Background
Methods
Study setting
Study design and sampling procedures
Data collection and measurement
Definition of variables
Unwanted pregnancy
Sexual coercion
Circumstance surrounding sexual debut
Ethical consideration
Data analysis
Quantitative data
Qualitative data
Results
Characteristics of participants
Individual factors | N (%) |
---|---|
Age† | |
15-19 | 97 (23.3) |
20-24 | 319 (76.7) |
Religion | |
Protestant | 94 (22.6) |
Catholic | 148 (35.6) |
Muslim | 114 (27.4) |
Others** | 60 (14.4) |
Level of education | |
Pre secondary | 78 (18.8) |
Post primary | 338 (81.3) |
Current marital status | |
Married® | 334 (80.3) |
Unmarried†† | 82 (19.7) |
Knowledge of contraceptives | |
No knowledge | 113 (27.2) |
Knowledgeable | 303 (72.8) |
Ever used contraceptives | |
No | 256 (61.5) |
Yes | 160 (38.5) |
Contraception use at the time of conception | |
No | 364 (87.5) |
Yes | 52 (12.5) |
Age at sexual debut | |
18+ years | 197 (47.1) |
15-17 years | 165 (39.7) |
< 15 years | 23 (5.5) |
Unknown | 32 (7.7) |
Partner respondent age difference at sexual debut | |
Partners with the same age or younger | 52 (12.5) |
Partner 1–5 years older | 174 (41.8) |
Partner >5 years older | 112 (26.9) |
Unknown | 78 (18.8) |
Type of sexual debut | |
Consensual | 323 (77.6) |
Non consensual | 93 (22.4) |
Lifetime sexual partners | |
1-2 | 329 (79.1) |
3+ | 87 (20.9) |
Ever counseled on contraceptives at HCF | |
No | 267 (64.2) |
Yes | 149 (35.8) |
Ever counseled on sexual violence at HCF | |
Yes | 96 (23.1) |
No | 320 (76.9) |
Partners level of education | |
Low education | 33 (7.9) |
Secondary | 200 (48.1) |
Tertiary | 116 (27.9) |
I don’t know | 67 (16.1) |
Partner respondent age difference at time of study | |
Male partner less than 10 years older | 306 (73.6) |
Male partner younger or same age | 12 (2.9) |
Male partner > = 10 years or older | 65 (15.6) |
Unknown | 33 (7.9) |
Number of pregnancies before the current | |
Prime gravid♦ | 219 (52.64) |
1 | 117(28.13) |
2+ | 80 (19.23) |
Prevalence of sexual coercion and unwanted pregnancy
Variable | Sexual coercion in the past twelve months % (n/N) |
---|---|
Sexual coercion in the past twelve months | 24 (100/416) |
Age | |
15-19 | 29.9 (29/97) |
20-24 | 22.3 (71/319) |
Level of education | |
Pre secondary | 35.9 (28/78) |
Post primary | 21.3 (72/338) |
Current marital status | |
Married® | 21.0 (70/334) |
Unmarried†† | 36.6 (30/82) |
Ever counseled on sexual violence | |
Yes | 20.8 (20/96) |
No | 25.0 (80/320) |
Age at sexual debut | |
18+ years | 19.4 (38/196) |
15-17 years | 24.9 (41/165) |
< 15 years | 52.2 (12/23) |
Unknown | 28.1 (9/32) |
Type of sexual debut | |
Consensual | 22.6 (73/323) |
Non consensual | 29.0 (27/93) |
Partner respondent age difference at sexual debut | |
Partner with same age or younger | 17.3 (9/52) |
Partner 1–5 years older | 20.7 (36/174) |
Partner >5 years older | 27.7 (31/112) |
Unknown | 30.8 (24/78) |
Partner respondent age difference at time of study | |
Partner <10 years older | 22.6 (69/306) |
Partner same age or younger | 16.7 (2/12) |
Partner > =10 years older | 32.3 (21/65) |
Unknown | 24.2 (8/33) |
Life time sexual partners | |
1-2 | 21.9 (72/329) |
3+ | 32.2 (28/87) |
The unadjusted and adjusted prevalence proportion ratio of unwanted pregnancy
Variable | Had unwanted pregnancy % (n/N) | Unadjusted PR (95 % CI) | Adjusted PR (95 % CI) |
---|---|---|---|
OverallŦ | 18.3 (76/416) | ||
Sexual coercion in past twelve months | |||
No | 17.2 (40/316) | 1 | 1 |
Yes | 36.0 (36/100) | 2.84 (1.92-4.20) | 2.23 (1.49-3.32)* |
Age of participants | |||
15-19 | 27.8 (27/97) | 1 | 1 |
20-24 | 15.4 (49/319) | 0.55 (0.37-0.83)* | 0.53 (0.36-0.78)* |
Level of education | |||
Pre secondary | 25.6 (20/70) | 1 | 1 |
Post primary | 16.6 (56/338) | 0.65 (0.41-1.01) | 1.06 (0.68-1.64) |
Current marital status | |||
Married® | 12.3 (41/334) | 1 | 1 |
Unmarried†† | 42.7 (35/82) | 3.48 (2.37-5.09)* | 3.38 (2.31-4.93)* |
Knowledge of contraceptives | |||
No knowledge | 16.8 (19/113) | 1 | 1 |
Knowledgeable | 18.8 (57/303) | 1.12 (0.70-1.79) | 1.16 (0.77-1.76) |
Contraception use at the time of conception | |||
No | 17.6 (64/364) | 1 | 1 |
Yes | 23.1 (12/52) | 1.31 (0.76-2.26) | 1.41 (0.82-2.42) |
Number of pregnancies before the current | |||
Prime gravid♦ | 15.1 (33/219) | 1 | 1 |
1 | 22.2 (26/117) | 1.47 (0.93-2.34) | 1.44 (0.94-2.10) |
2+ | 21.3 (17/80) | 1.41 (0.83-2.39) | 2.21 (1.30-3.75)* |
Type of sexual debut | |||
Consensual | 15.5 (50/323) | 1 | 1 |
Non consensual | 28.0(26/93) | 1.81 (1.19-2.73)* | 1.72 (1.16-2.54)* |
Theme | Subthemes | Codes |
---|---|---|
Threatened and forced | Feared to be beaten |
He said that we had to do it [have sex] and if I shouted he would beat me.
|
Forced and used |
He told me that we had to have sex, so when I refused, he forced me and used me.
| |
Feared to be abandoned |
If we don’t have sex pack your things and leave.
| |
Forced to have sex by relatives |
There is one who was raped repeatedly by her uncle; he had warned her never to tell anyone.
| |
You may be staying with your sister’s husband. He will admire you and buy for you things. Then one day when your sister is not around, he will force you into sex.
| ||
Forced to have sex by a stranger |
I didn’t know that person though I used to see him but he raped me when I was going to bathe.
| |
A man broke into my house at night, he raped me and I became pregnant, but it took me long to discover that I was pregnant.
| ||
Deception | Deceived and impregnated |
He deceived me that he would give me a lot of things, but when I got pregnant he left me without giving me what he promised.
|
Ok, he first told me and I refused, then he started giving me gifts so as to seduce me and I accepted.
| ||
Lied with promises |
This man promised me something….I won’t tell you what it was, so we slept together, and I became pregnant. Unfortunately he never stood by his promises.
| |
Normally they deceive girls, that they will marry them, give them business or educate them; they use such things.
| ||
Deceiving them that they will marry them but after using them; whether they have got HIV or pregnancy, he runs away. | ||
Gifts mostly and use of persuasive words to deceive them. A man might deceive you that I will do this for you or come at home and pick this and that.
| ||
Poor socio-economic status | Not being able to afford |
You need something and you can’t get it from your parents, you have no money but you really want it, so you are forced to have sex with someone to get what you want.
|
Poor parents |
You find a parent leaves home in the morning without providing food for children or they will tell her that you also go and look for what you can eat.
| |
Forced to have sex to get what you want |
Gifts; they tend to deceive them with gifts. Normally they give them money to buy things like clothes, powder or to plait hair. Girls normally have a list of items they want and they cannot ask everything from their parents. Therefore, gifts are so much liked by girls and they end up getting unwanted pregnancies because if you keep going to the man’s place to request for such items, he will rape you and you may become pregnant.
| |
These young girls are given money either for tuition or pocket money and they end up having sex with these men and they get unwanted pregnancy.
| ||
Alcohol | Forced to have sex while under alcohol influence |
When a girl takes a lot of alcohol and gets drunk, men may use her and she ends up with an unwanted pregnancy and she cannot even think of contraceptives, since she will be drunk.
|
More so when the girl takes alcohol because if a man realizes that he cannot get her when she is not drunk, he will buy a lot of alcohol for her so that she gets drunk and he will do anything he wants. That’s why they always get pregnant when they don’t know anything at all.
| ||
Alcohol influencing contraceptive use |
They want to go and booze but when she is drunk at night, they will be only two and the man will use her.
| |
For example If a woman is drunk, she might not really think about a condom because her reasoning has been tampered with, by the substance.
| ||
Strategies | Youth friendly services |
If we have services specifically for young people so that there’s no fear of meeting ones mother or elder sister in the line. This will go a long way to improve the kind of service young people can access.
|
Punishing perpetrators |
What I would want the government to do is to put laws in place that punish such people who coerce girls. But because they are left unpunished they continue doing that to even more other girls. So they should really be treated by law and imprisoned so that they stop it.
| |
Sex education |
By having sensitizations, teaching them how to prevent unwanted pregnancies at an early age. Sensitize them; educate them about the disadvantages of having sex at an early age. Yes, and what they watch; actually when children are there, they should not cast blue movies.
| |
Girls should be counseled and also parents themselves; they should know what a girl needs and they should always talk peacefully with their children. You have to be free with your children.
| ||
Youth mobile services |
May be going around distributing boxes of condoms. Yes, one will be protected with that box in the pocket. Yes, because some fear to buy them from shops.
| |
Community services for the youth. |
Health workers should come to the community on specific days and just talk to us. Many of us leave with stepmothers and our fathers are too busy, so no one talks to us.
|
Types/contexts of sexual coercion and their relations with unwanted pregnancy
Threats and force
“I was walking with my friend when a boy came and told me that so and so is calling you. The man who had sent for me was in an incomplete house, he told me that he wanted to have sex with me,…..He said that we had to do it [have sex] and if I shouted he would beat me, he forced me to have sex and some months later I realized I was pregnant” (In-Depth Interview, pregnant 17 year old).
“A man who had been trying to befriend me and I had refused invited me to his home to pick a gift. It rained shortly after my arrival. He told me that we had to have sex, so when I refused, he forced me and used me. After sometime, I started feeling sick and I went to hospital where they told me that I was pregnant. When I told him about it, he said that, he had not reached the time of bearing a child; and that he was not responsible for my pregnancy” (In-Depth Interview , pregnant 18 year old).
“Sometimes these girls are just raped and they get an unwanted pregnancy. Rape just happens; some young girls are raped by their relatives. There is one who was raped repeatedly by her uncle; he had warned her never to tell anyone. They came here with the mother and that’s when the girl told us” (KII private health facility, female nurse).
Deceptive sex
“There is a man who kept on insisting that we have a relationship but I always refused, however, he kept on giving me presents. One time he invited me for a party at their home and the last thing I remember that day was that he gave me a soda; next morning when I woke up I was lying in his bed naked. Some months later I realized I was pregnant. I stopped schooling and my parents were very annoyed with me” (In-Depth Interview, pregnant 19 year old).
“This man promised me something….I won’t tell you what it was, so we slept together, and I became pregnant. Unfortunately he never stood by his promises” (In-Depth Interview, pregnant 20 years old).
Poor socio-economic status
“You need something and you can’t get it from your parents, you have no money but you really want it, so you are forced to have sex with someone to get what you want, but you may end up with an unwanted pregnancy” (In-Depth Interview, Pregnant 23 year old).
Similarly, some supported this finding
“These young girls are given money either for tuition or pocket money and they end up having sex with these men and they get unwanted pregnancies” (Key Informant private health facility, female counselor).
Alcohol
“When a girl takes a lot of alcohol and gets drunk, men may use her and she ends up with an unwanted pregnancy and she cannot even think of contraceptives, since she will be drunk” ( In-Depth Interview, Pregnant 22 year old ).
“When I realized I was pregnant I got very annoyed. I wanted to abort but I had no money and secondly I have seen my friends who aborted and died “ (In-Depth Interview, Pregnant 19 year old).
Strategies
“Health workers should plan talks for young people. They can choose a day and come to Kawala, to give a talk after informing all young people to attend. Some of us have no one to talk to us. For example my father is a business man, he doesn’t stay at home. Others stay with stepmothers, no one gives us information. At times you may be planning to do something, but when they tell you it’s dangerous you can change your mind or start protecting yourself as you have heard by using family planning” (In-Depth Interview, pregnant 19 year old).
“You know we don’t have a system where services for young people are offered, so that young people feel comfortable to come because services are for young people only. When you send them to the family planning clinic they are going to line up with married women who will ask the young girls whether they have also come for family planning. So we need services for these young people to give them ease of access” (KII private not for profit hospital, female nurse).