Factors associated with pre-marital sexual debut among unmarried high school female students in bahir Dar town, Ethiopia: cross- sectional study
© Mulugeta and Berhane; licensee BioMed Central Ltd. 2014
Received: 15 August 2013
Accepted: 22 May 2014
Published: 31 May 2014
Pre-marital sexual debut increase the risk of sexually transmitted infections (STIs) including HIV/AIDS and unwanted pregnancy. It may also affect their school performance and completion rate. In spite of this fact, number of unmarried female students who started sexual debut is increasing from time to time. However, information on the extent of pre-marital sexual debut and associated factors were not well studied and documented in the study area where pre-marital sexual debut is largely condemned. Therefore this study was conducted to assess the magnitude and associated factors of pre-marital sexual debut.
School based cross-sectional survey was conducted from May 10-13/2012. A total of 1123 unmarried high school female students were selected by multi- stage sampling technique. Data were collected using structured, self administered questionnaire. Descriptive statistics, binary and multivariable logistic regression analyses were used to identify factors associated with pre-marital sexual debut.
Among unmarried high school female students 30.8% reported pre-marital sexual debut. The major associated factors were frequent watching of pornographic video [AOR = 10.15, 95% CI: (6.63, 15.53)], peer pressure [AOR = 2.98, 95% CI: (1.57, 5.67)] and chewing khat [AOR = 8.99, 95% CI: (3.84, 21.06)].
Significant proportion of unmarried high school female students have started pre-marital sexual debut. The finding suggests the need for communicating and supporting school students to help them make informed and safer decisions on their sexual behavior. Therefore, Bahir dar city administration health and education bureau should design persistent and effective health education to decrease pre-marital sexual debut in unmarried female students.
KeywordsSexual debut Youth Unmarried female students
In Ethiopia, about 16% of unmarried female youth reported sexual debut . Of which 24.6% had two or more sexual partners but only 10% of them used condom during sexual intercourse . In Amhara region, where the study was conducted, pre-marital sexual debut was reported as early as 12 to 13 years [2, 3]. It is not uncommon for female students to establish sexual networks with local businessmen and uniformed men in return for money and gifts [2, 3].
Bahir dar town has a wide range of high-risk groups including Female sex workers, University students, high school students and migrant workers. Cross-generational and transactional sex between young girls and older men is the common practice in the town. High school girls also have sex with older men in return for gifts and money .
Female youth who have begin pre-marital sexual debut earlier appear more likely to have sex with high risk partners or multiple partners and are less likely to use condom and other contraceptives . Therefore, they are vulnerable to sexually transmitted infections including HIV/AIDS and unwanted pregnancy [6, 7].
Unwanted pregnancy may be associated with greater likelihood of early motherhood, unsafe abortion, and other pregnancy related complications. These events in turn, increase risk of morbidity and mortality both in the mother and the child. Furthermore, early motherhood tends to impede female students academic performance, and eventually dropout from school. It often results in reducing their economic opportunity .
Different studies identified inconsistent factors of pre-marital sexual debut. These factors include pear pressure, Living arrangement, age of students, religiosity, school performance, having pocket money, substance use, watching pornographic video, place of family residence and parental educational status [3, 9–24].
Although HIV/AIDS affects all segments of the population, young people were largely affected by this disease and young females were largely affected than young males . In Ethiopia according to antenatal care sentinel surveillance (ANC), the prevalence of HIV/AIDS among young people of age 15–24 years was 2.6%; specially Bahir dar town had the highest reported HIV prevalence rate .
Pre-marital sexual debut has the above serious immediate and long term consequences to female students in the contexts where the practice is widely condemned. Furthermore, there is double standard cultural expectations of virginity at marriage for females while lesser cultural pressure on males. However studies on magnitude of pre-marital sexual debut and its associated factors are scarce. Thus, this study was conducted with the objective of assessing the extent of pre-marital sexual debut and the factors associated with it among unmarried high female school students.
School based cross-sectional survey was conducted in Bahir Dar town from May 10-13/2012. The town is the capital city of Amhara National Regional State, located 564 km northwest of Addis Ababa (capital city of Ethiopia). In Ethiopia, high school includes education from the ninth to the twelfth grade. In Bahir dar town there were three high schools with a total of 3984 students during the time of the study. Of which 1845 were females and 1773 were unmarried females.
The required sample size of the study was calculated using single population proportion formula by considering the following assumption: a 95% confidence level, 5% marginal error, 44% proportion of pre-marital sexual debut , consider high non response rate because the topic is sensitive issue (18% non response rate) and 2.5 design effect. The final sample size was 1123 students.
Study participants were unmarried female students selected from the three high schools. Students were selected using multi stage sampling technique and probability proportionate to size of the students from each school. List of sections from each school used as a sampling frame. Sample sections were selected randomly using simple random sampling technique. Students from each section were selected again using lottery method from list of students in each selected section. The usual age range of students enrolled in Ethiopia high school is 15 to 24 years, however, in some instances; students could be younger or older than this age range. For this study, students who were not within this age range were ineligible and did not participate in the study.
Data were collected by adapted , pretested structured facilitator guided self administered questionnaire. The questionnaire was developed in English then translated in to Amharic (local language) then back to English to check consistency. Data were collected from all students selected from one school simultaneously in one day to overcome information contamination. Data collection facilitators and supervisors were recruited and trained. They helped in seating students in the classrooms designated for completing the survey and provided explanation on the study procedures and tools. They also ensured complete privacy during completing the questionnaire.
The dependent variable was pre-marital sexual début; it refers first penetrating heterosexual intercourse. While the independent variables were socio-demographic characteristics of respondents, school related and parental factors. Peer pressure in this study is presence of peer who started pre-marital sexual debut and encourage inexperienced female students to experiment it.
Data were cleaned, coded and entered on to EPi-Info version 3.5.2 Statistical package soft ware. Data were exported to SPSS version 16 program for analysis. Proportion of reported pre-marital sexual debut was computed. Logistic regression was used to control confounding effects. P value ≤ 0.2 was taken as a cut-off point for selecting variables for the logistic regression model. Residence, age, watching pornographic video, frequency of watching pornographic video, peer pressure, frequency of attained religious service, average mark, chewing khat, respondents currently living arrangement, pocket money, and religion were included in the final adjusted model. The model was built with backward elimination to avoid multicollinearity. P-values less than 0.05 was considered statistical significant. Education about disadvantage of pre-marital sex was given. Incentive in terms of money was not given for the participants.
The study was conducted after securing ethical approval of Institutional Review Committee of Gondar University. Written permission to conduct the study in the selected schools was obtained from the Regional Education Bureau. An informed consent was secured from each participant. The confidentiality was maintained throughout the study by excluding personal identifiers from the data collection form.
Socio-demographic characteristics of unmarried high school female students in Bahir Dar town, from May 10-13/2012
Frequency (n = 1093)
Attending religious service
3 or more times a week
Not at all
Had pocket money
Had no pocket money
Respondents currently live with
Parental place of residence
About 337 (30.8%) of unmarried female students reported having sexual debut. The mean age of sexual debut was 16.46 ± 1.43 years. The minimum age of sexual debut was 13 years and maximum age of sexual debut was 24 years.
Pre-marital sexual debut of unmarried high school female students in Bahir Dar town, from May 10-13/2012
Start pre-marital sexual debut (n = 1093)
Number of sexual partner (n = 337)
Three or more
Use of condom (n = 337)
Frequency of condom use (n = 216)
History of pregnancy (n = 337)
History of abortion (n = 82)
No (give birth)
Factors associated with pre-marital sexual debut among high school female students in Bahir Dar town, from May 10-13/2012
COR (95% C/I)
AOR (95% C/I)
16- 18 years
Frequency of watching pornographic video
≥2 times a week
≤ one times a week
Students chewing khat
Frequency of attained religious service
≥ 2 times a week
The logistic regression analysis showed that pre-marital sexual debut was more likely to occur among students chewing khat [AOR = 8.99, 95% CI: (3.84, 21.06)], watching pornographic video [AOR = 10.15, 95% CI: (6.63, 15.53)] and those had peer started pre-marital sexual debut [AOR = 2.98, 95% CI: (1.57, 5.67)]. Students those attained religious services two or more times a week were five times less likely to practice pre-marital sexual debut than those attained the service less than two times a week [AOR = 0.50, 95% CI: (0.28, 0.89)] (Table 3).
Pre-marital sexual debut predispose students to sexually transmitted infections including HIV and unwanted pregnancy . In spite of this fact, 30.8% of unmarried high school female students have initiated pre-marital sexual debut. This finding was similar with a study conducted in Gondar preparatory school . On the other hand, It was relatively higher than studies done in high school students of Addis Ababa, Jimma, Eastern Ethiopia and Rural South Africa [11, 17, 31, 32]. This difference might be due to the time gap between the studies, advancement of technology that enhance watching pornographic video and substance use (khat, alcohol, cigarette] which might increase the probability to be engaged in pre-marital sexual activities .
Age of respondents was associated with pre-marital sexual debut; those students whose age >18 years were 2 times more likely to start pre-marital sex compared to students age <18 years [AOR = 2.13, 95% CI: (1.40, 3.25)]. This finding is in agreement with study conducted in Rural South Africa, China, Jamaica and India [9, 11, 17, 34]. The age difference for pre-marital sexual debut in this study might be older (>18 years) youth might have stay sexually mature for a long period of time. Exposure to sexual risk factors for a prolonged period would be encourage to start pre-marital sexual debut .
Watching pornographic video is a risk factor for pre-marital sexual debut . In this study, frequency of watching pornographic video was associated with pre-marital sexual debut; students who watch pornographic video two or more times a week were 10 times more likely to start pre-marital sexual debut than those watching one or less times a week [AOR = 10.15, 95% CI: (6.63,15.53)]. This finding is similar with studies in high school students of North East Ethiopia and Singapore [36, 37]. Similarly, chewing khat is statistically associated with pre-marital sexual debut. Students who chewing khat were 9 times more likely to start pre-marital sexual debut compared to their counterparts [AOR = 8.99, 95% CI: (3.84, 21.06)]. This finding was supported by the studies in students of North East Ethiopia and in-school and out- of -school students in Ethiopia [16, 37]. It may reason out as; most of the time after chewing khat, they drink alcohol . Drinking alcohol decrease self control and predispose to risky behavior such as sexual intercourse [39–41].
Peer pressure was associated with pre-marital sexual debut. Youth who had peer pressure were three times more likely to initiate pre-marital sexual debut than their counterparts [AOR = 2.98, 95% CI = (1.57, 5.67)]. This finding was in line with other similar studies [9, 11, 32]; Possibly it might be; easier to discuss sensitive issues such as sexuality with peers than family members . This discussion plays a significant role in influencing views, attitudes and sexual behavior of inexperienced youth to start pre-marital sexual debut .
Strength of the study
High response rate, large sample size, sampling procedure and analysis methods utilized were appropriate to the study and considered as the strength of the study. The study provides useful information that will inform policy makers to design a strategy to increase number of unmarried female students who refrain from pre-marital sexual debut.
Limitations of the study
This study was based on cross-sectional survey; causality cannot be inferred from our findings. Relies on self response for sensitive issues can invite social desirability bias and therefore underestimate prevalence of pre-marital sexual debut. The study was school based; therefore precludes generalization to all youths in Ethiopia indicating a need for further study using a more representative sample of youths in the country.
In the study area significant number (30.8%) of unmarried high school female students practiced pre-marital sexual debut. Predominant factors associated with pre-marital sexual debut were peer pressure, age greater than 18 years, substance use like chewing khat and watching pornographic video.
The finding suggests the need for communicating and supporting school students to help them make informed and safer decisions on their social and sexual behaviors. Therefore, Bahir dar city administration health and education bureau should design persistent and effective health education to decrease pre-marital sexual debut in unmarried female students.
YM: BSC, MPH; I am working in Bahir Dar University, College of Medicine and Health Sciences, Bahir Dar, Ethiopia. YB: MD, MPH, PhD, Professor of Epidemiology and Public Health. Currently I am working in Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
The authors are indebted to Addis Continental Institution of Public Health for its support to undertake this research. We would like to thank students who participated in this study and provided valuable information with their full cooperation.
- Wouhabe M: Sexual behaviour, knowledge and awareness of related reproductive health issues among single youth in Ethiopia. Afr J Reprod Health. 2007, 11 (1): 14-21.PubMedGoogle Scholar
- Habte D: Assessment of the Distribution of At-risk Populations and HIV/AIDS Referral Services in Ethiopia: Baseline Assessment for Mobile HIV Counseling and Testing Program in Amhara Region. 2008, Bethesda: MD Private Sector Program-Ethiopia, Abt Associates IncGoogle Scholar
- Deribew A: Distribution of most at risk population group and their perception towards HIV/AIDS: a baseline survey in amhara region for the implementation of mobile HIV counseling and testing. 2009, Bethesda, MD: Private Sector Program-Ethiopia, Abt Associates Inc.Google Scholar
- Yilma M: Identifying at risk populations and HIV/AIDS referral services: baseline assessment for mobile counseling and testing program in the amhara region of Ethiopia. 2007, Bethesda, MD: Private Sector Program (PSP)-Ethiopia project, Abt Associates IncGoogle Scholar
- Michelle J, Adesegun O: Adolescent sexual and reproductive health in developing countries: an overview of trends and interventions. Int Perspect Sex Reprod Health. 2009, 35 (2): 58-10.1363/3505809.View ArticleGoogle Scholar
- Ruth D-M: International technical guidance on sexuality education. Stud Fam Plan. 2009, 41 (2): 159-162.Google Scholar
- BlessingUchenna M: Protection before the harm: the case of condom use at the onset of premarital sexual relationship among youths in Nigeria. Afr Popul Stud. 2008, 23 (1): 57-83.Google Scholar
- Barbara S, Wesley H, Cynthia B, Annabel S: Premarital sex, schoolgirl pregnancy, and school quality in rural Kenya. Stud Fam Plann. 2001, 32 (4): 285-301. 10.1111/j.1728-4465.2001.00285.x.View ArticleGoogle Scholar
- Hong Y, Li L, Yongyi B, Xunyu X, Shiyue L, Jay E: Family and peer influences on sexual behavior among female college students in Wuhan. Chin Women Health. 2010, 50 (8): 767-782. 10.1080/03630242.2010.530926.View ArticleGoogle Scholar
- Assefa S, Dessalegn W: Premarital sexual practice among school adolescents in Nekemte Town. East Wollega Ethiop J Health Dev. 2008, 22 (2): 169-Google Scholar
- Amsale C, Yemane B: Peer pressure is the prime driver of risky sexual behaviors among school adolescents in Addis Ababa. Ethiopia World J AIDS. 2012, 2: 159-164. 10.4236/wja.2012.23021.View ArticleGoogle Scholar
- Lawrence D, Rose T: Sexual initiation and contraceptive use among female adolescents in Kenya. Afr J Health Sci. 2007, 14 (1–2): 1-13.Google Scholar
- Olaniyi JE, Joana D-S, Michele R, Inmaculada CA, Laura HB, Mirjam-Colette K, John E, Pauline EJ: Initiation of heterosesexual activity among adolescents in rural Jamaica: the influence of family factors. J Educ Soc Dev. 2007, 1 (2): ISSN 1934–7200Google Scholar
- Alice L, Peter K, Richard AJ, Chomnad M, Philip AM, Supaporn J, Wat U, Fritsvan G: Sexual initiation, substance use, and sexual behavior and knowledge among vocational students In Northern Thailand. Int Fam Plan Perspect. 2006, 32 (3): 126-135. 10.1363/3212606.View ArticleGoogle Scholar
- Yi S, Poudel KC, Yasuoka J, Palmer PH, Yi S, Jimba M: Role of risk and protective factors in risky sexual behavior among high school students in Cambodia. BMC Public Health. 2010, 10: 477-10.1186/1471-2458-10-477.View ArticlePubMedPubMed CentralGoogle Scholar
- Frehiwot B, Yigeremu A, Reta A, Wuleta L, Tamrat A, Tewodros G: Khat and alcohol use and risky sex behaviour among in-school and out-of-school youth in Ethiopia. BMC Public Health. 2005, 5 (109): doi:110.1186/1471-2458-1185-1109Google Scholar
- Dlamini S: Gender factors associated with sexual abstinent behaviour of rural South African high school going youth in KwaZulu-Natal: South Africa. Oxford J. 2008, 24 (3): 450-460.Google Scholar
- Thabo T: The connection between poverty, sexual activity, knowledge about HIV/AIDS and willingness to test for HIV infection among young people. Eur J Soc Sci. 2010, 15 (1): 118-123.Google Scholar
- Monica A, Abbey L, Peggy C, Wendy D: Parenting and adolescents’ sexual initiation. J Marriage Fam. 2009, 71 (4): 969-982. 10.1111/j.1741-3737.2009.00647.x.View ArticleGoogle Scholar
- Peter B, Elizabeth O: Parental influence on adolescents sexual behaviour in Ibadan North local government area of Oyo State, Nigeria. Int J Afri Afri Am Stud. 2006, v (1): 41-55.Google Scholar
- Oladepo O, Fayemi MM: Perceptions about sexual abstinence and knowledge of HIV/AIDS prevention among inschool adolescents in a western Nigerian city. BMC Public Health. 2011, 11 (304): 1-10.Google Scholar
- Kazhila C, Choshi D, Cornelia N: Prevalence, distribution and behavioral determinants of coital activity among High School students in Namibia: a cross-sectional study. J Pub Health Epidemiol. 2011, 3 (7): 308-316.Google Scholar
- Kazaura M, Masatu M: Sexual practices among unmarried adolescents in Tanzania. BMC Public Health. 2009, 9 (373): doi:10.1186/1471-2458-1189-1373Google Scholar
- Habte D: Assessment of the Distribution of At-risk Populations and HIV/AIDS Referral Services in Ethiopia: Baseline Assessment for Mobile HIV Counseling and Testing Program in Oromia Region. 2008, Bethesda, MD: Private Sector Program-Ethiopia, Abt Associates IncGoogle Scholar
- WHO/UNICE: Global consultation on strengthening the health sector response to care, support. 2006, Blantyre Malawi: Treatment and Prevention for Young People Living with HIVGoogle Scholar
- Federal Democratic Republic of Ethiopia: Country Progress Report on HIV/AIDS Response. 2012, Addis Ababa Ethiopia,http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/GAP%20Report%202012.pdf,Google Scholar
- Amare M: Gender differentials in adolescent sexual activity and reproductive health risks in bahir Dar town. 2008, Addis Ababa University ThesisGoogle Scholar
- Central Statistical Agency [Ethiopia]and ICFInternational: Ethiopia demographic and health survey 2011. 2012, Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF InternationalGoogle Scholar
- John S, Mary A, Maureen L, Jennifer R, Daniel S, Rebecca S: Abstinence and abstinence-only education: a review of U.S. policies and programs. J Adolesc Health. 2006, 38: 72-81. 10.1016/j.jadohealth.2005.10.006.View ArticleGoogle Scholar
- Shiferaw Y, Alemu A, Girma A, Getahun A, Kassa A, Gashaw A, Alemu A, Teklu T, Gelaw B: Assessment of knowledge, attitude and risk behaviors towards HIV/AIDS and other sexual transmitted infection among preparatory students of Gondar town, north west Ethiopia. BMC Res Notes. 2011, 4: 505-10.1186/1756-0500-4-505.View ArticlePubMedPubMed CentralGoogle Scholar
- Tadesse A, Teklebrehan T: Knowledge and practice on emergency contraception among high school students of jimma university community high school, jimma, south west Ethiopia. Ethiop J Reprod Health. 2009, 3 (1): 31-36.Google Scholar
- Oljira L, Berhane Y, Worku A: Pre-marital sexual debut and its associated factors among in-school adolescents in eastern Ethiopia. BMC Public Health. 2012, 12: 375-10.1186/1471-2458-12-375.View ArticlePubMedPubMed CentralGoogle Scholar
- Eric WO, Richard JB, Jill CM, Rory CR: The impact of internet pornography on adolescents: a review of the research. Sex Addict Compuls J Treat Prev. 2012, 19 (1–2): 99-122.Google Scholar
- George C, Alary M, Otis J: Correlates of sexual activity and inconsistent condom use among high-school girls in Dominica. West Indian Med J. 2007, 56 (5): 443-448.Google Scholar
- Kabiru CW, Orpinas P: Factors associated with sexual activity among high-school students in Nairobi, Kenya. J Adolesc. 2008, 1-17. doi:10.1016/j.adolescence.2008.1008.1001Google Scholar
- Mee-Lian W, Roy K-WC, David K, Hiok-Hee T, Fong-Seng L, Shanta E, George B: Premarital sexual intercourse among adolescents in an Asian country: multilevel ecological factors. Pediatrics. 2009, 124 (1): 44-52. 10.1542/peds.2008-2954.View ArticleGoogle Scholar
- Fekadu M, Alemayehu W: Age at sexual initiation and factors associated with it among youths in North East Ethiopia. Ethiop J Health Dev. 2009, 23 (2): 154-162.Google Scholar
- Heather D, Merali B, Nicholas L: The health impacts of khat: a qualitative study among Somali-Australians. Med J. 2011, 195 (11): 666-669.Google Scholar
- Dawit A, Asfaw D, Amare D, Ambaye D, Almaz A, Kelbessa UK: Khat chewing habit as a possible risk behaviour for HIV infection: a case–control study. Ethiop J Health Dev. 2005, 19 (3): 174-181.Google Scholar
- Glenice C, Hagen R: Adverse effects of khat: a review. Adv Psychiatr Treat. 2003, 9: 456-463. 10.1192/apt.9.6.456.View ArticleGoogle Scholar
- Tilahun M, Ayele A: Factors associated with KHAT use and age at first initiation among youths in southern. Ethiopia Sci J Public Health. 2013, 1 (3): 113-118. 10.11648/j.sjph.20130103.11.View ArticleGoogle Scholar
- Desalegn G, Mesganaw F: Assessing communication on sexual and reproductive health issues among high school students with their parents, Bullen Woreda, Benishangul Gumuz Region. North West Ethiop Ethiop J Health Dev. 2010, 24 (2): 89-95.Google Scholar
- Bastien S, Kajula L, Muhwezi W: A review of studies of parent–child communication about sexuality and HIV/AIDS in sub-Saharan Africa. Reprod Health J. 2011, 8 (25): 1-17.Google Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.