Hope Enterprises - Jamaica (Wedderburn), Rakai Health Sciences Program - Uganda (Wagman), FHI, Research - North Carolina, US (Waszak Geary, Baumgartner, Toms Tucker, Johnson)

From the Youth Research Working Paper Series of Family Health International (FHI), this eighth Working Paper focuses on early sexual début and experiences of sexual coercion/violence as they are related to each other and to unintended adolescent pregnancy. The research was funded by FHI and the United States Agency for international Development (USAID).

From the Executive Summary: "The purpose of this project was to identify risk factors for adolescent pregnancy in order to inform culturally appropriate programs that aim to prevent unintended adolescent pregnancy. This study had two phases of research. The first phase was formative research to identify contextual factors and circumstances that influence pregnancy among young adolescents (15-17 years old) in Jamaica and Uganda. Factors of particular interest included influences on early sexual début, reports of sexual coercion/violence along a continuum of experiences, and participants’ perceptions and reports of their own sexual risk-taking behavior. The second research phase was a quantitative case-control study conducted in Jamaica that measured the relationships between sexual début, sexual coercion/violence, and sexual risk-taking among pregnant adolescents and their never pregnant, but sexually active peers."

Formative qualitative research in Jamaica and Uganda with pregnant and never-pregnant young adolescents consisted of four focus group discussions and a series of in-depth interviews with approximately 30 pregnant and never-pregnant participants in each country. A matched case-control study design with a quantitative survey was conducted in Jamaica only with 250 pregnant and 500 never-pregnant participants.

For many of the participants, their first sex was coerced; thus, the timing of their sexual début was not a choice. Results showed that conscious use of contraception appeared to be the main difference between pregnant and never-pregnant girls in both countries. However, there was a lack of knowledge and/or misconceptions about family planning methods other than condoms. Most pregnant participants did not plan their pregnancies and did not think it was the right time to be pregnant. In Uganda, married adolescent women constituted a unique group when it came to addressing sexual coercion and pregnancy. For example, findings from Uganda provide insight into sexual violence experienced by young married girls and add to findings of those whose research has found that marital sex is no protection against sexual violence for young women, and in fact, marriage is probably a risk factor for sexual violence among married teenagers.

According to the research, "Bivariate results from the survey indicated that compared to their never pregnant, sexually active peers, pregnant participants were more likely to: have lived in their community less than three years, not be involved in clubs/community groups, not live with their father, not live with their mother, not receive emotional/financial support from their mother, be in a stable relationship, have had an early sexual début, had a first sexual partner more than five years older, have had two or more sexual partners in their lifetime, and think that contraception is the woman’s responsibility."

Key findings from this research include the following:

• "First sexual experiences are unpleasant, even painful, for most girls. Most girls wished they had known more about what to expect and that they had waited until they were older.
• Most girls knew about contraception, but consistent use was related to concerns about the effects of an unwanted pregnancy on their future choices. The girls who had never been pregnant were more likely to verbalize this concern. In Uganda, most of the pregnant girls married early and childbearing was an expected consequence of being married at an early age.
• Sexual violence was a common experience for girls in both countries. Verbal harassment was common. Many girls described having been coerced to have sex at one time or another by their boyfriends or someone they had a relationship with; sometimes this meant actual force or threat of force and sometimes this meant feeling verbally pressured.
• Jamaican girls were more likely to describe resistance to sexual violence than the girls in Uganda, who were more likely to keep sexual violence a secret. The quantitative results from the case-control study in Jamaica found an association between pregnancy and early sexual debut but not between pregnancy and sexual violence. Though this lack of statistical association was a surprise, the prevalence of sexual violence among both pregnant and never pregnant girls indicates that it is an issue that cannot be ignored in programs for and with adolescent girls."

Based on the study's findings, the following are strategies and goals for programmes to reduce unintended pregnancy:

• "build adolescents’ self-esteem and future orientation
• address norms that encourage early marriage and enforce marriage-age laws
• discourage older partners
• encourage stronger connections with parents and community groups
• teach girls and boys about contraception and make it accessible
• teach the community about the benefits of delayed childbearing among married and unmarried adolescents
• teach boys to respect that girls have the right to refuse sex
• teach refusal skills to girls
• provide girls with good reasons to delay sexual début
• reach girls and boys at young ages (before age 14)."

The Development Experience Clearinghouse (DEC) Express e-bulletin on June 26 2009.