The focus of the next two lectures is on the importance of family. And how families can be supported to promote more healthy adolescent development. During adolescence, children move beyond the close containment of immediate family to engage in a wider world where peers and the community become of greater significance. As we have shown in the earlier lectures, as a result of these transitions, young people experience a far greater array of physical risks as well as emotional challenges. Young people themselves, rather than their parents, are required to negotiate a multitude of decision making points which can greatly influence their health and well being. The role of family continues to be a major protective influence on most young lives. However, young people need their families to provide much more than simply physical care as they mature. And, how is it that we assist families, as a community, to reorientate themselves around these changing needs for parenting, as children mature through adolescence. The United Nations Convention on the Rights of the Child recognises the growing maturity of adolescents to make independent choices and judgements about matters affecting them and their future. And that includes their health. In the earlier lectures, we have discussed that at times there can be tension between the special rights that legal minors have for protection versus the importance of young people having the opportunity, as they mature, to learn from the decisions that they can make about their own lives. The Convention on the Rights of the Child empowers children, in the context of their evolving capacities, and their families, to make autonomous decisions. This dovetails well with the British common law concept of the Mature Minor Doctrine, for example. In a way, the UN Convention on the Rights of the Child provides a global policy context that underpins the changing role of families across adolescence. Parents cannot be expected to appreciate the details of the UN Convention on the Rights of the Child however. And it is our role as a community, including as health care professionals to assist parents to appreciate the growing autonomy that young people have to make independent decisions about their lives, including decisions that effect their health and well being. Clinicians and health services that provide health care to adolescents also have a responsibility to engage with parents. We have a responsibility to help parents understand the changing patterns of health in young people, and the changing opportunities and responsibilities that health services themselves have to address these. We also have a responsibility to support parents to assist their children take on growing responsibilities, including around their health as they mature. And as we'll discuss in the later lectures on healthcare, health professionals have a responsibility to ensure that both parents, as well as adolescents, are informed about the legal context of health consultations with adolescents. In particular health services have a role in ensuring that parents appreciate that consulting with young people alone, for part or all of a consultation, is a strategy to enhance young people's capacity to engage more autonomously in their own healthcare as they grow up. Adolescents require safe and supportive families, safe and supportive schools, and healthy relationships with peers. However, in many countries and in many regions, the environment, including relationships between parents and adolescents, fall short of meeting adolescent's needs and protecting their rights. If we focus on sexual and reproductive health, it is apparent that in many parts of the world, parents rarely provide children information or guidance on sexual and reproductive health matters. For example, in Burkina Faso, fewer than two-fifths of girls and one-tenth of boys reported that a parent had discussed these matters with them. In India, less than 1% of youth reported that a parent had discussed reproductive processes with them. And there shown in this graphic, in many parts of the world, especially in Asia and sub-Saharan Africa, only around half of the adult population supports providing education about condoms to young people. If we look at these data which are the rights of unmet need for contraception in different parts of the world. We can see significant unmet contraception needs in 15 to 19 year old married adolescents. Imagine how much greater the unmet need for contraception will be in these same regions for unmarried sexually active adolescents. An important question is how is it that we support parents, teachers, religious leaders, and community elders to understand ways in which they can better support their children and adolescents to learn about sexual and reproductive health? Sustainable programs are sparse. And there is a need to create and test appropriate interventions in diverse sociocultural context. Staying on the theme of sexual and reproductive health, it is clear that family relationships have significant influences around adolescents' sexual behaviours. Research is very clear about what factors reduce the risk of adolescent pregnancy, shown here on the left, and what factors influence the risk of adolescent pregnancy. However, it is equally clear that family matters. There is no evidence whatsoever that parents who have honest and sensitive discussions with their children about sex increase the likelihood of early sexual activity. Indeed, the reverse is the case. Family closeness, supervision, clear values and regular communication around sexual and reproductive health are factors that are each associated with a reduced risk of adolescent pregnancy. No doubt through mediating these factors associated with reduced risk of adolescent pregnancy or greater risk of adolescent pregnancy, as shown in the upper half of this graphic. Indeed adolescents who have more sex based discussions with their mothers, than their friends are less likely to initiate sexual intercourse and more likely to have conservative values. This points to the importance of fostering good communication and comfort between parents and adolescents about sexual issues. How does this happen? Parents of younger children have a wealth of information available to them through health professionals such as maternal and child health nurses. Through parenting books and magazines. Through parents and grandparents. Through friends and increasingly through web sites. There is every expectation that new parents wish to become better informed about how to parent the young children. And there are many resources throughout the world to support novice parents. Fewer resources, however, are available to support parents of adolescents. Certainly there is no equivalent to maternal and child health nurses as a resource for parenting adolescents in most countries, even those that have a strong focus on parenting. Increasingly, the web is providing more accessible information, that is targeting parents of adolescents, especially in high income countries. One such website is the Raising Children Network. Funded by the Australian government, this evidence based parenting website was initially funded to provide web based information to parents of children up to eight years of age. Persistent advocacy was able to lift the upper age of the focus of educational material firstly to 15 years, and then to 18 years. As a centre that has significantly contributed to this website in terms of content, I can vouch for its quality. It is an evidence based site. I particularly like the coaching videos that showcase real life communication scenarios that parents face. And I would encourage you to check these out. I've listed the most commonly viewed adolescent parenting pages below. From, this is from the Raising Children Network. Interestingly, sexual health is not on this list. It is pleasing that there are a number of web-based resources that specifically target parents in support of them providing evidence-based sexuality education, including this one, answer sex education honestly, by Rutgers University. Websites such as these make quality parenting information much more accessible, including around sensitive topics, such as sexual reproductive health. It is hoped that sites like these increase the likelihood that parents are able to have more engaging and honest conversations with their children about a wide range of topics.
