撒哈拉以南非洲青少年中早婚、生育和初次性行为方面的不平等现象。

Inequalities in early marriage, childbearing and sexual debut among adolescents in sub-Saharan Africa.

机构信息

Countdown To 2030 for Women's, Children's and Adolescents' Health, Institute for Global Public Health, University of Manitoba, R070 Med Rehab Building, 771 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.

Women's and Children's Health Program, Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.

出版信息

Reprod Health. 2021 Jun 17;18(Suppl 1):117. doi: 10.1186/s12978-021-01125-8.

DOI:10.1186/s12978-021-01125-8

PMID:34134718

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8210338/

Abstract

BACKGROUND

Adolescent sexual and reproductive health (ASRH) is a major public health concern in sub-Saharan Africa (SSA). However, inequalities in ASRH have received less attention than many other public health priority areas, in part due to limited data. In this study, we examine inequalities in key ASRH indicators.

METHODS

We analyzed national household surveys from 37 countries in SSA, conducted during 1990-2018, to examine trends and inequalities in adolescent behaviors related to early marriage, childbearing and sexual debut among adolescents using data from respondents 15-24 years. Survival analyses were conducted on each survey to obtain estimates for the ASRH indicators. Multilevel linear regression modelling was used to obtain estimates for 2000 and 2015 in four subregions of SSA for all indicators, disaggregated by sex, age, household wealth, urban-rural residence and educational status (primary or less versus secondary or higher education).

RESULTS

In 2015, 28% of adolescent girls in SSA were married before age 18, declined at an average annual rate of 1.5% during 2000-2015, while 47% of girls gave birth before age 20, declining at 0.6% per year. Child marriage was rare for boys (2.5%). About 54% and 43% of girls and boys, respectively, had their sexual debut before 18. The declines were greater for the indicators of early adolescence (10-14 years). Large differences in marriage and childbearing were observed between adolescent girls from rural versus urban areas and the poorest versus richest households, with much greater inequalities observed in West and Central Africa where the prevalence was highest. The urban-rural and wealth-related inequalities remained stagnant or widened during 2000-2015, as the decline was relatively slower among rural and the poorest compared to urban and the richest girls. The prevalence of the ASRH indicators did not decline or increase in either education categories.

CONCLUSION

Early marriage, childbearing and sexual debut declined in SSA but the 2015 levels were still high, especially in Central and West Africa, and inequalities persisted or became larger. In particular, rural, less educated and poorest adolescent girls continued to face higher ASRH risks and vulnerabilities. Greater attention to disparities in ASRH is needed for better targeting of interventions and monitoring of progress.

摘要

背景

青春期性与生殖健康（ASRH）是撒哈拉以南非洲（SSA）的一个主要公共卫生问题。然而，与许多其他重点公共卫生领域相比，ASRH 不平等问题受到的关注较少，部分原因是数据有限。在这项研究中，我们研究了 ASRH 关键指标的不平等现象。

方法

我们分析了 1990 年至 2018 年期间在 SSA 进行的 37 个国家的家庭调查数据，以检查与青少年早婚、生育和初次性行为相关的青少年行为趋势和不平等现象，这些数据来自 15-24 岁的受访者。对每项调查进行生存分析，以获得 ASRH 指标的估计值。使用多水平线性回归模型，对 SSA 的四个次区域在 2000 年和 2015 年的所有指标进行估计，这些指标按性别、年龄、家庭财富、城乡居住和教育程度（小学及以下与中学及以上）进行了细分。

结果

2015 年，SSA 28%的少女在 18 岁之前结婚，2000-2015 年期间的平均年下降率为 1.5%，而 47%的少女在 20 岁之前生育，年下降率为 0.6%。男孩的早婚情况很少（2.5%）。分别约有 54%和 43%的少女和少年在 18 岁之前发生性行为。青春期早期（10-14 岁）的这些指标下降幅度更大。农村地区与城市地区以及最贫穷与最富裕家庭之间的少女在婚姻和生育方面存在较大差异，在早婚和生育发生率最高的西非和中非，不平等现象更为严重。2000-2015 年期间，城乡和贫富相关的不平等现象保持停滞或扩大，因为农村地区和最贫穷家庭的少女的下降速度相对较慢。无论在哪个教育类别中，ASRH 指标的流行率都没有下降或增加。