Adolescent love and romantic relationships
Making sense of their experiences, the participants in this study revealed how they sought love. They had also looked elsewhere for satisfying relationships and thinking that they had found love, their behaviours with their partners involved sexual intimacy. The experiences of seeking love and romantic relationships identified in the current study were broadly consistent with developmental theories [48, 49]. Previous studies on adolescent love and romantic relationships have found that those in middle to late adolescence worry about maintaining and sustaining relationships and intimacy levels, and emotional investment, skills and commitment in romantic experiences increase across all developmental stages of adolescence .
Adolescent romantic relationships can not only improve growth, resilience, and happiness, but can also constitute sexual development which is an important part of growing to adulthood . Most participants believed that having boyfriend or girlfriend can enhance one’s confidence. They were also happier in themselves with the support, trust, and closeness found in their romantic relationship. Similarly, qualities of adolescent romantic relationships can influence positive mental health development into adulthood . This mirrors findings of the link between supportive partners and increased mental health development.
Romantic relationships are an important aspect of individual development and socialisation, especially in adolescence . Through romantic relationships, individuals learn intimacy and crucial interpersonal skills. Romantic relationships can play a positive role in adolescent development , including psychological development [52, 53].
Adolescents commonly experience their first romantic relationships and may experience overpowering emotions associated with falling in love, which can lead to having sexual relationships despite rational objections to this. Relationships in which sexual activity is the primary aspect can also arise, such as transactional sexual encounters, which have can have serious socio-economic, sexual, and psychological impacts. This study illustrated the feelings of romantic love associated with enhancing happiness and life satisfaction in adolescent relationships with increasing maturity. Wheeler et al.  reinforced that the nature of romantic relationships during late adolescence and young adulthood can shed light on many aspects of adolescent development, including the distinctive developmental contexts of intimate relationships. Similarly, Kansky and Allen  revealed a link between romantic relationships with supportive partners and future intimate relationships and wellbeing. Adolescent romantic relationships have the potential to affect psychological functioning well into adulthood . Connolly and McIsaac  verified that adolescent romantic encounters are initial steps on an experience toward a mature relationship to adulthood. As a result of these effects, romantic relationships can cause adolescents to feel or to be perceived as more mature, with enhanced responsibilities and self-image, and future expectations, including with regard to long-term relationships [55, 56]. However, earlier studies found that adolescent intimate relationships with partners come with other risks, such as increased risk of STIs and unplanned pregnancy [30, 57].
Adolescents’ romantic relationships provide an opportunity of establishing and maintaining intimate relationships and developing positive effect on growth individual development . They can also assist adolescents in developing their self-esteem and improving self-worth which grows through relationships with others [58, 59]. Having romantic feelings and engaging in romantic relationships are significant indicators of adolescent development . However, adolescent romance may bring benefits to their growth but also lead to early sexual behaviour and serious SRH problems if adolescents are unprotected.
Romantic relationships which are characterised by intimacy and good communication can contribute to healthy adolescent growth, resilience, and happiness, and often provide a valuable foundation for long-term relationships into adulthood. However, while they are associated with healthy, normative development in most adolescents, they can be symptomatic of pathology in many others. Adolescent romantic relationships play an important role for the development of adolescence and can influence their future wellbeing [25, 55].
The power of SRH education
Participants in our study mainly learned about issues related to SRH such as puberty, contraception, sexual intercourse, becoming pregnant, and abstinence, from school, healthcare professionals, or the internet. A study of adolescent students by Deshmukh and Chaniana  also showed the most common sources of information about SRH to be teachers, mass media, and friends, while parents and siblings had the least important role. The role of school as a source of learning about SRH mainly relates to sex education/ health classes, which vary according to the age of the learners, cultural expectations, and national policies. Various forms of sex education are commonly offered from the early years of elementary school in Western countries, while in most Asian countries it is provided at the high school level. Among university students, participants reported that they received reiterations of SRH education with which they were familiar from their high schools.
SRH education axiomatically plays an important role in sexuality education programmes; in particular, it renders helpful knowledge and shapes attitudes towards human development, sexuality, relationships, gender roles, and decision-making about sexuality . It also breaks down barriers in the prevention of adolescent pregnancy . The integration of sexuality education in the curriculum provides a broad and rich channel of information about a variety of sexuality-related issues, from the growth and development of the human body and reproductive physiology to the development of healthy sexual attitudes and values.
Deshmukh and Chaniana  reported that very few parents were prepared to discuss reproductive health-related matters with their children at home, commonly due to a lack of awareness of reproductive health (60.75%), and fear about encouraging premarital sex (51.40%), aside from incidental shyness and stigma associated with sociocultural norms about discussing sexual issues with their own children. Notwithstanding, the current study found that parents openly communicated with their children concerning safe sex which influenced decision-making in contraception use. Indeed, parental communication is a crucial and effective tool for promoting healthy and safe sexual practices [60, 61].
This study also showed that most participants obtained SRH education in high school and university, which they considered important for their sexual health and decision-making concerning contraceptive methods. Over the course of many years of gathering knowledge of SRH, they perceived benefits of SRH education to include better and more accurate information and a better understanding of body changes, alongside empowerment with skills such as negotiation (particularly for females), decision making, and communication, in order to protect themselves from unintended pregnancy and STIs. This is in line with a study of Vongxay, Albers , which concluded that comprehensive sexual education and enabling information, as well as service access for adolescents, is essential to ensure that adolescents can access, understand, appraise, and apply good SRH knowledge in decision-making for optimum personal health. Oonyu  supported this and determined that SRH education was necessary for female university undergraduate students in Uganda.
The accuracy of SRH education was reported to be particularly important among participants in shaping their sexual relationship choices and consistency of contraception use, consistent with previous studies which revealed that adolescent attitudes toward contraception and the accuracy of condom and reproductive knowledge directly influence contraceptive use throughout adulthood [65, 66]. Conversely, Yared, Sahile  found that over half of university students in central Ethiopia knew about STIs but neglected to apply their knowledge to themselves and their sexual health. The majority of reproductive health problems in their study related to unwanted pregnancy and abortion caused by not using contraception. They thus suggested that SRH education should begin from high school, due to the fact that the majority of students in high school started sexual experience at an early age. Similarly, a study of Oonyu  in Uganda revealed that the majority of university students (66.3%) requested SRH education to assist them to overcome barriers, such as an inability to get reliable and accurate information to empower them in decision making, and to overcome inadequate education from parents and the existing university provision.
The lack of accurate information coupled with low access to contraceptives may increase the risk of STIs, unintended pregnancy, and other health consequences [66, 68]. Comprehensive SRH education and counselling could improve effective contraceptive behaviour throughout the lifecourse . Therefore, SRH education is necessary for university students to resolve decisions about relationships, sexuality, and sexual behaviours . However, the information transmitted about STIs and SRH via the media is commonly found to be boring by adolescents . It is suggested that such programmes should be youth-friendly, with separate packages targeted to STIs and SRH.
Previous research indicates that perceived risks of pregnancy and STIs and motivation to avoid these outcomes are linked with adolescents’ contraceptive method use [64, 65]. In this study, late adolescents perceived that the risks of pregnancy and STIs were associated with contraceptive use. This reflects cognitive development, whereby late adolescents link current behaviours with potential future consequences more strongly than younger adolescents and children. Morales, Vallejo-Medina  reinforced that adolescents more knowledgeable and displayed more favourable attitudes towards different aspects of HIV/AIDS. Adolescents who perceived greater risk and negative expectations about risky sex outcomes related to pregnancy and STI were more strongly influenced in their final decision to use dual contraceptive methods [65, 66]. Adolescents’ attitudes about practical, social, and moral implications of using birth control are also associated with their final protective decisions .
Adolescents need and have a right to SRH information and services . Providing SRH education in school and University is a cost-effective way of reaching adolescents . Having SRH education and enabling information for adolescents are essential to help adolescents adopt safe and responsible practices in decision-making to benefit their own health . The capacity of adolescents to make informed decisions based on correct knowledge on SRH is one of factors that contribute to the prevention of SRH problems, especially adolescent pregnancy, the risks of STIs and negative social consequences . Therefore, accessing comprehensive sexual education should be provided for every stage of adolescence in order to inform decision-making for right way to contribute to SRH . This is also the process of individual adolescents’ thought on an SRH problem before taking an action.
SRH covers many issues related to the reproductive system and its function. Sexual health indicates the ability to have a safe and satisfying sex life  and is also a human right and an achievement of the previous UN Millennium Development Goals. SRH education is an influencing factor for adolescent pregnancy, child marriage, and other adverse SRH outcomes and negative social consequences, which occur more often in poor, less-educated, and rural communities such as in Northern Thailand . This study exposed the connection of SRH education and making decisions about having sex safely. Therefore, SRH education should occur throughout the school journey, with information appropriate to students’ age, religion, and cultural background. It should go beyond the current focus on biological aspects of sex and reproduction, and incorporate communities’ attitudes, values, and skills.
Aside from schools and universities, SRH knowledge from parents was crucial in sexual education. Parents are the largest influence on their adolescents’ decisions about sex, and they have a profound impact on those decisions. Participants in this study stated their parents told them to take care of themselves and prevent themselves from the risks of having sexual relationships. The prospect of talking about topics related to sexuality creates anxiety and apprehension, and this may lead to avoidance of such discussions . This underscores the critical role of educational access for the realisation of SRH and rights for young people, especially girls .
Every adolescent has life-changing decisions to make about their SRH. The study illustrated critically important for providing sexual education to adolescents in order to improve adolescents’ SRH. As adolescents are at risk of adolescent pregnancy and their elevated risk of STIs, including HIV/AIDS, universal accessibility of information on SRHR plays a crucial role in the quality of life for everyone [2, 76]. Globally, as adolescents face with the double injustice of having limited access to SRHR information and services, several organisations working on adolescent and young people, have formulated guidelines to assist in creating curricula and examining previous curricula to expand knowledge for youth . Thus, improving SRH and rights is an important for adolescents in the next generation. Adolescents who have access to SRH education are better supported on their way to a healthier future and can benefit from having corrected knowledge resulted in decision- making to use contraceptive methods for protecting themselves as well as having positive impact on the family and the community at large [12, 76].
However, the lack of sexuality education to empower responsible decision-making can predispose adolescents to unintended adolescent pregnancy and STIs and leave females vulnerable to coercion . Lack of awareness of contraceptive use is also strongly associated with increased risk of early pregnancy. Disadvantaged adolescents are more inconsistent in their use of contraception, even when they do not want a pregnancy, and they tend to have more unintended pregnancies. A study in Thailand by Chirawatkul, Rungreangkulkij  found that adolescent women who achieved well in school and did not exhibit risky behaviours were likely to become pregnant when they do not have sufficient knowledge and skills to protect themselves from such behaviours, and that adolescent men had low understanding of how contraceptive methods work. Adolescents’ decisions and behaviours can have long-lasting implications, and being ill-informed can have lifelong adverse consequences, both for themselves and (potentially) their children.
Parental attitudes regarding adolescent relationships
In Thai tradition, having premarital sex has traditionally been viewed with social disapprobation and disgrace. Premarital sex in adolescence was traditionally viewed with stigma in Thai society, but it has become increasingly normalised nowadays. This is because attitudes towards premarital sex reflect the changing nature of modern society, and such behaviours are now widely accepted in society. In previous studies, adolescent sexuality and pregnancy seemed relatively normal phenomena in rural communities in Thailand [30, 78]. Sriyasak, Almqvist  reinforced that the changing of the dynamic social environment becomes the accepted in the traditional value in the North-eastern of Thailand. Notwithstanding, modernity is the factor that has stimatised adolescent pregnancy made it shameful in Thailand. As can be seen in many previous studies in Thailand, pregnancy in adolescence is viewed as problematic and a serious social problem and pregnant adolescents are sensitive to being personally shamed by the words and gestures of people around them [79, 80].
As this study found that parents play a major role in SRH of adolescents in Thailand. Leekuan  found that adolescents initially concealed their sexual relationship and pregnancy from anybody, especially their parents because of being afraid of rejection. Dalton  encouraged adolescents to commonly hide sexual-related behaviour from their parents in the American context. This is in a line with Saim, Dufåker  who revealed that Malaysian adolescents also tried to hide their sexual relationship and their pregnancies.
Parents have always been the most important influence on adolescents’ decisions about sex in many contexts, but parents commonly underestimate the impact they have on their children’s decisions . This study also found that parents know about and have confidence in their daughters’ decisions and activities. Surprisingly, this differs from a study by Anyanwu, Akinsola  in the South African context, which found that African adolescents were uncomfortable sharing their personal problems with their parents because they worried about their parents’ forbidding them dating. Generally, parenting tasks and responsibilities are an inherent part of raising children, and effectively promote their development. A study by Morales, Vallejo-Medina  in Colombia revealed adolescents believe that important people in their lives expect them to protect themselves during sexual intercourse, and most of them are willing to comply with these expectations. The relationships between parents and adolescents can also shape adolescent development .
Adolescents in this study recounted that their parents were concerned about sex-related issues, as well as birth control. Many previous studies presented similar findings, including parental perceptions of sexual relationships in adolescence . A study by Breuner, Mattson  identified that adolescents’ perceptions of parental expectations about sex and contraception had an important impact on their sexual activities, including the use of contraceptive methods.
Contrary to expectations, parents are more likely to talk with their adolescents about body changes and dating, rather than have discussion about sex-related issues, birth control, and STIs . International research shows that communication between adolescents and parents on issues such a sexual relationships, early pregnancy, HIV, and contraception is often very limited [69, 87, 88]. Because of a lack of knowledge and skills, as well as cultural norms and taboos concerning the discussion of sexual issues between parents and children, sexuality and sex education are commonly not discussed at home .
Previous research indicated that parental disapproval about adolescent sexual activity is an effective way to decrease the probability of adolescents engaging in sexually risky behaviours . Nonetheless, the findings in this study illustrated that the adolescents were more mature and could take responsibility, especially as they were studying at university with parental approval for their relationships with their partners. This suggests the great importance of adolescent responsibility and choices in such contexts, as Leekuan  studied cases of adolescent pregnancy and reported that although parents in many families consented to their adolescents cohabiting prior to marriage, and having sexual relationships, the adolescents did not give importance to protecting themselves from unintended pregnancy.
Although some adolescents’ parents approved early premarital sexual relationships, many were concerned about these relationships. Lack of disclosure about sexual relationships in this study was due to fear of the reactions from parents and families. A study in Kenya by Maina, Ushie  revealed similar findings where romantic relationships were covert as they were viewed as immoral as well as disruptive towards achieving education goals. This is a line with a study by Killoren, Campione-Barr  which found that American adolescents would choose to disclose general thoughts and concerns related to sexual relationship to their mothers but would not discuss thoughts and concerns related to dating.
Our study has show that some adolescents are satisfied their relationship with their parents and had parental approval of their having sexual relationships and were able to have open discussion and communication around sexual health and sexual attitudes. Parental attitude is key in establishing healthy, reliable, respectful and responsible to the individual provides the adolescents a solid feeling of self-identity . Indeed, the attitudes of the parents toward adolescent relationships are more important in the emotional and cognitive development of adolescence. Having an early premarital sexual relationship was not only approved by some parents’ adolescents, but it was also concerned about negative consequences of premarital sex [30, 33]. Otherwise, parental positive attitudes toward adolescents’ sexual relationships are particularly helpful to those adolescents having less parent-adolescent conflict . Adolescents’ parents should gradually provide information about sex education in order for decreasing adolescents’ risk-taking of SRH [30, 33].
Limitations and strengths
This study has some limitations that must be acknowledged. Firstly, this research has interpreted and given meanings to the experiences of sexual reproductive Health among 30 late adolescents recruited from a university in Northern Thailand. Individuals from other universities may have had different experiences and meanings, therefore the findings must be interpreted carefully. Secondly, late adolescents who participated in the study might have had different viewpoints from those who refused participation. Finally, socio-cultural differences among participants might have affected study findings.
The strength of the present study is its updating of knowledge on SRH experience among late adolescents in Thailand. Reported data provide a better insight into the meaning of SRH experiences pertaining to the risks of unplanned pregnancies and STIs in this population.