Attitudes and behaviours of young Indigenous people in Townsville concerning relationships, sex and contraception: the “U Mob Yarn Up” project

Adolescence is a time when many young people experiment and start to engage in sexual activity. Individual psychological factors,1,2 peer norms,3 family structure,4 neighbourhood factors,5 poverty, school engagement6 and cultural values about sexuality may all exert powerful influences on a teenager’s decisions (or absence of decisions) about sex.7

The high teenage fertility rate among Indigenous women of 69 per 1000 is more than four times the rate among all Australian teenage women;8 20.2% of pregnant women seen at the Mums and Babies section of Townsville Aboriginal and Islander Health Services are teenagers.9 Indigenous young people are considered a priority group for sexually transmitted infection (STI) strategies10 and teenage pregnancy programs,11 and have lower rates of contraceptive use than non-Indigenous young people.12 Indigenous adolescents deal with youth transitions and sexual maturation in a society that is often hostile,13 facing socioeconomic and educational disadvantage while working through tasks integral to forming their Indigenous cultural identity.14 Relations between males and females, and family and cultural norms for sexual behaviour may be different in Indigenous communities compared with non-Indigenous communities, and a pattern of earlier transitions and parenthood may be encouraged.15

Understanding the attitudes and behaviours of young people concerning relationships, contraception and safe sex, together with broader views about aspirations and parenthood, is integral to understanding factors around teenage pregnancy.

The Townsville region of Queensland has a large Indigenous population of 16 750 (5.2% of the population);16 70% of these are Aboriginal and 30% are Torres Strait Islander people. We aimed to gain a broad, contextual understanding of the attitudes of Indigenous teenagers in Townsville to pregnancy and parenthood, and the relationships between attitudes, behaviours and outcomes. We report data collected from non-pregnant Indigenous teenagers in three high schools and a homeless youth shelter.

We chose a mixed-methods study design with an inductive qualitative approach. Data collection involved a computer-assisted self-interview (CASI) and focus group interviews. The innovative consultative methods of the project are outlined in Box 1. Briefly, a Young Mums’ Group operating on a participatory action model17,18 served to design the project, and act as key participants and peer interviewers, and as a social support group.

Data were obtained between 27 April and 8 December 2004 from CASI surveys and focus group discussions with Indigenous Year 9–11 students at the three public high schools in Townsville with the highest enrolments of Indigenous students (although Year 12 students were included at one school at the request of students, staff and parents), and Indigenous residents of a homeless youth shelter. The laptop-based CASI, originally designed with input from other surveys,19-21 used appealing multimedia technology to ask questions about home, school, general health and substance use, relationships, sex and contraception, and attitudes towards childbearing. Participants completed the CASI in privacy, but with a peer interviewer ready to assist. Focus group discussions, facilitated by an Indigenous and a non-Indigenous researcher, covered similar areas. These were held with a subgroup of survey participants in single-sex friendship groups, chosen according to principles of theoretical sampling.22 Focus group sessions were audiotaped and transcribed in full. Consent was obtained from participants and their parents for high school students, and from participants alone for youth shelter residents.

The project received ethical approval from the James Cook University Human Research Ethics Committee, Education Queensland, and the Townsville Aboriginal and Islander Health Services Board of Directors.

Quantitative data were analysed with univariate descriptive measures and t tests or χ2 tests (with continuity correction) using SPSS version 11.0 for Windows (SPSS Inc, Chicago, Ill, USA). A two-tailed P value of less than 0.05 was considered significant. Qualitative data were managed within NVivo qualitative data analysis software (version 1.0; QSR International, Melbourne, Vic) and analysed thematically using inductive methods based on grounded theory.23 Triangulation, respondent validation and exploration of deviant cases were all used to strengthen our findings.22

Overall, 186 completed CASI surveys were received; 171 from the three high schools and 15 from the homeless youth shelter. There were few missing data for most variables. Uncertainty about the number of eligible Aboriginal or Torres Strait Islander students attending schools made it difficult to accurately calculate response rates. Estimated response rates for each school are listed in Box 2. We compared respondents with non-respondents at each school in terms of Year level and sex, and found no significant differences.

Eleven focus group discussions were held at the three schools; nine had between four and eight participants while two were small groups of two at the request of participants. Fifty-nine students participated in focus group discussions — 41 girls (in 8 groups) and 18 boys (in 3 groups). No focus group discussions were held at the youth shelter for logistical reasons.

One hundred survey participants (53.8%) were female, and 86 (46.2%) were male. The age range was 12–18 years (mean, 14.91 years; SD, 1.13). However, 66.3% were aged 14 or 15 years, reflecting lower Indigenous senior high school retention rates.24,25 Almost 56% of participants were identified as Aboriginal, with smaller groups identified as Torres Strait Islander (17.8%), Aboriginal and Torres Strait Islander (20.0%) and South Sea Islander (3.8%). South Sea Islanders were included at the request of students and parents, and did not differ significantly from other participants in terms of age or ethnicity by sex.

Although few in number, youth shelter participants were significantly younger (P = 0.004), more likely to use marijuana (9/15; P = 0.000) and to be unhappy with their lives (P = 0.000) than school students, and were disengaged from regular formal schooling. Despite their younger age, a larger proportion were sexually active (11/15; P = 0.051), with a tendency to have experienced more unwanted sexual touching (6/14), and fewer had used condoms at first sexual intercourse.

We present a “snapshot” of the attitudes and behaviours of young Indigenous people in Townsville concerning relationships, sex and contraceptive use, providing a contextual understanding of the transition to sexual adulthood for this population.

The 46% of our sample reporting sexual intercourse and inconsistent condom use is comparable to studies involving other groups of Australian young people.26-28 For example, a national survey of 2388 students found that 25% reported having had sexual intercourse by Year 10, and just over half by Year 12.26 Less information is available about the sexual behaviour of Indigenous young people. The large Western Australian Aboriginal Child Health Survey found that 74.5% of Aboriginal 17-year-olds reported having had sexual intercourse, and for 48.6% this occurred before the age of 16 years. Independent associations with having had sex were age, having left school, drinking alcohol and using marijuana.12 The slightly lower rates of sexual activity we found probably reflect our largely school-based, urban sample.

Young women were mostly concerned by unwanted pregnancy and damage to their reputations as consequences of sexual activity. The low salience of the risk of STIs for participants may represent underdiagnosis, or may be an accurate representation of prevalence in this population,29 but both this and the relatively large proportion of Indigenous adolescents reporting a gay or lesbian orientation warrant further exploration.

Young people’s knowledge about safe sex and birth control was variable, and 60% of sexually active participants reported always using condoms. The limiting factor in condom use seemed to be shame, in terms of bringing up the issue and negotiating condom use at the onset of a sexual relationship. That young womens’ reputations were at risk if they carried a condom or suggested its use encouraged sexual risk behaviour. This finding has been previously reported30,31 and poses challenges for sex education.

A strength of our project was that it was designed by a group of young Indigenous people within an Aboriginal medical service, ensuring that it was relevant to young peoples’ needs and well accepted by the community. Information was gathered through innovative, youth-friendly methods with peer interviewers. A disadvantage was that, like all cross-sectional descriptive studies, we report self-reported rather than actual behaviours of young people. We were also not able to measure changes in their self-reported behaviour over time. High student absenteeism meant that our response rates may be underestimates. This sample is not representative, and our findings are not generalisable, but our study does offer a unique insight into the attitudes and behaviours of a group of understudied regional Indigenous teenagers, and is likely to be relevant in work with similar groups elsewhere.

Indigenous teenagers, like other teenagers, are experimenting with sex, but not practising safe sex reliably. They need access to comprehensive information about sex, relationships, contraception and infections in a safe, shame-free environment.11,15

Poverty, family dysfunction and educational disadvantage for young Indigenous people may combine to make the consequences of early sexual initiation or pregnancy less cogent, especially for those disengaged from schooling. We cannot assume that early parenthood is “natural” for Indigenous young people, and they must have access to the same opportunities and reproductive rights as other young Australians.15

Targeted school-based programs in small, single-sex groups might be a good way to reach Indigenous students, but alternative approaches must be found to reach those who have disengaged from the education system. Programs must focus broadly on communication, relations between males and females, and healthy sexual relationships, in addition to diseases and pregnancy, to help young Indigenous people create more egalitarian and thus safer sexual relationships.

1 “U Mob Yarn Up*” project structure

* Local Indigenous slang for “let’s talk about it” and the name chosen by participants for the project. CASI = computer-assisted self-interview.