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Sexual & Reproductive Healthcare (2014)

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Sexual & Reproductive Healthcare

j o u r n a l h o m e p a g e : w w w. s r h c j o u r n a l . o r g

Premarital sexual activity among unmarried adolescents in northern

Ethiopia: a cross-sectional study
Nigussie Ahmedin Salih a, Henok Metaferia b, Ayalu A. Reda c,d, Sibhatu Biadgilign e,*
a

Bureau of Finance & Economic Development, Population Affairs Core Process, Bahir Dar, Ethiopia
School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
Global Health, Brown Advanced Research Institutes (BIARI), Brown University, Providence, Rhode Island, USA
d Department of Sociology, Brown University, Providence, Rhode Island, USA
e
Department of Epidemiology and Biostatistics, College of Public Health and Medical Science, Jimma University, Jimma, Ethiopia
b
c

A R T I C L E

I N F O

Article history:
Received 31 January 2014
Received in revised form 3 June 2014
Accepted 11 June 2014
Keywords:
Premarital
Sexual
Adolescent
Students
Ethiopia

A B S T R A C T

Background: Sexual activity can expose adolescents to the risks of unintended pregnancy, unsafe abortion and sexually transmitted infections including HIV/AIDS. This risk is magnied for girls. The objective of the study is to determine the magnitude and correlates of premarital sexual activity among unmarried
female adolescents in northern Ethiopia.
Methods: The study employed a cross sectional study design conducted at comprehensive secondary school
among unmarried female adolescents in Maichew town, northern Ethiopia. A pre-tested structured questionnaire was used for data collection. Data were analyzed using descriptive statistics and multivariable
logistic regression.
Results: A total of 624 secondary and preparatory school never married female adolescents were included in this study. About 183 (29.3%) reported to have started sexual intercourse. Mean age at rst
sexual intercourse was 16.6 years (SD 1.81). About 38% of the girls reported that they had used condom
at their last sexual activity. In multivariable analysis, older age, living with parents, parental residence,
elder sister or friends who had started premarital sexual activity, and peer inuence, were independently associated with sexual initiation.
Conclusions: The study of this nding clearly demonstrated that rural adolescents initiate sexual activity early with limited protection from infections and unintended pregnancies. Community and school
based sexual health education is recommended.
2014 Elsevier B.V. All rights reserved.

Introduction
The World Health Organization (WHO) denes an adolescent as
a young person between the ages of 10 and 19 years; and adolescence, the stage that involves appearance of secondary sexual characteristics to sexual and reproductive maturity, and transition from
total socioeconomic dependence to relative independence [1]. Adolescents are a growing and larger segment of the population of developing countries. Of an estimated 1.2 billion young people in the
world, 85% live in developing countries [2]. A signicant number
of adolescents all over the world are sexually active and an increasing proportion of their sexual activity is occurring outside marriage [3,4]. Similarly, several studies in sub-Saharan Africa have
documented high and increasing premarital sexual activity among

* Corresponding author. Tel.: +251911305011.

E-mail address: sibhatu2005@yahoo.com (S. Biadgilign).

adolescents [5]. Research reports indicate that young women are

increasingly becoming sexually active at an early age, increasing the
risks of unplanned pregnancy and exposure to HIV infections [4,6,7].
Similarly, in Ethiopia adolescents engage in premarital sexual relationship before marriage or earlier [8,9]. Studies have shown that
36.1% of in school female adolescents in Woreta town, and 12.6%
of school female adolescents in Addis Ababa had experienced sexual
intercourse [10,11]. Young persons relative lack of experience in
sexual and reproductive health matters and the cultural stigma attached to their sexual activity creates vulnerability [12,13].
Early sexual activity can expose girls to the risks of unintended
pregnancy, and sexually transmitted infections including HIV/
AIDS. Reports indicate that young women initiate sexual activity at
an earlier age compared with boys due to factors such as cultural
norms, peer pressure and economic pressure [14,15] or a combination thereof. In Ethiopia, only few studies have documented the
sexual behavior of rural girls. The objective of this study is to investigate premarital sexual activity among unmarried female adolescents in Maichew Town, northern Ethiopia.

http://dx.doi.org/10.1016/j.srhc.2014.06.004
1877-5756/ 2014 Elsevier B.V. All rights reserved.

Please cite this article in press as: Nigussie Ahmedin Salih, Henok Metaferia, Ayalu A. Reda, Sibhatu Biadgilign, Premarital sexual activity among unmarried adolescents
in northern Ethiopia: a cross-sectional study, Sexual & Reproductive Healthcare (2014), doi: 10.1016/j.srhc.2014.06.004

ARTICLE IN PRESS
N.A. Salih et al./Sexual & Reproductive Healthcare (2014)

Methods
Study setting and population
The study area, Maichew, is the capital of Southern Tigray province of Tigray region, northern Ethiopia. It is found at 662 km north
of Addis Ababa along the main highway to Mekele. The population of Maichew town was 23,484 in the 2007 census, of which
11,057 and 12,427 were males and females respectively [16]. In the
town there are six primary schools (Grade 18), one Secondary
School, four colleges including the two private colleges. The population of this study included unmarried female adolescents in the
age range of 1520 years.
Study design
A cross-sectional study design method was employed. The sample
size of the study was determined using the formula for estimation of a single population proportion [17]. We assumed the proportion of female adolescents who had sexual activities before
marriage as 50% since we did not have information regarding the
extent of the problem, with corresponding to 95% condence level,
and a margin of error of 0.04. The resulting sample size was 600.
A 5% contingency was added for non-response, providing an overall
sample size of 630. The study was conducted in January 2008.
Sampling technique/procedure
A probability sampling method was used for the selection of the
study participants. To ensure that each grade level (Grade 9, Grade
10, Grade 11 and Grade 12) is adequately represented in the sample,
proportional stratied random sampling method was employed. Accordingly, in the school the total female students were initially stratied in to four groups (strata): Grade 9, Grade 10, Grade 11 and Grade
12 female students. Then the total sample size of the study subjects was distributed to each strata using probability proportional
to their size (PPS). Subsequently a sampling frame containing list
of female students, was prepared from enrolment list of students
which was obtained from school records. Finally, systematic random
sampling method was used to select respondents with a sampling
interval of three from the list of female students in each stratum.
Thus, 259 unmarried female students from Grade 9; 183 from Grade
10; 67 from Grade 11; and 121 from Grade 12 were randomly
selected.

tionnaire Moreover, conducive environment and adequate time was

arranged for participants in order to avoid hurried responses. During
the actual data collection, the principal investigator checked the activities of each data collector in the school. The necessary feedback was also offered to the data collectors.
Data management and analysis
After data collection, each questionnaire was checked visually
for completeness. Data were entered, cleaned, and coded using SPSS
version 16. Descriptive analysis was used to describe the prole of
the respondents parental characteristics, individual characteristics, exposure related factors, and sexual activities of the respondents. Bivariate analysis was used to assess the relationship of several
independent variables with the dependent variable by using chisquare test. Multivariable analysis using a binary logistic regression model was used to measure the degree of the risk of attributes
to each factor and controlling possible intervening variables.
Ethical considerations
Ethical clearance was obtained from the Institute of Population Studies of Addis Ababa University. Furthermore, relevant administrative permission to execute the study was obtained from the
education bureau of the district. After explaining the purpose of the
study, verbal consent was asked from all participants prior to their
participation in this study. Furthermore, the respondents were informed that their participation in the study is voluntary and that
they would not be obligated to provide answers to any question (s)
with which they are uncomfortable.
Result
Socio-demographic characteristics of the study subject
A total of 624 secondary (9th and 10th grade class) and preparatory (11th and 12th grade are considered as college preparatory) school female adolescents were included in this study giving a
response rate of 95%. The age range of the sample was 5 (1520
years), where 93.8% lay in the age range of 1519. The mean age
of the respondents was 17.2 years. About 41% and 29.2% of respondents were attending grade 9 and grade 10, respectively. Table 1
displays the background characteristics of the respondents.
Sexual activities of unmarried female adolescents

Data collection and procedures

The questionnaire was translated from English to Tigrigna. Prior
to the start of the eldwork, the questionnaire was pre-tested among
20 respondents outside the study area. After pre-testing of the questionnaire was completed, the researcher modied some questions
(clarity, and wording of items) based on feedback from the pretest. Ten female data collectors who completed Grade 10; and who
could speak both Amharic and Tigrigna uently were recruited. Data
collectors were given two days intensive training before the actual
work about the aim of the study, research procedures, data collection technique, content of the questionnaire (by going through each
question of the questionnaire) and clarication was given on each
question to the data collectors.
The administration of the questionnaire was done with the help
of 10 data collectors. Before distribution of the questionnaire, the
objective of the study was explained clearly to the respondents. The
consent of each respondent was asked by the data collectors and
sucient time was given to contemplate on the implication of the
item and provide accurate information. The respondents congregated in different classrooms of the school to complete the ques-

Out of the total 624 sample never married female adolescents,

29.3% (183) reported to have started sexual intercourse. The age
range of the respondents at rst sexual activity was 1420 years,
respectively. Mean age at rst sexual intercourse was 16.6 years
(SD 1.81).
Among the respondents who had started sexual activity, 50.3%
initiated sexual activity while they were between the ages of 14 and
16 years, whereas 49.7% initiated sexual activity between the ages
of 17 and 20 years. With regard to rst sexual partners of respondents, 32.8% and 20.2% of adolescents reported they had rst sexual
intercourse with their boyfriend and anc, respectively (Table 2).
The most important reason for the rst sexual intercourse of the
respondents was to get married (33.9%), 29.5% due to love (29.5%),
9.3% to get money (9.3%) or coercion (10.5%).
The mean age of respondents rst sexual partner at the time
of their rst sexual activity was 22.2 years with standard deviation of 4 years. The majority of respondents (83.1%) had experienced sexual activity with only one partner. The rest 10.9% and 6%
of girls had experienced sexual activity with two (10.9%), and three
or more partners (6%). Girls who had sexual intercourse were also

Please cite this article in press as: Nigussie Ahmedin Salih, Henok Metaferia, Ayalu A. Reda, Sibhatu Biadgilign, Premarital sexual activity among unmarried adolescents
in northern Ethiopia: a cross-sectional study, Sexual & Reproductive Healthcare (2014), doi: 10.1016/j.srhc.2014.06.004

ARTICLE IN PRESS
N.A. Salih et al./Sexual & Reproductive Healthcare (2014)

Table 1
Percentage distributions of respondents parents by background characteristics,
Maichew Town, 2008.
Characteristics
Parental residence
Rural
Urban
Mothers education
No schooling
Primary (Grade 18)
Secondary or above
Fathers education
No schooling
Primary (Grade 18)
Secondary or above
Mothers occupation
Housewife
Employed(government or private)
Others (farmers)
Household Income
Less than Birr 500 per month
Birr 5001000 per month
More than Birr 1000 per month
Living arrangement
Intact
Non-intact

Number
(n = 624)

Percentage
(%)

307
317

49.2
50.8

497
44
83

79.6
7.1
13.3

427
85
112

68.4
13.6
17.9

278
171
175

44.6
27.4
28

347
186
91

55.6
29.8
14.6

328
296

52.6
47.4

asked whether they used condom at their last sexual activity or not.
About 38% reported that they had used condom at their last sexual
activity.
Factor associated with pre-marital sexual debut
In bivariate analysis, older age (OR 3.04; 95% CI: 2.12,4.35),
mothers with elementary education (OR = 1.92; 95% CI: 1.08
3.45), adolescents living alone (OR 2.34; 95% CI: 1.254.35), having
parents with rural residence (OR 1.75; 95%CI: 1.232.5), history of
communication on sexuality with parents (OR 2.08; 95% CI: 1.47
3.03), having an older sister who had started sexual activity before
marriage (OR 3.34; 95% CI: 2.274.76), having biological parents who
live together (OR 1.45; 95% CI: 1.022.04), having friends who had
started sexual activity before marriage (OR 4.35; 95% CI : 2.94
6.25), and perceived peer pressure to have sexual activity (OR 4.76;
95% CI: 3.037.14) were strongly associated with sexual initiation
(Table 3).
In multivariable analysis, older age (OR 2.94; 95% CI: 1.94
4.45), parents living in rural areas (OR 1.92; 95%CI: 1.282.94), communication about sexual matters with parents (OR 2.08; 95% CI :
1.373.12); having an elder sister who started sexual activity before
marriage (OR 2.85; 95% CI: 1.854.35), having friends who started
sexual activity before marriage (OR 3.22; 95% CI: 2.084.76) and close
friends ever encouraged them to have sexual activity (OR 2.85; 95%
CI: 1.784.76) were independently associated with female adolescents sexual practice (Table 3).
Discussions
The objective of this study was to investigate premarital sexual
practice among school female adolescents in northern Ethiopia.
Socio-economic and demographic characteristics of respondents, and
their family and social environment had signicant association with
premarital sexual activity.
Out of the total 624 sample never married female adolescents,
29.3% reported to have started sexual intercourse. The age range of
respondents at rst sexual activity was 1420 years, respectively.
Mean age at rst sexual intercourse was 16.6 years (SD 1.81). A study
from eastern Ethiopia reported that, 14.7% of never married in-

school female adolescent respondents reported pre-marital sexual

debut [18]. These gures were 17.8% in Addis Ababa high schools
[19] and 21.5% in western Ethiopia [20].
Age was one of the factors associated with premarital sexual
debut in this study. The association between age and premarital
sexual activity is well established. In a study form western Ethiopia, an age of less than 18 years was found to be protective against
premarital sexual practice [20] and others similarly reported that
older age was associated with a higher likelihood of having had
sexual activity and a higher lifetime number of partners for females
[21]. This signies consistency of ndings elsewhere regarding the
increasing odds of sexual intercourse initiation as adolescents approach sexual maturity and adulthood.
In this study, adolescents whose parents lived in rural areas had
higher odds of having had sexual activity as compared with their
counterparts whose parents lived in urban areas. This may be because
adolescents from rural areas had less access to appropriate

Table 2
Percentage distribution of respondents sexual behavior, Maichew Town, 2008.
Characteristics
Sexual experience (N = 624)
Ever had sexual activities
Never had sexual activities
Age at rst sexual activities (N = 183)
1416 years
1720 years
Sexual partners (N = 183)
Boy friend
Fianc
Others
Age of sexual partners (N = 183)
<20 years
2030 years
>30 years
Number of life time sexual partners (N = 183)
One
More than one
Major reason for involving into rst sexual
intercourse(N = 183)
To get married
Due to love
To get money
Forced or rape
Other reason
Used condom at last sexual intercourse
(N = 183)
Yes
No
Major reason for not having sexual intercourse
(N = 441)
Fear of HIV/AIDS
Religious reason
Want to wait until marriage
Not getting the right partner
Fear of parents
Other reasons
Attitudes towards premarital sexual
intercourse (N = 624) (A girl should
be virgin until marriage)
Agree
Disagree
It depends
Ever been pregnant (N = 183)
Yes
No
Ever had induced abortion (N = 183)
Yes
No
Ever had given birth (N = 183)
Yes
No

Number
(n = 624)

Percentage
(%)

183
441

29.3
70.7

92
91

50.3
49.7

60
37
86

32.8
20.2
47

48
130
5

26.2
71
2.7

152
31

83.1
16.9

62
54
17
21
29

33.9
29.5
9.3
11.5
15.8

70
113

38.3
61.7

46
30
307
23
6
29

10.4
6.8
69.6
5.2
1.4
6.6

477
36
111

76.4
5.8
17.8

79
104

43.2
56.8

46
137

25.1
74.9

30
153

16.4
83.6

Please cite this article in press as: Nigussie Ahmedin Salih, Henok Metaferia, Ayalu A. Reda, Sibhatu Biadgilign, Premarital sexual activity among unmarried adolescents
in northern Ethiopia: a cross-sectional study, Sexual & Reproductive Healthcare (2014), doi: 10.1016/j.srhc.2014.06.004

ARTICLE IN PRESS
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Table 3
Final logistic regression model that predict ever had pre-marital sexual debut in Maichew Town, 2008.
Variables

Age of the respondents

1517
1820
Current parental residence
Rural
Urban
Ever discussed sexual activity-related issues with parents
Yes
No
Elder sister who had started sexual activity before marriage
Yes
No
Close friends who had started sexual activity before marriage
Yes
No
Close friends ever encouraged them to have sexual activity
Yes
No

Premarital sexual activity

Crude OR (95% CI)

Adjusted OR (95% CI)

63 (18.9%)
120 (41.4%)

1
3.04 (2.12,4.35)

1
2.94 (1.94,4.45)

199 (64.8%)
242 (76.3%)

108 (35.2%)
75 (23.7%)

1.75 (1.232.5)
1

1.92 (1.282.94)
1

223 (78.8%)
218 (63.9%)

60 (21.2%)
123 (36.1)

2.08 (1.473.03)
1

2.08 (1.373.12)
1

81 (50.9%)
361 (77.4%)

78 (49.1%)
105 (22.6%)

3.34 (2.274.76)
1

2.85 (1.854.35)
1

104 (50%)
337 (81%)

104 (50%)
79 (19%)

4.35 (2.946.25)
1

3.22 (2.084.76)
1

45 (41.3%)
396 (76.9%)

64 (587%)
119 (23.1%)

4.76 (3.037.14)
1

2.85 (1.784.76)
1

Never had sexual

activity, N (%)

Ever had sexual

activity, N (%)

271 (81.1%)
170 (58.6%)

reproductive health information and move away from parents for

the purpose of study since most junior and high schools in Ethiopia
are located in towns. The rural girls travel to urban areas might result
in decreased parental control due to relocation. A study from southern Ethiopia reported that urban origin adolescents are two times
more likely to have knowledge of reproductive health than their rural
counterparts [22]. Further more studies indicate that females residing in small towns were substantially more likely than their counterparts residing in cities or large towns to have had multiple recent
partners according to a study from China [23]. In the United States
sexual initiation and behaviors differed by race, age, and urban
rural residence [2426].
Our ndings show that the respondents whose parents were
living together had lesser odds of having sexual activities. Similar
studies in Ethiopia on the relationship between living arrangement of parents and premarital sexual practice of female adolescent showed that adolescents in intact families had lower odds of
involving in sexual activities [10,11]. Conversely, being born out of
marriage, living in single families and experience of parental divorce
have been linked to sexual initiation and premarital pregnancy
[2729]. This could be due to that lack of positive inuence of parental control and sexual communication may come from living with
both parents.
In this study, about half of female adolescents who had sexually experienced elder sister had started sexual activity before marriage. Another powerful predictor of sexual activity in this study is
peer inuence as measured by having a friend who had started premarital sexual activity. This indicated that the inuence of peers is
high among adolescents to have sexual activity. A study conducted in Woreta town in north west Ethiopia showed that female
adolescents who had a sexually experienced friend reported higher
levels of sexual debut relative to their counterparts who had no sexually experienced friends [10]. A study conducted in Ghana has
shown that youth who perceived that their friends were sexually
active were more likely to be sexually experienced than those who
thought that their friends had not initiated sexual activities [21].
Limitations of the study
It is not possible to draw causal-conclusions from this study given
that we employed a cross-sectional study design. Furthermore, recall
and social desirability bias is the inherent characteristics of this type

of study. This may introduce the possibility of under-reporting due

to the sensitive nature of questions related to sexual behaviors.
However, we have tried to minimize this problem by providing an
environment of privacy during data collection. Furthermore, given
that the study was conducted among school adolescents, the ndings may not necessarily be generalized to out-of-school adolescents to which we suspect sexual activity might be similar or higher
according to studies elsewhere in the country [30,31].
Conclusion
In this study, we found that about one third of unmarried female
adolescent students are sexually active. About 17% of sexually experienced adolescents had sexual activity with more than one sexual
partner and 62% of sexually experienced respondents did not use
condom during their last sexual activity. An appropriate intervention program is required to meet the special needs of female adolescents focusing on education and counseling that will maximize
the awareness of adolescents about risky-sexual behavior; and help
them make wise decisions before involving in sexual intercourse.
Reproductive health and anti-HIV/AIDS clubs which are available
both in and out of the school have to equip adolescents with appropriate and meaningful reproductive health knowledge and
strengthening community and school based sexual health education is recommended.
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Please cite this article in press as: Nigussie Ahmedin Salih, Henok Metaferia, Ayalu A. Reda, Sibhatu Biadgilign, Premarital sexual activity among unmarried adolescents
in northern Ethiopia: a cross-sectional study, Sexual & Reproductive Healthcare (2014), doi: 10.1016/j.srhc.2014.06.004

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Please cite this article in press as: Nigussie Ahmedin Salih, Henok Metaferia, Ayalu A. Reda, Sibhatu Biadgilign, Premarital sexual activity among unmarried adolescents
in northern Ethiopia: a cross-sectional study, Sexual & Reproductive Healthcare (2014), doi: 10.1016/j.srhc.2014.06.004