Sex education and self-poisoning in Sri Lanka: an explorative analysis

Grace Crowley,Thilini Rajapakse,Sonali Gunasekera,Lalith Senarathna,Piumee Bandara,Duleeka Knipe,Ayodhya Malalagama

doi:10.1186/s12889-021-12374-4

Abstract

BackgroundSelf-harm and suicide are important causes of morbidity and mortality in Sri Lanka, but our understanding of these behaviours is limited. Qualitative studies have implicated familial and societal expectations around sex and relationships. We conducted an explorative analysis using case-control data to investigate the association between sex education and self-poisoning in Sri Lanka.MethodsCases (N=298) were self-poisoning inpatients on a toxicology ward, Teaching Hospital Peradeniya. Controls (N=500) were sex and age frequency matched to cases and were outpatients/visitors to the same hospital. Participants were asked whether they had received sex education, and to rate the quality and usefulness of any sex education received. Logistic regression models adjusted for age, sex, and religion quantified the association between receipt, quality and usefulness of sex education and self-poisoning. We tested whether the associations differed by sex.ResultsRoughly 1-in-3 cases and 1-in-5 controls reported having not received sex education. Individuals who did not receive sex education were nearly twice as likely to have self-poisoned than those who did (OR 1.68 (95% CI 1.11-2.55)). Those who reported the sex education they received as not useful were more likely to have self-poisoned compared to those who reported it useful (OR 1.95 (95% CI 1.04-3.65)). We found no evidence of an association between self-poisoning and the self-rated quality of sex education, or that associations differed by participant sex.ConclusionAs sex education is potentially modifiable at the population-level, further research should aim to explore this association in more depth, using qualitative methods and validated measurement tools.

Highlights

Self-harm and suicide are important causes of morbidity and mortality in Sri Lanka, but our understanding of these behaviours is limited
It has been suggested that lesbian, gay, bisexual, transgender, queer + (LGBTQ+) individuals may be at increased risk of suicidal ideation [16], as they remain highly stigmatised and criminalized in Sri Lanka, and are likely to be seen as non-conforming of strict gender and heterosexual norms
As sex education can be modified at a population level, this association should be explored further to predict whether improvements in sex education are associated with a reduction in self-poisoning

Summary

Introduction

Self-harm and suicide are important causes of morbidity and mortality in Sri Lanka, but our understanding of these behaviours is limited. Sri Lanka is a middle-income country that has seen a dramatic decrease in suicide rates since the 1990s, coinciding with the banning of the most toxic pesticides in the country [2]. Conflicts between parents and their children regarding sexual relationships have been identified as potential triggers for suicidal behaviour, especially among young people who have engaged in behaviour perceived to bring shame upon themselves and their family [12,13,14,15]. It has been suggested that lesbian, gay, bisexual, transgender, queer + (LGBTQ+) individuals may be at increased risk of suicidal ideation [16], as they remain highly stigmatised and criminalized in Sri Lanka, and are likely to be seen as non-conforming of strict gender and heterosexual norms

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