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Toska E, Saal W, Chen Charles J, Wittesaele C, Langwenya N, Jochim J, Steventon Roberts KJ, Anquandah J, Banougnin BH, Laurenzi C, Sherr L, Cluver L. Achieving the health and well-being Sustainable Development Goals among adolescent mothers and their children in South Africa: Cross-sectional analyses of a community-based mixed HIV-status cohort. PLoS One 2022; 17:e0278163. [PMID: 36480550 PMCID: PMC9731463 DOI: 10.1371/journal.pone.0278163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
The Sustainable Development Goals (SDGs) are a visionary and multi-sectoral agenda for human development. With less than a decade left to reach these targets, it is important to identify those at greatest risk of not meeting these ambitious targets. Adolescent mothers and their children are a highly vulnerable group. We mapped 35 SGD-related targets among 1,046 adolescent mothers and their oldest child (n = 1046). Questionnaires using validated scales were completed by 10- to 24-year-old adolescent girls and young women who had their first child before age 20 in an HIV-endemic district in the Eastern Cape province of South Africa. Maternal outcomes included 26 SDG-aligned indicators, while child-related outcomes included 9 indicators. Data was collected by trained researchers, following informed voluntary consent by the adolescent mothers and their caregivers. Frequencies and chi-square tests were conducted to compare progress along SDG-aligned indicators among adolescent mothers by HIV status. Overall, adolescent mothers reported low attainment of SDG-aligned indicators. While four in five adolescent mothers lived in poor households, nearly 93% accessed at least one social cash transfer and 80% accessed a child support grant for their children. Food security rates among adolescent mothers (71%) were lower than among their children (91%). Only two-thirds of adolescent mothers returned to school after childbirth, and only one-fifth were either studying or employed. Over half of adolescent mothers had experienced at least one type of violence (domestic, sexual or community). HIV-positive status was associated with higher rates of hunger and substance use, poorer school attendance, and higher rates of exposure to violence. Understanding progress and gaps in meeting the SDGs among highly vulnerable groups is critical, particularly for adolescent mothers and their children. These complex vulnerabilities suggest that programming for adolescent mothers must address their unique needs.
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Affiliation(s)
- Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Wylene Saal
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Jenny Chen Charles
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Camille Wittesaele
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nontokozo Langwenya
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Janina Jochim
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Kathryn J. Steventon Roberts
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Jason Anquandah
- Department of Statistics, University of Leeds, Leeds, United Kingdom
| | - Boladé Hamed Banougnin
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Christina Laurenzi
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, United Kingdom
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Shangase N, Kharsany ABM, Ntombela NP, Pettifor A, McKinnon LR. A Systematic Review of Randomized Controlled Trials of School Based Interventions on Sexual Risk Behaviors and Sexually Transmitted Infections Among Young Adolescents in Sub-Saharan Africa. AIDS Behav 2021; 25:3669-3686. [PMID: 33772695 DOI: 10.1007/s10461-021-03242-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/29/2022]
Abstract
Young adolescents in Sub-Saharan Africa (SSA) are at high risk of involvement in sexual risk behaviors; and curable sexually transmitted infections (STI), herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV) and unintended pregnancies remain persistently high in this population. Evidence based strategies are urgently needed to improve these outcomes. The aim of this systematic review was to synthesize the evidence from randomized controlled trials (RCT) to determine whether school-based interventions promote safe sex behaviors, reduce sexual risk behaviors and risk of curable STIs, HSV-2, HIV and unintended pregnancies among young adolescents aged 9-19 years in SSA. Electronic databases were searched for published studies and manual searches were conducted through reviewing of references of cited literature in the English language up to December 2019. Two independent reviewers screened and abstracted the data. We identified 428 articles and data from nine RCTs (N = 14,426 secondary school students) that fulfilled the selection criteria were analysed. Two studies measured pregnancy as an outcome and showed significant declines in unintended pregnancies. Of the five studies that measured HIV/AIDS related-knowledge, condom-use outcomes (normative beliefs, knowledge, and self-efficacy) and attitudes to HIV testing, four showed significant improvements. Of the six studies that measured sexual debut, four reported moderate but non-significant declines and in two studies sexual debut information was either incomplete or unreliable. One study measured curable STIs and found no significant declines; whilst the second study that measured HSV-2 and HIV, no significant declines were observed. This review highlights the need to undertake well-designed research studies to provide evidence on the impact of interventions on curable STIs, HSV-2 and HIV, critical to improving the health of young adolescents.
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Affiliation(s)
- Nosipho Shangase
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 2106 McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599-7435, USA
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa.
- School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Nonzwakazi P Ntombela
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Audrey Pettifor
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Lyle R McKinnon
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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Baloyi V, Kganakga K, Madzhie M, Chueng M. An exploration of the causes of student pregnancy and psychological stressors experienced by pregnant students at University of Venda, South Africa. COGENT PSYCHOLOGY 2020. [DOI: 10.1080/23311908.2020.1863176] [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] Open
Affiliation(s)
- Valeria Baloyi
- Department of Psychology, University of Venda, South Africa
| | | | - Mpho Madzhie
- Department of Psychology, University of Venda, South Africa
| | - Maphuti Chueng
- Research Office, School of Health Science, University of Venda, Thohoyandou, South Africa
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Blystad A, Moland KM, Munsaka E, Sandøy I, Zulu J. Vanilla bisquits and lobola bridewealth: parallel discourses on early pregnancy and schooling in rural Zambia. BMC Public Health 2020; 20:1485. [PMID: 32998733 PMCID: PMC7528241 DOI: 10.1186/s12889-020-09555-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background Adolescent pregnancy is a complex socio-economic phenomenon ranking high on the global health policy agenda. Early childbearing is associated with early marriage and school drop-out, and is defined as a problem to the health and development of girls. This paper reports from formative research. The formative research aimed to explore socio-cultural and structural dynamics at work behind early pregnancy and school drop out in rural Zambia. The study findings have been used to inform a school based intervention to reduce early pregnancy (RISE: ‘Research Initiative to Support the Empowerment of Girls’). Theoretically the study is informed by social constructionism. Methods A qualitative approach was employed. Semi-structured qualitative interviews (61) and focus group discussions (7) were carried out with girls (in and out of school), boys, parents, teachers, health workers and community- and district leaders in 2014–15. Systematic text condensation was drawn upon in the analysis of the material. Results The study findings indicate that the official Zambian discourse that presents early pregnancy as a serious challenge and schooling as the prime way to confront the problem enjoy substantial support at community levels. However, a parallel discourse on fertility, early marriage and childbearing as social and economic security surfaced and was articulated by the same study participants. The latter contrasting discourse questioned schooling as the only solution to secure a girl’s future arguing that there are many reasons why early pregnancy may emerge as rational. Conclusions Grasping the complexity of local discourse is vital in planning health interventions. The present study revealed that although delayed child bearing and schooling among girls enjoyed high status and legitimacy in the study area, the social and economic context worked to reward early marriage. Interventions to reduce early pregnancies in rural Zambian communities need to fundamentally address the material constraints that condition and reinforce a culture of early childbearing.
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Affiliation(s)
- Astrid Blystad
- CISMAC (Centre for Intervention Science in Maternal and Child Health), Bergen, Norway. .,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Karen Marie Moland
- CISMAC (Centre for Intervention Science in Maternal and Child Health), Bergen, Norway.,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ecloss Munsaka
- CISMAC (Centre for Intervention Science in Maternal and Child Health), Bergen, Norway.,School of Education, University of Zambia, Lusaka, Zambia
| | - Ingvild Sandøy
- CISMAC (Centre for Intervention Science in Maternal and Child Health), Bergen, Norway.,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Joseph Zulu
- CISMAC (Centre for Intervention Science in Maternal and Child Health), Bergen, Norway.,School of Public Health, University of Zambia, Lusaka, Zambia
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Jonas K, Duby Z, Maruping K, Dietrich J, Slingers N, Harries J, Kuo C, Mathews C. Perceptions of contraception services among recipients of a combination HIV-prevention interventions for adolescent girls and young women in South Africa: a qualitative study. Reprod Health 2020; 17:122. [PMID: 32795366 PMCID: PMC7427945 DOI: 10.1186/s12978-020-00970-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/03/2020] [Indexed: 02/05/2023] Open
Abstract
Background Adolescent girls and young women (AGYW) in low- and middle- income countries (LMICs) have high rates of unintended pregnancies and are at higher risk for HIV infection compared to older women of reproductive age. Using a socio-ecological model approach, this research investigated perceptions of contraception services among AGYW who had been recipients of a combination HIV-prevention intervention, to better understand factors affecting their access to and use of contraception services. Method Qualitative methods used in this study included focus group discussions (FGDs) and in-depth interviews (IDIs) with 185 AGYW aged 15–24 years living in five of the ten intervention districts. All interviews and FGDs were audio-recorded and data were analyzed thematically using Nvivo 12 software with manual identification of themes and labelling of raw data. Results The findings reveal that many AGYW, especially those in the younger age group 15–19 years, experience difficulties in accessing contraception services, mainly at the interpersonal and health service levels. Lack of support for the use of contraceptives from parents/caregivers as well as from sexual partners were key barriers at the interpersonal level; while providers’ negative attitude was the main barrier at the health service level. The majority of school-going AGYW felt that bringing contraception services and other sexual and reproductive health (SRH) services on to the school premises would legitimize their use in the eyes of parents and help to overcome barriers related to parental support and acceptance, as well as overcome some of the health service and structural level barriers. However, views among school-going AGYW about school-based provision of contraception services were mixed, clouded with concerns relating to confidentiality. Conclusion Interventions to improve parental/caregiver and sexual partner support for the use of contraception services by AGYW, as well as efforts to expand the provision of contraception services on the school premises are urgently needed. Future interventions should incorporate multi-level approaches to address structural and contextual barriers to access and use of contraception services to gain maximum effect.
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Affiliation(s)
- Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa. .,Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa.
| | - Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kealeboga Maruping
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Janan Dietrich
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Nevilene Slingers
- Office of AIDS and TB, South African Medical Research Council, Cape Town, South Africa
| | - Jane Harries
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Caroline Kuo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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Smith P, Tolla T, Marcus R, Bekker LG. Mobile sexual health services for adolescents: investigating the acceptability of youth-directed mobile clinic services in Cape Town, South Africa. BMC Health Serv Res 2019; 19:584. [PMID: 31426788 PMCID: PMC6701080 DOI: 10.1186/s12913-019-4423-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/09/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The Human Immunodeficiency Virus (HIV) epidemic is growing rapidly among South African adolescents and young adults (AYA). Although HIV counselling and testing, HIV prevention and treatment options are widely available, many AYA delay health-seeking until illness occurs, demonstrating a need for youth responsive, integrated sexual and reproductive health services (SRHS). While feasibility and cost-effectiveness have been evaluated, acceptability of mobile clinics among AYA has yet to be established. The objective of this study was to investigate patient acceptability of mobile AYA SRHS and compare mobile clinic usage and HIV outcomes with nearby conventional clinics. METHODS Patients presenting to a mobile clinic in Cape Town were invited to participate in an acceptability study of a mobile clinic after using the service. A trained researcher administered an acceptability questionnaire. Mobile clinic medical records during the study period were compared with the records of AYA attending four clinics in the same community. RESULTS Three hundred three enrolled participants (16-24 years, 246 (81.2%) female) rated mobile AYA SRHS acceptability highly (median = 4,6 out of 5), with 90% rating their experience as better or much better than conventional clinics. The mobile clinic, compared to conventional clinics, attracted more men (26% v 13%, p < 0,000), younger patients (18 v 19 years, p < 0,000), and yielded more HIV diagnoses (4% v 2%, p < 0,000). CONCLUSIONS Given the high ratings of acceptability, and the preference for mobile clinics over conventional primary health clinics, the scalability of mobile clinics should be investigated as part of a multipronged approach to improve the uptake of SRHS diagnostic, prevention and treatment options for AYA.
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Affiliation(s)
- Philip Smith
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
| | - Tsidiso Tolla
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Rebecca Marcus
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
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Jonas K, Roman N, Reddy P, Krumeich A, van den Borne B, Crutzen R. Nurses' perceptions of adolescents accessing and utilizing sexual and reproductive healthcare services in Cape Town, South Africa: A qualitative study. Int J Nurs Stud 2019; 97:84-93. [PMID: 31200221 DOI: 10.1016/j.ijnurstu.2019.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In Sub-Saharan Africa access to and utilization of sexual and reproductive healthcare is unsatisfactory. Consequently, rates of teenage pregnancy and unsafe abortions among adolescents in Sub-Saharan Africa, including in South Africa remain a public health challenge. The aim of this study was to explore nurses' views on and perceptions of adolescent girls' barriers and needs to accessing and utilizing sexual and reproductive healthcare services. METHODS Twenty-four purposively selected healthcare workers from nine public healthcare facilities in Cape Town, South Africa participated in this qualitative descriptive study. Data were collected through nine group discussions, and audio-recorded with hand-written notes taken during the discussions. Data were analyzed using thematic analysis, following the Tesch's eight steps for coding and analysing qualitative data. RESULTS Sexual and reproductive healthcare nurses are generally supportive of adolescents who ask for and use contraceptives. Non-compliance to family planning regimens and repeated requests for termination of pregnancies were perceived by nurses as irresponsible behaviours which are particularly frustrating to them and not in concordance with their personal values. The subsequent nurse-adolescent interactions sometimes appeared to hinder access to and utilization of sexual and reproductive healthcare services by adolescents. CONCLUSIONS Nurses perceive certain behaviours of adolescent girls as irresponsible and warrant their negative attitudes and reactions toward them. The negative attitudes and reactions of nurses potentially further compromises access to and utilization of sexual and reproductive healthcare services by adolescent girls in South Africa and requires urgent attention. Adolescent-friendly clinic hours together with youth-friendly nurses is likely to encourage adolescent girls to access sexual and reproductive healthcare services and improve the use thereof.
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Affiliation(s)
- Kim Jonas
- School of Public Health and Primary Care (CAPHRI), Department of Health Promotion, Faculty of Heath, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands; Health Systems Research Unit (HSRU), South African Medical Research Council (SA-MRC), Cape Town, South Africa; Division of Child and Adolescent Psychiatry, Adolescent Health Research Unit, University of Cape Town, Rondebosch, Cape Town, South Africa.
| | - Nicolette Roman
- Faculty of Community and Health Science, University of the Western Cape, South Africa.
| | - Priscilla Reddy
- Faculty of Community and Health Science, University of the Western Cape, South Africa; Human Sciences Research Council (HSRC), Population Health, Health Systems and Innovation Unit, Cape Town, South Africa.
| | - Anja Krumeich
- Department of Health, Ethics and Society/Global Health, Faculty of Heath, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Bart van den Borne
- School of Public Health and Primary Care (CAPHRI), Department of Health Promotion, Faculty of Heath, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
| | - Rik Crutzen
- School of Public Health and Primary Care (CAPHRI), Department of Health Promotion, Faculty of Heath, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
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Abstract
Research has documented a negative association between women's educational attainment and early sexual intercourse, union formation, and pregnancy. However, the implications that school progression relative to age may have for the timing and order of such transitions are poorly understood. In this article, I argue that educational attainment has different implications depending on a student's progression through school grades relative to her age. Using month of birth and age-at-school-entry policies to estimate the effect of advanced school progression by age, I show that it accelerates the occurrence of family formation and sexual onset among teenage women in Mexico. Focusing on girls aged 15-17 interviewed by a national survey, I find that those who progress through school ahead of their birth cohort have a higher probability of having had sex, been pregnant, and cohabited by the time of interview. I argue that this pattern of behaviors is explained by experiences that lead them to accelerate their transition to adulthood compared with same-age students with fewer completed school grades, such as exposure to relatively older peers in school and completing academic milestones earlier in life. Among girls who got pregnant, those with an advanced school progression by age are more likely to engage in drug use, alcohol consumption, and smoking before conception; more likely to have pregnancy-related health complications; and less likely to attend prenatal care visits. Thus, an advanced school progression by age has substantial implications for the health and well-being of young women, with potential intergenerational consequences.
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Margherio C. Centering female agency while investigating contraceptive use: a case study in Agincourt, South Africa. Int J Equity Health 2019; 18:60. [PMID: 31046765 PMCID: PMC6498472 DOI: 10.1186/s12939-019-0965-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rural areas of South Africa face persistently high teenage and premarital childbearing rates, reflecting a lack of or inconsistent use of modern contraception. In attempting to understand this behavior, much of the literature has denied agency to young women, portraying them solely as victims of their environments. This study moved beyond these approaches to understanding adolescent contraceptive use, to reframe the investigation to focus on the tension around exercising agency within specific structural constraints. METHODS Findings are based on a qualitative study in Agincourt, South Africa. Data were collected through six focus group discussions with 63 women aged 18-44. A grounded theory approach utilizing emergent coding was performed focusing on the decision-making processes around family planning. The focus group participants discussed attitudes and norms around: early first births, contraceptive use, unplanned pregnancy, abortion, and HIV testing. When possible, differences that emerged around these topics according to the age groups (18-24, 25-34, and 35-44) and/or nationality of village (South African or Mozambican) are highlighted. RESULTS Participants of all focus groups agreed that early first birth were common and undesirable. Younger participants described pregnancy prevention as a key rationale for contraceptive usage, while older participants were more inclined to cite HIV prevention. Women of all focus groups discussed the importance of women taking the initiative with family planning. Participants expressed a range of opinions about the acceptability of abortion, and all focus groups discussed concerns about the safety of abortion. Finally, all of the focus group participants stressed the importance of HIV testing, both to protect themselves and to protect their families. CONCLUSION This study found many locations of agency for young women in rural South Africa. The decision-making surrounding contraceptive use consists of a series of decision junctures at which women must assign values to certain factors and then select their behavior on the basis of those values. Young women weigh the costs and benefits of contraception and of pregnancy, while also taking into account the chances of actually becoming pregnant along with the costs and benefits of abortion. Furthermore, the women explicitly viewed contraception as within their own realm of decision-making and action (as opposed to within the realm of their male partners).
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Affiliation(s)
- Cara Margherio
- Center for Evaluation & Research for STEM Equity (CERSE), University of Washington, Box 353340, Seattle, WA, 98195, USA.
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10
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du Preez A, Johan Botha A, Rabie T, Manyathi DG. Secondary school teachers' experiences related to learner teenage pregnancies and unexpected deliveries at school. Health SA 2019; 24:1079. [PMID: 31934408 PMCID: PMC6917420 DOI: 10.4102/hsag.v24i0.1079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 09/28/2018] [Indexed: 11/01/2022] Open
Abstract
Background The incidence of learner teenage pregnancies can be reduced, provided that the major stakeholders, which include the Department of Education and the Department of Health, combine to address this issue. Despite the implementation of Life Orientation as a school subject, which focuses on sexual behaviour, health, decision-making, pregnancy risk, sexually transmitted infections and HIV and AIDS, the prevalence of learner teenage pregnancies at secondary schools remains alarmingly high. Aim The purpose of this study was to explore and describe teachers' experiences of learner teenage pregnancies in secondary schools in a province in South Africa. Setting Secondary schools in KwaZulu-Natal. Method A qualitative approach with exploratory, descriptive and contextual strategies was used in this research. Semi-structured interviews were conducted with teachers who had been selected through purposive sampling. Tesch's steps of systematic open coding were used to analyse all of the interviews. Results The results that emerged during the data analysis indicate that firstly, teachers' experiences of having pregnant learners in their classrooms are negative as these learners are frequently absent from school, perform badly and drop out of school. Secondly, teachers' experiences related to unexpected deliveries are coloured by their lack of the necessary skills and competencies to deal and their resultant insecurity. Thirdly, the teachers feel that they do not receive the assistance they need to deal with teenage pregnancies as well as unexpected deliveries. Conclusions Collaboration between and continuous support from the Department of Health and the Department of Education are crucial if teenage pregnancies at secondary schools are to be handled with greater success. Support from health care personnel should include guidance on contraception and health campaigns should target both the teachers and secondary school learners. Furthermore, coping strategies for the teachers should form part of the preservice curriculum of teachers.
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Affiliation(s)
| | - A Johan Botha
- Edu-HRight Research Unit, Faculty of Education, North-West University, South Africa
| | - Tinda Rabie
- NuMIQ Research Focus Area, North-West University, South Africa
| | - Dudu G Manyathi
- NuMIQ Research Focus Area, North-West University, South Africa
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Odimegwu C, Mkwananzi S. Family structure and community connectedness: Their association with teenage pregnancy in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2018. [DOI: 10.1080/14330237.2018.1544390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Clifford Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand
| | - Sibusiso Mkwananzi
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand
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12
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Jonas K, Crutzen R, Krumeich A, Roman N, van den Borne B, Reddy P. Healthcare workers' beliefs, motivations and behaviours affecting adequate provision of sexual and reproductive healthcare services to adolescents in Cape Town, South Africa: a qualitative study. BMC Health Serv Res 2018; 18:109. [PMID: 29433499 PMCID: PMC5810035 DOI: 10.1186/s12913-018-2917-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/06/2018] [Indexed: 11/25/2022] Open
Abstract
Background Adolescents’ sexual and reproductive healthcare (SRH) needs have been prioritized globally, and they have the rights to access and utilize SRH services for their needs. However, adolescents under-utilize SRH services, especially in sub-Saharan Africa. Many factors play a role in the under-utilization of SRH services by adolescents, such as the attitude and behaviour of healthcare workers. The aim of this study therefore, was to explore and gain an in-depth understanding of healthcare workers’ beliefs, motivations and behaviours affecting adequate provision of these services to adolescents in South Africa. Methods Twenty-four healthcare workers in public SRH services in Cape Town, South Africa participated in this qualitative study through focus group discussions. To fulfill the aims of this study, nine focus group discussions were conducted among the SRH nurses. Results SRH nurses indicated that they are experiencing challenges with the concept and practice of termination of pregnancy. They explained that this practice contradicted their opposing beliefs and values. Some nurses felt that they had insufficient SRH skills, which hinder their provision of adequate SRH services to adolescents, while others described constraints within the health system such as not enough time to provide the necessary care. They also explained having limited access to schools where they can provide SRH education and pregnancy prevention services in the surrounding area. Conclusions Nurses are faced with numerous challenges when providing SRH services to adolescents. Providing the nurses with training programmes that emphasize value clarification may help them to separate their personal beliefs and norms from the workplace practice. This may help them to focus on the needs of the adolescent in a way that is beneficial to them. At the health systems level, issues such as clinic operating hours need to be structured such that the time pressure and constraints upon the nurse is relieved. Electronic supplementary material The online version of this article (10.1186/s12913-018-2917-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kim Jonas
- School of Public Health and Primary Care (CAPHRI), Department of Health Promotion, Faculty of Heath, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. .,Division of Child and Adolescent Psychiatry, Adolescent Health Research Unit, University of Cape Town, Rondebosch, Cape Town, South Africa.
| | - Rik Crutzen
- School of Public Health and Primary Care (CAPHRI), Department of Health Promotion, Faculty of Heath, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Anja Krumeich
- Department of Health, Ethics and Society, Faculty of Heath, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Nicolette Roman
- Child and Family Studies, Faculty of Community and Health Science, University of the Western Cape, Cape Town, South Africa
| | - Bart van den Borne
- School of Public Health and Primary Care (CAPHRI), Department of Health Promotion, Faculty of Heath, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Priscilla Reddy
- Child and Family Studies, Faculty of Community and Health Science, University of the Western Cape, Cape Town, South Africa.,Population Health, Health Systems and Innovation Unit (PHHSI), Human Sciences Research Council (HSRC), Cape Town, South Africa
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Branson N, Byker T. Causes and consequences of teen childbearing: Evidence from a reproductive health intervention in South Africa. JOURNAL OF HEALTH ECONOMICS 2018; 57:221-235. [PMID: 29289811 PMCID: PMC6375086 DOI: 10.1016/j.jhealeco.2017.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 06/26/2017] [Accepted: 11/29/2017] [Indexed: 06/07/2023]
Abstract
We use a natural experiment to estimate the causal impact of a public health intervention aimed at reducing teenage childbearing. The geographic and timing variation in the rollout of the South African National Adolescent Friendly Clinic Initiative (NAFCI) in the early 2000s provides a plausibly exogenous increase in reproductive health knowledge and clinical access for teens. We investigate the causal pathway from the intervention's initial impact on early-teen childbearing to subsequent consequences for later-life outcomes of prime policy interest - education, employment and child health. Our empirical strategy uses GPS data from the National Income Dynamics Study to geolink women's location of residence during adolescence to the location and timing of the rollout. Our results show that living near a NAFCI clinic during adolescence delayed childbearing, substantially lowering the likelihood of early teen childbearing. We estimate that adolescents who had access to NAFCI completed more years of schooling and, consistent with increased human capital investments, earn substantially higher wages as young adults. Finally, children born to women who had access to youth-friendly services as teens show substantial health advantages, indicating a strong intergenerational benefit of delaying early teen childbearing in a developing country context.
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Affiliation(s)
- Nicola Branson
- Southern Africa Labour and Development Research Unit, School of Economics, University of Cape Town, South Africa.
| | - Tanya Byker
- Department of Economics, Middlebury College, United States.
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Toska E, Pantelic M, Meinck F, Keck K, Haghighat R, Cluver L. Sex in the shadow of HIV: A systematic review of prevalence, risk factors, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. PLoS One 2017; 12:e0178106. [PMID: 28582428 PMCID: PMC5459342 DOI: 10.1371/journal.pone.0178106] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/06/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Evidence on sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa is urgently needed. This systematic review synthesizes the extant research on prevalence, factors associated with, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. METHODS Studies were located through electronic databases, grey literature, reference harvesting, and contact with researchers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies that reported on HIV-positive participants (10-24 year olds), included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy), and were conducted in sub-Saharan Africa were included. Two authors piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and factors associated with sexual risk-taking, meta-analyses were not conducted. RESULTS 610 potentially relevant titles/abstracts resulted in the full text review of 251 records. Forty-two records (n = 35 studies) reported one or multiple sexual practices for 13,536 HIV-positive adolescents/youth from 13 sub-Saharan African countries. Seventeen cross-sectional studies reported on individual, relationship, family, structural, and HIV-related factors associated with sexual risk-taking. However, the majority of the findings were inconsistent across studies, and most studies scored <50% in the quality checklist. Living with a partner, living alone, gender-based violence, food insecurity, and employment were correlated with increased sexual risk-taking, while knowledge of own HIV-positive status and accessing HIV support groups were associated with reduced sexual risk-taking. Of the four intervention studies (three RCTs), three evaluated group-based interventions, and one evaluated an individual-focused combination intervention. Three of the interventions were effective at reducing sexual risk-taking, with one reporting no difference between the intervention and control groups. CONCLUSION Sexual risk-taking among HIV-positive adolescents and youth is high, with inconclusive evidence on potential determinants. Few known studies test secondary HIV-prevention interventions for HIV-positive youth. Effective and feasible low-cost interventions to reduce risk are urgently needed for this group.
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Affiliation(s)
- Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Marija Pantelic
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Franziska Meinck
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- OPTENTIA, School of Behavioural Sciences, North-West University, Vanderbeijlpark, South Africa
| | - Katharina Keck
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Oxford Policy Management, Johannesburg, South Africa
| | - Roxanna Haghighat
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Krugu JK, Mevissen F, Münkel M, Ruiter R. Beyond love: a qualitative analysis of factors associated with teenage pregnancy among young women with pregnancy experience in Bolgatanga, Ghana. CULTURE, HEALTH & SEXUALITY 2017; 19:293-307. [PMID: 27685083 DOI: 10.1080/13691058.2016.1216167] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Globally, an estimated 16 million young women aged 15 to 19 years give birth every year. Most teenage pregnancies are unintended and being pregnant or delivering a baby as a teenager can have serious adverse consequences. Knowledge of the environmental factors and social cognitive determinants influencing young women's failure to protect against unintended pregnancy is necessary to address the high rate of teenage pregnancies. We conducted semi-structured in-depth interviews with 21 young women, who had experience of pregnancy, in Bolgatanga, Ghana. The interview protocol included themes (relationships, sex, pregnancy, family planning) and determinants (knowledge, attitudes, self-efficacy, norms, risk perceptions) derived from empirical studies and theories related to sexuality behaviour. Findings show that young women's motivations for sexual relationships are mostly 'beyond love' and seem to focus on economic factors. The main means of sexual protection seems to be condom use. Other forms of contraception were believed to be linked to infertility. Sexuality remains a largely taboo topic for open discussion and sex education in schools seems limited to abstinence-only messages. The need for more open communication on matters of sexuality with young people and the provision of a more comprehensive sexuality education in school to address teenage pregnancies in Ghana, is discussed.
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Affiliation(s)
- John Kingsley Krugu
- a Department of Work and Social Psychology , Maastricht University , Maastricht , The Netherlands
- b Adolescent Sexual Reproductive Health Unit , Youth Harvest Foundation , Bolgatanga , Ghana
| | - Fraukje Mevissen
- a Department of Work and Social Psychology , Maastricht University , Maastricht , The Netherlands
| | - Meret Münkel
- a Department of Work and Social Psychology , Maastricht University , Maastricht , The Netherlands
| | - Robert Ruiter
- a Department of Work and Social Psychology , Maastricht University , Maastricht , The Netherlands
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Phaswana-Mafuya N, Tabane C, Davids A. Community member perceptions of influences on teenage pregnancies. JOURNAL OF PSYCHOLOGY IN AFRICA 2016. [DOI: 10.1080/14330237.2016.1185916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Nancy Phaswana-Mafuya
- Human Sciences Research Council, South Africa
- Office of the Deputy Vice Chancellor: Research and Engagement, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Cily Tabane
- University of South Africa, Pretoria, South Africa
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17
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Oluwole EO, Skaal L. Contraceptive practices among women seeking termination of pregnancy in one public hospital in Eastern Cape, South Africa. Afr J Prim Health Care Fam Med 2016; 8:e1-6. [PMID: 27608676 PMCID: PMC5016717 DOI: 10.4102/phcfm.v8i1.1094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 05/12/2016] [Accepted: 05/30/2016] [Indexed: 11/24/2022] Open
Abstract
Background There is significantly high contraceptive knowledge in South Africa, but the uptake of contraceptives is average to low with resultant soaring of unplanned pregnancy and rising statistics of termination of pregnancy (TOP) services. This study aimed to establish the contraceptive practices among women in the South African population seeking TOP in one public hospital in Eastern Cape, South Africa. Methods A cross-sectional study was carried out among women seeking TOP in a women’s clinic. Self-administered questionnaires were used as data collection tool, and the data collected were entered into SPSS software for analysis, using descriptive statistics to calculate frequencies and percentages while chi-square test was used to determine the associations between the socio-demography and contraceptive practices of the participants. Results Majority of the women were aged between 20 and 29 years, had secondary education, unemployed, single and resided in townships. Contraceptive uptake prior to termination of pregnancy (CTOP) among them was 44.1%, but 85.8% had good contraceptives knowledge. Their contraceptive practices are determined by partner’s opinion, source and availability of contraceptives, previous CTOP, side effect of contraceptives and having children. Age group, educational level and employment status were found to be related to the contraceptive practices of the participants but were not statistically significant. Conclusion To reduce unplanned pregnancies and subsequent number of women seeking CTOP, the socio-economic factors associated with contraceptive practices as well as the programmes, policies and guidelines of contraceptives need to be improved on for any improvement on the factors determining contraceptive practices.
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Affiliation(s)
| | - Linda Skaal
- Department of Public Health, University of Limpopo.
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Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, Arora M, Azzopardi P, Baldwin W, Bonell C, Kakuma R, Kennedy E, Mahon J, McGovern T, Mokdad AH, Patel V, Petroni S, Reavley N, Taiwo K, Waldfogel J, Wickremarathne D, Barroso C, Bhutta Z, Fatusi AO, Mattoo A, Diers J, Fang J, Ferguson J, Ssewamala F, Viner RM. Our future: a Lancet commission on adolescent health and wellbeing. Lancet 2016; 387:2423-78. [PMID: 27174304 PMCID: PMC5832967 DOI: 10.1016/s0140-6736(16)00579-1] [Citation(s) in RCA: 1760] [Impact Index Per Article: 220.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- George C Patton
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia.
| | - Susan M Sawyer
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia; Murdoch Childrens Research Institute, Columbia University, New York, NY, USA
| | - John S Santelli
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David A Ross
- World Health Organization, Geneva, Switzerland; London School of Hygiene & Tropical Medicine, London, UK
| | - Rima Afifi
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Nicholas B Allen
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; University of Oregon, Eugene, OR, USA
| | - Monika Arora
- Public Health Foundation of India, New Delhi, India
| | - Peter Azzopardi
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia
| | | | | | - Ritsuko Kakuma
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Terry McGovern
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ali H Mokdad
- Institute of Health Metrics and Evaluation, University of Washinton, Seattle, WA, USA
| | - Vikram Patel
- London School of Hygiene & Tropical Medicine, London, UK; Public Health Foundation of India, New Delhi, India
| | - Suzanne Petroni
- International Centre for Research on Women, Washington, DC, USA
| | - Nicola Reavley
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Jane Waldfogel
- School of Social Work, Columbia University, New York, NY, USA
| | | | | | - Zulfiqar Bhutta
- University of Toronto, Toronto, ON, Canada; Aga Khan University, Karachi, Pakistan
| | | | - Amitabh Mattoo
- Australia India Centre, University of Melbourne, Melbourne, VIC, Australia; Jawaharlal Nehru University, New Delhi, India
| | | | - Jing Fang
- Kunming Medical University, Kunming, China
| | - Jane Ferguson
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Russell M Viner
- Institute of Child Health, University College London, London, UK
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Toska E, Cluver LD, Boyes M, Pantelic M, Kuo C. From 'sugar daddies' to 'sugar babies': exploring a pathway among age-disparate sexual relationships, condom use and adolescent pregnancy in South Africa. Sex Health 2015; 12:59-66. [PMID: 25702156 DOI: 10.1071/sh14089] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 01/05/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Adolescent pregnancy has been linked to adverse outcomes. Most studies proposing risk pathways for adolescent pregnancy in South Africa are qualitative, hypothesising links among age-disparate relationships, reduced condom use and higher pregnancy rates. No known South African studies have quantitatively explored pathways to adolescent pregnancy. OBJECTIVES This study aimed to: (i) identify the factors associated with adolescent pregnancy and (ii) explore a pathway of risk by assessing whether condom use mediated the relationship between age-disparate sexual relationships and adolescent pregnancy. METHODS A cross-sectional survey of 447 sexually active girls aged 10-19 years was undertaken in six health districts of South Africa. Multivariate logistic regressions controlled for confounders. Mediation tests used bootstrapping. RESULTS Consistent condom use (β=-2.148, odds ratio (OR)=8.566, P≤0.001) and school enrolment (β=-1.600, OR=0.202, P≤0.001) were associated with lower pregnancy rates. Age-disparate sex (β=1.093, OR=2.982, P≤0.001) and long-term school absences (β=1.402, OR=4.061, P≤0.001) were associated with higher pregnancy rates. The indirect effect of age-disparate sex on adolescent pregnancy through condom use was significant, irrespective of age, age at sexual initiation, poverty and residential environment (B=0.4466, s.d.=0.1303, confidence interval: 0.2323-0.7428). CONCLUSION This survey supports hypotheses that inability to negotiate condom use in age-disparate sexual relationships may drive adolescent pregnancy. Interventions addressing these relationships, facilitating condom use and increasing access to sexual health services among adolescents might avert unwanted pregnancies.
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Affiliation(s)
- Elona Toska
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, OX1 23R, UK
| | - Lucie D Cluver
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, OX1 23R, UK
| | - Mark Boyes
- School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Marija Pantelic
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, OX1 23R, UK
| | - Caroline Kuo
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa
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Mkhwanazi N. Revisiting the dynamics of early childbearing in South African townships. CULTURE, HEALTH & SEXUALITY 2014; 16:1084-1096. [PMID: 25005345 DOI: 10.1080/13691058.2014.930512] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In South Africa over the last two decades, births to girls under the age of 20 years of age have steadily declined. The reason for the decline has been attributed to progressive social and educational policies and more accommodating reactions from families. This paper uses ethnographic data collected in 2001-2002 and again in 2013 in order to compare young women's perceptions and experiences of early childbearing at the turn of the twenty-first century with those of young women a decade later. It makes two main contributions to the literature on early childbearing in South Africa. First, it provides insight into the changes that have occurred regarding how young women experience pregnancy and motherhood over the last decade. Second, it considers changes not only in relation to time but also in relation to the significant social and ideological changes.
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Affiliation(s)
- Nolwazi Mkhwanazi
- a Department of Anthropology , University of the Witwatersrand , Johannesburg , South Africa
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21
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Eggers SM, Taylor M, Sathiparsad R, Bos AE, de Vries H. Predicting safe sex: Assessment of autoregressive and cross-lagged effects within the Theory of Planned Behavior. J Health Psychol 2013; 20:1397-404. [PMID: 24296737 PMCID: PMC4601078 DOI: 10.1177/1359105313512354] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite its popularity, few studies have assessed the temporal stability and cross-lagged effects of the Theory of Planned Behavior factors: Attitude, subjective norms and self-efficacy. For this study, 298 adolescent learners from KwaZulu-Natal, South Africa, filled out a Theory of Planned Behavior questionnaire on teenage pregnancy at baseline and after 6 months. Structural equation modeling showed that there were considerable cross-lagged effects between attitude and subjective norms. Temporal stability was moderate with test–retest correlations ranging from 0.37 to 0.51 and the model was able to predict intentions to have safe sex (R2 = 0.69) Implications for practice and future research are discussed.
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Mda P, O'Mahony D, Yogeswaran P, Wright G. Knowledge, attitudes and practices about contraception amongst schoolgirls aged 12–14 years in two schools in King Sabata Dalindyebo Municipality, Eastern Cape. Afr J Prim Health Care Fam Med 2013. [PMCID: PMC4502836 DOI: 10.4102/phcfm.v5i1.509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background In South Africa the teenage fertility rate is high. About 42% of women have their sexual debut by 18 years of age and 5% by 15. These young women are also at risk of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) infection. Despite widespread availability of contraception, 18% of sexually active teenagers do not use any. Previous research on the knowledge of, attitudes to and practices of contraception by teenagers has focused on older adolescents. Objectives This study explored knowledge, attitudes and practices about contraception amongst 12–14 year old unmarried schoolgirls with a view to inform planning of programmes to assist in reducing teenage pregnancies. Methods A qualitative study design with purposive sampling was used to select participants from two government-run schools in King Sabata Dalindyebo Municipality. In-depth and focus group interviews were conducted after obtaining written consent from parents and assent from participants. Interviews were audiotaped, transcribed verbatim, translated and analysed thematically. Findings Participants reported that young adolescents were sexually active, which included high-risk sexual behaviour such as multiple partners and casual and transactional sex. Knowledge about contraceptives varied widely. Condoms were the most preferred method of contraception, but it is unknown whether they ever used condoms as they professed to talk about the behaviour of others rather than themselves. Injectable contraceptives were believed to have long-term negative effects. Common sources of contraceptive information were friends or peers, school curriculum and to a lesser extent family members. Conclusions Findings of the study suggest that young adolescents are sexually active and have inadequate knowledge and misconceptions about contraception. These findings should inform educational programmes about risks of early sexual activity and about contraception.
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Affiliation(s)
- Pamela Mda
- General Practitioner, Mthatha, South Africa
| | - Don O'Mahony
- Department of Family Medicine, Walter Sisulu University, South Africa
| | | | - Graham Wright
- Faculty of Health Sciences, Walter Sisulu University, South Africa
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Males M. Adolescent apartheid. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2011. [DOI: 10.1016/j.appdev.2011.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Maree K. Editorial: Psychology — Tracing the SAJP's Progress in Helping Shape the Future of Psychology in South Africa. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2010. [DOI: 10.1177/008124631004000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kobus Maree
- University of Pretoria, Pretoria, South Africa
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