Lusting, learning and lasting in school: sexual debut, school performance and dropout among adolescents in primary schools in Karonga district, northern Malawi

Abstract

Age at sexual debut is known to have implications for future sexual behaviours and health outcomes, including HIV infection, early pregnancy and maternal mortality, but may also influence educational outcomes. Longitudinal data on schooling and sexual behaviour from a demographic surveillance site in Karonga district, northern Malawi, were analysed for 3153 respondents between the ages of 12 and 25 years to examine the association between sexual debut and primary school dropout, and the role of prior school performance. Time to dropout was modelled using the Fine and Gray survival model to account for the competing event of primary school completion. To deal with the time-varying nature of age at sexual debut and school performance, models were fitted using landmark analyses. Sexual debut was found to be associated with a five-fold increase in rate of subsequent dropout for girls and a two-fold increase in dropout rate for boys (adjusted hazard ratio [aHR] of 5.27, CI 4.22–6.57, and 2.19, CI 1.77–2.7, respectively). For girls who were sexually active by age 16, only 16% ultimately completed primary schooling, compared with 70% aged 18 or older at sexual debut. Prior to sexual debut, girls had primary completion levels similar to those of boys. The association between sexual debut and school dropout could not be explained by prior poor school performance: the effect of sexual debut on dropout was as strong among those who were not behind in school as among those who were overage for their school grade. Girls who were sexually active were more likely to repeat a grade, with no effect being seen for boys. Pathways to dropout are complex and may differ for boys and girls. Interventions are needed to improve school progression so children complete primary school before sexual debut, and to improve sex education and contraception provision.

Assessing the validity of and factors that influence accurate self-reporting of HIV status after testing: a population-based study

“…Regular community-wide surveys are conducted to capture information on socio-economic status, monitor HIV-infection patterns and evaluate impact of interventions carried out in the area. There are now over 40 000 people in the HDSS, most of whom are rural subsistence farmers, fishermen and small traders [ 9 ].…”

Contraceptive Conversations among Adolescent Girls and Young Women and Their Partners, Peers, and Older Female Family Members in Lilongwe, Malawi: A Qualitative Analysis

“…Among AGYW who were unmarried, the hesitation to discuss contraception was due to the implication that using contraception meant being sexually active. In Malawi, sexual activity before marriage, though common, is considered taboo (Bobel et al 2020;Munthali, Chimbiri, and Zulu 2004;National Statistical Office (NSO) and ICF Macro 2016; Sunny et al 2019). Studies among AGYW in other countries in SSA have similarly found that unmarried AGYW are unlikely to initiate conversations related to sexual health for similar associations with sexual activity and fears of being labeled as a "bad girl" or "immoral" (Hall et al 2018;Krugu et al 2016;Muhwezi et al 2015;Melaku et al 2014).…”

Gifting Relationships and School Dropout in Rural Malawi: Examining Differences by Gender and Poverty Level

“…2014) and usually functions as an impediment to reenrollment rather than a reason for leaving school (Grant 2012). In contrast, about 10 percent of the sexually active boys in the study cited marriage or pregnancy as the reason for dropout whereas around half reported “school‐related reasons” for dropping out, particularly those related to school performance, such as failing exams and repeating a grade, as well as losing interest in school (Sunny et al 2019).…”

“…However, non-gifting sexual relationships also erase the protective advantage of being nonpoor for girls, but not for boys. These results point to the value of examining poverty-gender interactions to gain a more nuanced understanding of the impact of sexual relationships on adolescent trajectories.Research from across sub-Saharan Africa has shown that adolescents in sexual relationships have a higher likelihood of dropping out of school, particularly girls (Clark and Mathur 2012;Frye 2017;Sunny et al 2019). In many settings, gift-giving from boyfriends to girlfriends is a routine part of adolescent romantic relationships (Kaufman and Stavrou 2004;Mojola 2014;Moore et al 2007;Poulin 2007;Verheijen 2011), and yet we know little about whether the exchange of gifts in these relationships heightens the risk of dropout.…”