Bartholomew, Parcel, Kok, and Gottlieb (2006), indicated that a rights-based method aids the needs of young people by involving them, thereby making policies and programs more effective and sustainable. This kind of method provides the framework for meeting the actual sexual and reproductive health needs of young people, and not just as perceived by adults.
Glacier (2006) restates that beyond the provision of infrastructure and services, adolescents have yet another need, in this case, the right to knowledge, access to services and above all, autonomy over their body and behavioral choices. In several societies, according to Carovano (1992), there is a culture of silence that surrounds sex and dictates that 'good' girls are anticipated to be oblivious about sex and unreceptive in sexual interactions. This makes it problematic for girls to be knowledgeable about sex risk reduction, or even when informed, makes it challenging for them to be taking the initiative in negotiating safer sex. Correspondingly, in cultures where virginity is highly valued, studies have shown that some adolescent girls practice unconventional sexual behaviors, such as anal sex, in order to preserve their virginity, although these behaviors may place them at high risk of HIV (Weiss, Whelan & Rao Gupta 2000; Awusabo-Asare, Abane & Kumi-Kyereme, 2004). Yet again, because ofthe strong customs of virginity and the culture of silence that surrounds sex and sex education, accessing family planning services can be highly stigmatizing for adolescents (UNAIDS 1999; Weiss et al, 2000).
Knowledge of sex education and sexuality are the foremost anxiety of the adolescent period, to a certain extent because earlier sexual maturation and later marriage have increased the period of risk for early or non-marital pregnancy and exposure to STis in young adolescents. Sexual affairs typically occur before adolescents gain experience and adequate information about sex education and sexuality and before they can even get access to health services and supplies such as condoms. By age 18, more than two-fifths of females (44 percent) and 26 percent of males had had sexual intercourse (Nabila & Fayorsey, 1996; Ghana Statistical Service (GSS), Ghana Health Service (GHS) & ICF Macro, 2008).
The above matters make it imperative for a conceptual framework to be established that would encapsulate all the determinants being that of political/policy factors, institutional, social and individual factors to deepen understanding on adolescents' knowledge and awareness of sexual-related educational issues and sexuality, and how these factors create barriers or enhance the adolescent in the acquisition of sex education and sexuality-related matters.
The Conceptual Framework
The international political environment, institutional, social and individual factors determine the outcomes for sexuality and sex education per the framework above (Figure 1). These policies, institutional structures and social dynamics seem to create conflicting purposes that negatively or positively affect the sex educational awareness and knowledge of adolescents (Wouhabe, 2007). Individual factors are relatively or wholly developed by the institutional, social and policy frameworks in a country or the community the adolescents found themselves. So for adolescents to be critically informed about their sexuality and sex perspective a comprehensive approach in education on sex is required and the policy factors, institutional factors and social factors are to be designed to free the individuals from their prejudices on sex education and sexuality in general. In the case of Ghana, an Adolescent Reproductive Health Policy is in position, but in practice, many organizations put emphasis on abstinence until marriage. This is regardless of demand from an estimated 22 to 27 percent of young people who want to use family planning but are unable because they cannot easily obtain contraceptive services (GSS et al, 2008). Adolescents often do not know where to go for impartial advice and sex education, and even there are less number of teen-friendly clinics providing these services is limited, especially outside the main cities.
The Concepts of the Conceptual Framework
Political/Policy Factors:
Sexual and reproductive health rights, expressly, were first officially documented at the International Conference on Population and Development (ICPD) in Cairo in 1994. Erstwhile to this documentation, reproductive health programming had focused on family planning, fertility control and safe motherhood, having emerged from concerns about population control but less emphasis on sex education. Family planning programs were the central focus and that is based on the idea that the state control of birth is a social good with its focus skewed towards adults, principally married couples and no position at all on adolescents. Though, the focus of sexual and reproductive health granted in Cairo claimed to move beyond family planning and adults: This included rights to sexual health, and centering not only on problems and diseases but on what should be positive experiences around pregnancy, parenthood, sexuality, and relationships (United Nations, 1994; Boraiah & Yeliyur, 2013; Venkat & Navya, 2013; Wouhabe, 2007; Davis et al., 1997; Weaver et al., 2002). Apart from the international treaties not catering for the sex educational needs of young adolescents; country-specific laws, customs, and practices affect adolescents differently than adults. They often restrict access of adolescents to sex education and reproductive health information and to a large extent reproductive health services especially when the young adolescents are not married. Some laws even reprimand young adolescents who responsibly seek such sex education and reproductive health services. Besides, even when reproductive health services do exist, provider attitudes towards adolescents seeking sex education and understanding of reproductive health services are seen as having sex already and for that often pose a significant barrier to use of those services (Finkelhor, 1995; Benzaken et al., 2011; Nair et al., 2012; Vashishtha & Rajshree, 2012).
The Conceptual Framework Diagram Independent Variables Dependent Variable I
Political/Policy
Factors:
International (Charters/Conventions/T realities)
local (Constitution/Acts/laws)
Social Factors:
Parent/Family Sexual Partners Peers
Organized Youth groups
InstitutionalFactors:
Media (Radio, lV, Internet)
Religious Agencies Community norms and rules
The Health stems
Economic conditions
IIndividualFactors
Age & Sex
Educational attainment
Religious affiliation
Sex Educ. outcome
Knowledge and awareness of sexuality and sex behaviors
Sexual Risk Perception and Assessment
Self-efficacy and Self-esteem
Knowledge of sources of Sex information and services
Figure 1: Conceptual Framework on awareness of sex education among adolescents (Author's own construction based on empirical and theoretical literature: Benzaken et al., 2011; Nair et al., 2012; Vashishtha & Rajshree, 2012; More, 2012; Boraiah & Yeliyur, 2013; Venkat & Navya, 2013; Wouhabe, 2007; Davis et al., 1997; Weaver et al., 2002; Sangole et al., 2003; Valimont, 2005; Suzuki & Hiraoka, 2007; Kohler et al., 2008; Eisenberg et al., 2008; Frimpong, 2010; Tobey et al., 2011; Adebayo & Exilder, 2014; Akpama, 2013; Adebayo & Silver, 2014)
Social and Institutional Factors
The explanatory or independent variables that is societal, institutional and political factors do impact the individual factors consisting of age and sex of the adolescent, as well as others within the young adolescent's volitional control such as religious affiliation, educational attainment, etc. become central to the sexual behavioral outcomes and sex information gamed by the adolescents to make sex decisions (Eisenberg et al., 2008; Frimpong, 2010; Tobey et al., 2011; Adebayo & Exilder, 2014; Akpama, 2013; Adebayo & Exilder, 2014).
In their study on Comprehensive and age-appropriate sexuality education: The need to address sexuality in schools, Boraiah and Yeliyur (2013), found that the sex knowledge level is poor among the students and the students requested that Sexuality Education be included in the school curricula. Teachers and Parents have also displayed their predisposition toward introducing Sexuality Education. On the other hand, Mahajan and Sharma (2005) studied Parents' attitudes toward sex education to their young adolescent girls. They found that the rural parents of young adolescent girls do not feel that it was necessary to impart sex education to their young adolescent girls whereas almost all the urban parents were in favor of providing sex education to their young adolescent girls.
Individual Factors
On Adolescent children's parental attitude towards sex education, Angadi (2011), establish that mothers of the young adolescent girl respondents were reluctant to talk about sex education to their daughters as they found it uncomfortable to discuss these subjects. Mostly, they avoid any reference to sex in their day-to-day relationships with their daughters, especially in rural areas. - A pilot study on Need assessment for sex education amongst university students, Kumar (2007), showed that 95% of students were in favor of mainstreaming sex education. The other 76.74% of students chose the teacher as the best source to provide sex education. Students favored grade levels to begin sex education curriculum containing information on sexual body changes during growth, contraceptives and sexually transmitted diseases and preventive measures. The majority of students received sex information from informal sources and they were not pleased with their knowledge on sex education. The majority of them support the implementation of sex education in educational institutes.
More (2012), in his study on the attitude of youths toward Sex Education, established that the attitude of youths was very high toward sex education. It concluded that attitudes of male and female youths were the same towards sex education. The study also showed the attitudes of male youths of rural and urban areas was not the same. The mean of both shows that the urban areas' male youth's attitude towards sex education and sexuality was very high and the rural areas' male youths' attitude was modest. The attitude of female youths of rural and urban areas was also dissimilar. The mean of both shows that the urban areas female youth's attitude towards sex education and sexuality was very high and the rural areas female youths' attitude was moderate. The result further revealed that there were significant differences in the attitude of rural and urban areas males and females attitude towards sex education and sexuality.
Suzuki and Hiraoka (2007), studied Attitudes towards sexuality among high school students m Japan, they found that the boys showed fears about a physiological aspect of sex, but the greater part of their questions communicated concern in sexual activity. Moreover, to physiological and psychological apprehensions, the girls' problem for the majority concerned with associating with the opposite sex. Unambiguously, almost all examples of this type of question from the girls referred to their mixed feeling about sexual activity; they were afraid of pregnancy but engaging in sexual activities anyway deference to their boyfriends' wants.
Akande & Akande (2007), in their study on Knowledge and Perception of Sexuality Education among Students of a Rural Secondary School in Kwara State, Nigeria, showed that awareness of sex education were higher (72. 3%) among the respondents through a casual approach. Many of the respondents, therefore, liked a formal sex education program included in the post-primary school curriculum. This study confirmed that 70% of the respondent aged between 10-18 years had under no circumstances discussed sex with their parents. However, 54.5% of the older respondents aged above 18 years had discoursed sex with their parents. All respondents approved that sex education be introduced and made mandatory in schools.
References
Angadi, G. R. (2011). Adolescents' children's parental attitude towards sex education. International Referred Research Journal, III (25).
Akande, A.A. & Akande, T.M. (2007). Knowledge and Perception of Sexuality Education among Students of a Rural Secondary School in Kwara State, Nigeria. Nigerian Medical Practitioner, 52 (3), 55-59.
Benzaken, T., Palep, A.H. & Gill, P.S. (2011). Exposure to and opinions towards sex education among adolescent students in Mumbai: A cross-sectional survey. BCM Public Health, 11:805.
Borah, J. & Yeliyur, S. (2013) Comprehensive and age-appropriate sexuality education: The need to address sexuality in schools. International Monthly Referred Journal of Research in Management & Technology 2.
Davis, P., Denman, S. & Pearson, J. (1997). A survey of attitudes to sex education among secondary school governors in Nottinghamshire. Health Education Journal, 56 (3), 231-240.
More, C.B. (2012). Study The Attitude Of Youths Towards Sex Education. Indian Streams Research Journal, 2 (7).
Nair, M.K., Leena, M.L., Paul, M.K., Pillai, H.V., Babu, G., Ruseell, P.S. & Thankachi, Y. (2012). An attitude of parents and teachers towards adolescent reproductive and sexual health education. Indian Journal of Pediatrics; Jan 2012.
Sangole, S., Tandale, B.V., Badge, P.S., & Thorat, D.M. (2003). Evaluation of the impact of health education regarding HIVIAIDS on knowledge and attitude among persons living with HIV. Indian Journal of Community Medicine, XXVIII (1).
Suzui, E. & Hiraoka, A. (2007). Attitudes towards sexuality among high school students m Japan. Kawasaki Journal of Medical Welfare. 12 (2), 89-96
Vashishtha, K.C. & Rajshree (2012) A study on attitude towards sex education as perceived by parents and teachers. Sawada- e-journal, 1 (2).
Weaver, A.D., Byers, E.S., Sears, H.E., Cohen, J.N., & Randall, E.S (2002). Sexual health education at school and at home: Attitudes and experiences of New Brunswick parents. The Canadian Journal of Human Sexuality, 11 (1).
Wouhabe, M. (2007). Sexual behavior, knowledge, and awareness of related reproductive health issues among single youth in Ethiopia. African Journal of Reproductive Health, 11(1), 15-27.
Valimont, A. S. (2005). The Effectiveness of Sex Education Programs in Virginia Schools. Unpublished dissertation in Master of Science in Sociology, Virginia Polytechnic Institute and State University.
Venkat, L.H. & Navya S. (2013). The attitude of Parents of Mild and Moderate Intellectually Challenged Children towards Imparting Sexual Health Education. International Research Journal of Social Science 2 (12), 1-5.