Country-Level Gender Equality and Adolescents' Contraceptive Use in Europe, Canada and Israel: Findings from 33 Countries

Assessing Condom Use and Views on HIV Counselling and Testing among TVET College Students in Limpopo Province, South Africa

South Africa's population is predominantly young, presenting a powerful resource for the country. Despite this, adolescents and young people remain at the epicentre of the HIV epidemic, particularly adolescent girls and young women (AGYW). There are limited studies that investigate the views on HIV Counselling and Testing (HCT) and condom use among adolescents and young people, and college students in particular, in South Africa. This cross-sectional study assessed condom use among college students and their views and opinions on HCT. Utilising an adapted questionnaire from the Australian Secondary students and the South African Sexual Health survey, the data from 396 students were analysed using univariate and multiple logistic regression performed using Stata IC version 16. The majority of the students (n = 339, 85.8%) had a sexual partner at the time of the study. Our findings reveal a relatively high occurrence of condom use in the last sexual encounter (n = 225, 60%) and high HCT uptake (n = 50, 88.4%). Females were generally more comfortable regarding HIV services compared to their male counterparts. More than half, 54.6% vs. 36.0% were comfortable about testing, 34.0% vs. 48.3% felt very scared about testing for HIV, 3.6% vs. 10.1% reported that they were not ready to take an HIV test, 7.6% vs. 5.6% intended getting tested soon (p = 0.0002). Condom use was significantly associated with the use of a condom during the first sexual encounter (aOR = 4.71, 95% CI: 2.14, 10.37) and knowing their partner's HIV status (aOR = 2.08, 95% CI: 1.19-3.65). The HCT and condom promotion strategies implemented by Higher Health in TVET colleges is showing success and colleges in other parts of the region could emulate these best practices. Program developers should consider tailor-made combinations of prevention interventions that would appeal to both female and male college students to improve condom use and uptake of HIV testing services.

Differences by age group in gender-related attitudes in Oromia, Ethiopia: Findings from a cross-sectional study of women of reproductive age

Attitudes on gender roles affect decision-making dynamics, resource distribution, and income-generating opportunities. However, little is known about how attitudes on gender roles differ by age group. Cross-sectional data collected from 1,113 households in Oromia, Ethiopia were used to assess differences in gender-related attitudes across female "youth" (ages 15-24), "young adults" (ages 25-34), and "older adults" (ages 35-49). Fifteen survey questions using a Likert scale measured attitudes on sexual and reproductive behaviors, expectations around livelihood activities, and perceived influence in household decision making. Associations between attitudes and age group were assessed using the Chi-squared test. Measures of perceived influence in decision making differed significantly by age group for household decisions about participation in wage employment, and use of revenue generated from wage employment, and crop and livestock production. Response patterns were consistent, with youth least likely to feel they have influence in decision making. The results suggest that policies and programs should continue to support the agency of female youth.

Separation-individuation from the community among religious Jewish teens in Israel

We wished to understand the contribution of personal, family, and community factors to the risky behaviors (RBs) of religious Jewish teens in Israel, and whether sense of community belonging mediated the religious estrangement/RB association. A convenience sample comprised 645 adolescents aged 14-19 (420 female/225 male) from Israel's national-religious sector was used in this study. Sociodemographic characteristics, self-esteem, future orientation, degree of religious estrangement, perceived parental acceptance, and sense of community belonging were reported. Being a male, older, and living in a rural community were associated with more RBs, as were higher religious estrangement and less acceptance from the mother. Sense of community was found to partially mediate the religious estrangement/RB association. We extended Blos's conceptualization of adolescence as a second separation-individuation from the parents to include a parallel process of separation-individuation from the community. The results may help in designing interventions for adolescents in religious communities.

Relationship Between Gender Equality and Husband Support in the Use of Postpartum Family Planning (PPFP)

Introduction

Postpartum family planning (PPFP) has been reported to decrease the risk of stunting by increasing the interval between pregnancies by 0.9 percent every month. In Indonesia, the prevalence of stunting affects 21.6% in 2022; however, it is expected that by 2024, the figure would drop to 14%.

Objective

This study aims to analyze the relationship between gender equality and husband support in the use of PPFP.

Methods

The study was conducted using a cross-sectional method and took place from August to October 2022. The participants comprised 210 women who had given birth in the first 4 to 12 months in Kulon Progo, Yogyakarta, Indonesia. The data was collected from women who visited the pediatrics and family planning clinics of community health centers from August to October 2022, using a structured questionnaire and analyzed using both the Chi-Square Test and Binary Logistic Regression Analysis.

Results

The results showed that 38.1% of the participants used PPFP. The estimated results reveal that variables such as education, husband support, gender equality, home visits, and postnatal visits (p < 0.05) influenced the implementation of postpartum contraception. While other variables such as age, occupation, income, number of children, and parity did not affect the model (p > 0.05).

Conclusion

Participating in postpartum family planning requires the husband's support and gender equality. We recommend a deliberate effort on improving postnatal mothers using postpartum family planning, one of the strategies is to increase intensive outreach to pregnant women with higher education to their husbands about the importance of postpartum family planning.

Prevalence of Good Condom Usage and Its Association with Condom Use Self-Efficacy among Youth Attending HIV/STDs Clinics in Primary-Care Settings in Malaysia

The low prevalence of condom usage among youth with Human Immunodeficiency Virus/Sexually Transmitted Diseases (HIV/STDs) is a concern. Condom use self-efficacy has been identified as a significant predictor of condom usage. This cross-sectional study examines the prevalence of good condom usage and its association with condom use self-efficacy among Malaysian urban youth, aged between 18 to 24 years old attending HIV/STDs clinics in primary-care settings, Selangor. Utilising the Harmonised Malay version of Condom Use Self-Efficacy Scale (CUSES M-H) questionnaire, the data from 218 responders were analysed using univariate and multiple logistic regression. The prevalence of good condom usage was 61% (95% CI: 54%, 68%). The average mean score of condom use self-efficacy was 3.07. Condom use self-efficacy was divided into four subscales of mechanics, perceived barriers, assertiveness and intoxicants. The assertiveness subscale had the highest average mean score of 3.42, while the intoxicant subscale score had the lowest average mean score of 2.24. Good condom usage was significantly associated with condom use during first sexual intercourse (aOR = 5.81, 95% CI: 1.97, 17.14), duration diagnosis of HIV/STDs of more than 12 months (aOR = 6.40, 95% CI: 2.30, 17.86) and the high assertiveness subscale score (aOR = 1.19, 95% CI: 1.03, 1.36). A behavioural change campaign that targets high-risk youth in primary care settings could promote condom use self-efficacy particularly assertiveness to increase condom usage among the youth.

Sexuality education for young people in Germany.Results of the 'Youth Sexuality' representative repeat survey

The Federal Centre for Health Education (BZgA) has been conducting the 'Youth Sexuality' representative survey on a regular basis since 1980. This continuous monitoring generates insights into the sexual and reproductive health of young people in Germany and constitutes an important basis for evidence-based health communication. A total of N=6,032 young people between the ages of 14 and 25 participated in a combination of oral and written interviews (Computer Assisted Personal Interviews (CAPI)). As primary sources of knowledge for, adolescents state that they obtain information through school lessons (69%), personal discussions (68%), and the Internet (59%). In addition to these sources, professional gynaecological counselling and sexuality education at home are also important sources of information. To what extent trusted contact persons are available in the family depends heavily on the adolescents' sociocultural backgrounds. Providing information and disseminating knowledge to young people in the field of sexual and reproductive health is organised intersectorally in Germany. In this way, it is possible to also reach those who do not have any contact persons at their disposal in their direct family. Maintaining and strengthening the current commitment in promoting sexual health is of key importance, as only this will ensure the next generation's sexual and reproductive health, and provide an evidence-based counterbalance to anecdotal information, especially in the digital domain.

Male condom and dual protection use by adolescent men in Brazil

OBJECTIVE

To assess the use of male condoms and dual protection by Brazilian adolescent men, as well as their associated aspects.

METHODS

A database from the Study of Cardiovascular Risks in Adolescents (ERICA) was used for this national cross-sectiotabelnal school-based research. The sample included adolescents of both sexes, aged between 12 and 17 years old, selected through cluster sampling in 2014 (n = 75,060). This study analyzed information from adolescent men who reported having had sexual intercourse (n = 12,215). The dependent variables were the use of male condoms and the use of dual protection (simultaneous use of male condoms and oral hormonal contraceptives) in the last sexual intercourse. Data were analyzed using univariate and multiple logistic regression.

RESULTS

Most adolescents used a male condom in the last sexual intercourse, while the use of double protection was quite low. The use of male condoms, reported by 71% (95%CI 68.7-73.1), was positively associated with age, living with both parents, and having used alcohol in the previous 30 days. The use of double protection, reported by 3.6% (95%CI 2.8-4.5) was positively associated with age and studying in a private school, as well as negatively associated with tobacco use in the previous 30 days.

CONCLUSIONS

The wide difference shown in the proportion of condom or dual protection use in the last sexual intercourse draws attention to the different logics that govern juvenile sexual relations. The low proportion of dual protection use may be a reflection of men's lack of knowledge about a function that has historically been attributed to women, which is contraception. Thus, one must deconstruct such dichotomy that the sphere of sexuality is of the domain/interest of men, while that of reproduction concerns only women.

Prevalence and inequalities in contraceptive use among adolescents and young women: data from a birth cohort in Brazil

Monitoring trends of contraceptive use and identifying the groups with less coverage are needed to guide public policies and make them more efficient. But, in Brazil, recent data about these aspects are limited. This study aimed to investigate the prevalence of contraceptive use and its inequalities during adolescence and early adulthood. Data from the 1993 Pelotas birth cohort, Rio Grande do Sul State, Brazil, were used. At 15, 18 and 22 years, respectively, 335, 1,458 and 1,711 women reported having started their sexual lives and were included in analysis. Prevalence and 95% confidence intervals were obtained to describe the most used contraceptive methods. Inequalities in modern contraceptive use were evaluated according to wealth index, scholastic backwardness and ethnicity. In all follow-ups, more than 80% of women used at least one modern method. The use of barrier methods decreased with age; at 22 this prevalence was 36.3%. Such use concomitant with other modern methods was lower than 50% in all follow-ups. We observed inequalities in the use of modern contraceptive methods, mainly in barrier methods used with other modern methods. These findings may contribute and improve the public policies in family planning.

[Sexual and contraceptive behavior of adolescents and young adults in Germany. Current results of the representative survey "Youth Sexuality"]

BACKGROUND

Since 1980, the Federal Centre for Health Education (BZgA) has regularly conducted the "Youth Sexuality" representative surveys. This continuous monitoring generates insights on the sexual and reproductive health of young people in Germany. The survey provides an important basis for the development of sexuality education and family planning measures.

AIM

The current sexual and contraceptive behavior of adolescents and young adults will be summarized using initial descriptive results from the ninth iteration of the survey.

METHODS

A total of N = 6032 adolescents and young adults participated in the survey. Data collection was conducted by computer-assisted personal interviewing (CAPI) in 2019.

RESULTS

A key finding of this iteration is that with regards to the age of the first sexual intercourse, the proportion of adolescents younger than 17 years has been declining for several years. For contraception, adolescents most frequently used condoms, and use of the pill has decreased.

DISCUSSION

The data from the current iteration indicate safe and responsible contraceptive behavior among young people in Germany. Nevertheless, it is important to maintain the commitment in the field of sexual health promotion and expand prevention measures for specific target groups. This is the only way to ensure the sexual and reproductive health of the next generation.

Individual and context correlates of the oral pill and condom use among Brazilian female adolescents

Background

Studies have examined the impact of contextual factors on the use of contraceptives among adolescents and found that many measures of income and social inequality are associated with contraceptive use. However, few have focused on maternal and primary health indicators and its influence on adolescent contraceptive use. This paper assesses whether maternal mortality rates, antenatal care visits, and primary healthcare coverage are associated with pill and condom use among female adolescents in Brazil.

Methods

We used data from the Study of Cardiovascular Risks in Adolescents (ERICA), a national, school-based cross-sectional study conducted in Brazil. A subsample of all female adolescents who had ever had sexual intercourse and were living in one of the 26 State capitals and the Federal District was selected (n = 7415). Multilevel mixed effects logistic regression models were estimated to examine the effect of contextual variables on pill and condom use.

Results

Sixty-five percent of female adolescents reported using pill while 21.9% reported using condom during the last sexual intercourse. Adolescents living in municipalities with low maternal mortality and high antenatal care coverage were significantly more likely to use pill during the last sexual intercourse compared to those from municipalities with high maternal mortality and low antenatal care coverage. Primary healthcare coverage (proportion of the population covered by primary healthcare teams) was not significantly associated with either condom or pill use during the last sexual intercourse.

Conclusion

Our findings suggest that promoting the use of pill among female adolescents may require approaches to strengthen healthcare systems rather than those focused solely on individual attributes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01447-6.

Rate of condom use among sexually active adolescents: a nationwide cross-sectional study in Taiwan from 2012 to 2016

OBJECTIVE

Adolescents' sexual behaviours are associated with sexually transmitted infections and unwanted pregnancies. This study aimed to estimate the sexual intercourse and condom use rates at first and last sex among Taiwanese adolescents in grades 7-12.

DESIGN

A secondary data analysis of the Taiwan Global School-Based Student Health Survey's 2012-2016 data. The survey was anonymous, cross-sectional and nationwide.

SETTING

Taiwan high school students (grades 7-12).

PARTICIPANTS

The sample comprised 27 525 students from junior high schools (grades 7-9), and senior high schools, comprehensive schools, vocational high schools and night schools (grades 10-12).

MAIN OUTCOME MEASURES

The rate of ever having had sexual intercourse; the rates and factors of condom use at first and last sex.

RESULTS

The sexual intercourse rate in each school type (in ascending order) was junior high school (1.62%), senior high school (4.14%), comprehensive school (9.08%), vocational high school (14.03%) and night school (41.09%). Condom use rate decreased from 57.07% (95% CI=54.31% to 59.83%) at first sex to 25.72% (95% CI=23.34% to 28.10%) at last sex (p<0.0001). The condom use rate (in ascending order) was junior high school (first sex: 37.67%, last sex: 19.76%), night school (55.83%, 22.62%), vocational high school (61.13%, 25.78%), comprehensive school (62.83%, 28.61%) and senior high school (68.38%, 34.96%). Older age at sexual debut was associated with condom use at first and last sex, and having one sexual partner was associated with condom use at last sex, as revealed by logistic regression analysis.

CONCLUSIONS

This study highlights an urgent need to instil a proper understanding of protected sex while adolescents are still in their formative years. Despite the low sexual intercourse rate (4.95%), there is lower condom use at last sex than at first sex, which indicates that many sexually active adolescents are not practising protected sex, especially among junior high school students.

Acceptability of immediate postpartum and post-abortion long-acting reversible contraception provision to adolescents: A systematic review

INTRODUCTION

Long-acting reversible contraception (LARC) methods are safe for adolescents and provide the greatest assurance against rapid repeated pregnancy when inserted during the immediate postpartum (IPP) and immediate post-abortion (IPA) period. Despite increasing enthusiasm for IPP/IPA LARC insertion, adolescents' preferences and experiences have seldom been examined. The objective of this review was to examine the attitudes of adolescents (aged 10-19 years) towards IPP/IPA LARC, their experiences and perceptions around having an LARC device fitted IPP/IPA and the factors involved in decision-making to use, not use or discontinue IPP/IPA LARC.

MATERIAL AND METHODS

In January 2021, we searched seven bibliographic databases for original research articles published in English, from the year 2000. Studies of any design focused on IPP/IPA LARC were eligible for inclusion. Three of the authors assessed articles for eligibility and extracted data relevant to the outcomes of the review. Joanna Briggs Institute Critical Appraisal Tools were used to assess methodological quality. Key themes emerging from the data were synthesized and reported narratively.

RESULTS

We identified 10 relevant articles, four of which were entirely adolescent-focused. Only three addressed IPA LARC. IPP availability was important for ensuring access to LARC postpartum. Attitudes towards LARC IPP were associated with adolescents' sociodemographic characteristics and positive perceptions related to the long duration of action. Determinants of discontinuation and nonuse included poor-quality contraceptive counseling, intolerable side effects and subsequent distress, misconceptions about LARC safety IPP and the influence of partners and community on autonomy. No factors involved in IPA LARC decision-making were available. Limited evidence demonstrated that adolescents may favor contraceptive implants over intrauterine devices, and in certain contexts may face greater barriers to IPA LARC access than adult women do.

CONCLUSIONS

Immediate insertion of LARC postpartum appears acceptable to adolescents who do not experience side effects and those with the opportunity to make autonomous contraception decisions. This important topic has been addressed in few studies involving an entirely adolescent population. Very limited evidence is available on IPA LARC. Further research on adolescents' lived experiences of IPP/IPA LARC access and use is necessary to inform the provision of person-centered care when assisting adolescents' contraceptive choice following pregnancy.

Gender Equity and Vertically Transmitted Infections: A Country-Level Analysis Across 153 Countries

Purpose: Gender inequality is a barrier to education toward women and accessibility to health facilities, which are important for preventing vertical transmission. This study was conducted to analyze the impact of gender equity on vertically transmitted infections (hepatitis viruses, human immunodeficiency virus [HIV], and syphilis) using country-level indicators.

Methods: The relationship between the Global Gender Gap Index (GGGI), which is indicator of gender equity, and vertical transmission was analyzed. GGGI scores were collected from 153 countries in 2020. Vertical transmission included 10 outcomes for hepatitis viruses, HIV, and syphilis. Generalized linear model (GLM) was used for analyzing the relationship. Other predictors included skilled birth attendant and country income.

Results: The median GGGI score was 0.706 (interquartile range, 0.664–0.736). GLM showed that the GGGI score was significantly associated with the incidence of both chronic hepatitis B and C in under 5 years (both p<0.001). For HIV, GGGI score was significantly associated with the pregnant women with unknown HIV status (p=0.001), no early infant diagnosis (p=0.027), and final transmission rate (p=0.005). There was no significant predictor for pregnant women who have not received antiretroviral therapy for prevention of mother-to-child transmission. All syphilis indicators have improved in high-income countries compared to low-income countries. GGGI score had a significant association only with no syphilis screening (p<0.001).

Conclusions: A lower GGGI score was associated with higher vertical transmission of hepatitis and HIV. The improvement of gender equity might prevent vertical transmission of these viruses. Further intervention studies are warranted to verify the results.

Prevalence and factors associated with modern contraceptives utilization among female adolescents in Uganda

Background

The sexual and reproductive health (SRH) needs of adolescents remain largely unmet. For instance, over 20 million female adolescents in need of, a modern contraceptive method are not using any. This study determined the factors associated with utilization of modern contraceptives among female adolescents in Uganda.

Methods

A cross sectional study was conducted using the Uganda Demographic and Health Survey (UDHS) 2016 data of 4, 264 adolescents aged 15 to 19 years. Multistage stratified sampling was used to select study participants. Multivariable logistic regression was used to determine the factors associated with modern contraceptive utilization. All our analyses were done using SPSS version 25.

Results

The prevalence of modern contraceptive utilization among female adolescents was 9.4% (401/4264: (95% CI: 8.6–10.3). The odds of contraceptive utilisation were 1.6 times (AOR = 1.60; 95% CI: 1.09–2.34) higher among married adolescents compared to unmarried adolescents. Adolescents whose age at first birth was less than 15 years (AOR = 2.01; 95% CI: 1.01–3.99) were twice more likely to utilize a modern contraceptive compared to those whose age at first birth was above 15 years. Women belonging to the Central region (AOR = 1.93; 95% CI: 1.01–3.69) and those in the middle wealth quintile (AOR = 1.91; 95% CI: 1.06–3.46) were 93% and 91% more likely to utilize a modern contraceptive compared to those in the Northern region and those in the poorest wealth index respectively.

Conclusion

The prevalence of modern contraceptive utilization was 9.4%. The findings show the need for designing targeted interventions due to differences in adolescents according to their wealth index, regions and marital status.

Who is at risk? Gendered psychological correlates in Italian students’ sexual risk profiles

Recent research has shown that sexual risk behaviours are rising substantially among Italian youth, but this evidence is still undervalued in public discussion. Adopting a multidimensional perspective for sexual risk and addressing gender differences, the present study investigates if and how some individuals’ psychological characteristics—namely body satisfaction, self-esteem and body sensation-seeking—are associated with unsafe and risky sexual behaviours of Italian emerging adults. We exploited the survey SELFY—Sexual and Emotional LiFe of Youths—conducted in 2017 in Italy. Several key points may be highlighted from our study. First, we identify two clusters characterized by high sexual risk-taking behaviours, which include one third of our sample, a non-negligible proportion. Second, we prove that women are generally less inclined to adopt risk-taking behaviours in sexual life. Third, our findings show that body satisfaction, self-esteem and sensation seeking are differently linked to sexual risk taking among women and men. Body satisfaction is associated with a higher probability of adopting risky and promiscuous sexual behaviours among men, while the relationship is not significant among women. Sensation seeking shows a certain relevance in defining sexual risk profiles, especially for men. Overall, our research suggests that body image and self-worth could be relevant areas of intervention for sexual health programs targeting emerging Italian adults. Notably, communication and education strategies on these issues should be differentiated for women and men.