Early Sexual Debut Research Articles

HIV vulnerability among adolescent girls and young women: a multi-country latent class analysis approach

ObjectivesTo stem the HIV epidemic among adolescent girls and young women (AGYW, 15–24 years), prevention programs need to reach AGYW who are most at risk. We examine whether individual- and household-level factors could be used to define HIV vulnerability for AGYW.MethodsWe surveyed out-of-school AGYW in urban and peri-urban Kenya (N = 1014), in urban Zambia (N = 846), and in rural Malawi (N = 1654) from October 2016 to 2017. LCA identified classes based on respondent characteristics, attitudes and knowledge, and household characteristics. Multilevel regressions examined associations between class membership and HIV-related health outcomes.ResultsWe identified two latent classes—high and low HIV vulnerability profiles—among AGYW in each country; 32% of the sample in Kenya, 53% in Malawi, and 51% in Zambia belonged to the high vulnerability group. As compared to AGYW with a low-vulnerability profile, AGYW with a high-vulnerability profile had significantly higher odds of HIV-related outcomes (e.g., very early sexual debut, transactional sex, sexual violence from partners).ConclusionsOut-of-school AGYW had differential vulnerability to HIV. Interventions should focus on reaching AGYW in the high HIV vulnerability profiles.

Why Too Soon? Early Initiation of Sexual Intercourse Among Adolescent Females in Ethiopia: Evidence from 2016 Ethiopian Demographic and Health Survey.

BackgroundEarly sexual initiation – sexual activity that begun earlier than 18 years of age – is among risky sexual behaviors which may be associated with increased risks of adverse outcomes such as sexually transmitted infections (STIs), unwanted pregnancy and unsafe abortions. However, there is no nationally representative evidence on early initiation of sexual intercourse and its determinant factors among adolescent females in Ethiopia.MethodsData were extracted from the 2016 Ethiopian Demographic and Health Survey (EDHS) to assess early initiation of sexual intercourse and factors contributing to it in adolescent females. The analysis included a weighted sample of 3881 adolescent females aged 15–19 years. A multivariable logistic regression analysis was conducted and the results were presented as adjusted odds ratio (AOR) at 95% confidence interval (CI), declaring statistical significance at a p-value <0.05 in all analyses.ResultsAbout 1 in 5 (21.9%, 95% CI: 20.5%, 23.33%) adolescent females experienced early sexual debut. Administrative regions (Amhara, AOR = 2.3, 95% CI: 1.30, 4.09 and Gambella, AOR = 4.89, CI 95%: 1.08, 22.07), religion (Muslim, AOR = 1.76, 95% CI: 1.24, 2.49), substance use (e.g., ever chewed khat, AOR = 2.02, 95% CI: 1.47, 2.77, ever drunk alcohol, AOR = 1.83, 95% CI: 1.35, 2.48) and having no knowledge on family planning (AOR = 4.47, 95% CI: 2.22, 8.99) were found to have statistically significant association with early sexual debut in adolescent females. Whereas any levels of formal education decreased the odds of early sexual debut (primary, AOR = 0.44, 95% CI: 0.35, 0.56; secondary, AOR = 0.19, 95% CI: 0.13, 0.28, and higher, AOR= 0.31, 95% CI: 0.15, 0.63). Similarly, all categories of wealth indices as compared to the poorest were protective of early sexual initiation in adolescent females (AOR = 0.40–0.57) as was for education as compared to no education (AOR = 0.19–0.44).ConclusionA significant proportion of adolescent females initiate early sexual intercourse in Ethiopia and multifaceted factors appear to determine their early sexual experiences. Contextualized interventions including strengthening information, education and communication on adverse consequences of early sexual initiation in regions and improving contraceptive knowledge of teenagers will play a paramount role.

Adolescents’ Knowledge of Sexuality and Perceptions Regarding Teenage Pregnancy: A Qualitative Study among Secondary School Students in Ibadan, Southwest Nigeria

Background: Adolescents are prone to myriads of developmental issues, including early sexual debut, risky sexual behaviours, sexually transmitted infections, teenage pregnancy and abortions. These challenges could be worse among adolescents who lack the understanding of sexuality. Mitigating these challenges among this age group, constituting two-thirds of the Nigerian population, may require exploring the knowledge and perceptions of sexuality and teenage pregnancy. Therefore, the present study aimed to investigate the knowledge of sexuality and perceptions about teenage pregnancy among in-school adolescents in Ibadan, Southwest Nigeria. Methods: We conducted a descriptive cross-sectional study using a qualitative approach. The population comprised 10-17-yearold female and male students of public and private secondary schools. We held focus group discussion sessions among 82 participants and manually analysed the data using a generated code book. Results: The mean age of participants was 13.5 years with a male to female ratio of 1.1:1; 51% of the subjects were from co-educational public schools. Participants’ knowledge about the contextual meaning of sexuality was sub-optimal but better regarding the prevention of sexuality problems and the associated causes and problems. The participants perceived teenage pregnancy as being on the increase and replete with adverse consequences. The focus group discussants had divergent opinions as to what to do if involved in unwanted pregnancy. Conclusions: A knowledge gap existed with regards to sexuality among the study participants. It is advocated that interventions be conducted to review the current status of sexuality education in secondary schools.

Predictors of sexual risk behaviour among unmarried persons aged 15-34 years in South Africa

ABSTRACT South Africa accounts for the largest share of the global HIV epidemic, both in the number of people living with HIV and in new infection rates. In the context of the high prevalence of HIV/AIDS and its ensuing adverse socio-economic impact, in South Africa, this study aimed at examining the factors that impact the sexual risk-taking behaviours of unmarried persons aged 15–34 years in the country. Specifically, the study sought to examine the effects of selected sociodemographic factors on the condom use and sexual partnership behaviours of three age cohorts: 15–19-year-olds (adolescents), 20–24-year-olds (emerging adults), and 25–34-year-olds (young adults). The results showed that being male, wealthy, and living in an urban area generally protected against sexual risk-taking behaviours among respondents. Furthermore, early sexual debut, province of residence, and unemployment are risk factors for unsafe sexual practices among respondents. These demographic predictors showed varied effects depending on the age cohort of respondents. The findings support targeted interventions to improve sex education for adolescents and emerging adults in South Africa.

Outcomes in women with biopsy-confirmed cervical intraepithelial neoplasia grade 1 or normal cervix and related cofactors: A 15-year population-based cohort study from China

ObjectiveTo estimate long-term outcomes of biopsy-confirmed cervical intraepithelial neoplasia grade 1 (CIN1) or normal cervix and identify the cofactors during disease progression. MethodsIn 1999, a cervical cancer screening cohort in Shanxi, China, enrolled 1997 women aged 35–45. They were followed up at year 6, 11, and 15 after enrollment with high-risk human papillomavirus (hrHPV) DNA testing, liquid-based cytology, and visual inspection with acetic acid. Progression, persistence, and regression rates were calculated, stratified by baseline hrHPV and cytological status. Risk factors associated with hrHPV acquisition, persistence, and progression were examined. ResultsThe cumulative rates of progression to CIN2+ among CIN1 over 6, 11, and 15 years were 7.5%, 21.4%, and 24.0%, respectively; the regression rates to normal cervix were 85.0%, 76.7%, and 72.9%, respectively. Over 6, 11, and 15 years, 0.7%, 2.9%, and 5.2% of normal cervix developed CIN2+, respectively, but over 90% remained normal after 15 years. CIN1 or normal cervix positive for hrHPV had significantly higher progression rates to CIN2+ than those without hrHPV. Similarly, the severity of cytological status was found to be associated with an increased risk of developing CIN2+. Women who had an earlier sexual debut were at a higher risk of acquiring new HPV infection and repeated HPV infections. ConclusionsClinical follow-up strategies for women with CIN1 or normal cervix could be adjusted accordingly based on hrHPV/cytology status.

Latent class analysis of sexual health markers among men and women participating in a British probability sample survey

BackgroundDespite known associations between different aspects of sexual health, it is not clear how patterning of adverse sexual health varies across the general population. A better understanding should contribute towards more effective problem identification, prevention and treatment. We sought to identify different clusters of sexual health markers in a general population, along with their socio-demographic, health and lifestyle correlates.MethodsData came from men (N = 5113) and women (N = 7019) aged 16–74 who reported partnered sexual activity in the past year in Britain’s third National Survey of Sexual Attitudes and Lifestyles, undertaken in 2010–2012. Latent class analysis used 18 self-reported variables relating to adverse sexual health outcomes (STI and unplanned pregnancy, non-volitional sex, and sexual function problems). Correlates included socio-demographics, early debut, alcohol/drug use, depression, and satisfaction/distress with sex life.ResultsFour classes were found for men (labelled Good Sexual Health 83%, Wary Risk-takers 4%, Unwary Risk-takers 4%, Sexual Function Problems 9%); six for women (Good Sexual Health 52%, Wary Risk-takers 2%, Unwary Risk-takers 7%, Low Interest 29%, Sexual Function Problems 7%, Highly Vulnerable 2%). Regardless of gender, Unwary Risk-takers reported lower STI/HIV risk perception and more condomless sex than Wary Risk-takers, but both were more likely to report STI diagnosis than Good Sexual Health classes. Highly Vulnerable women reported abortion, STIs and functional problems, and more sexual coercion than other women. Distinct socio-demographic profiles differentiated higher-risk classes from Good Sexual Health classes, with depression, alcohol/drug use, and early sexual debut widely-shared correlates of higher-risk classes. Females in higher-risk classes, and men with functional problems, evaluated their sex lives more negatively than those with Good Sexual Health.ConclusionsA greater prevalence and diversity of poor sexual health appears to exist among women than men in Britain, with more consistent effects on women’s subjective sexual well-being. Shared health and lifestyle characteristics of higher-risk groups suggest widespread benefits of upstream interventions. Several groups could benefit from tailored interventions: men and women who underestimate their STI/HIV risk exposure, women distressed by low interest in sex, and women experiencing multiple adverse outcomes. Distinctive socio-demographic profiles should assist with identification and targeting.

Quadrivalent human papillomavirus vaccination successfully reduces the prevalence of vaccine-targeted genotypes in a young, vaccine-eligible-age sample of Australian females

Females aged 16-25 years were recruited into the Young Female Health Initiative study, a young women's health study, via Facebook advertising from 2012 to 2017. Sexually active participants were asked to provide a self-collected vaginal swab for the detection of HPV DNA; positive samples were genotyped. Self-reported HPV vaccination status was confirmed by the National HPV Vaccination Program Register. Outcomes of the study were HPV acquisition and genotype, HPV vaccination status and factors associated with HPV. Overall, 22.8% of samples (95% confidence interval (CI) 17.8-27.8%; n = 62/272) were positive for any HPV DNA, of which 19.1% (95% CI 14.4-23.8%; n = 52/272) were oncogenic types. HPV 16 was detected in three samples (1.1%; 95% CI -0.1%, 2.3%; two not HPV vaccinated and one vaccinated after sexual debut). Early sexual debut (<16 years) and multiple sexual partners were independently associated with an increased risk of any HPV. In a community sample of vaccine-eligible-age females with a high vaccine uptake, the prevalence of vaccine-related HPV genotypes is extremely low. Early sexual debut and multiple sexual partners are positively associated with HPV, underscoring the importance of vaccination at the routinely recommended age of 12-13 years for best vaccine impact.

Viewing the resurgence of early syphilis in light of increasing male homosexuality and childhood sexual abuse.

Back Ground and Objectives:A rising trend of syphilis has been documented worldwide recently. After decriminalization of homosexuality in India more and more males having sex with males (MSMs) have come out to seek medical advice.Aim:We evaluated sexual behavior of patients with syphilis attending our sexually transmitted infections (STIs) clinic focusing on the factors associated with the increasing MSM practices and rising trend of syphilis among MSM.Materials and Methods:This is a 10-year (2006–2015) descriptive study from among STI patients attending the dermatology outpatient department in a tertiary care center. Recognizing the rising homosexuality, from 2011 onward, we had given a questionnaire to assess their sexual behavior and sexual practices.Results:Analysis of data from 560 cases diagnosed as having STI revealed a rising trend of all STIs including syphilis from 2011 onward. The MSM cases reporting to our STI clinic showed a sustained rise from 2011 onward. The most common STI in MSM was syphilis that too early acquired. More than half of the MSM indulged in bisexual activities and the predominant mode was anoreceptive. Nearly 70% had unprotected contact and most had early sexual debut (<20 years). Thirty-six percent gave a history of childhood sexual abuse (CSA) by a close male acquaintance.Conclusions:After 2011, we have observed a resurgence of early acquired syphilis which coincided with an increase in promiscuous homosexuality. Many of the MSMs were bisexuals and homosexuality was an acquired behavior. An alarming increase in the incidence of CSA was observed in MSMs.

Bruneian Suicidal behaviors among school attending adolescents: A nationwide cross sectional study

Background: It is aimed to determine the prevalence of suicidal behaviors regarding to epidemiological and psychosocial characteristics among Bruneian school-student adolescents. Methods: The cross-sectional study of 2599 (female: 49.9%; mean: 14.7 years old; SD: ±1.4) school-student adolescents aged between 13-17 years was based on the Global School-based Health Survey in Brunei. Data on suicidal behaviors, psychosocial and demographic characteristics were analyzed using multiple logistic regression model. Results: The prevalence of suicidal behaviors was 9.3%, 6.5% and 5.9% for suicidal ideation, suicidal plan and suicidal attempt respectively. Female adolescents reported more attempts (61.2%). It was found that some characteristics including suicide ideation (69%), anxiety (28%), loneliness (30%) were statistically different between the attempters of suicide and non-attempters among Bruneian school-student adolescents (p-value<0.001). Also, some suicide-related behaviors like planned suicide (52%), bullying victimization (21%), physical fight (29%), serious injury (28%), early sexual debut (8.5%), alcohol use at early age (20%), alcohol use in the past 30 days (12%) and physically attacked (30%) showed different rates between two groups of participants (p-value<0.001). Compared to those who did not report attempting suicide, the attempters were more likely to have suicide ideation (OR 10.58; 95% CI 5.10, 21.97); planned suicide (OR 9.82; 95% CI 4.60, 20.96); and sustained serious injury (OR 4.01; 95% CI 2.03, 7.93). Conclusion: The revealed suicidal behaviors, including being lonely, anxious, bullied, attacked physically, alcohol use among school students should be considered by parents and school and counselling service staff in order to prevent selectively.

Early Life Exposures and Risky Sexual Behaviors among Adolescents: A Cross-sectional Study in Ghana.

Background:Risky sexual behaviors (RSBs) are behaviors that could result in unwanted pregnancies and sexually transmitted infections. These behaviors are often initiated during adolescence, and the frequency of engagement in such behaviors rises with increasing age during the teenage years. It has been asserted that exposures to sexual materials early in life could lead to early sex debut among adolescents.Objective:The objective of this study was to determine the early life exposures contributing to RSBs among basic school pupils in the Twifo Praso District of Ghana.Materials and Methods:A descriptive cross-sectional study was conducted using a structured questionnaire. Three hundred and sixty basic school pupils were selected by simple random sampling technique. Data were analyzed using SPSS version 20.Results:The study found that 64.4% of the respondents have had sexual intercourse at a mean age of 13.7 years. Respondents from polygamous homes were more likely to engage in earlier sexual debut than those from monogamous home (r = 0.0343, P = 0.003). Furthermore, having a high number of friends who have had sex was associated with an early sexual debut (r = 0.720, P = 0.000).Conclusion:Adolescents are initiating sexual intercourse very early in life and this calls for customized reproductive health promotion activities aimed at minimizing risky sexual behaviors. Further studies on how parent–child sexual communication could delay sexual debut are recommended.

Global School-based Student Health Survey reveals correlates of suicidal behaviors in Brunei Darussalam: a nationwide cross-sectional study.

:Background:This study aimed to determine the prevalence of and correlates for suicidal behaviors among school attending adolescents in Brunei.Methods:Nationally representative cross-sectional data on (n=2599) adolescents derived from the Global School-based Health Survey in Brunei Darussalam were examined. Data on suicidal behaviors, psychosocial and demographic characteristics were analyzed using multiple logistic regression taking survey design into account.Results:Twelve months prior to being surveyed, the prevalence of suicidal behaviors was 9.3%, 6.5% and 5.9% for suicidal ideation, suicidal plan and suicidal attempt, respectively. Females were overrepresented in attempts (61.2%).Several self-reported characteristics such as suicide ideation (69%), anxiety (28%), and loneliness (30%) were significantly different between the attempters of suicide and non-attempters (p less than 0.05). Also, some suicide-related behaviors such as having planned a suicide (52%), being bullied (21%), involved in a physical fight (29%), serious injury (29%), early sexual debut (8.5%), alcohol use at early age (21%), alcohol use in the past 30-days (12%), and being physically attacked (30%) differed by suicide category (p less than 0.05). Compared to those who did not report attempting suicide, attempters were more likely to have suicide ideation (OR=10.58; 95% CI 5.10, 21.97); have planned suicide (OR=9.82; 95% CI 4.60, 20.96); or sustained serious injury (OR=4.01; 95% CI 2.03, 7.93) within the recall period. Conclusions:This study provided evidence, which overall confirm that the psycho-social environment in school settings modify suicidal behavior. The results, taken together emphasize the importance of the school environment on the development of school attending adolescents. Where possible, the results may provide additional information on which self-reported behaviors represent avenues for potential preventive programming.

Detection and Associated Factors for Cervical Precancerous Lesions Among HIV-Positive Women from High HIV-Burden Areas - China, 2015-2016.

What is already known about this topic? Cervical cancer is one of the most common cancers among HIV-positive women. The World Health Organization (WHO) has recommended a program of cervical cancer screening for HIV-positive women. Prospective follow-up studies and specific recommendations on cervical cancer screening for HIV-positive women in China are not currently being performed. What is added by this report? Among HIV-positive women from high HIV-burden areas of China, the detection rate of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in the baseline survey and the incidence of CIN2+ in the follow-up survey after 18 months was high. High-risk human papillomavirus (hrHPV) infection and early (< 18 years old) sexual debut was associated with CIN2+ among HIV-positive women. What are the implications for public health practice? HIV-positive women need cervical cancer prevention and regular screening services. These women might benefit from a cervical cancer screening program that combines hrHPV test and cytology and has short intervals between screenings.

Sexual health of adolescent girls and young women in Central Uganda: exploring perceived coercive aspects of transactional sex

Adolescent girls and young women (AGYW) in Uganda are at risk of early sexual debut, unwanted pregnancy, violence, and disproportionally high HIV infection rates, driven in part by transactional sex. This paper examines the extent to which AGYW’s participation in transactional sex is perceived to be coerced. We conducted 19 focus group discussions and 44 in-depth interviews using semi-structured tools. Interviews were audio recorded, and transcribed verbatim. Data were analysed using a thematic analysis. While AGYW did not necessarily use the language of coercion, their narratives describe a number of coercive aspects in their relationships. First, coercion by force as a result of “de-toothing” a man (whereby they received money or resources but did not wish to provide sex as “obligated” under the implicit “terms” of the relationships). Second, they described the coercive role that receiving resources played in their decision to have sex in the face of men’s verbal insistence. Finally, they discussed having sex as a result of coercive economic circumstances including poverty, and because of peer pressure to uphold modern lifestyles. Support for income-generation activities, microfinance and social protection programmes may help reduce AGYW’s vulnerability to sexual coercion in transactional sex relationships. Targeting gender norms that contribute to unequal power dynamics and social expectations that obligate AGYW to provide sex in return for resources, critically assessing the meaning of consensual sex, and normative interventions building on parents’ efforts to ascertain the source of their daughters’ resources may also reduce AGYW’s vulnerability to coercion.

Mothers with a History of Child Welfare Involvement: A Brief Literature Review of Cross Generational Impact of Maternal Trauma.

A number of studies to this day have examined the role of maternal childhood trauma in parenting styles, mental health, and child attachment patterns; however, there are limited data on parenting of mothers who were raised in institutional care (IC) and involved in the child welfare system. The current review focuses on maternal history of institutionalization and foster care placement and its impact on parenting and child development. Studies show that the history of maternal trauma such as maltreatment, which is often linked to an orphan status, can be transferred to children through maladaptive parenting strategies, evoking a cycle of cross-generational maltreatment. Mothers raised in institutions show an early sexual debut that is often resulting in unplanned pregnancies, and are lacking competence in taking care of their own children. Directions for future research involving mothers with a history of IC are discussed.

An evaluation of male learners’ knowledge, attitudes and practices regarding sexual and reproductive health in rural northern KwaZulu-Natal province

Background: With a disparate HIV prevalence among young men and women, high rates of teenage pregnancies and a lack of responsible fatherhood, issues of reproductive health among young people need to be urgently addressed. The aim of this research was to assess the knowledge, attitudes and practices regarding sexual and reproductive health among young men in the Bethesda Hospital catchment area of northern KwaZulu-Natal province.Methods: This observational, descriptive cross-sectional study was conducted at six randomly selected high schools within the uMkhanyakude district. All grade 12 male learners ≥ 18 years completed a questionnaire regarding their reproductive health knowledge, attitudes and practices.Results: A total of 279 learners participated in the study with a median age of 20.2 years and a mean knowledge score of 63.8%. Only 28.3% of the learners showed good or excellent knowledge on basic sexual and reproductive health questions; 50.9% believed that girls say ‘no’ to sex when they mean ‘yes’, and 46.2% believed that girls were sexually aroused when dominated by a man. Some 156 (55.9%) of those who were sexually active did not know their current sexual partner’s HIV status. There were significant associations between being brought up in a female-headed family and early sexual debut but not between early sexual debut and paternalistic attitudes to women.Discussion and conclusions: Basic sexual and reproductive health knowledge among the majority of participants was adequate. Patriarchal attitudes of sexual domination were prominent, and these are probably influenced by sociocultural belief systems of traditional masculinity, which are defined and dominated by men. This perpetuates gender inequality and contributes to poor sexual and reproductive health outcomes. Poor health-seeking behaviour and attitude relating to sexually transmitted infections (STIs), and having concurrent multiple sexual partners, puts them and their sexual partners at risk of HIV/AIDS acquisition. Strategies need to be developed to enhance socially acceptable and comprehensive sexual and reproductive health education and services among young men in this area, foster positive attitudes towards women and encourage gender-equal relationships.

Adolescent motherhood in under 100 000 inhabitants communities in the first decades of the millennium

To analyze the adolescent motherhood trend and associated factors in under-100 000-inhabitants communities. Cross-sectional analysis of 16 686 women in under-100 000-inhabitants communities in Encuesta Nacional de Salud y Nutrición (Ensanut) 2006, 2012 and 100k 2018. We adjusted robust Poisson models with adolescent motherhood as dependent variable for women aged 12-19 and 20-24. Attending school and using modern contraceptives decrease adolescent motherhood prevalence in both age groups. Among adolescent girls, having a health financing scheme, and early sexual debut in the case of adults, is positively associated with adolescent motherhood. It is necessary to strengthen public policies seeking to modify structural factors that provide life choices, and to maintain and strengthen the actions and coverage proposed by Estrategia Nacional para la Prevención del Embarazo en Adolescentes (ENAPEA) targeting this population.

Sexual Practices among Senior Students in Private Secondary Schools in Uyo, Southern Nigeria.

Sexual practices of adolescents have enormous consequences on their health and career outcome. The objective of this study was to assess the sexual practices among senior secondary students in private schools in Uyo, Nigeria. This was a descriptive crosssectional study. Data were collected using structured, self administered questionnaire and analyzed with SPSS version 23 software. Level of significance was set at 0.05. A total of 353 respondents participated in the study. The mean age was 14.84±1.10 years with a male to female ratio of 1:1.17. The prevalence of sexual intercourse was 14.2%. The mean age of sexual debut was 11.7±2.60 years, being significantly lower in males, (10.83 ±2.64 years) than females, (12.67±2.42 years) (p=0.00). Risky sexual behaviour included low contraceptive use 15 (30.0%) and having multiple sexual partners 9(18%). A total of 25.8% males and 9.0% females engaged in pornography (p=0.00). Also, 8.6% of males and 2.6% females both masturbated and had sexually active friends respectively (p=0.01). In view of the early sexual debut and risky sexual practices reported among senior secondary students in private schools in Uyo, there is need for early integration of sexuality education into the curriculum of such schools to improve sexual behaviour among the students.

An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi.

BackgroundTeenage pregnancies and childbearing are important health concerns in low-and middle-income countries (LMICs) including Malawi. Addressing these challenges requires, among other things, an understanding of the socioeconomic determinants of and contributors to the inequalities relating to these outcomes. This study investigated the trends of the inequalities and decomposed the underlying key socioeconomic factors which accounted for the inequalities in teenage pregnancy and childbearing in Malawi.MethodsThe study used the 2004, 2010 and 2015–16 series of nationally representative Malawi Demographic Health Survey covering 12,719 women. We used concentration curves to examine the existence of inequalities, and then quantified the extent of inequalities in teenage pregnancies and childbearing using the Erreygers concentration index. Finally, we decomposed concentration index to find out the contribution of the determinants to socioeconomic inequality in teenage pregnancy and childbearing.ResultsThe teenage pregnancy and childbearing rate averaged 29% (p<0.01) between 2004 and 2015–16. Trends showed a “u-shape” in teenage pregnancy and childbearing rates, albeit a small one (34.1%; p<0.01) in 2004: (25.6%; p<0.01) in 2010, and (29%; p<0.01) in 2016. The calculated concentration indices -0.207 (p<0.01) in 2004, -0.133 (p<0.01) in 2010, and -0.217 (p<0.01) in 2015–16 indicated that inequality in teenage pregnancy and childbearing worsened to the disadvantage of the poor in the country. Additionally, the decomposition exercise suggested that the primary drivers to inequality in teenage pregnancy and child bearing were, early sexual debut (15.5%), being married (50%), and wealth status (13.8%).ConclusionThe findings suggest that there is a need for sustained investment in the education of young women concerning the disadvantages of early sexual debut and early marriages, and in addressing the wealth inequalities in order to reduce the incidences of teenage pregnancies and childbearing.

Sexual and reproductive rights violations at sexual debut of male and female adolescents in Ghana.

To examine the social and ethical challenges in enforcing sexual and reproductive rights of male and female adolescents abused at sexual debut in Ghana. This was a secondary analysis of cross-sectional survey data on 278 sexually experienced male and female teenagers from 12 communities selected by cluster random sampling in the Ejisu-Juben district. We extracted relevant data from a 2009 academic thesis project involving 481 respondents. We assessed differences between sexual debut experiences of males and females using Pearson's chi-square and ANOVA tests. P-values ≤0.05 were considered significant. Mean ages at sexual debut for males and females were 16.05±1.8 and 15.98±1.47years respectively (P=0.719). Adolescents of both sexes experienced defilement and forced sexual debut; similar proportions had early sexual debut. Females who had early sexual debut were more likely than their older counterparts to have low educational attainment and induced abortion. Many male and female adolescents experience sexual and reproductive rights breaches at sexual debut. Prevailing circumstances hinder optimization of sexual and reproductive rights of juveniles in Ghana. We recommend making clear provisions for young persons in the law on sexual offences in the criminal code to facilitate development of interventions to improve access to justice for offenders and victims.

Early sexual debut and risky sex in young adults: the role of low self-control

BackgroundThe purpose of this study was to examine the role of low self-control as a mediator or moderator between early age at sexual debut and risky sexual behavior in young adulthood.MethodsData on 5734 male and female Add Health participants were used. Self-control (waves 1 & 3), age at sexual debut (wave 3) and risky sexual behavior (wave 4) were used in a structural equation modeling framework to assess the relationships of interest.ResultsApproximately 17% of respondents were < 15 years at first sexual intercourse. Among females only, both early age at first intercourse (Parent-report: z = 5.08, p < .001; Self-report: z = 2.05, p < .05) and low self-control at wave 3 (Parent-report: z = 2.30, p < .05; Self-report: z = 2.31, p < .05) mediated the relationship between low self-control at wave 1 and risky sexual behaviors in young adulthood. Similarly in the male-only model, both early age at first intercourse (Parent-report: z = 2.92, p < .01; Self-report: z = 3.04, p < .01) and low self-control at wave 3 (Parent-report: z = 1.99, p < .05; Self-report: z = 3.15, p < .01) mediated the relationship between low self-control and risky sexual behaviors in young adulthood. There was evidence of moderation in the male-only model (− 0.26, p < .01), such that lower impulsivity strengthened the relationship between early sex and risky sex.ConclusionsThis study confirms the role of executive functions in sexual behaviors and suggests that interventions aimed at improving self-control may be beneficial in reducing risky sexual behavior.