Inequalities in early marriage, childbearing and sexual debut among adolescents in sub-Saharan Africa

Abstract

Background Adolescent sexual and reproductive health (ASRH) is a major public health concern in sub-Saharan Africa (SSA). However, inequalities in ASRH have received less attention than many other public health priority areas, in part due to limited data. In this study, we examine inequalities in key ASRH indicators. Methods We analyzed national household surveys from 37 countries in SSA, conducted during 1990–2018, to examine trends and inequalities in adolescent behaviors related to early marriage, childbearing and sexual debut among adolescents using data from respondents 15–24 years. Survival analyses were conducted on each survey to obtain estimates for the ASRH indicators. Multilevel linear regression modelling was used to obtain estimates for 2000 and 2015 in four subregions of SSA for all indicators, disaggregated by sex, age, household wealth, urban–rural residence and educational status (primary or less versus secondary or higher education). Results In 2015, 28% of adolescent girls in SSA were married before age 18, declined at an average annual rate of 1.5% during 2000–2015, while 47% of girls gave birth before age 20, declining at 0.6% per year. Child marriage was rare for boys (2.5%). About 54% and 43% of girls and boys, respectively, had their sexual debut before 18. The declines were greater for the indicators of early adolescence (10–14 years). Large differences in marriage and childbearing were observed between adolescent girls from rural versus urban areas and the poorest versus richest households, with much greater inequalities observed in West and Central Africa where the prevalence was highest. The urban–rural and wealth-related inequalities remained stagnant or widened during 2000–2015, as the decline was relatively slower among rural and the poorest compared to urban and the richest girls. The prevalence of the ASRH indicators did not decline or increase in either education categories. Conclusion Early marriage, childbearing and sexual debut declined in SSA but the 2015 levels were still high, especially in Central and West Africa, and inequalities persisted or became larger. In particular, rural, less educated and poorest adolescent girls continued to face higher ASRH risks and vulnerabilities. Greater attention to disparities in ASRH is needed for better targeting of interventions and monitoring of progress.

Sexual risk-taking behavior amongst emerging adults in Africa: a systematic review and meta-analysis

“…Our estimate was comparable to the range of 4.0-65.7% prevalence reported from a review of studies among HIV-infected adolescents aged 10-24 years from Africa [16], but higher compared to the range of 10-17% prevalence reported in three studies among adolescents and young adults from the USA [36-38]. The higher prevalence of age-disparate relationships among EmA from Africa may be explained by the low socio-economic status in the African context, with adolescents and younger adults, mostly from disadvantaged backgrounds, engaging in relationships with older, more established partners for material gains, as has been reported elsewhere [39]. Indeed, and in our findings, low socio-economic status stood out as a risk factor for age-disparate relationships [3, 40].…”

“…Most heterogeneity was partially explained by variations from sex, with female participants having higher pooled prevalence in four of the seven outcomes, compared to their male counterparts. Differences in the way emerging female adults are socialized in the African context may have impacted on their increased SRTB [39, 41]. In addition, low socio-economic status, along with cultural practices like child marriage and coercion of young girls into early sexual activities with adults are common and may have led to increased SRTB among emerging female adults [39].…”

Prevalence and associated factors of early sexual initiation among female youth in East Africa: further analysis of recent demographic and health survey

“…Rwanda was selected as a reference for its low percentage of early sexual beginning. This could be ascribed to altering conventional norms as a result of globalization, which causes changes in socio-demographic characteristics such as religion, media exposure, education, and youths people's socioeconomic situation [52][53][54]. This difference could be the reason why young females' sexual debuts differ across the country.…”

Adolescent sexual and reproductive health for all in sub-Saharan Africa: a spotlight on inequalities

“…• The paper by Melesse et al extends this point to within country inequalities, underscoring that disparities in age of sexual debut, early marriage, and early childbearing are persisting and growing across a number of countries [9]. • The paper by Wado et al notes that while all groups of adolescent girls/young women (and adult women for that matter) are affected by intimate partner violence, those who are from poor families, have limited education and live in rural areas are most affected [10].…”