The Role of Parents and Family Networks in Adolescent Health‐Seeking in Ethiopia
| Author | Mao‐Mei Liu,Challi Jira,David P. Lindstrom |
| DOI | http://doi.org/10.1111/jomf.12567 |
| Published date | 01 August 2019 |
| Date | 01 August 2019 |
D P. L Brown University
M-M L University of California∗
C J Jimma University∗∗
The Role of Parents and Family Networks in
Adolescent Health-Seeking in Ethiopia
Objective: This study examines the roles
of parents, extended kin, and exchange net-
works in adolescent health-seeking behavior
in Ethiopia.
Background: Prior studies highlight the role
of mothers in children’shealth, whereas fathers,
extended kin, and other network partners remain
largely unexamined. The gender intensication
hypothesis suggests that adolescents gravi-
tate toward same-gender parents for advice
and assistance with health-related issues. A
more expansive view of the hypothesis suggests
that other same-gender adults may also be
important sources of support.
Method: Survey data were used from a random
sample of 2,084 youth ages 13 to 17 collected
in urban and rural communities in southwest-
ern Ethiopia. Sources of advice, treatment,
and accompaniment to get treatment were
examined. Random intercept logistic regression
models were used to identify factors associated
with receipt of formal health care.
Department of Sociolgy, Maxcy Hall Box 1916, Brown
University,Providence, RI 02912
(David_Lindstrom@brown.edu).
∗Departments of Demography and Sociology, Universityof
California, Berkeley, CA.
∗∗Deceased.
Key Words: adolescent health, fathers, gender roles, health
care, parent involvement.
Results: Fathers and mothers played an
important role in all phases of adoles-
cent health-seeking behavior. Fathers’
involvement was especially common in rural
areas and more so with boys than girls.
Extended kin and exchange networks also
played a role and were even more important
for boys in female-headed households, sug-
gesting that they may have substituted for
absent fathers.
Conclusion: Adolescents rely heavily on parents
and other adults for health advice and treatment.
Who children go to for assistance is highly gen-
dered, especially in rural areas.
Implications: Studies of adolescent health-
seeking and interventions designed to improve
health services utilization need to recog-
nize the important involvement of parents
and other closely related adults in advising
youth and accompanying them to get treatment.
I
Ample research examines the role of parents
in young children’s health care. However,
there is a signicant knowledge gap in under-
standing how parents and families inuence
adolescent health and health-seeking behavior
(S. K. Harris et al., 2016; Patton et al., 2016;
Viner et al., 2012). Many studies of adolescent
health emphasize the role of mothers, reecting
the traditional gendered role specialization
of women in family health, and the primacy
830 Journal of Marriage and Family 81 (August 2019): 830–846
DOI:10.1111/jomf.12567
Role of Parents in Adolescent Health-Seeking 831
that scholars and practitioners have histori-
cally given to reproductive, maternal, and child
health (Aboud, Singla, Nahil, & Borisova,
2013; Aboud & Yousafzai, 2015; Bhutta et al.,
2013; Black et al., 2013; Glasier, Gülmezoglu,
Schmid, Moreno, & Van Look, 2006; Van Ler-
berghe, Manuel, Matthews, & Cathy, 2005).
Consequently, many interventions designed to
improve children and adolescents’ health target
mothers and ignore the role of fathers. The
mothering bias is evident in recent reviews of
parenting and child well-being research that give
little attention to the role of fathers (Armstrong,
Birnie-Lefcovitch, & Ungar, 2005). Neverthe-
less, scholarly interest in fatherhood (Lamb,
2004; Marsiglio, Amato, Day, & Lamb, 2000)
and in the role of fathers in child and adolescent
health and well-being is growing, particularly
in high-income countries (Bögels & Phares,
2008; Carlson, 2006; Carr & Springer, 2010;
Guilamo-Ramos et al., 2012; K. M. Harris,
Furstenberg, & Marmer, 1998; Panter-Brick
et al., 2014; Shulman & Seiffge-Krenke, 2015).
The limited evidence suggests that father’s
involvement is associated with adolescent
well-being (Flouri & Buchanan, 2003a), and
early involvement is protective of children’s
subsequent mental health in adolescence and
adulthood (Flouri & Buchanan, 2003b). In this
article, we examine the role of mothers and
fathers in adolescent health-seeking behav-
ior in a random sample of 13- to 17-year-old
youth in southwestern Ethiopia. We extend
the gender intensication hypothesis, with its
emphasis on the parent–child dyad, to include
the potential involvement of other adults in the
provision of support and guidance in adolescent
health-seeking behavior. Because adolescents
are not fully independent of adult support,
understanding the role of fathers as well as that
of mothers is critical for developing effective
outreach programs that improve adolescent com-
munication about health needs and increase their
utilization of healthcare services. Bringing other
adults into the picture is also important, espe-
cially for households headed by women where
male kin and other network partners may ll in
for absent fathers. Studies and interventions that
focus solely on the parent–child relationship will
miss the broader household and network con-
texts within which adolescent socialization and
support occur.
B T
Research in sub-Saharan Africa on parental
involvement in adolescent health and health-
seeking behavior is primarily focused on behav-
ioral monitoring and communication with
respect to sexual activity and reproductive
health (Babalola, Tambashe, & Vondrasek,
2005; Biddlecom, Awusabo-Asare, & Bankole,
2009; Dimbuene & Defo, 2011; Kumi-Kyereme,
Awusabo-Asare, Biddlecom, & Tanle, 2007;
Ngom, Magadi, & Owuor, 2003). In general,
the research nds that mothers and fathers tend
to have distinct roles, with mothers serving as
a source of advice and information, and fathers
taking on a disciplinarian and authoritarian role
(Ngom et al., 2003). Research on the utilization
of reproductive health services consistently
nds that youth are not comfortable accessing
services with their parents and that issues of
condentiality and privacy are a primary bar-
rier to service utilization (Berhane, Berhane,
& Fantahun, 2005; Motuma, Syre, Egata, &
Kenay, 2016; Tegegn & Gelaw, 2009). Even so,
many studies nd that youth express a strong
preference for receiving sexual and reproductive
health information from their parents (Dit-
tus, 2016). However, little is known about the
role of parents in adolescent health-seeking in
general, and especially in sub-Saharan Africa.
In contrast, there is well-developed literature
on parent–child relationship dynamics during
adolescence in the United States and other
high-income countries. In particular, there is
considerable research on the differences in how
mothers, fathers, daughters, and sons relate to
one another during adolescence. The gender
intensication hypothesis argues that as chil-
dren transition into adolescence, parents take
on greater responsibility in socializing their
children into gender-typed roles and behaviors
(Hill & Lynch, 1983; Laursen & Collins, 2009;
McHale, Crouter, & Tucker, 1999; Updegraff,
McHale, & Crouter, 1996). In this process,
fathers draw closer to their sons and mothers to
their daughters (Collins & Russell, 1991). The
intensication of gender socialization arises
from social pressures for adolescents and young
adults to conform to gender norms and social
expectations regarding mothers’ and fathers’
responsibilities for socializing children into
gender-specic adult roles (Crouter, Manke, &
McHale, 1995). Mothers’ and fathers’ experi-
ences as women and men may also make them
better suited to socialize their same-gender
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