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PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262016
Author(s):  
Naomi Monari ◽  
James Orwa ◽  
Alfred Agwanda

Background Adolescent fertility in Kenya is vital in the development and execution of reproductive health policies and programs. One of the specific objectives of the Kenyan Adolescent Sexual Reproductive Health (ASRH) policy developed in 2015 is to decrease early and unintended pregnancies in an attempt to reduce adolescent fertility. We aimed to establish determinants of adolescent fertility in Kenya. Methods The Kenya Demographic and Health Survey (KDHS) 2014 data set was utilized. Adolescent’s number of children ever born was the dependent variable. The Chi-square test was utilized to determine the relationship between dependent and independent variables. A Proportional-odds model was performed to establish determinants of adolescent fertility at a 5% significance level. Results Over 40% of the adolescent girls who had sex below 17 years had given birth i.e, current age 15–17 years (40.9%) and <15 years (44.9%) had given birth. In addition, 70.7% of the married adolescents had given birth compared to 8.1% of the unmarried adolescents. Moreover, 65.1% of the adolescents who were using contraceptives had given birth compared to only 9% of the adolescents who were not using a contraceptive. Approximately 29.4% of the adolescents who had no education had given birth compared to 9.1% who had attained secondary education. Age at first sex (18–19 years: OR: 0.221, 95% CI: 0.124–0.392; 15–17 years: OR: 0.530, 95% CI: 0.379–0.742), current age (18–19 years: OR: 4.727, 95% CI: 3.318–6.733), current marital status (Not married: OR:0.212, 95% CI: 0.150–4.780), and current contraceptive use (Using: OR 3.138, 95% CI: 2.257–4.362) were associated with adolescent fertility. Conclusion The study established that age at first sex, current age, marital status, and contraceptive use are the main determinants of adolescent childbearing. The stated determinants should be targeted by the government to control the adolescent birth rate in Kenya. Consequently, delaying the age at first sex, discouraging adolescent marriage, and increasing secondary school enrollment among adolescent girls are recommended strategies to control adolescent fertility in Kenya.


2021 ◽  
Author(s):  
Van Kinh Nguyen ◽  
Jeffrey W Eaton

Background: Debuting sexual intercourse is a life course event marking exposure to pregnancy or fatherhood, and sexually transmitted infections (STIs), including HIV. We systematically analysed the timing, distribution, and trends in age at first sex (AFS) in 42 sub-Saharan Africa (SSA) countries. Methods: We collated individual-level AFS data from nationally representative household surveys across SSA. We used a log-skew-logistic distribution to model the distribution of AFS in a Bayesian spatio-temporal hierarchical random-effect model to estimate national trends of AFS over time and space, adjusting for age at report biases. Findings: Small changes in AFS are observed between the birth cohorts entering adulthood between 1985 and 2020, ranging 0.79 years [-0.01-1.51] and 0.48 [-0.03-1.92] for female and male, respectively. Northern SSA countries show appreciable increase in AFS but its gender gap remains the widest compared with minimal gender gap in the southern countries. The gender gap shows little evidence of change over time in most of the countries. Female's AFS approach to a similar age across SSA while male's AFS varies between regions. Proportion ever had sex under fifteen and eighteen are as high 34% and 83%, respectively. AFS distribution is typically asymmetric with most of sexual debut events occur in a span of 3.9 [3.4-5.0] years. Female teen often reports higher AFS compare to their late twenties while male teen report lower AFS; both sexes tend to recall a higher AFS in older ages compared to their thirties. Interpretation: Women debut sexually earlier and in a shorter span of age than men. Northern and southern SSA gender gap are distinctively different. Since the ratifying of HIV/AIDS intervention programs in SSA, a stagnant trend in AFS had remained in the countries most affected by the epidemic.


2021 ◽  
Author(s):  
Van Kinh Nguyen ◽  
Jeffrey W Eaton

Age at first sex (AFS) is a key indicator for monitoring sexual behaviour risk for HIV and sexually transmitted diseases. Reporting of AFS data, however, suffer social-desirability and recall biases which obscure AFS trends and inferences constructed from it. We illustrated examples of the biases using data from multiple nationally-representative Demographic and Health Surveys household surveys conducted between 1992 and 2019 in Ethiopia (4 surveys), Guinea (4 surveys), Senegal (8 surveys), and Zambia (8 surveys). Based on this, we proposed a time-to-event, interval censored model for the AFS that uses overlapping reports by the same birth cohort in successive surveys to adjust reporting biases. The three-parameter log-skew-logistic distribution described the asymmetric and nonmonotonic hazard exhibited by empirical AFS data. In cross-validation analysis, incorporating a term for AFS reporting bias as a function of age improved model predictions for the trend of AFS over birth cohorts. The interquartile range for the AFS was 16 years to 23 years for Ethiopian and Senegalese women and 15 years to 20 years for Guinean and Zambian men. Median AFS increased by around one to 1.5 years between the 1960 and 1989 birth cohorts for all four datasets. Younger male respondents tended to report a younger AFS while female respondents tended to report an older AFS than when asked in later surveys. Above age 30, both male and female respondents tended to report older AFS compared to when surveyed in their late twenties. Simulations validated that the model recovers the trend in AFS over birth cohorts in the presence of reporting biases. At least three surveys are needed to obtain reliable trend estimate for a 20-years trend. Mis-specified reference age at which reporting is assumed unbiased did not affect the trend estimate but resulted in biased estimates for the median AFS in the most recent birth cohorts.


Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ruth Ponsford ◽  
Rebecca Meiksin ◽  
Elizabeth Allen ◽  
G. J. Melendez-Torres ◽  
Steve Morris ◽  
...  

Abstract Background Positive Choices is a whole-school social marketing intervention to promote sexual health among secondary school students. Intervention comprises school health promotion council involving staff and students coordinating delivery; student survey to inform local tailoring; teacher-delivered classroom curriculum; student-run campaigns; parent information; and review of sexual/reproductive health services to inform improvements. This trial builds on an optimisation/pilot RCT study which met progression criteria, plus findings from another pilot RCT of the Project Respect school-based intervention to prevent dating and relationship violence which concluded such work should be integrated within Positive Choices. Young people carry a disproportionate burden of adverse sexual health; most do not report competence at first sex. Relationships and sex education in schools can contribute to promoting sexual health but effects are small, inconsistent and not sustained. Such work needs to be supplemented by ‘whole-school’ (e.g. student campaigns, sexual health services) and ‘social marketing’ (harnessing commercial marketing to social ends) approaches for which there is good review-level evidence but not from the UK. Methods We will conduct a cluster RCT across 50 schools (minimum 6440, maximum 8500 students) allocated 1:1 to intervention/control assessing outcomes at 33 months. Our primary outcome is non-competent first sex. Secondary outcomes are non-competent last sex, age at sexual debut, non-use of contraception at first and last sex among those reporting heterosexual intercourse, number of sexual partners, dating and relationship violence, sexually transmitted infections, and pregnancy and unintended pregnancy for girls and initiation of pregnancy for boys. We will recruit 50 school and undertake baseline surveys by March 2022; implement the intervention over the 2022–2024 school years and conduct the economic and process evaluations by July 2024; undertake follow-up surveys by December 2024; complete analyses, all patient and policy involvement and draft the study report by March 2025; and engage in knowledge exchange from December 2024. Discussion This trial is one of a growing number focused on whole-school approaches to public health in schools. The key scientific output will be evidence about the effectiveness, costs and potential scalability and transferability of Positive Choices. Trial registration ISRCTN No: ISRCTN16723909. Trial registration summary: Date:. Funded by: National Institute for Health Research Public Health Research Programme (NIHR131487). Sponsor: LSHTM. Public/scientific contact: Chris Bonell. Public title: Positive Choices trial. Scientific title: Phase-III RCT of Positive Choices: a whole-school social marketing intervention to promote sexual health and reduce health inequalities. Countries of recruitment: UK. Intervention: Positive Choices. Inclusion criteria: Students in year 8 (age 12–13 years) at baseline deemed competent by schools to participate in secondary schools excluding pupil referral units, schools for those with special educational needs and disabilities, and schools with ‘inadequate’ Ofsted inspections. Study type: interventional study with superiority phase III cluster RCT design. Enrollment: 1/9/21-31/3/22. Sample size: 50 schools and 6440–8500 students. Recruitment status: pending. Primary outcome: binary measure of non-competent first sex. Secondary outcomes: non-competent last sex; age at sexual debut; non-use of contraception at first and last sex; number of sexual partners; dating and relationship violence (DRV) victimisation; sexually transmitted infections; pregnancy and unintended pregnancy for girls and initiation of pregnancy for boys using adapted versions of the RIPPLE measures. Ethics review: LSHTM research ethics committee (reference 26411). Completion data: 1/3/25. Sharing statement: Data will be made available after the main trial analyses have been completed on reasonable request from researchers with ethics approval and a clear protocol. Amendments to the protocol will be communicated to the investigators, sponsor, funder, research ethics committee, trial registration and the journal publishing the protocol. Amendments affecting participants’ experience of the intervention or important amendments affecting the overall design and conduct of the trial will be communicated to participants.


Author(s):  
Coady Babin ◽  
Terry Humphreys

The purpose of the current study was to explore first sex experiences in lesbian, gay, and bisexual individuals (LGB) using the Virginity Beliefs Framework ( Carpenter, 2001 ; Humphreys, 2013 ; Eriksson & Humphreys, 2014 ). The specific focus was on LGB individuals who have had both a sexual experience with a member of a different sex and a member of the same sex. This phenomenon is what the current study is defining as second virginity loss. Participants consisted of 275 self-identified LGB individuals; the sample was approximately half women (57%) between the ages of 18 and 56. Further, six semi-structured interviews were conducted to gain a clearer understanding of LGB individuals first sex experiences. Two primary research questions were proposed: (1) how do the virginity belief frames map onto the two “first” sexual experiences of LGB individuals? and (2) are there differences in the virginity belief frames between the two “first” times? Results found that LGB individuals hold stronger process beliefs than gift or stigma beliefs for both of their “first” times. The qualitative interviews suggested that the process of understanding virginity was enmeshed with a larger exploration, and eventual validation, of sexual identity. There was also a significant drop in the strength of some of the gift, process, and stigma beliefs from different-sex experience to same-sex experience for many in the gay and bisexual samples, but not in the lesbian sample. The current study is the first to explore the phenomenon of second virginity loss in LGB individuals and could be used as a foundation for future research on LGB first sexual experiences.


Author(s):  
Abraham P. Buunk ◽  
Odette J. Van Brummen-Girigori ◽  
Glenn L. Leckie

AbstractWe examined the effects of culture and ethnicity on life history strategies in terms of sexual and reproductive behaviors. The sample included 500 adults, aged 25–50 years, from the five major ethnic groups in Suriname, i.e., the Maroons, Creoles, Hindustani, Javanese, and Mixed. First, there were strong gender differences: men reported to have had more sex partners and to have had their first sexual experience earlier than women, whereas women had their first child earlier and had more children than men. Second, in general, ethnicity affected life history substantially. The Maroons stood out by a relatively fast life history: they reported to have had more sexual partners, to have had their first sex and first child at an earlier age, and to have more children than all other groups. The Creoles were in general similar to the Maroons, whereas the Hindustani and the Javanese were characterized by a relatively slow life history: they reported to have had the lowest number of sexual partners, to have had their first sex and first child at the latest age, and to have had the lowest number of children. The differences between the ethnic groups were upheld when controlling for income, educational level, and father absence during childhood. A lower education was associated with reporting to have had one’s first sex as well as one’s first child at a younger age and children who grew up without a father reported to have had their first sex at a younger age.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Desalegn Anmut Bitew ◽  
Yohannes Ayanaw Habitu ◽  
Abebaw Addis Gelagay

Abstract Introduction The first birth is the most significant events in a woman's life that indicates the beginning of undertaking the intensive responsibilities of motherhood and childcare. Age at first birth has health, economic and social consequences and implications. But little has been known on the time to first birth and its determinants in Ethiopia. Therefore, this research is planned to address this issue. Objectives of the study To assess the time to first birth and its determinants among married female youths in Ethiopia, 2020. Methods The data was accessed freely through (https://www.dhsprogram.com). Survival analysis of time to first birth was done based on EDHS 2016 data among 2597 weighted study subjects. The data was extracted using STATA version 14.0. Kaplan Meier’s survival and Log rank test were used to compare survival experiences of respondents using categorical variables. Proportional hazard assumption was checked and was not violated. Cox proportional hazard model was applied, hazard ratio with 95% CI was computed and variables with p value < 0.05 in the multivariable analysis were taken as significant determinants. Results Overall median survival time was 18 years (IQR = 17–20). The significant determinants of time to first birth are place of residence (being rural (AHR = 1.49, 95% CI 1.13, 1.97),Religion (being Muslim [AHR = 1.57, 95% CI 1.22, 2.02),being protestant (AHR = 1.73, 95% CI 1.34, 2.24)], age at first sex [first sex < 15 years (AHR = 1.68, 95% CI 1.23, 2.29)] and first sex between 15 and 17 years (AHR = 1.54, 95% CI 1.29, 1.85), age at first marriage (marriage < 15 years (AHR = 6.52, 95% CI 4.91, 8.64), marriage between 15 and 17 (AHR = 2.63, 95% CI 2.20, 3.14), unmet need for family planning (AHR = 1.23, 95% CI 1.00, 1.52) Conclusion In this study, the median age at first birth was 18 years. This show, about 50% of study participants give birth for the first time before their 18th birth day. This age is the ideal age for schooling and to do other personal development activities. Therefore giving birth before 18 year will limit female youths from attending school and performing personal development activities in addition to health and demographic consequences of early child bearing.


BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047727
Author(s):  
Wing Hin Stanford Siu ◽  
Pei-Ru Li ◽  
Lai-Chu See

ObjectiveAdolescents’ sexual behaviours are associated with sexually transmitted infections and unwanted pregnancies. This study aimed to estimate the sexual intercourse and condom use rates at first and last sex among Taiwanese adolescents in grades 7–12.DesignA secondary data analysis of the Taiwan Global School-Based Student Health Survey’s 2012–2016 data. The survey was anonymous, cross-sectional and nationwide.SettingTaiwan high school students (grades 7–12).ParticipantsThe sample comprised 27 525 students from junior high schools (grades 7–9), and senior high schools, comprehensive schools, vocational high schools and night schools (grades 10–12).Main outcome measuresThe rate of ever having had sexual intercourse; the rates and factors of condom use at first and last sex.ResultsThe sexual intercourse rate in each school type (in ascending order) was junior high school (1.62%), senior high school (4.14%), comprehensive school (9.08%), vocational high school (14.03%) and night school (41.09%). Condom use rate decreased from 57.07% (95% CI=54.31% to 59.83%) at first sex to 25.72% (95% CI=23.34% to 28.10%) at last sex (p<0.0001). The condom use rate (in ascending order) was junior high school (first sex: 37.67%, last sex: 19.76%), night school (55.83%, 22.62%), vocational high school (61.13%, 25.78%), comprehensive school (62.83%, 28.61%) and senior high school (68.38%, 34.96%). Older age at sexual debut was associated with condom use at first and last sex, and having one sexual partner was associated with condom use at last sex, as revealed by logistic regression analysis.ConclusionsThis study highlights an urgent need to instil a proper understanding of protected sex while adolescents are still in their formative years. Despite the low sexual intercourse rate (4.95%), there is lower condom use at last sex than at first sex, which indicates that many sexually active adolescents are not practising protected sex, especially among junior high school students.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Douglas Andabati Candia ◽  
Ephraim Kisangala

Abstract Background Multiple-partner fertility is a relatively new area of study, especially in Sub-Saharan Africa. This study focused on identifying determinants of multiple partner fertility among males in Uganda. Method The assessment was carried out using a logistic regression model and secondary data from the 2016 Uganda Demographic and Health Survey. Results Among the males, 42% had children with multiple partners. Older age, being Muslim, and being divorced or separated increased the likelihood of multiple partner fertility whereas residing in the Western region, reporting an age at first sex above 19 years and being married or cohabiting reduced the likelihood. Increase in number of wives or partners and lifetime sex partners resulted into a higher likelihood of multiple partner fertility. Conclusion There is need to come up with policies and programs aimed at increasing the age at first sex so as to reduce the likelihood of multiple partner fertility among males in Uganda. Government and other stakeholders such as cultural and religious institutions should sensitize and educate the masses on the negative outcomes of having children with multiple partners and promote fidelity for those in marriage. There is also need to increase modern contraceptive use and coverage.


Author(s):  
Melinda C. Mills ◽  
Felix C. Tropf ◽  
David M. Brazel ◽  
Natalie van Zuydam ◽  
Ahmad Vaez ◽  
...  
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