Peer-reviewed article
"When He Asks for Sex, You Will Never Refuse": Transactional Sex and Adolescent Pregnancy in Zambia.
Karen Austrian, Erica Soler-Hampejsek, Zoe Duby, Paul C Hewett ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examines transactional sex as a driver of adolescent pregnancy in Zambia, where one-third of girls aged 15-19 have experienced pregnancy. Using interviews and four rounds of longitudinal data from 1,853 unmarried adolescent girls, the research found that girls engaged in transactional sex face nearly 30 percent higher risk of first pregnancy than peers who have not. The qualitative data reveal that girls feel obligated to have sex when they perceive a debt to their partner, which prevents them from refusing sex or using condoms. The findings suggest that addressing economic resources and transactional sex dynamics is crucial for designing effective programs to delay adolescent pregnancy.
Key points
- One-third of girls aged 15-19 in Zambia have experienced pregnancy
- Transactional sex was identified in qualitative interviews as the main driver of pregnancy
- Girls who engage in transactional sex have a hazard ratio of 1.30 for first premarital pregnancy compared to peers who do not
- The feeling of owing sex to a partner prevents girls from declining sex or using condoms
- The increased pregnancy risk from transactional sex persists even when controlling for other sexual risk behaviors
Limitations
The study does not establish causation, only association, and cannot determine whether transactional sex directly causes pregnancy or is correlated with other unmeasured factors affecting pregnancy risk. The sample is limited to unmarried, never-pregnant girls at baseline, which may not represent all adolescent girls in Zambia.
Abstract
Pregnancy among adolescent girls in Zambia is a significant concern on its own and as a factor in school dropout and early marriage, with one-third of girls aged 15-19 having experienced pregnancy. Using qualitative and quantitative data from the Adolescent Girls Empowerment Program, we explore transactional sex as a driver of adolescent pregnancy. In qualitative interviews, transactional sex was repeatedly discussed as the main driver of pregnancy, as respondents indicated that when a girl feels that she "owes" a man sex, it prevents her from declining sex or using condoms. In addition, multivariate Cox proportional hazards models using four rounds of longitudinal data from a sample of unmarried and never pregnant adolescent girls (n=1,853) show that girls who have engaged in transactional sex face a hazard of first premarital pregnancy almost 30 percent greater than their peers who have not, independent of the effect of other risk-related sexual behaviors such as condom use and number of sexual partners. Identifying and understanding the role of transactional sex in adolescent pregnancy is important for designing effective curricula and programs that delay pregnancy, and highlights the importance of addressing access to economic resources in adolescent health outcomes.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Adolescent Girls Empowerment Program (data source for analysis of transactional sex and pregnancy outcomes)
- Population
- Unmarried and never-pregnant adolescent girls in Zambia (n=1,853)
Key finding
Girls who engaged in transactional sex faced a hazard of first premarital pregnancy 30 percent greater than peers who had not
Austrian et al. · PubMed (US National Library of Medicine) · 5 Aug 2019