research work on premarital sex

• Open access
• Published: 29 June 2023

Prevalence and predictors of premarital sexual intercourse among young women in sub-Saharan Africa

• Eugene Budu 1 , 2 ,
• Abdul-Aziz Seidu 3 , 4 , 5 ,
• Ebenezer Kwesi Armah-Ansah 1 ,
• James Boadu Frimpong   ORCID: orcid.org/0000-0002-9416-1176 6 , 7 ,
• Richard Gyan Aboagye 8 ,
• Stephen Kofi Anin 9 , 10 ,
• John Elvis Hagan Jr 6 , 11 &
• Bright Opoku Ahinkorah 3 , 12  

Reproductive Health volume  20 , Article number:  99 ( 2023 ) Cite this article

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Introduction

Premarital sexual intercourse (PSI) without adequate information and/or appropriate application of the relevant knowledge about sex before marriage, potentially has adverse effects on the sexual and reproductive health outcomes of vulnerable young women in sub-Saharan Africa (SSA). This study sought to examine the prevalence and predictors of PSI among young women aged 15–24 in SSA.

Nationally representative cross-sectional data from 29 countries in SSA were extracted for the study. A weighted sample size of 87,924 never married young women was used to estimate the prevalence of PSI in each country. A multilevel binary logistic regression modelling approach was used to examine the predictors of PSI at p  < 0.05.

The prevalence of PSI among young women in SSA was 39.4%. Young women aged 20–24 (aOR = 4.49, 95% CI = 4.34, 4.65) and those who had secondary/higher educational level (aOR = 1.63, 95% CI = 1.54, 1.72) were more likely to engage in PSI compared to those aged 15–19 and those with no formal education. However, young women who belonged to the Islamic religion (aOR = 0.66, 95% CI = 0.56, 0.78); those who were working (aOR = 0.75, 95% CI = 0.73, 0.78); belonged to the richest wealth index (aOR = 0.55, 95% CI = 0.52, 0.58); were not exposed to radio at all (aOR = 0.90, 95% CI = 0.81, 0.99); were not exposed to television at all (aOR = 0.50, 95% CI = 0.46, 0.53); resided in rural areas (aOR = 0.73, 95% CI = 0.70, 0.76); and those who were living in the East African sub-region (aOR = 0.32, 95% CI = 0.29, 0.35) were less likely to engage in PSI compared to those who were traditionalist, unemployed, belonged to the poorest wealth index, exposed to radio frequently, exposed to television frequently, resided in urban areas, and lived in the Southern Africa sub-region, respectively.

Sub-regional variations in the prevalence of PSI exist amidst multiple risk factors among young women in SSA. Concerted efforts are required to empower young women financially, including education on sexual and reproductive health behaviors such as the detrimental effects of sexual experimentation and encouraging abstinence and/or condom use through regular youth-risk communication advocacy.

Plain Language Summary

Having premarital sexual intercourse (PSI) without adequate knowledge and application of the knowledge could have adverse effects on the sexual and reproductive health of vulnerable young women in sub-Saharan Africa (SSA). This study examined the prevalence and predictors of PSI among young women in SSA. Nationally representative cross-sectional data from 29 countries in SSA were used. A sample size of 87,924 never married young women was used to estimate the prevalence of PSI. A multilevel binary logistic regression was used to examine the predictors of PSI. The prevalence of PSI among young women in SSA was high. Young women aged 20–24 and those who had attained secondary/higher educational level were more likely to engage in PSI. However, young women who belonged to the Islamic religion; were working; belonged to the richest wealth index; were not exposed to radio at all; were not exposed to television at all; resided in rural areas; and those who were living in the East African sub-region were less likely to engage in PSI. Sub-regional variations in the prevalence of PSI exist amidst multiple risk factors among young women in SSA. Concerted efforts are required to empower young women financially, including education on sexual and reproductive health behaviors such as the detrimental effects of sexual experimentation and encouraging abstinence and/or condom use through regular youth-risk communication advocacy.

Peer Review reports

The world has seen a significant increase in the total number of young people and it has been estimated that more than three-quarters of the world’s 1.8 billion young people reside in developing regions including sub-Saharan Africa (SSA) [ 1 , 2 ]. Majority of these young people engage in premarital sexual intercourse (PSI) or sex before they attain their second decade in life [ 1 ].

PSI among young women has become a major public health concern as the  world began witnessing a significant increase in reported sexual activities leading to teenage pregnancies and abortions in most developing regions [ 2 , 3 , 4 , 5 , 6 ]. PSI has been explained to encompass penetrative vaginal intercourse that occurs between two individuals before he/she starts a formal marriage life [ 5 , 7 , 8 , 9 ]. PSI in SSA has been defined as sexual intercourse before attaining age 18 [ 10 , 11 ]. This is the more vulnerable group of people who are mostly not married and are young [ 12 ].

Although PSI is common among young people, it does not translate into contraceptive use [ 13 ]. This has had an adverse effect on their sexual and reproductive health outcomes [ 14 , 15 ]. Young people are involved in PSI without adequate information and knowledge of reproductive health and contraceptives [ 9 , 16 , 17 , 18 ]. It is essential to note that many life events, health-damaging behaviours, and PSI start at these youthful years [ 2 ]. Therefore, the onset of sexual intercourse is a potentially life-changing milestone in the physical and psychological development of women in all settings and the timing and circumstances within which it happens can have either an immediate or long-term consequences on their health and wellbeing [ 19 ].

At this stage of development, young women are faced with exploration and risk-taking behaviours [ 20 ]. These risky behaviours are associated with pressure to use alcohol, cigarettes, drugs, early  sexual relationships, intentional and unintentional injuries, having multiple sexual partners, violence that could lead to unwanted pregnancy, unsafe abortion, and sexually transmitted infections (STIs) including HIV/AIDS, hasty and unpromising marriage, lesser employment opportunity, unplanned parenthood, and dropping out of school [ 2 , 6 , 7 , 21 ].

It has been documented that young women in SSA tend to engage in early sexual debut than their male counterparts and it is one of the major predictors that put young women at a high-risk of HIV/AIDS [ 11 , 22 ]. This is because majority of the young women are challenged with peer pressure and are shy to discuss sexual matters with their parents explicitly due to culture reasons [ 1 ].

Studies have revealed that there are three categories of predictors of PSI among young women in SSA: namely individual, family, and institutional level predictors [ 12 , 22 ]. The individual-level predictors include age, sex, ethnicity, love affair, and loneliness [ 12 ]. The family-level predictors consist of family type, family income, occupation, broken families, and parenting while the institutional level predictors are not only limited to social network, organization, communication (mobile phones, internet, books and magazines, radio and television) but includes policies and laws [ 12 , 23 ]. Also, studies have indicated that factors such as urban poor settings, high unemployment, unstable wages, low literacy, and inadequate recreational facilities have been linked to young women's engagement in PSI and multiple sexual partners [ 14 , 24 , 25 ].

There is a high prevalence of risky sexual behaviours (e.g., multiple sexual partners, transactional sex, early sexual debut) among young women in SSA [ 26 , 27 ]. Evidence suggest that by age 15 years, young women in Kenya would have had at least a sexual intercourse in their lifetime while the median age at first sexual intercourse among young women in Ghana and Malawi is 16 years [ 22 ].

Studies on sexual practices and behaviours in SSA have mainly focused on adolescents [ 1 ]; correlates of early sexual debut [ 22 ]; university students [ 28 , 29 ]; preparatory school students living with and without parents [ 18 ]; magnitude and associated factors of premarital sex [ 2 ]; in-school youths [ 16 ]; parenting style [ 6 ]; impact of premarital sex on health [ 12 ]; and adolescent students’ attitude towards premarital sex [ 23 ].

Since there is a paucity of studies related to the prevalence and predictors of premarital sexual intercourse among young women in SSA, it is essential to understand and identify current trend of this behavioral practice of young women in order to develop appropriate and context-specific interventions in the sub-region. Findings from this study will play an invaluable role in inspiring young women about the risk of premarital sexual practice and inform policymakers as well as for organizations that work in this area.

Data source and study design

Data for the study were extracted from the most recent Demographic and Health Surveys (DHS) of 29 countries in SSA. We pooled the data from the women’s recode files in each of the countries. The DHS is a comparatively nationally representative survey conducted in over 85 low-and-middle-income countries worldwide [ 30 ]. DHS employs a descriptive cross-sectional design. Respondents for the survey were recruited using a two-stage cluster sampling method. Detailed sampling technique has been highlighted in the literature [ 31 ]. Standardized structured questionnaires were used to collect data from the respondents on health and social indicators including age at first sexual intercourse. We included a total of 87,924 never married young women in our study. Only the women with complete cases of variables of interest were included in the study using listwise deletion. The dataset used is freely available at https://dhsprogram.com/data/available-datasets.cfm . This manuscript was drafted with reference to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement guidelines [ 32 ]. Table 1  provides details of the description of the study sample.

Outcome variable

The study used PSI as the outcome variable. PSI refers to any sexual relations a person has prior to marriage [ 33 ]. Simply put, it is when a person engages in sexual activities before they marry. Restricting the analytical sample to never married young women, this variable was derived using the question on age at first sex which was  “at what age did [NAME] first have sex?” For this study, those who had never had sex were put in the category “No PSI” and this category was coded as “0” while those who had sex at age eight (which was the minimum age at first sex for the study sample in all the countries) and above were put in the category “ever had PSI” and were given the code “1”. Studies that used the DHS dataset employed similar coding [ 34 , 35 , 36 ].

Explanatory variables

The explanatory variables considered in this study were selected based on their association with PSI from literature [ 21 , 28 , 37 ] and also their availability in the DHS dataset. A total of 10 variables were included in the study. These variables were grouped into individual level and contextual level factors. The individual level factors considered in this study were women’s age, educational level, religious affiliation, occupational status, wealth index, frequency of reading newspaper or magazine, frequency of listening to radio, and frequency of watching television. Place of residence and geographical subregion were the contextual level variables in the study. The categories of each of the variables are shown in Table 2 .

Statistical analyses

Data for the study were analysed using Stata version 16. First, a bar chart was used to show the prevalence of PSI among young women across the 29 countries. Next, the weighted frequencies and percentages for the explanatory variables were presented as indicated in Table 2 . Later, we presented the bivariate results on the distribution of PSI among young women across the explanatory variables using the Pearson chi-square test of independence (Table 2 ). We further conducted a cross-tabulation between age and the other explanatory variables as a sensitivity test to show how age is distributed across the other explanatory variables (Additional file 1 ). After this, we checked for collinearity multicollinearity among the explanatory variables using the variance inflation factor (VIF) and the results showed no evidence of high collinearity (Maximum VIF = 1.66, Minimum VIF = 1.07 and Mean VIF = 1.31). Finally, a four-model multilevel binary logistic regression (Model O-III) analysis was conducted. Model O was an empty model where no explanatory variable was used. Model I had only the individual level variables. Model II had only the contextual variables while Model III, which was considered as the complete model had both the individual and contextual level variables. The results were presented as adjusted odds ratio (aOR) with their respective 95% confidence interval (CI). All the analyses  were weighted while the survey command (svy) in Stata was used to adjust for the complex sampling structure of the data in the analyses.

Ethical consideration

In this study, ethical clearance was not sought due to the public availability of the DHS dataset. The datasets were obtained from the Monitoring and Evaluation to Assess and Use Results Demographic and Health Surveys (MEASURE DHS) after registration and approval were given for its usage. All the ethical guidelines concerning the use of secondary datasets in the publication were strictly adhered to. Detailed information about the DHS data usage and ethical standards are available at http://goo.gl/ny8T6X .

Prevalence of premarital sexual intercourse among young women in SSA

Figure  1 displays the prevalence of PSI among young women in SSA. The prevalence of PSI among young women in SSA was 39.4%. The country-specific prevalence indicated that Liberia recorded the highest (75.3%) prevalence whereas Comoros recorded the lowest (5.0%) prevalence.

Prevalence (%) of premarital sexual intercourse among young women in sub-Saharan Africa

Association between premarital sexual intercourse and explanatory variables

Table 2 outlines the results on the association between PSI and the explanatory variables. The study found that age, level of education, religion, employment status, wealth index, exposure to newspaper or magazine, exposure to radio, exposure to television, place of residence, and sub-region were all significantly associated with PSI at p  < 0.001.

Predictors of premarital sexual intercourse among young women in sub-Saharan Africa

Table 3 presents the results of the predictors of PSI among young women in SSA. The study found that young women aged 20–24 (aOR = 4.49, 95% CI = 4.34, 4.65) and those who had secondary/higher educational level (aOR = 1.63, 95% CI = 1.54, 1.72) had higher odds of engaging in PSI compared to those aged 15–19 and those with no formal education. However, young women who belonged to the Islamic religion (aOR = 0.66, 95% CI = 0.56, 0.78); were working (aOR = 0.75, 95% CI = 0.73, 0.78); belonged to the richest wealth index (aOR = 0.55, 95% CI = 0.52, 0.58); were not exposed to radio at all (aOR = 0.90, 95% CI = 0.81, 0.99); were not exposed to television at all (aOR = 0.50, 95% CI = 0.46, 0.53); resided in rural areas (aOR = 0.73, 95% CI = 0.70, 0.76); and those who were living in the East Africa sub region (aOR = 0.32, 95% CI = 0.29, 0.35) had lower odds of engaging in PSI compared to those who were traditionalist, not working, belonged to the poorest wealth index, exposed to radio almost every day, exposed to television almost every day, resided in urban areas and living in the Southern Africa sub-region, respectively.

The study examined the prevalence and predictors of PSI among young women in SSA. The study found that the pooled prevalence of PSI among young women in SSA was 39.4%. The country-specific prevalence indicated that Liberia recorded the highest (75.3%) prevalence whereas Comoros recorded the lowest (5.0%). The variations in the prevalence of PSI among young women noted in this study could be attributed to the differences in sociocultural practices in these countries. For example, it could be that young women in Comoros normalized premarital sexual behaviours or certain societal norms encouraged sexual experimentation among young women [ 1 ], which made them underreport their engagement in PSI. The fear that they would be identified and punished could have also led to the lower prevalence of PSI among young women from Comoros. The highest prevalence of PSI among young women in Liberia could be as a result of the young women’s incessant engagement in transactional sex [ 38 , 39 ]. Our finding indicates that young women in SSA could be at higher risk of contracting STIs. Therefore, both public and private organizations should intensify their efforts to educate young women about the consequences of engaging in  PSI.

Similar to the findings of other previous studies [ 1 , 16 , 20 , 40 ], our study found that the likelihood of PSI among young women heightened with increasing age. A plausible explanation for this finding could be as result of older women engaging in romantic relationships, which increase their likelihood of having PSI [ 16 , 41 , 42 ]. Since younger women aged 15–19 are generally expected to be in school, it is not surprising that they are less likely to have PSI. This finding suggests that sexual and reproductive health education should be targeted at older young women to reduce the occurrence of PSI in SSA.

Akin to the observation of previous study [ 1 ], this study found that young women who had secondary/higher educational level had higher odds of engaging in PSI compared to those with no formal education. This finding could be as a result of the influence of peers who convince their colleagues to engage in erotic relationships, which subsequently increases their likelihood of engaging in premarital sex [ 43 , 44 ]. It could also be that young women who have attained some level of education try to experiment sexual activities that might have been discussed in the schools, increasing their likelihood of having PSI [ 45 , 46 ]. This finding implies that having higher education is positively associated with PSI, hence, more concerted efforts should be put in educating young women in the school environment about the detrimental effects of sexual experimentation while encouraging abstinence or contraceptive use.

However, young women who belonged to the Islamic religion had lower odds of engaging in PSI relative to those who were traditionalists. This finding is similar to a study [ 47 ] which found that being more religious decreased the likelihood of sexual debut among females. Our finding could be attributed to the existence of certain Islamic teachings that frown upon PSI, reducing young women’s likelihood to engage in sexual activities before marriage [ 47 , 48 ]. Another reason for this finding could be that engaging in more religious activities such as praying five times daily and Quranic recitals protect young Islamic women from engaging in PSI [ 47 ].

Young women who were working had lower odds of engaging in PSI compared to those who were not working. Our finding could be that women who are employed are less encouraged to engage in PSI due to the workload which pose as a source of stress on them. Also, women who are unemployed may have the desire to engage in PSI because of curiosity, experimentation and for financial gains to sustain themselves economically [ 49 , 50 ]. This finding signifies that providing young women with economically sustainable jobs and empowering them financially could help reduce the occurrence of PSI in SSA.

Contrary to the finding of a previous study [ 51 ], this study revealed that young women who belonged to the richest wealth index had lower odds of engaging in PSI as against those who belonged to the poorest wealth index. This finding was observed probably because being financially buoyant protects people from engaging in risky sexual behaviors such as streetism, substance use, and transactional sex which increase women’s propensity of having PSI [ 52 ].

Despite the well-documented positive influence of mass media exposure (e.g., television and radio) on sexual behavior [ 26 , 53 ], this study revealed that young women who were not exposed to radio and television at all had lower odds of engaging in PSI compared to those who were exposed to radio and television almost every day. A probable explanation for this unexpected finding could be attributed to the influx of excess sexually explicit telenovelas and advertisement of sexual enhancing drugs that increase the desire of young women to have PSI [ 54 ]. For PSI among young women in SSA to reduce significantly, it is important for media outlets to regulate the programs they churn out for public consumption.

Contrary to the finding of previous studies [ 1 , 55 ], it was found in this study that young women who resided in rural areas had lower odds of engaging in PSI compared to those who resided in urban areas. A plausible explanation for this finding could be linked with the relatively lower standard of living in rural areas, which reduces young women’s likelihood of engaging in transactional sex for financial assistance [ 56 ]. Even though this is not clear, this finding calls for further studies to substantiate this probable reason.

Young women who were living in the East Africa sub-region had lower odds of engaging in PSI compared to those who were living in the Southern Africa sub-region. A plausible reason for this finding could be attributed to the variations in the socio-cultural practices among the sub-regions of SSA. For example, it is perceived in some parts of Southern Africa sub-region that having a child increases the chance of marriage, which also increases the rate of PSI among young women [ 57 ]. This was evident in this study where Southern African countries such as Angola, Lesotho, Namibia, and Zambia recorded a high prevalence of premarital sex among young women.

Strengths and limitations

Since the subject was very sensitive, ruling out social desirability bias in relation to the responses was impossible. Additionally, the cross-sectional nature of the study makes it difficult to establish causal inferences among the studied variables. Again, since the study used self-reported questionnaires, it could be that respondents might have underreported or over-reported their experiences. Despite the above-mentioned limitations, the study has certain strengths that need to be mentioned. Hence, findings from the study should be interpreted with caution. First, the study employed a relatively large sample size that is nationally representative and would be appropriate for generalization. Moreover, the use of statistical procedures to generate interesting findings that could be verified is a strength for the study.

Conclusions

The study revealed that the prevalence of PSI among young women in SSA was high with Liberia and Comoros recording the highest (75.3%) and lowest (5.0%) prevalences, respectively. The study has also identified factors that predict PSI among young women in the studied countries, hence, interventions that seek to alleviate PSI among young women should pay critical attention to these factors. The study recommends that more concerted efforts should be directed at empowering young women financially and educating them about their sexual and reproductive health behaviors such as the detrimental effects of sexual experimentation and also encouraging abstinence and/or contraceptive use.

Availability of data and materials

The dataset used for the study is freely available at https://dhsprogram.com/data/available-datasets.cfm .

Abbreviations

Sub-Saharan Africa

• Premarital sexual intercourse

Demographic and Health Surveys

Adjusted odds ratio

Confidence interval

Sexually transmitted illnesses

Strengthening the Reporting of Observational Studies in Epidemiology

Variance inflation factor

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Acknowledgements

We acknowledge MEASURE DHS for making the data freely available for the study.

No specific funding was obtained for this study.

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Department of Population and Health, University of Cape Coast, Cape Coast, Ghana

Eugene Budu & Ebenezer Kwesi Armah-Ansah

Korle Bu Teaching Hospital, P.O.Box 77, Accra, Ghana

Eugene Budu

REMS Consult, Takoradi, Ghana

Abdul-Aziz Seidu & Bright Opoku Ahinkorah

Centre for Gender and Advocacy, Takoradi Technical University, P.O. Box 256, Takoradi, Ghana

Abdul-Aziz Seidu

College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia

Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana

James Boadu Frimpong & John Elvis Hagan Jr

Department of Kinesiology, New Mexico State University, Las Cruces, NM, USA

James Boadu Frimpong

Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana

Richard Gyan Aboagye

School of Public Health, Bielefeld University, P.O. Box 100131, 33501, Bielefeld, Germany

Stephen Kofi Anin

Department of Industrial and Health Sciences, Faculty of Applied Sciences, Takoradi Technical University, P.O. Box 256, Takoradi, Ghana

Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany

John Elvis Hagan Jr

School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia

Bright Opoku Ahinkorah

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Contributions

Study conception: AS, BOA, JEH. Data analysis: EB, RGA, AS, BOA. Writing of manuscript: EB, EKA-A, JBF, AS, RGA, SKA, JEH, BOA. All authors read and approved the final manuscript.

Corresponding author

Correspondence to James Boadu Frimpong .

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In this study, ethical clearance was not sought due to the public availability of the DHS dataset. The datasets were obtained from the MEASURE DHS after registration and approval were given for its usage. All the ethical guidelines concerning the use of secondary datasets in the publication were strictly adhered to. Detailed information about the DHS data usage and ethical standards are available at http://goo.gl/ny8T6X .

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Additional file 1: table s1.

. Distribution of age across explanatory variables.

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Budu, E., Seidu, AA., Armah-Ansah, E.K. et al. Prevalence and predictors of premarital sexual intercourse among young women in sub-Saharan Africa. Reprod Health 20 , 99 (2023). https://doi.org/10.1186/s12978-023-01626-8

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Premarital Sex in America: How Young Americans Meet, Mate, and Think about Marrying

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This book tells the definitive story of the sexual and relationship values and practices of young adults. The authors draw upon their analysis of nationally representative data and scores of in-person interviews to help shed light on numerous questions about the sex lives of young Americans, including how long their relationships last, how quickly they become sexual, why the double standard is so stubborn, who remains a virgin and for how long, how gender imbalances in college change the rules of mating, the “price” of sex and its effects on relationship security, how online social networking and porn alter the market in relationships, how emerging adults think about marriage and relationship permanence, who marries early, why the age at marriage is rising rapidly, and how “red” and “blue” politics are reflected in our sexual choices. This book reveals striking disparities between college students and those who never pursued higher education, between conservatives and liberals, and between men and women in their experiences of romantic and sexual relationships. Although women continue to make great strides in higher education and the economy, their relationships are stalling and making many of them unhappy. Quests for sexual chemistry fall short or even backfire, revealing discordant experiences with serial monogamy among many men and women. And yet the powerful scripts of sexual equality and romantic individualism propel emerging adults forward to try again. The result is an omnibus study of sex and relationships in the lives of heterosexual emerging adults in America.

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• Research note
• Open access
• Published: 03 June 2019

Premarital sexual practice and associated factors among high school youths in Debretabor town, South Gondar zone, North West Ethiopia, 2017

• Wondmnew Lakew Arega 1 ,
• Taye Abuhay Zewale 2 &
• Kassawmar Angaw Bogale 3  

BMC Research Notes volume  12 , Article number:  314 ( 2019 ) Cite this article

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Premarital sex is voluntary sexual intercourse between unmarried persons. Prevalence and factors associated with premarital sexual practice in the study area are lacking. Thus, the aims of this study were to determine the prevalence and to identify factors associated with premarital sexual practice among Debretabor high school youths.

The prevalence of premarital sex among Debretabor town high school youths was 22.5% of which 63.9% of them were males. Among those high school youths, the majority (60.2%) had their first sexual intercourse at the age of 15–19 years. The main reason for initiation of sexual intercourse was due to fell in love which accounts 48.1%, followed by sexual desire 22.2%. Predictors that are risk for premarital sex were youths who did not attend religious education [AOR = 7.4, 95% CI (3.32, 16.43)], having boy or girl friends [AOR = 9.66, 95% CI (4.80, 19.43)], drinking alcohol every day [AOR = 9.43, 95% CI (2.86, 31.14)] and less than twice a week [AOR = 2.52, 95% CI (1.22, 5.21)], watching pornography film [AOR = 5.15, 95% CI (2.56, 10.37)] and youths came from rural residing families [AOR = 0.51, 95% CI (0.27, 0.96)].

Introduction

Youths are in a state of rapid physical and psychological change. They have curiosity and urge to experience new phenomena [ 1 ]. Nevertheless, youths are exposed to different circumstance like fears, worries and different desires, they feel shame to get advice and guidance from their parents and elders [ 2 ]. Over a life cycle approach, youths and their communities need to know about reproductive health so that, they can make informed decisions about their reproductive health and sexuality [ 3 , 4 ]. Premarital sex, defined as voluntary sexual intercourse between unmarried persons, is increasing worldwide [ 5 ]. It is unsafe because, most youths have no enough awareness on how to prevent and how to get guidance services on reproductive anatomy, physiology, sexually transmitted infection (STI), and Human Immunodeficiency Virus (HIV) [ 6 , 7 ]. As a result, they are exposed to serious problems including premarital sex with its consequences and emotional scar [ 8 , 9 ].

Though, schools are institutions where sufficient information and formal educations are provided to youths, premarital sexual practice among high school youths have been increased worldwide [ 10 ]. Globally, 35.3 million people live with HIV/AIDS of which youths account 2.1 million. Among 2.3 million new HIV infections, youths (15–24 years) account more than half [ 7 ].

Illegal abortions, risk of HIV infections and school dropout are the bad consequences of pre-marital sex in sub-Saharan Africa [ 11 ]. Up to 25% of 15–19 years, old youth’s exercised sex before age 15. In Ethiopia, the prevalence of premarital sex is increasing [ 12 , 13 , 14 ]. A study conducted in Eastern part of Ethiopia and Lalibela Town reported that above one-fourth of the school youths were exposed to premarital sex [ 12 , 15 ]. Another study which is done in west Shoa Zone reported that about 60% of high school youths were exercised premarital sex [ 9 ]. Different scholars identified inconsistent factors which were positively or negatively associated with premarital sexual practice. Some of these factors includes age of students, sex, residence, educational level, peer pressure, having pocket money, substance use, alcohol drink, watching pornography movie, living arrangement, discussion with parents about sexual issues, having peers who are experienced sex and fall in love and access religious and life skill education [ 9 , 12 , 13 , 14 , 15 , 16 , 17 ].

According to Debretabor district health office report sexually transmitted diseases, abortion and unwanted pregnancy are high in the study area among youths [ 18 ]. However, prevalence of premarital sexual practice and its associated factors among high school youths (grade 9th to grade 12th) in the study area was not dealt yet. Thus, this study aimed to determine premarital sexual practices and associated factors among high school youths in Debretabor town, south Gondar, Ethiopia.

Study design and setting

School based cross-sectional study design was conducted from September 18 to October 16, 2017, among high school youths in Debretabor town, South Gondar zone, Ethiopia. Debretabor town is located at 667 km from Addis Ababa, capital city of Ethiopia and has three high schools. The total numbers of high school youths in the study area by the year 2017 were 8892 (5220 females and 3672 males) [ 18 ].

Source population

The source population was all high school youths who were residing in Debretabor town and its surrounding rural Kebeles.

Study population

The study population was all high-school youths aged 15 to 24 years that were enrolled as a regular day-time student in 2017.

Inclusion criteria

All secondary school youths aged 15–24 attending regular class in Debretabor town during data collection period were included in the study.

Exclusion criterion

Married high school youths were excluded.

Sample size determination

Sample size was calculated using a single population proportion formula designated as \({\text{n}} = \frac{{(Z_{\alpha /2)}^{2} p\left( {1 - p} \right)}}{{d^{2} }}\) based on the assumptions of P -value = 0.25 which was the proportion of premarital sex among in-school youths in Jimma [ 19 ], a 95% confidence level, 4% margin of error (d) and 10% non-response rate. Accordingly, the total sample size calculated was 497.

Sampling procedure

All the high schools in the town were included in the study, and total sample size was proportionally allocated to each school. The lists of youths were obtained from the respective school registrar. Then, the study participants from each school were selected by computer generated simple random sampling technique after proportional allocation to their grade level.

Data collection

Pre-tested, self-administered structured Amharic (local language) questionnaire was used to collect the data. The questionnaire was pre-tested on 10% of the study participants at Alem-ber high school, which has the same setup to the study area, found in South Gondar zone. The questionnaire was amended according to the finding in the pretest before the distributions of final questionnaires. Training was given for data collectors and supervisors. Before the participants filled the questionnaires, the trained data collector gave orientation to youths regarding the aim of the study, the content of the questionnaire, the issue of confidentiality and respondents rights. Moreover, trained data collectors were involved in taking consents from participants and gathering filled questionnaires. However, data collectors were not present when the participants were filling the questionnaire.

The study used premarital sex practice as dependent variable and Socio-demographic Characteristics of youths and parents (age, sex, education level, religion, pocket money living arrangement, parental education, parental occupation, sexual issue discussion with parents), risk behavior and peer pressure (chat chewing, alcohol drinking, cigarette smoking, watching pornography, Peer friend initiation of sex) and history of partner hood, demand for condom utilization (number of partners, having the boy/girlfriend, condom utilization) as independent variable.

Data management and analysis

The data were entered using Epi-info version 7.2.1 and exported to SPSS version 23 for analysis. Descriptive statistics like frequency, percentage and standard deviation was computed. Binary logistics regression model was applied to identify determinant factors related premarital sexual practice. Variables with P value less than 0.25 on bi-variate analysis were entered to multi-variate analysis. 95% confidence interval was used to identify associated factors in multi-variable binary logistic regression model. Hosmer–Lemeshow goodness of the model fit was checked and analysis was done by entering procedure.

Socio-demographic characteristics of the respondents

Four hundred eighty high school youths were filled the questionnaire making a response rate of 96.6%. From the total respondents, more than half (53.8%) of them were females. Majority (71.2%) youths age were from 15 to 19 years. The average age and standard deviation of respondents were 17 and 1.29 years respectively. Larger proportion (35.8%) of the participants were grade nine students. The majority (97.5%) of the respondents were Orthodox Christians. Only 23.3% of in school youths had pocket money, about 89% of youths were living with their parents and attending religious services. Moreover, above half (61%) of the youths didn’t discuss about sexual issues with their parents (Table  1 ).

Sexual characteristics and risk behavior of respondents

From all respondents, 22.5% have had premarital sexual intercourse at the time of the survey, of which 63.9% were males and 60.2% had their first sexual intercourse at the age of 15–19 years. The main reason for initiation of sexual intercourse was due to fell in love which accounts 48.1%, followed by sexual desire 22.2%.

Concerning the number of sexual partners, majority (84.3%) of students have had sex with one partner and about 58% of the them were used condom during sexual intercourse. Coming to risky behavior, 28.1% of the youths drunk alcohol, 16.2% watched pornography and 2.7% chewed khat. About 61% of youths who watched pornography film were exposed to premarital sex (Table  2 ).

Factors associated with premarital sexual practice among high school youths in Debretabor town, 2017

The Logistic regression analysis showed that premarital sexual practice among youths who did not attend religious education was 7.4 times more likely exposed to premarital sex as compared to the counterpart [AOR = 7.4, 95% CI (3.32, 16.43)]. Similarly, youths who had a boy or a girl friend were 9.66 times more likely to start premarital sex than those who didn’t have a boy or a girl [AOR = 9.66, 95% CI (4.80, 19.43)]. Youths who were drinking alcohol every day and less than twice a week were 9.43 times [AOR = 9.43, 95% CI (2.86, 31.14)] and 2.52 times [AOR = 2.52, 95% CI (1.22, 5.21)] more likely engaged in premarital sex practice respectively as compared to those who did not drink alcohol. Students who watched pornography film were 5.15 times more likely practiced premarital sex as compared to those who didn’t watch pornography film [AOR = 5.15, 95% CI (2.56, 10.37)]. But it was found to be less likely among urban youths resident family as compared with youths who came from rural resident families (Table  3 ).

Premarital sexual practice of high school youths in this study was 22.5% (CI: 19.0, 26.5). This finding was in line with a study conducted in Nekemtie town (21.5%) [ 20 ], in Jimma (21%) [ 19 ] and school youths in Alamata (21.1%) [ 21 ]. However, it was higher than in Coast Province, Kenya youths (14.9%) [ 22 ], and Robit high school youths (14.9%) [ 10 ]. The difference might be as a result of sample size, coast province; Kenya used existing data available from Kenya Global School Based Health Survey (GSHS) which was national study. So it could be more precise as compared with this study. In addition, there might be socio-cultural differences in community among study areas.

But this finding was lower than in-school youths in Ghana (42%) [ 23 ], in Jimma (28.5%) [ 24 ] in Eastern Ethiopia (24.8%) [ 12 ] and in Debremarkos high school youths (37.5% [ 25 ]. The variation may be due to difference in periods of the study (2011–2014), showing a changing and improving trend in easiness of reporting sexual matters and increasing premarital sexual awareness from time to time [ 7 , 26 ]. The difference might also be due to variations on the prevalence of risky sexual behavior.

This study also found that those youths who didn’t attend religious education were more likely exposed to premarital sex as compared with their counter parts. It is in agreement with studies conducted in Bahir Dar City [ 14 ] and Mizan Aman [ 27 ]. The possible reason could be religious institutions strongly thought youths to be abstained until marriage.

High School youths who have a boyfriend or girlfriend were more likely to have premarital sexual intercourse than those who don’t. There were similar reports in Alamata [ 28 ], and Nekemt towns [ 20 ]. This could be due to the pressure from their boy/girl friend to have sexual practice.

Youths who drunk alcohol were engaged in premarital sexual practice as compared to their counterparts. This finding is the same as the studies done in South West [ 27 ] and Western Ethiopia [ 29 ]. The possible explanation might be, when youths drink alcohol, his/her ability of self-controlling decrease and this may expose to premarital sex.

Students who watched pornography film were more likely practiced premarital sex as compared to those who didn’t. There is similar finding in Shendi Town [ 13 ] and Northern Ethiopia [ 7 ]. The possible reason could be pornography film leads youths physiological and psychological motive for sexual intercourse.

Youths from rural family residents were more exposed to premarital sex urban youths. This is not in agreement with other studies [ 7 , 21 , 28 , 30 , 31 ]. This difference might be due to low parental control of rural youths as they lived with rented rooms, exposed to exercising sexual issues freely.

Conclusions

Significant numbers of high school youths were engaged in sexual practice before marriage. Not attending religious education, have a boy/girlfriend, watching pornography film, alcohol drinkers and came from rural residing families were identified risk factors. So, the school community and respective health sector need to establish and strengthen school health program and school clubs to give awareness about identified risks of premarital sex. In addition family should link their youths to religious education in parallel to formal school education.

Limitation of the study

Since the nature of this study is sensitive, reporting errors and biases can’t be controlled. In addition as this study used only quantitative data, the behavioral related information might be missed. Since the questionnaire was self-administered, lack of control over the responses rate, no control over who filled the questionnaires and questions may be miss-understood so that the true impression of the participants may not be gathered.

Availability of data and materials

All the data sets used for this study are available from the corresponding author and can be given with a reasonable request.

Abbreviations

Acquired Immune Deficiency Syndrome

adjusted odds ratio

confidence interval

Ethiopian calendar

Demographic Health Survey

Ethiopia Demographic Health Survey

standard deviation

Bachelor of Science

Human Immunodeficiency Virus

Masters of Public Health

Statistical Package for Social Science

sexually transmitted infection

World Health Organization

Global School Based Health Survey

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Acknowledgements

The researchers would like to thank Bahir-Dar University, College of Medicine and health Science for permitting to conduct this research and Debretabor town education offices and the respective staffs for providing the required information on time and their cooperativeness for the study. At last but not least, our gratefulness thanks go to the data collectors and the study participants.

Not applicable, there was no sources of funding for this study.

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Taye Abuhay Zewale

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WLA conceptualization of the study, designed the study, collected data, drafts the analysis, interpreted the data and drafts the manuscript. TAZ designs the work, enter the data and analyze using software, interpretation of results as well as critical review of the manuscript. KAB Participated in design the study, drafting the manuscript and subsequent review of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Taye Abuhay Zewale .

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The study was approved by the Institutional Review Board (IRB) of College of Medicine and Health Sciences at Bahir Dar University with reference number EPB/110/2017. Written permission letter was obtained from all concerned authorities. Written consents from parents of school youths were collected and verbal consent from each participant was obtained after explaining the purpose of the study. The right of participants to refuse or not to respond to questions if, they don’t feel comfortable with or discontinue participation at any time was ensured. Confidentiality was kept at each step of the data collection.

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Arega, W.L., Zewale, T.A. & Bogale, K.A. Premarital sexual practice and associated factors among high school youths in Debretabor town, South Gondar zone, North West Ethiopia, 2017. BMC Res Notes 12 , 314 (2019). https://doi.org/10.1186/s13104-019-4348-3

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Published : 03 June 2019

DOI : https://doi.org/10.1186/s13104-019-4348-3

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The Effect of Sex Education on Premarital Sex Among Adolescents; Literature Review

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A theoretical framework for premarital sexual decisions in the dyad

• Published: December 1973
• Volume 2 , pages 365–378, ( 1973 )

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• Roger W. Libby M.A. 1 &
• John E. Carlson Ph.D. 2  

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A theoretical framework and model designed to explain and predict decisions about premarital intercourse is presented. Decision-making is viewed within an exchange framework. Throughout the exchange process, variations in socialization, definitions of the situation, perceptions of group vs. individual profits, and variations in the values of the participants are related to decisions made. Consensual and accommodative decisions to have or not to have premarital intercourse are explored. Suggestions are made to utilize the framework to generate hypotheses and to develop the theory further.

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Washington State University, Pullman, Washington, USA

Roger W. Libby M.A. ( Research Assistant in Sociology )

University of Idaho, Moscow, Idaho, USA

John E. Carlson Ph.D. ( Assistant Professor of Sociology )

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Libby, R.W., Carlson, J.E. A theoretical framework for premarital sexual decisions in the dyad. Arch Sex Behav 2 , 365–378 (1973). https://doi.org/10.1007/BF01541010

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Issue Date : December 1973

DOI : https://doi.org/10.1007/BF01541010

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