Sexual Behavior and Attitudes Among Unmarried Urban Youths in Guinea
Context: In Guinea, modern contraceptive use is low, sexuality education is not part of the school curriculum and many young people are sexually active. Understanding what influences young people's sexual behavior and the consequences of that behavior may facilitate the design of effective pregnancy and disease prevention strategies.
Methods: In 1995, 3,603 unmarried men and women aged 15-24 in three towns were surveyed, and 25 focus groups were conducted, to explore young people's sexual behavior and related attitudes.
Results: The average age at first intercourse is 16.3 years for young women and 15.6 for young men. While the first sexual partner typically is a peer, the majority of young women later become involved with older, wealthy partners, whom they view as more attractive spouses than young men or as more likely to provide support if they become pregnant. Young males, who feel they cannot compete with older, wealthy men, have sex with much younger females. More than half of sexually active respondents have never used a contraceptive; 29% have used a condom. A quarter of the young women have been pregnant, and 22% of these have had an abortion.
Conclusions: Young people are exposed to health hazards through their sexual behavior, and timely gender-specific sexuality education must be made available. School-based sexuality education could benefit even out-of-school youths, because their partners often are students.
Adolescents all over the world are sexually active, but the age at which they start having intercourse varies between regions and, within a country, between urban and rural settings. Generally, young men report beginning sexual activity earlier than young women because premarital sex is accepted for males, whereas women are expected to postpone the initiation of intercourse until they marry.1
Despite the common belief that young people start having sex earlier than previous generations did, in most Sub-Saharan African countries, the average age at first intercourse has either remained the same or has increased, especially in urban settings.2 Of widespread concern are the problems related to pregnancies occurring outside a socially sanctioned union, including reduced educational opportunities for young women, unsafe abortions, high-risk deliveries, poor economic outcomes and compromised social status. Children born to single women often are neglected or abandoned.3
Adolescents bear an increased risk of exposure to infection with sexually transmitted diseases (STDs).4 It is estimated that half of all HIV infections occur among people younger than 25.5 As a result, the sexual behavior of youths and the consequences of this behavior are a major public health concern.
The risk of HIV infection is especially high if the age difference among sexual partners is large6 and if individuals have multiple or risky partners, or unprotected sex.7 Numerous studies in developing countries have shown that young people lack knowledge about contraception and disease prevention, and that they often have erroneous ideas about reproduction.8
The objective of this study was to understand the extent of exposure to health problems resulting from sexual behavior and to describe factors influencing this behavior among young people in Guinea.
According to results of the 1992 Demographic and Health Survey, Guinea has a young population (47% are younger than 15, and 20% are 15-24) and a high total fertility rate (5.7 lifetime births per woman). Women's mean age at marriage is rather young (15.8 years), and while it is similar in all ethnic groups, it is considerably higher in urban than in rural settings. Men, by contrast, enter their first marriage at a later mean age (26.3 years).9 Large differences in age at first marriage are typical in Sub-Saharan Africa. One reason for this is that in polygynous societies, older men have several wives and younger men face a relative shortage of women. Another reason is that cultural norms often dictate that men delay marriage until they are financially able to support a family; in the meantime, their sexual behavior traditionally has been restricted to contacts not involving heterosexual intercourse or with partners who are not considered potential spouses (e.g., prostitutes, divorced or widowed women, or married women in their clan).10
Of the country's total population of 7.4 million in 1995, 30% lived in urban areas.11 Whereas the urban population increases at an annual rate of 5%, the general population growth rate is 3% per year.12
Use of modern contraceptives is uncommon in Guinea. Fewer than 3% of women use a modern method; only 6% of women and 12% of men have ever used one.13 Sexuality education is not part of the regular school curriculum, either in secondary or in primary schools. However, family planning organizations occasionally provide contraceptive information in 10th-grade classes.
No population-based abortion figures exist. An analysis of hospital data in Conakry revealed that 17% of maternal deaths were due to induced abortions and 42% of abortions occurred among women aged 15-20.14
Guinea is said to have a low prevalence of HIV. However, few reliable data exist.15 A prevalence survey in southern Guinea found that 1% of pregnant women, 3% of long-distance drivers and 6% of commercial sex workers who visited an STD clinic were HIV-positive.16
Our study was conducted in 1995 among unmarried 15-24-year-old men and women in three towns with populations ranging from about 37,000 to 100,000—Faranah, Kissidougou and Guéckédou. We chose these towns for several reasons: They have undergone rapid growth during the last 10 years. They show the impressive mix of religious and ethnic groups typical of fast-growing urban communities, and have experienced rapid change in norms, values and gender roles. They attract many young people from the surrounding rural world with learning and earning opportunities.
We used both quantitative and qualitative methods. The quantitative component was a survey of 3,603 randomly selected young people. The sample consisted of 2,114 primary and secondary school pupils, who completed a self-administered questionnaire, and 1,489 out-of-school youths,* who were predominantly illiterate and participated in individual interviews. The 40-item questionnaire included respondents' age at first intercourse; coital frequency during the previous month; lifetime number of sexual partners; current partner's profession; and pregnancy, abortion and contraceptive histories.
Pupils were selected through a stratified cluster-sampling procedure, in which the different school grades (6-13) were defined as the strata and randomly selected classes from each grade as the clusters. All individuals present on the day of the interview were eligible for participation; our sample comprised 21% of youths enrolled in school.
For the out-of-school sample, we chose men and women of selected occupations that represent substantial segments of both the formal and the informal sectors: carpenters (male apprentices), cart-pushers (male unskilled worker), dressmakers (female apprentices) and itinerant vendors (female unskilled workers). Participants were randomly selected on the basis of an inventory of individuals belonging to each group; they totaled 16% of out-of-school young people.
The qualitative component of the study consisted of 25 same-sex focus groups--13 with pupils, seven with apprentices and five with youths from the informal sector--aimed at understanding young people's criteria of partner choice and attitudes toward premarital pregnancy and the prevention of pregnancy and disease. Participants were recruited from among the survey sample and were selected on the basis of their gender and grade or occupational sector. In all, 192 young people participated in the focus groups.
Of the 3,603 young people interviewed, 76% were 15-19 years of age, and 24% were 20-24; 42% were women, and 58% men (Table 1). Students and out-of-school respondents had roughly similar age distributions, but differed with respect to sex: Pupils were about evenly divided between men and women, but males outnumbered females in the out-of-school sample by nearly two to one.
The sample reflects the mix of ethnic groups typical for the region. The majority of respondents were Malinke (46%), followed by Kissi (24%), Fulani (14%), Soussou (4%) and various others (12%). Some 74% of the sample were Muslims, 18% Catholics, 5% Protestants and 3% members of other religious groups.
Overall, 50% of female and 76% of male participants were sexually experienced. The mean age at first intercourse was 16.3 years for females and 15.6 for males; except among adolescent males, pupils reported a significantly later mean age at initial sexual experience than out-of-school respondents (Table 2).
Sexually active young men reported a greater mean lifetime number of sexual partners (4.0) than sexually experienced young women (2.1), and respondents in their 20s had had more partners than adolescents. Female pupils had had fewer partners than their out-of-school counterparts; however, among young men, the reverse was true for adolescents, and no significant difference was found among those aged 20-24.
While 42% of females and 44% of males said they had had no coitus in the previous month, 45% and 51%, respectively, had had sex 1-3 times, and the remainder had had sex more often. Out-of-school males reported fewer sexual encounters in the previous month than did those in school, but the opposite was the case among young women.
Despite the apparent differences between male and female respondents' sexual behavior, their sexual activity can be described as episodic. In the focus groups, participants explained that having sex is perceived as a normal or inevitable part of friendship between young men and women. The reasons given for engaging in sex were manifold. Some participants viewed intercourse as a biological need.
"You're satisfying a need. The need is [there] every day, and this need must be satisfied, not every day but once a month or a week."--Female pupil
Young men and women alike favored episodic sex. They explained that for those who take their studies or their apprenticeship seriously, sex has its place only on weekends or at holiday times.
Many young people of both sexes believed that "either you are the right age and can start sexual activity or you are not the right age" and should abstain. When asked what is the "right" age to begin, respondents said 15-18 years old, and they gave a variety of reasons not to begin at an older or younger age. A fear was expressed that starting too early can cause weakness and illness. Several young men worried that they would not have enough sperm when they were older if they used them up early. On the other hand, a number of participants were afraid of becoming ill or infertile if they started sexual activity too late.
Young people reported that both their partners and their peers pressured them to have sex. Many women said they had succumbed to a male's desire; some even reported having been forced into having sex. Female participants said they fear losing their partner if they refuse and assume that any other boyfriend would express the same desire.
"To get on with a boy implies to have sex and to do what he wants you to do."--Female apprentice
Male participants admitted that in order to persuade a young woman to have sex, they would, if necessary, promise a long-lasting relationship and faithfulness. Some claimed that they were pressured by sexually experienced young women, and that if a young man does not agree to have sex, subsequent rumors may "damage" his reputation.
"If a girl runs after you and you don't have sex with her, everybody will laugh at you. She makes your name public in town--that you are not a real boy, that you are impotent."--Male pupil
If a young women seeks material support from a rich man, she is aware that in visiting him and explaining her problem, she has implicitly agreed to have sex with him.
"He does with her whatever he wants. Afterward, he gives her the money."--Female pupil
From the young men's perspective, it is normal to expect to have sex after giving a young woman money or a gift, because otherwise, the money has been wasted. Focus-group participants of both sexes described such exchanges of money or gifts as normal nowadays.
In promising future marriage, a young man might argue that having sex is the first step toward a serious engagement. But young women are afraid that their partner will not keep his promise and only use the argument to persuade them to participate in a sexual encounter.
Most sexually active female respondents (90% of pupils and 87% of those not in school) reported having a partner at the time of the survey. Among these young women, 51% of pupils and 35% of those out of school said their partner was a pupil; 2% and 4%, respectively, said he was an apprentice. Another 38% and 54%, respectively, said they had a partner with a monetary income, and the remainder gave other responses (Table 3).
The majority of relationships were among youths (e.g., pupil with pupil, apprentice with apprentice, apprentice with pupil). Younger women tended to have a partner of their own social group, while older women generally had a relationship with a wealthy man. For example, 68% of 15-16-year-olds reported that their partner was a pupil or apprentice, compared with only 20% of 20-24-year-olds (not shown).
Among sexually active young men, 81% of pupils and only 35% of those out of school currently had a partner. Of these, 58% and 23%, respectively, reported that their partner was a pupil; 15% and 23%, respectively, said she was a small trader, who made little money. A large proportion of young men's sexual partners (19% among pupils and 43% among out-of-school males) were maids or had no profession (Table 3).
The focus-group interviews throw light on young people's criteria for choosing a partner. For example, female students had different requirements, depending on whether they were concerned about finding a boyfriend or a potential spouse. Regarding boyfriends, they stressed the advantages of going out with a pupil. Above all, they highlighted the academic benefits, such as his being able to help at school and with homework; they also observed that intellectual compatibility enables an exchange of ideas.
In addition, the female students believed that because many pupils are sexually inexperienced, they exert little pressure on their partners to have intercourse. While young women appreciate this advantage, they admitted that if a relationship lasts for a long period of time, intercourse is likely to occur eventually. A final advantage of having an intellectual partner, according to the female pupils, is his understanding if a young woman refuses sex.
"If he is intelligent, if he is a student, if he asks you for intercourse, you can say 'Today is my fertile day,' and he will leave you alone."--Female pupil
A wealthy partner, on the other hand, "will inevitably insist on sexual intercourse"; this is the core part of the relationship with him. However, in the event of pregnancy, a wealthy partner is able to take care of the young woman and her child; a pupil, on the other hand, will be neither willing nor able to take economic responsibility or to marry the young woman. Thus, some young women prefer older partners, and their reasoning is supported by parental advice: Parents warn their daughters never to bear a poor boy's child. In addition, female respondents approved of the exchange of sex for money, especially if a young woman needs support for daily life.
Disagreement arose in the discussion about marrying while in school or during apprenticeship. Some young women would prefer to finish their education first, but others would welcome a marriage offer, especially if they would be allowed to continue their education.
According to school regulations in Guinea, a pregnant young woman must be expelled, unless she is married, but is allowed to return after delivery. Thus, marriage is a protection against compulsory expulsion. The search for a marriage partner thus may be a strategy for minimizing risk.
A young woman who does not go to school--especially one working in the informal sector--is expected by her family to marry early, in order to reduce the cost of feeding and clothing her. "She has eaten enough rice" was a typical parental statement noted by young people. Female respondents felt highly pressured to obtain a marriage partner.
"We pray to God to get married because at home you only get reproaches by your mother if one candidate presents himself and you refuse, then another comes and you refuse. It is much better if you are married."--Female apprentice
Most of the out-of-school women expressed their wish to find a partner who is able and willing to care for them and their family.
"I'm only looking for a rich man. No other man. Only a rich one."--Housemaid
Male pupils are interested in partners of their own social group, who support their main goal: to successfully finish school. They will consider a relationship with a young woman who is not in school if she supports that goal. The pupils saw themselves as competing with wealthy men, who easily attract young women with gifts and money, and they faulted their female peers for being too geared toward material benefits and not realizing the advantages of having a knowledgeable partner.
"If a girl is together with a student, he knows the methods. The others--for example, a businessman or a cart-pusher--they know nothing. In brief, we have something to tell them."--Male pupil
Male pupils have better access to young women in villages than in urban areas. In comparison to villagers, these young men are more knowledgeable and modern.
"A girl in the village feels attracted, even if I have nothing. She feels attracted because she has heard that I am [from] the town."--Male pupil
Out-of-school male respondents said they have difficulty finding a girlfriend because they are rarely able to fulfill young women's material expectations. In particular, the cart-pushers highlighted their low chances. They felt they are perceived as "nobodies" from the lowest social class, in a job paying just enough to survive on. They regarded getting a girlfriend as almost impossible.
"The cart-pusher does not have women, because if they learn that you push a cart, they don't need you anymore. They don't have confidence in you."--Cart-pusher
According to the male participants, young women leave their boyfriend as soon as he is short of money. But money is not the only factor when it comes to male competition. Literacy, or, in a wider sense, being "intellectually developed," constitutes a comparative advantage.
"He knows how to write. I have to pay to get something written. He might lie, saying that his father is in France or the United States. He will lie to corrupt the girl. For me, she knows my place."--Cart-pusher
Some explained that they would not be willing to compete for a young woman by spending the little money they have on her. They would prefer to concentrate on their education and thus create a basis for future economic independence and marriage. This is a reason for choosing a young woman who is an apprentice herself, in order to economize together.
AGE DIFFERENCE AMONG PARTNERS
On average, young women reported that their partners were 5.5 years older than them; young men reported that their partners were an average of 3.9 years younger than them. Depending on age and school status, the age difference increased from 3.1 years to 6.6 years among women and from 2.1 to 4.6 years among men (Table 2).
According to the explanations provided in the focus groups, a relationship with an older partner is not the preferred choice for young people. Young women accept a few years' age difference, but they do not want their partner to be much older, for fear that such a relationship will endanger their health, destroy their youth and contribute to early aging.
Young men try to avoid contact with older women. They believe that a relationship with an older woman makes a young man grow old or causes diseases or even an early death, while it rejuvenates the woman and makes her more beautiful. Participants observed that it is often difficult to refuse an offer from an older woman, especially if she is a member of one's family (e.g., a sister-in-law).
Young men are likely to follow their preference for avoiding sex with older partners. By contrast, young women often go out with partners who are many years older--irrespective of their preference.
CONTRACEPTIVE KNOWLEDGE AND USE
Among adolescent respondents, only about a quarter knew that the first coitus can result in pregnancy. Asked to choose from a list of methods those that can be used to prevent pregnancy, 70% of sexually active youths indicated the condom, 54% abstinence (i.e., avoidance of sex), 51% the pill and 29% coitus interruptus; about one in 10 cited ineffective methods or said they did not know (Table 4). Men mentioned male methods--the condom and coitus interruptus--more frequently than women did. Coitus interruptus was cited predominantly by youths in school.
The proportion of young people who said that all of the methods listed could be used to prevent pregnancy (11%) indicates that some are unable to distinguish between effective and ineffective methods. Even among those in school, the level of information is largely insufficient, especially among females, who have the most at risk.
Among sexually active respondents, 29% reported having used the condom, 20% the calendar method and 14% the pill. About half (53%) had never used any method or were not sure whether their partner had. Rates of never-use were much higher among out-of-school youths than among pupils.
Young women aged 15-16 are especially at risk because they are encouraged to delay first intercourse and may not learn about modern methods until after becoming sexually active. Whereas one-third or fewer of women at these ages know of the pill or condom, more than half know of abstinence (Figure 1). Many believe that the best way to prevent pregnancy is to avoid men.
"To avoid a pregnancy, you keep quiet, you don't go to town at night and if you are a student, you spend your evenings doing your homework. On Saturday and Sunday evenings, you study, and afterward you go to bed."--Female pupil
There is a widespread fear among young women that contact with men will inevitably lead to a sexual encounter, often by force. The critical point is entering a man's house or room.
"If you enter the house, the man invites you to have sex, and if you refuse, he'll beat you and you will accept."--Female pupil
Male respondents also mentioned abstinence as one means of avoiding pregnancy, but they argued that it is not acceptable for more than a few weeks.
Modern contraceptives are regarded with suspicion, because of perceived biological and social side effects--primarily that they cause infertility and enable young women to frequently change sexual partners or even engage in prostitution without fear of pregnancy. The condom is often mentioned, though mainly in relation to disease prevention or for individuals who do not trust their partner or who engage in one-night stands.
The menstrual cycle plays an important role in discussions on pregnancy prevention. Respondents of both sexes want to learn more about the menstrual cycle, on the assumption that infrequent intercourse combined with a sound awareness of fertile and infertile days would facilitate pregnancy prevention. Young women acknowledge that it is their responsibility to understand their cycle, but are worried by its irregularities. Furthermore, the concept of regularity is often misunderstood to mean that a woman's period will begin on the same date every month (e.g., the fifth of January, the fifth of February and so on).
PREGNANCIES AND ABORTIONS
Overall, 25% of sexually active young women reported having been pregnant, and 8% of sexually active young men reported having impregnated a partner. The pregnancy rate increased with age, but did not differ significantly between pupils and young people who were not in school (Table 2). The incidence of pregnancy also did not vary according to ethnic or religious group (not shown). Contrary to expectations, 20-24-year-old women who were in school had a higher pregnancy rate than their out-of-school counterparts. Thus, knowledge apparently is not the decisive factor for women in their 20s.
Focus-group participants described a premarital pregnancy as the major threat to a young woman's well-being. A pregnant young woman will likely be ridiculed by peers and teachers, and may face severe punishment at home. Her father may banish her from the house until her partner acknowledges his paternity and agrees at least to take financial responsibility. For this reason, young men also regard involvement in a premarital pregnancy as a threat. Furthermore, since an adolescent's father may regard her mother as responsible for guarding a young woman's chastity, the mother may be punished as well. On the other hand, many women, especially those aged 20-24, feel pressured to find a spouse or to prove their fertility.
Of the young women who had ever been pregnant, 22% reported having had an induced abortion. No significant difference was found in abortion between pupils and out-of-school women or among ethnic or religious groups.
The young people in the focus groups spoke of abortion as a definite possibility. The fact that abortions are not available legally in Guinea was not mentioned. Participants did, however, worry about the frequency with which abortion has fatal consequences.
The mean age at onset of sexual activity among the young people in our sample is similar to means elsewhere in the region.17 These men and women perceive sex as a normal part of their lives, a sign of modernism. As a result, young women are exposed to the risk of premarital pregnancies and their potentially negative consequences, including unsafe abortions.
Premarital pregnancies are widespread in part because young people have unprotected sex, owing to either ignorance or a lack of accessible services. The high value of fertility and the deeply rooted fear of infertility make young people susceptible to rumors about the side effects of contraceptives. In addition, young men may view modern method use as a threat to their control within their relationships and therefore tend to oppose these methods.
Young people in Guinea are still far from using contraceptives effectively, but their level of use compares quite favorably with that of the general population. In 1992, 6% of all women and 12% of all men had ever used a modern method;18 by contrast, about half of the sexually active unmarried young people in our sample had ever used one. Generally, survey data in Sub-Saharan Africa show that contraceptive use is lower among female adolescents than among women older than 20. But these data are misleading in that they tend not to differentiate between married and unmarried adolescents, and between sexually active and sexually inexperienced, unmarried teenagers.19 Data from Côte d'Ivoire20 and The Gambia21 show that sexually active, unmarried women are more likely to use modern contraceptives than are married women.
A common stereotype is that young women are seduced into their first sexual relationship by rich partners, or "sugar daddies." Our results, however, which are similar to findings for Nigeria,22 show that sexual initiation tends to be an affair between young peers; only once young women are sexually active do they begin to have older partners.
We found that one of the main reasons for this shift is that if young women are going to risk becoming pregnant, they want a partner who will be able to help support them and their children. If young women were sufficiently informed about contraceptive methods and had access to acceptable services, their interest in a partnership with an older and wealthy man might be reduced. (However, the fear of pregnancy as a result of contraceptive failure would remain; such a fear is justified when no safe abortion services are available.)
Another reason that sexually active young women become involved with older partners is to find a spouse. Although educated young women increasingly are becoming economically independent, women are often under intense pressure from their parents to marry as soon as they have reached the common age for marriage, and older men are more likely than younger men to be ready to marry. This motivation, along with women's fears that their odds of becoming infertile increase as they age, have to be considered in assessing the wantedness of premarital pregnancies: To the degree that premarital pregnancies among 20-24-year-olds are part of their marriage strategy, these pregnancies may not be unwanted.
Thus, it is important to create awareness among parents and other influential adults that many young people engage in sexual activity outside marriage; that pressure to marry is detrimental to young women's education; that contraceptive use prevents pregnancies and abortions, and may help dissuade young women from searching for older partners; and that safe abortions save lives.
Given that pupils receive little information about contraception, the rate of ever-use of a method among those who are sexually active is promising. It also suggests that sexuality education has the potential to influence attitudes and practice, as has been shown for The Gambia.23
Often the argument is made that in-school contraceptive or sexuality education programs have a limited impact because they cover only a small proportion of youths in need. Our findings suggest that in-school youths have a strong link to out-of-school youths, and that male pupils in particular are often the first partners of young women who are not in school; thus, if young people in school were better informed, they could play an important role as peer educators for their partners who are not in school. Such a role would have substantial benefits against a background of scarce resources.
An effective school-based program should start in primary school, prior to the onset of sexual activity, and should go far beyond providing anatomical, physiological and biomedical information about sex and contraception. It should be gender-specific in stressing males' responsibility regarding young women, and females' self-esteem and negotiation skills. It should also leave room to discuss moral values, traditional beliefs and peer values. The role of teachers in such programs requires critical examination because they are involved as sexual partners.
The shift to older partners has important implications for STD transmission. Since older men are more likely than younger men to have an STD, women increase their risk of becoming infected when they have sexual relationships with older men. If a young woman becomes infected and subsequently has sex with a peer, she may transmit the infection to him, and he in turn may transmit it to other young women. This issue has not yet been addressed in discussions on AIDS prevention in Guinea.
Another consequence of young women's shift to older partners is that men in their 20s find a shortage of partners their age and thus look for much younger women. This probably contributes to an increased demand for very young partners.
The low rate of sexual activity among young men who are not in school is primarily attributable to economic reasons. These young men, particularly unskilled workers, are unattractive partners to young women who are under pressure to marry or find a source of economic support. Thus, for young men, poverty lowers the chance of infection with STDs, whereas for young women, poverty increases their risk.
A mix of approaches to address premarital pregnancy and STD prevention among young people in Guinea is being examined. These include contraceptive services for youth, sexuality education by biology teachers and by a local nongovernmental family planning organization, youth theater groups, and roundtable discussions with teachers and parents and religious leaders. After careful evaluation, these approaches could lead to well-founded recommendations for countrywide application.
*Out-of-school youths may either learn a trade (e.g., carpentry, mechanics, painting or dressmaking) as apprentices in the formal sector or make a living as unskilled workers (e.g., shoe cleaners, cart-pushers, itinerant vendors or housemaids) in the informal sector.
A qualitative analysis prior to sampling showed that young people working in the informal sector would easily be missed by a household sampling procedure because they often sleep in the commercial area (e.g., cart-pushers may sleep in the cart owner's shop).
To conform to social norms, males may overreport their sexual experience, while females may underreport theirs. However, checks of our data for internal consistency confirmed the validity of the answers.
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