Asia's Tide of Change

Like father, like son. For centuries, this adage described traditional Asian cultures, as children followed in the footsteps of their parents and ancestors and adhered to ancient Confucian values such as respect for elders, family loyalty, emphasis on learning and virginity until marriage.

However, change is occurring in many Asian societies. With economic and social development—occurring at different rates and on different timetables from region to region—communities have been exposed to new forms of media and to outside influences.

But what exactly is changing? For starters, attitudes toward romance, marriage and sex.

Adolescents in particular are adopting Western attitudes and behaviors. In Hanoi, Shanghai and Taipei, colleagues of researchers at the Bill and Melinda Gates Institute for Population and Reproductive Health began to comment on these trends. Their observations led to a collaboration that has spanned three cities and several years.

To determine the extent of shifting sexual zeitgeists and to tease out how the process of change is working, and how it affects the current generation of adolescents, Laurie Schwab Zabin, Robert Wm. Blum and David Bishai and their Asian colleagues have explored behaviors and attitudes in the context of family, school, neighborhood, peers, parents and, of course, the media.

Although analysis is just getting under way, early findings point toward some conclusions. Long-Westernized Taipei is already plateauing at a high level of sexual behavior, says Zabin, professor of Population, Family and Reproductive Health (PFRH). Shanghai is in the midst of transition. And Hanoi, the most conservative of the three cities, "is entering the transition gingerly," says Zabin, principal investigator for the study.

The researchers looked at Internet use, media exposure, family contexts, and personal aspirations and expectations to determine whether access to the new media among young people ages 15 to 24 is associated with less traditional sexual behaviors and beliefs. So far, it seems that those with more liberal attitudes and behaviors are more likely to prefer the Internet and Western movies to radio, television and books. But Mark Emerson, the study's project coordinator, also notes that higher expectations for education and employment are associated with more conservative—and therefore less risky—attitudes and behaviors. "In all three cities," says Zabin, PhD '79, "knowing what it takes to get ahead decreases premarital sex."

Preliminary findings from "A Three-City Asian Study of Adolescents and Youth: Collaborative Surveys in Hanoi, Shanghai and Taipei" show that peers are most often the source of sex-related information for young people, with school a close second; parents lag far behind. (However, the findings do suggest that adolescents who openly communicate with their parents about many issues—not just sex—often practice safer behavior.) Perception of peers' sexual activity wields great influence on adolescents in these cultures—just as in the West. It appears that 15- to 19-year-olds are more vulnerable to those perceptions than those ages 20 to 24. In still-traditional Hanoi, this influence looms largest; in Taipei, peers have less influence.

Besides examining risky sexual behaviors like early sexual debut and misuse or non-use of contraception, the researchers looked at other risk-taking such as smoking, drug use and running away from home. In early analyses, it seems as if sexual risk-taking goes hand in hand with clusters of risk behaviors. Robert Blum, the William H. Gates Sr. Professor and Chair of Population, Family and Reproductive Health, found an association between risky behavior and suicidality. "Those who have lower Confucian values have higher suicidal attempts," says Blum, MD, PhD, MPH. "In most cultures, those with lower religiosity have higher suicidality. ... I am struck by seeing so many risk and protective factors appearing to be relatively consistent."

So what should be done with these findings? The researchers agree on a few things. First, the Internet needs to be exploited as a resource for adolescents about contraception and reproductive health. Second, the need for peer education programs is evident. And parents should make talking about sex part of their family values. Most importantly, public health organizations must be mindful of how these changes in attitudes and behaviors affect the need for services. "For example, in China, which has emphasized family planning in recent decades, those services are largely directed to married couples after their first child," says Zabin. "Now the public health sector must realize that the needs are different for different age groups. More and more, it will need to provide services appropriate to adolescents and young adult premarital populations."

The findings mirror a global trend. "In many countries we're seeing a loosening up of traditional values," says Zabin. This could precipitate a rise in sexually transmitted infections, including HIV/AIDS, and teen pregnancy. Says Blum: "We know how to minimize these risks. It's our challenge to bring to scale what we know works."