Nepal: student survey shows the power of parent-child communication

A study involving around 600 Nepalese adolescents has found that those who talk to their parents about sex are more likely to use sexual and reproductive health (SRH) services than other teenagers.

In 2017, researchers asked teenagers in Grades 11 and 12 (ages 15-19) from seven schools in Kailali to fill out an anonymous questionnaire about their sexual behaviours, whether they talk with their parents about seven SRH topics (puberty, menstruation, safer sex, contraception, condoms, unintended pregnancy, HIV and sexually transmitted infections), and whether they had used an adolescent SRH service. A public programme runs in 63 Nepalese districts, including Kailali, which provides age-appropriate, non-judgemental SRH services.

The students’ mean age was 17, 58% were female and 99% were unmarried.

While 57% said they did not talk to their parents about any of the seven SRH topics, around 20% had discussed one topic, 14% had discussed two, and 6% had discussed three or more.

The most common topics discussed were menstruation (18%), puberty (16%) and HIV or STIs (15%). Girls were more likely than boys to discuss menstruation and unintended pregnancy but there was no gender difference in relation to the other topics.

Around 13% of students said they had used an adolescent SRH service in the past year. Those reporting more SRH communication with their parents were significantly more likely to use these services than others. Being sexually active and male was also associated with SRH service use.

Contraception services were the most common service used, followed by services for SRH information, STIs or HIV, pregnancy and abortion.

Students from the Janajati ethnic group (about half of the students) were more likely than those from the Brahmin/Chhetri or Dalit ethnic groups to talk to their parents about sex. Janajati students were also more likely to use SRH services than others. It may be that stricter norms relating to young people’s SRH are present in the Brahmin/Chhetri and Dalit cultures, but further research is needed to explain this difference.

The majority of students (70%) lived with both parents, while 13% lived with a single parent, 10% lived alone, and 7% lived with siblings, relatives, or friends. Those living alone were less likely to use SRH services than those living with both parents. This is similar to findings from a 2013 study in Ethiopia, which found that HIV testing was more common among adolescents living with both parents than other teenagers.

As 45% of adolescents in Kailali have left school by Grades 11 and 12, the overall SRH picture for teenagers in the district could be quite different. For example, married female adolescents will have clear SRH needs but they tend to leave school early so their experiences are not represented.

The researchers did not examine whether parent communication directly caused respondents to access SRH services and students were not asked about this. Data was also self-reported, and although steps were taken to encourage honesty, it is not guaranteed that all students gave accurate responses.

But the findings suggest that parents who are willing to talk about sex and reproduction with their adolescent children could encourage them to use the services available to them, and ultimately prevent negative SRH outcomes.