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Choonara S, Hwati R, Tayebwa M, Govender K. Early and unintended pregnancy in Eastern and Southern Africa: analysis of adolescent sexual and reproductive health and rights policies. BMJ Glob Health 2024; 9:e013929. [PMID: 38594203 PMCID: PMC11015178 DOI: 10.1136/bmjgh-2023-013929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 03/25/2024] [Indexed: 04/11/2024] Open
Abstract
In 2019, there were 21 million pregnancies among adolescents aged 15-19 years globally; close to half of these pregnancies were unintended. Early and unintended pregnancy (EUP) remains a pressing concern with severe socioeconomic and health outcomes for adolescent girls aged 15-19 years, their offspring and society. In Eastern and Southern Africa (ESA), Zambia, the United Republic of Tanzania, the Democratic Republic of Congo, Malawi and Uganda have adolescent fertility rates (AFR) of more than 100 live births per 1000 adolescent girls aged 15-19 years. Ministers of Health and Education, through the ESA Ministerial Commitment, aimed to reduce EUP by 75% by 2020; the renewed ESA Ministerial Commitment aims to reduce EUP by 40% by 2030. This descriptive policy content analysis assesses the prioritisation of EUP within adolescent sexual and reproductive health and rights (ASRHR) policies. An assessment of nine countries in the region shows that EUP is a key policy priority among countries; however, other than Kenya, the majority of ASRHR policies in the region do not set out clear and costed interventions for EUP, and few have monitoring and evaluation frameworks in place. Despite AFRs declining in Kenya and strong policies in place, the gains made are at risk due to the rollback on SRHR, and the country has not renewed the ESA Ministerial Commitment. This policy content analysis points towards the gaps we are still to meet within the universal health coverage agenda: better planning, prioritisation, sound policy frameworks and long-term commitments to meet the needs of adolescents.
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Affiliation(s)
- Shakira Choonara
- Regional Inter-Agency Task Team for Children and AIDS in Eastern and Southern Africa, Johannesburg, Gauteng, South Africa
- Former Consultant, Shakira Choonara Development, Johannesburg, Gauteng, South Africa
| | - Roseline Hwati
- Regional Inter-Agency Task Team for Children and AIDS in Eastern and Southern Africa, Johannesburg, Gauteng, South Africa
| | - Morris Tayebwa
- Regional Inter-Agency Task Team for Children and AIDS in Eastern and Southern Africa, Johannesburg, Gauteng, South Africa
- Gender and Community Development, East African Community, Arusha, United Republic of Tanzania
| | - Kaymarlin Govender
- Regional Inter-Agency Task Team for Children and AIDS in Eastern and Southern Africa, Johannesburg, Gauteng, South Africa
- Health Economics and HIV and AIDS Research Division of University, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Methazia JJ, Bessenaar TP, Baum SE. " We mostly focus on preventing pregnancy, we don't really focus on preventing HIV … ": Young people's perceptions and priorities when preventing unplanned pregnancy and HIV. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2024:1-11. [PMID: 38426482 DOI: 10.2989/16085906.2023.2279646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/31/2023] [Indexed: 03/02/2024]
Abstract
In South Africa, the high rate of human immunodeficiency virus (HIV) infection among young people and unplanned pregnancies remains a concern. Using a qualitative approach, this study aimed to explore how young people between 18 and 24 years old perceive the risk of unplanned pregnancy and HIV, and how they give priority to and act to prevent both concerns. Fifty-four young people were recruited from three provinces in South Africa: KwaZulu-Natal, Eastern Cape, and Gauteng. Data collection took place between May and June in 2016. All data collection was carried out in person using a standardised discussion guide and a semi-structured interview guide in English. We conducted eight focus group discussions with young people and three in-depth interviews with young people who had become parents in their teens. We utilised thematic analysis grounded in a social constructionist framework to assess patterns and associations in the data. Respondents reported unplanned pregnancy and HIV as prevalent among their peers, but prioritised both concerns differently. Preventing pregnancy was a greater priority and threat than HIV. Respondents were less concerned about being infected with HIV which was perceived as invisible and not a death sentence because of the efficacy and ease of use of treatment. HIV was considered comparatively more manageable and less burdensome than other chronic illnesses and unplanned pregnancy. Our study suggests unplanned pregnancy and HIV prevention interventions should prioritise responding to young people's primary desire to control their fertility, but also encourage them to have holistic sexual and reproductive health goals that include HIV prevention. Our findings suggest a pressing need for biomedical therapies that offer combined HIV and pregnancy prevention for young people. Future programmes need to be agile and innovative in addressing young people's tendency to prioritise HIV and pregnancy differently, and they need to revive the sense of urgency to prevent HIV.
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Marcos V, Seijo D, Montes Á, Arce R. Prevalence and Quantification of the Effects of Sexual Harassment Victimization of School-Aged Adolescents. CHILDREN (BASEL, SWITZERLAND) 2023; 11:23. [PMID: 38255337 PMCID: PMC10814736 DOI: 10.3390/children11010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND/AIM Sexual harassment has become a serious social and public health problem in adolescents, causing adverse effects on mental health. Nevertheless, some behaviours arise that, due to their characteristics, might be misinterpreted as sexual harassment. A field study using a survey with non-probabilistic accidental sampling was designed in order to estimate the prevalence of sexual harassment victimization in the Spanish adolescent population as well as to quantify the harms. METHOD A total of 1028 Spanish adolescents, 54.3% females and 45.7% males aged 13-17 years (M = 15.21, SD = 1.03), responded to a diagnostic measure of sexual harassment victimization and an inventory measure of internalizing and externalizing mental health problems (MHPs). RESULTS The results showed a significant prevalence of diagnosed sexual harassment victimization of school-aged adolescents, 24.1%, 95% CI [0.215, 0.267], with adverse effects on internalizing and externalizing MHPs. As for the internalizing MHPs, the results exhibited moderate adverse effects on depression, anxiety, somatic burns, posttraumatic symptoms, and obsessive-compulsive symptoms, as well as mild adverse effects on social anxiety. Regarding externalizing MHPs, the results revealed moderate adverse effects on hyperactivity-impulsivity, anger control, and antisocial behaviour, as well as mild adverse effects on attention problems, aggression, and defiant behaviour. In addition, it was confirmed that sexual harassment victimization affects adolescent females to a greater extent, with the effect being significantly greater in internalizing than in externalizing MHPs. CONCLUSIONS The results obtained are discussed and future lines of research and intervention are proposed to promote the implementation of prevention and intervention programs that address this phenomenon and, in turn, improve the physical, psychological, and social well-being of adolescents.
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Affiliation(s)
| | | | | | - Ramón Arce
- Forensic Psychology Unit, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (V.M.); (D.S.); (Á.M.)
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Laurenzi CA, Toska E, Tallarico R, Sherr L, Steventon Roberts KJ, Hansen M, Tolmay J, Jochim J, Ameyan W, Yates R. Key normative, legal, and policy considerations for supporting pregnant and postpartum adolescents in high HIV-burden settings: a critical analysis. Sex Reprod Health Matters 2023; 31:2249696. [PMID: 37712411 PMCID: PMC10506436 DOI: 10.1080/26410397.2023.2249696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Rates of adolescent pregnancy within sub-Saharan Africa are increasing. Adolescent mothers ages 10-19 years face a distinct set of risks to their own and their children's health, compounded by many economic, social, and epidemiological challenges, such as living with HIV. In navigating this complex developmental period, many adolescent mothers face structural barriers impeding safe transitions to adulthood and motherhood. Drawing on existing literature and emerging data, we outline three normative, legal, and policy issues - violence and gender inequity, access to sexual and reproductive health services, and access to social and structural supports - which affect the health, wellbeing and development of adolescent mothers and their children. We also highlight emergent evidence about programming and policy changes that can better support adolescent mothers and their children. These key proposed responses include removing barriers to SRH and HIV service integration; ensuring implementation of return-to-school policies; and extending social protection systems to cater for adolescent mothers. Despite ongoing global crises and shifts in funding priorities, these normative, legal, and policy considerations remain critical to safeguard the health and wellbeing of adolescent mothers and their children.
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Affiliation(s)
- Christina A. Laurenzi
- Senior Researcher, Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Elona Toska
- Associate Professor, Centre for Social Science Research, Department of Sociology, University of Cape Town, Rondebosch, South Africa; Co-director, Accelerate Hub, University of Cape Town, Rondebosch, South Africa; Associate Professor, Department of Social Policy and Intervention, Oxford University, Oxford, United Kingdom
| | - Renata Tallarico
- Youth Team Lead and SYP Regional Coordinator, United Nations Population Fund, Eastern and Southern Regional Office, Johannesburg, South Africa
| | - Lorraine Sherr
- Professor, Clinical and Health Psychology, University College London, London, United Kingdom
| | - Kathryn J. Steventon Roberts
- Postdoctoral Researcher, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; Postgraduate Researcher, Institute for Global Health, University College London, London, United Kingdom
| | - Maja Hansen
- Technical Advisor, Gender Equality, United Nations Population Fund, Dar es Salaam, Tanzania
| | - Janke Tolmay
- Quantitative Research Assistant, Accelerate Hub, Centre for Social Science Research, University of Cape Town, Rondebosch, South Africa
| | - Janina Jochim
- Postdoctoral Research Officer, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Wole Ameyan
- Technical Officer, Adolescent HIV, Global HIV Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Yates
- Strategic Advocacy Lead, Accelerate Hub, University of Oxford, Oxford, United Kingdom
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Wollum A, Bornstein M, Mopiwa G, Norris A, Gipson JD. Assessing the relationship between reproductive autonomy and contraceptive use in rural Malawi. Reprod Health 2023; 20:142. [PMID: 37736687 PMCID: PMC10515069 DOI: 10.1186/s12978-023-01688-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
Reproductive autonomy, or the extent to which people control matters related to their own sexual and reproductive decisions, may help explain why some people who do not intend to become pregnant nevertheless do not use contraception. Using cross-sectional survey data from 695 women aged 16 to 47 enrolled in the Umoyo Wa Thanzi (UTHA) study in Malawi in 2019, we conducted confirmatory factor analysis, descriptive analyses, and multivariable logistic regression to assess the freedom from coercion and communication subscales of the Reproductive Autonomy Scale and to examine relationships between these components of reproductive autonomy and current contraceptive use. The freedom from coercion and communication subscales were valid within this population of partnered women; results from a correlated two-factor confirmatory factor analysis model resulted in good model fit. Women with higher scores on the freedom from coercion subscale had greater odds of current contraceptive use (aOR 1.13, 95% CI: 1.03-1.23) after adjustment for pregnancy intentions, relationship type, parity, education, employment for wages, and household wealth. Scores on the communication subscale were predictive of contraceptive use in some, but not all, models. These findings demonstrate the utility of the Reproductive Autonomy Scale in more holistically understanding contractive use and non-use in a lower-income setting, yet also highlight the need to further explore the multidimensionality of women's reproductive autonomy and its effects on achieving desired fertility.
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Affiliation(s)
- Alexandra Wollum
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles (UCLA), UCLA Bixby Center on Population and Reproductive Health, Los Angeles, USA.
| | - Marta Bornstein
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Gladson Mopiwa
- Adolescent Girls and Young Women Program-The Global Fund Grant ActionAid Malawi, Lilongwe City, Malawi
| | - Alison Norris
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Jessica D Gipson
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles (UCLA), UCLA Bixby Center on Population and Reproductive Health, Los Angeles, USA
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Chamdimba E, Kabiru CW, Ushie BA, Munthali A, Thakwalakwa C, Ajayi AI. Naïve, uninformed and sexually abused: circumstances surrounding adolescent pregnancies in Malawi. Reprod Health 2023; 20:114. [PMID: 37544984 PMCID: PMC10404372 DOI: 10.1186/s12978-023-01655-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/26/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Pregnancy and childbearing in adolescence could negatively affect girls' health and socio-economic wellbeing across the life course. Previous studies on drivers of adolescent pregnancy in Africa have not fully considered the perspectives of parents/guardians vis-à-vis pregnant and parenting adolescents. Our study addresses this gap by examining pregnant and parenting adolescents' and parents/guardians' narratives about factors associated with early and unintended pregnancy. METHODOLOGY The descriptive study draws on qualitative data collected as part of a larger mixed-methods cross-sectional survey on the lived experiences of pregnant and parenting adolescents. Data were collected between March and May 2021 in Blantyre, Malawi, using semi-structured interview guides. We interviewed 18 pregnant and parenting adolescent girls, 10 parenting adolescent boys, and 16 parents/guardians of pregnant and parenting adolescents. Recorded interviews were transcribed verbatim into the English language by bilingual transcribers. We used the inductive-thematic analytical approach to summarize the data. FINDINGS The data revealed several interconnected and structural reasons for adolescents' vulnerability to early and unintended pregnancy. These include adolescents' limited knowledge and access to contraceptives, poverty, sexual violence, school dropout, COVID-19 school closures, and being young and naively engaging in unprotected sex. While some parents agreed that poverty and school dropout or COVID-19 related school closure could lead to early pregnancies, most considered stubbornness, failure to adhere to abstinence advice and peer influence as responsible for adolescent pregnancies. CONCLUSION Our findings contribute to the evidence on the continued vulnerability of girls to unintended pregnancy. It highlights how parents and adolescents hold different views on reasons for early and unintended pregnancy, and documents how divergent views between girls and their parents may contribute to the lack of progress in reducing adolescent childbearing. Based on these findings, preventing unintended pregnancies will require altering community attitudes about young people's use of contraceptives and engaging parents, education sector, civil society organizations and community and religious leaders to develop comprehensive sexuality education programs to empower in- and out-of school adolescents.
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Affiliation(s)
- Elita Chamdimba
- Center for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi.
| | - Caroline W Kabiru
- Sexual, Reproductive, Maternal, New-Born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Boniface Ayanbekongshie Ushie
- Sexual, Reproductive, Maternal, New-Born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Alister Munthali
- Center for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | | | - Anthony Idowu Ajayi
- Sexual, Reproductive, Maternal, New-Born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
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Daniel AK, Casmir E, Oluoch L, Micheni M, Kiptinness C, Wald A, Mugo NR, Roxby AC, Ngure K. "I was just concerned about getting pregnant": Attitudes toward pregnancy and contraceptive use among adolescent girls and young women in Thika, Kenya. BMC Pregnancy Childbirth 2023; 23:493. [PMID: 37403049 DOI: 10.1186/s12884-023-05802-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Adolescent girls and young women (AGYW) have a high incidence of unplanned pregnancies, especially in low-resource settings. AGYW assess the overlapping risks of pregnancy, contraception, and STIs as they navigate relationships. Few studies have examined how AGYW consider the comparative risks of their decisions around sexual and reproductive health in this context or how risk perception influences contraceptive use. METHODS Twenty in-depth interviews (IDIs) and 5 focus group discussions (FGDs) were conducted with a subset of sexually active AGYW enrolled in the Girls Health Study (GHS), a longitudinal cohort study in Thika, Kenya, assessing HSV-2 incidence in a cohort of AGYW aged 16-20. Interview questions were focused on perspectives and decision-making around sexual and reproductive health. Interviews were conducted in both English and Kiswahili, transcribed, and coded using inductive and deductive approaches to identify emerging themes. RESULTS Misconceptions about long-acting reversible contraceptives (LARCs), injectables, and daily oral contraceptive pills strongly disincentivized their use among AGYW. Participants described pregnancy as undesirable, and AGYW reported prioritizing contraceptive methods that were effective and reliable in pregnancy prevention, even if not effective in preventing STI/HIV infection. Participants reported that AGYW relied heavily on emergency contraceptive (EC) pills for pregnancy prevention. CONCLUSIONS Though the goal of avoiding unintended pregnancy was common, this did not suffice to motivate the uptake of long-term contraceptives among AGYWs. Given the convenience, cost-effectiveness, and lower perceived risk of side effects, EC pills were more likely to be accepted as a form of contraception. Understanding the reasons for AGYW's acceptance of certain contraceptive methods over others can help future interventions better target communication and counseling about contraception and influence key drivers of AGYW behavior and decision-making around sexual and reproductive health.
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Affiliation(s)
| | - Edinah Casmir
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Partners in Health Research and Development, Thika, Kenya
| | - Lynda Oluoch
- Partners in Health Research and Development, Thika, Kenya
| | - Murugi Micheni
- National Syndemic Disease Control Council, Nairobi, Kenya
| | | | - Anna Wald
- University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nelly Rwamba Mugo
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- University of Washington, Seattle, WA, USA
| | - Alison C Roxby
- University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Box 19704-00202, Nairobi, Kenya.
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Alsalman Z, Turkistani J, Bohamad A, Alkhalaf A, Almukhtar M, Alkhalaf R, Alkhalaf B. Parents' Knowledge and Perception of Child Abuse and Neglect in the Eastern Province of Saudi Arabia. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:235-241. [PMID: 37533662 PMCID: PMC10393094 DOI: 10.4103/sjmms.sjmms_125_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 08/04/2023]
Abstract
Background Child maltreatment is a crucial issue worldwide that has negative consequences for children and their families. Inability to distinguish between traditional corporal punishment and abuse is part of the problem. Objectives To assess parents' knowledge and perception of child maltreatment and investigate the factors that influence their awareness. Materials and Methods This cross-sectional study recruited parents with at least one child aged <18 years. Data were collected using a self-administrated online questionnaire. Participants were categorized into two groups based on the median knowledge score. Results A total of 447 participants completed the questionnaire, of which 62% were female and the average age was 37 years. Almost two-thirds of the respondents (60.6%) consider child abuse and neglect (CAN) to be a common problem in Saudi Arabia. Only 53% had good knowledge of CAN, and more than one-third were unaware of the hotline number available to report any CAN. Almost half of the participants did not consider refusing childhood immunization or smoking in front of children to be a form of CAN. Logistic regression showed that higher education and family income levels were significantly associated with good knowledge (P = 0.013 and 0.003, respectively). Conclusions While most parents consider CAN to be a common problem in Saudi Arabia, they do not have adequate knowledge of what constitutes emotional abuse and neglect. These findings highlight the need for community-based education programs to increase parents and caregivers' awareness of child rights.
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Affiliation(s)
- Zaenb Alsalman
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Jamela Turkistani
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Abdullah Bohamad
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Abdullah Alkhalaf
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Mohammed Almukhtar
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Reda Alkhalaf
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Basem Alkhalaf
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
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Nwafor JA, Chamdimba E, Ajayi AI, Ushie BA, Munthali AC, Thakwalakwa C, Kabiru CW. Correlates of intimate partner violence among pregnant and parenting adolescents: a cross-sectional household survey in Blantyre District, Malawi. Reprod Health 2023; 20:60. [PMID: 37055778 PMCID: PMC10099731 DOI: 10.1186/s12978-023-01606-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/31/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Despite efforts from the government and developmental partners to eliminate gender-based violence, intimate partner violence (IPV) remains a pervasive global health and human rights problem, affecting up to 753 million women and girls globally. Few studies on IPV have focused on pregnant and parenting adolescent (PPA) girls in Africa, although the region has the highest rates of adolescent childbearing. This limited attention results in the neglect of pregnant and parenting adolescents in policies and interventions addressing IPV in the region. Our study examined IPV prevalence and its individual, household, and community-level correlates among pregnant and parenting adolescent girls (10-19 years) in Blantyre District, Malawi. METHODS We collected data from a cross-section of pregnant and parenting adolescent girls (n = 669) between March and May 2021. The girls responded to questions on socio-demographic and household characteristics, lifetime experience of IPV (i.e., sexual, physical, and emotional violence), and community-level safety nets. We used multilevel mixed-effect logistic regression models to examine the individual, household, and community-level factors associated with IPV. RESULTS The lifetime prevalence of IPV was 39.7% (n = 266), with more girls reporting emotional (28.8%) than physical (22.2%) and sexual (17.4%) violence. At the individual level, girls with secondary education (AOR: 1.72; 95% CI: 1.16-2.54), who engaged in transactional sex (AOR: 2.29; 95% CI: 1.35-3.89), and accepted wife-beating (AOR: 1.97; 95% CI: 1.27-3.08) were significantly more likely to experience IPV compared to those with no education/primary education, who never engaged in transactional sex and rejected wife beating. Girls aged 19 (AOR: 0.49; 95% CI: 0.27-0.87) were less likely to report IPV than those aged 13-16. At the household level, girls with fair and poor partner support had higher odds of experiencing IPV, but the effect size did not reach a significant level in the parsimonious model. A high perception of neighborhood safety was associated with a lower likelihood of experiencing IPV (AOR: 0.81; 95% CI: 0.69-0.95). CONCLUSION Intimate partner violence is rife among pregnant and parenting adolescent girls in Malawi, underscoring the need for appropriate interventions to curb the scourge. Interventions addressing IPV need to target younger adolescents, those engaging in transactional sex, and those having weaker community-level safety nets. Interventions to change social norms that drive the acceptance of gender-based violence are also warranted.
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Affiliation(s)
- Juliet Amarachukwu Nwafor
- Sexual, Reproductive, Maternal, New-Born, Child, and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, 00100, Kenya
| | - Elita Chamdimba
- Centre for Social Research, University of Malawi, P. O. Box 280, Zomba, Malawi
| | - Anthony Idowu Ajayi
- Sexual, Reproductive, Maternal, New-Born, Child, and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, 00100, Kenya.
| | - Boniface Ayanbekongshie Ushie
- Sexual, Reproductive, Maternal, New-Born, Child, and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, 00100, Kenya
| | - Alister C Munthali
- Centre for Social Research, University of Malawi, P. O. Box 280, Zomba, Malawi
| | | | - Caroline W Kabiru
- Sexual, Reproductive, Maternal, New-Born, Child, and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, 00100, Kenya
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Ajayi AI, Alex-Ojei CA, Ahinkorah BO. Sexual violence among young women in Nigeria: a cross-sectional study of prevalence, reporting and care-seeking behaviours. Afr Health Sci 2023; 23:286-300. [PMID: 37545979 PMCID: PMC10398436 DOI: 10.4314/ahs.v23i1.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Only a few studies, mostly hospital-based, have examined sexual violence among young people women in Nigeria. We examined the prevalence, correlates, perpetrators, reporting of and health-seeking behaviour for sexual violence using data of 395 young women (aged 17-24) obtained from a Nigerian university. METHODS We selected participants using stratified sampling and defined sexual violence as sexual acts or attempts to obtain sexual acts by violence or coercion by any person irrespective of their relationship to the victim. Descriptive and inferential statistics were used to summarise the data obtained. RESULTS Our analysis shows that 39.5% of the respondents had experienced some form of sexual violence. Adequate family financial support was protective against sexual violence after adjusting for all background characteristics (AOR: 0.60 95% CI: 0.39-0.93). However, young women who use alcohol had higher odds of reporting sexual violence experience than those who never used alcohol. In most cases (78.5%), perpetrators were well known to the victims. Only 3.3% of sexual violence cases were reported to law enforcement agencies and just 13.1% of victims sought care from health providers. CONCLUSION Sexual violence occurs at a tragically high frequency, and victims rarely report incidents to law enforcement agencies or access the much-needed care. The findings suggest a need for interventions that address why victims of sexual violence rarely report to law enforcement or seek care.
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Affiliation(s)
- Anthony Idowu Ajayi
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Centre, APHRC Campus, Manga Close, Nairobi, Kenya
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Namukisa M, Kamacooko O, Lunkuse JF, Ruzagira E, Price MA, Mayanja Y. Incidence of unintended pregnancy and associated factors among adolescent girls and young women at risk of HIV infection in Kampala, Uganda. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1089104. [PMID: 36910339 PMCID: PMC9995850 DOI: 10.3389/frph.2023.1089104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/18/2023] [Indexed: 02/25/2023] Open
Abstract
Background In sub-Saharan Africa, one in every five young women becomes pregnant, and 50% of these are unintended. Pregnancies in adolescent girls and young women (AGYW) are associated with poorer maternal and neonatal outcomes and a high abortion rate, yet data are still limited on incident pregnancies among AGYW in vulnerable situations. We studied the incidence and factors associated with unintended pregnancy among AGYW who were frequently engaged in transactional sex in Kampala, Uganda. Methods We analyzed data from a study that investigated the uptake of oral pre-exposure prophylaxis among AGYW from January 2019 to December 2020. Volunteers attended 3-monthly study visits for 12 months each. Contraceptive services were provided to interested volunteers free of charge. Interviewers collected data on sociodemographics, sexual behavior, reproductive health outcomes, and substance use. Pregnancy was determined by testing for beta-human chorionic gonadotropin hormone in urine. The pregnancy incidence rate was estimated using the Kaplan-Meier technique, and logistic regression was used to determine the correlates of pregnancy. Results We included 285 volunteers with a mean age of 19.9 [standard deviation (SD), ± 2.24] years; 54.7% had attained secondary school education or higher, 57.2% were single (never married), 92.6% reported engaging in transactional sex, 21.0% reported sex work as their main job, 51.9% consumed alcohol in the month prior to the interview, of whom 12.8% consumed alcohol daily, and 25.3% had Chlamydia trachomatis/Neisseria gonorrhoeae. The mean age at first sexual intercourse was 15.7 (SD, ±2.1) years. We recorded 44 pregnancies over 187.2 person-years of follow-up, an incidence of 23.5 per 100 person-years [95% confidence interval (CI), 17.5-31.6]. Incident pregnancies were more likely among volunteers who had ≥10 sexual partners in the past 3 months [adjusted risk ratio (aRR) 1.97; 95% CI, 1.05-3.70] and those who reported not using contraception (aRR 5.89; 95% CI, 2.74-12.66). Incident pregnancies were less likely among those who reported alcohol consumption in the past month (aRR 0.52; 95% CI, 0.30-0.90). Conclusion The incidence of unintended pregnancy was high despite the availability of free contraceptive services. We recommend sociobehavioral studies to explore this further. Sexual and reproductive health campaigns should strengthen demand creation and motivation to use contraception among young women with multiple sexual partners.
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Affiliation(s)
- Mary Namukisa
- Department of Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Onesmus Kamacooko
- Department of Data and Statistics, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Jane Frances Lunkuse
- Department of Data and Statistics, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Eugene Ruzagira
- Department of HIV Epidemiology and Intervention, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matt A. Price
- Department of Epidemiology, IAVI, New York, NY, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Yunia Mayanja
- Department of HIV Epidemiology and Intervention, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
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Schonewille NN, van den Eijnden MJM, Jonkman NH, van Kempen AAMW, van Pampus MG, Goedhart FG, van den Heuvel OA, Broekman BFP. Experiences with Family Planning amongst Persons with Mental Health Problems: A Nationwide Patient Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3070. [PMID: 36833766 PMCID: PMC9966993 DOI: 10.3390/ijerph20043070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
High rates of unintended pregnancies in patients with mental health problems reflect the unmet need for tailored family planning. This study aims to explore aspects of family planning that are especially challenging for patients experiencing health problems by obtaining the perspective of (former) patients and those with close relationships with the (former) patients. In August 2021, members of a Dutch national mental health panel, consisting of (former) patients and close ones, were invited to respond to a 34-question online survey that included questions on four domains: reproductive history, decision making, parenting, and sexuality. This study has revealed the severe and adverse impact of mental health problems across all of the four domains of reproductive health and family planning, which the questions specifically targeted. Based on these results, we recommend discussing family planning with all patients experiencing or at risk for mental health problems and their partners. These discussions should address a desire to have children, (involuntary) childlessness, uncertainties about parenting and sexuality, while remaining considerate of experienced taboos.
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Affiliation(s)
- Noralie N. Schonewille
- Department of Psychiatry and Medical Psychology, OLVG, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | | | - Nini H. Jonkman
- Department of Research and Epidemiology, OLVG, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - Anne A. M. W. van Kempen
- Department of Neonatology and Pediatrics, OLVG, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - Maria G. van Pampus
- Department of Gynecology and Obstetrics, OLVG, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - Francisca G. Goedhart
- Team Knowledge, Innovation and Research, MIND, Stationsplein 125, 3818 LE Amersfoort, The Netherlands
| | - Odile A. van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Anatomy & Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention Program, 1081 HV Amsterdam, The Netherlands
| | - Birit F. P. Broekman
- Department of Psychiatry and Medical Psychology, OLVG, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Adolescent Girls’ Experiences Regarding Teenage Pregnancy in the Rural Villages of Limpopo Province, South Africa. ADOLESCENTS 2022. [DOI: 10.3390/adolescents3010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Every year, 7.3 million girls become pregnant before they turn 18. Teenage pregnancy increases when girls are denied the right to make decisions about their sexual health and well-being, which is a gender equality issue. Among the challenges of gender equality are those expectations that communities have about girls and early motherhood, sexual violence, and rape. Another challenge is the early marriages of children to older men coupled with the unique risks faced by these girls during pregnancy, for example, the interruption of their education, health risks, such as HIV, premature birth, and increased maternal mortality, denying the girls the right to live a healthy life. This study sought to explore the experiences of adolescent girls regarding teenage pregnancy in the rural villages of the Mopani District, Limpopo. A descriptive, explorative, and qualitative design was followed to collect data from 20 pregnant teenagers in a 13–19 years-old age group. A nonprobability purposive sampling method was used to select the participants from the three villages of the Mopani District. The data were collected using an in-depth individual interview. Tesch’s eight steps of data analysis were also applied. The study findings reveal several factors that explain the high rates of teenage pregnancy in rural Limpopo. Among these are the socioeconomic and cultural factors that predispose teens to pregnancy. The consequences of teenage pregnancy were expressed in terms of regret and ill health.
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Das M, Tóth CG, Shri N, Singh M, Hossain B. Does sexual Intimate Partner Violence (IPV) increase risk of multiple high-risk fertility behaviours in India: evidence from National Family Health Survey 2015–16. BMC Public Health 2022; 22:2081. [PMCID: PMC9664657 DOI: 10.1186/s12889-022-14289-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
One in three women from lower and middle-income countries are subjected to physical and/or sexual intimate partner violence (IPV) in their life span. Prior studies have highlighted a range of adverse health impacts of sexual IPV. However, less is known about the link between multiple high-risk fertility behaviours and sexual intimate partner violence. The present study examines the statistical association between multiple high-risk fertility behaviours and sexual intimate partner violence among women in India.
Methods
The present study used a nationally representative dataset, the National Family Health Survey (NFHS-4) 2015–16. A total of 23,597 women were included in the study; a subsample of married women of reproductive age who have had at least one child 5 years prior to the survey and who had valid information about sexual IPV. Logistic regression models were employed alongside descriptive statistics.
Results
Approximately 7% of women who are or had been married face sexual IPV. The prevalence of sexual violence was higher among women who had short birth intervals and women who had given birth more than three times (12%). Around 11% of women who had experienced any high-risk fertility behaviours also experienced sexual violence. The unadjusted association suggested that multiple high-risk fertility behaviours were 32% (UORs = 1.32, 95% CI: 1.16–1.50) higher for those women who experienced sexual violence. After adjusting for other sociodemographic variables, except for women’s education and wealth quantile, the odds of multiple high-risk fertility behaviours were 16% (AOR = 1.16; 95% CI: 1.02–1.34) higher among women who faced sexual violence. The inclusion of women’s educational attainment and wealth status in the model made the association between sexual IPV and high-risk fertility behaviours insignificant.
Conclusion
Sexual intimate partner violence is statistically associated with high-risk fertility behaviours among women in India. Programs and strategies designed to improve women’s reproductive health should investigate the different dimensions of sexual IPV in India.
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Luis MA, Leite FMC, Letourneau N, Monroy NAJ, de Godoi LG, Lopes-Júnior LC. Sexual Violence against Adolescents in the State of Espírito Santo, Brazil: An Analysis of Reported Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14481. [PMID: 36361355 PMCID: PMC9654849 DOI: 10.3390/ijerph192114481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE We describe the prevalence of the reported cases of sexual violence against adolescents and analyze their associated factors. METHODS A cross-sectional analytical study (n = 561) was conducted with reported data on sexual violence against adolescents in the state of Espírito Santo registered in SINAN between 2011 and 2018 to understand the prevalence and predictors of sexual violence against adolescent victims, as well as to describe the perpetrators and the nature of the aggression. Variables to characterize the victim, aggression, and perpetrator were used. Bivariate analyses were performed using chi-square (χ2) and Fisher's exact tests, and multivariate analyses were conducted using log-binomial models; the results were presented with prevalence ratios. All analyses were stratified by sex. RESULTS The prevalence of sexual violence was 32.6%, and 93% of the victims were female. In both males and females, the reported sexual violence was associated with a younger age (10-12 years old), living at home, being related to the perpetrator, and a history of sexual violence. In females, the reported sexual violence was also associated with the number of perpetrators, and in males, with the perpetrator's age. CONCLUSIONS Our findings show the high frequency of reporting of sexual violence and the characteristics of the victim, the aggression, and the aggressor as factors associated with its occurrence in both sexes. The importance of health information systems for disseminating data and the need for measures to prevent and treat the violence among adolescents is urgent.
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Affiliation(s)
- Mayara Alves Luis
- Graduate Program in Public Health, Health Sciences Center, Federal University of Espírito Santo (UFES), Vitoria 29047-105, Brazil
| | - Franciéle Marabotti Costa Leite
- Graduate Program in Public Health, Health Sciences Center, Federal University of Espírito Santo (UFES), Vitoria 29047-105, Brazil
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 4V8, Canada
| | | | | | - Luís Carlos Lopes-Júnior
- Graduate Program in Public Health, Health Sciences Center, Federal University of Espírito Santo (UFES), Vitoria 29047-105, Brazil
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Eyeberu A, Getachew T, Sertsu A, Sisay M, Baye Y, Debella A, Alemu A. Teenage pregnancy and its predictors in Africa: A systematic review and meta-analysis. Int J Health Sci (Qassim) 2022; 16:47-60. [PMID: 36475034 PMCID: PMC9682880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE Although teenage pregnancy has declined in the last decade, it remains a major public health issue in Africa. Maternal mortality is common among teenagers due to their increased risk of obstetric and medical complications. In Africa, there is a lack of robust and comprehensive data on the prevalence and predictors of teenage pregnancy. As a result, this systematic review and meta-analysis were carried out to summarize evidence that will assist concerned entities in identifying existing gaps and proposing strategies to reduce teenage pregnancy in Africa. METHODS The review is registered by the international prospective register of systematic reviews (CRD42021275013). This search included all published and unpublished observational studies written in English between August 23, 2016, and August 23, 2021. The articles were searched using databases (PubMed, CINHAL [EBSCO], EMBASE, POPLINE, Google Scholar, DOAJ, Web of Sciences, MEDLINE, Cochrane Library, and SCOPUS). Data synthesis and statistical analysis were conducted using STATA version 14 software. Forest plots were used to present the pooled prevalence and odds ratio (OR) with a 95% confidence interval (CI) of meta-analysis using the random effect model. RESULTS A total of 43,758 teenagers (aged 13-19) were included in 23 studies. In Africa, the overall pooled prevalence of teenage pregnancy was 30% (95% CI: 17-43). Western Africa had the highest prevalence of teenage pregnancy 33% (95% CI: 10-55). Age (18-19) (OR = 2.99 [95% CI = 1.124-7.927]), wealth index (OR = 1.84 [95% CI = 1.384-2.433]), and marital status (OR = 6.02 [95% CI = 2.348-15.43]) were predictors of teenage pregnancy in Africa. CONCLUSION In Africa, nearly one-third of teenagers become pregnant. Teenage pregnancy was predicted by age (18-19), wealth index, and marital status. Strengthening interventions aimed at increasing teenagers' economic independence, reducing child marriage, and increasing contraceptive use among married teenagers can help to prevent teenage pregnancy.
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Affiliation(s)
- Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Sertsu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mekonnen Sisay
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yohannes Baye
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Alemu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Odimegwu CO, Ugwu NH. A multilevel mixed effect analysis of neighbourhood and individual level determinants of risky sexual behaviour among young people in South Africa. Reprod Health 2022; 19:119. [PMID: 35549967 PMCID: PMC9096753 DOI: 10.1186/s12978-022-01407-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite national and international commitments and efforts to prevent risky sexual behaviours, a high proportion of young people in South Africa are engaged in risky sexual behaviour. However, most efforts are currently directed toward addressing individual-level factors at the expense of not addressing neighbourhood-level determinants such as social disorganisation, contributing to risky sexual behaviour among young people in South Africa. This study investigated the multilevel factors of risky sexual behaviours among young people by gender in South Africa, using the lens of socio-ecological and social disorganisation frameworks. METHODS Data from a nationally representative sample of 1268 males and 2621 females aged 15-24 years, giving a total of, 3889 never-married youths, were drawn from the 2016 South Africa Demographic and Health Survey. Analysis was conducted using multilevel mixed-effect logistic regressions with random community-level effects. RESULTS Findings show that youth who were from a heterogeneous ethnic group (AOR = 0.49, CI: 0.35-0.67), household size of 5 + members (AOR = 0.78, CI: 0.54-1.15), community education (AOR = 0.97, CI: 0.72-1.32) were associated with low engagement in multiple sexual partnerships. Youths who were employed (AOR = 0.84, CI: 0.59-1.18), and from high-level community poverty (AOR = 0.76, CI: 0.58-1.00) were also associated with reduced odds of unprotected sex. In addition, older youth aged 20-24 years (AOR = 12.6, CI: 9.93-16.00); secondary education attainment (AOR = 1.01, CI 0.58-1.77); family structure (AOR = 1.37, CI: 0.75-1.15); Gauteng province (AOR = 1.45 CI: 0.92-2.28); residential mobility (AOR = 1.25, CI: 1.02-1.53), community media exposure to contraceptives (unprotected sex) (AOR = 1.38, CI: 1.09-1.76) were more likely to engage in risky sexual behaviour. CONCLUSION The study revealed that neighbourhood and individual-level factors were important in explaining the factors associated with risky sexual behaviour among young people in South Africa. In addition, engagement in risky sexual behaviour was high, with minimal variation among young females and males in South Africa. It specifies that the practice of risky sexual behaviour is significantly associated with multilevel factors of social disorganisation that cut across gender. These results imply that there is a need to review policies of sexual risks reduction for each gender, which might help mitigate the adverse effects of social disorganisation for women and men youths in South Africa.
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Affiliation(s)
- Clifford Obby Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nebechukwu Henry Ugwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,Institute for Development Studies, University of Nigeria, Enugu Campus, Nigeria.
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Insan N, Weke A, Forrest S, Rankin J. Social determinants of antenatal depression and anxiety among women in South Asia: A systematic review & meta-analysis. PLoS One 2022; 17:e0263760. [PMID: 35139136 PMCID: PMC8827460 DOI: 10.1371/journal.pone.0263760] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 01/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background Pregnancy is a time of major psychological changes making pregnant women more susceptible to depression and anxiety. Prevalence is higher among women living in Bangladesh, India and Pakistan, compared to high-income countries, due to poor understanding and lack of mental health integration within antenatal care. Antenatal depression/anxiety is associated with adverse outcomes including postnatal depression, low birth weight and impaired fetal development. Existing systematic reviews provided only limited information on the social determinants of antenatal depression/anxiety in these South Asian countries. Objective This review aimed to identify, synthesise and appraise the evidence on the social determinants associated with antenatal depression and anxiety in women living in Bangladesh, India and Pakistan. Methods We searched five databases (MEDLINE, Embase, PsycINFO, Scopus, Web of Science) and PROSPERO. Observational studies published between 1st January 2000 and 4th January 2021 were included if they were in the English language, used validated tools for measuring depression/anxiety in pregnant women and reported statistical associations or raw numbers. Summary estimates were obtained using random-effects model. Heterogeneity and publication bias was measured using the I2 statistic and Egger’s test, respectively. This review was registered on PROSPERO (reference: CRD42020167903). Results We included 34 studies (with 27,379 women). Meta-analysis of Adjusted Odds Ratios (AOR) found that Intimate partner violence (AOR 2.48, 95% CI 1.41–4.33), unplanned pregnancy (AOR 1.53, 95% CI 1.28–1.83), male gender preference (AOR 3.06, 95% CI 1.40–6.72) and poor relationship with in-laws (AOR 2.69, 95% CI 1.25–5.80) were significantly associated with antenatal depression/anxiety. Conclusion The review identified a complex range of social determinants of antenatal depression and anxiety in Bangladesh, India and Pakistan. Screening tools to identify pregnant women at high risk should be integrated within antenatal care to prevent adverse outcomes. Knowledge of these social determinants will inform the development of such screening tools and interventions.
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Affiliation(s)
- Nafisa Insan
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
- * E-mail:
| | - Anthony Weke
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Simon Forrest
- Department of Sociology, Durham University, Durham, United Kingdom
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
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Bolarinwa OA, Boikhutso T. A Mixed-Method Analysis of Inequalities Associated With Adverse Sexual and Reproductive Health Outcomes and the Requisite Interventions Among Young Women in Durban Informal Settlements, South Africa. Front Public Health 2022; 10:810216. [PMID: 35296047 PMCID: PMC8918490 DOI: 10.3389/fpubh.2022.810216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/03/2022] [Indexed: 11/26/2022] Open
Abstract
Background Over the years, positive sexual and reproductive health (SRH) outcomes have been made possible by a series of policies such as the Sustainable Development Goals, targeted toward different aspects of young women's SRH needs. Nevertheless, inequalities in the levels and trends of adverse SRH outcomes still exist in sub-Saharan Africa (SSA), including South Africa. Thus, this study examines the inequalities associated with adverse SRH outcomes among young women in Durban informal settlements, South Africa, using a mixed-method analysis and suggested requisite interventions to reduce or eliminate the disparity. Methods A mixed-method sequential explanatory design was used to address the research question. First, a quantitative cross-sectional survey was conducted among 547 young women aged 18 to 24 years in four informal settlements in Durban, South Africa, between April and July 2021. Thereafter, twenty (20) key informant interviews were conducted among different participants but with the same study characteristics. The study's outcome variable was adverse SRH outcomes, including HIV, STIs and unintended pregnancy, while the independent variable was inequality. The quantitative analysis employed binary and multivariable analysis to determine the association between the outcome and explanatory variables, using an alpha level of p < 0.05 to determine significance, while the qualitative analysis was done thematically. Results At the quantitative level, the prevalence of adverse SRH outcomes among young women dwelling in Durban informal settlements was 82.45%, 90.86% and 81.90% for STIs, HIV and unintended pregnancy, respectively. The adjusted odds ratio showed that young women who ever discussed sexual matters with their parents had a lower likelihood of reporting having STIs [aOR = 0.20; 95% (CI = 0.15-1.01)], HIV [aOR = 0.20; 95% (CI = 0.15-1.01)] and unintended pregnancy [aOR = 0.20; 95% (CI = 0.15-1.01)] compared to young women who never had a sexual discussion with their parents. Almost all the key informant interview participants shared the same perspective and proffered possible solutions in the qualitative results. Conclusion There are disparities in the factors associated with adverse SRH outcomes in Durban's informal settlements. Healthcare proximity, child support grants, cigarette smoking, alcohol consumption, polygamous family structures and gender based violence were associated with higher odds of reporting adverse SRH outcomes.
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Bolarinwa OA, Boikhutso T. Mapping evidence on predictors of adverse sexual and reproductive health outcomes among young women in South Africa: A scoping review. Afr J Prim Health Care Fam Med 2021; 13:e1-e10. [PMID: 34797120 PMCID: PMC8661283 DOI: 10.4102/phcfm.v13i1.3091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Globally, most young women have an unmet need for sexual and reproductive health (SRH), which remains a public health concern. Identifying the predictors can help reduce this challenge. Aim This scoping review maps evidence on predictors of adverse sexual and reproductive health outcomes among young women in South Africa. Method Askey and O’Malley’s framework guided this review. We searched five databases from January 2000 to December 2020 using relevant keywords, Boolean terms and medical subject heading terms. All relevant extracted data were organised into the study themes, and summary of all the findings were reported in a narrative format. Results Nine studies met the inclusion criteria out of 1219 studies identified. Four out of the nine studies were national-based studies, while the remaining five studies were conducted in Western Cape (two), Eastern Cape (two) and KwaZulu-Natal (one). Out of the nine studies included, three reported predictors of unintended pregnancy, while six reported predictors of sexually transmitted infections and HIV among young women in South Africa. The most prevailing predictors of adverse sexual and reproductive health outcomes were gender-based violence and alcohol use, while other predictors were lower socio-economic status, place of residence, multiple sexual partnerships, low education and being between the ages of 20–24 years. Conclusion We conclude that gender-based violence and alcohol abuse are the most prevailing predictors of adverse sexual and reproductive health outcomes among young women in South Africa.
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Affiliation(s)
- Obasanjo A Bolarinwa
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban.
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Nkala-Dlamini B. “It Was a Mistake, but We Knew That Something Might Happen”: Narratives of Teenage Girls' Experiences With Unintended Teenage Pregnancy. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:639544. [PMID: 36304037 PMCID: PMC9580800 DOI: 10.3389/frph.2021.639544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
It has been over a quarter of a century since the sexual reproductive health of young people came under the spotlight. The upsurge in human immunodeficiency virus (HIV) infections spurred on an era of intense development of services and strategies to ensure people's reproductive health rights were attainable, including the right to choose when to fall pregnant and have a baby. The statistics on teenage pregnancy are more than just numbers, but a represent stark reality for some girls in South African schools. Given that pregnancy in the teenage years is largely unintentional, prevention strategies need to extend beyond addressing risky sexual behavior; gaining deeper insights into teenagers' experiences and the events leading up to pregnancy would serve to better inform pregnancy prevention programs. This study explored the experiences of teenage mothers and pregnant teenagers, with the objective of acquiring a broader understanding of alternative approaches to preventing unintended pregnancy. A qualitative study was conducted in Ekurhuleni's township in the east of Johannesburg, South Africa. Fifteen narrative interviews with girls aged 13–19 years were conducted between July 2015 and July 2016, and were analyzed chronologically through narrative analysis. The findings revealed that participants who had engaged in socio-sexual and romantic relationships had no intention of falling pregnant and were familiar with existing strategies to prevent pregnancy. Social-sexual relationships were presented as an important aspect of their lives and demonstrated their ability to create spaces and opportunities to spend time with their social sexual partners and engage in sexual activity. Focusing on how teenage girls evaluate their sexual activity against the consequences of their actions is critical. However, sexual and reproductive health programs should refrain from representing young people's sexual behavior as a pathological condition, framing it instead as an integral component of creative sexual development. Programs should include relevant practical advice in relation to sexual engagement and be considered an extension of the State's existing Road to Health program.
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Ahinkorah BO, Obisesan MT, Seidu AA, Ajayi AI. Unequal access and use of contraceptives among parenting adolescent girls in sub-Saharan Africa: a cross-sectional analysis of demographic and health surveys. BMJ Open 2021; 11:e051583. [PMID: 34551951 PMCID: PMC8461275 DOI: 10.1136/bmjopen-2021-051583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We examined the divergent patterns, prevalence and correlates of contraceptive use among parenting adolescents in sub-Saharan Africa using the Demographic and Health Survey datasets of 17 countries. DESIGN We included a weighted sample of 9488 parenting adolescent girls in our analysis. Current contraceptive use was defined as the use of any methods to delay or avoid getting pregnant at the survey time. We reported the prevalence of any contraceptive use for all countries and used multilevel binary logistic regression analysis to examine the individual and contextual factors associated with contraceptive use. OUTCOME MEASURES Contraceptive use. RESULTS We found an overall contraceptive prevalence of 27.12% (CI 27.23% to 28.03%) among parenting adolescent girls in sub-Saharan Africa, ranging from 70.0% (CI 61.76% to 77.16%) in South Africa to only 5.10% (CI 3.04% to 8.45%) in Chad. The prevalence of contraceptive use was lowest in West andCentral Africa, with most countries having less than 20% prevalence. Increasing age (adjusted OR (aOR)=1.46, 95% CI 1.28 to 1.65), being married (aOR=1.63, 95% CI 1.43 to 1.87), having a secondary or higher level of education (aOR=2.72, 95% CI 2.25 to 2.3.27), and media exposure (aOR=1.21, 95% CI 1.08 to 1.36), were associated with higher odds of contraceptive use in the pooled data but preference for a higher number of children (more than five children) (aOR=0.61, 95% CI 0.52 to 0.72) was related to lower likelihood of use. Significant heterogeneity was observed in the country-level disaggregated results. CONCLUSION African countries differ widely when it comes to contraceptive use among parenting adolescent girls, with only three countries having a relatively high prevalence of use. The governments of countries in sub-Saharan Africa, particularly those in West and Central Africa, should invest in expanding access to contraceptives for adolescent mothers to prevent repeat pregnancy and improve the overall well-being of parenting adolescent girls.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Department of Estate Management, Takoradi Technical Unversity, Takoradi, Ghana
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
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Wiener SJ, Fitzgerald S, Einhorn H. A trauma-informed guide to caring for adolescents following sexual assault. Curr Opin Pediatr 2021; 33:354-360. [PMID: 34039900 DOI: 10.1097/mop.0000000000001030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Sexual assault is common among adolescents worldwide. Survivors of sexual assault may experience various immediate and long-term effects on their physical and mental health. It is important that pediatric healthcare providers (HCPs) are aware of the high prevalence of sexual assault and recognize the impact on their adolescent patients. The aim of this update is to discuss how pediatric HCPs can embody a trauma-informed approach when caring for survivors of sexual assault across various settings. RECENT FINDINGS All adolescent patients should be screened for sexual assault during routine clinical visits; in responding to a disclosure, providers should exhibit compassion, express validation, and help connect the patient to resources to aid in healing. Caring for survivors of sexual assault should ideally be multidisciplinary, involving treatment of the medical complications (including the possibility of pregnancy or infection) and mental health sequelae (including increased likelihood of depression, posttraumatic symptoms, and suicidality). SUMMARY A trauma-informed approach can be applied to all aspects of caring for survivors of sexual assault, from screening for sexual assault and responding to disclosure, to providing acute and longitudinal care following sexual assault.
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Affiliation(s)
- Susan J Wiener
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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