Association between sexual violence and unintended pregnancy among adolescent girls and young women in South Africa

Abstract

Background Unintended pregnancy has dire consequences on the health and socioeconomic wellbeing of adolescent girls and young women (AGYW) (aged 15–24 years). While most studies tend to focus on lack of access to contraceptive information and services, and poverty as the main contributing factor to early-unintended pregnancies, the influence of sexual violence has received limited attention. Understanding the link between sexual violence and unintended pregnancy is critical towards developing a multifaceted intervention to reduce unintended pregnancies among AGYW in South Africa, a country with high teenage pregnancy rate. Thus, we estimated the magnitude of unintended pregnancy among AGYW and also examined the effect of sexual violence on unintended pregnancy. Methods Our study adopted a cross-sectional design, and data were obtained from AGYW in a South African university between June and November 2018. A final sample of 451 girls aged 17–24 years, selected using stratified sampling, were included in the analysis. We used adjusted and unadjusted logistic regression analysis to examine the effect of sexual violence on unintended pregnancy. Results The analysis shows that 41.9% of all respondents had experienced an unintended pregnancy, and 26.3% of those unintended pregnancies ended in abortions. Unintended pregnancy was higher among survivors of sexual violence (54.4%) compared to those who never experienced sexual abuse (34.3%). In the multivariable analysis, sexual violence was consistently and robustly associated with increased odds of having an unintended pregnancy (AOR:1.70; 95% CI: 1.08–2.68). Conclusion Our study found a huge magnitude of unintended pregnancy among AGYW. Sexual violence is an important predictor of unintended pregnancy in this age cohort. Thus, addressing unintended pregnancies among AGYW in South Africa requires interventions that not only increase access to contraceptive information and services but also reduce sexual violence and cater for survivors.

Mapping evidence on predictors of adverse sexual and reproductive health outcomes among young women in South Africa: A scoping review

“…South Africa has been identified as one of the countries in SSA contributing significantly to the continuous increase in adverse sexual and reproductive health outcomes in terms of unintended pregnancy and STIs/HIV among young women. 25 , 26 , 27 This might be because of the high prevalence of early sexual debut among this cohort, 28 with about 41% of unintended pregnancies reported in a recent study. 27 Sexually transmitted infections and HIV prevalence have also been higher among South African young women, with approximately 9.8% STIs prevalence 29 and 21.0% HIV prevalence.…”

“… 25 , 26 , 27 This might be because of the high prevalence of early sexual debut among this cohort, 28 with about 41% of unintended pregnancies reported in a recent study. 27 Sexually transmitted infections and HIV prevalence have also been higher among South African young women, with approximately 9.8% STIs prevalence 29 and 21.0% HIV prevalence. 29…”

“…Four (44%) out of nine studies included were national-based studies, 37 , 38 , 39 , 40 while the remaining five (66%) studies were conducted in different provinces; Western Cape 41 , 42 and Eastern Cape 27 , 43 had two studies each and one study was conducted in KwaZulu-Natal. 26 Six (67%) were cross-sectional study design, 26 , 27 , 37 , 38 , 39 , 40 , two (22%) studies followed longitudinal design 41 , 43 and one (11%) was a randomised control trial. 42 All the included studies were quantitative.…”

Unequal access and use of contraceptives among parenting adolescent girls in sub-Saharan Africa: a cross-sectional analysis of demographic and health surveys

“…Open access reasons for the high rate of adolescent childbearing in SSA. [5][6][7][8][9][10][11] Adolescent childbearing has deleterious consequences, not only on the girls and their babies but also on society. 12 13 Early childbearing is associated with a greater risk of maternal mortality, unsafe abortion, pre-eclampsia/eclampsia, bleeding during pregnancy, vesicovaginal fistula and prolonged and obstructed labour.…”

Sexual Violence Against Adolescents in a Brazilian State: an Analysis of Reported Cases

“…Regardless of the type, every act of sexual violence is both intrusive and traumatic, ranging from direct physical contact to the use of force, or occurring through less direct forms, such as unwanted exposure to sexual language and images [8]. This phenomenon has short to long-term impacts on adolescents' physical and mental health, such as sexually transmitted infections, early pregnancy, gastrointestinal disorders [9][10][11][12], post-traumatic stress disorder, anxiety, depression, eating and sleep dis-orders, relationship problems, and suicidal behaviors [11,13,14]. In addition to these consequences, studies also show engagement in risky sexual behavior [15,16] and substance abuse [17,18] as a consequence of sexual violence.…”