Social exclusion and early or unwanted sexual initiation among poor urban females in Ethiopia.

CONTEXT Numerous studies of adolescent sexual behavior have explored factors associated with early sexual debut. However, few studies have examined the role of social exclusion and marginalization in relation to early and unwanted sexual initiation. METHODS A population-based study of 1,837 out-of-school females aged 10-19 was conducted in three low-income urban areas of Ethiopia in 2008. Descriptive and multivariate analyses were used to identify characteristics associated with having experienced coerced sexual initiation and sexual debut before age 15. RESULTS Nearly half (48%) of the young women in the sample were domestic workers, and many reported significant social exclusion, including lack of friends, community support networks and group membership. Overall, 23% reported being sexually experienced and 27% of those had first had sex before age 15. Compared with other young women, domestic workers were significantly more likely to have had sex before age 15 (odds ratio, 3.3), and to have been coerced into having sex (1.8). Social exclusion was associated with significantly higher odds of coerced first sex (2.0). CONCLUSIONS Programs for female adolescents should build their social capital and inclusion, as well as provide opportunities for them to stay in school and obtain positive and nonexploitive forms of work.