Early sexual debut: Voluntary or coerced? Evidence from longitudinal data in South Africa--the Birth to Twenty Plus study.

BACKGROUND Early sexual debut, voluntary or coerced, increases risks to sexual and reproductive health. Sexual coercion is increasingly receiving attention as an important public health issue owing to its association with adverse health and social outcomes. OBJECTIVE To describe voluntary and coerced experience at sexual debut. METHODS A longitudinal perspective among 2,216 adolescents (1,149 females, 1,067 males) in a birth cohort study in South Africa, analysing data collected on six occasions between 11 and 18 years. RESULTS The median age of sexual debut was 16 years for females and 15 for males. Reported coerced sexual debut included children < 11 years of age. Males reported earlier sexual debut with both voluntary and coerced sexual experience, than females (p < 0.0001). Sexual coercion at early sexual debut among both male and female adolescents occurred mostly through sexual intercourse with older adolescents and partners of the same age. CONCLUSION The identified time periods and age groups need to be targeted for interventions to delay sexual debut and prevent sexual coercion among young people. More research is needed to understand underlying predisposing risk factors for sexual coercion at sexual debut, both early and not early.