Abstract
Age at sexual debut is known to have implications for future sexual behaviours and health outcomes, including HIV infection, early pregnancy and maternal mortality, but may also influence educational outcomes. Longitudinal data on schooling and sexual behaviour from a demographic surveillance site in Karonga district, northern Malawi, were analysed for 3153 respondents between the ages of 12 and 25 years to examine the association between sexual debut and primary school dropout, and the role of prior school performance. Time to dropout was modelled using the Fine and Gray survival model to account for the competing event of primary school completion. To deal with the time-varying nature of age at sexual debut and school performance, models were fitted using landmark analyses. Sexual debut was found to be associated with a five-fold increase in rate of subsequent dropout for girls and a two-fold increase in dropout rate for boys (adjusted hazard ratio [aHR] of 5.27, CI 4.22-6.57, and 2.19, CI 1.77-2.7, respectively). For girls who were sexually active by age 16, only 16% ultimately completed primary schooling, compared with 70% aged 18 or older at sexual debut. Prior to sexual debut, girls had primary completion levels similar to those of boys. The association between sexual debut and school dropout could not be explained by prior poor school performance: the effect of sexual debut on dropout was as strong among those who were not behind in school as among those who were overage for their school grade. Girls who were sexually active were more likely to repeat a grade, with no effect being seen for boys. Pathways to dropout are complex and may differ for boys and girls. Interventions are needed to improve school progression so children complete primary school before sexual debut, and to improve sex education and contraception provision.
Highlights
Sexual initiation is a key point of transition from childhood to adulthood
Only a minority were eligible to participate in the sexual behaviour survey: 3153 (28.8%) who had reported their sexual debut status and age at sexual debut were included in the analysis
The results of this study show that sexual activity while still in primary school is an important risk factor for school dropout, with a five-fold risk for girls and a two-fold risk for boys
Summary
Sexual initiation is a key point of transition from childhood to adulthood. Early sexual debut increases exposure to risky sexual activity (Stöckl et al, 2013), including having older and multiple sexual partners, low use of contraceptives and condoms and contracting sexually transmitted infections, including HIV – especially for girls (Lloyd, 2005, p. 202; Zuilkowski & Jukes, 2012). Findings from the 2004 National Survey cross-sectional data on adolescents (aged 12–19 years) in Ghana, Burkina Faso, Malawi and Uganda (Biddlecom et al, 2008) showed that girls who had experienced sexual debut were 2–5 times more likely to drop out prior to completing primary school, compared with those who had not initiated sex. This association was found to be negligible. In southern Malawi, girls with strong future-oriented goals for schooling, pregnancy and marriage were found to be more likely to abstain from sex; while those already sexually active were interested in fulfilling short-term, and financial, needs (Kazembe, 2006; Poulin, 2007; Clark et al, 2009), which may lead to dropout
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