Chapter 2: Literature Review
2.5. Determinants of sexual and reproductive behaviour among young people
condoms can imply inappropriate experience for women. Young people also worry that asking for their partner to use a condom implies that they think their partner is diseased; thus, condom-free intercourse can be seen as a sign of trust. In South Africa and Uganda, for example, wanting to use a condom can be interpreted as a sign of carrying disease. Paradoxically, despite the stigmatising effect for women in carrying condoms or using other contraception, women, not men, are generally considered responsible for pregnancy prevention (Marston and King, 2006:1581).
The promotion of condom use in countries like Zambia with widespread heterosexual transmission remains one of the key public health prevention strategies. Condoms have produced substantial benefits in countries like Thailand where both transmission and condom promotion are concentrated in the area of commercial sex (Hearst and Chen, 2004). The impact of condoms may generally be limited by inconsistent use, low use among those at highest risk, and negative interactions with other strategies. Therefore, reducing the number of sex partners appears to be another important strategy in addition to promoting the use of condoms.
pregnancy and to infection with STIs, including HIV. In the following section, a number of other factors influencing age at first sex and age at first birth are explored.
2.5.2. Socio-cultural factors
Social and cultural factors such as parental control and the value placed on marriage institutions indirectly affect young people’s sexual behaviours. For example, the practice of abstinence and condom use among young people is influenced by views underlying national policies and religious and traditional beliefs. A study by Marindo et al. (2003) in Zimbabwe confirms these assertions by noting that young people’s decisions to adopt one or the other risk-reduction strategy may not necessarily indicate genuine individual choices.
Rather, it may reflect their deference to adults’ interests, as young people understand those interests. According to these researchers, there was evidence that young people are aware of the conflict between choices of strategies and sometimes conceal their condom use in order not to disappoint their parents who therefore have a direct influence on the behaviour of their children. In a study by Babalola et al. (2005) in Côte d'Ivoire, it was found that three parental factors (living in the same household as the father during childhood, perceived parental disapproval of early and premarital pregnancy, and parent-child communication about sexual abstinence) were positively associated with primary sexual abstinence (defined as yet to experience sexual debut), secondary sexual abstinence (defined as sexual abstinence subsequent to sexual debut), and reduced number of sex partners.
These findings suggest that parental monitoring and control are important predictors of youth’s sexual behaviours and underscore the need to target parents and guardians in an effort to promote responsible sexual behaviour among young people. For example, Kotchick et al. (2001) found that parental monitoring or supervision of adolescents’ social activities has been associated with less frequent sexual behaviour. Other studies have found that lower levels of monitoring have been associated with a higher number of sexual partners and inconsistent use of contraception (Kotchick et al., 2001). Moreover, a study by Gordon and Mwale (2006) in Chipata (Zambia) observed that among the many factors
which make young people vulnerable to HIV, include traditional and emerging gender and sexuality norms which encourage unsafe sexual activity among young people.
According to Marston and King (2006), throughout the world, not only is sexual behaviour strongly shaped by social forces, but these forces are surprisingly similar in different settings. The authors note that women’s sexual freedom, for example, is universally restricted compared with men’s. Nonetheless, they observe that ‘the exact nature of what is deemed inappropriate and the penalties for transgression – from verbal censure to “honour killings”, a practice in which a family member kills a female relative as punishment for sexual behaviour considered to have brought “dishonour” to the family vary both within and between societies’ (Marston and King, 2006:1582). These authors thus advance that:
Social rewards and penalties influence behaviour. Complying with gender expectations can raise social status: for men, by having many partners, for women, by chastity or securing a stable, exclusive relationship with a man.
While pregnancy outside marriage can be stigmatising, for some women pregnancy can be an escape route from the parental home. Young people may behave in particular ways through fear of being caught in the act. Sex can also be a way to obtain money and gifts from boyfriends: this is particularly well-described for sub-Saharan Africa, but is not exclusive to the region. (Marston and King, 2006:1582)
It is evident that social and cultural forces shape young people’s sexual behaviour and consequently how they respond to sexual education information campaigns and condom distribution programmes. As Warenius et al. (2006:124) succinctly puts it, ‘sexual and reproductive health services [are] at a critical intersection between the norms and values of the community – which advocates sexual abstinence before marriage – and the reality of premarital sex among young people’. Hence, young people are at constant conflict with such societal demands.
2.5.3. Socioeconomic factors
Socioeconomic factors such as education, gross family income and occupation of head of household all have a bearing on young people’s sexual behaviours. Socioeconomic status (SES) is ‘a composite measure that typically incorporate[s] economic status, measured by income; social status, measured by education; and work status, measured by occupation’
(Adler et al., 1994:15). The fact that associations between SES and sexual behaviour are found with each of the indicators suggests that a broader underlying dimension of social stratification or social ordering is a potent factor. A study by Juarez and LeGrand (2005) in Brazil found that higher socioeconomic status leads to earlier sexual activity for boys (in contrast with girls), but also to a greater likelihood of using condoms during first intercourse. Other studies have observed that lack of recreation facilities, schooling and unemployment may result in increased sexual activity among young adults (Mathews, 2005).
In addition, socioeconomic change affects the level of adolescent childbearing and the timing of the first birth through factors (the proximate determinants of fertility) which include the timing of first sexual relationship, union or marriage, use of contraceptives, and practice of abortion (Singh, 1998; Zabin and Kiragu, 1998). A study by Singh (1998) confirms these assertions when it notes that declines in adolescent childbearing are clearly more common and larger in size in urban areas than in rural areas, and more common among better-educated women. In general, Singh notes, educated women have lower levels of adolescent childbearing. Therefore, conditions such as socioeconomic living arrangements have an indirect bearing on young people’s sexual behaviour.
In sum, since sexual activity is a universal human drive, public health education among young people should focus on pregnancy and disease prevention. Prevention strategies aimed at reducing concurrent multiple partnerships, promoting increased condom use with non-regular sex partners, and education on high risk cultural practices among young people, are crucial to reduce HIV prevalence and high pregnancy levels in Zambia.