Adolescents' Sexual Wellbeing in Southwestern Uganda: A Cross-Sectional Assessment of Body Image, Self-Esteem and Gender Equitable Norms.

Elizabeth Kemigisha,Wendo Mlahagwa,Viola Nyakato,Kristien Michielsen,Anna Ninsiima,Katharine Bruce,Gad Ndaruhutse Ruzaaza,Els Leye,Gily Coene

doi:10.3390/ijerph15020372

Abstract

Measures of sexual wellbeing and positive aspects of sexuality in the World Health Organization definition for sexual health are rarely studied and remain poorly understood, especially among adolescents in Sub-Saharan Africa. The objective of this study was to assess sexual wellbeing in its broad sense—i.e., body image, self-esteem, and gender equitable norms—and associated factors in young adolescents in Uganda. A cross-sectional survey of adolescents ages 10–14 years in schools was carried out between June and July 2016. Among 1096 adolescents analyzed, the median age was 12 (Inter-Quartile Range (IQR): 11, 13) and 58% were female. Self-esteem and body image scores were high with median 24 (IQR: 22, 26, possible range: 7–28) and median 22 (IQR: 19, 24, possible range: 5–25) respectively. Gender equitable norms mean score was 28.1 (SD 5.2: possible range 11–44). We noted high scores for self-esteem and body image but moderate scores on gender equitable norms. Girls had higher scores compared to boys for all outcomes. A higher age and being sexually active were associated with lower scores on gender equitable norms. Gender equitable norms scores decreased with increasing age of adolescents. Comprehensive and timely sexuality education programs focusing on gender differences and norms are recommended.

Highlights

The World Health Organization (WHO) defines sexual health as “a state of physical, mental and social wellbeing in relation to sexuality
We looked at several aspects related to wellbeing, namely self-esteem, gender equitable norms and body image scores, as well as their associations with socio-demographic characteristics, school and family environment, and sexual activity
The other items developed to relate to the Uganda context included, “If there is a sick person at home, only a girl should stay home to care for the sick one as the boy goes on with school” or “My mother more than my father should be blamed for my mistakes.”

Summary

Introduction

The World Health Organization (WHO) defines sexual health as “a state of physical, mental and social wellbeing in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence” [1]. Understanding positive sexual health attributes is important as these empower young people to make informed choices for better sexual and reproductive health (SRH) outcomes [2]. This is important among young adolescents (10–14 years) who are commonly neglected in research.

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Results

Discussion

Conclusion