Nonmarital Sex and Condom Knowledge among Ethiopian Young People: Improved Estimates Using a Nonverbal Response Card

Misperception of peer beliefs reinforces inequitable gender norms among Tanzanian men

Gender role ideology, i.e. beliefs about how genders should behave, is shaped by social learning. Accordingly, if perceptions about the beliefs of others are inaccurate this may impact trajectories of cultural change. Consistent with this premise, recent studies report evidence of a tendency to overestimate peer support for inequitable gender norms, especially among men, and that correcting apparent 'norm misperception' promotes transitions to relatively egalitarian beliefs. However, supporting evidence largely relies on self-report measures vulnerable to social desirability bias. Consequently, observed patterns may reflect researcher measurement error rather than participant misperception. Addressing this shortcoming, we examine men's gender role ideology using both conventional self-reported and a novel wife-reported measure of men's beliefs in an urbanising community in Tanzania. We confirm that participants overestimate peer support for gender inequity. However, the latter measure, which we argue more accurately captures men's true beliefs, implies that this tendency is relatively modest in magnitude and scope. Overestimation was most pronounced among men holding relatively inequitable beliefs, consistent with misperception of peer beliefs reinforcing inequitable norms. Furthermore, older and poorly educated men overestimated peer support for gender inequity the most, suggesting that outdated and limited social information contribute to norm misperception in this context.

Life expectations in early adolescence and the timing of first sex and marriage: evidence from a longitudinal survey in Ethiopia

BACKGROUND

Raising the median age at first sexual intercourse and first marriage among females is a policy goal of the Ethiopian government. Education figures prominently in the government's plans for achieving its goals, including primary and secondary schools; higher education; and out-of-school interventions such as youth centers, peer clubs, and youth associations In this study, we tested whether adolescents and youth who had high educational and occupational expectations at younger ages were at a lower risk of first sexual intercourse and marriage during adolescence and early adulthood.

METHODS

Data came from multiple waves of a longitudinal survey of households and adolescents conducted in southwestern Ethiopia. A measure of career expectations was created from educational and occupational expectations measured at baseline when the adolescents were ages 13-17. The occurrence and timing of first sexual intercourse (called first sex) and marriage were measured four years later in a wave 3 survey. Discrete-time logistic hazard regression models were applied to a person-year file to predict first sex for males and females separately and first marriage for females.

RESULTS

Male and female adolescents who had high career expectations at young ages were at a significantly lower risk of first sex during adolescence and early adulthood. Unlike the delaying effect of being in school, the effect of high career expectations did not wear off as adolescents aged. Among female adolescents, delaying first sex, staying in school, and having parents who desired them to marry at older ages were all associated with a significantly lower risk of marriage during adolescence and early adulthood.

CONCLUSIONS

The educational and occupational expectations and family plans that youth develop early in adolescence influence the timing of the transition into sexual activity and marriage. Ethiopian youth who develop high career expectations delay first sex, which for female youth is a key predictor of age at first marriage. Adolescents' perceptions of parents' expectations for them are strongly associated with their own expectations and behavior.

Nonverbal Response Cards Reduce Socially Desirable Reporting of Violence Among Adolescents in Rural Burkina Faso: A Randomized Controlled Trial

PURPOSE

Accurate measures of violence are difficult to obtain from self-reported data because of stigmatization and social undesirability of the topic. Most methods that attempt to reduce such biases require literacy and either remove the benefits of interviewer guidance or do not give individual-level results. We tested a low-tech nonverbal response card that avoids revealing interviewees' responses to interviewers while retaining interviewer support among adolescents in communities with very low educational attainment.

METHODS

As part of a broader health questionnaire, we asked a sample of 1,644 adolescents, aged 12-20 years, in northwestern Burkina Faso about their experiences of physical and sexual violence. We randomized participants to either a conventional verbal response arm or a nonverbal response card arm where respondents' answers were unspoken and not displayed to interviewers. We first evaluated response validity and reliability in each arm, then compared prevalence rates across arms and evaluated whether any differences varied by respondent characteristics using regression models.

RESULTS

The level of internal reliability of responses among nonverbal respondents was similar to or greater than that of verbal respondents. Nonverbal respondents reported similar patterns of physical assault and sexual debut as verbal respondents but significantly higher levels of sexual assault and forced sex. These differences were broadly similar across sample subgroups defined by age, gender, proneness to social desirability, and mental health.

CONCLUSIONS

Nonverbal response cards offer a practical and beneficial method for reducing underreporting of stigmatized and traumatic experiences while maintaining data quality in low-literacy populations.

He for she? Variation and exaggeration in men's support for women's empowerment in northern Tanzania

Achieving gender equality fundamentally requires a transfer of power from men to women. Yet data on men's support for women's empowerment (WE) remains scant and limited by reliance on self-report methodologies. Here, we examine men's support for WE as a sexual conflict trait, both via direct surveys (n = 590) and indirectly by asking men's wives (n = 317) to speculate on their husband's views. Data come from a semi-urban community in Mwanza, Tanzania. Consistent with reduced resource competition and increased exposure to relatively egalitarian gender norms, higher socioeconomic status predicted greater support for WE. However, potential demographic indicators of sexual conflict (high fertility, polygyny, large spousal age gap) were largely unrelated to men's support for WE. Contrasting self- and wife-reported measures suggests that men frequently exaggerate their support for women in self-reported attitudes. Discrepancies were especially pronounced among men claiming the highest support for WE, but smallest among men who held a professional occupation and whose wife participated in wage labour, indicating that these factors predict genuine support for WE. We discuss the implications of these results for our understanding of both individual variation and patriarchal gender norms, emphasising the benefits of greater exchange between the evolutionary human sciences and global health research on these themes.

Premarital sex and pregnancy in Greater Jakarta

Social taboos and stigmas around sexuality and non-marital sex in Indonesia have led to substantial underreporting of the prevalence of premarital sex. In this study, we explore underreporting amongst young adults in Greater Jakarta. We use the 2010 Greater Jakarta Transition to Adulthood Survey (GJTAS), a survey of more than 3000 people aged 20–34 years, to derive estimates of underreporting based on discrepancies reported in the timing of marriage, first child birth and first sexual intercourse and sexual activities. Survival and life table analyses are utilised to identify individual and societal predictors of premarital sex and its reporting and to estimate cumulative incidence across young adulthood. The results reveal substantial evidence of underreporting, particularly amongst women, arising from premarital pregnancies. We estimate that the proportion of the female cohort who will engage in premarital sex by the age of 35 years increases from 4.4 to 22% after taking into account evidence of underreporting. Premarital pregnancies and unreported premarital sex is found to be particularly common amongst lower educated people. This raises important questions for policy and research in terms of the provision of information and support for young couples and the methodological implications of substantial underreporting.

Does schooling protect sexual health? The association between three measures of education and STIs among adolescents in Malawi

While multiple studies have documented shifting educational gradients in HIV prevalence, less attention has been given to the effect of school participation and academic skills on infection during adolescence. Using the Malawi Schooling and Adolescent Study, a longitudinal survey that followed 2,649 young people aged 14-17 at baseline from 2007 to 2013, we estimate the effect of three education variables: school enrolment, grade attainment, and academic skills-numeracy and Chichewa literacy-on herpes simplex virus type 2 (HSV-2) and HIV incidence using interval-censored survival analysis. We find that grade attainment is significantly associated with lower rates of both HSV-2 and HIV among girls, and is negatively associated with HSV-2 but not HIV among boys. School enrolment and academic skills are not significantly associated with sexually transmitted infections (STIs) for boys or girls in our final models. Efforts to encourage school progression in high-prevalence settings in sub-Saharan Africa could well reduce, or at least postpone, acquisition of STIs.

Delaying first birth: an analysis of household survey data from rural Southern Tanzania

BACKGROUND

Currently, family planning metrics derived from nationally-representative household surveys such as the Demographic and Health Surveys (DHS) categorise women into those desiring to space or limit (permanently stop) births, or according to their age in the case of young women. This conceptualisation potentially ignores a large and growing group of young women who desire to delay a first birth. This study uses household survey data to investigate the characteristics and needs for family planning of women who want to delay their first birth.

METHODS

The research was conducted in two rural districts in southern Tanzania (Tandahimba and Newala), and nested within the Expanded Quality Management Using Information Power (EQUIP) study. Data were collected as part of a repeated cross sectional household survey conducted between September 2013 and April 2014. The socio-demographic characteristics, including parity, contraceptive practices and fertility intentions of 2128 women aged 13-49 were analysed. The association between women's life stages of reproduction (delayers of first birth, spacers of subsequent pregnancies and limiters of future birth) and selected contraceptive outcomes (current use, unmet need and demand for modern contraceptives) was assessed using the point estimates and 95% confidence intervals for each indicator, adjusted for the survey design.

RESULTS

Overall, four percent of women surveyed were categorised as 'delayers of first birth', i.e. sexually active but not started childbearing. Among this group, the majority were younger than 20 years old (82%) and unmarried (88%). Fifty-nine percent were currently using a modern method of contraception and injectables dominated their contraceptive use. Unmet need for contraception was higher among delayers (41%; 95% CI 32-51) and limiters (41%; 95% CI 35-47) compared to spacers (19%; 95% CI 17-22).

CONCLUSIONS

Delayers of first birth have very high unmet needs for modern contraceptives and they should be routinely and separately categorised and measured within nationally-representative surveys such as Demographic and Health Survey and Multiple Indicator Cluster surveys. Acknowledging their unique needs could help catalyse a programmatic response.

Prevalence and risk factors of sexual dysfunction in postpartum Australian women

INTRODUCTION

Female sexual dysfunction is highly prevalent and reportedly has adverse impacts on quality of life. Although it is prevalent after childbirth, women rarely seek advice or treatment from health care professionals.

AIM

The aim of this study was to assess the sexual functioning of Australian women during the first year after childbirth.

METHODS

Postpartum women who had given birth during the previous 12 months were invited to participate in this cross-sectional study. A multidimensional online questionnaire was designed for this study. This questionnaire included a background section, the Female Sexual Function Index, the Patient Health Questionnaire (PHQ-8), and the Relationship Assessment Scale. Responses from 325 women were analyzed.

RESULTS

Almost two-thirds of women (64.3%) reported that they had experienced sexual dysfunction during the first year after childbirth, and almost three-quarters reported they experienced sexual dissatisfaction (70.5 %). The most prevalent types of sexual dysfunction reported by the affected women were sexual desire disorder (81.2%), orgasmic problems (53.5%), and sexual arousal disorder (52.3%). The following were significant risk factors for sexual dysfunction: fortnightly or less frequent sexual activity, not being the initiator of sexual activity with a partner, late resumption of postnatal sexual activity (at 9 or more weeks), the first 5 months after childbirth, primiparity, depression, and relationship dissatisfaction.

CONCLUSION

Sexual satisfaction is important for maintaining quality of life for postpartum women. Health care providers and postpartum women need to be encouraged to include sexual problems in their discussions.

Sex ratio effects on reproductive strategies in humans

Characterizations of coy females and ardent males are rooted in models of sexual selection that are increasingly outdated. Evolutionary feedbacks can strongly influence the sex roles and subsequent patterns of sex differentiated investment in mating effort, with a key component being the adult sex ratio (ASR). Using data from eight Makushi communities of southern Guyana, characterized by varying ASRs contingent on migration, we show that even within a single ethnic group, male mating effort varies in predictable ways with the ASR. At male-biased sex ratios, men's and women's investment in mating effort are indistinguishable; only when men are in the minority are they more inclined towards short-term, low investment relationships than women. Our results support the behavioural ecological tenet that reproductive strategies are predictable and contingent on varying situational factors.

Recent trends in the timing of first sex and marriage among young women in Ethiopia

CONTEXT

Ethiopia has been characterized by high population growth. Recent social and economic developments have the potential to alter reproductive patterns in the country. Some of these developments include sustained economic growth, urbanization, rapid growth in school enrollments, expansion of primary health care, and a rise in contraceptive access and use. In other national contexts, these developments have been associated with a gradual decoupling of the transition into sexual activity and marriage among young women. We investigate recent trends in the transition into first sex and marriage among three cohorts of Ethiopian women.

METHODS

Using data from the 2000, 2005, and 2011 Ethiopia Demographic and Health Surveys (DHS) we estimate survival curves and discrete-time hazards models to examine recent trends in age at first sex and first marriage among women ages 20-29.

RESULTS

Across the three survey years the median age at first sex has remained relatively stable at 17 years, although the median age at marriage has increased from 17 to 18 years between the 2005 and 2011 surveys. Net of the effects of education and place of residence, there is evidence of a slight trend away from premarital first sex to sexual initiation in the context of marriage. However, among the most educated women and women living in urban areas (who are a small minority of women), there is a much greater tendency to initiate sexual activity outside of marriage compared to women with little schooling and women living in rural areas, and once they have begun sexual activity they tend to wait longer before they get married. We also find evidence in the most recent survey that women who have first sexual intercourse before marriage are delaying marriage more than was the case among earlier cohorts.

Challenges in measuring the sequencing of life events among adolescents in Malawi: a cautionary note

Using data from two rounds of the Malawi Schooling and Adolescent Survey, this research note examines consistency of retrospective reporting on the timing and sequencing of sexual initiation, school leaving, and marriage. The analysis, which compares reporting of events both within and between rounds, indicates substantial inconsistency in reporting of event sequences and highlights difficulties in measuring transitions to adulthood in sub-Saharan Africa with survey data.

Attitudinal and behavioral characteristics predict high risk sexual activity in rural Tanzanian youth

The incidence of HIV infection in rural African youth remains high despite widespread knowledge of the disease within the region and increasing funds allocated to programs aimed at its prevention and treatment. This suggests that program efficacy requires a more nuanced understanding of the profiles of the most at-risk individuals. To evaluate the explanatory power of novel psychographic variables in relation to high-risk sexual behaviors, we conducted a survey to assess the effects of psychographic factors, both behavioral and attitudinal, controlling for standard predictors in 546 youth (12–26 years of age) across 8 villages in northern Tanzania. Indicators of high-risk sexual behavior included HIV testing, sexual history (i.e., virgin/non-virgin), age of first sexual activity, condom use, and number of lifetime sexual partners. Predictors in the statistical models included standard demographic variables, patterns of media consumption, HIV awareness, and six new psychographic features identified via factor analyses: personal vanity, family-building values, ambition for higher education, town recreation, perceived parental strictness, and spending preferences. In a series of hierarchical regression analyses, we find that models including psychographic factors contribute significant additional explanatory information when compared to models including only demographic and other conventional predictors. We propose that the psychographic approach used here, in so far as it identifies individual characteristics, aspirations, aspects of personal life style and spending preferences, can be used to target appropriate communities of youth within villages for leading and receiving outreach, and to build communities of like-minded youth who support new patterns of sexual behavior.

Lifting the curtain on the conditions of sexual initiation among youth in Ethiopia

PURPOSE

Deriving accurate estimates of the level of sexual coercion is challenging because of the stigma that is attached to the experience. This study examines the effectiveness of a nonverbal response-card method to reduce social desirability bias in reports of the conditions of sexual initiation among youth in southwestern Ethiopia.

METHODS

The conditions surrounding sexual initiation are examined using data from a pilot survey and a final survey of youth aged 13-24 years. Half of the respondents in each survey were randomly assigned to a nonverbal response-card method for sensitive questions on sexual attitudes and behavior, and the other half of the respondents were assigned to a control group that provided verbal responses. Responses for the two groups to questions regarding the conditions of sexual initiation are compared.

RESULTS

Respondents who used the nonverbal response card were more likely to report pressure from friends or a partner, having sex for money or another gain, and rape as conditions of sexual initiation than those who provided verbal responses. Among sexually experienced youth, 29.3% of respondents who used the card method reported some form of coercion during sexual initiation compared with 19.4% of respondents who gave verbal responses.

CONCLUSIONS

The nonverbal response card provides an effective method for reducing social desirability bias when soliciting responses to sensitive questions in the context of an interviewer-administered survey. The analysis also suggests that coerced sexual initiation is underreported by youth in interviewer-administered surveys that use conventional verbal responses.

The relationship history calendar: improving the scope and quality of data on youth sexual behavior

Most survey data on sexual activities are obtained via face-to-face interviews, which are prone to misreporting of socially unacceptable behaviors. Demographers have developed various private response methods to minimize social desirability bias and improve the quality of reporting; however, these methods often limit the complexity of information collected. We designed a life history calendar-the Relationship History Calendar (RHC)-to increase the scope of data collected on sexual relationships and behavior while enhancing their quality. The RHC records detailed, 10-year retrospective information on sexual relationship histories. The structure and interview procedure draw on qualitative techniques, which could reduce social desirability bias. We compare the quality of data collected with the RHC with a standard face-to-face survey instrument through a field experiment conducted among 1,275 youth in Kisumu, Kenya. The results suggest that the RHC reduces social desirability bias and improves reporting on multiple measures, including higher rates of abstinence among males and multiple recent sexual partnerships among females. The RHC fosters higher levels of rapport and respondent enjoyment, which appear to be the mechanisms through which social desirability bias is minimized. The RHC is an excellent alternative to private response methods and could potentially be adapted for large-scale surveys.

Food insecurity and age at menarche among adolescent girls in Jimma Zone Southwest Ethiopia: a longitudinal study

BACKGROUND

Age at menarche is the reflection of cumulative pre-adolescent exposure of girls to either adverse environment such as food insecurity or affluent living conditions. Food insecurity could result in inadequate nutrient intake and stress, both of which are hypothesized to have opposing effects on the timing of menarche through divergent pathways. It is not known whether food insecure girls have delayed menarche or early menarche compared with their food secure peers. In this study we test the competing hypothesis of the relationship between food insecurity and age at menarche among adolescent girls in the Southwest Ethiopia.

METHODS

We report on 900 girls who were investigated in the first two rounds of the five year longitudinal survey. The semi-parametric frailty model was fitted to determine the effect of adolescent food insecurity on time to menarche after adjusting for socio-demographic and economic variables.

RESULTS

Food insecure girls have menarche one year later than their food secure peer (median age of 15 years vs 14 years). The hazard of menarche showed a significant decline (P = 0.019) as severity of food insecurity level increased, the hazard ratio (HR) for mild food insecurity and moderate/severe food insecurity were 0.936 and 0.496, respectively compared to food secure girls. Stunted girls had menarche nearly one year later than their non-stunted peers (HR = 0.551, P < 0.001).

CONCLUSION

Food insecurity is associated with delay of age at menarche by one year among girls in the study area. Stunted girls had menarche one year later than their non-stunted peers. Age at menarche reflects the development of girls including the timing of sexual maturation, nutritional status and trajectory of growth during the pre-pubertal periods. The findings reflect the consequence of chronic food insecurity on the development and well-being of girls in the study area.