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Sexual initiation and readiness to have sex among in-school and out-of-
school young women in Katima Mulilo district, Namibia

Article  in  African Journal for Physical Health Education, Recreation and Dance · September 2014

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African Journal for Physical, Health Education, Recreation and Dance
(AJPHERD) Supplement 1:2 (September), 2014, pp. 291-300.

Sexual initiation and readiness to have sex among in-school and


out-of-school young women in Katima Mulilo district, Namibia
SPHIWE MADIBA

School of Public Health, Department of Environmental and Occupational Health, Faculty of


Health Sciences, University of Limpopo (Medunsa Campus), Box 215, Medunsa 0204,
Ga-Rankuwa, South Africa. E-mail: sphiwe_madiba@embanet.com

Abstract

Despite evidence that large proportion of adolescents in sub-Saharan Africa engage in sexual
activities at younger ages, studies investigating sexual behavior of adolescents have not focused
on the circumstances which lead to sexual initiation. The objectives of the study were to
determine the age of adolescents, their perceptions about their readiness to have sex at sexual
initiation and assess their subsequent sexual behaviour. Cross-sectional survey was conducted in
Katima Mulilo district in Namibia with 339 female in-school and out-of-school adolescents aged
15-19 years. Data were collected using a self-administered pre tested questionnaire and analyzed
using descriptive summary statistics. The majority 274 (81%) were in-school and 65 (19%) were
out-of-school. High proportion (280; 83%) ever had sex, 142 (50.8%) had first sex between 6-15
years, and 138 (49.2%) between 16-19 years. Over two thirds (186; 66%) had sexual partners
who were of their age, and a third (92; 33%) had older sexual partners. Almost half 134 (48%)
were not ready to have sex the first time, 37 (34%) were forced to have sex, and 12 (11.2%) were
tricked to have sex by their sexual partners. The majority 192 (69.2%) had sex the first time at
their partner’s home. Early sexual initiation with an older partner and unwanted non-consensual
sex were common occurrences. Sex education starting with younger adolescents at primary
school level should provide them with sexual, reproductive health, and HIV prevention
education. Reproductive programmes for in-school and out-of-school youth should also address
non-consensual sex and provide abstinent and sexually active adolescents with skills to remain
safe.

Keywords: Sexual initiation, adolescents, unwanted sex, non-consensual sex, in-school youth,
out-of-school youth, Namibia

How to cite this article:


Madiba, S. (2014). Sexual initiation and readiness to have sex among in-school and out-of-school
young women in Katima Mulilo district, Namibia. African Journal for Physical, Health
Education, Recreation and Dance, September (Supplement 1:2), 291-300.

Introduction

In Sub Saharan Africa, adolescents are disproportionately affected by the HIV


epidemic and other poor reproductive health outcomes like unintended
pregnancies (Erulkar, 2004; Hindin & Fatusi, 2009; UNAIDS, 2004). They
engage in early sexual activities with poor knowledge of reproduction and
contraception (Erulkar, 2004). The Joint United Nations Programme on
HIV/AIDS (UNAIDS) and the World Health Organization (WHO) estimates that
only eight percent of out-of-school youth have access to sexual health and
292 Madiba

prevention education programmes (UNAIDS/WHO/UNICEF, 2010). Because of


the high prevalence of HIV among young people, many community-based
programmes focus on HIV prevention (Hindin & Fatusi, 2009). As a result, high
numbers of adolescents in developing countries have unmet reproductive health
needs (Ajuwon et al., 2006).

Namibia is amongst the sub Saharan countries with a generalized HIV/AIDS


epidemic, and a national HIV prevalence rate of 17.8% among those aged 15-49
years. Similar to other countries, the prevalence is higher among females who are
also infected very young. A survey conducted in northern Namibia indicated a
gradual decline in the average age of first sex; a relatively high proportion of
young people between 15-24 years were younger than 16 years when they had
sex the first time (Parker & Connolly, 2007 ). A later study in the same region
showed that young people initiate sex at a much younger age, often before the
age of 13 years (Lawoyin & Kanthula, 2010).

Early sexual initiation has implications for public health interventions because of
its association with multiple sexual partners and unprotected sex. They are also
exposed to unintended pregnancies and abortion, which may lead to school
dropout (Fatusi & Blum, 2008; Gupta & Mahy, 2003; Hindin & Fatusi, 2009;
Mazengia & Worku, 2009). Providing adolescents with sexual education at a
much younger age will give them skills to remain safe. Those who had initiated
sex should be provided with skills and services to practice safe sexual life while
those who had not initiated sex should be encouraged to delay sexual initiation
(Mazengia & Worku, 2009).

Hindin and Fatusi (2009) argue that sex education should promote safe sexual
behaviour and not only messages that promote abstinence. Although the sexual
behavior of young people have been studied in-depth, there are limited data on
the sexual behavior of younger adolescents aged 12-16 years (Gupta & Mahy,
2003; Bankole et al., 2007; Marston et al., 2013). Erulkar (2004) argues that
there is a general assumption from the literature that when young people have
sex, it is wanted and consensual, despite evidence that acts of sexual coercion are
common among the youth. This study was conducted to investigate when, where,
why, and with whom adolescents in an urban township of Namibia had sex the
first time. The objectives were to determine the age of adolescents at sexual
initiation, assess their perceptions about their readiness to have sex, and
determine their subsequent sexual behaviour. It is crucial to understand the
circumstances in which early sexual initiation occurs in order to develop
effective interventions targeted at younger adolescents early in life.
Sexual initiation and readiness to have sex among young women 293

Methodology

Study design

A cross-sectional survey was conducted in 2008 in Katima Mulilo district,


Namibia. The sample size comprised 339 female adolescents recruited from
three urban primary health care clinics, a voluntary counselling and testing
(VCT) center, and a youth center. In Katima Mulilo, VCT centers are attached to
the local clinics where the youth and adults go for counselling and testing. Both
in-school and out-of-school adolescents between 15-19 years who visited the
study sites were selected.

Data collection

A structured questionnaire designed in English and later translated to Silozi was


used to collect data. The instrument was pre-tested during a pilot study that was
conducted in one clinic which was not included in the main study. The pilot test
assessed whether the questionnaire measured what it was intended to measure.
Following the pilot test, the questionnaire was modified and necessary changes
were effected before it was subsequently used to collect data for the study. The
questions captured information on the socio demographic characteristics and
sexual behaviour of the adolescents. A Master of Public Health student and a
trained research assistant distributed the questionnaires to the adolescents and
remained in the consulting room during the completion of the questionnaire for
consistency of responses and to ensure completeness of the questionnaire.

Ethical considerations

Ethical clearance was obtained from the Medunsa Research and Ethics
Committee of the University of Limpopo. After ethical clearance by the research
ethics committee, permission was sought and granted by the Namibian Ministry
of Health and Social Services Research Unit and by the managers of the three
study sites. The adolescents were informed about the purpose and objectives of
the study and written informed consent was obtained from individual
participants. They were also informed that participation was voluntary and that
they may withdraw from the study at any time without repercussion.
Confidentiality of the information was assured and anonymity maintained.

Data analysis

Data were cleaned, coded, entered into Microsoft Excel, and thereafter analysed
using STATA 10.0.1. The data were analysed descriptively to obtain summary
statistics of the study participants and the results were presented in simple
294 Madiba

percentages. Probability values (p values) were calculated at the 0.05 level of


significance.

Results

Characteristics of participants

Table 1 presents background characteristics of the adolescents. A total of 339


adolescents responded to the questionnaire. Their ages ranged between 15-19
years with a median age of 17 years. Of the 339 adolescents, 274 (81%) were in-
school while 65 (19%) were out-of-school. Of the 274 adolescent students, 163
(59%) were in grades 10-12, and 111 (41%) in grades 7-9.

Table 1: Characteristics of in-school and out-of-school youth (n =339)


Variables Frequency Percent (%)
In-school 274 81
Out-of-school 65 19

Out-of-school youth:
Completed grade 12 33 51
Dropped out of school 32 49

Age in years:
15 years 54 16
16 years 50 15
17 years 60 18
18 years 81 24
19 years 94 27

Grades:
Grade 7 12 4.4
Grade 8 39 14.2
Grade 9 60 22
Grade 10 60 22
Grade 11 45 16.4
Grade 12 58 21.2

Sexual initiation and sexual behaviour

A high proportion (280; 83%) of adolescents ever had sex and indicated the age
when they first had sex. Slightly over half (142; 51%) reported that they had
their first sex between 6-15 years and 138 (49%) between 16-19 years. Of the
280 adolescents who ever had sex, the majority (186; 66%) reported having a
sexual partner who was their age group and a third (92; 33%) had an older sexual
partner. Adolescents also described the relationship that they had with the person
they had their first sex with, and the majority (120; 43%) reported that the person
was their steady boyfriend, (94; 34%) reported the person as just a friend, 40
Sexual initiation and readiness to have sex among young women 295

(14%) reported that they went out once in a while with the person, and 26(9%)
reported that they just met the person they had sex with the first time.

The results further showed that the majority (182; 65%) of sexually active
adolescents had experienced sexual intercourse with one person and 98 (35%)
had had sex with more than one person (Table 2).

Table 2: Sexual characteristics of adolescents (n=339)


Variable Frequency Percent
Ever had sex:
Yes 280 83
No 59 17

Age at sexual initiation:


6-10 years 6 2.2
11-15 years 136 48.6
16-19 years 138 49.2

Age of sexual partner:


My age 186 66
Older than me 92 33
Younger than me 1 2

Relationship with sexual partner:


Steady boyfriend 120 43
We were just friends 94 34
Went out once in a while 40 14.2
We had just met 26 9.2

Number of sexual partners:


One partner 182 65%
More than one partner 98 35

Condom use at first sexual initiation

The majority (179; 64%) of adolescents reported that they used contraceptives
the first time they had sex while 101 (36%) did not use them. Of the 179 who
used contraceptives, 123 (69%) used condoms while 56 (31%) did not. Majority
(85; 69%) of those who used condoms reported that they always used condoms,
38 (31%) used condoms inconsistently.

Ready to have sex at sexual initiation

Table 2 presents responses concerning readiness to have sex. Adolescents who


ever had sex were asked whether they thought they were ready to have sex at
sexual initiation. Slightly over half (146; 52%) agreed that they were ready,
while 134 (48%) stated otherwise.
296 Madiba

The most reasons cited by adolescents who reported that they were not ready
included, being forced to have sex by the sexual partner (37; 34%), not knowing
anything about sex (22; 20.6%), peer pressure from friends (12; 12%), and being
tricked to have sex by the sexual partner (12; 11.2%).

Table 3: Reasons given in support of not being ready for sex (n=339)
Responses Freq. Percent
He forced me to have sex with him 37 34.6
I did not know anything about sex 22 20.6
Peer pressure from my friends 13 12.1
He tricked me into having sex with him 12 11.2
It just happened, we did not plan 6 5.6
I was scared of having sex 6 5.6
I was afraid of getting pregnant and contracting STIs 5 4.7
I was afraid to refuse, I wanted to make him happy 3 2.8
I made a mistake 3 2.8

Location of first sexual initiation

Adolescents who ever had sex indicated the place where they had sex the first
time, most (192; 69.2%) had sex at their partner’s home (Table 4).

Table 4: Location of first sexual initiation (n=280)


Place Frequency Percentage
My partner’s home 194 69.2
My home 37 13.2
My friend’s home 32 11.4
Car 1 0.4
Hotel/motel 2 0.7
Park 2 0.7
Shebeen or tavern 4 1.4
Party 4 1.4
Others 4 1.4
Total 280 100%

Discussion

The study investigated sexual initiation among in-school and out-of-school


adolescents, and indicated that most of them (83%) have ever had sex. The
prevalence in the current study was significantly higher than those of previous
studies conducted in the country. An Earlier study with in-school adolescents
found that a third of the adolescents ever had sex (Chinsembu et al., 2008).
While a study conducted with out-of-school youth workers showed that 90%
ever had sex (Lawoyin & Kanthula, 2010). The higher prevalence observed in
that study might be attributed to the fact that it was conducted with out-of-school
youth aged between 15-30 years, while the age of the adolescents in the current
study ranged from 15-19 years. Nevertheless, the prevalence in the current study
Sexual initiation and readiness to have sex among young women 297

(83%), is higher than those reported in Tanzania (40%) and Nigeria (24.8%)
(Kazaura & Masatu, 2009). There is evidence that early sexual initiation is
increasing in sub Saharan Africa (Gupta & Mahy, 2003; Hindin & Fatusi, 2009).

More than half of the adolescents initiated sex between 6-15 years. This finding
is not surprising as young age of sexual initiation was reported in previous
studies in Namibia. For example, a study conducted with out-of-school youth
workers documented 12 years as the youngest age of sexual initiation (Lawoyin
& Kanthula, 2010). Similar to previous studies, a significant proportion of
adolescents reported that they never used condoms at sexual initiation and during
the most recent sexual activity (Gupta & Mahy, 2003; Hindin & Fatusi, 2009;
Kazaura & Masatu, 2009; Lawoyin & Kanthula, 2010; Mazengia & Worku,
2009). Other studies also reported limited use of condoms during the most recent
sexual activity of adolescents (Exavery et al., 2011; Kazaura & Masatu, 2009;
Mazengia & Worku, 2009; Njau, 2012). According to Exavery et al. (2011) older
adolescents aged 15-19 years are most likely to use condoms compared to
younger ones who were 10-14 years old. The current study also found that over a
third of the adolescents reported that they had sex with more than one person.

Almost half of the adolescents admitted that they were not ready to have sex at
first sexual initiation. The results showed that for over a third of the adolescents,
sex was unwanted and non-consensual. They reported that they were forced and
or tricked to have sex by their sexual partners. Similar findings were reported in
a study conducted among secondary school students in Australia where a third
reported ever experiencing unwanted sex (Smith et al., 2009). Unwanted sex was
also reported in studies conducted among students in Nigeria (11%), Tanzania
(15.9%), and Kenya (21%), who also indicated that they were tricked by their
sexual partners to have sex (Ajuwon et al., 2006; Erulkar, 2004; Kazaura &
Masatu, 2009). The results further showed that a high proportion of the
adolescents did not have any romantic relationships with the male person they
had sex with. More than half had sex the first time with someone they were
friends with, someone they went out with once in a while, and or someone they
had just met. Smith et al. (2009) also reported that over a quarter of adolescents
in their study had recent sexual encounter with someone they had known for a
while but were not in a relationship with.

Over and above evidence of high rates of non-consensual sexual activities among
adolescents, Mazengia and Worku (2009) argue that often first sexual initiation
is unplanned and unprotected. Of public health concern is the thin line between
unwanted or non-consensual sex and rape. Several studies have reported on the
significantly high rates of non-consensual sexual activities among adolescents in
both developed and developing countries (Erulkar, 2004). These studies are
silent on issues of rape, resulting in lack of clarity on the difference between rape
and non-consensual sex. In the current study, some of the adolescents’
298 Madiba

experiences might be described as rape. For example, one adolescent said “we
just met, so I was not expecting to have sex with him”, another said “I was just
making new friends, but he forced me to have sex with him” One said “he asked
me to accompany him to his house so that he can show me something, but when
we arrived there, something turned to sex”.

The results further found that a third of the adolescents reported having a sexual
partner who was older at sexual initiation. Those who reported that sex was
unwanted also stated that they were afraid to say no because their partner was
older than them. Some reported that they were afraid to infuriate the older
partner and wanted to make him happy. Ford, Sohn and Lepkowski (2001) also
found that female adolescents whose first sexual partners were older reported
that sex was unwanted. For female adolescents, having a partner who is older is
related to initiation of sexual activities at a young age; and non-use of
contraceptives, increased risky sexual behaviour, unplanned pregnancies, STIs
and HIV(Kaestle, Morisky & Wiley, 2002). The majority of adolescents had sex
the first time at the sexual partner’s home. This behaviour might be associated
with having an older sexual partner. Similar findings were reported by Smith et
al. (2009) in their study in which female adolescents had sex at a partner’s house
more than male adolescents.

Limitations

The study findings are subject to recall bias as well as socially desirable
responses. The adolescents might have under-reported their sexual activities as
well as their willingness to have sex when they had sex for the first time because
of the negative connotations attached to youth’s sexual behaviour. The potential
for recall bias might have occurred when participants were asked about their age
when they had sex the first time, this response was also subjected to socially
desirable responses especially if the participant had sex at a much early age.
Social desirable bias was minimized by the fact that the researchers were not part
of the clinic staff or youth center.

Conclusion

Early sexual initiation was common among the adolescents. More than half had
their first sexual initiation before 16 years. Most female adolescents had sex with
sexual partners that they did not have a romantic relationship with. Almost half
of the adolescent’s experienced unwanted sex, were not ready to have sexual
intercourse at first sexual initiation, and reported that they were forced and
tricked to have sex by their sexual partners who were likely to be older than
them.
Sexual initiation and readiness to have sex among young women 299

Our findings have implications for the development of public health


interventions. Considering that adolescents are sexually active at an early age,
comprehensive sex education should start early at primary school to give
adolescents a broad-based understanding of non-consensual sex and its
consequences. It is imperative that sex education programmes at schools and in
health facilities should address the circumstances that lead to early sexual
initiation as well as develop appropriate sexual education interventions to
address the sexual and reproductive needs that sexually active adolescents
experience, and promote abstinence.

Acknowledgements

We acknowledge Francesca Silumbu, the Master of Public Health student, for


her role in data collection.

References

Ajuwon, A. J., Olaleye, A., Faromoju, B. & Ladipo, O. (2006). Sexual behavior and experience
of sexual coercion among secondary school students in three states in North Eastern Nigeria.
BMC Public Health, 6(1), 310.

Bankole, A., Biddlecom, A., Guiella, G., Singh, S. & Zulu, E. (2007). Sexual behavior,
knowledge and information sources of very young adolescents in four Sub-Saharan African
countries. African Journal of Reproductive Health, 11(3), 28.

Chinsembu, K. C., Siziya, S., Muula, A. S. & Rudatsikira, E. (2008). Prevalence and social
correlates of sexual intercourse among schoolgoing adolescents in Namibia. SAHARA: Journal of
Social Aspects of HIV/AIDS Research Alliance, 5(3), 129-135.

Erulkar, A. S. (2004). The experience of sexual coercion among young people in Kenya.
International Family Planning Perspectives, 30(4), 182-189.

Exavery, A., Lutambi, A. M., Mubyazi, G. M., Kweka, K., Mbaruku, G. & Masanja, H. (2011).
Multiple sexual partners and condom use among 10-19 year-olds in four districts in Tanzania:
What do we learn? BMC Public Health, 11(1), 490.

Fatusi, A. O. & Blum, R. W. (2008). Predictors of early sexual initiation among a nationally
representative sample of Nigerian adolescents. BMC Public Health, 8(1), 136.

Ford, K., Sohn, W. & Lepkowski, J. (2001). Characteristics of adolescents' sexual partners and
their association with use of condoms and other contraceptive methods. Family Planning
Perspectives, 33(3), 100-105.

Gupta, N. & Mahy, M. (2003). Sexual initiation among adolescent girls and boys: Trends and
differentials in sub-Saharan Africa. Archives of Sexual Behavior, 32(1), 41-53.

Hindin, M. J. & Fatusi, A. O. (2009). Adolescent sexual and reproductive health in developing
countries: an overview of trends and interventions. International Perspectives on Sexual and
Reproductive Health, 35(2), 58-62.
300 Madiba

Kaestle, C. E., Morisky, D. E. & Wiley, D. J. (2002). Sexual intercourse and the age difference
between adolescent females and their romantic partners. Perspectives on Sexual and
Reproductive Health, 34(6), 304-309.

Kazaura, M. & Masatu, M. (2009). Sexual practices among unmarried adolescents in Tanzania.
BMC Public Health, 9(1), 373.

Lawoyin, O. O. & Kanthula, R. M. (2010). Factors that influence attitudes and sexual behavior
among constituency youth workers in Oshana Region, Namibia. African Journal of Reproductive
Health, 14(1), 55-69.

Marston, M., Beguy, D., Kabiru, C. & Cleland, J. (2013). Predictors of sexual debut among
young adolescents in Nairobi's informal settlements. International Perspectives on Sexual &
Reproductive Health, 39(1), 22-31.

Mazengia, F. & Worku, A. (2009). Age at sexual initiation and factors associated with it among
youths in North East Ethiopia. Ethiopian Journal of Health Development, 23(2), 154-162.

Njau, B. (2012). Motivating factors and psychosocial barriers to condom use among out-of-
school youths in Dar es Salaam, Tanzania: A cross sectional survey using the Health Belief
Model. ISRN AIDS, 2012. http://dx.doi.org/10.5402/2012/170739.

Parker, W. & Connolly, C. (2007). HIV/AIDS Strategic Information Report: A Mid-Term


Household Analysis of Residents in Rundu. Windhoek: NawaLife Trust.

Smith, A., Agius, P., Mitchell, A., Barrett, C. & Pitts, M. (2009). Secondary Students and Sexual
Health 2008, Monograph Series No. 70, Melbourne: Australian Research Centre in Sex, Health
& Society, La Trobe University.

UNAIDS (2004). Joint United Nations Programme on HIV/AIDS: HIV and Young People: The
Threat for Today’s Youth. Geneva: World Health Organization.

UNAIDS/WHO/UNICEF (2010). Epidemiological Fact Sheet on HIV and AIDS, 2008 Update.
Geneva: World Health Organization.

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