Association between sexual violence and unintended pregnancy among adolescent girls and young women in South Africa

Ajayi, Anthony Idowu; Ezegbe, Henrietta Chinelo

doi:10.21203/rs.3.rs-34833/v4

Cited by 5 publications

(6 citation statements)

References 11 publications

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“…Our ndings on how poverty, lack of contraceptives and sexual violence contribute to adolescent pregnancy are consistent with previous literature [11][12][13]. There is evidence that sexual violence and poverty are associated with higher probability of adolescent pregnancy.…”

Section: Discussion Of Findingssupporting

confidence: 92%

“…For example, a mixed-methods study by Ajayi et al, [10] showed that higher proportions of unintended adolescent pregnancies in Kenya were among girls out-of school, married and not using contraceptives. Other studies identi ed early sex and marriage, wealth status, low contraceptive use, low educational levels, low socio-economic status, limited knowledge of sexual and reproductive health, and physical/sexual violence as drivers of adolescent pregnancy [11][12][13]. Interestingly, studies show that adolescent pregnancy and school dropout usually have the same drivers, including early sexual debut and poverty.…”

Section: Introductionmentioning

confidence: 99%

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Naïve, uninformed and sexually abused: circumstances surrounding adolescent pregnancies in Malawi

Chamdimba

Kabiru

Ushie

et al. 2022

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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 explorative study draws on qualitative data collected as part of a 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 document how divergent views between girls and their parents contribute to the lack of progress in reducing adolescent childbearing. Based on these findings, preventing unplanned 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 programme to empower in- and out-of school adolescents.

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Section: Discussion Of Findingssupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Naïve, uninformed and sexually abused: circumstances surrounding adolescent pregnancies in Malawi

Chamdimba

Kabiru

Ushie

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…These have an overall negative impact on women's health [1,3,4]. Furthermore, sexual IPV increases the risk of an unplanned, mistimed, or unintended pregnancy among women, who lack access to family planning methods [5][6][7][8]. High-risk fertility behaviour is one hypothesized activity in which sexual IPV influences unwanted pregnancy and related health effects in mothers [9].…”

Section: Introductionmentioning

confidence: 99%

Does sexual Intimate Partner Violence (IPV) increase risk of multiple high-risk fertility behaviours in India: evidence from National Family Health Survey 2015–16

et al. 2022

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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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“…Existing models of care have failed to adequately address the gap in sexual health needs, access to- and uptake of-HIV and contraceptive services among adolescents in South Africa (1). The rate of unintended pregnancy among adolescents remains high, with about a quarter of adolescent girls and young women (AWYG) giving birth before age 20 (2)(3). According to UNAIDS, the incidence rate for HIV infection among adolescents aged 10-19 was 54 per 1000 population in 2018 in South Africa with adolescent girls disproportionally affected(4).…”

Section: Introductionmentioning

confidence: 99%

A modeling framework for translating discrete choice experiment results into cost-effectiveness estimates: an application to designing tailored and scalable HIV and contraceptive services for adolescents in South Africa

Govathson

Long

Russell

et al. 2022

Preprint

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Background: Youth in South Africa are disproportionately affected by STIs, HIV, and unintended pregnancies. Despite this, their uptake of HIV and contraceptive services remains a challenge. South Africa urgently needs tailored, scalable interventions to address both HIV infection and early pregnancy prevention for young people. These interventions generally take years to design, implement, and evaluate, leaving a gap. To that end, we have developed a framework to translate the expected impact of facility level attributes in increasing HIV/contraceptive service uptake for youth from a discrete choice experiment (DCE) into a cost effectiveness analysis (CEA). Methods: We used a DCE (n=805) conducted in Gauteng, South Africa, which found that staff attitude, confidentiality, WiFi, subsidized food, afternoon hours and youth-only services were preferred attributes of health services. Based on this we simulated uptake of services adapted for these preferences. We divided preferences into modifiable attributes that could readily be adapted (e.g. WiFi), and non-modifiable (more nuanced attributes that are more challenging to cost and evaluate): staff attitude and estimated the incremental change in uptake of services using adapted services. Costs for modifiable preferences were estimated using data from two clinics in South Africa (2019 US$). We determined the incremental cost effectiveness ratio (ICER) of 15 intervention combinations, and report the results of interventions on the cost-effectiveness frontier. Results: Greatest projected impact on uptake was from friendly and confidential services, both of which were considered non–modifiable (18.5% 95%CI:13.0-24.0%; 8.4% 95%CI:3.0-14.0% respectively). Modifiable factors on their own resulted in only small increases in expected uptake. (Food: 2.3% 95%CI:4.0%-9.00%; WiFi: 3.0% 95%CI: -4.0%-10.0%; Youth only services: 0.3% 95%CI: -6.0%-7.0%; Afternoon services: 0.8% 95%CI: -6.0%-7.0%). The order of interventions on the cost-effectiveness frontier are WiFi and youth-only services (ICER US$7.01- US$9.78), WiFi, youth-only services and food (ICER US$9.32 - US$10.45), followed by WiFi, youth-only services and extended afternoon hours (ICER US$14.46–US$43.63) Conclusion: Combining DCE results and costing analyses within a modelling framework provides an innovative way to inform decisions on effective resource utilisation. Modifiable preferences, such as WiFi provision, youth only services and subsidized food, have potential to cost-effectively increase the proportion of youth accessing HIV and contraceptive services.

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Association between sexual violence and unintended pregnancy among adolescent girls and young women in South Africa

Cited by 5 publications

References 11 publications

Naïve, uninformed and sexually abused: circumstances surrounding adolescent pregnancies in Malawi

Naïve, uninformed and sexually abused: circumstances surrounding adolescent pregnancies in Malawi

Does sexual Intimate Partner Violence (IPV) increase risk of multiple high-risk fertility behaviours in India: evidence from National Family Health Survey 2015–16

A modeling framework for translating discrete choice experiment results into cost-effectiveness estimates: an application to designing tailored and scalable HIV and contraceptive services for adolescents in South Africa

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