Determinants of Risky Sexual Behavioral Practices among Teen-girls in Malawi

1. INTRODUCTION

For every additional sexual partner that an individual has, there is a high propensity of increasing the risk of exposure to sexually transmitted diseases, HIV and AIDS and the spread of pathogens [1]. The number of sexual partners quantifies the cumulative risks for sexually transmitted diseases [2]. For instance, sexually transmitted infectious diseases, such as gonorrhea and syphilis, which could be accelerated by risky sexual behaviors among women having multiple sexual partners other than spouses and without the use of condom during extra-marital sexual intercourse, affect the quality of life of the people; and these diseases burden the socioeconomic development of the country [3, 4].

The number of sexual partners other than a spouse that a woman has is a precise measure for assessing the risky sexual behavior [5], especially, if the woman is having unprotected sex with the extra-marital partner [1]. A clinical study that investigated the sexually transmitted infection cases, indicated that the number of sexual partners a patient had, correlated with the acquisition of not only bacterial sexual transmitted diseases (STD) [6], but also viral STD’s [7]. In view of this health challenge, the Centre for Diseases Control posits safer sexual behavioral practices as a way of improving sexual and reproductive health among the youths [1]. However, this is poorly supported by the youth, as evidenced by the number of young women who are still having multiple sexual partners apart from their spouses and have sexual intercourse with such partners without using a condom [6, 8]. This, consequently, increases levels of health vulnerability among the women, which eventually affects the quality of the labor force negatively [9, 10].

In Malawi, young women below the age of 20 are more vulnerable to sexually related health risks attributed to persistent risky sexual practices [11]. This health challenge remains high among young women despite the government's effort to achieve improved sexual and reproductive health at the community level [12]. Factors perpetuating the notable risky sexual practices are not well known, at least in the case of Malawi. Additionally, the impact of the health policy on sexual and reproductive health is scantly researched, more especially, on the risky sexual behavioral practices affecting teen women under 20 years. On the contrary, studies that envisaged to examine risky sexual behavioral practices had little articulation of the determinants affecting the youthful women. For instance, in a related study, using the 2010 Demographic and Health Survey data, Wilson (2015) defined and estimated covariates of multiple sexual partners [13]. However, the study excluded an estimate of condom use, a major risk increasing the people’s vulnerability. Powers et al. (2011) studied risky sexual behavior emphasizing on noting sexual partner trends and linkages to HIV and STI [14]. Other studies assessed HIV prevalence and sexual behaviour at older ages in rural Malawi [15]. These studies lacked comprehensive postulation of the determinants insinuating the risky sexual behavioral practices. In a closely related study, other scholars examined the Factors Influencing Risky Sexual Behaviours among Youths and Adult Men in Malawi [16]. Evidently, the study omitted the most vulnerable youthful women. All the previous studies left some gaps in addressing sexual and reproductive health challenges among youthful women. Therefore, this study quests to fill the gap by examining the factors associated with risky sexual behavior among the teen girls in Malawi using 2015-16 Demographic and Health Survey data.

2. MATERIALS AND METHODS

3. RESULTS

4. DISCUSSION

The study shows a string of association of the determinants affecting risky sexual behaviors, defined as, having multiple sexual partners and practicing sexual risky behaviors with partners other than the spouse. Evidence has shown variations in the effect of the different determinants on the multiple sexual partners and challenges of risky sexual behavioral practices. Our study results indicate a stronger and significant relationship between education, regardless of completion status, and the tendency of having multiple sexual partners among girls. The results concur with studies conducted in different regions in both developed and developing countries [3, 17]. Considering the importance of education on improved health among human populations and national socioeconomic development, this study therefore, calls for more holistically focused approaches towards sexual education while being mindful of the fact that education alone has limited impact on enlightening girls about the consequences of having multiple sexual partners.

Furthermore, the current study found that those girls who were mothers during their teen years had a reduced propensity of having multiple sexual partners relative to those who had no children. Our findings contradict the earlier research, which indicates that women’s debut in early sexual activities result in increased tendency of having more than 2 multiple sexual partners [17, 18]. Erfrina et al. (2019) added that some socio- cultural challenges existing at family levels negatively affect younger women in acquiring health living [19]. This, consequently, exposes them to engage in immoral behavioural practices for survival. Under such situations, concerted community-based mitigation efforts would be paramount to empower younger women, either as single mothers or married, with survival skills to improve their health and early motherhood statuses.

The study has shown that knowledge of family planning among women does not change their risky sexual behavioral practices in Malawi. This supports the arguments of other researcher who posits that the use of family planning provides flexibility among women on sexual intercourse, thus, increasing the practice of having multiple sexual partners [20-22]. Unexpectedly, it was noted that women who had tested for HIV and AIDS increased the likelihood of having multiple sexual partners. Nevertheless, in East Africa, knowledge of HIV testing among women influenced their decision on multiple sexual partners [23], this controls women from engaging in risky sexual practices like having multiple sexual partners [24]. The current study therefore, reiterates the need for an extensive awareness campaign on sexuality and reproductive health targeting youthful women in order to minimize the practice of risky sexual behavior.

On gender of the household head, the study found that youthful women coming from female headed households were more likely to have multiple sexual partners relative to male headed households. Such finding echoes a study which argues on existent differentials in socio–demographic attributes between male and female headed households, stressing that female headed households are more vulnerable to engaging in multiple sexual partnerships’ [25] than the male headed households. This is partly because female led households have low moral tangible support to exercise preventive check to minimize risky sexual and reproductive health lifestyle [26]. Generally, there is less control over the youthful women on matters of sexual behaviour in female headed households because in the absence of viable economic skills among the girls in the household, as a sole bread winner, cumbered with responsibilities to fend for the household socioeconomically, dealing with the youths tends to be a daunting task for the woman heading a household.

Concerning household wealth, the study found that the higher the wealth statuses the higher the likelihood of having multiple sexual partners. This finding concurs with Uthma and others (2008) who posit that individuals who are economically stable increased their practice of having multiple sexual partners [27]. This is attributed to the use of disposable income for social satisfaction, including indulging in risky sexual behavioral practices [28]. Therefore, this study emphasizes on stiffer measures against the moral decadence displayed by the wealthy men on the vulnerable poor youthful women. As a preventive measure, health care service providers need to devise proper mechanisms including life skills training aimed at empowering young women socioeconomically and provision of the necessary facilities for the control of risky sexual behavioural practices among the youthful women.

On media exposure, the study found an increase in the number of sexual partners among the women under age 20 who had both radio and television. This development affected levels of assimilation of the messages, hence, dire effect on decision to have multiple sexual partners [29]. Indeed, one would expect exposure to multi-media to have positive influence on behavioral change regarding risky sexual practices. Nevertheless, as observed in a related study by Shapiro et al. (2003), “exposure to media becomes more effective if targeted programmes are consistently scheduled to inform society about the consequences of risky sexual practices toward one’s health [16].

All in all, problem to unavailability of the health care facilities at community level, was found to increase indulgence of risky sexual practices. For instance, it is reiterated that distance to access the health care facilities disadvantages women to acquire not only health education, but also some sexual and reproductive health advisory information for enhanced sexual and reproductive health well-being [29, 30]. Indeed, long distance to institutions that support people’s life tends to be a deterrent to socioeconomic development of the masses especially the weak and vulnerable members of society. Without any tangible incentive to the youthful women coupled with limited knowledge on reproductive health, long distance to health care facilities would remain one of the critical challenges to curb the malpractice of indulging with multiple sexual partners among the youthful women.

Around the world, the scholarly discourse had it that improved education is fundamental to enlighten women on issues related to reproductive health and subsequent change in their risky sexual practices [31, 32]. Contrary to the sentiments of the world scholars this study observes that regardless of the level of education among the teen mothers in Malawi, risky sexual behavior remains a challenge. Probably, this should serve as a wakeup call on structuring of formal school education. The observed failure of education to influence behavioural change among teen mothers could be a reflection of a mismatch between content in the formal school education and the policy direction on reproductive health. This study’s finding could mean inadequate coverage of reproductive health education in Malawi’s formal education system and absence of peer-to-peer interaction among the teen mothers on issues related to sexual and reproductive health.

The study found that despite having taken HIV and AIDS test, risky sexual behaviour did not change among teen women in Malawi. A study by Gong in 2015 postulates that people’s behavior developed over long a period remains intact if the behavioural change is weakly advocated [33]. Similarly, Paula and colleagues in 2013 supported the argument in Malawi, that despite being tested for HIV, men continued getting involved in risky sexual behavioral practices [34]. Having such men and women who are indifferent to behavioral change vis-à-vis HIV and AIDS creates a serious public health challenge; such a behavior exacerbates the risky sexual practices among women.

On the gender divide, the study noted that female headed households were unable to control the girls within the household and were more likely to practice risky sexual behavior relative to those from male headed households. Abajobir and others in 2017 argue the existence of different control systems at household levels which determine the behaviors of the children, more especially on sexual and reproductive health [35].

On wealth status and risky sexual practices, the study found that a majority of the girls from middle and rich households were less likely to indulge in risky sexual behavioral practices (non-use of condom) compared to those from poor households. This is so because the teen women from the middle and rich households tend to have a ready disposable income to enable them purchase condoms to use during sexual intercourse with the multiple partners. Previous scholars hypothesized and proved that poor households’ girls are more vulnerable to the practice of risky behaviors due to struggle to meet their daily demands relative to those from middle and rich wealth status [2, 32, 36].

The study noted that teen women’s access to media to positively changed their perspective on reproductive health and reduced risky sexual behavioral practices. However, this is contrary to findings of other scholars who expressed media exposure as an accelerator of risky sexual behavioral practices [37]. Additionally, use of internet media among adolescents was found to result in worst risky sexual behaviors among the teen children [37]. This implies that there need to reconsider best practices on dissemination of sexual and reproductive health information strategies through the media in order to ensure a meaningful and significant impact on behavioral change that can reduce risky sexual behavioral practices among the teenage girls.

CONCLUSION

Using the 2015-16 Malawi Demographic Health Survey, the study assessed the determinants of risky sexual behavioral practices among teen women in Malawi. A sample of 5263 women under 20 years of age was used for the analysis with bivariate and multivariate statistical models. The findings have shown that educational attainment, early motherhood status, knowledge of family planning, wealth status, unavailability of health care services within the community and media exposure positively explained women behavior of having multiple sexual partners during teen years. On the contrary, improved wealth statuses and education attained reduced risk of not using condoms with the partner other than the spouse during the sexual debut. On condom use with multiple sexual partners, the study found that education attainment, gender of household head, availability of health care facilities at the community level, access to reproductive health through multi-media and household wealth status significantly influenced teen girls’ decision to use or not to use condom during extra-marital sexual intercourse.

Based on the findings, the study emphasizes the need to advocate for inclusive education programmes beyond the formal school curriculum to holistically address issues of sexuality and reproductive health, life skills learning and development for wealth creation in order to reduce risky sexual behavioral practices among young girls in Malawi. Equipping girls at the community level with basic knowledge and understanding about the dangers of indulging in risky sexual behavior and practices are fundamental for the enhancement of their socio-economic support.

REFERENCES