Abstract
PurposeTo assess the extent to which adolescents aged 10–14 have communicated about sexual relationships, pregnancy, and contraception and how agency in the form of voice and decision-making along with an enabling socioecological environment are associated with sexual and reproductive health (SRH) communication. MethodsUsing data from the Global Early Adolescent Study, we included 1,367, 697, and 1,424 adolescents in Kinshasa, Cuenca, and Shanghai, respectively. Patterns of SRH communication and agency levels were described by site and sex. Multivariable logistic regressions assessed odds of SRH communication first in relation to socioecological characteristics and second with levels of agency, after adjustment for social environmental factors. Interaction terms tested sex differences in associations. ResultsExperiences of SRH communication ranged from one in ten in Kinshasa to about half in Cuenca. Pregnancy was the most discussed SRH topic. Socioecological factors consistently related to SRH communication included older age and pubertal onset, while others varied by context. In multivariable analyses, voice was linked to all forms of SRH communication in Kinshasa and Cuenca with adjusted odds ratios ranging from 1.6 to 2.2, but not in Shanghai. In Cuenca, decision-making was associated with a 50% and 60% increase in odds of communication about pregnancy and contraception, respectively. In Kinshasa, a stronger association between voice and pregnancy discussions was observed for girls than boys. ConclusionsDevelopmental characteristics and voice were linked to communication about SRH among young adolescents across two contexts. Results suggest agency may play a role in shaping antecedents, like communication, to sexual behaviors.
Highlights
To assess the extent to which adolescents aged 10e14 have communicated about sexual relationships, pregnancy, and contraception and how agency in the form of voice and decisionmaking along with an enabling socioecological environment are associated with sexual and reproductive health (SRH) communication
While the social factors contributing to adolescents' SRH communication [16,17] and outcomes [18]dsuch as age, puberty, family structure, parental relationships, and perceptions of the communitydhave been explored extensively in the literature, this study examines how a combination of these social factors interact with dimensions of agency to inform SRH outcomes
Using baseline data collected in three sites, the objectives of the present study are to (1) describe patterns of SRH communication across sites and by sex, (2) examine associations between adolescents' socioecological environments and SRH communication, and (3) assess whether agency in the form of either voice or decision-making power relates to young people's history of communication about SRH, adjusting for the social environment, and whether this association is consistent by sex and across contexts
Summary
To assess the extent to which adolescents aged 10e14 have communicated about sexual relationships, pregnancy, and contraception and how agency in the form of voice and decisionmaking along with an enabling socioecological environment are associated with sexual and reproductive health (SRH) communication. Multivariable logistic regressions assessed odds of SRH communication first in relation to socioecological characteristics and second with levels of agency, after adjustment for social environmental factors. Voice was linked to all forms of SRH communication in Kinshasa and Cuenca with adjusted odds ratios ranging from 1.6 to 2.2, but not in Shanghai. This study provides novel evidence about the links between empowerment and sexual and reproductive health (SRH) skills in early adolescence by documenting experiences of SRH communication and their associations with agency and developmental factors
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