Examining adolescence in Asia: How does family influence sexual and reproductive health outcomes?

Purpose: Across all borders, parents/guardians have a significant role in shaping the reproductive and sexual behaviors of adolescents. However, our knowledge of how their influence varies in different cultural contexts is limited. In particular, adolescents living in East and Southeast Asia have been found to have substantially lower levels of premarital sex and late ages of sexual initiation compared to adolescents in other world regions. Adolescents in this region may be ‘protected' from engaging in high risk sexual activity because of the way parents strongly encourage sexual virginity for girls and uphold Confucian philosophies that emphasize hierarchy and obedience. This study conducts a literature review on the risk and protective factors within the family domain found to be significantly related to sexual and reproductive health outcomes among adolescents in this region. Methods: Studies selected for the review were based on whether they: 1) were conducted in an East or Southeast Asian country; 2) used multivariate analysis to examine the relationships between risk and protective factors and sexual and reproductive health outcomes; 3) included a sample size ≥100 between the ages of 10 and 24 years; and, 4) were conducted between 1997 and 2007. Results: A total of 17 studies were included in the final review; the majority examined factors related to premarital sex (n=8). Other outcomes included were sexual initiation (n=3); adolescent pregnancy (n=2); early childbearing (n=2); and condom use (n=2). Family structure, mother's educational level, and living away from home were found to be statistically significantly related to at least one sexual and reproductive health outcome in more than one study. Amongst these factors, living away from home contributed most to adolescents' risks for premarital sex, sexual initiation, and childbearing. Notably, both risk and protective factors demonstrated greater effects among girls than boys. Conclusions: There is a great need to expand on this body of research, in particular with longitudinal studies to analyze causality among the factors and data stratification by gender to enable a better understanding for how these factors differ between adolescent males and females. Future research and programs will thus be able to utilize a known set of protective factors that promote healthy adolescent development.