Challenges in communication between mothers and adolescent daughters concerning sexual and reproductive health issues, Puducherry

Background: Mothers play a key role as an educator for adolescent girls especially with respect to sexual and reproductive health (SRH). However, these conversations are affected largely by the socio-cultural context and the rapport between them. Studying the communication between mother, daughter dyad would give key insights for planning interventional strategies. This study aims to explore challenges in communication between mothers and adolescent daughters regarding SRH issues and to assess mothers’ perceptions of the extent, barriers and facilitating factors influencing such communication. Methods: An exploratory mixed-methods study (Qual→QUAN) was conducted in an urban slum of Puducherry. The qualitative component included four focus group discussions (two with mothers and two with adolescent girls), analysed using an inductive thematic approach. Findings informed the development of a semi-structured questionnaire for the quantitative cross-sectional survey among 210 mothers selected through cluster sampling. Data were analyzed using descriptive statistics. Results: Four major themes of barriers emerged: maternal factors (perception that daughters are too young, embarrassment, poor knowledge), daughter-related factors (fear of disapproval and judgment), relationship issues (lack of trust, educational divide) and socio-cultural influences (restrictive norms, time constraints).While more than 90% of mothers reported talking about menstruation and sexual abuse, there was little discussion on contraception (7%), reproductive tract diseases (34%) or pregnancy. There was a significant discrepancy between perceived and real communication. Trust, friendly relationship, exposure to neighbourhood events and health worker involvement were the facilitating factors. Conclusions: Complex interpersonal and sociocultural factors influence mother-daughter communication on SRH and there are differences between perceived and actual practices. To facilitate efficient communication, interventions should concentrate on improving parental understanding, building relationships based on trust and incorporating community and health system support.