Family-focused policies can strengthen adolescent health – in Uganda and beyond

Despite decades of progress in adolescent health in sub-Saharan Africa, policies concerning sexual and reproductive health remain fragmented and weakly connected to families. Parents and caregivers are often left without the tools to communicate effectively about these matters. By strengthening parental engagement from early childhood through adolescence, national policies can build more resilient systems that promote adolescent health, gender equity and intergenerational trust.

Viola N Nyakato, Dorcus Achen, James Oloo, Daniel Atwine, Harriet R Kagoya Kibuule, Ian Tuhumwire, Vivienne Kirabo, Nicholas Mwine, Caroline Birungi, Monica Natukunda, Olivia Clare Kiconco, and Rachel Beyagira

Sexuality education is vital to adolescent health, yet implementation remains fragmented and uneven across the globe. In sub-Saharan Africa, most programmes are school-based and externally driven External link, opens in new window., with limited parental involvement, leaving a critical gap in family-led communication and support for adolescent sexual and reproductive health (SRH). Responding to this gap, and in line with the African Union’s Continental Strategy on Adolescent Health External link, opens in new window. (2019–2030), Africa Health Strategy External link, opens in new window. (2016–2030) and Agenda 2063 External link, opens in new window., this brief advances evidence for a life-course model that strengthens parental engagement from early childhood through adolescence.

Family, media and school – roles and gaps

In many African contexts, SRH education has traditionally been the role of paternal aunts and uncles External link, opens in new window., rather than parents. Today, shifting realities – such as advocacy for girls’ education, the need to prevent gender-based violence, and the rise of nuclear families – demand stronger parental involvement. Although both parents and adolescents want open conversations on SRH, many lack the skills and confidence External link, opens in new window. required. Research shows that adolescents in Uganda and similar sub-Saharan African settings access SRH information from multiple sources. Among these, social and mass media channels – such as television, radio and newspapers External link, opens in new window. – are the most influential, followed by peers and schools. Yet media content is often highly sexualised, unregulated and misleading External link, opens in new window..

While schools offer structured sexuality education through Sexuality Education (SE) programmes, in the absence of reinforcement at home the effectiveness of these interventions is limited. A 2019 process evaluation External link, opens in new window. of an SE intervention implemented in Uganda among young adolescents attending school concluded that while school-based interventions improved knowledge, their impact on behaviour and communication was constrained by limited parental involvement and weak community linkages. The evaluation highlighted the fact that, without reinforcement of SRH messages at home, adolescents lacked consistent guidance and supportive dialogue to translate knowledge into practice. Many families lack the knowledge, the skills and the emotionally supportive environment necessary for sustained and open dialogue on SRH issues. This gap in family-based communication becomes even more critical during periods of crisis, such as the Covid-19 pandemic External link, opens in new window. or displacement External link, opens in new window., when schools may be inaccessible and families become the primary source of guidance and protection.

Six barriers to parent–child SRH dialogue

The research review, upon which this policy note is based, identifies six recurring barriers that undermine effective SRH communication within families:

1. Neglect of boys and restrictive masculinity norms
   Cultural expectations around masculinity External link, opens in new window. restrict dialogue between caregivers and boys, leading to emotional neglect and limited SRH guidance.
2. Shame-based messaging directed at girls
   Patriarchal control and moral regulation External link, opens in new window. shape restrictive and moralistic messages toward girls.
3. The breakdown of traditional family roles
   Social change and urbanisation External link, opens in new window. have weakened traditional mentorship roles (once held by extended family members) in SRH education, increasing the need for parental re-engagement.
4. Lack of emotional safety and trust at home
   Parent–child communication is often inhibited by authoritarian parenting styles and cultural taboos External link, opens in new window., leaving adolescents uncomfortable and mistrustful when discussing SRH issues with their caregivers.
5. Weak support for school-based SRH education
   Without parental reinforcement External link, opens in new window., lessons from SE at school rarely translate into behavioural change at home.
6. Parental stress during crises hinders SRH dialogue
   Emergencies weaken communal and family support structures External link, opens in new window., diminishing parents’ capacity to sustain SRH communication.

Despite strong evidence that parental involvement plays a protective role in adolescent SRH outcomes, adolescents rarely identify their parents (especially fathers) as a primary source of SRH information. This was, for example, shown in a study conducted in rural south-western Uganda External link, opens in new window.. The study, which used focus-group discussions, in-depth interviews and community stakeholder meetings with the parents and caregivers of adolescents aged 10–14, explored how gender norms shape communication about SRH within families. The findings show that parent–adolescent SRH communication is limited, irregular and often reactive, taking place mainly after a problem arises. Fathers are rarely involved, as cultural norms assign these discussions to mothers or female relatives. When communication occurs, it is often framed by fear or moral warnings, rather than open dialogue. Many parents say they have low confidence and limited knowledge to address SRH topics effectively.

This and similar evidence consistently demonstrates that effective adolescent SRH outcomes depend on trust-based, gender-sensitive and family-centred communication. However, entrenched gender norms, weakened family structures and limited parental capacity continue to restrict meaningful dialogue. Addressing these barriers through training, policy integration and cross-sectoral collaboration is essential for sustaining adolescent health gains.

The life-course approach

In many African countries External link, opens in new window., parenting and child health policies place a heavy emphasis on early childhood (age 0–5), but pay little attention to adolescents. This reflects a broader global trend External link, opens in new window. in which investments in child health development taper off before adolescence, resulting in weak continuity between early childhood care and adolescent health programmes. Existing frameworks lack age-specific SRH content for adolescents aged 10–19, overlook the emotional and mental health dimensions of development, and offer few mechanisms for linking early childhood and adolescent programmes. This fragmentation leaves parents and caregivers without structured guidance to sustain SRH communication across the developmental spectrum.

Research shows that beliefs and behaviour related to sexual safety, gender norms, body image and emotional expression begin forming well before adolescence. For example, a study from 2018 External link, opens in new window. observed that gender-equitable attitudes tend to decline with age. The study surveyed over a thousand adolescents aged 10–14 in south-western Uganda to assess their body image, self-esteem and gender-equitable norms. Using structured questionnaires and validated psychometric scales, the researchers found that – even at this early age – young adolescents already hold defined beliefs and attitudes related to gender roles, body image and emotional well-being – all factors that shape later sexual and reproductive behaviour. The study observed that gender-equitable attitudes tended to decline with age.

When SRH communication starts only at puberty, it tends to be reactive, inconsistent and disconnected from family support systems. A life-course approach helps close this gap by providing an integrated framework that positions parents and caregivers as the primary, formative actors in shaping SRH understanding from birth through adolescence.

A guide designed for health workers

To help put this approach into practice, the Helping Parents Lead guide has been developed and is currently being piloted. It is grounded in the life-course perspective and organised into five SRH-relevant developmental stages: birth to 2 years (foundation of trust and care), 3 to 5 years (awareness and body safety), 6 to 9 years (values formation and respect), 10 to 14 years (puberty and identity development) and 15 to 19 years (decision making and relationships). The guide offers a structured, stage-specific pathway that connects developmental milestones with culturally and contextually appropriate SRH communication strategies.

Designed primarily for health workers and service providers who are at the frontline of community engagement, the guide serves as a tool for training parents and caregivers. It equips them to foster trust, reinforce protective behaviours and promote open family dialogue on SRH and well-being. Using a life-course approach, the guide connects early childhood nurturing and adolescent health, ensuring consistent guidance that is both evidence-based and age-appropriate.

Integrating this model into national parenting and adolescent health strategies can shift the focus from fragmented, school-based interventions to sustained, family-led SRH education, strengthening communication and shared responsibility across generations.

Multidimensional benefits

Strengthening communication between parents and their adolescent children yields sustained benefits, not only for the health of the latter, but also for the entire family. Evidence shows that when parents are empowered as primary SRH educators, the positive outcomes extend beyond individual behaviour change to strengthen family cohesion, promote gender equity and foster intergenerational trust.

• Benefits for adolescents. The adolescents get help to make informed choices. Improved dialogue also promotes early health-seeking behaviour and supports preventive practices, such as human papillomavirus (HPV) vaccination, menstrual hygiene, voluntary medical male circumcision and prevention of sexually transmitted infection. Consistent communication also fosters emotional security, personal safety, positive body image, resilience and confidence.
• Benefits for parents, caregivers and families. Parents gain confidence, empathy and stronger relationships with their children. SRH discussions deepen their understanding of adolescent development and promote shared values, mutual respect, equity and protection. Such discussions also position them as a reliable source of guidance and support, especially during times of crisis.

Policy recommendations

While the policy recommendations have specific elements for Uganda’s policy makers, they have overarching implications for the context of sub-Saharan Africa. We recommend the following actions:

• Review the strategies. Review Uganda’s Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) Sharpened Plan strategies on adolescent health to formally recognise and promote parent–child SRH communication as a foundational element in adolescent well-being. This includes embedding a life-course perspective that begins in early childhood and extends through adolescence.
• Train the health workers. Provide comprehensive pre-service and in-service training for health workers and service providers on how to use the Helping Parents Lead guide and support caregivers in initiating and sustaining SRH communication with their children.
• Intergrate communication training in health and support programmes. Integrate SRH communication training into existing parenting-support curricula, community health outreach and school health programmes to ensure widespread, context-sensitive delivery of messages across multiple touchpoints.
• Improve through regular feedback. Establish mechanisms for adaptive learning through regular feedback from parents, adolescents and frontline service providers, especially in refugee and host communities, to continuously improve training materials and delivery.
• Partner up with community groups and align with local values. Promote inter-ministerial engagements and partnerships with development agencies, community-based organisations and faith groups, to deliver coherent, culturally appropriate SRH messaging aligned with national development goals and local values.

Sources

This policy note is based on a desk review of 32 peer-reviewed articles from previous collaborative research projects funded by VLIRUOS External link, opens in new window., an agency under the Flemish Universities and Higher Education Council that funds scholarships and university partnerships between Flanders and institutions in Africa, Latin America and Asia for sustainable development. The project focused on adolescent sexual and reproductive health in sub-Saharan Africa, with particular emphasis on Uganda. The review was conducted in collaboration with civil society organisations, government agencies and research institutions. It forms part of the Addressing Neglected Areas of Sexual and Reproductive Health and Rights in sub-Saharan Africa (ANeSA External link, opens in new window.) initiative – grant No. 110714, supported by Canada’s International Development Research Centre, Global Affairs Canada and the Canadian Institutes of Health Research. The study also reviewed national policy documents on early childhood development, community-based resource persons and parenting guidelines.