Where do Babies Come from? Parent-Child Communication about Sex Education

Sex education for early childhood is very important to protect children from unwanted things in the future. The purpose of this research is to find out how parent-child communication is in sex education. The stages are in accord-ance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIS-MA). This study uses the systematic literature review (SLR) method with reference to 10 valid articles published in the last 10 years with years of publication between 2014 and 2023. The results of the literature show that although parents in this study are aware of the importance of providing information about sex education, people's communication parent-child about sex education is rare. This is because the taboo culture is still strong. In addition, parents do not understand sex education in a broad sense so that it can be taught to children from an early age. Parents lack confidence in discussing sex education for their children and do not facilitate children's curiosity about the world of sexuality. There needs to be a reorientation of parents to communicate better with their children, and start discussions about sex education


Introduction
One of the characteristics that early childhood has is great curiosity.Children are little researchers.They will ask adults anything they want to know, including their parents.As parents, we must facilitate their curiosity, including their curiosity about things related to sexuality.In the process of child development, parents must encounter questions from their early childhood such as 'where do babies come from?' and other similar questions.
In addition, the recent rise in cases of sexual abuse in early childhood shows that children do not understand the world of sexuality.Even though children who have experienced sexual abuse make them unprepared in the development process and tend to get social sanctions in society (Jin et al., 2016;Rudolph & Zimmer-gembeck, 2018).Children who have experienced sexual abuse have a tendency to become perpetrators of sexual violence in the future (Ma, 2018;Guastaferro et al., 2020).
Sexual harassment can occur due to various factors, including parents who have an important role in involving children in sexual abuse.Other research reveals that parents are an important factor causing children to experience sexual harassment (Azira et al., 2020).Knowledge, attitudes, and behaviour of parents have an impact on preventing an increase in cases of sexual abuse in children.Therefore, parents have an important role in guiding children to meet the developmental needs of their sexuality.
Unfortunately, not all parents do.Parents' reluctance and shame to talk about sex education seems to reinforce negative messages about unacceptable, prohibition and mystification of early childhood (Zhao et al., 2020).Even though parents play a role in forming the basis on which early childhood begins to develop an understanding of the world of sexuality (Guastaferro et al., 2020).It is not easy to talk about matters related to sexuality in early childhood.Parents must think of strategies so that children are not confused by the explanations given (Morawska et al., 2015;Zhao et al., 2020).
Sex education in early childhood continues to be colored by various controversies.Most of this social anxiety stems from cultural discourse that perpetuates the perspective that sex education is irrelevant, incompatible with child development, dangerous for children, and still considered taboo (Robinson et al., 2017;Fitrianai et al., 2021;Ismiulya et al., 2022).As a consequence, sex education for children is seriously disrupted, especially in terms of the age at which this education should start (Costin, 2021;Nafisah et al., 2022).Parents are still confused about when, how, and by whom sex education should be taught (Kusmiwiyati & Dwi Widyana, 2021;Ismiulya et al., 2022).
Many misunderstand that sex education in early childhood is how to teach just how to have sex.Even though more than that, sex education in early childhood provides a broader understanding according to the child's age level (Nadeem et al., 2020;Kusmiwiyati & Dwi Widyana, 2021).Sex education in early childhood provides children with an understanding of the functions of the sexual organs to instincts that can arise at any time and how to overcome them (J.Rudolph & Zimmer-gembeck, 2018;Nafisah et al., 2023).
The social anxiety faced by many parents continues even though times are advancing but sex education is still considered taboo.It is also important to teach sex education to early childhood so that they understand more about matters related to sexuality, such as sex, instincts, and even marriage (Sanjiwani & Pramitaresthi, 2021).Giving sex education to early childhood makes children grow into individuals who are able to understand several matters related to their sexuality (Fitzpatrick et al., 2022;Nafisah & Pranoto, 2022).
From the description above, parents need openness and confidence to talk about sex education in their early childhood so that children grow up with a better understanding of sexuality and are better able to protect themselves from sexual harassment which has recently been rampant in early childhood.This writing tries to find out more about the perspectives and some of the challenges of parents to open communication about sex education in early childhood.

Methodology
This study uses the Systematic Literature Review (SLR) method.The stages are in accord-ance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIS-MA) (Higgins & Green, 2008;Moher et al., 2009) are as follows: Eligibility criteria.At this stage, articles as references were selected based on the following criteria: a.) report-ing the influence of perspectives and some of the challenges of parents to open communication about sex education in early childhood, b.) using articles in English, and c.) referring to articles published in the last 10 years, with the publi-cation year of 2014-2023.Fur-thermore, articles were not included in the review based on the following exclusion criteria: a.) articles did not report the influence of prespektif dan beberapa tantangan orang tua untuk membuka komunikasi mengenai pendidikan seks pada anak usia dini, b.) articles were not written in English, and c.) articles were published under the last 10 years, before 2014.
Information sources and search strategy.A source was carried out through the Google Scholar site and Publish or Perish 8 from May to June 2023.The data source was searched by using the keywords of early childhood; family interaction; parent-child relations; and sexual communication.
Study selection.The search strategy is applied to each database.Next, the identified records are downloaded and combined into a single library in Mandeley.The duplicate articles (those identified by search strategies across multiple databases) were eliminated, and the title and abstract notes were filtered out twice.The articles which deemed ineligible by both reviewers (by title or ab-stract) were excluded.The eligible articles were included in the final review.The articles that do not meet the requirements are officially excluded (with exception reasons).
Data collection and quality assessment.A data extraction table was created to assist with the synthesis of eligible articles.The table includes article publication characteristics (author, year, country), trait measures, main findings of writing, self-identified limitations, and quality rating scores.The author uses the AXIS tool to critically as-sess the quality and transparency of all eligible articles in this study.This tool consists of a twenty-point checklist that requires a yes, no, or do not know answer (for calculation purpos-es, yes = 1, no/do not know = 0), and has been designed to be used.A quality score of 20 was then identified based on the subjective interpretation of the quality score according to the AX-IS tool.Scores 1-7 indicate low quality, scores 8-14 (moderate quality).

Study selection
The initial search found 403 articles.After the titles and abstracts were filtered, there were 67 which met the criteria.Moreover, 10 articles met the inclusion criteria (the specifications of the search selection process as illustrated in Figure 1.PRISMA flow chart depicting the ar-ticle selection process).Main Findings QR (20) Muhwezi et al., (2015) Children perceive fathers as strict, intimidating, unapproachable and not always around.While boys are more likely to discuss sexual issues with their mothers, boys communicate less with anyone about sex, relationships, and condoms.Most presumably parent-child communication focuses on sexually transmitted infections and body changes.It is considered that sex education is rarely carried out by parents for their children.17 Widman et al., (2016) Sexual communication with parents, particularly mothers, plays a minor protective role in safe sex behavior among children; this protective effect was more pronounced in girls than in boys.
18 Agbeve et al., (2022) Child sexuality education at SSA is not comprehensive due to structured power relations.Thus, parent-child sexuality communication is far from the value of sexuality education to obtain accurate and complete sexual health information.Though it is very important to make decisions when they grow into adults.
18 Mbachu et al., (2020) Communication between parents and children about sexual health and matters related to reproduction is rare.However, when they do occur, they consist mostly of strong warnings that may not protect children from making unhealthy sexual and reproductive health choices.Interventions to improve parent-child communication about sexual and reproductive health should aim at increasing parents' capacity to communicate sexual and reproductive health issues, and deconstructing socio-cultural norms around child sexuality.17 De Looze et al., (2015) Overall, 75% of parents reported having discussed at least one topic multiple times with their child.Romantic relationships are most frequently discussed.Hierarchical logistic regression analysis showed that parent-child sexual communication about protection and contraception was positively related to child sexual initiation and contraceptive pill use but not condom use.This may reflect that children, when they become sexually active, are more likely to discuss sexuality with their parents.17 Motsomi et al., (2016) Identified factors included: shyness when discussing sexual topics; children's misunderstanding that their parents want to engage in sexual activity with them; strong belief among parents that discussing reproductive health with children encourages sexual experimentation; the belief that the child is too young to understand; an environment that is not conducive to open discussion of sexual and reproductive health issues; cultural and religious beliefs.
18 Othman et al., (2020) The parents described their willingness to "destroy the shame culture".Three main strategies emerge: (1) gendermatch, (2) mothers as a safe space and (3) seek help from others, which cover two sub-themes: combining other people, and relying on the delivery of sex education in schools.Strengths and challenges are inherent in each strategy, and topics of discussion vary according to the strategy used.Interventions are suggested to target the knowledge and confidence of parents to provide sex education to their children.18 Usonwu et al., (2021) Fear of the personal, social, and economic consequences of high-risk sexual behavior acts as a stimulus for communication but also carries a negative framework that hinders open discussion.Lack of parental self-efficacy and cultural and religious norms create an uncomfortable environment leaving peers, the media, teachers, and siblings as important and sometimes preferred sources of sexual health information.17 Malacane & Beckmeyer, (2016) Communication about sex education between parents and children is still rare.This is because there are parent-based barriers to communicating with children about sex.These barriers are: limited knowledge of sexual health, believing youth are not ready to discuss sex, discomfort discussing sex, and demographic factors.

Study characteristics
All of those 10 articles which meet the criteria are published between 2014 until 2023.They reflect perspectives and some of the challenges of parents to open communication about sex education in early childhood.The table 1 presents a synthesis of the relevant data from the eligible studies.

Synthesis of major findings
The synthesized evidence shows that early childhood is considered a period that is not yet the time to be given sex education.with the belief that children do not or should not know anything about sexuality (or, by implication, certain details about their own bodies).But sexual innocence is a contested concept where contradictory views deny and acknowledge early childhood sexuality, consider the examples of the 'mummy and daddy' play or the 'chase kisses' game that occurs in school playgrounds (Muhwezi et al., 2015;Ndari et al., 2021;Nafisah, Pranoto, et al., 2022).
The concept of sexual innocence in early childhood is socially constructed, where adults determine how children should behave, decide what they should know, when they should know it and how they should learn to protect and preserve the existing culture (Malacane & Beckmeyer, 2016;Attribution-sharealike & License, 2023).Knowledge related to sexuality is generally considered inappropriate and redundant in early childhood, especially when the strongest fear is associated with knowledge of the physical act of intercourse (Muthengi et al., 2015;Kusmiwiyati & Dwi Widyana, 2021).
The narrowness of parents' thoughts regarding sex education by adopting views and approaches to sex education only on biological relationships and narrow reproductive orientation.Parents make several critical issues involving gender perception, body comfort, sexual organ functions, and self-confidence potentially ignored by parents (Nurhapipa & Hanifah, 2020).Thus, it means that parents limit knowledge, giving reasons that if they don't ask, they don't want to know and are not ready to know (Sanjiwani & Pramitaresthi, 2021;Usonwu et al., 2021).
If all educational learning is based on these principles then no anticipatory precautionary advice can be given regarding, for example, reproductive hygiene, crowd safety or knife risk.Lack of parental preparation in sex education itself seems to result in answers that are considered bad or inconsistent in being given to questions related to sexuality (Mbachu et al., 2020;Pranoto et al., 2021;Agbeve et al., 2022).
These findings suggest that parents often feel isolated with their decisions about the best approach to explaining sexual questions of their children.As a result, many parents are worried about the criticism and judgment of others about being "bad parents" if they give sex education to their children (Nadeem et al., 2020).Naming the genitals with their original names, if it's a man, then "penis" and women "vagina" alone has created an unfavorable perception from society, especially to the point of explaining "where do babies come from" (Mbachu et al., 2020;Zhao et al., 2020).
When sex education should begin, how to deliver it, and when certain topics should be discussed, it seems that parents are still confused.Nonetheless, parents firmly believe that they are still in control, as far as possible, over the sex education that their children receive (De Looze et al., 2015;Motsomi et al., 2016;Setiawan et al., 2022).In fact, parents still consider sex education a taboo and do not answer the truth when their children ask questions about sexuality.
This finding illustrates that parents in terms of providing sex education in early childhood are full of anxiety and challenges, especially because there are no clear rules or agreements in the parenting social group on how to handle problems.However, it would be a mistake to assume that as a result of parents' fear of sex education, children know nothing about sexuality.Whereas on the contrary, since children are born they are faced with implicit and explicit sexual messages from family, peers, the media, and the early education environment (Robinson et al., 2017;J. I. Rudolph et al., 2022).Without explanation from parents, the messages are likely to remain disjointed and contradictory to children (Zhang & Yuan, 2023).
Since the child is in the womb, sex education must be started.Parents' expectations of the sex of the child they contain are also a form of sex education from the womb.This is because such expectations affect how parents treat children and how children accept their gender (Ganji et al., 2018).Meanwhile, early childhood is curious about stimulation in their bodies.Like children playing with their genitals.This needs parental assistance to explain that it is natural to do it yourself, people shouldn't see it, and don't let other people touch it let alone play it (Ballard & Gross, 2009;Rakhmawati et al., 2022).
Not only that, early childhood will be curious about "where do babies come from", "how can babies be born", or even more detailed questions come out of early childhood mouths with their innocence.As an adult, you must be able to respond in detail and in language that is easy for young children to understand and digest.Early childhood also needs to be taught body anatomy, private areas, bad touch, and good touch.From an early age, boys are taught not to be naked and to bathe together in front of women, even if they are their own siblings.Parents don't realize these small things but are considered trivial that they are part of the sex education that parents can give to their children.
From parents who are reluctant to open up to talk about sex education for their children, children don't get that information from people they trust.As a result, children seek information about sex education from peers and the internet, considering that early childhood is now good at playing gadgets.This is certainly more dangerous because if children get information from the internet, the information is not filtered (Usonwu et al., 2021;Fitzpatrick et al., 2022).It also encourages parents to control what their children watch, including controlling who their children befriend.

Conclusion
Although the parents in this finding realized the importance of providing information about sex education, parent-child communication about sex education was rare.This is because the taboo culture is still strong.In addition, parents lack understanding of sex education in a broad sense so that it can be taught to children from an early age.Parents lack confidence in discussing sex education for their children and do not facilitate children's curiosity about the world of sexuality.There needs to be a reorientation of parents to communicate better with their children, and start discussions about sex education.Knowledge-building interventions will provide parents with the confidence they need to initiate these discussions as early as possible, and to provide the best possible early childhood knowledge of sexuality.So that in the future, this is an anticipation of things that should not happen to children, such as sexual abuse.

Figure 1 .
Figure 1.PRISMA flow chart depicting the article selection process