Age-disparate relationships at first sex and reproductive autonomy, empowerment, and sexual violence among adolescent girls and young women in Rwanda

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Ssm-Population Health Pub Date : 2024-02-15 DOI:10.1016/j.ssmph.2024.101617

Jacqueline Kunesh , Rebecca Hémono , Emmyson Gatare , Laetitia Kayitesi , Laura Packel , Rebecca Hope , Sandra I. McCoy

{"title":"Age-disparate relationships at first sex and reproductive autonomy, empowerment, and sexual violence among adolescent girls and young women in Rwanda","authors":"Jacqueline Kunesh , Rebecca Hémono , Emmyson Gatare , Laetitia Kayitesi , Laura Packel , Rebecca Hope , Sandra I. McCoy","doi":"10.1016/j.ssmph.2024.101617","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Age-disparate relationships (ADR) place adolescent girls and young women (AGYW) at higher risk of unprotected sex and HIV infection; few studies have investigated ADR at first sex in sub-Saharan Africa. This study investigates ADR at first sex and its association with reproductive autonomy, reproductive empowerment, contraception coercion, and consent at first sex among female Rwandan youth.</p></div><div><h3>Methods</h3><p>Cross-sectional data from a randomized trial (n = 5768) of in-school youth ages 12–19 at enrollment were analyzed with focus on those who reported sexual activity (n = 1319). General estimating equation linear models and Poisson models were used to estimate linear coefficients and prevalence ratios (PR), with 95% confidence intervals (CIs) estimated using robust standard errors.</p></div><div><h3>Results</h3><p>Females reported a significantly higher average partner age gap than males by 2.43 years (2.90 years vs. 0.46 years, 95% CI: 2.01, 2.86). Overall, 23.4% (n = 102) of sexually active AGYW engaged in an ADR at first sex. The prevalence of non-consensual first sex was 60% higher among AGYW reporting ADR at first sex compared to AGYW reporting similar-aged partners (adjusted PR = 1.59, 95% CI: 1.25, 2.02). No association was found between ADR at first sex and reproductive autonomy, reproductive empowerment, or contraception coercion.</p></div><div><h3>Conclusions</h3><p>Our results suggest a high prevalence of sexual violence among AGYW engaging in first sex with an age-disparate partner. However, we did not find evidence that ADR at first sex affects reproductive autonomy or empowerment within the first few years of sexual initiation. Further research is needed to explore the impact of ADR at first sex and longer-term trajectories of sexual behavior, empowerment and autonomy.</p></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"25 ","pages":"Article 101617"},"PeriodicalIF":3.6000,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S235282732400017X/pdfft?md5=aebec6a232ff939b391fa8607f04c0e1&pid=1-s2.0-S235282732400017X-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ssm-Population Health","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S235282732400017X","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Age-disparate relationships (ADR) place adolescent girls and young women (AGYW) at higher risk of unprotected sex and HIV infection; few studies have investigated ADR at first sex in sub-Saharan Africa. This study investigates ADR at first sex and its association with reproductive autonomy, reproductive empowerment, contraception coercion, and consent at first sex among female Rwandan youth.

Methods

Cross-sectional data from a randomized trial (n = 5768) of in-school youth ages 12–19 at enrollment were analyzed with focus on those who reported sexual activity (n = 1319). General estimating equation linear models and Poisson models were used to estimate linear coefficients and prevalence ratios (PR), with 95% confidence intervals (CIs) estimated using robust standard errors.

Results

Females reported a significantly higher average partner age gap than males by 2.43 years (2.90 years vs. 0.46 years, 95% CI: 2.01, 2.86). Overall, 23.4% (n = 102) of sexually active AGYW engaged in an ADR at first sex. The prevalence of non-consensual first sex was 60% higher among AGYW reporting ADR at first sex compared to AGYW reporting similar-aged partners (adjusted PR = 1.59, 95% CI: 1.25, 2.02). No association was found between ADR at first sex and reproductive autonomy, reproductive empowerment, or contraception coercion.

Conclusions

Our results suggest a high prevalence of sexual violence among AGYW engaging in first sex with an age-disparate partner. However, we did not find evidence that ADR at first sex affects reproductive autonomy or empowerment within the first few years of sexual initiation. Further research is needed to explore the impact of ADR at first sex and longer-term trajectories of sexual behavior, empowerment and autonomy.

查看原文本刊更多论文

卢旺达少女和年轻妇女初次性行为与生殖自主、赋权和性暴力之间的年龄差异关系

背景不同年龄段的性关系（ADR）使少女和年轻女性（AGYW）面临更高的无保护性行为和感染 HIV 的风险；在撒哈拉以南非洲，很少有研究调查初次性行为时的不同年龄段性关系。本研究调查了卢旺达女青年初次性行为时的 ADR 及其与生殖自主权、生殖授权、避孕胁迫和初次性行为时的同意之间的关系。方法分析了一项随机试验的横截面数据（n = 5768），对象是入学时年龄为 12-19 岁的在校青年，重点是那些报告有性行为的青年（n = 1319）。使用一般估计方程线性模型和泊松模型估计线性系数和流行率（PR），并使用稳健标准误差估计 95% 置信区间（CI）。结果女性报告的平均性伴侣年龄差距明显高于男性 2.43 岁（2.90 岁 vs. 0.46 岁，95% CI：2.01, 2.86）。总体而言，23.4%（n = 102）性活跃的非洲裔青年妇女在初次性行为时发生了 ADR。与报告年龄相仿伴侣的 AGYW 相比，报告初次性行为时有 ADR 的 AGYW 非自愿初次性行为的发生率高出 60%（调整后 PR = 1.59，95% CI：1.25, 2.02）。我们的结果表明，在与年龄相仿的伴侣发生初次性行为的 AGYW 中，性暴力的发生率很高。然而，我们并没有发现证据表明，初次性行为中的 ADR 会影响开始性行为后最初几年内的生殖自主权或赋权。我们需要进一步开展研究，探讨初次性行为中的 ADR 对性行为的长期轨迹、赋权和自主性的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Ssm-Population Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.50

自引率

2.10%

发文量

298

审稿时长

101 days

期刊介绍： SSM - Population Health. The new online only, open access, peer reviewed journal in all areas relating Social Science research to population health. SSM - Population Health shares the same Editors-in Chief and general approach to manuscripts as its sister journal, Social Science & Medicine. The journal takes a broad approach to the field especially welcoming interdisciplinary papers from across the Social Sciences and allied areas. SSM - Population Health offers an alternative outlet for work which might not be considered, or is classed as ''out of scope'' elsewhere, and prioritizes fast peer review and publication to the benefit of authors and readers. The journal welcomes all types of paper from traditional primary research articles, replication studies, short communications, methodological studies, instrument validation, opinion pieces, literature reviews, etc. SSM - Population Health also offers the opportunity to publish special issues or sections to reflect current interest and research in topical or developing areas. The journal fully supports authors wanting to present their research in an innovative fashion though the use of multimedia formats.