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See discussions, stats, and author profiles for this publication at: <a href=https://www.researchgate.net/publication/271459072 Sexual initiation and readiness to have sex among in-school and out-of- school young women in Katima Mulilo district, Namibia Article in African Journal for Physical Health Education, Recreation and Dance · September 2014 CITATIONS READS 0 118 1 author: Sphiwe Madiba Sefako Makgatho Health Sciences University 75 PUBLICATIONS 304 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Sexual behaviour and prevention of STI in high risk populations, capitalising on STI partner-notification modalities View project evaluation of an HIV counselling programme View project " id="pdf-obj-0-2" src="pdf-obj-0-2.jpg">

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/271459072

Article in African Journal for Physical Health Education, Recreation and Dance · September 2014

 

CITATIONS

READS

0

118

1

author:

75 PUBLICATIONS 304 CITATIONS SEE PROFILE
75 PUBLICATIONS
304 CITATIONS
SEE PROFILE

Some of the authors of this publication are also working on these related projects:

  • Sexual behaviour and prevention of STI in high risk populations, capitalising on STI partner-notification modalities View project

  • evaluation of an HIV counselling programme View project

African Journal for Physical, Health Education, Recreation and Dance (AJPHERD) Supplement 1:2 (September), 2014, pp. 291-300.

Sexual initiation and readiness to have sex among in-school and out-of-school young women in Katima Mulilo district, Namibia

SPHIWE MADIBA

School of Public Health, Department of Environmental and Occupational Health, Faculty of Health Sciences, University of Limpopo (Medunsa Campus), Box 215, Medunsa 0204, Ga-Rankuwa, South Africa. E-mail: sphiwe_madiba@embanet.com

Abstract

Despite evidence that large proportion of adolescents in sub-Saharan Africa engage in sexual activities at younger ages, studies investigating sexual behavior of adolescents have not focused on the circumstances which lead to sexual initiation. The objectives of the study were to determine the age of adolescents, their perceptions about their readiness to have sex at sexual initiation and assess their subsequent sexual behaviour. Cross-sectional survey was conducted in Katima Mulilo district in Namibia with 339 female in-school and out-of-school adolescents aged 15-19 years. Data were collected using a self-administered pre tested questionnaire and analyzed using descriptive summary statistics. The majority 274 (81%) were in-school and 65 (19%) were out-of-school. High proportion (280; 83%) ever had sex, 142 (50.8%) had first sex between 6 -15 years, and 138 (49.2%) between 16-19 years. Over two thirds (186; 66%) had sexual partners who were of their age, and a third (92; 33%) had older sexual partners. Almost half 134 (48%) were not ready to have sex the first time, 37 (34%) were forced to have sex, and 12 (11.2%) were tricked to have sex by their sexual partners. The majority 192 (69.2%) had sex the first time at their partner’s home. Early sexual initiation with an older partner and unwanted non-consensual sex were common occurrences. Sex education starting with younger adolescents at primary school level should provide them with sexual, reproductive health, and HIV prevention education. Reproductive programmes for in-school and out-of-school youth should also address non-consensual sex and provide abstinent and sexually active adolescents with skills to remain safe.

Keywords: Sexual initiation, adolescents, unwanted sex, non-consensual sex, in-school youth, out-of-school youth, Namibia

How to cite this article:

Madiba, S. (2014). Sexual initiation and readiness to have sex among in-school and out-of-school

young women in Katima Mulilo district, Namibia. African Journal for Physical, Health Education, Recreation and Dance, September (Supplement 1:2), 291-300.

Introduction

In Sub Saharan Africa, adolescents are disproportionately affected by the HIV epidemic and other poor reproductive health outcomes like unintended pregnancies (Erulkar, 2004; Hindin & Fatusi, 2009; UNAIDS, 2004). They engage in early sexual activities with poor knowledge of reproduction and contraception (Erulkar, 2004). The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) estimates that only eight percent of out-of-school youth have access to sexual health and

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prevention education programmes (UNAIDS/WHO/UNICEF, 2010). Because of the high prevalence of HIV among young people, many community-based programmes focus on HIV prevention (Hindin & Fatusi, 2009). As a result, high numbers of adolescents in developing countries have unmet reproductive health needs (Ajuwon et al., 2006).

Namibia is amongst the sub Saharan countries with a generalized HIV/AIDS epidemic, and a national HIV prevalence rate of 17.8% among those aged 15-49 years. Similar to other countries, the prevalence is higher among females who are also infected very young. A survey conducted in northern Namibia indicated a gradual decline in the average age of first sex; a relatively high proportion of young people between 15-24 years were younger than 16 years when they had sex the first time (Parker & Connolly, 2007 ). A later study in the same region showed that young people initiate sex at a much younger age, often before the age of 13 years (Lawoyin & Kanthula, 2010).

Early sexual initiation has implications for public health interventions because of its association with multiple sexual partners and unprotected sex. They are also exposed to unintended pregnancies and abortion, which may lead to school dropout (Fatusi & Blum, 2008; Gupta & Mahy, 2003; Hindin & Fatusi, 2009; Mazengia & Worku, 2009). Providing adolescents with sexual education at a much younger age will give them skills to remain safe. Those who had initiated sex should be provided with skills and services to practice safe sexual life while those who had not initiated sex should be encouraged to delay sexual initiation (Mazengia & Worku, 2009).

Hindin and Fatusi (2009) argue that sex education should promote safe sexual behaviour and not only messages that promote abstinence. Although the sexual behavior of young people have been studied in-depth, there are limited data on the sexual behavior of younger adolescents aged 12-16 years (Gupta & Mahy, 2003; Bankole et al., 2007; Marston et al., 2013). Erulkar (2004) argues that there is a general assumption from the literature that when young people have sex, it is wanted and consensual, despite evidence that acts of sexual coercion are common among the youth. This study was conducted to investigate when, where, why, and with whom adolescents in an urban township of Namibia had sex the first time. The objectives were to determine the age of adolescents at sexual initiation, assess their perceptions about their readiness to have sex, and determine their subsequent sexual behaviour. It is crucial to understand the circumstances in which early sexual initiation occurs in order to develop effective interventions targeted at younger adolescents early in life.

Sexual initiation and readiness to have sex among young women 293

Methodology

Study design

A cross-sectional survey was conducted in 2008 in Katima Mulilo district, Namibia. The sample size comprised 339 female adolescents recruited from three urban primary health care clinics, a voluntary counselling and testing (VCT) center, and a youth center. In Katima Mulilo, VCT centers are attached to the local clinics where the youth and adults go for counselling and testing. Both in-school and out-of-school adolescents between 15-19 years who visited the study sites were selected.

Data collection

A structured questionnaire designed in English and later translated to Silozi was used to collect data. The instrument was pre-tested during a pilot study that was conducted in one clinic which was not included in the main study. The pilot test assessed whether the questionnaire measured what it was intended to measure. Following the pilot test, the questionnaire was modified and necessary changes were effected before it was subsequently used to collect data for the study. The questions captured information on the socio demographic characteristics and sexual behaviour of the adolescents. A Master of Public Health student and a trained research assistant distributed the questionnaires to the adolescents and remained in the consulting room during the completion of the questionnaire for consistency of responses and to ensure completeness of the questionnaire.

Ethical considerations

Ethical clearance was obtained from the Medunsa Research and Ethics Committee of the University of Limpopo. After ethical clearance by the research ethics committee, permission was sought and granted by the Namibian Ministry of Health and Social Services Research Unit and by the managers of the three study sites. The adolescents were informed about the purpose and objectives of the study and written informed consent was obtained from individual participants. They were also informed that participation was voluntary and that they may withdraw from the study at any time without repercussion. Confidentiality of the information was assured and anonymity maintained.

Data analysis

Data were cleaned, coded, entered into Microsoft Excel, and thereafter analysed using STATA 10.0.1. The data were analysed descriptively to obtain summary statistics of the study participants and the results were presented in simple

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percentages. Probability values (p values) were calculated at the 0.05 level of significance.

Results

Characteristics of participants

Table 1 presents background characteristics of the adolescents. A total of 339 adolescents responded to the questionnaire. Their ages ranged between 15-19 years with a median age of 17 years. Of the 339 adolescents, 274 (81%) were in- school while 65 (19%) were out-of-school. Of the 274 adolescent students, 163 (59%) were in grades 10-12, and 111 (41%) in grades 7-9.

Table 1: Characteristics of in-school and out-of-school youth (n =339)

Variables

Frequency

Percent (%)

In-school

274

81

Out-of-school

65

19

Out-of-school youth:

 

Completed grade 12

33

51

Dropped out of school

32

49

Age in years:

 

15

years

54

16

16

years

50

15

17

years

60

18

18

years

81

24

19

years

94

27

Grades:

Grade 7

12

4.4

Grade 8

39

14.2

Grade 9

60

22

Grade 10

60

22

Grade 11

45

16.4

Grade 12

58

21.2

Sexual initiation and sexual behaviour

A high proportion (280; 83%) of adolescents ever had sex and indicated the age when they first had sex. Slightly over half (142; 51%) reported that they had their first sex between 6-15 years and 138 (49%) between 16-19 years. Of the 280 adolescents who ever had sex, the majority (186; 66%) reported having a sexual partner who was their age group and a third (92; 33%) had an older sexual partner. Adolescents also described the relationship that they had with the person they had their first sex with, and the majority (120; 43%) reported that the person was their steady boyfriend, (94; 34%) reported the person as just a friend, 40

Sexual initiation and readiness to have sex among young women 295

(14%) reported that they went out once in a while with the person, and 26(9%) reported that they just met the person they had sex with the first time.

The results further showed that the majority (182; 65%) of sexually active adolescents had experienced sexual intercourse with one person and 98 (35%) had had sex with more than one person (Table 2).

Table 2: Sexual characteristics of adolescents (n=339)

Variable

Frequency

Percent

Ever had sex:

Yes

280

83

No

59

17

Age at sexual initiation:

6-10 years

6

2.2

11-15 years

136

48.6

16-19 years

138

49.2

Age of sexual partner:

My age

186

66

Older than me

92

33

Younger than me

1

2

Relationship with sexual partner:

Steady boyfriend

120

43

We were just friends

94

34

Went out once in a while

40

14.2

We had just met

26

9.2

Number of sexual partners:

One partner

182

65%

More than one partner

98

35

Condom use at first sexual initiation

The majority (179; 64%) of adolescents reported that they used contraceptives the first time they had sex while 101 (36%) did not use them. Of the 179 who used contraceptives, 123 (69%) used condoms while 56 (31%) did not. Majority (85; 69%) of those who used condoms reported that they always used condoms, 38 (31%) used condoms inconsistently.

Ready to have sex at sexual initiation

Table 2 presents responses concerning readiness to have sex. Adolescents who ever had sex were asked whether they thought they were ready to have sex at sexual initiation. Slightly over half (146; 52%) agreed that they were ready, while 134 (48%) stated otherwise.

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The most reasons cited by adolescents who reported that they were not ready included, being forced to have sex by the sexual partner (37; 34%), not knowing anything about sex (22; 20.6%), peer pressure from friends (12; 12%), and being tricked to have sex by the sexual partner (12; 11.2%).

Table 3: Reasons given in support of not being ready for sex (n=339)

Responses

Freq.

Percent

He forced me to have sex with him

37

34.6

  • I did not know anything about sex

22

20.6

Peer pressure from my friends

13

12.1

He tricked me into having sex with him

12

11.2

It just happened, we did not plan

6

5.6

  • I was scared of having sex

6

5.6

  • I was afraid of getting pregnant and contracting STIs

5

4.7

  • I was afraid to refuse, I wanted to make him happy

3

2.8

  • I made a mistake

3

2.8

Location of first sexual initiation

Adolescents who ever had sex indicated the place where they had sex the first time, most (192; 69.2%) had sex at their partner’s home (Table 4).

Table 4: Location of first sexual initiation (n=280)

Place

Frequency

Percentage

My partner’s home

194

69.2

My home

37

13.2

My friend’s home

32

11.4

Car

1

0.4

Hotel/motel

2

0.7

Park

2

0.7

Shebeen or tavern

4

1.4

Party

4

1.4

Others

4

1.4

Total

280

100%

Discussion

The study investigated sexual initiation among in-school and out-of-school adolescents, and indicated that most of them (83%) have ever had sex. The prevalence in the current study was significantly higher than those of previous studies conducted in the country. An Earlier study with in-school adolescents found that a third of the adolescents ever had sex (Chinsembu et al., 2008). While a study conducted with out-of-school youth workers showed that 90% ever had sex (Lawoyin & Kanthula, 2010). The higher prevalence observed in that study might be attributed to the fact that it was conducted with out-of-school youth aged between 15-30 years, while the age of the adolescents in the current study ranged from 15-19 years. Nevertheless, the prevalence in the current study

Sexual initiation and readiness to have sex among young women 297

(83%), is higher than those reported in Tanzania (40%) and Nigeria (24.8%) (Kazaura & Masatu, 2009). There is evidence that early sexual initiation is increasing in sub Saharan Africa (Gupta & Mahy, 2003; Hindin & Fatusi, 2009).

More than half of the adolescents initiated sex between 6-15 years. This finding is not surprising as young age of sexual initiation was reported in previous studies in Namibia. For example, a study conducted with out-of-school youth workers documented 12 years as the youngest age of sexual initiation (Lawoyin & Kanthula, 2010). Similar to previous studies, a significant proportion of adolescents reported that they never used condoms at sexual initiation and during the most recent sexual activity (Gupta & Mahy, 2003; Hindin & Fatusi, 2009; Kazaura & Masatu, 2009; Lawoyin & Kanthula, 2010; Mazengia & Worku, 2009). Other studies also reported limited use of condoms during the most recent sexual activity of adolescents (Exavery et al., 2011; Kazaura & Masatu, 2009; Mazengia & Worku, 2009; Njau, 2012). According to Exavery et al. (2011) older adolescents aged 15-19 years are most likely to use condoms compared to younger ones who were 10-14 years old. The current study also found that over a third of the adolescents reported that they had sex with more than one person.

Almost half of the adolescents admitted that they were not ready to have sex at first sexual initiation. The results showed that for over a third of the adolescents, sex was unwanted and non-consensual. They reported that they were forced and or tricked to have sex by their sexual partners. Similar findings were reported in a study conducted among secondary school students in Australia where a third reported ever experiencing unwanted sex (Smith et al., 2009). Unwanted sex was also reported in studies conducted among students in Nigeria (11%), Tanzania (15.9%), and Kenya (21%), who also indicated that they were tricked by their sexual partners to have sex (Ajuwon et al., 2006; Erulkar, 2004; Kazaura & Masatu, 2009). The results further showed that a high proportion of the adolescents did not have any romantic relationships with the male person they had sex with. More than half had sex the first time with someone they were friends with, someone they went out with once in a while, and or someone they had just met. Smith et al. (2009) also reported that over a quarter of adolescents in their study had recent sexual encounter with someone they had known for a while but were not in a relationship with.

Over and above evidence of high rates of non-consensual sexual activities among adolescents, Mazengia and Worku (2009) argue that often first sexual initiation is unplanned and unprotected. Of public health concern is the thin line between unwanted or non-consensual sex and rape. Several studies have reported on the significantly high rates of non-consensual sexual activities among adolescents in both developed and developing countries (Erulkar, 2004). These studies are silent on issues of rape, resulting in lack of clarity on the difference between rape and non-consensual sex. In the current study, some of the adolescents’

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experiences might be described as rape. For example, one adolescent said “we just met, so I was not expecting to have sex with him”, another said “I was just making new friends, but he forced me to have sex with him” One said “he asked me to accompany him to his house so that he can show me something, but when we arrived there, something turned to sex”.

The results further found that a third of the adolescents reported having a sexual partner who was older at sexual initiation. Those who reported that sex was unwanted also stated that they were afraid to say no because their partner was older than them. Some reported that they were afraid to infuriate the older partner and wanted to make him happy. Ford, Sohn and Lepkowski (2001) also found that female adolescents whose first sexual partners were older reported that sex was unwanted. For female adolescents, having a partner who is older is related to initiation of sexual activities at a young age; and non-use of contraceptives, increased risky sexual behaviour, unplanned pregnancies, STIs and HIV(Kaestle, Morisky & Wiley, 2002). The majority of adolescents had sex the first time at the sexual partner’s home. This behaviour might be associated with having an older sexual partner. Similar findings were reported by Smith et al. (2009) in their study in which female adolescents had sex at a partner’s house more than male adolescents.

Limitations

The study findings are subject to recall bias as well as socially desirable responses. The adolescents might have under-reported their sexual activities as well as their willingness to have sex when they had sex for the first time because of the negative connotations attached to youth’s sexual behaviour. The potential for recall bias might have occurred when participants were asked about their age when they had sex the first time, this response was also subjected to socially desirable responses especially if the participant had sex at a much early age. Social desirable bias was minimized by the fact that the researchers were not part of the clinic staff or youth center.

Conclusion

Early sexual initiation was common among the adolescents. More than half had their first sexual initiation before 16 years. Most female adolescents had sex with sexual partners that they did not have a romantic relationship with. Almost half of the adolescent’s experienced unwanted sex, were not ready to have sexual intercourse at first sexual initiation, and reported that they were forced and tricked to have sex by their sexual partners who were likely to be older than them.

Sexual initiation and readiness to have sex among young women 299

Our findings have implications for the development of public health interventions. Considering that adolescents are sexually active at an early age, comprehensive sex education should start early at primary school to give adolescents a broad-based understanding of non-consensual sex and its consequences. It is imperative that sex education programmes at schools and in health facilities should address the circumstances that lead to early sexual initiation as well as develop appropriate sexual education interventions to address the sexual and reproductive needs that sexually active adolescents experience, and promote abstinence.

Acknowledgements

We acknowledge Francesca Silumbu, the Master of Public Health student, for her role in data collection.

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