Teenage pregnancy in South Africa: Where are the young men involved?

Background. The level of unintended pregnancies among teenage girls in South Africa (SA) has remained a public health concern. However, studies and interventions generally do not consider young men's involvement in teenage pregnancies. Objective. To investigate the sociodemographic and sexual behaviour characteristics of young men who have impregnated at least one teenage girl. Methods. The study used data from the Centre for Justice and Crime Prevention (2009), which included responses from young men (aged 12 - 22 years) across all SA provinces. Univariate and bivariate analyses and binary logistic regression were performed. Results. The results showed that 93.2% of the sample had ≥2 lifetime sexual partners, 22.4% rarely used condoms and 11.5% had never used condoms. Teenage pregnancy incidence was ≥35% in all provinces except Gauteng and the Western Cape. The likelihood of being involved in a teenage pregnancy was higher among respondents who reported having ≥2 lifetime sexual partners (odds ratio (OR) 2.510; 95% confidence interval (CI) 0.43 - 14.77). Respondents with a higher education were less likely to be involved in a teenage pregnancy (OR 0.819; 95% CI 0.36 - 1.84) than those with a lower education (OR 1.219; 95% CI 0.59 - 2.50). Conclusion. Engaging in multiple sexual partnerships could increase the vulnerability of young people to sexually transmitted infections or teenage pregnancies. Initiatives to create awareness among SA youth regarding the consequences of sexual behaviour are recommended, with a specific focus on addressing young men's involvement in teenage pregnancy

The influence of adolescent age at first union on physical intimate partner violence and fertility in Uganda: a path analysis

Background. Uganda has a high fertility rate, high levels of intimate partner violence (IPV) and also very young ages at first union. Experiencing IPV has previously been shown to increase fertility rates. Entering marriage at a later age has been shown to decrease fertility rates in some countries. Given that a large proportion of Ugandan women are married by the end of adolescence, marital age may be a key proximate determinant of fertility in Uganda. Objective. To examine the effect of age at first union on fertility, via the intermediate effect of physical IPV, among Ugandan women of reproductive age. Methods. Data from the 2011 Ugandan Demographic and Health Survey were used to create an integrated path model to investigate the effects of age at first union on fertility. Known factors that influence fertility were included in the model. The interaction with age at first union in increasing fertility differentials, via the intermediate effect of physical IPV, was assessed. Results. Results show that women who are preadolescent or adolescent at first union have a higher likelihood of experiencing IPV, indicated by both direct and indirect pathways that work via known intermediate and proximate factors. Furthermore, age at first union increases fertility, expressed as the number of children born to a woman, via a direct interaction. Conclusion. Most Ugandan women enter their first union during adolescence (<19 years), which exposes them to a higher risk of IPV and a longer period of childbearing, thereby increasing fertility rates

Individual versus community-level measures of women decision-making involvement and child survival in Nigeria

Background. Although decision-making authority is associated with maternal healthcare utilisation, the evidence on the relative importance of individual-level v. community-level decision-making participation for child survival in sub-Saharan Africa is limited. Objectives. To assess the net effects of individual- and community-level measures of decision-making involvement (DMI) on under-5 mortality in Nigeria. Methods. Data on a nationally representative sample of 31 482 children in the 2013 Nigeria Demographic and Health Survey were analysed. Mothers who reported involvement in decision-making on own healthcare, major household purchases and visits to friends and relatives were categorised as having high DMI. Community-level measures of DMI were derived by aggregating the individual measures at the cluster level. Kaplan-Meier estimates of childhood mortality rates were computed. Multilevel discrete-time hazard models were employed to investigate the net effect of individual- and community-level DMI on childhood mortality. Results. Childhood mortality, at 59 months, was higher among children of women with low DMI (120 per 1 000) compared with those with high DMI (84 per 1 000). The full multilevel model showed that there was no difference in the risk of childhood death between children whose mothers had high v. low DMI (hazard ratio (HR) 1.01, CI 0.90 - 1.12). However, mortality risk was found to be lower among children in communities with medium DMI (HR 0.84, CI 0.74 - 0.96). Maternal age at child's birth, education, household wealth index and preceding birth interval were significantly associated with under-five mortality. Conclusion. Besides socioeconomic and biodemographic characteristics, community- and not individual-level DMI was associated with under-5 mortality. Women's empowerment programmes targeting maternal and child health outcomes should also focus on communities

Pregnancy Termination in Sub-Saharan Africa: The Need for Refined Data

Purpose: This study examines the levels and pattern of; as well as the factors associated with; pregnancy termination in seventeen Sub-Sahara African countries. Methods: The 2000 round of demographic and health survey (DHS) data sets for the countries are used. The study population are women aged 15-49 who have ever been exposed to the risk of pregnancy and interviewed during the surveys. Univariate analysis is done to examine the distribution of the women. Bivariate analysis of selected background; contraceptive; sexual behaviour and fertility variables by having ever had a terminated pregnancy are also carried out. Lastly; multivariate logistic regression models are fitted to examine the magnitude of associated variables while controlling for others. Results: the associated factors vary from country to country. However; age and marital status are associated with and are critical predictors of having ever had a terminated pregnancy in all the countries. For example; the odds of having ever had a terminated pregnancy is about 54 and 32 times (for currently and formerly married women; respectively) that of those that have never married in Rwanda. Conclusion: This study has come up with findings that provoke more thinking and research on the topic of pregnancy termination and to reproductive health in general. This is because `ever had a terminated pregnancy' as used in the DHS context made no distinction between the three different pathways through which a pregnancy may not result into a live birth

Sexual Behaviour of Nigerian University Students

Objective - The objective of this study was to document selected aspects of the sexuality of Nigerian university students; specifically sexual behaviour; attitudes about sexuality; the circumstances of sexual intercourse and preventive sexual behaviour.Method - A total of 1 153 students at two federal universities in Nigeria completed a self administered questionnaire. Results - The mean age of first intercourse was 17.0 years for males and 19.1 years for females. Male students were more likely to have had sex and to engage in unsafe sex. There were no obvious differences between the genders in the numbers of same-sex partners. Levels of sexual activity were high. For example; 53.8had experienced intercourse; and 24.4reported more than one regular sex partner. Male students displayed more permissive attitudes than female students. A minority reported having the same sexual attitudes as their parents or friends; and discussing their sex lives with their parents. A substantial proportion of the students believed that if you loved a partner you could not ask him/her to use condom while having sex. Condoms were the most commonly reported preventive method that was used. The majority of both male and female students reported that they 'always' or 'often' used protection when having sex. Conclusions - There is a need to begin to address emerging reproductive health issues in Nigerian tertiary institutions. Data regarding attitudes about sexuality and circumstances of intercourse can inform the content of intervention programmes

Sexual Behaviour of Nigerian University Students

Objective - The objective of this study was to document selected aspects of the sexuality of Nigerian university students; specifically sexual behaviour; attitudes about sexuality; the circumstances of sexual intercourse and preventive sexual behaviour.Method - A total of 1 153 students at two federal universities in Nigeria completed a self administered questionnaire. Results - The mean age of first intercourse was 17.0 years for males and 19.1 years for females. Male students were more likely to have had sex and to engage in unsafe sex. There were no obvious differences between the genders in the numbers of same-sex partners. Levels of sexual activity were high. For example; 53.8had experienced intercourse; and 24.4reported more than one regular sex partner. Male students displayed more permissive attitudes than female students. A minority reported having the same sexual attitudes as their parents or friends; and discussing their sex lives with their parents. A substantial proportion of the students believed that if you loved a partner you could not ask him/her to use condom while having sex. Condoms were the most commonly reported preventive method that was used. The majority of both male and female students reported that they 'always' or 'often' used protection when having sex. Conclusions - There is a need to begin to address emerging reproductive health issues in Nigerian tertiary institutions. Data regarding attitudes about sexuality and circumstances of intercourse can inform the content of intervention programmes