Background

Ethiopia is one of the developing countries in Sub-Saharan Africa with an estimated 80 percent of the population inhabited in the rural area [1]. Notwithstanding, the recent urbanization rate in the country is rapidly increasing at about 5.4 percent per year, and by 2028 the country’s population in urban areas will reach 30 percent [2]. Internal migration (mainly rural to urban) is the main reason for the rapid increase [3].

Internal migrations in Ethiopia are due to social, economic, climatic and political factors like elsewhere in sub-Saharan Africa [4, 5]. The reasons include but not limited to factors such as drought, war, famine, political turmoil, forced migrations, education, searching for a better job opportunity and marriages, or escaping from early marriages [4, 6, 7]. Young people are a dominant group among all internal migrants in the country [6–8]. However, they are an economically disadvantaged group with little education and limited skills [6, 9].

Migration during the formative adolescent and early adult years can affect life-course transitions through several pathways and can lead young people to risky sexual behaviors [10, 11]. First, migration can alter existing sexual partnerships and provide mobile individuals with an opportunity to acquire new partners. Secondly, migrants are physically separated from their usual social norms and networks so that they may experience social isolation [12, 13]. Thirdly, they also might feel emotionally distanced from partners at home [12, 14]. Moreover, migrants have limited knowledge and access to reproductive health services [15, 16]. So, they are more likely to engage in risky sexual behaviors than non-migrants [12, 14, 17, 18]. Risky sexual behavior may result in serious health problems such as unintended pregnancy, abortion, and sexually transmitted infections (STIs) including HIV [19].

In Ethiopia, risky sexual behavior was higher among migrants than non-migrants [6, 7, 20–22]. According to the study conducted in Northwest Ethiopia, 80.4% of young female internal migrants were engaged in risky sexual practices [21]. Indeed, there is a high prevalence of multiple sexual partners, less utilization of condoms, and higher proportion of commercial sex engagement among migrants than non-migrants in the country [6].

Most studies conducted on risky sexual behaviors in Ethiopia were mainly focused on key populations such as female sex workers, secondary school students, university students, adolescents, youths, and substance users [6, 20, 21, 23–25]. Nevertheless, the study that focused on the sexual behavior of internal migrants is very limited. As a result, very little is known about the relationship between migration and risky sexual behavior among young female internal migrants in Ethiopia. Therefore, this study examined risky sexual behavior and associated factors among sexually-active unmarried young female internal migrants working in Burayu town, Ethiopia.

Objectives

The specific objectives were:

• To determine the magnitude of risky sexual behaviors among sexually-active unmarried young female internal migrants working in Burayu town, Ethiopia
• To identify the factors associated with risky sexual behaviors among sexually-active unmarried young female internal migrants working in Burayu town, Ethiopia

Methods

Sample size determination

The sample size (n) was determined based on a single population proportion formula with the following assumptions. The prevalence of risky sexual behavior among young female internal migrants was 80.4%, which was taken from a study conducted in Tiss Abay town, Ethiopia [21]. The level of confidence (α) was set at 0.05 (Z (1-α) = 1.96) and the margin of error was taken as 0.05. Accordingly, the calculated sample size with 10% consideration for non-response rate was 267.

Where; n = Minimum sample size for a statistically significant survey

Z = Standard normal deviate at 95% confidence interval two-tailed test is; = 1.96

P = Prevalence of risky sexual behavior among young female internal migrants was considered as 80.4%

q = 1-p, d = margin of error taken as 5% = 0.05

Results

Socio-demographic characteristics of the participants

The majority of (153{57.3%}) the participants were in the 15–19 years’ age (with a mean = of 18.85 years), (SD = 2.337). With regard to religious affiliation, the majority (123{46.1%}) of the participants were protestants, and 98(36.7%) were Ethiopian Christian orthodox religious followers. In addition, nearly half (124{46.4%}) of the study participants attended religious service more than once per week (Table 1).

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Table 1. Percentage distribution of socio-demographic characteristics of sexually active unmarried young female internal migrants in Burayu Town, Ethiopia.

https://doi.org/10.1371/journal.pone.0240695.t001

Behavioral characteristics of study participants

This study revealed that more than one-fourth (73{27.3%}) of the study participants went to the clubs over the last six months while one-fifth (53{19.9%}) of them went to the cinema or movie houses. Ninety-two (34.5%) study participants watched pornography at least once over the last six months. Nearly three-fourth of (195{73.0%}) the study participants used social media, and the majority of (107{54.9%}) them used it many times daily. In addition, 94(48.4%) respondents who were active on the social media engaged in sexting with men over the last six months [Table 2].

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Table 2. Percentage distribution of behavioral characteristics of sexually active unmarried young female internal migrants in Burayu Town, Ethiopia.

https://doi.org/10.1371/journal.pone.0240695.t002

With regard to substance use, more than half (136{50.9%}) of the participants used alcohol, 47(17.6%) chewed khat while 63{23.6%) respondents smoked cigarettes or weeds [Table 2].

Discussion

In this study, 34.5% of the study participants had sexual debut before the ages of 18 years [Fig 1]. This finding is higher than found among a comparable sample of young migrant women in China [17] but lower than among young working in hair salons in Nigeria [27]. The high prevalence of early sexual debut in this study might be explained by poverty, unemployment, lack of comprehensive knowledge on the impact of early sexual initiation, being less connected with parents, being from the rural community (in this study the most of the internal migrants were rural-urban migrants), alcohol drinking and exposure to pornographic materials [23, 28–30].

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Fig 1. Magnitude of risky sexual behavior among sexually-active unmarried young female internal migrants in Burayu Town, Ethiopia.

https://doi.org/10.1371/journal.pone.0240695.g001

Nearly one-fourth (23.97%) of the study participants had multiple sexual partners during the last six months [Fig 1]. Similar findings have been reported among female internal migrant workers in China [31]. On the contrary, the present finding was slightly lower than a comparable study conducted among university students in Ethiopia, which reported (30.14%) prevalence of multiple sexual partners [32]. It was evidenced that males were more likely to have multiple sexual partners compared to women in Ethiopia [33]. In fact, the study conducted among university students in Ethiopia has included both male and female respondents while the present study included female respondents only. Therefore, the disparity in the prevalence of multiple sexual partners could be attributable to this.

This study found that 64.4% of the respondents had sex without a condom or inconsistently used condoms in their most recent sexual intercourse during the last six months [Fig 1]. This was supported by a study conducted among unmarried female migrants in Shanghai which reported, 66.8% prevalence [34] and relatively lower compared to another study conducted among female internal migrants workers in China which reported 84% [31]. However, this doesn’t necessarily mean the finding of the present study is acceptable compared to the higher prevalence reported in China. The high proportion of sex without a condom or inconsistent use of a condom in the present study could be explained by the existence of a considerable proportion of transactional sexes in this study which was definitely associated with unprotected sex as reported by earlier studies conducted elsewhere [18, 21, 35, 36]. It could also be attributed to an unfavorable attitude toward using a condom or the social norms in which the youth live and grow. For instance, using a condom is considered as distrusting sexual partners by some people in Ethiopia and a significant proportion of internal migrants in the country reported that either they or their sexual partner do not like condom [21].

This study found that about 72% of the respondents reported at least one form of risky sexual behavior, which was slightly lower than the finding of a similar study conducted in Ethiopia (80.4%) [21]. This similarity reflects the considerable burden of RSB among internal migrants within the country. The slight disparity could be attributed to the difference in the composition of the study subject, viz., the present study was conducted among all types of internal migrants while the comparable study was done mainly among rural to urban migrants. In addition, the previous study was conducted in a semi-urban setting compared to this study. It has been reported that the migrants in small urban areas acquire reproductive health knowledge sooner than migrants in the metropolitan area [37].

More than one-third (34.5%) of the study participants watched pornography at least once over the last six months [Table 1]. The finding of this study was higher than that of a comparable study conducted among preparatory students in Southwest Ethiopia [25]. The variation in the findings could be attributed to the fact that the study from Southwest Ethiopia included both migrants and non-migrants while the present study included only internal migrants. The later has less control from family so that they could engage themselves in activities that deviate from their culture [38].

This study found that one-fourth of (25.8%) the study participants were raped by their sexual partners or strangers over the last six months preceding the data collections period [Table 3]. The studies conducted in Northwest Ethiopia among street women [39] and that held in Southern Ethiopia among university students [40] found similar results even though they reported lifetime and one-year prevalence of rape, respectively.

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Table 3. Percentage distribution of sexuality and reproductive health characteristics of sexually-active unmarried young female internal migrants in Burayu Town, Ethiopia.

https://doi.org/10.1371/journal.pone.0240695.t003

Regarding the discussion and communication with family about SRH, only one-fifth (19.5%) of the study participants ever discussed about SRH with at least one of their family members [Table 3]. Despite the fact that the study population was different, an earlier study conducted among internal migrant children in Ethiopia reported that 21% of the migrant parents talked to them about HIV and only 11% reported discussions on sex [8].

Consequently, this study found out that about 58% of the respondents expressed the perceived risks of contracting HIV [Table 4], which was far lower than the study conducted among construction laborers in China which reported 71% [41]. This could be ascribed to a difference in the age composition of the two studies; the present study used only young people while the study from China was conducted among all age groups. In fact, older people might have higher risk perceptions than the younger age groups.

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Table 4. Risk perception, knowledge and attitude toward condom use among sexually-active unmarried young female internal migrants in Burayu Town, Ethiopia.

https://doi.org/10.1371/journal.pone.0240695.t004

A significant association was observed between the age of participants and RSB [Table 5]. It was observed that the internal migrants in the age group of 15–19 were at about two times an increased risk of risky sexual behavior compared with age group of 20–24 on crude analysis. However, after adjusting for potential covariates, the age of the study participants was no more statistically significant [Table 5]. Similarly, comparable studies were realized statistically significant association between age and RSB, in which younger age was found to be a predictor of RSB [41, 42].

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Table 5. Factors associated with risky sexual behavior among sexually-active unmarried young female internal migrants in Burayu Town, Ethiopia.

https://doi.org/10.1371/journal.pone.0240695.t005

Previous studies have documented enhanced vulnerability to risky sexual behavior when individuals use alcohol because of the fact that the nature of alcohol in decreasing attention to safe sexual practices, altering rational decision-making, and increasing risk-taking behaviors [43, 44]. The presents study findings also provided supportive evidence. Indeed, the young female migrants who used alcohol before sexual intercourse were about three times more likely practiced RSB than their counterparts [Table 5]. However, the association was only significant on crude analysis.

Recent technology is facilitating the tendency to have multiple sexual partners and practical sexual behavior as shown in earlier studies [45, 46]. Similarly, our study revealed that the young female who uses social media many times daily were about eleven times at increased risk of practicing RSB than the respondents who use social media occasionally [Table 5]. In agreement with this finding, a study conducted in Nigeria showed that spending much time with social media increases the risk of vulnerability to RSB among young people [47]. The finding of this study also identified that the respondents who shared sexually explicit texts, images, or/and videos with their sexual partners over social media were about 3.5 times more likely to experience RSB than those never sexted [Table 5]. Consistent with this study finding, sexting of any kind was associated with higher rates of engaging in risky sexual behaviors among adolescents in the United States [48]. On the contrary, another study from the United States showed that sexting was not associated with RSB among teenagers [45]. Further studies are recommended for a better understanding of the association between sexting and risky sexual behavior among this group.

It was clear that rape victims were vulnerable to RSB in earlier studies [39, 40]. In our study, we also found that the respondents had forced sex over the last six months preceding the field data collection were about five times more likely to have RSB than their counterparts on crude analysis [Table 5]. Even though our finding was not statistically significant on adjusted analysis, it has still public health relevance after adjusting for confounders. Indeed, female migrants who had forced sex were at 2.6 times increased risk of practicing RSB than those who had volunteered sexual intercourse [Table 5].

Young women who had received sexuality education through schools, parents, or other family members were less likely to engage in RSB [49, 50]. Our findings also supported this evidence. Accordingly, a young female migrant who received school-based sexuality and reproductive health information was 48% less likely engaged in RSB than those who never received school-based sexuality education on crude analysis. This association was no more established after adjusting for confounding variables but still have public health significance [Table 5].

The unadjusted analysis of the present study implies that the study participants who gave sex in exchange for money were nearly four times more likely to have risky sexual behavior than their counterparts. In agreement with this study, transactional sex was associated with risky sexual behavior according to the research conducted in Northwest Ethiopia [21].

Evidence suggested that the women who reported hunger were more likely to engage in transactional sex that could expose them to unprotected sexual intercourse [18, 36]. In agreement with aforementioned studies, the woman who received food invitation were over three times at increased risk of practicing RSB than their counterparts on the crude analysis of our study. Despite the fact that this finding was not statistically significant on multivariate analysis, its public health significance was more noted on the adjusted analysis. Hence, the woman who gave sex after food invitation or received the gift was over fifteen times at increased risk of unprotected sexual intercourse than the reference group [Table 5]. A possible explanation for this result could be that migrants are economically disadvantaged so that they might have been participated in risky behavior to support their daily life.

The study participants who reported a feeling of embarrassment to buy condoms were about eight times more likely to have RSB than the reference group [Table 5]. In agreement with this finding, it has been reported that embarrassment to buy condoms was a key predictor for RSB among young people [50, 51]. Moreover, the respondents who had a negative attitude about the use of condom for steady and loving relationships were about six times more likely to have RSB than those who had a positive attitude about the importance of condoms for the same purpose after adjusting for confounders, [AOR 5.72(95%; CI; 1.47–22.24)] [Table 5]. It has been reported that young people are less likely to perceive themselves at risk of contracting HIV/AIDS or unwanted pregnancy when they believe they are practicing true love with their partner [52].

The women who reported the ability to refuse sex without condoms were 85% less likely to have RSB than their counterparts in this study [Table 5]. Our finding agrees with the result of research conducted in Cameroon [53]. Therefore, it has significant implications for policy makers if they give attention to strategies that can promote self-efficacy toward the refusal of sex without condoms.

The perceived risks of getting pregnant independently predict risky sexual behavior in the present study. Accordingly, the women who reported the perceived risk of getting pregnant were 95% less likely to practice risky sexual behavior than their counterparts after adjusting for potential confounders [Table 5].

Conclusion

A considerable proportion of respondents in this study practice RSB, which could endanger their future life. Some variables were found to have been determined RSB in this study. These included sexting, frequent engagement in social media, feeling of embarrassment to buy condoms, unfavorable attitudes towards using a condom for a steady and loving relationship. Even though the association was not established after adjustment, age of respondent, family composition, the frequency at clubs or parties, a cinema house, watching pornography, alcohol use, rape, planned first sex after migration, and transactional sex was also associated with risky sexual behavior. On the other hand, perceived self-efficacy to use a condom and perceived risks of getting pregnancy, adequate knowledge of condom, school-based SRH education, parental child communication on SRH, and perceived risks of contracting HIV/STIs were found to be protective of risky sexual behavior among respondents. This finding suggests an urgent need for intervention to promote safe sex among sexually-active young female internal migrants. Special attention and prompt interventions are needed to promote the use of a condom. Such interventions should include targeting the prevailing misconceptions, unfavorable attitudes, and other dynamics related to not using a condom or inconsistent condom use which was prominent in this study. Strategies to channel young female internal migrants into productive and safe livelihoods should be emphasized to reduce rape, transactional sex, and sex work.

Supporting information

Acknowledgments

Our deepest gratitude goes to Pan African University, University of Ibadan, and the management of Oromia regional Health Bureau for facilitating this study. Finally, our special respect goes to all respondents and data collectors in this study.