Hello, hello, Parents of Ubusha. Welcome to the dual podcast-article series in which we have a sit down with experts on sexual and reproductive health, and related issues. In this series our experts draw on their work and experience to give us reliable, accurate and scientifically-based information in an easy to understand way.
In this month’s episode we talk about abuse in the home with Jabu Mathenjwa. Jabu is a professional social worker and pre-teen/teen life coach with extensive experience working with families and communities on domestic violence, gender based violence, bullying, human trafficking, and related issues. At present, coach Jabu is stationed at a police station as part of a social crime unit assisting with the process of victim reporting in a dignified manner, as well as providing necessary support.
We would like to thank coach Jabu for generously sharing her insights on this important issue. We hope parents, guardians and community members listening are now better equipped to support the adolescents in their lives through this crazy thing called life.
Do enjoy.
Key Points
Reference:
Image – https://pin.it/7hv7dmb
Reference:
*https://www.saps.gov.za/resource_centre/women_children/domestic_violence.php
Pinterest image: https://pin.it/7hv7dmb
Hello, hello, Parents of Ubusha. Welcome to the dual podcast-article series in which we have a sit down with experts on sexual and reproductive health, and related issues. In this series our experts draw on their work and experience to give us reliable, accurate and scientifically-based information in an easy to understand way.
In this month’s episode we talk about Physical Activity with Zolani Nyuliwe. Zolani Nyuliwe is a group exercise instructor, personal trainer, road Cyclist and 8 time Comrades marathon medalist. In addition to his extensive experience in the health and fitness industry, he is a qualified economist and teacher.
We would like to thank Zolani Nyuliwe for generously sharing his insights on this important issue. We hope parents, guardians and community members listening are now better equipped to support the adolescents in their lives through this crazy thing called life.
Do enjoy.
Key Points
*https://www.healthychildren.org/English/healthy-living/fitness/Pages/Encouraging-Your-Child-to-be-Physically-Active.aspx
Hello, hello, Parents of Ubusha. Welcome to the dual podcast-article series in which we have a sit down with experts on sexual and reproductive health, and related issues. In this series our experts draw on their work and experience to give us reliable, accurate and scientifically-based information in an easy to understand way.
In this month’s episode we talk about The Cost of sexual health with Sister Tetelo Nethenzheni. Sister Nethenzheni hails from a village called Tafelkop, in Limpopo Province. She holds a Master’s degree in Midwifery and neonatal nursing from the University of the Western Cape, and has over 6 years of experience in nursing. Sister Nethenzheni currently works at a public hospital midwife in Cape Town.
We would like to thank Sister Nethenzheni for generously sharing her insights on this important issue. We hope parents, guardians and community members listening are now better equipped to support them through this crazy thing called life.
Do enjoy.
Key Points
Sexual and reproductive choices are not without implications. Whether you encourage your teen to practice abstinence or safe sex, every decision comes at a cost. It is therefore important that as a parent you communicate some of the involved costs that your teen needs to be aware of so they can be empowered to make the best decision they can for the life that they envision for themselves.
It is intuitive to regard decisions about sexual and reproductive health as decisions about the physical body. After all, it is the body that is most evidently impacted by sexual and reproductive choices. This being the case, it is important that a conversation on the implications of different choices includes the ways in which the body will be affected by the choice to have sex or abstinence. Speak to your child about the risks of STIs, the impact of pregnancy on the body, etc. Allergies, or possibilities thereof, to contraceptives and condoms are also to be taken seriously as these do affect the body and the experience of sex. It is important that as a parent you bring awareness to your child about the physical implications of their sexual and reproductive choices.
Cultures have numerous rituals and norms that mark sex permissible, legal, legitimate and desirable, just as they are taboos around sex. In modern culture some of these norms include going on dates, buying gifts, and hosting weddings. Not only do these events and rituals come with financial costs, but also social pressures. Your teen is more attentive than you assume. They have paid attention to how you speak about, and act towards, people in your community that abide or transgress social norms around sex. Your teen is juggling numerous social pressures. It is not easy to make the most sound decisions. Be gentle, kind and understanding.
Just as there are physical and social implications to sexual and reproductive choices, so too are there emotional implications. Both abstinence and sexual activity impact and are impacted by our emotions. The decisions we make in this area of our lives can be based on how we feel about ourselves, about others and about sex itself. It is important that parents have honest age-appropriate conversations with their, and around, their teen regarding the emotional responsibilities that come with making decisions about one’s health and rights. It is important to remind your teen about the amount of emotional maturity necessary to make sound decisions that protect both themselves and their partner, just as it is important for them to note that their emotions are a guide for decision making but not the ultimate authority on issues that will impact them for their whole lives. Create space for your teen to express their concerns and feelings with minimal judgment or being dismissive. You are more likely to get the desired outcome by affirming existing emotions yet directing their expression, than with invalidating emotions that are real.
Health care professionals have noted that teenage pregnancy comes with increased stress, risk of depression and anxiety, and poor adaptation to changes in circumstances. The social stigma against teen pregnancy or contracting of STIs or even being sexually active makes it such that sexually active adolescents endure various stressors. Likewise teens deal with various peer pressures related to sexuality, dating, sex and reproduction. As such it is wise to watch out for red flags in your teen that might be signaling psychological distress. Again, you can be stern and responsible as a parent while being kind, understanding and patient.
In many households the distinction between parent and child is stark. The role of the parent is primarily marked out by taking on the financial burden of the household, while the child benefits from this. Until your adolescent youth must provide for their own material needs, it is unlikely that they will have a real sense of how expensive things are – even less so the costs that come with childbearing and rearing. One way to help your teen comprehend the cost of living is to involve them in the financial discussions and planning of the household. Not only is this an eye opener but also empowering for them as well.
Hello, hello, Parents of Ubusha. Welcome to the dual podcast-article series in which we have a sit down with experts on sexual and reproductive health, and related issues. In this series our experts draw on their work and experience to give us reliable, accurate and scientifically-based information in an easy to understand way.
In this month’s episode we talk about Teenage Pregnancy with Sister Makhosazane ‘Khosi’ Ndlovu. Sister Khosi is a registered clinic nurse practitioner based at The Women’s Clinic in Mbombela. With over 14 years worth of experience as a professional nurse, Sr Ndlovu has worked extensively in various areas including but not limited to community nursing, midwifery and psychiatry. She holds a 4 year Diploma in General nursing as well as Primary Health Care. Sister Ndlovu is currently the manager and head nurse at Mbombela Women’s Clinic, where she alongside two gynecologists prioritize sexual and reproductive health especially that of women.
The Women’s Clinic based in Mbombela offers comprehensive healthcare to women and girls in the area. Whether it be a simple checkup or more complex treatment regimen, the highly skilled dedicated team at the well resourced Women’s Clinic will provide you with the best care, making an effort to make sure you always feel welcome and at ease. To book your appointment today head over to https://www.clinic4women.org/ or dial 0645487656.
We would like to thank Sister Ndlovu for generously sharing her insights on this important issue. We hope parents, guardians and community members listening are now better equipped to support them through this crazy thing called life.
Do enjoy.
It is a fit of rage and deep disappointment – teenage pregnancy. It is also understandable that you will put a lot of blame on your child especially if you are the parent of the pregnant girl. However, it is important to remember that she did not get pregnant on her own. Disclosure around how and with whom pregnancy occurred is important. Create an environment where your child can tell you what happened. This is important for two reasons primarily. First, it helps to establish whether there was consent or sexual violation. Be mindful of the age of your child. Secondly, you can hold the other party responsible and accountable. Young women carry a lot of stigma, shame and sacrifice when they fall pregnant. They may feel isolated and alone. It is important that they are supported during pregnancy especially since pregnancy during adolescent carries a lot of medical risk.
Pregnancy in adolescence raises a lot of key questions especially around that of consent. In 2020 StatsSA reported that almost 1000 teen pregnancies during the year were in girls younger than 13 years. The consenting legal age in South Africa is 16 years. Poverty and other socio-economic ills have pushed a lot of young girls into transactional sex, and relationships with much older partners. The inequality in power and resources had meant that a lot of girls do not have the opportunity to negotiate condom use, and the terms of sex in these interactions. Violent sexual crime has also led to unplanned pregnancy. It is important to speak frankly and compassionately with your child about this so that the necessary legal action can take place promptly if indeed consent was not given. If you know of an adult or are an adult in a sexual relationship with a girl/boy younger than 16 years, note that statutory rape is a serious offense.
Studies have found that teenage pregnancies is a high risk pregnancy due to its association with many medical complications for young girls. The body takes serious strain when pregnancy occurs. Mortality is always a risk both to the growing fetus and mother. The sooner pregnancy is detected, antenatal care should start. Unfortunately, because of the stigma of teen pregnancy a lot of young mothers wait until the late stages of pregnancy to present at a clinic or doctor. This means that whatever intervention may have been necessary early on, are significantly delayed which can have serious implications. If your child is pregnant or got someone pregnant, emphasize going for antenatal checkup as early as possible. The screening of STIs among other things, is incredibly important early in pregnancy.
One of the greatest disadvantages that teen moms have is that of not having the opportunity to return to school once pregnant. Although in South Africa and many other places it is illegal to prohibit someone from continuing with their education due to pregnancy, sometimes families are unwilling or unable to provide alternative means of childcare. There are many NGOs and government run programs that try to bridge this gap by providing childcare to young mothers so they can continue with schooling. This is an important form of support. It has been shown in studies that school is a good social buffer against the likelihood of additional pregnancies at a young age, and against the risk of generational poverty. Education has been shown to be effective in cutting the poverty cycle in many families. Support your child to return and stay in school.
While we may assume that all children over the age of 12 years know how babies are made and where they come from, many of us would be surprised how many people have a distorted or misinformed idea. It is important to have an age-appropriate and factual conversation with your child about sexual and reproductive health and choices. This does not promote promiscuity but rather empowers. Communicate clearly and compassionately about choices and consequences of choices in the short, medium and long term. It is important that you alert your child, male or female, of the seriousness of pregnancy and the impact it has socially, mentally, financially and physically.
Hello, hello, Parents of Ubusha. Welcome to the dual podcast-article series in which we have a sit down with experts on sexual and reproductive health, and related issues. In this series our experts draw on their work and experience to give us reliable, accurate and scientifically-based information in an easy to understand way.
In this month’s episode we speak to attorney Mandla Matshiyane. Adv. Mandla Matshiyane is an admitted attorney of the High Court in South Africa. He is a practising attorney with 6 years experience specialising in civil law and is director of M. Matshiyane Attorneys based in Mbombela, Mpumalanga.
Attorney Mandla Matshiyane believes in servanthood which is best expressed in his motto “The best by your side”. Prior to joining the legal field, he practised as a pastor for a period of 10 years. Mandla Matshiyane finds pleasure in serving others, something that he does well. In this episode he speaks to us about sexual violence and what the law has to say about that.
We would like to thank Attorney Matshiyane for generously sharing his insights on this important issue. We hope parents, guardians and community members listening are now better equipped to support teens through this crazy thing called life.
Do enjoy.
Key Points
*This dialogue is based on the transcript of the interview with Attorney Mandla Matshiyane conducted on 23 July, 2023. The text has been edited and adapted according to length specifications, for increased readability and coherence from the original audio-visual recording. The full audio recording is available on the Ubusha Bami podcast, available on all streaming networks.
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Rape, both general and statutory, are but one kind of sexual violence there is. Other forms include sexual exploitation, grooming, flashing, child pornography and other forms of physical assault that are sexual in nature and have not been consented to. When speaking to your child about sexual violence, make them aware that if something makes them feel uncomfortable and in danger, they must report it. Online safety and privacy is also important as child predators also use social media and the internet to exploit children. Keep watch over what and who your child interacts with online and offline. Have an awareness of where they go and with whom. Create an environment where you discuss their day to day frequently, that way you will pick up if something is off.
Reports on sexual violence show that majority of perpatrators are male and people known to the victim. However this does not mean that these are the only perpertrators. There are case of sexual assault and violence committed by women, and other children. Whether you are a child or women, the laws apply.
We don’t hear it often but it is true. There are a significant number of cases where men and boys have been victims of sexual violence. Remember that rape particularly is about power rather than sexual desire. It is expected then that the abuse of power will occur in multiple circumstances. It is wise to discuss sexual violence with both your daughter and your son, so that both know what to look out for and where to go should they feel the threat of violence or experience it.
It is said time heals everything, however this is somewhat of a misleading statement if not completed. Time heals everything that we face head on and work towards healing – that is the complete statement. If your child, or you, have been a victim of sexual violence do not expect that ignoring what has happened will fix the damage it has done. You must face what has happened head on, difficult and painful as it may be. Legally the sooner action is taken the better. This is true emotionally, physiologically and psychologically as well. Don’t give into the temptation to turn a blind eye, thinking your child is young and will forget with time. They might forget but the body will remember and it will complicate their life in unimagined ways.
You and your child are strong and able.to face abuse and violence. Reach out to the appropriate organizations – you are not alone.
If you watch the news, listen to people speak or even draw on what you’ve seen and heard in your own life, you may be tempted to hold the view that sexual violence is so common that it is now acceptable and should just be regarded as just another issue. It is true that unfortunately sexual violence is rampant. However it is not true that we should accept it as normal, thereby adjusting social standards to accommodate a social ill. Whatever the reasons we may come up with to understand why and how sexual violence became wide spread, is not aimed at justifying or excusing it. Explanations help us understand the problem in depth so we can deal with it adequately. Never should explanations be excuses. Sexual violence is criminal, immoral and harmful. It is wrong. And we should continue to fight against it even when it feels like throwing a pebble into an ocean. Even if it saves the life of one person, that is one life that matters.
Hello, hello, Parents of Ubusha. Welcome to the dual podcast-article series in which we have a sit down with experts on sexual and reproductive health. In this series our experts share reliable, accurate and scientifically-based information in an easy to understand way so you can support your adolescent on their journey to good choices about their health.
In this episode we speak to Dr. Khutso Mabokela who holds a PhD in Media Studies from the University of Limpopo. Dr. Mabokela currently at the University of Venda, has a long history in journalism and media studies, having been part of news reporting teams for numerous publications and future journalist programs. In 2013 she co-founded VikeMap Communications, and has spent her career in various positions including public relations, marketing and radio broadcasting, and of course academia.
We would like to thank Dr. Mabokela for generously sharing insights on adolescents and their use of media. We hope parents, guardians and community members listening are now better equipped to support them through this crazy thing called life.
Do enjoy.
16 Things to know
*This dialogue is based on the transcript of the interview with Dr. Khutso Mabokela conducted on July, 2023. The text has been edited and adapted according to length specifications, for increased readability and coherence from the original audio-visual recording. The full audio recording is available on the Ubusha Bami podcast, available on all streaming networks.
Reference:
Keep calm and acquaint yourself with the ways in which you can make it as safe as possible for use in your home and for those in your family. The digital age is real and has found place in almost every aspect of our lives. Instead of wishing it away, take some time to get to understand how it impacts your family life and assess whether or not the ways in which various media of communication enabled through and by the internet are compatible with your family values and goals. Do not be afraid of what you do not understand, empower yourself with knowledge so you know what you are up against.
There is a constant temptation to think and live as though your teen is you. Logically you know that is not the case. They have parts of you biologically, and perhaps even some of your mannerisms and personality traits, but they are no less a separate being from yourself. Often separateness is evident in difference. Differences are not a bad thing all the time. Your adolescent child may express that they prefer to be communicated with in certain manner which may be different from your own. Maybe your teen prefers texts over face to face conversation when discussing certain topics. Make room for this. Sure it may not always be practical or even wise to accommodate all preference. However where possible negotiate for the best possible outcome. Remember, you want to encourage your teen to feel safe and confident to communicate honestly with you.
Speech is possibly the most frequently relied on means of communication in our society. There is ample attention and weight on the spoken word. We expect that people best express their emotions, thoughts and actions via speech so much so that we risk giving attention to other means of communication. Verbally communicating need, emotion, thought, ambitions etc. is not the strength of every person. Pay attention to the other ways in which your teen may be trying to get a message across. Give weight to the things they leave unsaid. Be attentive to silence, body movements, behavioral patterns and other forms of communication. Be discerning with photographs and drawings if your child is artistic in that way. In every way that your child is communicating, give an affirmation of listening. To be able to do that, you must accept that your teen may not always choose verbal communication to communicate even the most important pieces of information about themselves and the world they live in.
You would be surprised to learn that although your teen seems to never listen to what you say when you are saying it to them directly, they are attentive to what you say, how you say it, when you say it and to whom you say it. They are constantly watching for verbal and nonverbal cues from you. They take from you how to be – and not to be – in the world. There really isn’t anything you can do about this. Perhaps it is sufficient to know that your adolescent child did not completely outgrow watching you, and mimicking you, for clues about the world, themselves and others. With this in mind, take every opportunity you can to communicate love, truth, kindness, encouragement and positivity in your words, actions, and choices.
Far too much goes unsaid between child and parent. Sometimes what is said is not what is meant, and what is meant is that which is left unuttered. It is better to always live in the moment fully. Tomorrow is not promised to anyone at all, nor is an opportunity missed ever perfectly regained. So do not take for granted moments of connection and open communication between yourself and your teen. Chasten in love and patience, celebrate without comparison or counting losses. Whatever you do, remember that the fragility of life denies you the option of leaving anything unsaid.
Hello, hello, Parents of Ubusha. Welcome to the podcast series in which we have a sit down with experts to talk all things adolescents. In this series our experts share reliable, accurate and scientifically-based information in an easy to understand way so you can support your adolescent on their journey to good choices.
In this episode we speak to Dr. Sue Bond from the University of Johannesburg. Dr. Bond holds a Master’s degree in Clinical Social Work from the Nelson Mandela Metropolitan University. Her masters looked at couples and families while her D. Litt et Phil focused on the development of possible selves and resilience in young people about to leave residential care (child and youth care centres). Dr. Bond’s current research looks into youth in care, and those transitioning from care. In addition to her research work, Sue has had a long career in child protection providing statutory services, worked in couples and family counselling, adoptions, and in a shelter with abused women and their children. Her commitment to working with families has also been evident in her work in schools, oncology and rehabilitation, as well as managing an inpatient facility for substance abuse.
We would like to thank Dr. Bond for generously sharing insights on adolescents. We hope parents, guardians and community members listening are now better equipped to support them through this crazy thing called life.
If you found this episode worth the listen, do share with everyone you know. You’ll also be pleased to know that a summary version of this episode is available as text on our website along with many other resources.
Until the next episode, happy parenting.
15 Points for Parents*
*This summary is based on an interview with Dr. Bond conducted on May 11th , 2023. The text has been edited, paraphrased and adapted according to length specifications, for increased readability and, for coherence from the original audio-visual recording. Word choice and emphasis is based on the Ubusha Bami team and does not constitute direct quotations from the interviewee. The full audio recording is available on the Ubusha Bami podcast, available on all streaming networks.
1) Accept that your ‘baby’ may want to explore and experiment with substances both legal and illegal – This might be a harsh and hard truth to come to terms with but one that is necessary. You may be tempted to hold on to the version of your child as this fragile baby that relies on you for all their knowledge of, and about, the world. But this isn’t so. As your child grows more aware of the various things around them, curiosities and proclivities will surface. The more accepting you are of this, the better off you are at preparing your child to make wise and safe decisions as they explore the world.
2) Peer-pressure is still a thing, and your child is not above its influence nor exerting it on others – it is often easier to warn your child against peer-pressure and not imagine that they could be an instigator. Peer-pressure is not altogether bad. Peers can pressure each other towards positive behaviors such as excelling academically, acting responsibly in tough situations, and being optimistic about difficult situations. It is equally true that peers can also pressure each other towards negative or undesirable behaviors – we have all read and seen ample examples of this hence it is where our minds go when we talk about peer-pressure. It is prudent to remember that at this age, peer approval and acceptance are very important. You cannot convince your teen to be socially isolated, in fact, it will probably not serve them well to do so. Rather encourage them to think independently and critically about their choice in friends, associates and social groups. Remind them that their social network can be an asset or liability, and that they are better off choosing the asset option and better yet, being one themselves.
3) Keep your eyes and ears wide open – Many children begin to experiment with legal and illegal drugs, tobacco and alcohol much sooner than parents think. At family dinners, neighborhood hang outs and through friends, substances are within reach of young teens. The medicines you keep in your home and food you consume, may well be substances themselves. Your own relationship with substances does not go unnoticed by your teen. While not everyone will develop a detrimental relationship with substances, it is still worthwhile to be aware that that is a possibility especially if there is a family history of this. You want to be as aware as possible of the latest drugs going around, as well as your teens’ relationship to substances. It is also important to be watchful of the ways and extent to which your teen consumes legal substances such as medicines and caffeine. This requires you to keep your eyes and ears on the ground.
4) You don’t have to do it alone – Many parents of teens battling addiction feel isolated and stigmatized. We live in a society where there is a lot of parent-blame. Compassion on families especially parents living with children in active addiction can be hard to come by. But best believe you are not alone. Organisation’s like Alcoholics Anonymous and Narcotics Anonymous have adjacent support groups for those who are part of the substance-users’ support system. Speak to a family counselor or social worker about this.
5) Addiction is a lifelong battle, not a phase your teen will outgrow – If your teen develops a substance addiction, they will contend with it their whole lives. This of course means everyone in their network will deal with it their whole lives. It is better to fight the addiction together than to fight each other. Easier said than done, but remember that more often than not, someone wanting to overcome active addiction is truly not proud or happy to be struggling with it in the first place. They are also not unaware of the hurt and difficulty it brings. Perhaps you also have a history with active addiction and therefore can relate. Whatever the circumstance, turning a blind eye will not make it go away nor will blame and shame. Addiction is complex and requires a wholistic approach. It is better dealt with when all hands are on deck, as honesty, firmness and boundaries are balanced with patience, compassion and understanding.
What other tips do you have regarding substance use that you are noticing or teaching your teen? Share some of your tips by leaving us a comment.
Hello, hello, Parents of Ubusha. Welcome to the dual podcast-article series in which we have a
sit down with experts on sexual and reproductive health. In this series our experts share
reliable, accurate and scientifically-based information in an easy to understand way so you can
support your adolescent on their journey to good choices about their health.
In this episode we speak to Dr. Elona Toska, from the University of Cape Town. Dr. Elona
Toska is an adolescent health and well-being expert and emerging leader in adolescent and
HIV/AIDS research. She holds an MSc and DPhil from the University of Oxford (UO) in Evidence Based Social Intervention. She is the Director and Chief Research Officer of the Adolescent
Accelerators Research Hub at the Centre for Social Science Research at the University of Cape
Town (UCT).
We would like to thank Dr Toska for generously sharing insights on adolescents. We hope
parents, guardians and community members listening are now better equipped to support
them through this crazy thing called life. Do enjoy.
Q & A*
Who are adolescents, and how can we understand the ways in which they make choices
regarding their sexual and reproductive health?
It is a time of incredible change in our bodies, in our minds and in how we position ourselves in society.
[It is also a time of change in] how we interact with our parents. It’s a process of kind of creating more
and more independence and in some ways rejecting, not in a bad way, but kind of saying [to the parent]
‘I don’t need you as much as before’. So this transition is difficult, but also [comes with] trying new
things and the phrase of learning by doing cannot be truer in adolescence because our brains at that
time [are] developing. Think of it as a tree in the spring: there’s new branches and leaves everywhere.
It’s a phase, and it hopefully continues for the rest of our lives, truly driven by our bodies so there’s not,
you know, malicious intent to wake up and be risky. But [what is there] is [the] intent inside the brain to
try new things and learn by doing. The community [becomes important] and sometimes [that is] kind of
against who we’ve been as a child, [but it is] a way of being your new [self].
Does some of this exploration and sense of adventure show up in the sexual and reproductive area of
their lives as well?
Yes. Sexual reproductive health does not start in adolescence. It is a taboo topic, but actually we are
born with bodies that have some physical pathways, patterns in our organs and hormones. And there
are big hormonal changes in adolescence starting with puberty, and they result in both physical changes
but also emotional changes. So the moodiness we often think about [when thinking about] adolescence
or the risk-taking, [or] the sleeping late in the morning. These are all linked to that physical change. But
that physical change doesn’t appear like with a button the day you turn 10. Actually many young people
will have already felt changes in their bodies before adolescence but we don’t label them or we don’t
talk about them.
[During adolescence you also] realize that you want to be friends with someone, maybe more than
friends. And this is all quite new, right? Who you socialize with is determined totally by your parents and
the caregivers and the community [earlier in your life then] suddenly you are free to talk to [others],
meet someone elsewhere, have play a new game etc. [This is all] it’s linked to that exploration, but it’s
also linked to learning how to be a human and form relationships which can be physical as well. They
can be emotional, they can be purely physical, they can be a combination of both.
You mention that the physical aspects of ones being does not emerge at puberty or at adolescence,
and yet there’s a taboo around it. Why might that be? Why is so much attention given to it around
that age group?
As a parent, I can acknowledge that it’s very hard to [see your child grow up]. You’ve had this little
human for, like, several years. You’re doing your best to keep them alive and safe from hurting
themselves and feed them well and vaccinate them and worry when they are sick or not sleeping. And
then that time goes fast. And then there you are trying to get them through school, teach them how to
dress themselves and pack. And then that time also goes [by fast]. And suddenly there’s this new topic
that you weren’t ready [for], and they’re moving at the speed of light and you feel stuck sometimes.
It’s not only about sex, it’s about everything. It’s about whether a mother has her period and if a father
can talk about morning erections, for example.
There’s lots of things that happen in our bodies that grown-ups shy away from [and hid from] our
children because they were so little. But they in the meantime have more curiosity and interests and
that is a part that catches us by surprise. I’d say as parents [we don’t have] easy available spaces for
most of us to practice talking about it [these things]. It’s not easy to say “hey, Vanessa, my son and
daughter said this yesterday. What do you do when that happens or how do I respond if my son says
that, you know, making a baby requires a penis in vagina, and he heard that at school?. Or he heard
something that’s not true at school.” We’re often caught by surprise because we’re not initiating all the
learning and the conversations anymore – children or adolescents are bringing up these topics or
sometimes learning and discussing them separately [from the parents]. We’re not on top of it anymore.
We don’t have full knowledge and control over their lives. And it’s very difficult.
It seems the conversation is not just about sex then – it is about looking at the holistic being.
Yes, and it is in the context of keeping [the adolescent] safe. There is this need for independence. And
that does come with these barriers also in between. But it is important to remember that our job of
keeping our young people safe does not end just because they’re pushing us away a little bit.
They still need us; we all need it. I still need to be safe in my support group [even] in my ripe age of 3
decades of experience, so there’s no reason our young people don’t need that. But it is harder to
provide [safety]. So to think about coming always from a space of “I care for you, I want to keep you
safe, let me know how and if I can do it”, and realizing that you won’t be the sole source of that [safety
and protection] anymore as they grow older [is necessary]. There’s other sources [from where] they’re
getting support. Sometimes [they will get] less support, so they’ll get hurt. [For instance] not using
condoms, maybe having a sugar daddy or blesser or having multiple girlfriends or boyfriends. But those
are the contexts of what we as parents are. The way I think about it is I want to keep my children safe
while they’ll do these things, and be there in case they need me.
What would you say we need to understand in terms of how young adolescents make decisions?
That’s a big question. How we discuss this in the research world is that a young persons, but really even
from childhood, do not make their decisions based just on their individual factors. Think of it as circles – the person in the center and there’s factors linked to them. Some of it is biological. Sometimes there are
factors linked to puberty. There may be in some cases living with HIV, which brings in some biological
results and how they grow.
Then there’s the family space where there’s a lot about, as I said earlier, on interaction with your
caregiver. And there’s a lot of research on dimensions of parenting or caregiving. It doesn’t have to be
the biological parent but the adult who is your adult or adults. It could be on armed or grandma or a or a
grandfather or a single parent. There are multiple dimensions of the relationship with the child and
talking about sex and relationships is only one of them.
We also think that if adolescents are factually informed, they will suddenly make good decisions. The
best way we summarize this in our research to date and our knowledge and maybe many parents will
realize this, is knowledge is necessary but not sufficient. You can have knowledge, but it doesn’t
translate in perfect actions. When it comes to knowledge and facts and information, young people,
children, everyone will absorb what they’re ready mentally to absorb cognitively. So we could tell them
this perfect curriculum of information but if they only absorb the pieces that they can handle
[cognitively]. Assuming that having talked once about something [therefore] they now know it is not
right. And just because they are 17 [years old] doesn’t mean that they took it all in, for example.
The third I think in terms of this kind of knowledge [has to do with being] responsive. Imagine me being
like “hey, today we’re going to talk about periods” [ to someone who hasn’t] had theirs. Because your
brain is not ready or, you know, that’s what you think, [it won’t stick]. But then another day [they may]
see something happen at school or with friends and [they] will come [to you to talk about it]. That’s
where the responsiveness comes in. It will be important to have a space where you could ask that
question so that the grown-ups or the peers, if it’s a peer support program, can provide that
information. So it’s kind of a pull and push. We’re pushing information onto a young person and pulling
[by] being enabling them to drive the conversation – we need both.
Then there’s the parenting, communication dimension. What has emerged from research in South Africa
and other places is what we call parental monitoring. Imagine a skyscraper and you’re like painting or
building it. You need scaffolding to kind of hold it. [It is being able to answer questions like] “Do you
know where your adolescent is going at night? Do you know when they leave the house where they’re
going? Do you know who their friends are? Do they come back at a certain time every day, like knowing
where they are so that you can kind of hold them?” That’s monitoring or supervision and I think having
positive supervision is quite important. That’s throughout their lives.
Then there’s the positive parenting element, which is about praise. Now it’s not all about saying you’re
the most beautiful child in the world, even though I say that all the time to my children; it’s about saying
seeing them, like, truly seeing them and saying “I really loved how you looked after your sister earlier
today or thank you so much for cleaning up after yourself”. And I know that when we’re busy and
stressed out as parents, it’s the last thing that comes to your mind. And you don’t have to do it 45 times
a day. But I think helping each other feel seen and modeling that with our young people helps. It helps
them feel important and valued.
Another dimension is being very good about not having harsh discipline. There is extremely strong
evidence that beating a child or emotional abuse, calling them names, shouting at them is associated
with violent perpetration later on in life and risk-taking [behavior]. So [minimizing] exposure to early
childhood violence, and I know we don’t intend to make it violent, but it is to them, whether it’s at
school or home, is really one of the things that we can do to help set up a safer relationship with our
adolescent. There are ways of having good discipline and good discipline is about setting boundaries and
being clear about consequences and following through with them.
And then the other thing that’s maybe hard to do is just spend time with your children and it can be 5
minutes. Maybe it’s doing a quick phone game on your phone. It’s watching something on TV, talking
about it. It doesn’t have to be 5 hours of walking around the neighborhood and chitchatting. It is about
key elements of that relationship that can keep them safe.
From the research, what do we know about the ways in which parents communicate or relate to their
child or their growing adolescent and the impact that has on the choices that they make, the
behaviors they exhibit and propensity for high risk taking?
So what I’ve been trying to say is that young people feel kind of compelled to take risks, and we may
define risk very differently amongst different individuals. And it doesn’t mean that they should not be
punished for it. That’s one of the first things, right. So it’s not about telling them the right thing to do. It’s
also how we react.
[Being] clear about how we respond to risk taking is important and one of the important things is to
acknowledge that something has happened, not to shy away from it. There’s a lot of inner work that a
parent or caregiver has to do when you respond to them becoming their own person and taking risks.
But in a lot of our, particularly in some of our communities where we do research and work, there’s a lot
of shaming of the parent when the child does something wrong. And of course there is something there
because as we just discussed how one is in the home shapes who you are as a child.
But there’s also other influences that a parent can’t always control. So how we respond in those cases is
important, and being aware that there is this inner work we are doing as parents. So it’s about us as
well. But it’s not about us to fix it. What we want to do is provide the young person the space to talk
about it and retrace their behavior in the future. It’s very hard work, I want to acknowledge this.
How can a parent respond to the following example: An adolescent asking “What negatives are there
if I use a condom, but I still have multiple sexual partners”.
First of all, to have a young person say that to the parent is probably quite unusual, right? I would
suspect that most parents wouldn’t know it, but maybe they noticed something or something comes up
in the space and I think it’s important to sync around the patterns through which these are happening
and that there are what we call gender norms. There is a really amazing book called Becoming Men by
Malusi Langa, who works with young men in Alex for a long period, and he talks about the pressure of
being a young man who has many sexual partners and how this a kind of showing off, but it’s also
extremely stressful for these young men because they feel that that’s the only way that they will be
valued – by being able to show that they can manage multiple girlfriends and please them sexually and
romantically. This is not a conversation that parents would have with their young men, for example. But
if it does come up, one of the things that one could say is, “gosh, isn’t it hard work to do this with all of
them? Are you OK? Do you know their HIV status. Have you been checked?”
I know this is hard to do, but kind [express that] I’m worried about you. It’s hard to do. My first reaction
is also like “please stop doing what you’re doing” but actually that doesn’t help. They’re not going to
stop it because what has led to those spaces is not so obvious, and they didn’t wake up in the morning
necessarily saying today I’m going to be a have multiple concurrent sexual partners.
It is a bit challenging because maybe for a period in their lives they will have multiple sexual partners. So
then the question is, how can we keep them safe in those relationships? [The parent can ask
themselves] “Can I help them have an identity that doesn’t depend on having multiple sexual partners to
prove their worth or prove their value in society?” How we promote safe sex in those practices is an
important way to support them. Maybe slowly [they will] stop doing it is but it’s not going to happen by
just telling them “Don’t do it” ; and it’s certainly not going to happen by ignoring it.
How can parents initiate a conversation with my adolescent about their sexual and reproductive
health?
I think being available when someone gives you cues. May the adolescent will never come to the parent
and say “tell me about how to use a condom”. That’s actually quite unlikely to happen to be honest. It’s
not bad. I think one of the ways to be responsive is to be aware of cues, [for example] maybe you’re
watching a movie together and something happens, you can use it as an opening, as an opportunity to
say “Oh gosh, you know, they could have used the condom, gosh no one in my time used condoms. We
didn’t even talk about them with our parents. But I saw some at the clinic recently, so I picked them up
and I put them in the space. If you want to use them, they’re there”. So something like that kind of
normalizes that conversation.
We have a lot of good data from South Africa and other countries that staying in school as long as
possible, is highly protective. We [can think of] school as a social vaccine. A lot of young people struggle
in school and drop out, then it kind of sets off a cascade of challenging issues in part because they’re
searching for meaning outside of who they are, in part because being out of school means we have
more available time. You’re where no one can look after you, et cetera. So if there’s ways to support
your young person, even if they’re struggling in school, remaining in school in the safeway that is quite
important.
And then we have emerging data that where young women report not having enough food at home,
there’s links more directly to higher rates of transactional sex and sex with an older partner. Now we all
have heard stories of blessers and young women wanting extensions [therefore getting into these] really
sexual relationships. I’m not saying they never happened, but when we look at large survey data, hunger
at home or not [having] enough food to eat is a very strong factor associated with later sexual risk.
Early sexual debut is also associated with later sexual risk. So once you start risk early, it continues. You
may sit there and say, “gosh, but it’s already happened. What do I do?” Well, if you know about it, you
can kind of help mitigate a bit, soften the potential risk by helping the [young woman] get on
contraception or get those condoms and bring them at home for a young man. At least then they know
that there is a space where they can access some of the supportive services for young women who
become pregnant. It’s quite important to support them to return to school.
Part of the issue is the stigma around early motherhood. And I wanted to bring this up specifically
because we’ve put a lot of effort in prevention, but much of it is around talking. Even though there’s lots
of social issues, family and community which are drivers of early pregnancy, we seem to forget about
the young mother once she’s had a child. I think it’s just quite important to realize and remember they
did not get pregnant by themselves. Now, this isn’t about blaming the father. Tracking down the father,
forcing them to pay maintenance or negotiating inhlawulo. All of those have their own practices of how
they happen. It is also about recognizing that there is a lot at stake with a young woman for her life and
future, but also that of the child. And acknowledging that there may have been good and bad reasons
why this pregnancy happened, but it doesn’t end there, we need to actually support them, and it’s a
large cohort of them.
One of the last factors that’s quite important for us and I don’t know how parents can do this, but the
healthcare providers, nurses and counselors and doctors and pharmacists, the guard at the door of a
clinic, at the gate of a clinic [and so on, are] parents themselves. We don’t enter these facilities or
schools as teachers or maybe police officers, maybe community health workers or social workers – many
of us do not enter our workspaces and suddenly become a new person. So, we often treat adolescents
and young people in these spaces, but the impact is particularly great in facilities and health facilities, in
the same way that we treat adolescents at home which means often with avoidance of the topic. [There
is imposing of the idea that] “
if you do these three things, you’ll be the perfect woman or the perfect man” or through shaming like
“you missed your appointment or you’re late, go to the back of the queue”.
Now I also haven’t been treated so great sometimes in my life, we all have had those cases. But as an
adult person, the impact on me is different. I can handle it. I have self-confidence etc. But a young
person, the impact of being treated that way in a public space like a facility where it’s taken a huge
amount of emotional effort to show up to access the service, has a great impact. So this is another space
where interactions with adults are quite important. It’s not just about the parent at home, it’s also about
the relationships with teachers at school and healthcare providers.
It seems when care is prioritized, you get more from the parent-child relationship than you do from
shaming, guilting and embarrassing them. Is that what we’re seeing very clearly in the data?
Yeah, I mean the data we see is that physical hitting by parents or caregivers and calling names,
shouting, belittling, which we call home violence is associated with later risk-taking in life. It is often
when there is good parental supervision, monitoring and positive parenting that the praising makes a
difference to soften the blow, so to speak.
Similar with being exposed to violence at schools or being hit with a ruler or a belt, [this] is also very
strongly associated with risk-taking, but also, for example taking antiretrovirals in young people living
with HIV. This is particularly true in early adolescence, where you’re still very connected to the adult
relationships and then the third element is in facilities. We have both qualitative and quantitative data
[which] very strongly associates how you feel [about experiences at health] facility with [likelihood] of
taking your medication if you’re living with HIV.
Contraception use in young women and young mothers specifically and reduced condom use are linked
to experiences at facilities.
What or who do we refer to when we speak of young mothers?
The official definition of an adolescent mother is someone who had their first child before the age of 20.
Teenage Moms, adolescent mums. But in many ways, it’s about how ready and supported you are near
early motherhood, so you could be 20 or 21 and still not feel ready or be in a safe relationship. But in
our work with over 1000 young mothers and their children in the Eastern Cape it is with young women
who had their first child before they were 20.
I want to say this, just because something that one doesn’t want [to happen] did happen, doesn’t mean
that actually they are a rebel or a rule breaker because I don’t have the data and we don’t have the data,
but it’s actually extremely hard to make condoms available in schools because those parents who are
often in school governing bodies or other people in the community find it very difficult to imagine that
young people need condoms.
So it’s quite important to support people to think through that assumption and work backwards. For
example, the LO curriculum is very detailed and it would make both of us blush; they’re learning this at
age 11. The same parents are also teachers so often the quality of what [adolescents are] being taught
in school makes people are embarrassed so they either don’t [teach] it at all or they do it in a minimal
way. It is difficult to teach rowdy teenagers such a topic, so we’re part of the research questions that we
have is, “should it be a mobile phone app? Should it be a game?” Can it truly be learned in a classroom
setting through an adult [given] that [there is a] power dynamic [and] at the same time, they’re also
learning and exposed to phone and other devices and cyber.
Do male adolescence differ in terms of how they negotiate and navigate sexual freedom and
boundaries compared to female adolescence?
In general the development of gender identity starts early on, but it really flourishes and settles in
adolescents and young adulthood. And it is about biology, obviously, but it’s also about socializing. So
we definitely socialize young men and young women differently, and therefore the way that they
engage with relationships is different. Now, this varies, in urban/ rural settings [and] sometimes other
layers, such as culture, family traditions, etc.
I would hesitate to make blanket statements, but
whatever we observe in the broader society of how men behave, it’s already starting in young, young
men – adolescent boys – and what we think of young women is also being kind of initiated in [early].
One of the things that struck me in the research that I’ve been looking at [is that] for young men there is
increased pressure to perform the toxic masculinity narrative and hegemonic masculinity. Parents may
have heard these words, but it means that there is only one way to be a man.
And that one way sort of scripted somewhere, everyone seems to knows what it means, but it’s kind of
the little bit different in everyone’s minds.
In the effort to become a real man, young man will then do a lot of things that they think are part of this.
They’ll judge each other. It can involve having sexual conquests [and] having multiple sexual partners.
But at the core, those have spent time talking to young men realize that [young men] are unsure how to
express their love, and they do not want to be valued for their money or their sexual prowess. So to
support young men, [we need] to think about relationships more broadly and how they show their care;
it can be material support, but it can also be emotional support.
And so to break some of these provider loves patterns, [which is what it is called because] you [are]
loved because you’re the provider, [we must acknowledge that] some parts of our societies are very
gender fluid and the future generations are going to be more and more so. But what we also model as
care-givers and communities also shapes these expectations and then they translate in how people have
sex. But sex is the last thing. In some ways it’s everything else around that makes the opportunities or
choices available to them.
You mentioned some of the drivers for young women dating older men, are young men dating up as
well or are they kind of staying with the same age group? Do we know anything about that?
A lot of our research on this topic has come from the world of HIV and what we have realized there is
that young women, not all, are having relationships with older men. It’s not a huge proportion, but it’s
sufficient to feed into this cycle of HIV transmission and acquisition, which is what we’re trying to
interrupt through that work. But they also are having relationships with their peers, even if not
concurrent. So obviously those young men then are part of that relationship. [There are] relationships in
schools. The issue with older men, it’s not the age. I would hesitate to judge every young woman who
has a relationship or a sexual or romantic, or both, with someone purely on the age difference. The main
issue [with age] is the power inequality. It’s whether the exchange or gifts brings up the lack of condom
use or inability to negotiate contraception or feeling unsafe. Depending financially on that partner,
which can lead to spaces of violence, emotional or physical, [is why this is a point worry]. It may happen
with young men [too], but I think the power dynamic there would be different because the norms
around the young men are different. It’s tricky for young woman to then also negotiate consent [when
these differences are in place].
Then I’ve been speaking a in terms of heterosexual [sexual relationships], so I should apologize for my
heteronormativity. The prior conversation about exploration would apply to all kinds of sexual
exploration and there’s a much larger proportion of young people in Generation Alpha and Z as the
current children and adolescents are [referred too], are going to have the highest proportion of
exploring of relationships, not just in terms of gender identity, but also sexual orientation. So keeping an
open mind around that is going to be another challenge for us as parents.
Do you have top three myths or untruths about sexual reproductive health and regarding adolescence
that you think absolutely must be debunked?
1) That young women are getting pregnant to get the Child Support grant. There is huge qualitative
and quantitative data [indicating] that is not true.
2) That sexual risk-taking, drinking or drugs [are] forms of delinquency only.
3) That shaming, blaming and hitting are the answer to forcing good behavior. –
*This dialogue is based on the transcript of the interview with Dr. Toska conducted on April 14th, 2023. The text has been edited and adapted according to length specifications, for increased readability and coherence from the original audio-visual recording. The full audio recording is available on the Ubusha Bami podcast, available on all streaming networks.
References:
1) Set boundaries as early as possible – The adolescent years are characterised by exploration and experimentation. As such, it is on brand for your teen to push childhood boundaries as far as they can. Adjusting the boundaries of childhood to match the new developmental stage is important. It not only gives the teen a sense of orientation and realisation that they are in fact at a different place in their lives, but also grants you the opportunity to intentionally and critically think about where the new line is. Remember, how boundaries are communicated is just as important as what and where they are. These should be formulated and articulated as soon as possible, and reviewed as often as possible. Needless to say, this requires attentive and proactive parenting.
2) Freedom is necessary – Boundaries are not only meant as restraint. Although they can be used in this way where necessary, they are also what allows freedom and security. It is necessary to put in place boundaries that protect your child, but do not choke life out of them. Research has found that children who are overprotected, smothered to be frank, do not build up resilience, self-trust or social skills as quickly nor as adequatly as their peers. Freedom is necessary for the overall wellbeing of your teen, who will grow to be an adult. Age-appropriate boundaries protect them while they learn to handle themselves as autonomous, responsible beings.
3) Responsibility is not burdensome – Freedom and boundaries come with responsibility. It is wise to build positive associations with responsibility, to speak of it as honorable and noble, around your teen. Far too many young people want rewards but do not in fact want, and are often unwilling, to do the actual hard work and endure sacrifice associated with those rewards. Often this is because they have never had to be responsible for anything significant in their lives. They have lost or broken something, spoken an unkind word to a peer at school, and perhaps even crashed your car. Yet in these events, they were not held responsible for their actions and choices. It is no surprise that they have a limited sense of the reality that their actions change reality in some way, and therefore that is a super power. They do not realize that this super power requires that they move in the world in intentional ways. Knowing that their decisions have an impact empowers them rather than burdens them.
4) Consequences are both punishment and reward – Often when we speak about consequences we are referring to something negative or painful. But strictly speaking, consequence is more synonymous with effect or outcome than it is with punishment. Just as it is important to encourage your teen to be mindful of their actions and words, because they change the world and their lives in some way, it is important to make it clear that there is a link between action and outcome. Desired behavior should be rewarded explicitly to encourage repetition. Likewise, undesired behavior ought to be punished to discourage repetition. In both instances the teen must be aware of what they did (or did not do) that led them to the consequence they are now having to deal with. This is also why it is important to outline what the boundaries are prior to the behavior so that the teen is aware when they abide or transgress. It may not always be possible to draw a straight line between the behaviour and the outcome, but as far as is possible, outline the link. This will encourage discipline and a good use of one’s freedom.
5) The truth is always best – Sometimes you will be tempted to outright lie or conceal the truth from your teen. Unfortunately, the truth has a way of making its way to the surface without asking for permission to do so. It is important to work on a honesty-based relationship with your teen. Honesty will facilitate trust. In a trust relationship, boundaries are not taken as a compromise of individuality but rather as a way to orientate one into the big world within a space with a lot of support. In an honest parent-child relationship, freedom is not abused but considered a privilege that can be revoked. In a trust parent-child relationship, responsibility is not considered as a whip used by the parent forcing the child to grow up quickly, but rather as acknowledgement of a growing child who must be prepared gradually to be a functional, independent adult. In an honest relationship, when desired behaviour is rewarded there is no doubt that it is earned, just as when undesired behaviour is punished, it is clear what was done wrong and what can be done to remedy the situation.
What other tips do you have regarding the freedoms and boundaries you are noticing or teaching your teen? Do you have examples of the above in your relationship with your child? leave us a comment.
Hello, hello, Parents of Ubusha. Welcome to the dual podcast-article series in which we have a sit down with experts on sexual and reproductive health. In this series our experts share reliable, accurate and scientifically-based information in an easy to understand way so you can support your adolescent on their journey to good choices about their health.
In this episode we speak to distinguished Professor Ann. Strode, from the University of Kwazulu-Natal. Professor Strode has worked in the socio-legal space for over twenty years, with most of her work addressing HIV as a human rights issue. Her more recent work has focused on issues of consent in health research with children and adolescents, not neglecting her co-authored 2016 article on the evolving sexual and reproductive health rights of adolescents.
We would like to thank the professor for generously sharing what the law says about Human Rights and Sexual and Reproductive Rights in the South African context respectively, as well as some ideas on the role and responsibilities that parents, guardians and communities have in creating a world in which Sexual and Reproductive health rights as human rights are not taken for granted. Do enjoy.
Q & A*
What exactly are human rights and what are sexual reproductive rights respectively?
So Human Rights are really a special kind of right, because they are a right that is given to everyone at birth simply by being human. So since 1948, with the adoption by the United Nations of the Universal Declaration of Human Rights, that was the first time, I mean, which is very sad that was took as long as to get to 1948 before the international community actually recognized that there was something called human rights.
And that everyone, every single human, ought to be entitled to this set of fundamental human rights. And it really came out of the Second World War because in the Second World War there were all those human rights violations at so many different levels. But particularly perhaps it was the extermination of 6 million Jewish people, the extermination of gay people, extermination of gypsies and all the other violations that ordinarily come with war.
So in 1948, the United Nations as a universal body, adopted this document called the Universal Declaration of Human Rights,
which set out a whole range of rights that
every individual would have. They especially made it a declaration because within the United Nations system if you’re going to make something legally binding, it has to be in the form of a convention or a treaty, and then individual countries have to sign up to it. So something like The Convention On The Elimination Of All Forms Of Discrimination Against Women, you’d actually have to get every country to agree to it. And they wanted something that would go beyond that, that would just be a declaration. So it’s not legally binding, but sets that high standard of rights that every individual ought have. Now one of the rights within the Universal Declaration of Human Rights is around a standard of living; that everyone ought to be entitled to a dignified standard of living. And one aspect of that standard of living is health, and in the Universal Declaration they very wisely put it in relation to human well-being, you know, it’s part of shelter, it’s part clothing because you have to have all of those things for you be healthy. So within health is where we would situate the sexual and reproductive health rights.
But it took from 1948 and then in 1966, the United Nations adopted the International Convent on Economic, Social and Cultural Rights. This was now a legally binding document that countries could sign up to, and within that there was the Right to the highest attainable standard of health. So it’s not that we have a right to health; we have a right to, for our countries must strive to give us, the highest attainable standard of health. And that was 1966, it was implemented in 1976. 1994 was the next milestone because there in Cairo, we had a world Population and Development Conference where it was actually recognized for the first time that part of the right to health is sexual and reproductive health rights.
So it took us through all the way from 1948 right till 1994 to start recognizing that an important subset of human rights is sexual and reproductive health rights, and sexual reproductive health rights are a subset of rights that deal with anything to do with essentially reproduction. So they’re various elements of it. It would be a right to, to have sex, that is a fundamental right. Then if you’re going to have sex, obviously there need to be the right to have access to sexual reproductive health services. Because we’re going to have sex we’re going to need contraceptives, pregnancy services etc. Then lastly the other part of sexual reproductive health rights, which is so important, is that right to make reproductive health choices. Do I want to have a family? Do I not want to have a family? What’s the size of my family going to be? Those sorts of choices. So it’s those 3 core things around autonomy; making our own choices. And so even just our own choices about our sexual partners: Do I want a female partner? Do I want a heterosexual partner, etc. So having access to services and then also the right to actually have sex.
From work that you have done, how is South Africa fairing with regards to Sexual and Reproductive Rights?
So let’s start at the top with our Constitution. Our Constitution was the first in the world to actually specifically mention sexual and reproductive health rights in two places. So firstly, if we look at Section 12 of the Constitution, that’s the right to bodily and psychological integrity. Your body is your own. You must make your own choices about your body. It’s really an autonomy right, and that people can’t interfere with that right. They can’t harm you or hurt you in anyway. And what’s important about Section 12 is that it specifically states that part of bodily integrity is the right to make sexual and reproductive health choices. So that was the first in the world to have that in the Constitution and having that provision has meant that we’re able to have, for example, a choice and termination of pregnancy Act. So I’m like in the US with, they’ve now got such restrictive abortion legislation, we’ve actually got that right to make our own choices in the constitution around reproduction.
So if I don’t want to have children, I don’t have to have children. I have those choices around my reproduction. Then the second thing that was very progressive in our Constitution is Section 27 in the Bill of Rights, the right to access healthcare services, which was trying to move away from the Apartheid separate services that people were provided, which were all differential with white people getting allocated 3/4 if not more of the budget. Now everyone has access to healthcare services. And what’s interesting is, that includes sexual and reproductive health services. So out of all the services the state must provide (they must provide mental healthcare services, they must provide services obviously to elderly people, cancer patients, HIV); the Constitution actually elevates sexual and reproductive health rights and so the state must also provide these rights. So those two rights in Section 12 and 27 created this great framework for sexual and reproductive healthcare in South Africa because the Constitution is our supreme law, and everything must comply with it. So we’ve got a great constitutional framework.
And then from there where we have done very well is that we as a country from 1996 when Parliament passed the choice on Termination of Pregnancy Act, we have progressive termination of pregnancy legislation. We also have protective legislation around sterilisation from 1998. Again there’s special requirements for sterilisation, as you can’t sterilise someone under the age of 18. The Act’s very clear about consent – that you must have consent for sterilisations. So we’ve got abortions, we’ve got sterilizations. And then the other big legislative area has been the Children’s Act. In the Children’s Act, in a very progressive and pragmatic move, the government, the Parliament, provided that from the age of 12 you can access contraceptives all without parental consent, you can access medical treatment, you can access HIV testing. At 16 you can access male circumcision if you are a young man; you can make that choice independently. So we have got a great legislative framework. In practice all the research shows that we’re not doing as well. So actually access to these services is not that easy and that’s where our problem is.
We also have one red flag for me in the legislative framework, and it is that the Children’s Act actually has made a harmful cultural practice legal. So what was good in the Children’s Act is that they said you can’t have female genital mutilation. It’s clear, it’s there, which is great. So we’ve got that as a protective measure for young girls. But then they also provided that virginity testing is legal. And I feel that’s a harmful cultural practice, that they should never have said it’s legal. What they’re saying is the act is that it’s legal if you’re 16, if you consent to it, if the status of whether you’re virginity or virginity is not going to be disclosed. It can be on both girls or boys. But we know in reality, there’s only virginity testing of girls. And we know that it’s not done in a way in which it’s kept confidential. In fact it’s harmful because some girls have been sexually abused and then it comes up they’re not virgins.
Actual the practice is not scientific anyway, to tell whether you a virgin or not, but then you get essentially marked in your community. So that for us is one area where it’s a great pity they did that. I have not actually even seen a rationale for why, when it’s under the heading that you can’t have harmful cultural practices. Maybe they’re rationale was they wanted to take a harmful practice and put protections in that the girl or the boy would consent, and that it has to be kept confidential. But in practice the literature shows it doesn’t work that way. And I’m sorry I’m stigmatizing, in fact, in KwaZulu in eMsinga a rural area here, there was even some years ago now probably 6-7 years ago, the local municipality actually created a bursary fund for virgins based on this provision because you know, you could do virginity testing, it was legal. And then they offered bursaries to go to university to girls who were virgins. So it has that kind of unintended consequence I feel. Because it’s unscientific, we don’t know, but it really did then discriminate against these so-called non-virgins who may well have been virgins because it’s not a scientific process. But you were humiliated in front of your whole community because you didn’t meet that bar.
What processes and institutions are provided in the governmental framework as well as perhaps culturally, to address the violations of sexual and reproductive rights? Where do you go? Who do you call? How do you begin that process, and what protections are in place for those kinds of violations?
Before I get there, the other piece of legislation is obviously the criminal law because it is closely linked to sexual and reproductive health rights. We do have a very good laws around rape. Rape is essentially when someone has sex with you without your consent. So that’s also obviously very important that that’s our standard for sex. There must be consent and failure means that you can go and report that as a crime.
And then linked to that is actually the adolescent issues because our law says that you can only consent to sex at 16. But again, we know in reality children, adolescents, are having sex at a younger age. So that’s another problem with our legal framework – the Children’s Act and the Criminal Law come with two different approaches. There was this gap between ‘I can go and get contraceptives’, but I’m not supposed to be having sex. And so there is often a problem with services being provided. There was a challenge in the Constitutional Court around this, that and around the criminalization of sex. And after that the law was amended and narrowed. So now you can have sex between 12 and 15, which is below the age of consent, provided there’s less than a two year age gap between you and your sexual partner.
Problem though is again, if we look at reality, it’s young woman who are disadvantaged because young woman tend to have older partners. There is very little peer-sex unfortunately, in that age group. Like a young girl of 14 or 15 is likely to have sex with a partner up to five years older than her, if not more. And so then those young women are still vulnerable because if I’m 15 and my partner’s 23, he’s committing a criminal offence, but obviously I’m the witness to that criminal offence. So I am also brought into the criminal justice system to give evidence about him. Obviously, no young woman with a 23 year old boyfriend is going to want to report them to the police. So that’s another problem in our system is that we haven’t really worked out with consensual sex, because those are all consensual crimes. I’ve consented to it because if I didn’t consent to that, it doesn’t matter about my age. You know, that is rape – if someone doesn’t get my agreement. We need to look at when it’s about consent ; when should the criminal law be involved and when not.
So to go back to your question though, if there’s no consent it’s a criminal justice matter and one would report that to the police. Also when there’s sex under 12, the law says you don’t have capacity to consent to sex. So any sex under 12, there the remedy is the criminal law and the police etc. Especially for very young children, there’s actually a very harsh, it’s not helpful in terms of sexual and reproductive health rights. Just the other day I was contacted by a psychologist who’s working at a Johannesburg hospital. She was saying that when pregnant teenagers come to her to the hospital where she is working, if they’re under 16 and they are coming for antenatal services, then the first thing that happens to them is they’re told to go to the social worker and the social worker fills in a form asking them who their sexual partner is. It’s form 22 which is actually the form you’d use for reporting child abuse. So this teenage girl has to go there first then she comes back for her pregnancy services. And their data she told me is showing that because that’s quite coercive (I mean it’s very embarrassing to be told now we’re going to report this to the police), their data is showing that young girls are coming very late for pregnancy services if they’re under 16 which is a real problem because those are actually risk pregnancies. And we would want to intervene as soon as possible so it’s a safe pregnancy in terms of HIV and giving services and making sure that that young mom is going to have proper support once her child’s born, etc.
So this is like a push-pull in our system where we have some progressive laws but then the way they’re implemented makes the young girl not want to go and use the services. So these sexual reproductive health and rights, especially for young girls, seem to not be making a difference in their lives, which is very concerning. So the one whole set of institutions is the police and the prosecutions – the courts that can be used. Your other main institution is a health clinic. Young girls and young boys should be able to go to clinics and get, before they even sexually active, get contraceptives, get information, get advice. If they have an STI, get immediate treatment because that’s another problem. There’s research now being done by UCT which is showing for example, that with STIs because they’ll give you a set of antibiotics to clear up the STI but you really need to go back because they need to do another after certain time period (a week or two), they need to do a second test to check that you clear and that you’re not infectious, young people say ‘I’m not going back’. So you’re not necessarily sure that they’re clear of that STI which means then they can still spread it, you know, and it all seems to be coming back to these services – they are not friendly. If I’m going to go there and they’re going to shout at me and say: ‘oh, why did you have sex? You only 13’ or ‘Oh, this is your 4th partner’, I won’t go.
It seems our services are still judgmental. There are moralistic attitudes around sex and when you should have it and when it’s appropriate. And it’s also even more difficult for young men having sex with young men or even adult men having sex with men, women having sex with woman, you know. So I think there’s a huge problem around adolescence and sex, then it’s same-sex relationships – they also get a lot of negativity. I mean, I’ve heard stories of nurses calling other nurses to come in and look at anal warts and say: “Have you seen this?”. It’s like a deliberate humiliation and violation, not concerned about someone’s dignity and how hard it’s been for them to even come to the health service. And it means you have to really be in pain to go and seek a health service if you’re a gay man. And then also generally around sexual and reproductive health rights, another area in which the law and people are starting to write about and think about is obstetric violence. Women, birthing moms, and the treatment they get is often appalling. At an emotional level, mums are shouted at, screamed at. There seems to be some physical abuse: slapping, shouting you must breathe at this time and not breathe at that time, not bringing people pain relief, etc. There’re whole lot of abuses that actually take place around the birthing process which now people are speaking about.
So if we’re looking at the human rights framework, some of the interventions the state is trying to introduce are Public health programs like antenatal services, etc. Whereas some human rights advocates are now arguing that we should be reframing it around health justice, making it more in the human rights domain. It’s not just giving everyone contraceptives. How do you give them contraceptives? Do you listen to what their needs are? If it’s a gay man, do you sit and properly listen to what their need may be around condom use and lubricants, you know, in a dignified way, not in a giggling and ‘eish this is bad behaviors’. So we’re trying to reframe how we actually approach this issue because it is about justice and justice is fairness. It’s dignity. And for a birthing mom to have someone screaming at me when I’m in pain, that’s not dignity at all. And apparently with young woman, they will shout at you and say “oh you were so happy to open your legs and nine months ago and now you don’t want to open your legs”. There’s so many layers of it: you are in extreme pain, you’ve been treated in a humiliating way, especially if it’s a first pregnancy woman are afraid; you don’t know how this is all going to unfold. So the whole experience becomes negative and it also appears, the research is showing, that the women doesn’t know this is not what you should expect. They think “well, this is what happens to everyone, this is normal”. So women don’t actually report it or do anything, which means this cycle carries on and on and on. So they ultimately go to human rights NGOs because you’re not getting access to that termination of pregnancy – that’s also a thing. Sometimes the healthcare services just delay you. With terminations acting quickly is so important; you can’t say to someone come back in two weeks’ time because the sooner you act, the better for the woman’s health. So there’s all sorts of pressures like just pushing you downstream till suddenly you 16 or 17 weeks and now it’s a much more difficult procedure, more painful and greater risk.
So really I think my bottom line is we’ve generally got a great framework, but it’s how we implement it. That’s where we need new strategies, new approaches and much better training for healthcare workers, which helps them identify the difference between my own values (and I might believe, for religious reasons, terminations are wrong and that’s fine because that’s my choice and I don’t have to have a termination), and someone else’s. I need to respect someone else’s, another woman’s choice or another man’s, choice around this. You got to learn to distinguish between my choices, my values, and the choices, and the values on which someone else has made their choice and respect that which is at the heart of all of this. Just respect other people.
You’ve identified the police and clinics, all of which are institutions that help us to maintain and uphold and have access to all these rights. We have other institutions like the family, like the schooling system and the community. What role do they play, if any, in assisting to uphold, maintain and having access to sexual and reproductive rights particularly for adolescents and younger people which you’ve mentioned as vulnerable?
I think they’re absolutely essential. Starting at school, we have a Life Skills program and education at schools.
But the problem with that program, and this is purely from an anecdotal point of view of my two children who have finished school and so have completed that program, it’s like for my daughter there was no focus on that autonomy of ‘you make the choice’; these are your choices. So like she was in a girl’s only school and they showed them all how to use condoms. But my daughter came home and said, “why am I learning to put a condom on?” They had not taught her that it’s about you taking control. If your sexual partner doesn’t want to use a condom, you can say “I’ve got a condom. I can put it on”. They weren’t teaching young woman, I feel, how to take control which is really what we need because so much of so many problems come from inequality in relationships. We need to be empowering, especially young woman, to know It’s OK, you can make this choice or not, but you be in the centre. And we weren’t. Seemed like we weren’t. And my son at his school, he was in a Christian School, and there was much more of a focus on you just get married which doesn’t help you. That’s not something that’s going to help you make a choice. They were both using the same curriculum, but I just think there seems to be a failure around specifically not just giving people information but actually giving them skills if they’re going to protect themselves. I think maybe we misunderstand it’s actually about self-esteem. If a child has self-esteem then they protected against peer pressure and all of that. You’ve got to feel good about yourself and because I feel good about myself as a teenager, I can make choices that might not necessarily be popular, etc. So it’s most likely there’s just like too much of that public health kind of focus on use a condom, have an injection or take a pill. Not enough about how do you negotiate. How do you start the conversation with your 14 year old boyfriend? Like what do you say? What are the words?
I think the education is a bit misdirected.
And then it just seems to me that we don’t make services as accessible as they could be, because it’s schools. I mean, a school is a captive place. Kids are supposed to be there when they’re teenagers for X number of hours a day so really there should be more sexual and reproductive health services like the mobile clinic going there once a week or something, or once a month or something. You really need to be making those services so accessible. At my daughter’s, what was very enlightening, was the headmistress asking me to go through the policies. So my daughter was a day girl, but at a boarding school. So because it was a boarding school, it had a clinic at the school. So at that school they offered, the nurse offered confidentially, if you went and said I had unprotected sex on the weekend, she would give you the emergency contraceptives right there. You could be going to the clinic at the school for any reason, you could be going because you had a headache that day – it didn’t matter. And so while she was in her five years at high school there was one pregnancy in her school. That shows me that you can decide at a small level and have services right there. Those girls would have been having the same amount of sex as everyone else, you know what I mean? Let’s not kid ourselves. I think that there would have been sexually active girls there, many of them, probably most of them, but having the service has made the difference. So look at their outcomes. To me, it’s about the health outcomes and impact on those girls lives. Only one fell pregnant. They are that one step ahead of so many of their peers, you know, it means so much for women’s equality. Somehow, we’re not getting services and integrating services into something like a school health program.
And to me, you wouldn’t be stigmatized for going to the health clinic because I might be going because I’ve got a headache or I’ve got pimples or
I’ve got growing pains, you know. To me, there’s so many reasons why I could be going to the clinic, even if other people ask me I just say “well this itchy patch on my arm” or you know. It is really about trying to make services so much more accessible and then also you start good health patterns for life. Because I’m learning that I go to the clinic and it’s good and I have these things tested and then hopefully for life, I’m going to continue with that pattern as a male or a female. I’m going to have my weight checked and blood pressure, etc. and it just becomes normalized and becomes health seeking behavior.
It was very difficult for the school to actually get to the point of providing those services because a lot of the teachers didn’t want the emergency pill to be given, there was a lot of pushback with people saying they were encouraging sex and all of that. And this was some years ago now, but she said no one had actually ever gone to the clinic, in her tenure as headmistress and asked for a termination which was interesting. They asked for the emergency pill, but obviously, maybe for terminations, they went different routes. But I just thought it was a good model that the school was doing all of that and they were openly talking about and, you know, the headmaster asked me to please come and look at their policy and where they could improve, and what they should do. And they’ve taken a specific decision that they wouldn’t emphasize the criminal law. They wouldn’t say it’s an offence, but that they are just talking about your health and that’s it. But as I say, even then in that progressive environment, my feeling was that my daughter wasn’t taught about the her autonomy. So I guess there’s still so much to learn about how we can empower young people.
Speaking of emphasis on child and adolescence safety, there are a number of research programs and projects going around and parents having to consent on behalf of their child and so on. And as a researcher and as an ethicist, what should parents lookout for and what are some of the questions they should ask and anticipate to have in place when a researcher asks to do a study with their children around some of these sensitive issues?
So for me, in terms of a child rights perspective, the first thing you need to ask as a parent is: “if my child discloses information, say my child discloses that the uncle is abusing them or something like that, what is going to happen to that information? And will my child be protected? Will I be told?” Because the law doesn’t require any disclosure to the parent. So if my child is in trouble, or says I’ve got 5 sexual partners and I’m not using any contraceptives or just a range of things could be disclosed, would I want to know.
So I would want to know that at least there is going to be a service that the researcher is going to refer my child and say, look, you need contraceptive counselling. That there is a service and some link to a community service. And I think it’s also very important in the consent form for parents to look and see what ‘am I going to be told’ and what is my child going to be told because, especially some of these clinical trials like for HIV prevention, there’s probably going to be regular pregnancy testing for girls. Will that be told to you as a parent?
Would it not? Will my child be referred to termination of pregnancy services? Because sometimes for parents, that’s a deal breaker – they want to know. And they need to be no surprises so that everyone through the consent process knows.
Even if their parent is consenting to the research, the child would have right to some privacy in the study because they’ve got the right to consent to their own contraceptives from 12. So even if my parent is signing for me to be in the study, there are something’s I would have privacy rights over and that really needs to be in the consent form. So parents need to look at that and make sure they’re happy that with what is there. Yeah. So for me it would be the services, the referrals, and I think as a parent I think it’s really important that we encourage and support parent-child relationships. Children are part of families and families are part and natural, and one of the most important institutions in our society. So that for example, if it’s HIV prevention and my child tests positive, they are going to be supported to disclose to me or to another family member.
Supportive processes around things like disclosure is going to be important long term – I think it’s hard to do without support. So consider what’s going to be offered like “will my child be referred into a treatment program” and “will there be services”. So I’d be looking at child protection which is the sort of mandatory reporting stuff, something like if a teacher has been coercing my child into sex, I would want to know that that’s going to be reported. That’s going to be stated intervention. Then my child’s wellness –
if information around my child’s wellness is going to be explored, are there going to be referred to other services. And then the third is around privacy – are we all on the same page around what’s going to be disclosed, and not disclosed. I think often pregnancy is that one where a parents may want that information, but the child may not want to disclose that. So it’s a 3-way relationship between the child, the researcher and the parent. Everyone must be clear so that there are no surprises if something comes up.
You don’t want later on for the parent to come back and say “I signed a consent form, my daughter tested positive for pregnancy, you referred for termination of pregnancy and I was never told”; and being very angry with the researchers. Rather there is all that disclosure up front so the parent knows and hopefully the parent would realise that if there’s a good parent-child relationship the daughter will disclose to you anyway, hopefully. But you know, you just don’t want surprises also because of the risk of physical violence for some. In families this sort of thing happens. We must always be mindful of child welfare. You must know that the child is actually going to be OK. We don’t want them harmed by the research in any way.
To round off, are there any things that you feel the public should be aware of with regards to human rights and/or sexual and reproductive rights?
I think it’s very important to actually just contextualize this as a rights issue. Sexual and reproductive health is part of the Right to health. We need to see it that way and perhaps start to focus more on it because it’s a right, and with rights come duties. Therefore we need to see ourselves as rights holders and we need to say to the state “you need to fulfill your obligations to all of us as sexual and reproductive health beings” because these are very basic human rights which relate to our health. The fact that they are mentioned twice in the Constitution shows how important it was considered in all of the human rights that we were given in our new constitution. It really was given great prominence because it’s so significant in all of our lives; it a very important part of our health and wellbeing.
Reference:
*This dialogue is based on the transcript of the interview with Prof. Strode conducted on March 2nd, 2023. The text has been adapted for increased readability and coherence from the audio-visual recording. The full audio recording is available on the Ubusha Bami podcast, available on all streaming networks.
The 17 Sustainable Development Goals (SDGs) are possibly the most recognised initiatives of the United Nations. The SDGs, also referred to as the Global Goals, were adopted by the United Nations in 2015 as a universal strategy and action plan towards ending poverty, caring for the planet and actively working towards global peace and prosperity.
While it is widely accepted that the SDGs focus on overall universal well-being, Goals #3: Good Health and Wellbeing, focuses specifically on health on individuals across the globe. With the rise in mental illnesses and adjacent difficulties, some lifestyle induced and others environmentally triggered, this Goal is increasingly becoming an important one.
It is worth mentioning that mental illness however is not without implications and relation to the other Goals. Overall well-being requires a systematic and holistic approach. For instance, Goal #4: Quality Education, in the SDGs, is an important aspect of promoting healthy habits such as eating healthy, getting fresh air and living a low stress life – all of which have been linked with good mental health. A quality education also means a higher probability for a profession and long career, which in many instances may decrease stressors such as financial precarity, which compromise mental health.
Goal #12, Sustainable Cities and Communities, also has unexpected relations to good health and wellbeing. With billions of people migrating to cities in search of economic opportunities and other prospects, the demands on urban spaces and resources to cater for the large numbers has placed significant strain on the environment. Perhaps what has been unexpected is also the strain that the space and demands of urban life have placed on individuals. Studies in Urban Sociology show that urban and metropolitan life reconfigures the human experience, with scholars like George Simmel arguing that in the cities, people have to constantly contend with a variety and amass of stimuli which challenge who they are and how they make sense of themselves in the space. As a consequence, the external world exerts pressure on the individual, and their internal world, so much so that they are overstimulated and have to constantly differentiate between what is important and what is not in light of the many things and choices contesting for attention.
To constantly be hyper-alert, to be differentiating and making choices, can be incredibly taxing and challenging, resulting in difficulty with mental illness. In light of this, prioritizing sustainability in cities and communities offers a possibility for alleviating some of the major stressors and environmental-dangers negatively impacting the mental well-being of people in urban areas. More than this, through community building efforts and spatial redesign, more of the positive factors that increase well-being can be optimized.
It is evident from these examples that all the SDG goals can be linked to the Well-being goal. In other words, with a little bit of effort one can see how each one of the 17 SDGs is actually centered on Good Health and Well-being globally. In addition to physical wellbeing, mental wellbeing is also centered as the world becomes more complex and challenging to exist in. Mental wellbeing therefore is not on the periphery of the leading global goals, but finds itself right at the center. Afterall, a mentally well society is a prosperous society.
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Ubusha Bami futhi yimi lo – My youth and this is me! © 21 February 2023