately. “Sometimes, it’s not easy. But I try hard to keep her informed about the sexual risks that she may have to face and how to protect herself from them.”

For many mothers, this was a difficult topic to communicate with their children. “There are things that we cannot explain in depth.”

Issues related to menstruation, preventing sexual violence, chastity, and sexual abstinence were the commonly discussed topics between the mother and daughter. “I have discussed with my daughter about problems related to the menses. I ask about the duration of the bleeding and check whether it is regular.”

“I have told my daughter to inform me if a stranger touches her body and not to open the door when she is alone at home.” 

“I often advise my daughter not to let anyone see or touch her private parts.”

Mothers had warned their adolescent girls about having romantic relationships and had advised their daughters to avoid sex within a relationship. They used indirect words such as “unwanted things” and “close contacts” to depict sex within a relationship, which showed the mothers’ embarrassment over using direct language. 

“I have told my daughter that if she starts a romantic relationship with a man and if an unwanted thing happens, she will never get a chance to marry another man. I have told her that she has to protect herself until marriage.” 

“My girl has a boyfriend. I have told her that it’s alright to have a boyfriend but I advise her not to have intimacy. I have made her aware of the adverse things that can happen if she gets into an intimate relationship.”

Although mothers wanted to communicate sexual health matters with their adolescent daughters, they were reluctant to communicate certain sexual matters. “I have not told my daughter about the sexual act or how a conception occurs. It’s embarrassing.”

At times, they provided dishonest answers to the questions raised by their children. “I have told her that babies are born from a cut made on the abdomen.”

Discussing contraceptive methods 

Many mothers did not agree with discussing contraceptive methods with their children. “I don’t think that it’s a good decision to make them aware of contraceptive methods.”

Many mothers who had been discussing SRH matters with children, have been doing so while watching or listening to incidences of sex-related matters. “I find the opportunity to discuss these matters with my daughter when we are watching TV. When they report about sexual abuse incidents in the news, I teach about these things” 

“When I see sexual violence cases reported in the newspapers, I ask her to read too. Then, she comes up with questions.”

Mothers’ concerns about providing SRH info to adolescents

Adolescents need to be taught about the negative consequences of having premarital sex. The majority believed that the provision of sexual health information to adolescents should be done within limits. They were more concerned about the chastity of their female children. “The girls should be made aware of the negative effects of having sexual relationships during this time.”

They wanted to make their girls aware of the consequences of premarital sex and the importance of keeping bodily boundaries until marriage. “It is important to tell the children what bad sex before marriage can do to a young girl during this time.”

Mothers believed that too much information may cause unnecessary fear in children. “In my daughter’s school, they had shown some videos and discussed some cases of sexual abuse with our children. These cases were about rape and crimes that happened to children of that age. My girl was frightened after seeing these videos and hearing the stories, thinking that these might happen to her too.”

Sexuality information should be provided age appropriately

Mothers suggested a step-by-step approach to providing SRH information to teenagers. “If the children were provided this information in a step by step manner, this would not have happened, but, when the information is given all at once, the children get fearful or feel dismay.”

They were also concerned about providing information in a manner that is appropriate to the age of the girl. “I think that information about menses should be given at an early age around 10 or 11 years. Information about sexual violence and the consequences of premarital sex should be given at an age earlier than 15 years, probably at 13-14 years. Information about family planning methods must be given at a later age, probably at the age of 18-20 years.”

Family planning information should not be shared with children

Mothers believed that providing contraceptive information to children should be done with caution since it may encourage children to engage in sexual behaviours at an early age. “I have never discussed family planning methods with my daughter. I think that making them aware of contraception might encourage them to try these methods and to engage in these activities without fear.”

The provision of SRH information should be individualised to the needs of the child

Mothers also believed that sexual information should be individualised to the needs of their children. “I think that before we give knowledge and information to our children, we should know clearly what our girls are up to. There are some children who would want to protect themselves from these risks. But, there might also be some others who try to experience these.”

Talking about sexual health matters would encourage children to explore sex

Some mothers avoided talking to their children about sex, thinking that communicating about sex may increase a child’s curiosity to explore about sex more. “I feel that talking about these things would aggravate a child’s curiosity to explore these things more.”

Talking about sexual matters may lead to the loss of the child’s respect towards the parents

Some of the parents assumed that children may lose respect towards their parents if they talk about more informal topics like “sex” with their children. “I’m afraid that she might think that I’m alright with these things if I talk to her about these topics.”

Escaping the responsibility to educate their children on SRH

Some mothers wished that their children would obtain knowledge about sexual health from other sources. “I don’t know how to discuss these things with children. Rather, I wish they would learn from their peers and other sources.”

Barriers to communicating SRH topics with daughters

Difficulty responding to questions

Mothers feared if their children would come up with questions when they communicate sexual health-related matters. “Children sometimes ask how females get pregnant. Then, it’s actually difficult for us to answer. Sometimes, we lie to them.”

Difficulty using direct language

They had difficulty in using direct language when communicating sexual health matters with children. “I don’t use the exact words when talking about these things. It’s embarrassing.”

Inadequate skills and knowledge to communicate with children

Many mothers were uncertain as to whether they are practising the correct way of communicating sexual matters with children. “I’m concerned as to whether my way of telling these things is the appropriate way to communicate these things with a young child. I’d rather keep my mouth shut.”

Some mothers doubt whether they have adequate knowledge and skills to communicate these matters with children. “I want to teach my girl about these things, yet, I’m not sure whether I have enough knowledge.” 

“I don’t discuss these things with my daughter because I don’t know how to do it.”

“I fear about the questions that she might raise if I start a discussion with her on this subject.”

Shame and embarrassment around the topic

Embarrassment was one other factor that prevented mothers from discussing sexual matters with their offspring. “Yes, we should answer their queries. Still, at times, I’m unable to do that. Sometimes, I know the answer, but I'm shy to tell my daughter these things. However, it’s still good if we can give them accurate information.”

Adolescent girls’ reluctance to open up to their parents

Mothers also talked about the fact that their adolescent daughters are reluctant to open up to their parents regarding this topic. “These girls sometimes try to hide their feelings. Some girls tell only a little and the rest they refrain from telling their parents.”

Mothers’ suggestions to overcome the challenges of mother-daughter SRH communication

Mothers need to be educated about delivering SRH information to children.

Mothers wanted to know more about SRH issues faced by adolescent girls. They also wished that they knew the correct method to deliver SRH messages to children at the appropriate age. “I need to improve my knowledge on these things more.” 

“I think that I have both the knowledge and skills to discuss these things with my daughter. But, I have not talked to my daughter about these things because I don’t know when to discuss these things with her.” 

“If mothers can be trained on how to tell and what to tell according to the child’s age, that would be very useful.”

Mothers found it easier to discuss sexual matters with children when they had prior sexuality education in school.