Sexual Behavior Among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings

Abstract

Purpose This study sought to assess whether risky sexual behaviours and sexual exploitation of orphaned adolescents differed between family-based and institutional care environments in Uasin Gishu County, Kenya. Methods We analyzed baseline data from a cohort of orphaned adolescents aged 10–18 years living in 300 randomly-selected households and 19 Charitable Children’s Institutions. The primary outcomes were having ever had consensual sex, number of sex partners, transactional sex, and forced sex. Multivariable logistic regression compared these between participants in institutional care and family-based care, while adjusting for age, sex, orphan status, importance of religion, caregiver support and supervision, school attendance, and alcohol and drug use. Results This analysis included 1,365 participants aged ≥10 years; 712 (52%) living in institutional environments and 653 (48%) in family-based care. Participants in institutional care were significantly less likely to report engaging in transactional sex (AOR 0.46 95% CI: 0.3–0.72) or to have experienced forced sex (AOR=0.57 95% CI: 0.38–0.88) when controlling for age, sex, and orphan status. These associations remained when adjusting for additional variables. Conclusion Orphaned adolescents living in family-based care in Uasin Gishu, Kenya, may be at increased risk of transactional sex and sexual violence compared to those in institutional care. Institutional care may reduce vulnerabilities through the provision of basic material needs and adequate standards of living that influence adolescents’ sexual risk-taking behaviours. The use of single items to assess outcomes and non-explicit definition of sex suggest the findings should be interpreted with caution.

The Production and Reproduction of Kinship in Charitable Children’s Institutions in Uasin Gishu County, Kenya

“…Parent-like support and family-related environments might be associated with the positive outcomes of OSCAs within the CCIs (Atwoli et al 2014;Braitstein et al 2013;Embleton et al 2014Embleton et al , 2017, which are consistent with findings of other studies (Whetten et al 2009(Whetten et al , 2014 conducted in similar low-and middle-income countries. Some CCIs provided a positive environment where children were able to focus on their education, were provided with their basic needs, and formed long-term positive relationships.…”

“…We found that family-based care environments in UG County were less likely to be able to provide for children's basic material needs than were CCIs and may not be able to provide an adequate standard of living. This study, our other work, and our observations in UG County led to the study question for this paper (Atwoli et al 2014;Braitstein et al 2013;Embleton et al 2014Embleton et al , 2017.…”

“…The ethnographic record and guidelines on alternative care (UNICEF and Republic of Kenya 2014) underscore the importance of family-especially consanguinity and descent-in caring for orphaned and vulnerable children. There is, however, some evidence to suggest that the outcomes of children in CCIs in some places may be better, or at least not worse, than their counterparts living in kinship care (Atwoli et al 2014;Braitstein et al 2013;Embleton et al 2014Embleton et al , 2017Whetten et al 2009Whetten et al , 2014. It is important to understand how and why this may be the case, given that, until more robust infrastructure and comprehensive services exist to support and protect orphaned and vulnerable children, institutions may remain a "necessary evil".…”

“…In Zambia, a study by Human Rights Watch found that orphans who were taken in by extended family members were frequently subjected to sexual violence from uncles, stepfathers and cousins" (p. 69). Recent evidence suggests that, despite the common assumption that extended families provide superior care (Braitstein 2015), CCIs in developing countries may, in fact, produce better outcomes in areas including nutritional status (Braitstein et al 2013), sexual health (Embleton et al 2017), basic child rights (Embleton et al 2014), and mental health (Atwoli et al 2014). For example, a study conducted in UG County, Kenya, provides evidence indicating that the prevalence of posttraumatic stress disorder was significantly higher among OSCAs in households than those in CCIs, and OSCAs in households had a higher prevalence of sexual abuse than those in CCIs (Atwoli et al 2014, p. 6).…”

Using Social Ecological Theory to Identify Factors Associated With Risky Sexual Behavior in Cambodian Adolescent Girls and Young Women Aged 10 to 24 Years: A Systematic Review

“…9,18 Microenvironment Level of SEM Many studies suggest adolescents who reside with at least one parent or identify with the views of their parents are less likely to engage in RSB. 32,33 Being an orphan 32 may lead to a low socioeconomic status for female youths and could compel the girls to indulge in transactional sex. 32 The majority of sexually active girls had multiple sexual partners, 20 or were involved in transactional sex, 21 and reported non-use or irregular use of condoms by most of the boyfriends or sexual partners.…”