research about premarital sex

Premarital Sex Is Nearly Universal Among Americans, And Has Been For Decades

The vast majority of Americans have sex before marriage, including those who abstained from sex during their teenage years, according to "Trends in Premarital Sex in the United States, 1954–2003," by Lawrence B. Finer, published in the January/February 2007 issue of Public Health Reports . Further, contrary to the public perception that premarital sex is much more common now than in the past, the study shows that even among women who were born in the 1940s, nearly nine in 10 had sex before marriage.

The new study uses data from several rounds of the federal National Survey of Family Growth to examine sexual behavior before marriage, and how it has changed over time. According to the analysis, by age 44, 99% of respondents had had sex, and 95% had done so before marriage. Even among those who abstained from sex until age 20 or older, 81% had had premarital sex by age 44.

"This is reality-check research. Premarital sex is normal behavior for the vast majority of Americans, and has been for decades," says study author Lawrence Finer, director of domestic research at the Guttmacher Institute. "The data clearly show that the majority of older teens and adults have already had sex before marriage, which calls into question the federal government’s funding of abstinence-only-until-marriage programs for 12–29-year-olds. It would be more effective to provide young people with the skills and information they need to be safe once they become sexually active—which nearly everyone eventually will."

Indeed, while the likelihood that Americans will have sex before marriage has remained virtually unchanged since the 1950s, people now wait longer to get married, so they are sexually active and unmarried for much longer than in the past. During this period, Dr. Finer concludes, young adults have an especially great need for accurate information about how to protect themselves against unintended pregnancies and sexually transmitted infections.

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Premarital sexual intercourse and associated factors among adolescent students in Debre-Markos town secondary and preparatory schools, north west Ethiopia, 2017

• Geremew Kindie Behulu 1 ,
• Kiber Temesgen Anteneh 1 &
• Getie Lake Aynalem 1  

BMC Research Notes volume  12 , Article number:  95 ( 2019 ) Cite this article

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To assess the magnitude and factors associated with premarital sexual intercourse among adolescent students of the secondary and preparatory school in Debre-Markos town, northwest Ethiopia, 2017.

Among secondary and preparatory school adolescent students, 31.3% reported pre-marital sexual intercourse. This shows that premarital sexual intercourse among secondary and preparatory school adolescents is high. Significantly associated factors were: being male (AOR = 1.9, 95% CI 1.21, 2.93), having pocket money (AOR = 3.1, 95% CI 2, 4.81), adolescents who did not discuss sexual issue with close friends (AOR = 8.6, 95% CI 5.27, 13.91) and peer pressure (AOR = 7.7, 95% CI 3.73, 15.69).

Introduction

Premarital sex is penetrative vaginal intercourse performed between couples before formal marriage [ 1 , 2 ]. World Health Organization (WHO) defines adolescent as persons between the age group of 10–19 years old [ 3 ]. Adolescence is the period of transmission from childhood to maturity and is characterized by spurt of physical, mental, emotional, social and psychosexual development [ 4 ].

Adolescents are a growing and larger segment of the population of developing countries and an estimated 1.2 billion young people in the world, 85% live in developing countries [ 5 ]. Nearly 85% of the world’s adolescent population live in developing countries and in some sub-Saharan countries, population below 15 years of age is five times greater than the population over 55 years of age [ 6 ].

The adolescent years are the time of rapid growth, exploration, and risk-taking. In many countries, an average of 29% of boys and 23% of girls are sexually active including premarital sex [ 7 ].

Many adolescents face pressures to use alcohol, cigarettes, or other drugs and to initiate sexual relationships at earlier ages, to put themselves at high risk for intentional and unintentional injuries and risky sexual behaviors [ 8 ]. Females, particularly adolescent girls may end up with unwanted pregnancies, abortions, teenage deliveries, and various complications of these including death. Moreover, the girls may drop out from school to look after their children, and in most cases, they become economically reliant on upon their parents [ 1 ].

Nearly 70% of premature deaths among adults can be linked to behaviors that were initiated during adolescence [ 9 ]. Unwanted pregnancy can be associated with higher likelihood of early motherhood, unsafe abortion, and other pregnancy-related complications [ 10 ].

Several studies in sub-Saharan Africa have also documented high and increasing premarital sexual activities among adolescents [ 8 ]. According to EDHS 2016, 13 percent of women age 15–19 in Ethiopia have begun childbearing [ 11 ]. In Amhara region, pre-marital sexual debut was reported as early as 12 to 13 years [ 10 ].

Studies have documented that early sexual initiators were more likely to report undesired consequences of sexual initiation such as teenage motherhood, not using a condom at first sex and sexually transmitted infections (STIs). Adolescents are also likely to have an intimate partner who is five or more years older and be involved in multiple sexual partnerships [ 12 ].

Even though some studies were conducted on this topic, most of them focused on only females [ 5 , 10 , 13 ], youth [ 14 , 15 ] and university students [ 7 , 8 ], there is a gap of including males, married females and adolescents. Therefore, this study tried to fill the above gaps.

Study design and setting

An institutional based cross-sectional study design was conducted among secondary and preparatory school adolescent students in Debre-Markos town from November 23–27, 2017. The town is located at about 295 km to the capital city of Ethiopia. Based on the 2007 national census conducted by the Central Statistical Agency of Ethiopia (CSA), this town has a total population of 62,497, of whom 29,921 were men. The majority Ethiopian Orthodox Christianity followers, with 97.03% reporting [ 16 ]. There are three secondary and two preparatory schools in the town.

Sample size and sampling procedure

A single population proportion formula was used to calculate the sample size of 624 by taking the following assumptions. From the previous study conducted in Jimma town on premarital sexual practice among school adolescents [ 17 ], 25.27%, 95% CI, 5% marginal error and n = ((Zα/2) 2 p (1 − p))/W 2 . Adding a 15% non-response rate and design effect of 2, the total sample size required was 624.

Multi-stage stratified sampling technique used to select adolescent students. All regular adolescent students (secondary and preparatory) attending class at the time of the survey in Debre-Markos secondary and preparatory school divided into different strata. Grade considered as strata. The number of adolescent students from each grade level and sections according to their sex identified by using the name and sex list of each section.

Operational definitions

Age at initial sexual contact is age at first intercourse (vaginal–penile penetration).

Early sexual initiation was taken as an experience of first intercourse before 18 years of age.

Sexually active A student who had a penetrative sexual intercourse (vaginal) at least once prior to the study.

Peer pressure when the individual said yes/no to question saying “did your friend initiate you to do sex?” [ 18 ].

Pocket money when the individual said yes/no to question saying “did you have pocket money?” [ 19 ].

Data collection instrument and process

Data were collected using a semi-structured, pre-tested and self-administered questionnaire adapted from the literatures. The data collection tool was prepared in English and then translated into local language Amharic and finally returned to English by English language expertise. Four midwives were involved in the data collection process.

Appropriate information and instructions were given on the objective, the relevance of the study, confidentiality of information, respondent’s rights, informed consent, and technique of data collection and 1-day training was given to data collectors and the supervisor on data collection. Before the actual data collection, pre-test was done on 5% of students in Dejen secondary and preparatory school which was out of the study setting but nearby. The collected data checked for completeness and clarity by principal investigator and supervisor. Privacy and confidentiality of the respondents were maintained throughout the data collection period.

Data analysis

Data coded and entered into a computer using Epi info version 7.2.0.1 and checked for completeness and transferred to SPSS version 20 for analysis. Descriptive statistics like frequencies, percentage, proportion and mean computed. Bi-variate logistic regression used to identify variables that crudely associated and variables with p-values less than or equal to 0.05 fitted to multiple logistic regression. Then association between dependent and independent variables was assessed using adjusted odds ratio (AOR), 95% CI and p value of ≤ 0.05 considered statistically significant.

Socio-demographic characteristics

From the selected 624 school adolescents, a total of 600, adolescents aged between 10 and 19 completed the questionnaire while 24 refused to participate in the study, giving a response rate of 96.15%. Three hundred four (50.7%) of the respondents were females. The mean age was 17.31 years. The minimum and maximum ages were 15 and 18 years respectively. Five hundred eighty-three (97.2%) were Amhara in ethnicity (Table  1 ).

Parental characteristics

From the total participants, three-hundred thirty three (55.4%) responded that they were living with their mothers and fathers, 583 (97.2%) and 552 (92%) of respondents reported that their mothers and fathers were alive respectively. Two hundred sixty-four (44.3%) reported that they did not know their parents’ income and 263 (44.1%) participants responded this as greater than 53.6 USA dollars (Table  2 ).

Habits of the respondents

Greater than two third, 413 (68.8%) of the participants responded that they were not alcohol users but 62 (10.3%) reported that they were khat users.

Sexual behavior of respondents

Two hundred forty seven (41.2%) of the participants responded that they usually watch films and magazines having sexual contents and nearly one third, 188 (31.3%) of the whole participants responded that they had girl/boyfriends and practiced sexual intercourse.

Reproductive health

From the total respondents, only 95 (15.8%) participants responded that they had sexual issue discussion with their parents. Three hundred seventeen (52.8) responded that they had sexual issue discussion with their close friends and 72 (12%) were pressured to have sexual intercourse.

Associated factors of premarital sexual a intercourse

Crudely associated variables were: sex, current residence, pocket money, with whom usually live, mother alive, father alive, place of parent’s live, discussion the sexual issue with close friends and peer pressure.

Independently and positively associated variables in adjusted analysis were: being male, having pocket money, adolescents who did not discuss the sexual issue with close friends and Peer pressure (Table  3 ).

Proportion of adolescents who had premarital sex was 31.3%, 95% CI (27.3, 34.8). It was in line with the study from Bahir-Dar, 30.8% [ 10 ], Maichew, 29.3% [ 5 ], Gondar and Meteme, 31.9% [ 13 ].

But this study’s finding was lower than the study from Nepal, 36.5% [ 20 ]. This disparity could be justified by the difference in a background of the study participants and variation in the study areas.

Also, this study’s finding was higher than a study from Shendi, 19% [ 14 ], Shire-Endasellassie, 19% [ 9 ], Alamata, 21.1% [ 21 ] and Jimma, 25.3% [ 17 ]. This could be explained by decrement of discussion about reproductive health risks and rise of peer pressure.

One of the predictor variables in this study was sex. It shows that male students were more engaged for premarital sexual intercourse (AOR = 1.9, 95% CI 1.21, 2.9). It was consistent with studies from Yabello [ 15 ], Bahir Dar [ 22 ] and Malaysia [ 23 ]. It might be due to males have more freedom in sexual engagement than females.

The other variable that was positively associated with premarital sexual intercourse was having pocket money. It triggers adolescent student to have sexual intercourse (AOR = 3, 95% CI 1.9, 4.8). It was similar with the studies from Arba Minch [ 24 ] and Jimma [ 19 ]. It could be due to financially equipped students are likely to drink alcohol, to date their opposite friends and to buy the porn films that all can trigger for sexual intercourse.

And also, the other positive predicator variable for premarital sexual intercourse was having discussions with close friends. Those who did not have discussions with their close friends were more engaged with premarital sexual intercourse (AOR = 8.6, 95% CI 5.28, 13.9). It could be explained as those who have discussions are likely to be knowledgeable about premarital sexual intercourse risks including HIV transmission which can make adolescent students to abstain from sexual intercourse.

The additional positive predictor variable for premarital sexual intercourse was peer pressure. Those who were pressurized by their friends were more engaged with premarital sexual intercourse (AOR = 7.7, 95% CI 3.7, 15.7). It was consistent with studies from Bahir-Dar [ 10 ], Maichew [ 5 ], Alamata [ 21 ], Gondar and Metema [ 13 ]. It could be due to the fact that peers in adolescents is an important factor to influence personality and behavior changes.

Limitations

It was good if the data collection tools were triangulated with the qualitative data collection techniques like in-depth interview.

Abbreviations

adjusted odds ratio

confidence interval

crude odds ratio

sexually transmitted infection

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Authors’ contributions

GKB brought the idea. GKB, KTA and GLA equally contributed on proposal development, data collection process, data management and analysis, and write up. All authors read and approved the final manuscript.

Acknowledgements

We would like thank the University of Gondar, a College of the Health Science, School of Midwifery for approving the topic, assigning advisors and giving ethical clearance and Amhara Regional Health Bureau for their financial support for this study. We want to thank study participants for their time and willingness to participate, data collectors and supervisors for their commitment. Our appreciation also extended for Debre-Markos education bureau for their cooperativeness and provision of supportive letters.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Not applicable because there are no individually detailed data, videos or images.

Ethics approval and consent to participate

Ethical clearance obtained from institutional reviewers board of University of Gondar, College of Medicine and Health Science, Department of Midwifery. A formal letter submitted to Debre-Markos educational office to receive their support. Support letters were received from the educational office. These letters were submitted to schools to get permission. And then, permission letters were obtained from school directors. Study participants and the authorized representatives who were parents or guardians (for those participants whose age group was from 15 to 17 years) were informed about the purpose of the study and a written consent was taken from each participants and the authorized representative parents or guardians (with assent from each participants who were incapable of giving an informed consent) before the collection. Moreover, all the study participants were told their right to refuse at any time. Furthermore, the study participants assured for the attainment of confidentiality for the information obtained from them and the information they gave not contain their names or any identifiers which refer to them.

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Behulu, G.K., Anteneh, K.T. & Aynalem, G.L. Premarital sexual intercourse and associated factors among adolescent students in Debre-Markos town secondary and preparatory schools, north west Ethiopia, 2017. BMC Res Notes 12 , 95 (2019). https://doi.org/10.1186/s13104-019-4132-4

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March 6, 2023

Testing common theories on the relationship between premarital sex and marital stability.

• Our results suggest that none of the commonly theorized explanatory mechanisms can account for the relationship between premarital sex and divorce rates. Tweet This
• Having between one and eight premarital sex partners increases the odds of divorce by 50%. The higher levels of divorce proneness are reserved for those with 9 or more partners. Tweet This
• Premarital sex increases the chances of divorce between twofold and threefold. Tweet This

In 1938, psychology pioneer (and infamous eugenicist) Lewis Terman first  showed  that premarital sex is strongly correlated with marital instability, with more partners generally associated with more divorce. Since then, many scholars have replicated this finding. What’s less well known is why. Without much evidence, many social scientists have concluded this association can be attributed to sample selection: the kinds of people liable to have a lot of sex partners are the same kinds of people who will get divorced. Of course, there’s an alternative possibility: the experience of having premarital sexual partners might change people’s beliefs or behaviors in ways that make it harder to sustain a marriage later on.

The best of these  studies , from sociologists Joan Kahn and Kathryn London, used data from the National Survey of Family Growth (NSFG), and a statistical model that showed that sample selection could account for the relationship between being a virgin and the likelihood of divorce. But their study only contrasted virgins with people who had previously had sex, and didn’t seek to identify the specific mechanisms driving the selection. Their paper is also more than 30 years old, and only looked at white women. In 2016, Nick wrote an IFS  post  that used recent NSFG data to explore how different numbers of sex partners affected women’s marital stability, but didn’t try to explain why premarital partners increased the chances of divorce.

The time is therefore right for research that seeks to explain the premarital sex-divorce relationship using recent data. This was the basis of a  paper  we just published in  Journal of Family Issues . Using data on both men and women from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we revisit the effects of premarital sex partners on marital stability. We sought to test the sample selection argument by using a welter of the variables commonly identified as the basis of the selection, including religiosity, sexual attitudes, and psychological attributes. We also explored whether having many multiple premarital sex partners results in incrementally higher divorce rates.

Our results suggest that none of the commonly theorized explanatory mechanisms can account for the relationship between premarital sex and divorce rates. We don’t rule out the possibility that selection is driving our results, but lay down a marker for future research: scholars will have to look elsewhere in explaining why premarital sex makes divorce more likely. We also find that having nine or more partners produces higher divorce rates than having less than that. Finally, we show there’s no gender difference: premarital sex raises the divorce rate for both men and women.

We’re not aware of earlier research that’s used the Add Health data to look at premarital sex and divorce. Add Health, a panel data set with a large initial sample, contains much more detailed information about respondents than is available in the cross-sectional National Survey of Family Growth. 1

The table below shows the wide range of variables we used to try to explain the relationship between premarital sex partners and divorce. Do any of them matter? The answer is a clear no. Without controls, people with premarital partners are 161% more likely to dissolve their marriages compared to people who tie the knot as virgins. In other words, premarital sex increases the chances of divorce between twofold and threefold. After including the laundry list of covariates shown in the table, the odds of divorce remain 151% higher—in other words, a statistical artifact away from being identical.

Few Americans marry as virgins these days. The  median  American man now has five lifetime partners, while the median woman has three. Our research shows that normative levels of premarital sex—between one and eight partners—still increase the odds of divorce, but only by 50 percent. The higher levels of divorce proneness are reserved for people who have nine or more partners, more common than people who marry as virgins but still a minority of Americans. These different divorce rates over marital duration are shown in the figure below. Moreover, these statistical relationships remain unaffected by the factors listed in the table.

The other finding of note is the absence of any gender difference in how premarital sex affects marital stability. This is surprising because of how different sex is for men and women. Men, of course, are  more inclined to casual sex  and more likely to  exaggerate their sexual biographies . But none of that seems to matter, and we’re not sure why.

One way to frame our findings is as a null result: we were unable to explain the relationship between premarital sex and marital stability with a very wide range of measured factors. That’s not wrong, but we’re inclined to highlight how we’ve contributed to this longstanding question of social science interest: all of the posited factors other social scientists have pointed to as significant—religion, attitudes towards sex, and much more—do not hold up to empirical scrutiny. 

This leaves two broad possible explanations for our results. One is that there could be a causal relationship here: having premarital sexual partners, especially a lot of them, does in fact undermine the prospect of a successful marriage. Perhaps as people accumulate partners, they find that breakups get easier, develop an “other fish in the sea” mentality, or move into peer groups with weaker marriage norms, any of which might make divorce seem like more of an option. The other possibility is that selection mechanisms might still be driving these differences, but we need to reconsider what those mechanisms are. Maybe there are genetic factors at work, or unmeasured psychological traits such as  hypersexuality  that contribute to both promiscuity and divorce. Our findings don’t resolve these questions, but we have defined the terrain for future research: scholars looking for the mechanisms linking premarital sex and divorce will have to look harder.

In another recent  paper , Nick and Sam Perry showed that premarital sex partners have a causal impact on marriage rates, but a narrower focus reveals that the effect of premarital sex is limited to recent partners. Perhaps the effect of premarital sex partners on divorce is similarly constrained. Or perhaps not. It’s a question for future research. Either way, the current paper has shown that the conventional wisdom in this line of research will always benefit from empirical scrutiny.

Jesse Smith is a Ph.D. candidate in sociology and demography  at The Pennsylvania State University.  Nicholas H. Wolfinger  is Professor of Family and Consumer Studies and Adjunct Professor of Sociology at the University of Utah. He is the author of  Thanks for Nothing: The Economics of Single Motherhood since 1980 , coauthored with Matthew McKeever, forthcoming from Oxford University Press.

1. We analyze two different Add Health subsamples. The first of these includes all respondents married at Wave IV of the survey. This sample lets us test whether myriad differences between respondents can explain the relationship between premarital sex and marital stability. The second subsample is limited to respondents who married after Wave III of Add Health. These respondents reflect adults who married after their mid 20s, enabling better measurement of their premarital sexual activity.

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• Published: 25 June 2014

Premarital sexual practices and its predictors among in-school youths of shendi town, west Gojjam zone, North Western Ethiopia

• Alemayehu Bogale 1 &
• Assefa Seme 2  

Reproductive Health volume  11 , Article number:  49 ( 2014 ) Cite this article

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Youth who begin early pre-marital sexual activity are more likely to be engaged in unsafe sex. Early sexual debut puts them at increased risk for acquiring or transmitting sexually transmitted infections, including HIV; and makes them highly vulnerable to unwanted pregnancy and its consequences. This study was conducted to assess premarital sexual practices and its predictors among in-school youths in North West Ethiopia.

A cross-sectional study was carried among 826 in school youths from December; 2011 to January; 2012 in Shendi town. A multistage sampling technique was used to select the study participants. Binary and multiple logistic regression analyses were performed to examine the relationship between premarital sexual practices and selected exposure variables.

Nearly one fifth 157 (19%) of the participants reported having had premarital sexual intercourse, of which 91 (22.7%) were males and 66 (15.5%) were females. The mean (SD) age at first sexual intercourse was 16 .48 (1.59) for males and 15.89 (1.68) for females. More than three - fourth of sexually active in-school youths engaged in premarital sexual relationship before celebrating their 18th birthday. Being greater than 20 years (AOR = 3.67; 95% CI = 1.98, 6.82), living with friends or relatives (AOR = 2.47; 95% CI = 1.46, 4.16), living alone (without parental control (AOR = 2.51; 95% CI = 1.38, 4.55) and watching pornographic movies (AOR = 1.73; 95% CI = 1.18, 2.53) were found to be significantly associated with premarital sexual practices.

A significant number of in-school youths had started premarital sexual activity that might predispose them to different sexual and reproductive health risks. Therefore, various efforts need to be initiated through school-based information, education, and behavioral change communication, interventions, such as life skills education and negotiation.

Peer Review reports

According to the 2007 Ethiopian census, youths aged 15–24 years were more than 15.2 million which contributes to 20.6% of the whole population [ 1 ]. These very large and productive groups of the population are frequently exposed to various forms of sexual and reproductive health risks including, sexual coercion, early marriage or sexual debut, female genital cutting, unplanned pregnancies, closely spaced pregnancies, abortion, sexually transmitted infections (STIs), and HIV/AIDS [ 2 , 3 ].

Early sexual debut increases young peoples' risk for infection with HIV and other STIs. Youth who begin early sexual activity are more likely to be exposed to high-risk sex, often having multiple partners and revealed that premarital sexual practices range from 11.8% to 23.2% among in-school youths.

Unprotected sexual activity results not only in exposing youths to STIs, including HIV/AIDS, but also unwanted pregnancy for females, which may cause serious health, social and economic problems. In addition, unwanted pregnancy may lead to school dropout and a failure to complete their education. The situation gets worse for those who are not physically and mentally maturated, such as the youth. Most frequently, unwanted pregnancies also end up with unsafe abortion, which can lead to death and loss of life [ 2 ].

According to the 2005 Ethiopian behavioral surveillance survey, the prevalence of premarital sexual practices among in-school youths in Amhara Region was 4.5% [ 4 ]. Moreover, different studies conducted afterwards in the region showed that premarital sexual practices among in-school youth are increasing. With the higher level of HIV infection and poorer sexual and reproductive health outcomes among youths [ 5 , 6 ], it is crucial to identify the determinants of sexual activity to inform policy makers and local program managers. However, in-school youth premarital sexual practice and its related health effects were not dealt in-depth within the study area. Besides, most youths in secondary education in Shendi town are living far apart from their families and in an environment away from home without the usual familial control. Therefore, studying premarital sexual practices and its predictors is an essential issue. Thus, this study tried to explore premarital sexual practices and associated factors among in-school youths in Shendi town of North West Ethiopia.

Study design and setting

A cross-sectional study with quantitative and qualitative data collection methods was conducted from December 2011 to January 2012 to assess the prevalence of premarital sex and associated sexual and reproductive health risks among in-school youths of Shendi town, West Gojjam Zone, Amhara National Regional State, Ethiopia. The town is located 427 kilo meters to the North West of Addis Ababa. There are 2 high schools in the town - Dejazemach Bekele high school and Mekonnen Shendi preparatory school.

Target population

Source population.

The source population for the study included all in-school youths who were residing in Shendi town or its surrounding kebeles (districts) and who were schooling during the survey.

Study population

The study population was in-school youths aged 15 to 24 years who were enrolled as a regular day-time student in the 2011/2012 academic calendar.

Sampling method and data collection

Sample size determination.

Sample size was calculated using a single population proportion formula based on the assumptions of 20.2% prevalence (P) of premarital sex among in-school youths in Injibara town of Awi zone [ 5 ], a 95% confidence level (Za/2), a 4% margin of error (d), a design effect of 2 and a 10% non-response rate. Accordingly, the total sample size calculated was about 851.

Sampling strategy

A multistage cluster sampling with proportional to size allocation technique was used to select the required number of study subjects as briefly described below. First, thirty four sections were randomly selected out of the total seventy three sections and the samples assigned to each school were distributed proportional to the section size. All never married, day-time; regular students who were aged 15 to 24 years and schooling at the time of the study were identified from the register.

Data collection

A structured, pre-tested and self-administrated Amharic (a local language) questionnaire was used to collect the required information. Training was given for data collectors and supervisors for 2 days about, the contents of the questionnaire, its administration and issues related to confidentiality of the responses and the rights of the respondents. The data collection was coordinated by the first author and supervised by high school teachers.

To supplement the quantitative findings, four focus group discussions (FGDs) among purposively selected 15–24 yrs in-school youths were conducted. The FGDs, segregated by sex and school, were conducted using semi-structured and open-ended questions which enabled the discussants to reflect on pre-marital sexual practices, predisposing factors and reproductive health risks; by using a pre prepared discussion guide. In addition to notes taken, the discussants' ideas were tape-recorded.

The study used premarital sexual practices as the dependent variable and socio demographic characteristics (age, sex, grade, parental education and occupation), peer pressure, substance use (alcohol, cigarette and khat), religion and living arrangement as independent variables.

Statistical analysis

The quantitative data were first entered into Epi Info version 3.5.1 and later exported to and analyzed using SPSS version 16.0. Descriptive statistics was computed to determine the frequencies of the dependent and independent variables. Bivariate analyses were done to evaluate associations of each independent variable with the outcome variables. Variables which showed significant association with the outcome variables in the bivariate analyses were entered into multiple logistic regression model to control for confounding and identify independent predictors of premarital sexual practices. Statistical significance was set at a P value of <0.05. The tape-recorded qualitative data were first transcribed, translated and then thematically analyzed. The emerged themes of the qualitative findings were used to supplement the quantitative findings.

Ethical review

The study was approved by the Institutional Review Board (IRB) of College of Health Sciences at Addis Ababa University. Written permission letter was obtained from all concerned authorities. Verbal consent from each participant was obtained after explaining the purpose of the study. The right of participants to refuse or not to respond to questions they don’t feel comfortable with or discontinue participation at any time was ensured. Confidentiality was kept at each step of the data collection and then after.

Socio-demographic characteristics of the study participants

Eight hundred twenty six in-school youth were willing to respond to the questionnaire making a response rate of 97.1%. Of the total respondents, little more than half (51.5%) were females. The majority 732 (88.6%) of the study participants were in the age group of 15–19 years, with a mean (SD) age of 17.6 (±1.4). Also more than half (51.6%) were grade nine students. With regard to ethnic and religious background, eight hundred fifteen (98.7%) were Amharas and 96.7% were followers of Orthodox Christianity, respectively. More than two-third (69%) of the students reported that they attend religious services on a daily basis. With regard to living arrangements, 384 (46.5%) were living with friends or relatives while 165 (20%) reported living alone with out closer familial control (Table  1 ).

Majority 653 (79%) of students' parents were currently married and reside in rural areas; 694 (84%). Four hundred fifty eight (58.2%) of the students had illiterate mothers and more than a quarter 197 (26.5%) had illiterate fathers. The majority 646 (86.8%) of the students fathers, were farmers while 418 (53%) and 323 (41%) of the students’ mothers were farmers and housewives, respectively. Majority 610 (73.8%) of the students perceived that they are from families with medium economic status (Table  2 ).

Substance use by in-school youths

Five hundred eighty eight (71.2%) students reported consumption of local alcoholic drinks (local beer, also called ' tela, ' and/or' areke ') while only eight (1%) reported consumption of “khat” at least once in their life time. Of those who consumed alcohol, 393 (66.8%) had drunk occasionally, 170 (28.9%) once or twice a week and 25 (4.3%) daily. Only one student reported smoking cigarette on a daily basis.

Sexual behavior and condom use by in-school youths

Little more than half 426 (51.6%) of the study participants reported to have ever seen pornographic movies or read some pornographic magazines, while nearly one-third 257 (31%) of the students reported having had boy/girlfriends. Of the total study participants, 157 (19%) reported to have had premarital sexual intercourse at the time of the survey of which 66 (42%) were females. The mean age (±SD) at first sexual intercourse was 16.5 (±1.6) for males and 15.9 (±1.7) for females. Out of all sexually active youths, 20 (12.7%) had their first sexual intercourse before the age of 15 years.

Nearly half 76 (48.6%) of the sexually experienced students reported that their first sexual partner was a boy/girlfriend outside the school, 64 (40.8%) experienced sex with a school boy or girl friend and 12 (7.6%) had sexual experience with commercial sex workers. Seventy three (46.5%) of sexually experienced students reported that their first sexual partner was of the same age while 55 (35%) and 25 (15.9%) had first sexual encounter with older and younger age partners, respectively. When asked on the number of life time sexual partners they ever had, most 118 (75.2%) sexually active students reported that they had only one sexual partner while 39 (24.8%) reported having had two or more sexual partners (Table  3 ). Almost half (48.4%) of youths claimed that the main reason for the initiation of first sexual intercourse was falling in love (Figure  1 ).

Reasons to have sex among in-school youth in Shendi town, West Gojjam Zone, January 2012.

About three in ten (28.7%) sexually active in-school youths had used condom during their first sexual intercourse. Eighty-eight (56%) claimed that they had used condom in the last 12 months before the survey. One third 30 (34.1%) of respondents reported using condom consistently for the last 12 months. Reasons for none or inconsistent condom uses were cited as follows: trusting partner 49 (38.6%), ashamed to ask partner 31 (24.4%), fear to buy from shops or pharmacies 21 (16.5%), lack of interest 12 (9.4%), lack of knowledge to use 10 (7.9%) and thought it reduces sexual pleasure 8 (6.3%). Only 8 (5.1%) of sexually active in-school youths reported signs and symptoms of sexually transmitted infections.

Factors associated with premarital sexual practices and condom use

There was a positive association between age, living arrangement and watching pornographic movies with ever having premarital sex. Youths aged 20 years or more were nearly four times more likely to experience premarital sex compared to younger ones (AOR = 3.79, 95%CI = 2.04,7.02). Youths living with their friends or relatives were more than two times more likely to experience premarital sex compared to youths living with both biological parents (AOR = 2.53, 95% CI = 1.50, 4.29). Similarly in-school youths who reported to live alone were more than two times more likely to exercise premarital sex compared to youths living with both biological parents (AOR = 2.62, 95% CI = 1.44, 4.77). The study also showed that youths who reported watching pornographic movies were about two times more likely to experience premarital sex than those who didn't (AOR = 1.74, 95% CI = 1.19, 2.54) (Table  4 ).

The multivariate logistic regression analysis also showed that condom use was associated with sex, discussion on sexuality with their close friends and perceived economic status of the family. Males were more than two times more likely to use condom as compared to females (AOR = 2.56, 95% CI = 1.26, 5.22), youths who discuss on sexuality issues with their close friends were nearly three times more likely to use condom than those who didn't discuss (AOR = 2.84, 95% CI = 1.27, 6.37). On the other hand, youths whose perceived family economic status was medium were found to be three times more likely to use condom as compared to those with perceived poor economic status of the family (AOR = 2.92, 95% CI = 1.28, 6.68) (Table  5 ).

Results of the qualitative data collection

A total of 32 participants were involved in four focus group discussions. The themes emerged from the discussion are presented as follows:

Youth’s premarital sexual practices and its consequences

According to the discussants; youth’s premarital sex is becoming a common practice in the study area and considered by youths as a fashion. ‘ Let alone in secondary schools where one can find older youths, now a days it is becoming a usual practice in primary schools as well ’. Most of the students are coming from rural areas and renting a house alone or with their friends without closer monitoring or supervision from parents/or guardians. Such exposure to new environment and obtaining a relative freedom (being away from parental monitoring and control) makes youths to be highly vulnerable to such early sexual practices. One of the discussants said the following,

“ Now a days, most of the students coming from rural areas have more than one boy/girl friends just for sex ”. He added, “ Surprisingly , my intimate male friend, 10 th grader, had sexual experience with more than 10 sexual partners in this school ”.

Most students recognize problems associated with premarital sexual practices but they are involved on it. They just practice it because they observe others practicing it. One of the female discussants said,

“ Since sexual practices among in-school youth is well recognized in the community, most of the landlords do not want to rent their house to female students due to fear of conflicts between male visitors/strangers who visit the female tenant”

Early sexual initiation and multiple sexual partners

Majority of the focus group discussants agreed that early sexual initiation and having multiple sexual partners is a common phenomenon in the study area. They emphasized that early and premarital sexual practices are the basis for STIs and HIV/AIDS transmission, unwanted pregnancy, abortion, school dropout and premature death. An 11th grade female student sadly explained how she lost her closest friend:-

“…. due to premarital and unsafe sexual practices in early age, one of my closest friend had lost her life ……after unprotected sex she became pregnant… she died when she tried to abort a five months old fetus using herbs from a traditional healer” .

Majority of the FGD discussants didn’t consider the use of condom as an acceptable means of prevention because of perceived reduction in sexual pleasure. Youth discussants raised the flesh-to-flesh contact as the most satisfying part of the sexual intercourse. According to these participants, some of the reasons for non-use of condom are perceived reduction in the sexual pleasure.

“Using condom is like walking in the rain with a person enclosed by plastic sheet…., you will never feel the rain…it means you never taste the rain.” a young male student discussed.

Others have cited lack of decision making power as reasons for non-use. A 17 years old girl discussant said “…The decision for condom use is made by males, we females can’t decide and this makes females not to use condom” .

Discussions

In this larger study conducted with the aim of assessing the magnitude of premarital sex and its predictors among in-school youths. About one-fifth (19%) of high school and preparatory school students reported to have had premarital sexual intercourse. The result is more consistent with a study done in Ambo [ 7 ]. However, it is higher than previous study results from the Ethiopian Behavioral Surveillance Survey, Bullen Woreda of Benishangul Gumuz region of Ethiopia and Malaysian school survey [ 4 , 8 , 9 ], and lower than the study findings of Nekemte [ 10 ], West Gojjam [ 6 ] and Nepal [ 11 ]. This discrepancy may be due to the difference in socio– cultural and schooling status among the study participants.

With regard to premarital sexual practice, more than 75% of in-school youths reported that they had started practicing sex before celebrating their 18th birthday. In addition, early sexual practice initiators were more likely to be involved in subsequent high risk sexual behaviors such as having multiple sexual partners and no or inconsistent condom use. This finding is in line with several other studies previously done in diverse settings [ 4 – 6 , 10 , 12 ]. Moreover, female students sexual partners’ age at sexual debut were more likely to be older, who might have experienced different sexual and reproductive health problems. This early initiation of sexual activity and having an older age sexual partner, particularly among female students, may prolong the period of exposure to risks of unwanted pregnancy and contracting STIs, including HIV, during their reproductive life span.

The results of this study showed that, among nonsexual risky behaviors, like viewing pornographic materials at earlier age was an independent predictor of premarital sexual initiation. This finding was in agreement with the study conducted in North East Ethiopia [ 12 ]. Moreover, premarital sexual activity was found to be significantly more common among youths coming from rural areas compared with in-school youth living in a relatively urban area. The result is consistent with earlier study findings conducted in Nekemte and Tanzania [ 10 , 13 ]. The most likely explanation is due to a difference in living arrangement, i.e. youth coming from rural areas often live with relatives instead of their biological parents, and thus lack familial control, and lack of adequate knowledge about sexual and reproductive health risks.

One in four students reported having had two or more sexual partners in their life time. This finding was comparable with the results of the Ethiopian Behavioral Surveillance Survey (EBSS) 2005 [ 4 ]. However, it was lower than the finding in Nekemte [ 10 ] but higher than the findings in Injibara and Gedeo zones of Ethiopia [ 5 , 14 ]. One alarming finding in this particular study is that a higher proportion of the sexually active male students (13.2%) had sexual contact with commercial sex workers. This finding was consistent with the study findings conducted in Nekemte but more than two times higher than the study findings conducted in West Gojjam zone [ 10 , 6 ].

Forced sex was most commonly reported in the Amhara region (14.9%) [ 4 ]. This particular study was also witnessed that nearly one in six (15.9%) of female students reported forced sexual initiation. Performing premarital sexual practices are statistically significant with age, living arrangement, and watching pornographic movies.

Another typical feature that makes youth sexual activity risky is the absence or incorrect use of condom during sex. Accordingly, only 28.7% of the sexually active youth reported using a condom during their first sexual practice, and only 34.1% reported that they used condom consistently during the past 12 months prior to the study. The major reason mentioned for inconsistent or none use of condom was; trusted their sexual partner (38.6%). This finding is consistent with the results of the 2005 Ethiopian Behavioral Surveillance Survey (EBSS) [ 4 ]. However, it is higher than previous study results conducted in Ambo [ 7 ] and lower than the study findings of Thailand [ 15 ]. Of those male students who practiced sex with commercial sex workers, only 26.7% reported that they had used condom correctly and consistently. The main reason for none or inconsistent use was fear of buying from shops or the pharmacy. The reported low utilization rate of condom in this study may indicate the prevailing fact that high-risk sexual behaviors are still widely prevalent among in-school youth unlike what it is thought to be.

Results of the FGDs support that condom utilization by youths are minimal. One young boy discussant explained the situation as follows, “using condom is like walking in the rain with a person enclosed by plastic sheet…., you will never feel the rain…it means you never taste the rain.” Another female discussant also said, “ In our culture, men are dominant over women in all matters associated with sex and sexual relationship. As a result, the decision to use condom is often made by men, and this makes women not to use condom despite they may get access to it ”.

Limitations of the study

Since this study touches very sensitive and very personal issue; social desirability responding cannot be ruled out. Also, the cross-sectional nature of the study makes it impossible to draw inferences about the direction of relationship between the dependent and independent variables. Moreover, the study is retrospective and thus is subjected to recall bias.

In conclusion, this particular study indicated that a substantial proportion of in-school youths were practicing premarital sexual practices. Being greater than 20 years, students living arrangement (i.e. living with their relatives, friends or alone), and watching pornographic movies were found to be the significant and independent predictors of premarital sexual practice. Also, a significant number of in-school youths had started sexual intercourse very early and are involved with high-risk sexual practices, including multiple sexual partner, unprotected sex and sex with commercial sex workers. Therefore, health care authorities in the different hierarchy should give attention to the identified problems in order to promote the sexual and reproductive health of in-school youth.

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Acknowledgements

We sincerely appreciate Addis Ababa University and UNFPA for their financial support. We would also like to thank Womberema Woreda Education Office, Dejazemach Bekele high school and Mekonnen Shendi preparatory school administrative staffs and teachers for facilitating the data collection. Our deepest gratitude goes to the study participants for their willingness to participate in the study and for their genuine responses.

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Bogale, A., Seme, A. Premarital sexual practices and its predictors among in-school youths of shendi town, west Gojjam zone, North Western Ethiopia. Reprod Health 11 , 49 (2014). https://doi.org/10.1186/1742-4755-11-49

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Going All the Way: Public Opinion and Premarital Sex

Fifty years ago during the Summer of Love, the emerging hippie subculture captured the attention of the nation. Young people outraged their elders with unconventional haircuts, clothes, and music; skeptical attitudes about property and traditional religion, and, perhaps most shockingly, belief in free sexual expression outside the bounds of marriage. Public opinion polling from the time indicates that the counterculture position on “free love” was indeed antithetical to the majority view of marriage as a morally necessary precondition for sexual activity. But the poll questions themselves also reveal an increasing openness about sexuality in the 1960s that preceded and anticipated major changes in public attitudes.

Something “Wicked”: Polling on Sex Pre-1960

The language of the archive’s earliest polling question on sexuality has not aged well. A 1939 Roper/Fortune survey first broached the subject of morality of sexual relations by asking if it was “all right, unfortunate, or wicked” for young men and women to have sexual relations before marriage. Interestingly, the question about young “girls” was posed only to men, and that about young “men” only to women. More importantly, these questions were only asked of respondents of the same sex as their interviewer. The subject of sex was seemingly too delicate to be discussed between the sexes, even in a research context.

In 1943, Roper revisited this question, asking only women their perceptions of sex before marriage for both sexes. A slightly larger proportion said it was “wicked” for young girls (46%) to have premarital sex than said the same about young men (37%).

In 1950, a NORC poll asked respondents whether they agreed with the statement: “No decent man can respect a woman who has had sexual relations before marriage.” Just 29% agreed. In 1953, NORC refielded the question, with similar results (33%). These results may seem surprisingly positive about premarital sexual activity, particularly in light of the earlier Roper questions; however, the strong wording of the statement, while providing a socially acceptable framework for the question, may have triggered a high negative response.

These questions represented nearly all those asked about the morality of sex in a general sense before 1960. Polls in the thirties, forties, and fifties occasionally touched on matters related to sex, like birth control and management of venereal disease in the military. But generally such subjects were skirted.

 Let’s Talk about Sex: Polling in the ‘60s

The turn of the decade marked an increase in questions about sexuality. While the overall Roper Center polling archive holds slightly more questions from the 1950s than the 1960s, the number of questions about sex shifted from just 13 in the 1950s to 94 in the 1960s. A 1962 survey of American women, married and unmarried, delved into issues including whether women of the respondents’ acquaintance discussed sexual matters frankly with each other (48% of married women said yes), whether most husbands were sexually satisfied with their wives and vice versa, and whether respondents knew any married people who were having sexual affairs. Women were also asked if moral standards in the country had changed. While 25% said no, 44% said moral standards had become too loose, 10% that there was too much sex, and 11% that sex was discussed too openly. Those giving the latter answer might have felt the survey itself, with its candid questions, was a fine case in point.

A battery of questions asked by NORC in 1963 delved deeply into American attitudes about premarital sexual activity, with neutral questions that differentiated between the sexes, the level of relationship, and the type of sexual behavior. While some behaviors were considered more acceptable for young men than young women (particularly “petting” when engaged to be married), the greatest distinctions were between the level of sexual involvement, not the sex of the participant or even the relationship between the parties involved. Very few Americans thought premarital sex was acceptable for anyone. Even when asking about young men or women engaged to be married, the survey found fewer than one in five who considered premarital sex acceptable.

By mid-decade, pollsters were specifically addressing the question of cultural changes in sexual attitudes. In 1964, Gallup asked if Americans believed there had been a change in attitudes towards sex since the end of World War II. Over half (56%) said there had been a great change, and 26% some change. Only 13% said there hadn’t been much change at all. Sixty-four percent of respondents in the same survey said that teenagers today had different attitudes about sex than they did when they were teenagers.

Another indicator of changing attitudes was the inclusion of a question about homosexuality in a 1965 Harris poll, a subject never before broached in public opinion polling. The public was disapproving overall: Seventy percent said homosexuals were more harmful than helpful to American life, though 29% said they neither harmed nor helped. But the topic had been raised, and when the question was repeated in 1969, just after the Stonewall riots, the proportion saying homosexual people were harmful had shifted downward slightly, to 63%.

May I Speak Frankly? The 1970s

Despite the greater openness in polling questions, there was little in the actual responses in the 1960s to indicate that Americans’ attitudes toward sexual matters had changed substantially. A 1969 Gallup poll found that just 21% thought it was not wrong for a man and woman to have sex before marriage.

In 1972, NORC started the General Social Survey (GSS), an ongoing series of polls on social attitudes. The question GSS used about premarital sex was more nuanced than Gallup’s, allowing a range of responses from “not at all wrong” to “always wrong.” In the first GSS study, the public was nearly evenly split between those who thought that sex outside marriage was wrong only sometimes or not at all and those who thought it was always or almost always wrong. Since then, the proportion who think premarital sex is always or almost always wrong has drifted slowly downward, reaching a low of 25% in 2014.

Over the next few years, GSS added questions about pornography and sexual activity with someone other than one’s spouse. NORC wasn’t the only survey research organization to tackle these new areas. Over the course of the seventies, any reticence pollsters may have shown towards asking questions about sex disappeared. Polls now covered topics including women’s sexual satisfaction; discrimination against gay people, acceptability of homosexual behavior, and mothers “becoming active lesbians”; cohabitation; sexual infidelity; prostitution; and venereal disease. Polls of women became particularly personal, asking whether respondents’ pregnancies had been planned, whether they spoke as frankly about sex with men as with women, and whether the respondents themselves were sexually fulfilled.

Such questions represented an enormous change from delicate inquiries about “wickedness”. In a 1978 Yankelovich, Skelly & White poll of adults in families, 63% said they welcomed the more open talk about sex in today’s society. The public opinion research community surely agreed, as the increased candor about sex that emerged in the 1960s introduced a whole new world of American attitudes and behaviors for survey researchers to explore.

Kathleen Weldon is Director of Data Operations and Communications at the Roper Center. She manages data provider relations, oversees the data curation process, plans archival development, and works closely with the IT development team in building new user tools.

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Premarital Sex: Increasing Worldwide

• by Joseph Chamie ( new york )
• Thursday, April 05, 2018
• Inter Press Service

A global survey conducted several years ago involving 40 countries, covering three-fourths of the world's population, found a minority, 46 percent, saying that sex between unmarried adults was morally unacceptable. However, a distinct split in attitudes concerning the acceptability of premarital sex was observed between developed and developing countries (Figure 1).

Among developed countries minorities considered sex between unmarried adults to be morally unacceptable. In France, Germany and Spain, for example, less than 10 percent said that sex between unmarried adults is unacceptable. And in Japan, Russia and the United States the proportions of those who said premarital sex is morally unacceptable were less than one third.

In contrast to the views indeveloped countries, large majorities in most developing countries said that sex between unmarried adults is morally unacceptable. Among those countries were some of the most populous, including China (58 percent), Egypt (90 percent), India (67 percent), Indonesia (97 percent), Nigeria (77 percent), Pakistan (94 percent) and the Philippines (71 percent).

The attitudes of most developed countries concerning premarital sex in the recent past were likely not dissimilar from the current views of the less developed countries. In the United States, for example, whereas the proportion of those who viewed premarital sex as unacceptable was nearly universal at the start of the 20 th century, it declined to about 70 percent  by midcentury, 40 percent by the 1970s and is approximately 25 percent today.

While surveying the public's views on the moral acceptability of premarital sex can be challenging at times, arriving at reliable estimates of premarital sexual behavior is a far more difficult undertaking. In addition to social disapproval, moral sensitivities and the desire for personal privacy, premarital sex is unlawful in a number of countries , including Iran, Morocco, Pakistan, Saudi Arabia, Somalia and Sudan, and was unlawful in some developed countries in the recent past. Consequently, reported estimates of premarital sexare likely to underestimate actual levels .

Survey data for many developed countries found that at the beginning of the 21 st century more than two thirds of young people had premarital sex while still in their teens. The proportion was over 80 percent in Denmark, Finland, Germany, Iceland, Norway, the United Kingdom and the United States.

Available survey data for various developing countries in Africa ,  Asia and Latin America also report increased prevalence of premarital sex. The rise in premarital sex in China is particularly noteworthy. Whereas a generation ago, 15 percent of Chinese reported having premarital sex, recent surveys find that about 70 percent admit to having sex before marriage. Even in countries where premarital sex is still a taboo, such as India , Indonesia and Iran , studies report its increasing prevalence.

A major factor in the worldwide increase in premarital sex is the improvement in contraceptive technology that occurred over the past half-century.The use of modern contraception, such as the oral pill and the intrauterine contraceptive device (IUD), has virtually eliminated the fear of an unintended pregnancy. According to recent surveys, more than 90 percent of women aged 15 to 24 years know about at least one contraceptive and most are familiar with more than one. In addition, the percent of adolescent women using contraceptives has increased markedly in many countries over the past several decades.

The movement away from marriage to cohabitation , especially evident in developed western countries, has also contributed to the rise in premarital sex. Among the 28 members of OECD , for example, the average percent of young couples aged 20 to 34 years who were cohabiting in 2011 was more than 40 percent (Figure 2). In some of those countries, including Denmark, France, the Netherlands, New Zealand, Norway, Sweden and the United Kingdom, the majority of young couples were not married, but cohabiting.

Increased levels of cohabitation have also been reported among Latin American countries .  Among men aged 25 to 29 years in 2010, for example, more than half were cohabiting in Argentina, Brazil, Columbia, Costa Rica, Cuba, Ecuador, Panama, Peru and Venezuela.

Even in traditional Asian societies, such as China , India , Iran and Japan, increasing numbers of young couples, especially in urban areas, are choosing to live together before deciding whether or not to marry. Among the explanations for the rapid rise of cohabitation is that it allows individuals to assess compatibility with a partner while keeping future options open.

The trend towards later marriage in many countries is another factor that has contributed to the rise in the prevalence of premarital sex. Delaying marriage to older ages increases the temporal opportunities for premarital sex. The gaps between ages at first sexual intercourse and first marriage have become substantial, especially for men (Figure 3).For example, the gaps between median ages at first sexual intercourse and first marriage for men and women born between 1965 and 1969 are11 and 7 years in the United States and 8 and 5 years in Great Britain.

Modern urban life styles, including more years of schooling, career development, independent living, tolerance of diversity and greater degree of anonymity, have also contributed to the rise in premarital sex. The migration to urban centershas rapidly transformed many historically rural developing countries, such as China, Indonesia, Iran and Turkey, to predominantly urban societies.

The globalization of mass media, most recently through the Internet, has also contributed to transforming traditional normative values regarding sexual behavior, including premarital sex. The strong relationship between the media and the sexual expression of teenagers may be due to the media's role as an important source of socialization for young men and women.

Traditional attitudes and behavior of men and women with respect to premarital sex have changed relatively rapidly worldwide over the past half-century. Large majorities of the populations in developed countries no longer view premarital sex as morally unacceptable. In addition, young men and women are increasingly having sex prior to marriage as well as cohabiting before deciding whether to marry or not.

In developing countries, in contrast, large majorities continue to consider premarital sex morally unacceptable. However, the prevalence of premarital sex in those countries is increasing, especially in urban centers. The dichotomy between attitudes and behavior with respect to premarital sex observed in many developing countries poses serious challenges to traditional practices, religious values and cultural norms requiring abstinence until marriage.

While governments, religious groups and social conservatives may continue to insist on abstinence until marriage, global trends of premarital sex over the past half-century suggest otherwise. In sum, based on the available evidence attempts to regulate the premarital sexual behavior of young men and women in hopes of returning to the abstinence-until-marriage era are unlikely to succeed, which will consequently necessitate adjusting to the realities of the sexual revolution that is continuing to spread worldwide.

© Inter Press Service (2018) — All Rights Reserved Original source: Inter Press Service

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The Effect of Premarital Sex on Sexually Transmitted Infections (STIs) and High Risk Behaviors in Women

Musie s. ghebremichael.

† Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts

Matthew D. Finkelman

# Tufts University School of Dental Medicine, Boston, Massachusetts

This research aimed to study the effect of premarital sex on sexually transmitted infections (STIs) and high risk behaviors among women in sub-Saharan Africa. It included 1393 women randomly selected from the Moshi urban district of northern Tanzania. Participants’ demographic and socio-demographic characteristics, alcohol use, condom use, number of partners, symptoms of STIs and age at first sex and marriage were obtained. Moreover, blood and urine samples were tested for HIV-1, HSV-2, syphilis, chlamydia, gonorrhea, trichomonas and Mycoplasma genitalium infections. The average duration of premarital sex in the study participants was 1.66 years (SD of 2.61 years). Women with longer duration of premarital sex had higher odds of HIV-1, HSV-2 and other STIs. Moreover, women with longer duration of premarital sex were more likely to report multiple sexual partners. These findings highlight the importance of a lengthy period of premarital sex as a public health issue. STIs prevention programs in sub-Saharan Africa should address factors leading to a longer period of premarital sex in women

Introduction

Sub-Saharan Africa has been more devastated by HIV/AIDS than any other region in the world. An estimated 22.9 million people infected with HIV, i.e., around two thirds of the global total, live in sub-Saharan Africa ( UNAIDS, 2011 ). Around 1.2 million deaths from AIDS occurred in sub-Saharan Africa ( UNAIDS, 2011 ). Less than a third of people living with HIV in sub-Saharan Africa have access to antiretroviral therapy ( UNAIDS, 2010 ). In the absence of an effective vaccine and universal access to antiretroviral therapy, recognition and comprehensive control of risk behaviors that are associated with HIV transmission remains the most promising strategy to curb and reverse the spread of the epidemic in the sub-region.

The age at first sex is an important risk factor for the acquisition of HIV. Individuals who start their sexual activity at a young age are more likely to report higher rates of STIs, drug and alcohol abuse, multiple sexual partners and to engage in unprotected sex ( Dickson et al., 1998 ; Duncan et al., 1990 ; Greenberg et al., 1992 ; Manning et al., 2000 ). Several studies from sub-Saharan Africa reported a negative association between delaying sexual debut and HIV prevalence ( Gregson et al., 2006 ; Stoneburner and Low-Beer, 2004 ). Age at marriage could also be another risk factor for HIV acquisition in the region. However, the relationship between age at marriage and the risk of HIV infection is not clear. Some studies suggested that late marriage is a risk factor for HIV infection ( Bongaarts, 2007 ; Glynn et al., 2003 ). Bongaarts (2007) reported that late marriage after sexual initiation leads to a long period of premarital intercourse with multiple partners and facilitates the risk of acquiring HIV. However, other studies failed to report a positive association between late marriage and HIV acquisition and indicated that early marriage elevates the risk of HIV infection ( Bruce and Clark, 2003 ; Clark, 2004 ). Marriage occurs at a young age for many women in sub-Saharan Africa (i.e., first sex occurs at marriage for many sub-Saharan African women). However, the young women are often married to considerably sexually experienced older men, who are likely to have had more sexual partners; thus women are at increased risk of HIV acquisition. A study in Uganda reported that the risk of HIV infection in young married women whose husbands were 10 or more years older were doubled compared to young married women whose husbands were only up to four years older ( Kelly et al., 2003 ). Further knowledge about the association between age at first marriage and acquisition of HIV-1 might have important public health implications for the prevention of HIV and other STIs in sub-Saharan Africa.

The present study examines the association between duration of premarital sex and the risk of acquiring STIs, including HIV-1 and HSV-2, among women in sub-Saharan Africa. We hypothesized that a longer gap between first sex and marriage is associated with higher risk of STIs. To test this hypothesis, we analyzed data from a community-based survey in the Moshi urban district of Tanzania. Moshi is the capital of the Kilimanjaro region of northern Tanzania. The Kilimanjaro region, located in northern Tanzania adjacent to the Kenyan border, is one of Tanzania’s 20 regions. According to the 2002 Tanzania National Census, the population of the Moshi urban district was 144, 336 ( National Bureau of Statistics (NBS), 2002 ). Tanzania has a population of 34.5 million people, with approximately 7% of adults infected with HIV ( Tanzania Commission for AIDS (TACAIDS), National Bureau of Statistics (NBS), and ORC Macro, 2005 ). In the Moshi district of northern Tanzania the prevalence of HIV infection is about twice that of the national average.

Study Participants

The data set used in this paper comes from a cross-sectional survey conducted from November 2002 to March 2003 in the Moshi urban district of Tanzania. The rationale, organization, and recruitment of the survey have been described in detail elsewhere ( Larsen et al., 2007 ). In brief, the survey involved a two-stage sampling procedure. In the first stage of sampling, a total of 150 clusters were selected using probability proportional to the number of women aged 20–24 living in the study area. In the second stage of sampling, 18 households were randomly selected from each cluster. A total of 2,019 women aged 20–44, who were residents of the selected households, were interviewed. Information was collected on fertility, marriage, sexual practices, symptoms of STIs, socio-demographic characteristics, and husband-wife relations including domestic violence and alcohol use. Blood and urine samples were drawn to test for HIV-1, HSV-2, syphilis, chlamydia, gonorrhea, trichomonas and Mycoplasma genitalium infections. The study was approved by the Harvard School of Public Health IRB (HSC Protocol #0108ACOM), University of Maryland IRB (Protocol #05-0031), Kilimanjaro Christian Medical Center Ethics Committee, Research and Ethical Clearance of the Tanzanian National Institute for Medical Research, the Centers for Disease Control and Prevention Institutional Review Board. Written informed consent for participation in the study was obtained from participants.

Study Measures

Demographic characteristics including age (20–24, 25–29, 30–34, 35+), education (pre-secondary, secondary and above), ethnicity (Chagga, Pare, other), and religion (Muslim/other, Catholic, Protestant) were considered. Moreover, STIs infections and symptoms, alcohol abuse, condom use in the last twelve months, and number of sexual partners they had in the last three years were considered. Alcohol abuse was measured by the CAGE score ( Mayfield et al., 1974 ). An STI symptom was defined as a positive response to at least one of the following questions: abdominal pain, abnormal genital discharge, foul smell in the genital area, excessive genital secretions, swellings in the genital area, itching in the genital area, burning pain on micturition, pain during intercourse, and genital ulcers. Blood and urine samples were tested for HIV-1, HSV-2, syphilis, chlamydia, gonorrhea, trichomonas and Mycoplasma genitalium .

Statistical Analysis

Two-sample T-tests and one way ANOVA were used to compare duration of premarital sex between groups. Regression analyses were carried out using generalized linear mixed effects regression models to examine the association between duration of premarital sex, high-risk behaviors and STIs. More specifically, two-level mixed effects logistic regression models were used to examine the association of duration of premarital sex with STIs and high risk behaviors. Random intercepts were included in the logistic regression models to model the combined effect of all unobserved cluster-specific covariates. The regression analyses allowed for the two-level nested nature of the data, with women nested within geographic clusters, and were conducted using a generalized linear mixed models procedure, i.e., PROC GLIMMIX, in SAS version 9.2 (SAS Institute Inc., Cary, NC, USA).

Sixty percent (n=1,218) of the sampled women were either married or were living with a cohabitating partner at the time of the survey. Almost 13% (n=257) of the women were widowed, divorced or separated at the time of the survey. Twenty-seven percent (n=543) reported they had never been married. Premarital sex was defined as the time from sexual initiation to age at marriage. The analysis included the participants who provided complete information on age at first sex and age at marriage. Participants who reported that they had never had sexual intercourse and participants with unknown age at first sex or marriage were excluded from the analyses.

Out of the 2,019 surveyed women, 70% (n=1,414) provided their age at first sex and marriage. Out of the 1,414 participants with complete information, twenty-one women were excluded as their reported age at first sex was greater than their age at marriage. Thus, the analysis was restricted to the 1,393 women who provided complete data on age at first sex and marriage. The average duration of premarital sex was 1.66 years (SD of 2.61 years). Table 1 display the distribution of premarital sex duration by socio-demographic characteristics, alcohol and condom use. The duration of premarital sex significantly varied among the different age groups (p<0.01). Women aged 25–34 years reported longer duration of premarital sex compared to younger (< 25 years) or older (>34 years) women. Women with secondary school education and above reported longer duration of premarital sex compared to women with no or lower than secondary school education (p<0.01). Furthermore, duration of premarital sex was significantly associated with ethnicity (p<0.01) and religion of the women (p=0.01). Women who reported condom use in the previous twelve months had longer duration of premarital sex compared to women who reported no condom use (p=0.02). However, there was no significant difference in duration of premarital sex between women who abused alcohol versus those who did not use alcohol (p=0.91).

Distribution of premarital sex duration by socio-demographic characteristics, high-risk behaviors and sexually transmitted infections in Moshi women, Tanzania, 2002–2003.

Table 1 also presents the distribution of premarital sex duration by STIs and number of sexual partners. The duration of premarital sex was significantly higher for women tested positive for HIV-1 (p<0.01), HSV-2 (p=0.01), and other STIs (p=0.02). Moreover, women with multiple partners had longer duration of premarital sex compared to women with one partner (p<0.01). Although it did not reach statistical significance, women with STIs symptoms reported longer duration of premarital sex (p=0.07) compared to women with out STIs symptoms.

Figure 1 displays the odds of STIs and multiple sexual partners per 1-year increase in duration of premarital sex. The odds of HIV-1 (OR=1.13; 95% CI=1.07–1.21; p<0.01), HSV-2 (OR=1.06; 95% CI=1.01–1.11; p=0.01) and other STIs (OR=1.07; 95% CI=1.01–1.13; p=0.03) increased by 13%, 6% and 7%, respectively, for a 1-year increase in duration of premarital sex. Moreover, the odds of having multiple partners increased by 14% per 1-year increase in duration of premarital sex (OR=1.14; 95% CI=1.07–1.21; p<0.01). Though women with longer premarital sex years reported higher odds of STIs symptoms, there was no significant association between premarital sex and symptoms of STIs (OR=1.04; 95% CI=0.99–1.09; p=0.07). Multivariate models were used to assess the association between duration of premarital sex and number of partners after adjusting for the effect of age, education, religion, tribe and condom use. The multivariate models used to examine the association between duration of premarital sex and STIs adjusted for the effect of multiple partners in addition to age, education, religion, tribe and condom use. The findings from both unadjusted and adjusted models were similar and were reported in Figure 1 .

Odds of STIs and multiple sexual partners associated with 1-year increase in duration of premarital sex in Moshi women, Tanzania, 2002–2003. The adjusted analyses control for the effect of age, education, religion, tribe and condom use in the previous 12 months. Moreover, besides these variables, the adjusted analyses of STIs (HIV-1, HSV-2, other STIs, symptoms STIs) control for the effect of number of sexual partners.

The primary focus of this study was to assess the relationship between duration of premarital sex, multiple sexual partners and the risk of acquiring STIs. Our study has revealed that time spent single after sexual debut was significantly associated with HIV and other STIs. We found higher odds of HIV-1, HSV-2 and other STIs among women with longer duration of premarital sex. Moreover, women with longer duration of premarital sex were more likely to report multiple sexual partners. These findings are consistent with previous studies from Tanzania and other sub-Saharan Africa countries ( Bongaarts, 2007 ; Zaba et al., 2009 ). Bongaarts (2007) reported a positive association between late marriage after sexual initiation and HIV prevalence. In a study by Zaba et al (2009) , longer duration of premarital sex was associated with higher rates of partner acquisition. Our study differs from previous studies by reporting both symptoms of STIs at the time of interview and STIs confirmed by laboratory testing in a large community based sample.

The results of our study should be interpreted in light of the following limitation. First, the data set is ten years old and changes in prevention, treatment and management of STIs should be taken into account while interpreting our findings. The accuracy of the information regarding multiple partners, age at first sex, and age at marriage may be affected by respondent and recall biases. In most sub-Saharan Africa cultures, women are not permitted to have sex outside marriage and multiple sexual partners. Thus, the self-reported data on women’s sexual behaviors could be an underestimation and may not be very reliable. Moreover, age at first sex and marriage were measured by self-report, which might have been affected by recall bias. Missing data is another limitation of the study. The analyses included only women who provided complete information on age at first sex, age at marriage, socio-demographic variables, high-risk behaviors, STIs and STIs symptoms. Analysis of the complete cases ignores the possible systematic difference between the women who provided information on these variables and those who did not. Finally, the use of recent number of partners data as a proxy for lifetime partners is subject to bias. Despite these limitations, our study has several strengths including a large sample size and a laboratory-confirmed STI diagnosis in a population based sample.

Our findings highlight the importance of long duration of premarital sex as a public health issue. These findings can be used to guide future HIV and other STIs preventive measures on late-marrying women in the region. Prevention programs should address factors leading to longer period between first sex and marriage, which may not be under the control of the woman. Further research is needed to identify the risk factors associated with longer period of premarital sex and to illuminate the association between premarital sex and STIs, which is of public health significance especially in sub-Saharan Africa where women are disproportionally affected by HIV and other STIs.

Acknowledgments

We thank the women of Moshi urban district of Tanzania for their participation and staff at the National Bureau of Statistics in Tanzania for conducting the survey. The study was supported by grants from Harvard University Center for AIDS Research (HU CFAR NIH/NAIDS P30-AI 060354).

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What really drives anti-abortion beliefs? Research suggests it’s a matter of sexual strategies

Assistant Professor of Psychology, Oklahoma State University

Professor of Psychology, University of California, Los Angeles

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The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

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Many people have strong opinions about abortion – especially in the wake of the U.S. Supreme Court decision that overturned Roe v. Wade, revoking a constitutional right previously held by more than 165 million Americans.

But what really drives people’s abortion attitudes?

It’s common to hear religious, political and other ideologically driven explanations – for example, about the sanctity of life. If such beliefs were really driving anti-abortion attitudes, though, then people who oppose abortion might not support the death penalty ( many do ), and they would support social safety net measures that could save newborns’ lives ( many don’t ).

Here, we suggest a different explanation for anti-abortion attitudes – one you probably haven’t considered before – from our field of evolutionary social science .

Why do people care what strangers do?

The evolutionary coin of the realm is fitness – getting more copies of your genes into the next generation. What faraway strangers do presumably has limited impact on your own fitness. So from this perspective, it is a mystery why people in Pensacola care so strongly about what goes on in the bedrooms of Philadelphia or the Planned Parenthoods of Los Angeles.

The solution to this puzzle – and one answer to what is driving anti-abortion attitudes – lies in a conflict of sexual strategies: People vary in how opposed they are to casual sex . More “sexually restricted” people tend to shun casual sex and instead invest heavily in long-term relationships and parenting children. In contrast, more “sexually unrestricted” people tend to pursue a series of different sexual partners and are often slower to settle down.

These sexual strategies conflict in ways that affect evolutionary fitness.

The crux of this argument is that, for sexually restricted people, other people’s sexual freedoms represent threats. Consider that sexually restricted women often get married young and have children early in life. These choices are just as valid as a decision to wait, but they can also be detrimental to women’s occupational attainment and tend to leave women more economically dependent on husbands .

Other women’s sexual openness can destroy these women’s lives and livelihoods by breaking up the relationships they depend on. So sexually restricted women benefit from impeding other people’s sexual freedoms. Likewise, sexually restricted men tend to invest a lot in their children , so they benefit from prohibiting people’s sexual freedoms to preclude the high fitness costs of being cuckolded.

Benefiting from making sex more costly

According to evolutionary social science , restricted sexual strategists benefit by imposing their strategic preferences on society – by curtailing other people’s sexual freedoms.

How can restricted sexual strategists achieve this? By making casual sex more costly.

For example, banning women’s access to safe and legal abortion essentially forces them to endure the costs of bearing a child. Such hikes in the price of casual sex can deter people from having it.

This attitude is perhaps best illustrated by a statement from Mariano Azuela, a justice who opposed abortion when it came before Mexico’s Supreme Court in 2008: “I feel that a woman in some way has to live with the phenomenon of becoming pregnant . When she does not want to keep the product of the pregnancy, she still has to suffer the effects during the whole period.”

Force people to “suffer the effects” of casual sex, and fewer people will pursue it.

Also note that abortion restrictions do not increase the costs of sex equally. Women bear the costs of gestation, face the life-threatening dangers of childbirth and disproportionately bear responsibility for child care . When women are denied abortions, they are also more likely to end up in poverty and experience intimate partner violence .

No one would argue this is a conscious phenomenon. Rather, people’s strategic interests shape their attitudes in nonconscious but self-benefiting ways – a common finding in political science and evolutionary social science alike.

Resolving awkward contradictions in attitudes

An evolutionary perspective suggests that common explanations are not the genuine drivers of people’s attitudes – on either side of the abortion debate.

In fact, people’s stated religious, political and ideological explanations are often rife with awkward contradictions. For example, many who oppose abortion also oppose preventing unwanted pregnancy through access to contraception .

From an evolutionary perspective, such contradictions are easily resolved. Sexually restricted people benefit from increasing the costs of sex. That cost increases when people cannot access legal abortions or prevent unwanted pregnancy.

An evolutionary perspective also makes unique – often counterintuitive – predictions about which attitudes travel together. This view predicts that if sexually restricted people associate something with sexual freedoms, they should oppose it.

Indeed, researchers have found that sexually restricted people oppose not only abortion and birth control, but also marriage equality , because they perceive homosexuality as associated with sexual promiscuity, and recreational drugs , presumably because they associate drugs like marijuana and MDMA with casual sex. We suspect this list likely also includes transgender rights, public breastfeeding , premarital sex, what books children read (and if drag queens can read to them ), equal pay for women, and many other concerns that have yet to be tested.

No other theories we are aware of predict these strange attitudinal bedfellows.

Behind the link to religion and conservatism

This evolutionary perspective can also explain why anti-abortion attitudes are so often associated with religion and social conservatism.

Rather than thinking that religiosity causes people to be sexually restricted, this perspective suggests that a restricted sexual strategy can motivate people to become religious . Why? Several scholars have suggested that people adhere to religion in part because its teachings promote sexually restricted norms . Supporting this idea, participants in one study reported being more religious after researchers showed them photos of attractive people of their own sex – that is, potential mating rivals.

Sexually restricted people also tend to invest highly in parenting, so they stand to benefit when other people adhere to norms that benefit parents. Like religion , social conservatism prescribes parent-benefiting norms like constricting sexual freedoms and ostensibly promoting family stability. In line with this, some research suggests that people don’t simply become more conservative with age . Rather, people become more socially conservative during parenthood .

Restricting everyone to benefit yourself

There are multiple answers to any “why” question in scientific research. Ideological beliefs, personal histories and other factors certainly play a role in people’s abortion attitudes.

But so, too, do people’s sexual strategies.

This evolutionary social science research suggests that restricted sexual strategists benefit by making everyone else play by their rules. And just as Justice Thomas suggested when overturning Roe v. Wade , this group may be taking aim at birth control and marriage equality next.

• Birth control
• Contraception
• Death penalty
• Social psychology
• Evolutionary psychology
• Political views
• Social attitudes
• Abortion access
• Anti-abortion
• Abortion bans
• Access to contraception
• Dobbs v. Jackson Women’s Health Organization
• Dobbs v. Jackson
• Access to abortion

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