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Teaching Asian mothers and teenagers how to talk about sex

Lao youth and adolescents work together to rank risky behaviours for girls during a Lao PDR workshop session to introduce Creating Connections to regional representatives

By Karen Emmons

October 2010 - Puberty, it seems, can make a paradox of parenting.

Whether it’s shyness, politeness, cultural reigns or just plain fear, too many parents withdraw into silence. As in Viet Nam where they say, “We don’t want to show the deer the way to run.”

“Here, read this book”, is a fall-back tactic for many people with a teenager.

But what happens where there are no sexuality books, which is common throughout Asia and the Pacific? Or little – or no – sexuality education in school, also common in the region, or sexuality education that avoids sexual issues?

Three years ago, girls in Viet Nam said they were unprepared for taking care of themselves. They were responding to focus group questions on adolescence, puberty and reproductive health and what they had learned from their mothers. The girls acknowledged that their mothers didn’t know much about sexuality and reproductive health and this contributed to their silence.

More recently, a group of Lao adolescent girls and young women told an older generation of Lao women and intrigued outsiders what they wanted to know about growing up. The group was participating in an unusual workshop in Vientiane on talking about such sensitive topics as sex, menstruation and pregnancy prevention as well as dating, relationships, rights and risky behaviour.

Never mind that they were nearly grown up.

“We want to know how to say no or no to unsafe sex,” a 20-year-old Lao woman with hair bangs and wearing a traditional Lao skirt and high heels explained.

“We have to be aware how to get ourselves out of a dangerous situation,” she continued. “Like if you go with your boyfriend drinking and get drunk, you’re not aware of the risks or how to get out of a bad situation. And we want to know how to protect ourselves from STDs and other diseases. We want to know about changes in our body, especially our physical development.”

Added another young Lao woman in a purple sweater and traditional skirt, “Sometimes the risk of a situation is unwanted. We go out with friends and it’s unexpected. If it happens, we worry about our mothers and we don’t want to break the trust. But we never expected a boy will do [certain] things.”

Role playing a scenario of cultural restrictions on girls during the Creating Connections workshop in Lao PDR

A taboo-breaking idea

The Vientiane workshop was promoting a pioneering idea started by the Viet Nam Women’s Union with the World Health Organization, UNAIDS and the Ford Foundation to help mothers and daughters learn to open up with each other about life’s seemingly sticky subjects as well as important health and protection issues.

The concept, called Creating Connections, combines information with practice through dialogue, explained Margaret Sheehan, UNICEF’s East Asia and Pacific Regional Adviser on Adolescent Development, who is hoping to see the programme adapted throughout the region.

“It is changing the social norm of silence around sexuality and challenging good mothering behaviour,” added Ms. Sheehan. In Viet Nam, she said, the Women’s Union’s saw it within their mandate to protect the family and prevent health and social problems. Thus, she said, they see it as “their job to talk about sexuality” and that a good, responsible mother teachers her daughter – and son – how to be safe.

Because the Women’s Union often works with a club structure, it seemed natural for them to set up mothers’ clubs and daughters’ clubs that would meet once a month for 13 two-hour sessions. The mothers and daughters in each club came from different families.  The final session combined both clubs for practice conversations between them.

Using games to break barriers

Relying on games, problem-solving exercises and role playing, the programme was designed to suggest constructive ways to have certain types of conversations. It also gave mothers, who were raised in a cultural tradition of shyness on these issues, the information they needed and the confidence to talk about these matters with their husband, children and friends.

It gave everyone involved an almost new vocabulary that they used repeatedly through the role playing, such as sex and condom, which helped to break down the taboos often associated with those words.

The programme covers the medical aspects of sex as well as peer and romantic relationships, love, reproduction, gender rights, HIV, risk taking and peer influence.

One game, for example, asks the participants to identify all the changes that take place with puberty, using a line drawing of a boy’s or girl’s body. In another game, participants practise various possible conversations between a mother and daughter using a scenario in which the mother has learned from a neighbour that her daughter was walking with a boy.  

Highlighting changes the male body goes through during puberty in a Lao PDR workshop session to introduce Creating Connections to regional representatives

“Games take us out of ourselves. They help to build the social support necessary for people to develop confidence to explore these topics and assert their needs,” said Helen Cahill, a former educator and Deputy Director of the Youth Research Centre, University of Melbourne, who with a Vietnamese doctor, Hoang Tu, Anh, developed the Creating Connections format.

In addition to creating a playful atmosphere, the games “help us to introduce metaphors that carry programme messages, such as the importance of protective behaviours,” Dr. Cahill said. She emphasized the research that indicates that girls who are more educated about sex tend to delay sexual activity and that adolescents with more positive attitudes towards condoms are more likely to use them.

The methodology of Creating Connections, she believes, helps people go deeper faster because it is participatory and because it allows people “to construct their own meaning and conversations and relate them to their own circumstances and challenges”. And it lets them have some fun in their otherwise labour-filled lives. 

Closer family connections 

Statistics on age of first sexual activity are scarce throughout the region. But the focus of much concern seems to be on premarital sex, with estimates placing 30–40 per cent of young men and 15–20 per cent of young women (aged 15–24) sexually active before they marry.

A few reliable surveys suggest that premarital sex is becoming more common, and there is also increasing general acceptance of sex before marriage. There remains a gender difference, with more young men open to premarital sex than young women. The average age for first sexual experience reported in Viet Nam (by both married and unmarried young people) was 18.5 for males and 18 for females – but there were twice as many males as females responding. A small study also in Viet Nam indicated that about 30 per cent of abortions reported (and which are legal) involved unmarried women younger than 25.

Although data indicates that fewer Asian youth engage in premarital sex than Western youth, the large population – or the youth bulge – in Asia mean millions and millions of young people are not prepared for their sexual or reproductive lives, said Ms. Sheehan. Creating Connections empowers both adolescent and adult women as well as delivering young women’s right to information and to participate in decisions affecting their life. 

Uncomfortable with leaving sexuality education to MTV, schools or friends sharing misconceptions, the Viet Nam Women’s Union was open to piloting Creating Connections in selected provinces. At the end of an 18-month experiment and satisfied with what they saw as positive impact, they opted to introduce it across the country and have commissioned a boys clubs programme as well as an extension programme for girls and women.

Over the trial period from 2007 to 2008, the Women’s Union broadened its own views about sexuality education and allowed more topics to be included and “more nuanced and empowering conversations to take place around sexual and reproductive health and rights”, according to Hoang Tu Anh, the founder and director of the Centre for Creative Initiatives in Health Promotion in Hanoi who worked with Dr. Cahill to create the concept.

A comparison of findings from pre- and post-programme surveys shows that knowledge about reproductive health among the mothers jumped from 34 per cent to 75 per cent. With knowledge gained from the club, nearly 65 per cent of the mothers said that they had talked to their children about sex while only 26 per cent had admitted doing so before the programme. The mothers who said they were “satisfied” with their relationship with children increased from 68 per cent to 94 per cent; among the girls, it hopped from 40 per cent to 62 per cent.

Knowledge on reproductive health also increased women’s confidence in communicating with their husband. 

Nervous at first that no one would come to the club, Dr. Hoang quickly had to worry how to limit the participants by the second girls’ session. 

“I was inspired,” she said. The girls asked boundless questions and told stories of what they had heard.

She recalled how girls in a Ha Nam club complained of being touched inappropriately by boys during school time. They felt violated but also powerless to do anything about it, she said. From the club talk, they learned they didn’t have to tolerate it. After discussing it during a club session, they posted complaint notes on the school bulletin board and they approached a bullying boy as a group to tell him it was unacceptable.

Spreading the connections

UNICEF is working with the United Nations Population Fund to spread the Creating Connections methodology to other countries.

Game playing a debate on contraceptive use during a Lao PDR workshop session to introduce Creating Connections to regional representatives

The women and men attending the introductory workshop in Vientiane came from government ministries and other organizations in Bangladesh, Cambodia, Lao PDR, Myanmar and Nepal and found themselves charmed and convinced by the games and tactics used to break down barriers.

“I have wondered how we can encourage mothers to stop keeping silent,” said Hou Nirmita, the director of the Department of Women and Health in Cambodia’s Ministry of Women’s Affairs. Excited by what she had learned about Creating Connections, she said, “It will be good for us…. I think we must do it.”






Related link

What we do in the region: Adolescent development and participation


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