Breaking the Silence: Factors Associated With Perceived Social Norms Regarding Sexual And Reproductive Health Among Adolescent Students In Monastic Schools, Myanmar
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Abstract
This study assessed perceived SRH social norms, SRH knowledge, and associated factors among adolescent students in monastic schools in Myanmar. Data were drawn from the 2016 baseline survey of the Integrated Multi-Sectoral Approach (IMSA) project, involving 870 students aged 11–18 years from eight monastic schools in Magway Region. Perceived descriptive and injunctive SRH social norms were measured and analyzed using ANOVA and multiple linear regression. The mean perceived social norms score was 33.9 (SD = 5.3; range: 17–50), with lower scores indicating more favorable perceived social norms. Good knowledge of puberty was reported by 56.2% of students. Higher education (β = -1.49, p < .01) and receiving SRH education from peer educators (β = -1.71, p < .01) were significantly associated with more favorable perceived social norms. Better SRH knowledge was associated with more favorable perceived social norms, although the association was not statistically significant (β = -0.315, p = .386). Strengthening comprehensive sexuality education (CSE) by addressing unfavorable social norms and improving access to accurate, age-appropriate SRH information through trained teachers and peer educators may promote more favorable SRH-related social norms among adolescents. Future research should evaluate the long-term effects of CSE interventions on social norms.
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References
• Ahumuza, S. E., Matovu, J. K., Ddamulira, J. B., & Muhanguzi, F. K. (2014). Challenges in accessing sexual and reproductive health services by people with physical disabilities in Kampala, Uganda. Reproductive Health, 11, Article 59. https://doi.org/10.1186/1742-4755-11-59
• Akuiyibo, S., Anyanti, J., Idogho, O., Piot, S., Amoo, B., Nwankwo, N., & Anosike, N. (2021). Impact of peer education on sexual health knowledge among adolescents and young persons in two North Western states of Nigeria. Reproductive Health, 18(1), Article 204. https://doi.org/10.1186/s12978-021-01251-3
• Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T
• Babalola, S., John, N., Ajao, B., & Speizer, I. (2015). Ideation and intention to use contraceptives in Kenya and Nigeria. Demographic Research, 33(8), 211–238. https://doi.org/10.4054/DemRes.2015.33.8
• Baek, S. K., Aye, W. T., Htet, A. S., Stigum, H., Gopinathan, U., & Bjertness, E. (2024). Educational inequalities and self-reported health among men and women aged 18–49 years in Yangon Region, Myanmar: Analysis of a population-based, cross-sectional study. BMJ Open, 14(6), Article e074468. https://doi.org/10.1136/bmjopen-2023-074468
• Bagnall, A. M., South, J., Hulme, C., Woodall, J., Vinall-Collier, K., Raine, G., Kinsella, K., Dixey, R., Harris, L., & Wright, N. M. (2015). A systematic review of the effectiveness and cost-effectiveness of peer education and peer support in prisons. BMC Public Health, 15, Article 290. https://doi.org/10.1186/s12889-015-1584-x
• Barbagallo, M., & Boon, H. (2012). Young people's perceptions of sexuality and relationships education in Queensland schools. Australian and International Journal of Rural Education, 22(1), 107–124. https://doi.org/10.47381/aijre.v22i1.608
• Berhane, Y., Worku, A., Tewahido, D., Fasil, N., Gulema, H., Tadesse, A. W., & Abdelmenan, S. (2019). Adolescent girls' agency significantly correlates with favorable social norms in Ethiopia: Implications for improving sexual and reproductive health of young adolescents. Journal of Adolescent Health, 64(4), S52–S59. https://doi.org/10.1016/j.jadohealth.2018.12.018
• Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Harvard University Press.
• Brown, G., Sorenson, A., & Hildebrand, J. (2012). How they got it and how they wanted it: Marginalised young people's perspective on their experiences of sexual health education. Sex Education, 12(5), 599–612. https://doi.org/10.1080/14681811.2011.634141
• Brunelli, L., Bravo, G., Romanese, F., Righini, M., Lesa, L., De Odorico, A., Bastiani, E., Pascut, S., Miceli, S., & Brusaferro, S. (2022). Sexual and reproductive health-related knowledge, attitudes and support network of Italian adolescents. Public Health in Practice, 3, Article 100253. https://doi.org/10.1016/j.puhip.2022.100253
• Burke, E., Kébé, F., Flink, I., van Reeuwijk, M., & le May, A. (2017). A qualitative study to explore the barriers and enablers for young people with disabilities to access sexual and reproductive health services in Senegal. Reproductive Health Matters, 25(50), 43–54. https://doi.org/10.1080/09688080.2017.1329607
• Burnet Institute. (2020). Integrated multi-sectoral approach (IMSA) to improve the sexual and reproductive health of adolescents in Magway, Myanmar. https://www.burnet.edu.au/our-work/projects/integrated-multi-sectoral-approach-imsa-to-improve-the-sexual-and-reproductive-health-of-adolescents-in-magway-myanmar/
• Chandra-Mouli, V., Lane, C., & Wong, S. (2015). What does not work in adolescent sexual and reproductive health: A review of evidence on interventions commonly accepted as best practices. Global Health: Science and Practice, 3(3), 333–340. https://doi.org/10.9745/GHSP-D-15-00126
• Cislaghi, B., & Heise, L. (2019). Using social norms theory for health promotion in low-income countries. Health Promotion International, 34(3), 616–623. https://doi.org/10.1093/heapro/day017
• Cislaghi, B., & Shakya, H. (2018). Social norms and adolescents' sexual health: An introduction for practitioners working in low- and middle-income African countries. African Journal of Reproductive Health, 22(1), 38–46. https://doi.org/ 10.29063/ajrh2018/v22i1.4
• Decker, M. J., Atyam, T. V., Zárate, C. G., Bayer, A. M., Bautista, C., & Saphir, M. (2021). Adolescents’ perceived barriers to accessing sexual and reproductive health services in California: A cross-sectional survey. BMC Health Services Research, 21(1), Article 1263. https://doi.org/10.1186/s12913-021-07278-3
• Döring, N., Daneback, K., Shaughnessy, K., Grov, C., & Byers, E. S. (2017). Online sexual activity experiences among college students: A four-country comparison. Archives of Sexual Behavior, 46(6), 1641–1652. https://doi.org/10.1007/s10508-015-0656-4
• Ganle, J. K., Baatiema, L., Quansah, R., & Danso-Appiah, A. (2020). Barriers facing persons with disability in accessing sexual and reproductive health services in sub-Saharan Africa: A systematic review. PLOS ONE, 15(10), Article e0238585. https://doi.org/10.1371/journal.pone.0238585
• Jewkes, R., Morrell, R., & Christofides, N. (2009). Empowering teenagers to prevent pregnancy: Lessons from South Africa. Culture, Health & Sexuality, 11(7), 675–688. https://doi.org/10.1080/13691050902846452
• Kågesten, A. E., Pinandari, A. W., Page, A., Wilopo, S. A., & van Reeuwijk, M. (2021). Sexual wellbeing in early adolescence: A cross-sectional assessment among girls and boys in urban Indonesia. Reproductive Health, 18(1), Article 206. https://doi.org/10.1186/s12978-021-01230-8
• Little, R. J. A., & Rubin, D. B. (2019). Statistical analysis with missing data (3rd ed.). John Wiley & Sons. https://doi.org/10.1002/9781119482260
• Lundgren, R., & Amin, A. (2015). Addressing intimate partner violence and sexual violence among adolescents: Emerging evidence of effectiveness. Journal of Adolescent Health, 56(1 Suppl.), S42–S50. https://doi.org/10.1016/j.jadohealth.2014.08.012
• Madans, J. H., Loeb, M. E., & Altman, B. M. (2011). Measuring disability and monitoring the UN Convention on the Rights of Persons with Disabilities: The work of the Washington Group on Disability Statistics. BMC Public Health, 11(Suppl. 4), Article S4. https://doi.org/10.1186/1471-2458-11-S4-S4
• Mackie, G., Moneti, F., Shakya, H., & Denny, E. (2015, July 27). What are social norms? How are they measured? UNICEF and University of California, San Diego, Center on Global Justice. http://gjustice.ucsd.edu/wp-content/uploads/2012/11/Social-Norms-Measurement-WP-UCSD-UNICEF.pdf
• Malhotra, A., Amin, A., & Nanda, P. (2019). Catalyzing gender norm change for adolescent sexual and reproductive health: Investing in interventions for structural change. Journal of Adolescent Health, 64(4 Suppl.), S13–S15. https://doi.org/10.1016/j.jadohealth.2019.01.013
• Medley, A., Kennedy, C., O'Reilly, K., & Sweat, M. (2009). Effectiveness of peer education interventions for HIV prevention in developing countries: A systematic review and meta-analysis. AIDS Education and Prevention, 21(3), 181–206. https://doi.org/10.1521/aeap.2009.21.3.181
• Michielsen, K., Beauclair, R., Delva, W., Roelens, K., Van Rossem, R., & Temmerman, M. (2012). Effectiveness of a peer-led HIV prevention intervention in secondary schools in Rwanda: Results from a non-randomized controlled trial. BMC Public Health, 12, Article 729. https://doi.org/10.1186/1471-2458-12-729
• Mudzimu, E. (2021). Religious and cultural encounters: Sexual and reproductive health and rights among the Korekore women in Zimbabwe [Doctoral dissertation, University of Groningen]. https://doi.org/10.33612/diss.156014173
• Ogul, Z., & Sahin, N. H. (2024). The effect of an educational peer-based intervention program on sexual and reproductive health behavior. Journal of Adolescence, 96(7), 1642–1654. https://doi.org/10.1002/jad.12371
• Oo, Y. T. N., Zaw, K. K., Than, K. K., & Mar, K. K. (2011). Do parents and adolescents talk about reproductive health? Myanmar adolescents' perspective. South East Asia Journal of Public Health, 1(1), 40–45. https://doi.org/10.3329/seajph.v1i1.13219
• Phyu, K. H., & Han, B. (2021). Strengthening the resilience of Myanmar children studying in monastic schools. Archive for the Psychology of Religion, 43(3), 269–296. https://doi.org/10.1177/00846724211036960
• Preeda, P. A. (2020). Buddhism and education in Thai Society. International Journal of Multidisciplinary in Management and Tourism, 1(1), 1–18. https://doi.org/10.14456/ijmmt.2021.1
• Pulerwitz, J., Blum, R., Cislaghi, B., Costenbader, E., Harper, C., Heise, L., Kohli, A., & Lundgren, R. (2019). Proposing a conceptual framework to address social norms that influence adolescent sexual and reproductive health. Journal of Adolescent Health, 64(4 Suppl.), S7–S9. https://doi.org/10.1016/j.jadohealth.2019.01.014
• Rolleri, L. A. (2013). Research facts and findings: Gender norms and sexual health behaviors. ACT for Youth Center of Excellence. www.actforyouth.net/ resources/rf/rf_gender2_1213.pdf
• Storey, J. D., & Kaggwa, E. B. (2009). The influence of changes in fertility related norms on contraceptive use in Egypt, 1995–2005. Population Review, 48(1), 1–19. https://doi.org/10.1353/prv.0.0017
• Swe, Z. Y., Mon, N. O., Than, K. K., Azzopardi, P. S., Kennedy, E. C., Davis, J., Burns, L. J., & Hennegan, J. (2022). Adolescent girls' experiences of menstruation and schooling in monastic schools in Magway Region, Myanmar: A mixed-methods exploration. Frontiers in Reproductive Health, 4, Article 893266. https://doi.org/10.3389/frph.2022.893266
• Tangmunkongvorakul, A., Banwell, C., Carmichael, G., Utomo, I. D., Seubsman, S. A., Kelly, M., & Sleigh, A. (2012). Use and perceptions of sexual and reproductive health services among northern Thai adolescents. Southeast Asian Journal of Tropical Medicine and Public Health, 43(2), 479–500. https://www.tm.mahidol.ac.th/seameo/2012-43-2/22-5141-17.pdf
• Thin Zaw, P. P., Liabsuetrakul, T., McNeil, E., & Htay, T. T. (2013). Gender differences in exposure to SRH information and risky sexual debut among poor Myanmar youths. BMC Public Health, 13, Article 1122. https://doi.org/10.1186/1471-2458-13-1122
• UNFPA. (2021a, August 11). Breaking barriers between religion and sexuality education for young people in Bhutan. https://bhutan.unfpa.org/en/news/breaking-barriers-between-religion-and-sexuality-education-young-people-bhutan-0
• UNFPA. (2021b, July 11). Empowering women in Myanmar to exercise sexual and reproductive health rights and choices in the midst of the COVID-19 pandemic. https://myanmar.unfpa.org/en/news/empowering-women-myanmar-exercise-sexual-and-reproductive-health-rights-and-choices-midst-covid
• UNFPA. (2022, September 7). Ensuring sexual and reproductive health and rights for youth and adolescents in Myanmar through innovation amid COVID-19 pandemic and political crisis. https://myanmar.unfpa.org/en/news/ensuring-sexual-and-reproductive-health-and-rights-youth-and-adolescents-myanmar-through
• Wakjira, D. B., & Habedi, D. (2022). Barriers to access and utilisation of sexual and reproductive health services among adolescents in Ethiopia: A sequential mixed-methods study. BMJ Open, 12(11), Article e063294. https://doi.org/10.1136/bmjopen-2022-063294
• Vongxay, V., Albers, F., Thongmixay, S., Thongsombath, M., Broerse, J. E. W., Sychareun, V., & Essink, D. R. (2019). Sexual and reproductive health literacy of school adolescents in Lao PDR. PLOS ONE, 14(1), Article e0209675. https://doi.org/10.1371/journal.pone.0209675