Centre for Social Science Research, University of Cape Town, Rondebosch, South Africa.
J Adolesc Health. 2024 Jan;74(1):186-193. doi: 10.1016/j.jadohealth.2023.08.025. Epub 2023 Oct 7.
Considering the high levels of female genital mutilation (FGM) in Sierra Leone with over 83% of girls and young women aged 15-24 years having undergone the practice, the study explores the potential influence of FGM on sexual behaviors of adolescent girls and young women (AGYW) in Sierra Leone.
Cross-sectional data from the 2019 Demographic Health Survey were utilized to examine the association between FGM and three sexual behaviors; sexual debut before 18 years, child marriage and adolescent motherhood. To model this association, a generalized estimation equation technique was employed, while controlling for socio-demographic characteristics. Additionally, the study corrected for multiple-hypothesis testing using the Benjamini-Hochberg procedure with a specified false discovery rate of 0.05. Finally, percentage predicted probabilities of occurrence of the sexual risk behaviors in the presence of FGM were also calculated.
Of the 5524 AGYW, 76% had undergone FGM. FGM was associated with all three sexual risk behaviors. Sexual debut before 18 years had the highest predicted probability increase (+18.00 ppt, 95% CI: 14.41 to -21.59), followed by adolescent motherhood (+13.38 ppt, 95% CI: 10.16-16.60) and child marriage (+12.61 ppt; 95% CI: 10.22-15.01). Education was found to be protective against all three sexual risk behaviors.
The findings of this study demonstrate that FGM remains a prevalent practice in Sierra Leone, even among the younger generation. This practice is strongly associated with sexual behaviors that pose a significant risk to the health outcomes of AGYW. Investments in education by removing barriers to access for AGYW could lead to multiple gains.
鉴于塞拉利昂女性生殖器切割（FGM）的比例很高，超过 83%的 15-24 岁女孩和年轻女性都接受了这种做法，因此本研究探讨了 FGM 对塞拉利昂青春期女孩和年轻女性（AGYW）性行为的潜在影响。
本研究使用 2019 年人口健康调查的横断面数据，检验了 FGM 与三种性行为之间的关联：18 岁之前的初次性行为、童婚和未成年母亲。为了建立这种关联，采用了广义估计方程技术，同时控制了社会人口特征。此外，研究还使用 Benjamini-Hochberg 程序进行了多重假设检验校正，指定的错误发现率为 0.05。最后，还计算了存在 FGM 时发生性行为风险的百分比预测概率。
在 5524 名 AGYW 中，76%的人接受过 FGM。FGM 与所有三种性行为风险因素均相关。18 岁之前的初次性行为的预测概率增加最高（+18.00%，95%CI：14.41-21.59），其次是未成年母亲（+13.38%，95%CI：10.16-16.60）和童婚（+12.61%，95%CI：10.22-15.01）。研究发现，教育对所有三种性行为风险因素都具有保护作用。
本研究结果表明，FGM 在塞拉利昂仍然是一种普遍存在的做法，即使在年轻一代中也是如此。这种做法与对 AGYW 健康结果构成重大风险的性行为密切相关。通过消除 AGYW 获得教育的障碍，投资于教育可以带来多重收益。
