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Sexuality Education -- Do Our Children Need It? Perspective of Parents from Coastal South India

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Title: Sexuality Education -- Do Our Children Need It? Perspective of Parents from Coastal South India
Language: English
Authors: Ballal, Vaishnavi, Thapar, Rekha (ORCID 0000-0003-2278-1445), Sandepudi, Bhavya, Narayan, Abinand, Devaraj, Manganahalli, Jayarajan, Shreehari Manikoth, Kumar, Nithin, Unnikrishnan, Bhaskaran (ORCID 0000-0003-0892-8551), Mithra, Prasanna
Source: Sex Education: Sexuality, Society and Learning. 2022 22(3):379-392.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 14
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Descriptors: Sex Education, Foreign Countries, Parent Attitudes, Religious Factors, Cultural Influences, Adolescents, Parent Child Relationship, Parent Role, Individual Characteristics, Socioeconomic Status, Family Structure, Age Differences, Gender Differences, Educational Attainment, Parent Background
Geographic Terms: India
DOI: 10.1080/14681811.2020.1843011
ISSN: 1468-1811
1472-0825
Abstract: Sexuality education although essential in today's world remains a taboo and a hotly debated topic. This is linked to uncertainties associated with the topic and varied perceptions by parents, teachers and community members, which are in turn influenced by prevailing religious and cultural beliefs. In this cross-sectional study, 233 parents of adolescent children were assessed regarding their perceptions and practices of providing sexuality education to their children. The mean age of study participants was 44.3 ± 6.5 years. Of the 202 parents who believed sexuality education should be provided to their children, 59.9% (N = 121) provided it themselves. Among the remaining 81 parents who believed in the importance of providing sexuality education but did not provide it to their children, the most common reason was that the children would learn about the issues on their own and that they, as parents, were uncomfortable discussing it with their children. This study demonstrated that, although a large proportion of parents were aware of the value of sexual education and were in favour of its inclusion in academic curriculum, not all of them were able to effectively provide it to their children.
Abstractor: As Provided
Entry Date: 2022
Accession Number: EJ1345197
Database: ERIC
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  Value: <anid>AN0156394077;bf401may.22;2022Apr21.04:11;v2.2.500</anid> <title id="AN0156394077-1">Sexuality education – do our children need it? Perspective of parents from coastal South India </title> <p>Sexuality education although essential in today's world remains a taboo and a hotly debated topic. This is linked to uncertainties associated with the topic and varied perceptions by parents, teachers and community members, which are in turn influenced by prevailing religious and cultural beliefs. In this cross-sectional study, 233 parents of adolescent children were assessed regarding their perceptions and practices of providing sexuality education to their children. The mean age of study participants was 44.3 ± 6.5 years. Of the 202 parents who believed sexuality education should be provided to their children, 59.9% (N = 121) provided it themselves. Among the remaining 81 parents who believed in the importance of providing sexuality education but did not provide it to their children, the most common reason was that the children would learn about the issues on their own and that they, as parents, were uncomfortable discussing it with their children. This study demonstrated that, although a large proportion of parents were aware of the value of sexual education and were in favour of its inclusion in academic curriculum, not all of them were able to effectively provide it to their children.</p> <p>Keywords: Sex education; adolescents; sexuality; parents; India</p> <hd id="AN0156394077-2">Introduction</hd> <p>At a time of rapid advance in technology and communication, understanding of complex matters is constantly changing. However, the value of sexuality education continues to be debated and considered a taboo. Sexuality education is an age‐appropriate, culturally relevant approach to teaching about sex and relationships by providing scientifically accurate, realistic, non-judgemental information (UNESCO [<reflink idref="bib36" id="ref1">36</reflink>]). In countries such as India, cultural beliefs influence people's perceptions, attitudes and decision-making regarding topics such as sex and sexuality. Even among the educated classes, discussion related to sex and sexuality education is considered inappropriate. Sexuality education remains controversial in Indian culture and is often viewed as a social evil arising out of rapid globalisation. However, with the advent of social media and the Internet, information on sex and sexuality education is becoming readily available and easily accessible to the younger generation. This has given rise to a situation where young people may be exposed to incorrect, incomplete or inappropriate information leading to risk-taking and experimentation (Ismail et al. [<reflink idref="bib10" id="ref2">10</reflink>]).</p> <p>Controversy surrounding sexuality education relates to content, who should teach it, the age at which it should be delivered, and the mode and nature of instruction (IPPF [<reflink idref="bib9" id="ref3">9</reflink>]). One of the key issues of debate is the age at which sexuality education should be provided. Young people aged 10–19 years are the target age group for sexuality education in most countries (UNFPA [<reflink idref="bib38" id="ref4">38</reflink>]). They are usually curious about the physical changes happening to their body and accompanying emotions. These changes along with peer pressure and the need for independence make some young people more susceptible to taking risks, putting them at risk of unwanted pregnancy and sexually transmitted infections (STIs). In India, knowledge regarding HIV prevention in the 15–24 year age group continues to remain low. A youth survey in 2006 reported 45% young men and 28% young women had comprehensive knowledge regarding the prevention of HIV and STIs (MoHFW [<reflink idref="bib19" id="ref5">19</reflink>]). In a more recent report, 32% men and 22% women aged 15–24 years had knowledge regarding HIV prevention. (UNAIDS Data [<reflink idref="bib35" id="ref6">35</reflink>])) Similar findings were also made in a national general population survey of those aged 15 − 49 years in which only 32.5% of men and 20.9% of women had comprehensive knowledge regarding prevention of HIV. (MoHFW [<reflink idref="bib20" id="ref7">20</reflink>]). Poor knowledge regarding HIV and STI prevention among adolescents is a significant problem as they comprise 20.9% of the population local to this study (Census [<reflink idref="bib5" id="ref8">5</reflink>]). Guidance and support at this stage of development can help to reduce the burden of STIs and teenage pregnancy.</p> <p>Children are usually educated about sexual health issues by parents, teachers or both. The family, as a primary unit in most societies, plays an important role in socialisation. Parents are the first people from whom a child learns healthy behaviour and obtains knowledge regarding culture, beliefs and behaviour (Turnbull, Van Werch, and Schaik [<reflink idref="bib34" id="ref9">34</reflink>]). In most settings, mothers are responsible for providing health education, including sexuality education, to children as they are more accessible. (Turnbull, Van Werch, and Schaik [<reflink idref="bib34" id="ref10">34</reflink>]; Shams et al. [<reflink idref="bib27" id="ref11">27</reflink>]). However, in conservative communities and societies, where discussion about sex and sexuality education is considered taboo, or where parents' sexual health knowledge may be poor, teachers play an important role in providing accurate information. Hence, the active participation of both parents and teachers is required for the effective delivery of sexuality education.</p> <p>Children usually first encounter sexuality education when learning about the human reproductive system or during health and physical education classes (NCERT [<reflink idref="bib24" id="ref12">24</reflink>]). Despite the existence of curriculum and guidelines regarding the content and delivery of sexuality education (NCERT [<reflink idref="bib24" id="ref13">24</reflink>]), there are varied opinions between teachers and parents due to lack of clarity and consensus regarding its delivery. This causes confusion for those delivering the curriculum and those receiving it, creating a barrier for the effective delivery of sexuality education.</p> <p>In a culturally diverse country like India, where regional customs, traditions and beliefs supersede scientific rationale, achieving consensus on a delicate subject such as sexuality and sexuality education in the absence of set guidelines is a big challenge. In this context, regional studies are important to capture the mind-set of the local population regarding this controversial topic. This in turn could be used to guide policy makers to ensure the provision of sexuality education content which is accurate and engages with cultural norms.</p> <p>Good quality sexuality education has been shown to result in positive behaviour among adolescents, as evidenced by delay in initiating sexual relationships, having a lower number of partners, and the increased use of safe sex and contraceptive practices (Tripathi and Sekhar [<reflink idref="bib33" id="ref14">33</reflink>]). Age-appropriate sexuality education encourages positive attitudes towards sexuality and helps young adults acquire and adopt life skills to establish and maintain healthy relationships with family members, peers and sexual partners (UNFPA [<reflink idref="bib39" id="ref15">39</reflink>]).</p> <p>The present study aimed to 1) assess the perceptions of parents regarding the relevance and importance of sexuality education for their children; 2) explore parents' views on who should be providing sexuality education to their children, the topics to be taught, and the timing of sexuality education in the school curriculum; 3) find out whether parents themselves had received sexuality education during their childhood; and 4) examine the factors influencing parents' decision to provide sexuality education to their children.</p> <hd id="AN0156394077-3">Materials and methods</hd> <p></p> <hd id="AN0156394077-4">Background and context</hd> <p>This cross-sectional study was carried out in Mangalore, the largest city and the administrative headquarters of Dakshina Kannada District in coastal South India. Mangalore is also the chief port city and major industrial and commercial centre of the Indian State of Karnataka, where most people's traditional occupation is fishing and agriculture (Census [<reflink idref="bib5" id="ref16">5</reflink>]). Mangalore has an overall literacy rate of 93.7%, with male literacy being 96.0% and female – 91.4% (Census [<reflink idref="bib6" id="ref17">6</reflink>]), which is higher than the national overall average of 74% (males – 82.1%, females 65.5%) (Census [<reflink idref="bib7" id="ref18">7</reflink>]). The population is composed of Hindus (68.9%), Muslims (17.4%) and Christians (13.1%) (Census [<reflink idref="bib6" id="ref19">6</reflink>]). The Department of Community Medicine at Kasturba Medical College Mangalore has field practice areas spread over urban Mangalore, Karnataka, India. One of the field practice areas was chosen for this study.</p> <hd id="AN0156394077-5">Methodology</hd> <p>A total of 233 parents with at least one adolescent child (10–19 years old) were interviewed about their perceptions and practices regarding sexuality education. The sample size was determined based on a previous study in which 65% of the study subjects perceived that sex education should be imparted to their children. (Nagpal and Fernandes [<reflink idref="bib22" id="ref20">22</reflink>]). The formula N = Z<sups>2</sups>pq/d<sups>2</sups> was used where N = sample size, z = level of confidence according to the standard normal distribution (for a level of confidence of 95%, z = 1.96), p = proportion of the population that presents the characteristic, q = (1-p) and d = tolerated margin of error or precision (set at 7%).</p> <p>Data were collected using a semi-structured questionnaire in three sections: section A – general information about the parents, section B – perceptions and practices regarding sexuality education, and section C – socioeconomic status of the household. Socioeconomic status of the parents was assessed using the Modified Kuppuswamy scale (Singh, Sharma, and Nagesh [<reflink idref="bib29" id="ref21">29</reflink>]), which is commonly used to measure socioeconomic status in urban and peri-urban communities in India using three parameters – education, occupation of the head of household and monthly household income. Each of these parameters was scored, and the final score ranged from 3 to 29. Based on the scores, the families were divided into five socioeconomic classes – upper (26–29), upper middle (16–25), lower middle (11–15), upper lower (5–10), and lower (<5).</p> <p>Approval was obtained from the Institutional Ethics Committee of Kasturba Medical College, Mangalore prior to commencement of the study. Households were chosen at convenience. One parent from each household was included in the study. The parent present in the house at the time of the visit of the investigator was interviewed; in case both the father and mother were present at the time of the visit, one of them was interviewed after mutual agreement between them. The nature and objectives of the study were explained to the parents in their local vernacular, their queries addressed, and written informed consent was obtained from all willing parents. Face-to-face interviews were conducted, which took approximately 15–20 minutes per interview.</p> <hd id="AN0156394077-6">Analysis</hd> <p>Data were analysed using IBM SPSS Statistics 25.0 for Windows and expressed as means (standard deviation) and percentages. Since both upper middle and lower middle class are a part of the general category of middle class, for subgroup analysis and interpretation of the findings, both the groups were combined together into a single category of middle class. Parents with a professional degree, graduate qualification or post-graduate degree were grouped into a single category of those having higher educational status while those with intermediate or post high school diplomas, high school certificates, middle school certificates or primary school certificates were grouped as lower educational status. This was done to form two groups based on the level of education (higher educational status and lower educational status) for subgroup analysis of interpretation of results.</p> <p>The association between sociodemographic variables such as age of the parent, the gender of the parent, religion, education, socioeconomic status, number of children, gender and age of the first child, and parents providing sexuality education was assessed using univariate and multivariate analyses. Factors found to be significant in univariate analysis were examined using logistic regression. The fit of the logistic model was assessed with the Hosmer and Lemeshow goodness of fit test. Values of p < 0.05 were considered to be statistically significant. Unadjusted and adjusted odds ratio and corresponding 95% confidence intervals (CIs) are also reported.</p> <hd id="AN0156394077-7">Results</hd> <p>Background information on the study participants is provided in Table 1. A total of 233 parents of young people 10–19 years of age were included in the study. The overall mean age of the study participants was 44.3 ± 6.5 years, with the mean ages of mothers and fathers being 42.5 ± 6.0 and 47.1 ± 6.3, respectively. The majority of respondents were mothers (N = 145, 62.2%). A high proportion (N = 100, 42.9%) of parents were over 45 years of age, had completed their intermediate or high school diploma (N = 94, 40.3%), and belonged to the middle class (N = 121, 60.5%). The majority of the parents (N = 214, 91.8%) had children studying in private schools. Most of the parents (N = 218, 93.6%) were aware of sexuality education, with 61% (N = 133) being mothers. Of these 218 parents, 72 (31.3%) had received sexuality education during their childhood and more than half of them (52.1%) had received it from their teachers.</p> <p>Table 1. General information of study participants (N = 233)</p> <p> <ephtml> <table><thead><tr><td>Characteristics</td><td>N (%)</td></tr></thead><tbody><tr><td><bold>Age Group (yrs)</bold></td></tr><tr><td>≤ 35</td><td>027 (11.6)</td></tr><tr><td>36–40</td><td>036 (15.5)</td></tr><tr><td>41–45</td><td>070 (30.0)</td></tr><tr><td>> 45</td><td>100 (42.9)</td></tr><tr><td><bold>Parent</bold></td></tr><tr><td>Father</td><td>088 (37.8)</td></tr><tr><td>Mother</td><td>145 (62.2)</td></tr><tr><td><bold>Educational status of the parent</bold></td><td /></tr><tr><td>Professional degree</td><td>38 (16.3)</td></tr><tr><td>Graduate or Post graduation</td><td>54 (23.2)</td></tr><tr><td>Intermediate or post high school diploma</td><td>94 (40.3)</td></tr><tr><td>High school certificate</td><td>33 (14.2)</td></tr><tr><td>Middle school certificate</td><td>07 (03.0)</td></tr><tr><td>Primary school certificate</td><td>07 (03.0)</td></tr><tr><td><bold>Religion</bold></td></tr><tr><td>Hindu</td><td>188 (80.7)</td></tr><tr><td>Muslim</td><td>018 (07.7)</td></tr><tr><td>Christian</td><td>024 (10.3)</td></tr><tr><td>Others</td><td>003 (01.3)</td></tr><tr><td><bold>Socioeconomic status</bold></td></tr><tr><td>Upper class</td><td>073 (31.3)</td></tr><tr><td>Middle class</td><td>141 (60.5)</td></tr><tr><td>Lower class</td><td>019 (08.2)</td></tr><tr><td><bold>Number of children</bold></td><td /></tr><tr><td>1</td><td>093 (40.3)</td></tr><tr><td>2</td><td>123 (53.2)</td></tr><tr><td>3</td><td>012 (05.2)</td></tr><tr><td>4</td><td>003 (01.3)</td></tr></tbody></table> </ephtml> </p> <p>The perceptions of parents towards providing sexuality education to their children are depicted in Table 2. The majority of parents (N = 202, 86.6%) believed their children should be taught sexuality education. A large proportion of the parents stated that sexuality education should include information regarding changes during puberty (N = 194, 85.1%), while 76.3% (N = 174) believed that education about sexual abuse and crimes should be included in sexuality education. Parents expressed that sexuality education should be provided by teachers (N = 163, 81.0%) or parents (N = 150, 74.3%). A large proportion of parents (N = 191, 82.0%) stated that sexuality education should be included in the academic curriculum. Over half of the parents (N = 106, 55.5%) perceived high school to be the ideal time to receive sexuality education. In addition, 94.5% (N = 191) of the parents expressed that sexuality education should be received by both boys and girls, and 64.9% (N = 131) were of the opinion that it should be given separately to both boys and girls.</p> <p>Table 2. Perceptions of parents towards providing sexuality education to their children (N = 233)</p> <p> <ephtml> <table><thead><tr><td>Perceptions regarding sexuality education</td><td>N (%)</td></tr></thead><tbody><tr><td>Sexuality education should be included in the curriculum</td><td>191 (82.0)</td></tr><tr><td>Sexuality education should be provided to their children</td><td>202 (86.6)</td></tr><tr><td>Reasons for believing that SE should be provided to their children (N = 202)*</td></tr><tr><td><list list-type="Bullet"><list-item><p>It is necessary to know</p></list-item></list></td><td>180 (89.1)</td></tr><tr><td><list list-type="Bullet"><list-item><p>They might get information from wrong sources</p></list-item></list></td><td>091 (45.0)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Prevents children from asking uncomfortable questions</p></list-item></list></td><td>027 (13.4)</td></tr><tr><td>Reasons for believing sexuality education should not be provided to their children (N = 31)*</td></tr><tr><td><list list-type="Bullet"><list-item><p>They are too young</p></list-item></list></td><td>023 (74.2)</td></tr><tr><td><list list-type="Bullet"><list-item><p>It leads to dangerous experimentations</p></list-item></list></td><td>019 (61.2)</td></tr><tr><td><list list-type="Bullet"><list-item><p>We never got any sex education, so it is not necessary</p></list-item></list></td><td>007 (22.5)</td></tr><tr><td>Sexuality education should include information about* (N = 202)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Changes during puberty</p></list-item></list></td><td>194 (85.1)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Sexual abuse and crimes</p></list-item></list></td><td>174 (76.3)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Sexually transmitted diseases</p></list-item></list></td><td>120 (52.6)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Birth control</p></list-item></list></td><td>098 (43.0)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Sexual activity</p></list-item></list></td><td>098 (43.0)</td></tr><tr><td>Parents' opinion on who should provide sexuality education * (N = 202)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Teachers</p></list-item></list></td><td>163 (81.0)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Parents</p></list-item></list></td><td>150 (74.3)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Experts</p></list-item></list></td><td>065 (32.2)</td></tr><tr><td>Parents' opinion on when sexuality education should start (N = 202)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Primary school</p></list-item></list></td><td>024 (11.8)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Middle school</p></list-item></list></td><td>047 (23.3)</td></tr><tr><td><list list-type="Bullet"><list-item><p>High school</p></list-item></list></td><td>106 (52.5)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Before entering college</p></list-item></list></td><td>010 (05.0)</td></tr><tr><td><list list-type="Bullet"><list-item><p>College</p></list-item></list></td><td>015 (07.4)</td></tr><tr><td>Parents' opinion of the importance of sexuality education * (N = 202)</td></tr><tr><td><list list-type="Bullet"><list-item><p>It might reduce sexual abuse</p></list-item></list></td><td>190 (81.5)</td></tr><tr><td><list list-type="Bullet"><list-item><p>It might reduce the number of teenage pregnancies</p></list-item></list></td><td>126 (54.1)</td></tr><tr><td><list list-type="Bullet"><list-item><p>It might reduce sexually transmitted diseases like AIDS</p></list-item></list></td><td>132 (56.7)</td></tr><tr><td><list list-type="Bullet"><list-item><p>They will understand the difference between good and bad touch</p></list-item></list></td><td>006 (03.0)</td></tr><tr><td>Sex education should be included in the academic curriculum</td><td>191 (82.0)</td></tr><tr><td>Parents opinion on who should receive sexuality education (N = 202)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Both</p></list-item></list></td><td>191 (94.5)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Girls</p></list-item></list></td><td>010 (05.0)</td></tr><tr><td><list list-type="Bullet"><list-item><p>Boys</p></list-item></list></td><td>001 (00.5)</td></tr><tr><td>Sexuality education should be given separately to boys and girls</td><td>131 (64.9)</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>*</emph> Multiple response questions.</p> <p>Table 3 shows the practice of parents providing sexuality education to their children. Among the 202 parents who believed sexuality education should be provided to their children, 59.9% (N = 121) provided it themselves. The main reason given for providing sexuality education was the belief that children needed to know about the changes in their bodies. Topics related to sex crimes and sexual abuse, menstruation, pregnancy and difference between good and bad touch were most often discussed by the parents with their children. For the 81 parents who believed sexuality education should be provided but did not do so themselves, the most common reason stated was that the children would learn about it on their own and that they were uncomfortable discussing it with their children. Among these parents, 48.2% (N = 54) were willing to provide sexuality education to their children in future.</p> <p>Table 3. Practices of parents regarding sexuality education (N = 202)</p> <p> <ephtml> <table><thead><tr><td>Practices regarding sexuality education</td><td>N (%)</td></tr></thead><tbody><tr><td>Parents who provided sexuality education to their children</td><td>121 (59.9)</td></tr><tr><td>Reasons for providing sexuality education to their children* (N = 121)</td><td>Children need to know about the changes taking place in their bodies.</td><td>104 (85.9)</td></tr><tr><td>Rise in sex crimes; children need to be able to tell right from wrong.</td><td>084 (69.4)</td></tr><tr><td>They need to get the right information from the right source.</td><td>082 (67.7)</td></tr><tr><td>Topics that parents discuss with their children* (N = 121)</td><td>To beware of sex crimes and sexual abuse.</td><td>093 (76.9)</td></tr><tr><td>Normal processes like menstruation, pregnancy, etc.</td><td>091 (75.2)</td></tr><tr><td>To differentiate between a good touch and a bad touch.</td><td>088 (72.7)</td></tr><tr><td>Reasons for not providing sexuality education to their children * (N = 81)</td><td>They will learn it on their own when the time comes.</td><td>062 (76.5)</td></tr><tr><td>Uncomfortable discussing it with them.</td><td>044 (54.3)</td></tr><tr><td>Unsure of what exactly is to be told to them.</td><td>030 (37.0)</td></tr></tbody></table> </ephtml> </p> <p>2 <emph>*</emph> Multiple response questions.</p> <p>Table 4 shows the factors associated with providing sexuality education. Univariate analysis showed a statistically significant correlation between providing sexuality education and having a higher educational status, belonging to the middle socioeconomic group, having male firstborn children, and having children in private schools. The likelihood of parents providing sexuality education to their children was higher among those of high educational status as compared to parents with lower educational status (OR 2.11, 95% CI 1.23 − 3.61), parents belonging to middle-class group compared to high SES (OR 2.69, 95% CI 1.49–4.89), having a male first born child as compared to parents with first born female child (OR 1.89, 95% CI 1.12–3.19) and having children in private schools compared to parents with children in government school (OR 3.29, 95% CI 1.18–10.54) provided sexuality education to their children which was found to be statistically significant (p < 0.05).</p> <p>Table 4. Univariate analysis of factors influencing the provision of sexuality education (N = 233)</p> <p> <ephtml> <table><thead><tr><td><bold>Characteristics</bold></td><td><bold>Provided sexuality education</bold></td><td><bold>Unadjusted</bold><bold>OR</bold><bold>(95% C.I)</bold></td><td><bold>P value</bold></td></tr><tr><td><bold>Yes (N = 121)</bold></td><td><bold>No (N = 112)</bold></td></tr><tr><td><bold>n (%)</bold></td><td><bold>n (%)</bold></td></tr></thead><tbody><tr><td><bold>Age (Years)</bold></td></tr><tr><td>≤ 40</td><td>29 (46.0)</td><td>34 (54.0)</td><td>1.38 (0.77 − 2.47)</td><td>0.277</td></tr><tr><td>> 40</td><td>92(54.1)</td><td>78 (45.9)</td><td /></tr><tr><td><bold>Parent</bold></td></tr><tr><td>Father</td><td>39 (44.3)</td><td>49 (55.7)</td><td>1.63 (0.96 − 2.80)</td><td>0.072</td></tr><tr><td>Mother</td><td>82 (56.6)</td><td>63 (43.4)</td><td /></tr><tr><td><bold>Educational status of the parents</bold></td></tr><tr><td>Higher</td><td>58(63.0)</td><td>34 (37.0)</td><td>2.11 (1.23–3.61)</td><td><bold>0.006</bold></td></tr><tr><td>Lower</td><td>63 (44.7)</td><td>78 (55.3)</td><td /></tr><tr><td><bold>Religion</bold></td></tr><tr><td>Hindu</td><td>93 (49.5)</td><td>95 (50.5)</td><td /><td>0.128</td></tr><tr><td>Non-Hindu</td><td>28 (62.2)</td><td>17 (37.8)</td><td>0.59 (0.30–1.16)</td></tr><tr><td><bold>Socio-economic status</bold></td></tr><tr><td>Upper class</td><td>51 (69.9)</td><td>22 (30.1)</td><td /><td /></tr><tr><td>Middle class</td><td>65 (46.1)</td><td>76 (53.9)</td><td>2.69 (1.49–4.89)</td><td><bold>0.0009</bold></td></tr><tr><td>Lower class</td><td>05 (26.3)</td><td>14 (73.7)</td><td>6.34 (2.08 − 21.83)</td><td>0.0008</td></tr><tr><td><bold>Number of Children</bold></td></tr><tr><td>1 child</td><td>47 (50.5)</td><td>46 (49.5)</td><td>1.09 (0.64–1.85)</td><td>0.730</td></tr><tr><td>More than 1 child</td><td>74 (52.9)</td><td>66 (47.1)</td><td /></tr><tr><td><bold>Gender of the first child</bold></td></tr><tr><td>Male</td><td>51 (44.0)</td><td>65 (56.0)</td><td>1.89 (1.12–3.19)</td><td><bold>0.016</bold></td></tr><tr><td>Female</td><td>70 (59.8)</td><td>47 (40.2)</td><td /></tr><tr><td><bold>Age of the first child</bold></td></tr><tr><td>≤ 15</td><td>53 (51.0)</td><td>51 (49.0)</td><td /><td>0.791</td></tr><tr><td>> 15</td><td>68 (52.7)</td><td>61 (47.3)</td><td>0.93 (0.55–1.56)</td></tr><tr><td><bold>Type of school</bold></td><td /><td /><td /><td /></tr><tr><td>Private</td><td>116(54.2)</td><td>98(45.8)</td><td>3.298(1.18–10.54)</td><td><bold>0.021</bold></td></tr><tr><td>Government</td><td>05 (26.3)</td><td>14(73.7)</td><td /></tr></tbody></table> </ephtml> </p> <p>Multivariate analysis revealed a correlation between providing sexuality education and belonging to middle socio-economic group (OR 3.48, 95% CI 1.37–8.85) and having male first born children (OR 1.90, 95% CI 1.11–3.28) which was found to be statistically significant (Table 5).</p> <p>Table 5. Multivariate analysis of factors influencing the provision of sexuality education by the parents (N = 233)</p> <p> <ephtml> <table><thead><tr><td><bold>Characteristics</bold></td><td><bold>Unadjusted</bold><bold>OR (95% CI)</bold></td><td><bold><italic>P</italic></bold><bold>value</bold></td><td><bold>Adjusted</bold><bold>OR (95% CI)</bold></td><td><bold><italic>P</italic></bold><bold><italic>value</italic></bold></td></tr></thead><tbody><tr><td><bold>Educational status of the parents</bold></td><td /><td /><td /><td /></tr><tr><td>Professional</td><td>1</td><td /><td>1</td><td /></tr><tr><td>Non-professional</td><td>2.11 (1.23–3.61)</td><td>0.006</td><td>0.73 (0.30 − 1.77)</td><td>0.49</td></tr><tr><td><bold>Socioeconomic status</bold></td><td /><td /><td /><td /></tr><tr><td>Upper class</td><td>1</td><td /><td>1</td><td /></tr><tr><td>Middle class</td><td>2.69 (1.49–4.89)</td><td>0.0009</td><td>3.48 (1.37–8.85)</td><td><bold>0.009</bold></td></tr><tr><td>Lower class</td><td>6.34 (2.08 − 21.83)</td><td>0.0008</td><td>9.00 (1.94 − 41.81)</td><td>0.005</td></tr><tr><td><bold>Gender of the first child</bold></td><td /><td /><td /><td /></tr><tr><td>Male</td><td>1.89 (1.12–3.19)</td><td>0.016</td><td>1.90 (1.11 − 3.28)</td><td><bold>0.020</bold></td></tr><tr><td>Female</td><td>1</td><td /><td /><td /></tr><tr><td><bold>Type of School</bold></td><td /><td /><td /><td /></tr><tr><td>Private</td><td>1</td><td /><td>1</td><td /></tr><tr><td>Government</td><td>3.298(1.18–10.54)</td><td>0.021</td><td>0. 94(0.11–8.02)</td><td>0.960</td></tr></tbody></table> </ephtml> </p> <hd id="AN0156394077-8">Discussion</hd> <p>The UN Sustainable Development Goals call for countries to work towards the promotion of gender equality, human rights, good quality education, and reproductive health (UNESCO [<reflink idref="bib37" id="ref22">37</reflink>]). Age-appropriate and holistic sexuality education plays an important role in the transition of a child to adolescence and adulthood by providing reliable and evidence-based information, which in turn empowers individuals to make responsible decisions regarding their health and general well-being. It is necessary to understand the importance of sexuality education and incorporate it in the existing adolescent health programmes, thereby facilitating the achievement of good health and well-being, quality education and gender equality (UNESCO [<reflink idref="bib37" id="ref23">37</reflink>]).</p> <hd id="AN0156394077-9">Parents' perceptions regarding sexuality education</hd> <p>The majority of the parents in this study (86.6%) believed that sexuality education should be provided to their children. In a similar study from the urban area of Jammu, India, 80% of the parents favoured sexuality education (Mahajan and Sharma [<reflink idref="bib16" id="ref24">16</reflink>]). Studies from other parts of the world have also reported high percentages of parents in favour of providing sexuality education to their children (Kirana et al. [<reflink idref="bib12" id="ref25">12</reflink>]; Nadeem, Cheema, and Zameer [<reflink idref="bib21" id="ref26">21</reflink>]; Kantor and Levitz [<reflink idref="bib11" id="ref27">11</reflink>]; Robinson, Smith, and Davies [<reflink idref="bib26" id="ref28">26</reflink>]). However, in a study conducted in Bangladesh, less than half of the parents were found to be in favour of sexuality education (Bhuiyan [<reflink idref="bib4" id="ref29">4</reflink>])</p> <hd id="AN0156394077-10">Inclusion of sexuality education in the academic curriculum</hd> <p>In 2012, the Global Youth Forum of the International Conference on Population and Development (ICPD) held in Bali, Indonesia stressed the need to create and maintain a favourable environment and policies to provide young people access to sexuality education in both formal and non-formal settings. Such an approach has been widely supported by parents, communities and stakeholders in the educational sector (UNESCO [<reflink idref="bib37" id="ref30">37</reflink>]). The majority of parents in this study (82%) stated that sexuality education should be included in the academic curriculum. Studies from Puducherry in India (Manivasakan and Sankaran [<reflink idref="bib18" id="ref31">18</reflink>]), Bangladesh (Rob et al. [<reflink idref="bib25" id="ref32">25</reflink>]) and Malaysia (Makol-Abdul et al. [<reflink idref="bib17" id="ref33">17</reflink>]) have also reported a high percentage of parents who were in favour of including sexuality education in the curriculum.</p> <hd id="AN0156394077-11">Content of sexuality education</hd> <p>Sexuality education cannot serve its purpose unless it is accurate, sensitive and non-judgemental, focusing on the physical, social and emotional development of the individual. (UNESCO [<reflink idref="bib36" id="ref34">36</reflink>]; Ismail et al. [<reflink idref="bib10" id="ref35">10</reflink>]). Topics included in sexuality education should be age-appropriate, relevant and wide-ranging. Comprehensive Sexuality Education (CSE) should include information on human development, anatomy and reproductive health as well as information regarding contraception, childbirth and sexually transmitted infections (STIs) including HIV (UNFPA [<reflink idref="bib40" id="ref36">40</reflink>]). In this study, changes during puberty were the most important topic parents wanted to be included in sexuality education. Other topics were information about sexual abuse and criminal acts, STIs including HIV, birth control and sexual activity. Each of these reflect current concerns prevalent in the country. (Sivagurunathan et al. [<reflink idref="bib30" id="ref37">30</reflink>])</p> <p>The content of sexuality education as perceived by parents in different countries is influenced by custom and tradition as well as by socio-cultural and religious views (Latifnejad Roudsari et al. [<reflink idref="bib13" id="ref38">13</reflink>]). Other studies have reported parental interest in the inclusion of topics such as personal and genital hygiene (Nair et al. [<reflink idref="bib23" id="ref39">23</reflink>]) emotional changes (Manivasakan and Sankaran [<reflink idref="bib18" id="ref40">18</reflink>]), puberty and menstruation (Weaver et al. [<reflink idref="bib41" id="ref41">41</reflink>]), religious views about sexuality (Makol-Abdul et al. [<reflink idref="bib17" id="ref42">17</reflink>]), sexual physiology (Shin, Lee, and Min [<reflink idref="bib28" id="ref43">28</reflink>]) and the functions of sexual organs (Mahajan and Sharma [<reflink idref="bib16" id="ref44">16</reflink>]), family formation and values, and tolerance and respect towards members of the opposite sex (Bhuiyan [<reflink idref="bib4" id="ref45">4</reflink>]).</p> <hd id="AN0156394077-12">Who should provide sexuality education?</hd> <p>By virtue of their being primary educators, parents and teachers are logical facilitators of sexuality education. Health-care providers and subject specialists can also provide sexuality education to young people. The majority of parents in this study agreed that teachers should be the ones to provide sexuality education to children. On the other hand, another study from India showed that parents preferred to provide sexuality education to their children themselves (Toor [<reflink idref="bib32" id="ref46">32</reflink>]). Similar responses have been reported in studies from China and Korea. (Liu et al. [<reflink idref="bib15" id="ref47">15</reflink>]; Liu and Edwards [<reflink idref="bib14" id="ref48">14</reflink>]; Shin, Lee, and Min [<reflink idref="bib28" id="ref49">28</reflink>]). Interestingly, previous studies have found that health professionals (Manivasakan and Sankaran [<reflink idref="bib18" id="ref50">18</reflink>]) and specialist organisations (Kirana et al. [<reflink idref="bib12" id="ref51">12</reflink>]) may be the preferred choice of educators in studies in other countries.</p> <hd id="AN0156394077-13">When should sexuality education be undertaken?</hd> <p>The best time to begin sexuality education in terms of age and school grade is often debated. Parents in this study wanted the inclusion of sexuality education in high school. Similar findings have been reported in studies conducted in Puducherry, India (Manivasakan and Sankaran [<reflink idref="bib18" id="ref52">18</reflink>]) and Nepal (Acharya et al. [<reflink idref="bib1" id="ref53">1</reflink>]). Studies in Korea (Shin, Lee, and Min [<reflink idref="bib28" id="ref54">28</reflink>]) and Malaysia (Makol-Abdul et al. [<reflink idref="bib17" id="ref55">17</reflink>]) found that parents wanted sexuality education to be introduced in primary school.</p> <hd id="AN0156394077-14">Parents' opinions on the importance of sexuality education</hd> <p>Sexuality education has an impact on teenage pregnancy, STIs, sexual abuse, and gender-based violence by creating awareness among children and adolescents and equipping them to make responsible sexual health decisions (EEGSE [<reflink idref="bib8" id="ref56">8</reflink>]). The majority of the parents in this study believed that sexuality education would reduce the incidence of sexual abuse and STIs. Studies in other parts of India have produced slightly different findings. Parents in a study in Ludhiana, India and China thought that sexuality education would instil responsible sexual behaviour in their children (Toor [<reflink idref="bib32" id="ref57">32</reflink>]; Liu et al. [<reflink idref="bib15" id="ref58">15</reflink>]), while in Puducherry, India parents believed that sexuality education would discourage teenagers from having premarital sex (Manivasakan and Sankaran [<reflink idref="bib18" id="ref59">18</reflink>]).</p> <hd id="AN0156394077-15">Who should receive sexuality education?</hd> <p>Religious, cultural and social beliefs influenced parents' opinions regarding which gender should receive sexuality education. The majority of the parents believed that both girls and boys should receive sexuality education, with 64.9% believing that sexuality education should be provided to boys and girls separately. Similar findings have been reported in studies in Ludhiana, India and China where a high percentage of parents said they would like separate sexuality education sessions for boys and girls (Toor [<reflink idref="bib32" id="ref60">32</reflink>]; Liu and Edwards [<reflink idref="bib14" id="ref61">14</reflink>]). In contrast, parents in a study in Nepal were in favour of having sexuality education sessions together for boys and girls. (Acharya et al. [<reflink idref="bib1" id="ref62">1</reflink>])</p> <hd id="AN0156394077-16">Parent-child communication regarding sexuality education</hd> <p>Societal norms and prevailing customs greatly influence the content, method and timing of parents providing sexuality education to their children (Ismail et al. [<reflink idref="bib10" id="ref63">10</reflink>]). Although the majority of parents in this study believed that sexuality education was necessary, only half of them had ever provided sexuality education to their children.</p> <hd id="AN0156394077-17">Sexuality education provided by parents</hd> <p>Among the parents in this study who provided sexuality education to their children, the majority (85.9%) wanted to make their children aware of age-related changes in their bodies. Awareness of sex crimes, sexual abuse and normal physiological function were the most commonly discussed topics. In a similar study from south India, the topics most commonly discussed by parents with their children were – rapid gain in height and weight and white discharge in girls. (Nair et al. [<reflink idref="bib23" id="ref64">23</reflink>]). Topics related to reproductive organs and sexual physiology were discussed by parents in studies from Jammu, India (Mahajan and Sharma [<reflink idref="bib16" id="ref65">16</reflink>]) and Korea (Shin, Lee, and Min [<reflink idref="bib28" id="ref66">28</reflink>]).</p> <hd id="AN0156394077-18">Reasons for not providing sexuality education</hd> <p>Among the parents in our study who did not provide sexuality education, most believed that their children would learn about the issues on their own while some felt uncomfortable discussing the topic with them. Parents in a study in Thailand stated that they were too embarrassed to discuss the subject of sexuality education with their children (Sridawruang, Pfeil, and Crozier [<reflink idref="bib31" id="ref67">31</reflink>]). In a study in South India, parents did not discuss sexuality education with their children as they felt it was not necessary (Nair et al. [<reflink idref="bib23" id="ref68">23</reflink>]) while parents in Korea cited not knowing the content of sexuality education as the reason for not imparting it to their children. (Shin, Lee, and Min [<reflink idref="bib28" id="ref69">28</reflink>])</p> <hd id="AN0156394077-19">Conclusion</hd> <p>This study found that although a large proportion of parents were aware of sexuality education and were in favour of its inclusion in the school curriculum, a smaller percentage provided sexuality education to their children, a finding which is in line with previous research conducted in other parts of India. There was a clear discrepancy between parents' awareness and approval of sexuality education and providing it to their children. For sexuality education to be universally available, it is imperative for parents to be recognised as one of the key stakeholders. This requires them to be equipped with adequate and appropriate knowledge and skills. This could be facilitated by community dialogue and outreach built into existing maternal and child health programmes.</p> <hd id="AN0156394077-20">Acknowledgments</hd> <p>We thank the Department of Community Medicine, Kasturba Medical College, Mangalore, and the Manipal Academy of Higher Education for their support for this research and its publication.</p> <hd id="AN0156394077-21">Disclosure statement</hd> <p>There are no conflicts of interest to declare.</p> <ref id="AN0156394077-22"> <title> References </title> <blist> <bibl id="bib1" idref="ref53" type="bt">1</bibl> <bibtext> Acharya, D. R., M. Thomas, R. Cann, and P. R. Regmi. 2019. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Sexuality Education -- Do Our Children Need It? Perspective of Parents from Coastal South India
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Ballal%2C+Vaishnavi%22">Ballal, Vaishnavi</searchLink><br /><searchLink fieldCode="AR" term="%22Thapar%2C+Rekha%22">Thapar, Rekha</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-2278-1445">0000-0003-2278-1445</externalLink>)<br /><searchLink fieldCode="AR" term="%22Sandepudi%2C+Bhavya%22">Sandepudi, Bhavya</searchLink><br /><searchLink fieldCode="AR" term="%22Narayan%2C+Abinand%22">Narayan, Abinand</searchLink><br /><searchLink fieldCode="AR" term="%22Devaraj%2C+Manganahalli%22">Devaraj, Manganahalli</searchLink><br /><searchLink fieldCode="AR" term="%22Jayarajan%2C+Shreehari+Manikoth%22">Jayarajan, Shreehari Manikoth</searchLink><br /><searchLink fieldCode="AR" term="%22Kumar%2C+Nithin%22">Kumar, Nithin</searchLink><br /><searchLink fieldCode="AR" term="%22Unnikrishnan%2C+Bhaskaran%22">Unnikrishnan, Bhaskaran</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-0892-8551">0000-0003-0892-8551</externalLink>)<br /><searchLink fieldCode="AR" term="%22Mithra%2C+Prasanna%22">Mithra, Prasanna</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Sex+Education%3A+Sexuality%2C+Society+and+Learning%22"><i>Sex Education: Sexuality, Society and Learning</i></searchLink>. 2022 22(3):379-392.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 14
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2022
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Sex+Education%22">Sex Education</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Attitudes%22">Parent Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Religious+Factors%22">Religious Factors</searchLink><br /><searchLink fieldCode="DE" term="%22Cultural+Influences%22">Cultural Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Role%22">Parent Role</searchLink><br /><searchLink fieldCode="DE" term="%22Individual+Characteristics%22">Individual Characteristics</searchLink><br /><searchLink fieldCode="DE" term="%22Socioeconomic+Status%22">Socioeconomic Status</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Structure%22">Family Structure</searchLink><br /><searchLink fieldCode="DE" term="%22Age+Differences%22">Age Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Attainment%22">Educational Attainment</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Background%22">Parent Background</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22India%22">India</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/14681811.2020.1843011
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1468-1811<br />1472-0825
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Sexuality education although essential in today's world remains a taboo and a hotly debated topic. This is linked to uncertainties associated with the topic and varied perceptions by parents, teachers and community members, which are in turn influenced by prevailing religious and cultural beliefs. In this cross-sectional study, 233 parents of adolescent children were assessed regarding their perceptions and practices of providing sexuality education to their children. The mean age of study participants was 44.3 ± 6.5 years. Of the 202 parents who believed sexuality education should be provided to their children, 59.9% (N = 121) provided it themselves. Among the remaining 81 parents who believed in the importance of providing sexuality education but did not provide it to their children, the most common reason was that the children would learn about the issues on their own and that they, as parents, were uncomfortable discussing it with their children. This study demonstrated that, although a large proportion of parents were aware of the value of sexual education and were in favour of its inclusion in academic curriculum, not all of them were able to effectively provide it to their children.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2022
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1345197
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1345197
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        Value: 10.1080/14681811.2020.1843011
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 14
        StartPage: 379
    Subjects:
      – SubjectFull: Sex Education
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Parent Attitudes
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      – SubjectFull: Religious Factors
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      – SubjectFull: Cultural Influences
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      – SubjectFull: Adolescents
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      – SubjectFull: Age Differences
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      – SubjectFull: India
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      – TitleFull: Sexuality Education -- Do Our Children Need It? Perspective of Parents from Coastal South India
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