Risk for Coerced Sex among Female Youth in Ghana: Roles of Family Context, School Enrollment and Relationship Experience

By Bingenheimer, Jeffrey B.; Reed, Elizabeth | International Perspectives on Sexual and Reproductive Health, December 2014 | Go to article overview

Risk for Coerced Sex among Female Youth in Ghana: Roles of Family Context, School Enrollment and Relationship Experience


Bingenheimer, Jeffrey B., Reed, Elizabeth, International Perspectives on Sexual and Reproductive Health


High rates of sexual coercion and sexual violence against adolescent females have been consistently reported in Ghana and elsewhere in Sub-Saharan Africa. (1-4) Sexual victimization has been recognized as a violation of human rights, as well as a major threat to the health and wellbeing of females, and adverse physical, sexual, behavioral and mental health consequences have been reported in studies around the world. (5,6) Among the most notable and well-documented consequences of sexual victimization are the effects on adolescents' reproductive and sexual health, including unplanned pregnancy, poor pregnancy outcomes (e.g., stillbirth, miscarriage, low birth weight), and STIs and HIV infection. (3,4,7-11) A public health focus on adolescent females is particularly important, given their high rates of victimization and because such experiences have been found to have long-lasting negative impacts on their passage into adulthood (e.g., via unintended pregnancies, HIV infection, psychosocial effects and influences on health behaviors). (5,6,12)

Efforts to address sexual victimization require improved understanding of the factors driving male perpetration, as well as identification of the aspects of females' lives (e.g., relationship, school, family) that may be associated with victimization. (13,14) Social norms that promote gender inequities (e.g., male dominance) have been consistently found

to be associated with male perpetration of violence against girls and women,15-23 and thus contexts in which such inequities are promoted are likely to have higher levels of victimization. In contrast, social contexts in which there is equal investment in girls and boys may reduce females' vulnerability to sexual victimization. In such contexts, other factors may be present that help prevent victimization, such as increased monitoring. (13,14) Altogether, these findings highlight the need for a contextual-level approach to address sexual coercion, including the recognition that gender-specific characteristics may contribute to the perpetration of sexual violence against young women.

One primary risk factor for experiencing sexual coercion is being in an intimate relationship. (14,24) Previous research suggests that most coerced sex is not perpetrated by strangers but by persons who are known to the victim, and particularly by partners in intimate relationships. (5,6) Much research has therefore focused on characteristics such as age, socioeconomic and power differentials between partners associated with an elevated risk of coerced sex in intimate relationships. (25,26) Comparatively little research, however, has examined whether simply being (versus not being) in a romantic relationship is a proximate risk factor for coerced sex. Furthermore, many studies of correlates of sexual victimization restricted their analytic samples to adolescent females who had reported a history of sexual activity (3,4,27) Yet sexually inexperienced females are also at risk of coerced sex, and excluding them from studies may result in misleading conclusions. One study, for example, found that being in school was associated with coerced first sex among adolescent females in Malawi. (2) Because the analysis excluded sexually inexperienced females, however, this association could in fact be attributable to in-school females being at lower risk than out-of-school females for consensual first sex rather than at higher risk for coerced first sex.

A substantial body of literature suggests that, in Sub-Saharan Africa, school enrollment is a powerful impediment to the formation of intimate partnerships. While enrollment may increase the opportunity to meet males and form relationships, multiple studies have shown that enrolled females are much less likely than those not enrolled to have sex and to be in romantic relationships. (28-30) Many studies suggest that females who are enrolled in school may be exposed to social norms that discourage the development of sexual and romantic relationships, (29,30) and that these norms may also support investment in females, hence decreasing their vulnerability to victimization. …

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