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Henderson M. Do initiation rites hasten sexual debut among adolescent girls? A longitudinal analysis from Ghana. CULTURE, HEALTH & SEXUALITY 2023; 25:382-397. [PMID: 35275028 DOI: 10.1080/13691058.2022.2047226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
Many Ghanaians identify their country's most enduring female initiation rite as a risk factor for early sexual debut, claiming that initiates interpret the rite as a normative starting point for sexual activity as was standard in the past. However, the assumption that African initiation rites may hasten sexual debut has not been statistically substantiated. This study explores this association using three waves of longitudinal data collected between 2010 to 2013 from 690 girls and young women aged 12-19, about half of whom had participated in the rite. The results suggest that initiates typically participate in the rite at age 11 and begin having sex around age 16, about six months earlier than non-initiates. Results from survival analyses correspondingly indicate that initiates are 50% more likely to report sexual debut than their non-initiated counterparts. This relationship remains robust when accounting for confounding variables and reverse causality and is not moderated by socioeconomic status. Findings suggest that initiation rites should be understood as having potentially meaningful implications for adolescent sexual debut and sexual and reproductive health outcomes in sub-Saharan Africa. Capitalising on initiation rites for their role in sexual socialisation may be a valuable opportunity to promote sexual and reproductive health among youth.
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Affiliation(s)
- M Henderson
- Department of Sociology, McGill University, Montreal, Quebec, Canada
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Kumar M, Yator O, Nyongesa V, Kagoya M, Mwaniga S, Kathono J, Gitonga I, Grote N, Verdeli H, Huang KY, McKay M, Swartz HA. Interpersonal Psychotherapy's problem areas as an organizing framework to understand depression and sexual and reproductive health needs of Kenyan pregnant and parenting adolescents: a qualitative study. BMC Pregnancy Childbirth 2022; 22:940. [PMID: 36522716 PMCID: PMC9756635 DOI: 10.1186/s12884-022-05193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Peripartum adolescents experience significant interpersonal transitions in their lives. Depression and emotional distress are often exacerbated by adolescents' responses to these interpersonal changes. Improved understanding of pregnancy-related social changes and maladaptive responses to these shifts may inform novel approaches to addressing the mental health needs of adolescents during the perinatal period. The paper aims to understand the sources of psychological distress in peripartum adolescents and map these to Interpersonal Psychotherapy's (IPT) problem areas as a framework to understand depression. METHOD We conducted interviews in two Nairobi primary care clinics with peripartum adolescents ages 16-18 years (n = 23) with experiences of depression, keeping interpersonal psychotherapy framework of problem areas in mind. We explored the nature of their distress, triggers, antecedents of distress associated with an unplanned pregnancy, quality of their relationships with their partner, parents, and other family members, perceived needs, and sources of support. RESULTS We found that the interpersonal psychotherapy (IPT) framework of interpersonal problems covering grief and loss, role transitions, interpersonal disputes, and social isolation was instrumental in conceptualizing adolescent depression, anxiety, and stress in the perinatal period. CONCLUSION Our interviews deepened understanding of peripartum adolescent mental health focusing on four IPT problem areas. The interpersonal framework yields meaningful information about adolescent depression and could help in identifying strategies for addressing their distress.
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Affiliation(s)
- Manasi Kumar
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, 00100 (47074), Nairobi, Kenya ,grid.470490.eBrain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Obadia Yator
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, 00100 (47074), Nairobi, Kenya
| | - Vincent Nyongesa
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, 00100 (47074), Nairobi, Kenya
| | - Martha Kagoya
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, 00100 (47074), Nairobi, Kenya
| | - Shillah Mwaniga
- Nairobi Metropolitan Services, Nairobi, Kenya ,grid.12380.380000 0004 1754 9227Vrije University, Amsterdam, Netherlands
| | - Joseph Kathono
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, Kenya and Nairobi Metropolitan Services, Nairobi, Kenya
| | - Isaiah Gitonga
- grid.95004.380000 0000 9331 9029Department of Psychology, National University of Ireland, Maynooth, Ireland
| | - Nancy Grote
- grid.34477.330000000122986657School of Social Work, University of Washington, Seattle, USA
| | - Helena Verdeli
- grid.21729.3f0000000419368729Global Mental Health Lab, Columbia University, New York, USA
| | - Keng Yen Huang
- grid.137628.90000 0004 1936 8753New York University, New York, USA
| | - Mary McKay
- grid.4367.60000 0001 2355 7002Vice Provost of Interdisciplinary Initiatives, University of Washington, St Louis, USA
| | - Holly A. Swartz
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburg, USA
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Smith AD, Chipeta E, Stones W, Mmari K. Why do young people engage in dating relationships during early adolescence? An inter-generational qualitative analysis from Blantyre, Malawi. CULTURE, HEALTH & SEXUALITY 2022; 24:842-855. [PMID: 33750271 DOI: 10.1080/13691058.2021.1889672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
Engagement in dating relationships plays an important role in the health trajectories of young people, particularly during the early adolescent period between ages 10-14. Yet little is known about such relationships among youth in low resource contexts. This study sought to contribute to the literature on this topic by exploring reasons why school-going young people aged 12-14 years engage in dating relationships in Blantyre, Malawi. A thematic analysis was used to code and analyse in-depth interview data from 23 young people and 19 caregivers. Against the backdrop of growing sexual desires and feelings of attraction, participants stressed harassment from boys and coercion from older men, peer pressure, social status attainment, financial deprivation and encouragement during initiation ceremonies as reasons for engaging in dating relationships. Girls were found to be subject to multiple power dynamics-including gender power relations, as well as power dynamics within same-gender peer groups-that influenced their sex and relationship involvement. These findings carry implications for the design and timing of sexual and reproductive health youth programmes in Sub-Saharan Africa and emphasise the need for multi-level interventions to address the multiple influences in young people's dating lives.
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Affiliation(s)
- Annie D Smith
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Effie Chipeta
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - William Stones
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kristin Mmari
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Maina BW, Sikweyiya Y, Ferguson L, Kabiru CW. Conceptualisations of masculinity and sexual development among boys and young men in Korogocho slum in Kenya. CULTURE, HEALTH & SEXUALITY 2022; 24:226-240. [PMID: 33289439 DOI: 10.1080/13691058.2020.1829058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/21/2020] [Indexed: 06/12/2023]
Abstract
Youth and adolescence are times when young men negotiate their identity in relation to social and cultural expectations of being a man, with enduring implications for sexual health and wellbeing. This study explored how boys aged 10-14 years living in Korogocho slum in Nairobi, Kenya conceptualised masculinity, their perceptions of how masculinities are performed, and the linkage between conceptualisations of masculinity and sexual development. Three bases of gender socialisation were identified: (1) verbal messaging (mainly from parents and teachers); (2) observing the behaviours of older men in the community; and (3) information received from mainstream and social media. Masculinity conceptualisations focussed on financial stability, family life and responsibility, physical attributes, character and religion. Two contrasting portrayals of masculinity emerged in the form of idealised and dominant masculinities. A close linkage was found between masculinity conceptualisations and sexual development. Findings are important for programmes that aim to transform harmful gender norms and signal the need for longitudinal research exploring how gender beliefs may change over time.
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Affiliation(s)
- Beatrice W Maina
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Population Dynamics, Sexual and Reproductive Health and Rights Unit, African Population and Health Research Centre, Nairobi, Kenya
| | - Yandisa Sikweyiya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Gender and Health Research Unit, South Africa Medical Research Council, Pretoria, South Africa
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, USA
| | - Caroline W Kabiru
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Population Dynamics, Sexual and Reproductive Health and Rights Unit, African Population and Health Research Centre, Nairobi, Kenya
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Yu C, Lou C, Lian Q, Tu X, Zhang J, Zuo X. The pattern of romantic and sexual related experiences among Chinese young adolescents: an exploration with multi-group latent class analysis. Reprod Health 2021; 18:184. [PMID: 34544440 PMCID: PMC8454020 DOI: 10.1186/s12978-021-01235-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/02/2021] [Indexed: 02/08/2023] Open
Abstract
Background Studies on very young adolescents’ romantic and sexual experiences would help inform the context in which early sex arises. However, such studies are scant in China due to sparse data and cultural issues. Method This study used the GEAS baseline data conducted among1776 adolescents in Shanghai. Multi-group latent class analysis was used to explore adolescents’ romantic and sexual experiences patterns and subgroups. Multi-nominal logistic regression was performed to identify the factors distinguishing different subgroups subsequently. Results There were gender differences in the lifetime prevalence for very young adolescents’ romantic and sexual-related behaviors. The Multi-group latent class analysis indicated that the participants could be classified into three classes: general group, early romance group, and sex exploratory group. Multi-nominal logistic regression showed youth in the early romance group were more likely to had friends of both gender, ever had a romantic relationship, and had more autonomy in deciding where to go than the general group; while male respondents in the sex exploratory group were older, ever had a romantic relationship, believed that boys should be more sexually active and more proactive than girls, had more autonomy on deciding where to go, and perceived less school connection and neighborhood cohesion. Female respondents in the sex exploratory group were older and less empowered in decision-making than the general group. Conclusions The result provides a picture of romantic and sexual behavior patterns among both gender of very young adolescents in China. Current sex education needs not only to be culturally appropriate but also to address the harm of gender inequality and stereotypes, as well as to provide accessible and supportive services to help young adolescents personalize their received information and strengthen their skills in communication, decision making, and critical thinking. Studies on teenagers' romantic and sexual experiences would help to prevent early sex arises before it really takes place. However, such studies are limited, especially in China. The traditional culture thought that youth should not start romance before college. This study used the Global Early Adolescent Study Shanghai site baseline data collected among1776 teenagers to explore their romantic and sexual experiences patterns and identify the influencing factors. There were significant gender differences in teenagers’ romantic and sexual-related behaviors. According to the multi-group latent class analysis, we classified the teenagers into three classes: the general group, the early romance group, and the sex exploratory group. The multi-nominal logistic regression showed youth in the early romance group were more likely to had friends of both boys and girls, ever had boyfriend/girlfriend and were freer to go out than the general group; while boys in the sex exploratorygroup were older, ever had a boyfriend/girlfriend, believed it was normal for boys to be sexually active than girls, had more freedom to go out, and had less perception of care from school adults and neighborhood. Girls in the sex exploratory group were older and less likely to make decisions on their own. Given the result we found, we call for health researchers and educators to conduct sex education programs promoting more equal gender norms and provide services to help young adolescents get right information and strengthen their skills in communication, decision making and critical thinking.
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Affiliation(s)
- Chunyan Yu
- NHC Key Lab. of Reproductive Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, 200237, Shanghai, People's Republic of China
| | - Chaohua Lou
- NHC Key Lab. of Reproductive Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, 200237, Shanghai, People's Republic of China
| | - Qiguo Lian
- NHC Key Lab. of Reproductive Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, 200237, Shanghai, People's Republic of China
| | - Xiaowen Tu
- NHC Key Lab. of Reproductive Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, 200237, Shanghai, People's Republic of China
| | - Jiashuai Zhang
- NHC Key Lab. of Reproductive Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, 200237, Shanghai, People's Republic of China.,School of Public Health, Fudan University, Shanghai, China
| | - Xiayun Zuo
- NHC Key Lab. of Reproductive Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, 200237, Shanghai, People's Republic of China.
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Carney A, Kaaya S, Kajula L, Ibitoye M, Marwerwe G, Sommer M. ‘Most of the Youth Are Drinking Because They Have Nothing to Do’: How Idle Time Facilitates Adolescent Alcohol Use in Urban Tanzania. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2021. [DOI: 10.1080/1067828x.2021.1888169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Allison Carney
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sylvia Kaaya
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lusajo Kajula
- Office of Research – Innocenti, UNICEF, Dar es Salaam, Tanzania
| | - Mobolaji Ibitoye
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Maina BW, Orindi BO, Osindo J, Ziraba AK. Depressive symptoms as predictors of sexual experiences among very young adolescent girls in slum communities in Nairobi, Kenya. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2020; 25:836-848. [PMID: 32537261 PMCID: PMC7254498 DOI: 10.1080/02673843.2020.1756861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/14/2020] [Indexed: 12/03/2022] Open
Abstract
Mental health issues are a predisposing factor for HIV acquisition. We examined the association between depressive symptoms and patterns of sexual experience among girls aged 10–14 years living in Korogocho and Viwandani slums in Nairobi, Kenya. We analysed data collected in 2017 from a random sample of 606 girls. Using Latent Class Analysis, we modelled patterns of sexual experiences and used multivariable regression analysis to determine the association between self-reported depressive symptoms and sexual experiences. Seven in ten girls reported at least one symptom of self-reported depression in the past 12 months. About 13% of girls had had a sexual experience, resulting in two patterns of sexual experience – naïve and experienced. Girls reporting depressive symptoms were more likely to be sexually experienced. Sexual and reproductive health programs targeting adolescent girls should consider including intervention packages that address mental health conditions such as depression.
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Affiliation(s)
- Beatrice W Maina
- African Population and Health Research Center, Nairobi, Kenya.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Benedict O Orindi
- African Population and Health Research Center, Nairobi, Kenya.,Department of Public Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium
| | - Jane Osindo
- African Population and Health Research Center, Nairobi, Kenya
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Parent-child sexual and reproductive health communication among very young adolescents in Korogocho informal settlement in Nairobi, Kenya. Reprod Health 2020; 17:79. [PMID: 32487239 PMCID: PMC7268390 DOI: 10.1186/s12978-020-00938-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 05/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background Parents are an important source of sexual and reproductive health (SRH) information for very young adolescents and are likely to have a significant influence on adolescents’ sexual attitudes, values, and risk-related beliefs. This study explored the nature and content of parent-child communication about SRH issues. Methods Thirty-two parents and 30 adolescent boys and girls aged between 11 and 13 years participated in narrative interviews in a resource-poor urban setting in Nairobi, Kenya. Interviews were audio-recorded, transcribed, translated into English, and uploaded on Atlas.ti software for coding and analysis. Results Findings from the study show gender differences in parent-child communication. More girls than boys reported that they had talked with their parents about romantic relationships. Four approaches—no communication, fear-based communication, supportive communication, and involving an external person were used by parents in SRH communication. Parents hostile attitudes towards romantic relationships during adolescence discouraged adolescents from disclosing their relationship status. While communication did occur, it was mainly reactive, one-sided, and authoritarian, often initiated by parents. Conclusions Parents need to be empowered with adequate and factual SRH information and effective communication strategies to enhance communication with very young adolescents. There is a need for further research to identify the most effective parent-child communication approaches to improve SRH outcomes among adolescents.
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Maina BW, Orindi BO, Sikweyiya Y, Kabiru CW. Gender norms about romantic relationships and sexual experiences among very young male adolescents in Korogocho slum in Kenya. Int J Public Health 2020; 65:497-506. [PMID: 32270236 PMCID: PMC7275025 DOI: 10.1007/s00038-020-01364-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives To investigate the association between gender norms about romantic relationships and sexual experiences of very young male adolescents (VYMA) living in Korogocho slum in Nairobi, Kenya. Methods We used cross-sectional data from a sample of 426 VYMA living in Korogocho slum. We conducted an exploratory factor analysis and confirmatory factor analysis to, respectively, explore and validate the factor structure underlying gender norms scale items. We used structural equation modelling to assess the association between gender norms and sexual experiences of VYMA. Results We found high endorsement of heteronormative beliefs about romantic relationships and low endorsement of sexual double standards. Sexual experience was associated with low endorsement of heteronormative beliefs, being pre-pubertal, school absenteeism and being below recommended grade for age. Sharing a sleeping room with more than two people, been born outside Nairobi, and living in households headed by older persons lowered the likelihood of sexual experience. Conclusions Our findings underscore the need for further research to understand how gender norms evolve as young boys transition through adolescence to adulthood and how these changes impact on sexual behaviors Electronic supplementary material The online version of this article (10.1007/s00038-020-01364-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Beatrice W. Maina
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Benedict O. Orindi
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Yandisa Sikweyiya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Caroline W. Kabiru
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Population Council, Nairobi, Kenya
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Ninsiima AB, Michielsen K, Kemigisha E, Nyakato VN, Leye E, Coene G. Poverty, gender and reproductive justice. A qualitative study among adolescent girls in Western Uganda. CULTURE, HEALTH & SEXUALITY 2020; 22:65-79. [PMID: 32045321 DOI: 10.1080/13691058.2019.1660406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/22/2019] [Indexed: 06/10/2023]
Abstract
Low socio-economic status has been consistently identified as a primary risk factor for sexual and reproductive health violations affecting young women. This study shows how poverty interacts with gender power relations to impact upon adolescent girls' sexual and reproductive lives in Western Uganda. Qualitative research with 147 participants was undertaken. This comprised 59 in-depth interviews and 11 focus group discussions with groups of 12-14 year-old young women, teachers and parents. Data were analysed manually using open and axial coding, and conclusions were generated inductively. Findings reveal that young women are restricted in exercising their sexual and reproductive rights not only by poverty and unequal gender relations, but also by corruption and poor service provision. In contrast to interventions using liberal rights-based approaches, we advocate the use of a 'marketplace of options' since access to sexual and reproductive health services is very limited for poor girls and not evenly distributed. Moreover, while poverty and unequal gender relations render girls vulnerable to sexual coercion and violence, the criminal justice system is often weak, leaving victims powerless. Investment in appropriate resources and inclusive and affordable access to justice is essential to advance young women's sexual and reproductive health.
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Affiliation(s)
- Anna B Ninsiima
- Research Centre on Gender, Diversity and Intersectionality, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kristien Michielsen
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Elizabeth Kemigisha
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Viola N Nyakato
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Els Leye
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Gily Coene
- Research Centre on Gender, Diversity and Intersectionality, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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