From ‘sugar daddies’ to ‘sugar babies’: exploring a pathway among age-disparate sexual relationships, condom use and adolescent pregnancy in South Africa
Elona Toska A F , Lucie D. Cluver A B C , Mark Boyes D , Marija Pantelic A and Caroline Kuo B C E
+ Author Affiliations
- Author Affiliations
A Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, OX1 23R, UK.
B Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa.
C Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa.
D School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
E Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University, 121 South Main Street, Box G-S121-4th Floor, Room 406, Providence, RI 02912, USA.
F Corresponding author. Email: elona.toska@spi.ox.ac.uk
Sexual Health 12(1) 59-66 https://doi.org/10.1071/SH14089
Submitted: 21 May 2014 Accepted: 5 January 2015 Published: 23 February 2015
Abstract
Background: Adolescent pregnancy has been linked to adverse outcomes. Most studies proposing risk pathways for adolescent pregnancy in South Africa are qualitative, hypothesising links among age-disparate relationships, reduced condom use and higher pregnancy rates. No known South African studies have quantitatively explored pathways to adolescent pregnancy. Objectives: This study aimed to: (i) identify the factors associated with adolescent pregnancy and (ii) explore a pathway of risk by assessing whether condom use mediated the relationship between age-disparate sexual relationships and adolescent pregnancy. Methods: A cross-sectional survey of 447 sexually active girls aged 10–19 years was undertaken in six health districts of South Africa. Multivariate logistic regressions controlled for confounders. Mediation tests used bootstrapping. Results: Consistent condom use (β = –2.148, odds ratio (OR) = 8.566, P ≤ 0.001) and school enrolment (β = –1.600, OR = 0.202, P ≤ 0.001) were associated with lower pregnancy rates. Age-disparate sex (β = 1.093, OR = 2.982, P ≤ 0.001) and long-term school absences (β = 1.402, OR = 4.061, P ≤ 0.001) were associated with higher pregnancy rates. The indirect effect of age-disparate sex on adolescent pregnancy through condom use was significant, irrespective of age, age at sexual initiation, poverty and residential environment (B = 0.4466, s.d. = 0.1303, confidence interval: 0.2323–0.7428). Conclusion: This survey supports hypotheses that inability to negotiate condom use in age-disparate sexual relationships may drive adolescent pregnancy. Interventions addressing these relationships, facilitating condom use and increasing access to sexual health services among adolescents might avert unwanted pregnancies.
Additional keywords: reproductive health, risk behaviours, youth.
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