The Influence of Early Sexual Debut and Sexual Violence on Adolescent Pregnancy: A Matched Case-Control Study in Jamaica

Article excerpt

CONTEXT: Contraceptive knowledge and use at first sex have increased over time among Jamaican adolescents, yet high unintended pregnancy rates persist. More information on risk factors for adolescent pregnancy is needed to inform programs.

METHODS: Structured interviews were conducted with 15-17-year-old females--250 who were currently pregnant and 500 sexually experienced, but never-pregnant, neighborhood-matched controls. Bivariate and multivariate analyses were used to examine associations between adolescent pregnancy and early sexual debut, sexual coercion or violence and sexual risk-taking behaviors.

RESULTS: Greater proportions of pregnant youth than of their never-pregnant peers reported having had first sex by age 14 (54% vs. 41%), a first sexual partner who was five or more years older (33% vs. 20%) or multiple partners (63% vs. 50%); a greater proportion of never-pregnant youth had used contraceptives at first sex (88% vs. 80%). Almost half (49%) of all young women reported ever having experienced sexual coercion or violence. Compared with controls, pregnont youth had greater odds of having had an older partner at first sex and believing contraception is a woman's responsibility (odds ratios, 1.3 and 2.1, respectively), and had lower odds of ever having experienced sexual violence and thinking that it is important to protect oneself against pregnancy (0.5 and 0.2, respectively). An interaction between early sexual debut and multiple partners was found. Having had multiple partners was associated with pregnancy only for youth with early sexual debut.

CONCLUSIONS: Encouraging adolescents to delay sexual debut and reduce their number of sexual partners may help prevent unintended pregnancies. Experiences of sexual coercion and violence were common among both groups, highlighting the need to address gender-based violence at the community level.

International Perspectives on Sexual and Reproductive Health, 2009, 35 (1):21-28.

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Adolescent pregnancy continues to be a major public health problem in Jamaica. Despite widespread contraceptive knowledge and increased contraceptive use at first intercourse among Jamaican adolescents over the last decade (43% in 1993 vs. 67% in 2002), 35% of Jamaican women have their first pregnancy by age 19. (1-3) Furthermore, among currently or ever-pregnant 15-19-year-olds, 88% of pregnancies are unintended. (1) Adolescent pregnancy contributes to increased maternal and child morbidity and mortality, school dropout and a decreased likelihood of being gainfully employed. (4-6) There is a need to more fully understand what factors beyond contraceptive knowledge and use influence unintended pregnancy among sexually active adolescents. This study examines risk factors for adolescent pregnancy in Jamaica by comparing pregnant adolescents with their sexually experienced, but never-pregnant, peers.

According to some studies, early sexual debut (commonly defined as having had first sexual intercourse at or before age 14) and experience of sexual coercion or violence contribute to unintended adolescent pregnancy. (7-13) In Jamaica, the national Reproductive Health Survey (RHS) reports that 24% of women aged 15-24 have had sexual intercourse by age 14, and a community-based household survey of youth aged 15-19 found that 30% of females had had sex before age 14. (1), (3), (14), (15) According to the Jamaica RHS, 20% of sexually experienced 15-19-year-olds report ever being forced to have sex. (1) Another study in Jamaica demonstrated a relationship between early sexual debut and childhood sexual abuse of young women. (14) Early sexual debut may not only increase the length of time in adolescence in which a young woman can become pregnant, but is associated with experiences of sexual coercion and violence as well. (7), (8), (14), (16-21) Moreover, early sexual debut may lead to increased sexual risk-taking behavior, such as having multiple partners and not using contraceptives, and may be independently associated with pregnancy. …