Early sexual debut: Voluntary or coerced? Evidence from longitudinal data in South Africa – the Birth to Twenty Plus study

Richter, L; Mabaso, M; Ramjith, J; Norris, A The South African Medical Journal, 2015; www.samj.org.za/index.php/samj/article/view/8925/6640

Early sexual debut is commonly defined as having had first sexual intercourse at or before age 14 years and is associated with risks to sexual and reproductive health. Sexual coercion, which is also attributed to early sexual debut, is increasingly receiving attention as an important public health issue owing to its association with adverse health and social outcomes. In severe cases, sexual coercion culminates in prostitution and psychological problems. While social outcomes include acceptance of violence, especially towards women, adherence to traditional gender roles such as male dominance, poor educational achievement as a result of withdrawal from school, and inability to build adult partnerships with loss of marriage prospects.

This paper describes voluntary and coerced sexual experience at sexual debut among a large sample of young South Africans. 2,216 adolescents aged between 11 – 18 years of age (1,149 females, 1,067 males) participated in the Birth to Twenty Plus cohort (Bt20). It is the only study in South Africa that has collected prospective data from the pre-teen years. 

Data was gathered through the study of:

  • Sexual behaviour measures (age at first foreplay, oral, anal and/or vaginal intercourse, age and gender of partner, coerced or voluntary) were collected from age 11 years at six subsequent time points (11 - 12 years, 13 years, 14 years, 15 years, 16 years and 17 - 18 years).
  • Self-reported responses were submitted through the method of secret ballot.
  • Questions remained standard and included reports of the first time a young person experienced foreplay, oral sex and sexual intercourse, whether the experience was coerced or not, and characteristics of the first-time partner.

Findings

  • Median age of sexual debut was 16 years for females and 15 for males.
  • Reported coerced sexual debut included children under 11 years of age.
  • Males reported earlier sexual debut, with both voluntary and coerced sexual experience, than females.
  • By 15 years of age, 14.2% of females and 38.2% of males had engaged in sexual intercourse.
  • By age 18, 42.9% of females and 59.5% of males had engaged in intercourse.
  • Reported sexual intercourse before age 12 was ten times higher among boys than girls. 
  • Sexual coercion at early sexual debut among both male and female adolescents occurred mostly through sexual intercourse with older adolescents and partners of the same age.

This study draws attention to high rates of sexual coercion of young men, a phenomenon little studied in sub-Saharan Africa. Targeted interventions aimed at delaying sexual debut and sexual coercion will help to prevent adolescent sexual risk behaviour, unwanted pregnancy and STIs, including HIV. 

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