Education and risky sex in Africa: Unraveling the link between women’s education and reproductive health behaviors in Kenya
Introduction
A number of studies (Gregson et al., 2001, Michelo et al., 2006, World Food Programme, 2006) have found that increased education is associated with a lower risk of HIV/AIDS. Indeed, the role of education for decreasing the risk of HIV/AIDS in Africa has been referred to as the “education vaccine” (Vandemoortele and Delamonica, 2002). Further, this pattern appears robust across various contexts. A number of US-based studies (Lammers et al., 2000, Ohannesian and Crockett, 1993) have found that more highly-educated women are less likely to engage in riskier sex-related behaviors (i.e. casual sex, multiple sex partners and sex without a condom). A similar relationship has been found in Africa, where high rates of HIV/AIDS make behavior such as unprotected sex particularly risky.
Numerous studies (Hallett et al., 2007, De Walque, 2007, Filmer, 2002, Zellner, 2003) have found that education decreases the likelihood of riskier sex-related behaviors that may result in HIV/AIDS contraction, which is the leading cause of death among all young adults in some sub-Saharan Africa countries, and an especially burgeoning one among women (Dodoo et al., 2003, Zulu et al., 2003). Regrettably, significantly less attention has been given to explaining the mechanisms behind the relationship between education and safer sex-related behaviors in the region and around the world. In many nations, women’s education lags significantly behind that of men, and in sub-Saharan Africa these disparities are especially stark. This is due in part to the patriarchal structure that favors men’s educational and economic advancement and overall status, which also makes it particularly challenging for women to engage in safer sex-related behaviors. Thus, risky behavior that arises from interactions between men and women must be couched in a larger framework of gendered inequality that leaves women disadvantaged in social and cultural capital that enhance health-promoting attitudes and behaviors. Identifying specific factors that lead to safer sex-related behaviors among women in sub-Saharan Africa could contribute to solutions that would have implications not only for the spread of HIV/AIDS, but the spread of other sexually transmitted diseases (i.e. Chlamydia and herpes). This, in turn, would have broader implications for a country’s overall level of development.
Using data from the 2003 Kenya Demographic and Health Survey, we assess the mediating role of women’s knowledge about HIV/AIDS, gendered norms and interactions, economic security, and male human capital to explain the relationship between women’s education and age at first sex, multiple partners, casual sex partners, and condom use. We find that greater education among husbands, as well as partner discussions about family planning, partially mediate the relationship between women’s education and condom use amongst married couples. For all women, awareness of and accurate knowledge about HIV/AIDS partially accounts for the relationship between education and condom use. Further, more educated women have a later age of first sex, in part, because they are less likely to tolerate norms that justify partner violence. Finally, education appears to empower women to use their knowledge about HIV/AIDS and attitudes that support gender equality to delay the timing of first sex.
Section snippets
Education, HIV, and sex-related behaviors
While current research recognizes education as an important factor for limiting the spread of HIV/AIDS (Vandemoortele and Delamonica, 2002), researchers who explored the epidemic in its earlier stages (Smith et al., 1999, Hargreaves and Glynn, 2002, De Walque et al., 2005) found that more educated individuals were more likely to contract HIV/AIDS. Some explanations for this finding include higher incomes (i.e. disposable income) and lifestyles (i.e. travel, more leisure time) that seemed to
Education and knowledge about HIV/AIDS
As mentioned above, the mechanism that has received the most attention for explaining the inverse relationship between education and HIV/AIDS is knowledge about HIV/AIDS. Various studies (Gregson et al., 1998, Frolich and Vazquez-Alvarez, 2009) have found some influence of HIV/AIDS campaigns on sex-related behaviors that could limit the likelihood of contracting HIV/AIDS. Beginning in November 1999, the first intensive information campaign started in Kenya (Shanya, 2005), while that same year
Education and empowerment
Unequal power dynamics in relationships and social norms in sub-Saharan Africa place women’s sexual health at risk. Women are frequently in submissive positions in their social relationships with men, weakening their power to request safer sex practices (Zulu et al., 2003). Those who are married or with partners may face the greatest risk of unprotected sex, as partners may use their dominance to avoid condom usage for sexual pleasure. Further, due to the cultural tradition of bride wealth
Education for married women
Some researchers (Klomegah, 2006, Speizer et al., 2005) have demonstrated that family planning decisions are not made solely by women, but also by their partners. The Kenya 2003 Demographic and Health Survey, for example, finds that 40% of women have the final say in their own health, while 9% make decisions jointly with their husbands, and 27% report that the decision is primarily made by her husband or partner. A number of studies (Zellner, 2003, Lagarde et al., 2001) have found that men’s
Moderating effects of education
Thus far we have focused on the mechanisms that might explain the relationship between education and riskier sex. We also consider that education could moderate the effects of knowledge about HIV/AIDS, a higher status job, and support of gender equality on riskier sex-related behaviors. Much of the research (De Walque, 2007, De Walque et al., 2005, Glynn et al., 2004) that has examined the changing relationship between education and HIV/AIDS over time has suggested that more educated people are
Data and methods
This study relies on cross-sectional data from the 2003 Demographic and Health Survey (DHS) of Kenya. The Kenyan DHS is a national study of men and women age 15–49.
Age at first sex
Table 2 examines the mediating effects of HIV/AIDS knowledge, disapproval of wife beating norms, and occupation/work status for explaining the relationship between education and first sex, multiple sex partners in the past year, and knows sex partner. Model 1 shows that even with controls for HIV testing, age, wealth, religion, community size, and number of children, as education increases, a women’s age at first sex also increases. Contrary to our first hypothesis, Model 2 shows that HIV/AIDS
Discussion and conclusion
This study examined the relationship between education and riskier sex-related behaviors among Kenyan women. Even after controlling for marital status, age, wealth, religious affiliation, community size, number of children, and whether she has been tested for HIV/AIDS, better educated women have a later age at first sex, fewer sex partners, are more likely to know their sex partner, and are more likely to use condoms within and outside of a marital relationship. We then moved beyond prior
Acknowledgements
Special thanks to two anonymous reviewers for comments on the paper. An earlier version of this paper was presented at the 2010 Annual Meeting of the American Sociological Association.
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