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Multilevel influences of women’s empowerment and economic resources on risky sexual behaviour among young women in Zomba district, Malawi

Published online by Cambridge University Press:  20 October 2020

Melissa Ward-Peterson Open the ORCID record for Melissa Ward-Peterson [Opens in a new window] ,
Kristopher Fennie ,
Sarah Baird ,
Stefany Coxe ,
Mary Jo Trepka  and
Purnima Madhivanan
Melissa Ward-Peterson*
Affiliation:
Community-Based Research Institute, Florida International University, Miami, FL, USA
Kristopher Fennie
Affiliation:
Division of Natural Sciences, New College of Florida, Sarasota, FL, USA
Sarah Baird
Affiliation:
Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
Stefany Coxe
Affiliation:
Department of Psychology, School of Integrated Science and Humanity, College of Arts, Sciences, and Education, Florida International University, Miami, FL, USA
Mary Jo Trepka
Affiliation:
Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
Purnima Madhivanan
Affiliation:
Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA Public Health Research Institute of India, Mysore, India
*
*Corresponding author. Email: [email protected]
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Abstract

Gender disparities are pronounced in Zomba district, Malawi. Among women aged 15–49 years, HIV prevalence is 16.8%, compared with 9.3% among men of the same age. Complex structural factors are associated with risky sexual behaviour leading to HIV infection. This study’s objective was to explore associations between multilevel measures of economic resources and women’s empowerment with risky sexual behaviour among young women in Zomba. Four measures of risky sexual behaviour were examined: ever had sex, condom use and two indices measuring age during sexual activity and partner history. Multilevel regression models and regression models with cluster-robust standard errors were used to estimate associations, stratified by school enrolment status. Among the schoolgirl stratum, the percentage of girls enrolled in school at the community level had protective associations with ever having sex (OR = 0.76; 95% CI: 0.60, 0.96) and condom use (OR = 1.06; 95% CI: 1.01, 1.11). Belief in the right to refuse sex was protective against ever having sex (OR = 0.76; 95% CI: 0.60, 0.96). Participants from households with no secondary school education had higher odds of ever having sex (OR = 1.59; 95% CI: 1.14, 2.22). Among the dropout stratum, participants who had not achieved a secondary school level of education had riskier Age Factor and Partner History Factor scores (β = 0.51; 95% CI: 0.23, 0.79, and β = 0.24; 95% CI: 0.07, 0.41, respectively). Participants from households without a secondary school level of education had riskier Age Factor scores (β = 0.26; 95% CI: 0.03, 0.48). Across strata, the most consistent variables associated with risky sexual behaviour were those related to education, including girl’s level of education, highest level of education of her household of origin and the community percentage of girls enrolled in school. These results suggest that programmes seeking to reduce risky sexual behaviour among young women in Malawi should consider the role of improving access to education at multiple levels.

Keywords

Risky sexual behaviourEconomic resourcesWomen’s empowerment
Type
Research Article
Information
Journal of Biosocial Science , Volume 53 , Issue 6 , November 2021 , pp. 887 - 907
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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