Sexual Expressions in Jamaica

1
Chapter 1
Sociodemographic correlates of age at sexual debut among women of the
reproductive years in a middle-income developing nation
Paul A. Bourne
Introduction
In 1997, statistics revealed that the median age at first sexual intercourse for Jamaican women
was 17.3 years and this fell to 16.0 years in 2002.1
Embedded in this finding is the lowering of
premarital sexual relations with the passing of time, and the reproductive health problems
associated with early sexual debut among women aged 15-49 years. Early sexual debut poses
both health (STIs, HIV, HPV, pregnancy) and social (school drop-outs) risks, and continues to be
a public health concern among several nations.1
Inconsistent contraceptive use coupled with the
continuous lowering of the age of sexual relations offers an explanation of the failure of public
health programmes to effectively address sexual behaviour of females in many developing
countries, particularly in Jamaica. This is embedded in statistics which showed that only 43.3%
of Jamaican women aged 15-19 years old and about 66% of women aged 15-49 years reported
using a condom in the last 30 days1
, indicating not only premarital sexual relations, but also risky
lifestyle practices and the likely to the spread of HIV/AIDS and other sexually transmitted
infections.1
The lowering of the age at sexual debut further goes beyond unwanted pregnancies
to health problems such as cervical cancers, human papillomavirus (HPV) and genital or anal
ulceration, unsafe abortions, psychological trauma and the socioeconomic challenges for the
society in the future, which makes it a public health problem worth studying.

2
Almost 2 in every 5 Jamaican women have been pregnant at least once prior to reaching
the age of 20; most of pregnancies are unplanned, especially during the adolescent years (80%). 1
The average age at first sexual initiation in Jamaica is 15.8 for females and 13.5 for males,1
much
of which is forced and is seen as a direct link with violence, as well as one of the roots of sexual
and reproductive health problems in the international community.2
Such problem goes against
the principles of the ICPD 1994, which stipulates that when it comes to matters of sexual
relations, full respect for the integrity of the individuals involved should be of the utmost.2
“First
sexual intercourse almost always take place outside of a formal union”3
and with older men (for
the females) 4
, this occurrence is likely to result in health situations relating to STIs and HIV, as
well as drug abuse.5
Inspite of the reality of the lowering of age at first sexual debut, particularly with regard
to premarital sex of adolescents, the developing societies, in particular Jamaica, do not frown
upon this practice.6,7
Although teenage fertility is not actively condoned in the Caribbean,6
the
churches and family planning interventions have been actively campaigning against this practice
as well as early sexual debut, but the practice continues. Early sexual debut, inconsistent condom
usage and teenage pregnancy are not atypical in the developing world, more specifically
Jamaica. A study of some sub-Saharan African and South-East Asian nations show similar
sexual behaviour and attitude of young people.8
According to Warren et al.,9
the high fertility
population in Jamaica was women ages 14-24 years, indicating a high degree of premarital
sexual activities and inconsistent condom use within the context of reduced age at first sexual
intercourse.10
A study by Henry-Lee11
showed that 66% of Jamaican women used contraceptives,
but only 34% of pregnancies were planned indicating that inconsistent contraceptive use is

3
accounting for increased HIV/AIDS and STIs in Jamaica and on a wider scale in other
developing countries, as young adults are engaged in risky sexual practices.12,13
In Antigua and Barbuda, Haiti, Guyana, Trinidad and Tobago and Dominica Republic,
one in six women between the ages of 15 and 24 became sexually active before the age of 15
years.14, 15
According to Crawford, McGrowder and Crawford, 16
2 in every 5 Jamaican women
have been pregnant at least once, 4 in every 5 adolescent women pregnancies were unplanned
and 74% of females ages 15-17 years old were sexually active compared to 47% of males of the
same age. Moreover, Crawford and colleagues found that of the sample of adolescents, none of
the females were having sexual intercourse with males within their age cohort compared to 39%
of adolescent males.16
Ninety-five percentages of adolescent females’ sexual partners were 17+
years old compared to 78.2% of adolescent males. It can be extrapolated from the afore-
mentioned findings that premarital sexual relations are on the rise in developing nations, in
particular Jamaica, and the lowering of age at first sexual intercourse among young women in the
developing world is a public health concern.
In a study which looks at sexual initiation of persons within the age range of 15-44 years,
it was seen that protestants (similar to those of non-religion) were more likely to have their first
sexual initiation within their 16th
year, when compared to the Catholics (within their 17th
year)
and those of other religion (18th
year).4
In addition to the factor of religion, the said study pointed
out that young individuals who resided with both parents encountered sexual initiation later than
those in other family situations.4
Another study conducted by Fatusi & Blum,17
using a sample of
2,070 adolescents who were never married, found that condom efficacy, positive attitude to
family planning use, condom access, alcohol use, and higher level of religiosity were associated
with age at first sexual debut. Fatusi & Blum’s work concurs with some of the findings of an

4
earlier study, which found self-efficacy, alcohol and drug use, norms about having sexual
intercourse, poor academic performance and gender to be factors that explain sexual initiation
among middle-school, inner city youth.18
Penfold et al., 19
using a sample of 4,379 Scottish
adolescents, found that family (parental monitoring), school life (enjoyment), gender, self-
esteem, religion, and informal sexual health intervention were associated with self-reported first
sexual intercourse. Penfold et al.’s work added more variables to the existing body of literature
on age at first sexual debut. Rosenthal et al.20
added to the afore-mentioned factors which are
also associated with age at first sexual initiation. They found that the perception of greater
physical maturity, expectations of earlier autonomy among gender, and the use of illicit drugs to
be statistically associated with age at first sexual debut among high schoolers.
Inspite of the lowering of age at first sexual relations and statistics showing that HIV, and
other malignant neoplasm are among the 10 leading causes of mortality among Jamaican
women; 21
as well as the direct association between early age of sexual debut, the increased risk
of cervical cancers, 22
the relationship between cervical cancer and STI, in particular human
papillomavirus (HPV), and age at first sexual debut23-25.
The issue of factors explaining age at
first sexual initiation is unresearched in Jamaica.
Most studies that have examined factors associated with age at first sexual intercourse
have used young people between ages 10-30 years. In this study, we seek to elucidate correlates
which account for age at sexual debut of women aged 15-49 years in Jamaica. This study is not
far fetched as a previous study in Europe used ages 16-44 years.26
The main objective of this
paper was to elucidate the socioeconomic variables which explain age at first sexual initiation of
Jamaican women (ages 15-49 years). It explored variables relating to early sexual debut such as
age of menarche, contraception, religion, education, crowding, shared sanitary convenience,

5
forced sexual experience, marital status, employment status, subjective social class, and area of
residence among women in the reproductive years.
Methods
Sample
This descriptive cross-sectional study used a secondary dataset from the National Family
Planning Board (Reproductive Health Survey, RHS). There are two sets of inclusion criteria,
which are females and ages. The eligibility criterion for age was 15 to 49 years at last birthday.
Since 1997, the National Family Planning Board (NFPB) has been collecting information on
women (aged 15-49 years) in Jamaica regarding contraception usage and/or reproductive health.
In 2002, the Reproductive Health Survey (RHS) collected data on Jamaican men ages 15-24
years as well as women 15-49 years old. The current study extracted only females aged 15-49
years from 2002 Reproductive Health Survey to carry out this research. The study population
was 7,168 women of the reproductive ages.
Stratified random sampling was used to design the sampling frame from which the
sample was drawn. Using the 2001 Census sector (or sampling frame), a three-stage sampling
design was used. Stage 1 was the use of a selection frame of 659 enumeration areas (or
enumeration districts, EDs). This was calculated based on probability proportion to size. Jamaica
is classified into four health regions. Region 1 is composed of Kingston, St. Andrew, St. Thomas
and St. Catherine; Region 2 comprises Portland, St. Mary and St. Ann; Region 3 is made up of
Trelawny, St. James, Hanover and Westmoreland, with Region 4 being St. Elizabeth, Manchester
and Clarendon. The 2001 Census showed that Region 1 comprised 46.5% of Jamaica compared
to Region 2, at 14.1%; Region 3 at 17.6% and Region 4 at 21.8%.1

6
In stage 2, the households were clustered into primary sampling units (PSUs), and each
PSU constituted an ED, which in turn was comprised of 80 households. The previous sampling
frame was in need of updating, and so this was performed between January and May 2002. The
previous sampling frame was in need of updating, and so this was carried out between January
2002 and May 2002. The new sampling frame formed the basis upon which the sampling size
was computed for the interviewers to use.
Stage 3 was the final selection of one eligible female from each sampled household and
this was done by the interviewer on visiting the household.
The Statistical Institute of Jamaica (STATIN) provided the interviewers and supervisors,
who were trained by McFarlane Consultancy, to carry out the survey. The instrument
administered was a 35-page questionnaire. The data collection began on Saturday, October 26,
2002 and was completed on May 9, 2003. Prior to the date of the final data collection, pre-testing
of the instrument was conducted between March 16 and 20, 2002. A total of 175 instruments
were pre-tested.. Modifications were made to the pre-tested instrument (questionnaire), after
which the final exercise was carried out. Validity and reliability of the data were conducted by
many statisticians, statistical agency, and university scholars before the data was used as the data
are for national policy planning. After which it was released to the University of the West Indies,
Mona, Data Bank for use by scholars. The data was weighted in order to represent the population
of female aged 15 to 49 years in the nation.1
Statistical analyses
Data were entered, stored and retrieved using SPSS for Window, Version 16.0 (SPSS Inc;
Chicago, IL, USA). Descriptive statistics were performed on particular sociodemographic
characteristics of the sample (frequency, mean, standard deviation (SD), and range). All metric

7
variables were tested for normality (age at first sexual debut, crowding, age, and years of
schooling). Where skewness was found to be less than 0.5, the variable was used in its current
form and a value more than 0.5 was normalized by natural log, or another method. Independent
sample t-test was used to examine differences in age at sexual debut between those who
frequently attend churches and those who infrequently visit churches and F-statistic was
employed for age of respondents by age at sexual debut. Finally, ordinary least square (OLS)
regression was used to fit the data because the dependent variable (age at sexual debut) was a
continuous one. Stepwise multiple linear regression was used to fit the one outcome measure
(age at first sexual debut) by different sociodemographic variables. Thus, only explanatory
variables (i.e. statistically significant variables) are shown in Table 1.3. Where collinearity
existed (r > 0.7), variables were entered independently into the model to determine those that
should be retained during the final model construction.27
To derive accurate tests of statistical
significance, we used SUDDAN statistical software (Research Triangle Institute, Research
Triangle Park, NC), and this adjusted for the survey’s complex sampling design. A p-value <
0.05 (two-tailed) was used to establish statistical significance.
Measures
Age at first sexual debut (or initiation or intercourse) was measured based on a respondent’s
answer to the question “At what age did you have your first intercourse? Crowding is the total
number of persons in a dwelling (excluding kitchen, bathroom and verandah). Age is the number
of years a person is alive up to his/her last birthday (in years). Contraceptive method comes from
the question “Are you and your partner currently using a method of contraception? …”, and if
the answer is yes “Which method of contraception do you use?” Age at which began using
contraception was taken from “How old were you when you first used contraception? Area of

8
residence is measured from “In which area do you reside?” The options were rural, semi-urban
and urban (1 = rural, 0 = otherwise; 1 = semi-urban, 0 = otherwise, and urban is the reference
group). Currently having sex is measured from “Have you had sexual intercourse in the last 30
days?” (1=yes, 0 = otherwise). Education is measured from the question “How many years did
you attend school?” Marital status is measured from the following question “Are you legally
married now?”, “Are you living with a common-law partner now? (that is, are you living as man
and wife now with a partner to whom you are not legally married?)”, “Do you have a visiting
partner, that is, a more or less steady partner with whom you have sexual relations?”, and “Are
you currently single?” Age at menarche is measured from “How old were you when your first
period started (first started menstruation)?” Gynaecological examination is taken from “Have
you ever had a gynaecological examination?” (1 = yes, 0 = no). Pregnancy was assessed by “Are
you pregnant now?” (1=yes, 0 = otherwise or no). Religiosity was evaluated from the question
“With what frequency do you attend religious services?” The options range from at least once
per week to only on special occasions (such as weddings, funerals, christenings et cetera)
(1=frequent attendance from response of at least once per week, 0 = otherwise). Subjective social
class is measured from “In which class do you belong?” The options are lower, middle or upper
social hierarchy (1 = middle class, 0 = otherwise; 1 = upper class, 0 = otherwise; reference group
is lower class). Forced to have sexual relations was assessed from the question “Were you forced
to have sex at your first intercourse?” and the options were yes, no, don’t know and refused to
answer (1= yes, 0 = otherwise). Age at first sexual debut, age at menarche, age at first
contraceptive use, and years of schooling were used as continuous variables. Early sexual debut
is having sexual intercourse before the statutory legal age to do so (in Jamaica, this is 16 years
old).

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Result
Table 1.1 presents the demographic characteristics of the sample, which comprises 7,168
respondents (women who are ages 15-49 years at their last birthday). Most of the women in the
survey have been pregnant (84.3%) prior to this study and (4.4%) were pregnant at the time of
the study. Only 40.6% of the sample indicated that they had wanted to become pregnant, when
they realized they were. The mean age of menarche was 13.5 years (SD = 4.4 years), with the
median age of first sexual relations being 16.0 years (Range = 36 years). The mean age at which
the sample began using a contraceptive method was 19.8 years (SD = 4.3 years). Twenty-five
percentages of women began having sex at 15 years, fifty percentages at 16 years and seventy-
five percentages at 18 years. One-half of the sample indicated that they began learning about sex
education at 13.0 years (Range: 10, 29 years). The mean age for those who had their first sexual
intercourse was 15.2 years (SD = 5.9). One-half of the sample stated that they were dating their
partners for 2 years (Range: 0, 15 years) prior to their first sexual encounter.
Almost 38% of the sample attended church at least once per week; 19% at least once per
month and 7.3% attended church even on special occasions such as christening, wedding,
funerals or graduation. Eight-four percent (84%) of those who were married were living with
their husbands at the time of this study, five percent (5%) of those who have been pregnant had
still births, 12.1% had miscarriages, and 11.4% have been forced to have sexual relations with
another person.
Fifty-six percentages of the respondents are currently using a contraceptive to prevent
pregnancy. The study also shows that the condom was the most prevalent contraceptive method
(40.5%) among the respondents. This result was followed by the pill (32.9%), tubal ligation
(23.8%) and injection (22.9%).

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Figure 1.1 provides information on the relations between the respondents and the persons
with whom they (respondents) had her first sexual encounter. Majority of the sample indicated
that they used a contraceptive method on their first sexual relations (64.1%). These methods
include the condom (95.1%); rhythm or knaus-ogino method (2.3%); pill (1.9%); injection and
intra-uterine device (0.1%) each. Two percent of the sample who had an abortion did so once
(13.6%), twice (2.4%), thrice (0.8%) and four times (0.0%). The reasons given for the abortion
were risk to mother’s health (22.5%); risk of birth defects (2.9%); financial challenges (29.4%);
unwanted pregnancy by mother (12.7%); unwanted pregnancy by partner (4.9%); the absence of
a partner (2.0%) and other issues (22.5%). Thirty-five percentage of the respondents indicated
that they became pregnant while attending school, of which 28.3% continued their education
after the birth of their child.
When the respondents were asked ‘How many weeks after _________ birth of [last child]
did you resume sexual relations?, 25% of them said 2 weeks, 50% indicated 3 weeks and 75%
claimed at most 14 weeks.
Two-thirds of the sample used private health care facilities (private clinician, 64.6%;
private hospitals, 0.7% and private clinics, 1.3%) when compared with 31.1% of those who used
public/government facilities (public hospitals, 8.9%; government clinics, 22.2%).
Frequent attendees to church begin having sexual relations on average (mean) at 17.4
years (SD = 3.2) compared to 16.4 years (SD = 2.4 years) for non-frequent attendees – t-test = -
12.6, P < 0.0001.
A significant statistical difference emerged among age at sexual relations of residence of
particular geographical areas (F-statistic = 32.4, P < 0.0001). On average rural women began
having sexual intercourse at 16.5 years (SD = 2.6 years) compared to 1.7 years (should this be

11
17.4 years or another year) (SD = 2.9 years) for residence of semi-urban areas and 17.2 years
(SD = 3.0) for those in urban zones.
Table 1.2 shows information on the age of the respondents and age at sexual debut.
Statistical difference was found among the age of respondents and age at sexual debut of the
studied population (F statistic = 47.3, P < 0.0001).
Table 1.3 examines factors that are associated with the age of first sexual relations of
women ages 15 to 49 years in Jamaica. Using multiple regressions analyses, of the 17 variables
that were tested in the model, 11 variables emerged as statistically significant predictors of age of
first sexual relations (F-statistic [11, 5720] = 176.2, P-value < 0.0001). The factors explained
27.8% of the variability in age of first sexual relations.
Discussion
The sociodemographic related evidence of early sexual initiation has been put forward in
this study and shows consonance with the literature. It is realized that sexual intercourse at an
early age is usually by someone older and who is outside of a union. The risk associated with this
factor is that “older male partner presents a greater HIV transmission risk because they are more
likely than adolescent men to have had multiple partners; to have had varied sexual and drug use
experience and to be infected with HIV.”5
Sometimes the young female is persuaded by the their
older male perpetrators or partner, from using condom because of varying personal ideologies
and are therefore, less likely to use condom at first sexual intercourse (82%),5
unlike the findings
of this study (64.1%). This not only result in STIs but also unwanted pregnancy (which affects
more than 80 million people worldwide 28
), thus the high possibility of school drop-out, most
times after receiving up to approximately 12 years of formal education (similar to the findings of

12
this study). Where females are persuaded from using condom at first sexual intercourse, this may
be explained by the fact that males tend to be more casual about sexual relations and are more
willing to emphasize sexual aspects than their female counterparts, who are more likely to
romanticize sexual relationships.
This view point bears consistency with the findings of this study, whereby drop-outs were
more prevalent among those who became pregnant while attending school (35%) when
compared to those who continued their education after the pregnancy (28.3%). Other schools of
thought postulated that sexual activity and pregnancy among adolescents or teenagers in
Jamaica, Guatemala, and Latin America have been thought to be associated with poor education,
poverty and other social factors.10, 29, 30
The current findings highlighted that rural women on
average began having sex 8 months earlier than other women (at 16.5 years) that is the age in
which they would be in grades 10 and/or 11. Those grades are pivotal for the completion of
secondary level education, which means that lower level education will be greater among rural
women than those in other geographic areas. It is this lowered age of sexual debut and ignorance
of contraception that accounts for higher fertility and unwanted pregnancies among rural women.
Research has shown that at least 120 million women would have used contraceptives if
information was available.2
Therefore, “the lack of knowledge and available options
undermines the right of couples and individuals to exercise control over their fertility and to have
children in health and by choice”.2
Knowledge about contraception and the various services
available regarding its access is considered an obligation of national governments, especially
from a human rights perspective.31
In Jamaica, many youths lack accurate sexual health
information, especially with regard to the possibility of pregnancy at first intercourse; protection
against STIs via the correct use of the correct contraceptives; the effectiveness of oral

13
contraceptives against pregnancy; fallacies relating to contraceptive methods.32
Such asymmetric
information result in unintended pregnancies, STIs, and abortion. Where abortion is illegal and
access to contraception is limited, more than half of the pregnancies end in abortion.28
Take for
instance, in the cases of Chile, Hungary, Russia, Turkey, Czech Republic, abortion rates declined
significantly owing to access to modern forms of contraception.28
Similarly, in Canada, access to
user-friendly reproductive health services, high quality sex education and the increase use of oral
contraception has resulted in a decline in teen pregnancy rate.33
In Jamaica, a research by McNeil
concurs with the aforementioned studies that teenage pregnancy fell by 14.6% (from 1997 to
2000) because of sex education programmes, training, counseling, skills training and increased
contraceptive use.34
Many scholars view early pregnancies as a potential population problem as this increases
the chance of larger family size. This has contributed to 30% birth in islands such as St. Kitts and
Nevis, Dominica, St. Lucia and 32% for Jamaica.35
In an effort to avoid poor education or school
drop-outs, pregnancies are sometimes interrupted (induced abortion), which is about 60% among
the average teenager.14
In South Africa, a study found that 32% of pregnant teenagers complete
high school,36
suggesting and agreeing that medical or surgical abortions reduce the probability
of poor educational attainment. Another study shows that “adolescent girls contribute 55% of all
clandestine abortions” in Nigeria.37
While abortion still remains a public policy and public health
debate, in some countries it is considered a human right (Sweden), 31
legal (Guyana and Haiti
and illegal (Jamaica, Nicaragua and Chile). The reality is “Over 19 million women globally
resort to unsafe abortion each year, largely among the world’s poorest and most vulnerable
women, especially young women”,38
indicating that the illegality of abortion does not abate its
practices, but it becomes a public health concern. In Jamaica, abortion is considered a serious

14
offence under the Offences Against the Person Act 1973, Section 73, 39
and this goes to reducing
their reproductive health choice and open avenues of them seeking the service in unsafe
conditions. The reality is, with poverty being greater in rural areas and among females in
Jamaica,40
unwanted pregnancies which are arising from ignorance of contraception and earlier
sexual initiation means that educational disparity and income inequality if not abated will see a
higher fertility, adoption and unsafe abortions among those women.
Worldwide, “more than half a million women die every year from pregnancy-related
causes”.2
Many deaths resulted from approximately 20 million unsafe abortions that occur
yearly, especially among adolescent girls and young women in developing countries.2
In many
developing countries, abortion (if unsafe) is considered a common cause of maternal mortality,
hence a serious social problem.31
Nevertheless, “a lack of access to safe and legal abortions is an
obstacle to their enjoyment of human rights”.31
The goal of the World Summit on Social
Development (WSSD) Declaration and Programme of Action 1995, the ICPD 1994 and the
World Conference on Human Rights (WCHR), Declaration and Programme of Action 1993 is to
“…….reduce maternal mortality and morbidity and greatly reduce the number of deaths from
unsafe abortion”.2
Women in Jamaica like other Caribbean islands (such as Antigua and Barbuda, Haiti,
Guyana, Trinidad and Tobago and Dominica Republic) show a similar age of sexual debut. One
in six women in other Caribbean nations between the ages of 15 and 24 became sexually active
before the age of 15 years, 14,15
and 1 in 4 women in Jamaica begin at 15 years, and this is even
lower among non-frequent religious women (14.7 years). The current research shows a marginal
difference in the Crawford, McGrowder and Crawford’s16
which had that the mean age of sexual
debut for female was 15.8 years in Jamaica. Disaggregating the age at which women aged 15-49

15
years had their first sexual intercourse, we found that the mean age at sexual debut was lowest
for women aged 15-19 years old (15.2 years (SD = 1.6)) compared to other aged women.
While Crawford, McGrowder and Crawford found that much of earlier sexual debut was
out of violence, this research disagrees as we found that only 11.4% of those who have had
earlier sexual intercourse were raped,16
which indicates that the majority of first sexual debut
was a consensual act although by statutes all sexual relations below 16 years is a rape.41
A study
in New Zealand found that 7% of first sexual intercourse was forced, 42
which is marginally
lower than that of Jamaica. The time difference may account for this dissimilarity as Dickson et
al.’s work 42
was in 1993-1994, while the current study used data for 2004. Moreover, “First
sexual intercourse almost always took place outside of a formal union”3
and with older men (for
the females).4
We found that the majority of first sexual relations took place with a boy friend in
a visiting relationship with the respondent.
Based on the foregoing, “The timing of sexual debut among adolescents is influenced by
a wide range of factors including: age, gender, poverty, family structure, educational level,
pubertal timing, socio-economic status, self-efficacy, peer influences, religiosity, knowledge and
perceived risk of sexually transmitted infections, parenting practices and parental supervision,
community, media and health inequalities”.43
Outside of those factors which explain early first
coitus in the developing nations, particularly the Caribbean is the masculine orientation and
culture.44
Research demonstrates that the role of culture in the socialization of children is critical
to fashioning the adult, and as soon as females begin to grow breast and to menstruate there is a
perception of womanhood. During this growth and development process, the female adolescents’
physiology of reproduction sometimes begins in order to establish womanhood.

16
The validity of recall of age of first sexual intercourse has been established by a group of
researchers in 1997. They found that the test-retest correlations for the recall of age at first sexual
relations was 0.85 for females and 0.91 for males,45
which indicates the validity of usage of
recall data to measure the phenomenon. Hence, there is legitimacy in the use of cross-sectional
survey data to examine age at first sexual intercourse in Jamaica, and the findings therefore
provide invaluable insight into the attitude, behaviour and practices of women in Jamaica and
those factors which are associated with age at first sexual debut.
The current study, therefore, have added variables to the literature: gender, ethnicity,
income, mother’s education, family structure, interpersonal relationship and other socioeconomic
conditions are associated with age at first sexual intercourse.46-48
It also concurs with other
studies that sexual activity is no longer strongly predicted by marriage49-52
as the majority of
women who had their first sexual experience, engaged in such activity with a boy friend, stranger
or mere acquaintance (87 out of every 100 women). With the low condom usage on first sexual
intercourse found in this research, young women are open to the risk of STI, pregnancy and
psychological challenges of early sexual relations, and therefore this justifies the rationale for
wanting to modify sexual practices of adolescents.53,54
While the current reality of age at first sexual intercourse in Jamaica appears low, this is
equally the case in other nations as we found that 80% of a recent cohort of youths who had sex
did so become 20 years.55
The image that is embodied in these figures is the sexual complaints
which are likely to result from the adult sexual decision that will be taken by adolescents, 56, 57
and the possible life changing situations that are likely to result from a sexual encounter. Clearly,
the current public health intervention programmes in Jamaica, as well as other geopolitical areas
in the world are not reaching adolescents as they are have committed (under the ICPD 1994), and

17
by extension have failed to reduce the lowering of age of first sexual intercourse. With the
factors which emerged from the current study as accounting for age at first sexual intercourse, as
well as those from other studies, 58-60
like McGrath and colleagues, 61
we believe that a
multisectoral approach is needed to address these growing public health and legislative problems
– not as a single variable (age at first sexual intercourse) but other factors that are purported in
the reviewed studies, 62-64
as well as the evidentiary support of Jamaica. Within the context of
lowered age at first sexual intercourse of Jamaican women as well as the association between
forced sexual relations and early age of sexual debut, 65
this would be contributing to the current
public health problems of teenage pregnancies, high fertility, STIs, increased maternal and child
mortality, and psychologically challenged young people as they undergo the difficulty of the
experience.66-68
Clearly, this study highlighted the finding that the average age at first sexual debut for
Jamaican women (median age was 16.0 years) was lower than that of women in rural South
African (median age was 18.5 years)69
and eastern Zimbabwe (median age was 18.5 years).70
A
study, using European women ages 16-44, found that the average age of first sexual debut was
less than 16 years, and offers little solace for public health practitioners in Jamaica.23
Although
South Africa had the highest HIV infection rate in the world69
and an age at first sexual debut
lower than that of Jamaican women, public health specialists need to use the current findings to
ensure that the premarital sexual relations, inconsistent condom use and STI infections,
especially HIV, do not reach the levels of those in South Africa as previous studies have shown
the association between age at first sexual intercourse and having an STI.70
The rationale for this
prescriptive recommendation for public health specialists is embedded in the association between
early sexual debut and sexually transmitted infections as well as evidence which shows that STIs

18
are a gateway to complications such as pelvic inflammatory infections, infertility, ectopic
pregnancy, fetal abnormality and HIV/AIDS.70-72
Those are not the only issues of concerns at age
at first sexual debut as many studies have shown that gender, illicit drugs, age at menarche,
religiosity, area of residence and other factors are associated with this
phenomenon.19,20,22,25,69,70,73
This study concurs with the literature and added more variables such
as age at contraceptive use, forced sexual relations, employment status, shared sanitary
convenience, area of residence, and marital status, indicating that multi-variables are associated
with age at first sexual initiation of Jamaican women.
Conclusion
Public health policies have failed to effectively increase the age at first sexual intercourse for
women in Jamaica. This study shows that a multisectorial philosophy to the intervention is
needed in order to address the multidimensional nature of the factors which are associated with
age at first sexual debut. Sexual intercourse is commonly initiated in the adolescence years, and
with the increased risk of sexually transmitted infections, teenage pregnancy and adoption with
early sexual initiation, the public health consequences will be dire if they are felt unabated or the
age at sexual debut allowed to fall lower than current value.
Disclosures
The author report no conflict of interest with this work.

19
Disclaimer
The researcher would like to note that while this study used secondary data from the
Reproductive Health Survey, none of the errors in this paper should be ascribed to the National
Family Planning Board, but to the researcher.
Acknowledgement
The author thank the Data Bank in Sir Arthur Lewis Institute of Social and Economic Studies,
the University of the West Indies, Mona, Jamaica for making the dataset (2002 Reproductive
Health Survey, RHS) available for use in this study, and the National Family Planning Board for
commissioning the survey.

20
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24
Table 1.1. Demographic characteristic of studied population, n = 7, 168
Characteristic n %
Shared sanitary convenience with other household
No 5907 82.9
Yes 1219 17.1
Employment status
Employed 3025 42.2
Unemployed (including students) 4143 57.8
Main source of financial support
Partner 4129 57.6
Other 3039 42.4
Marital status
Legally married 1542 21.5
Common-law 1733 24.2
Visiting 1959 27.3
Not currently in union 1934 27.0
Currently pregnant
Yes 288 4.4
No 6219 94.6
Ever been pregnant
Yes 5301 84.3
No 985 15.7
Forced to have sex
Yes 747 11.4
No 5707 86.8
Health conditions
Diabetes 284 12.2
Anemia 438 18.8
Heart disease 94 4.0
Pelvic inflammatory disease 125 5.4
Urinary tract infection 800 34.3
Asthma 587 25.0
Hepatitis B 6 0.3
Area of residence
Urban 1144 16.0
Semi-urban 2079 29.0
Rural 3945 55.0
Socioeconomic class
Lower 1705 23.8
Middle 3079 43.0
Upper 2384 33.2
No. of pregnancies that resulted in live births median (range) 2.0 (0, 14)
Years of schooling mean (SD) 13.0 years (3.0 years)
Age mean (SD) 31.3 years (9.3 years)
Age at sexual debut median (Range) 16.0 years (29 years; max age 36
years)

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Figure 1.1 Person with whom respondents had their first sexual relations

26
Table 1.2. Age cohort of respondents by age at sexual debut
Age cohort of respondents (in years)
Age at sexual debut (in years)
Mean (SD1
)
15 – 19 15.2 (1.6)
20 – 24 16.2 (2.0)
25 – 29 16.8 (2.4)
30 – 34 17.1 (2.9)
35 – 39 17.2 (3.1)
40 – 44 17.2 (3.2)
45 – 49 17.1 (3.0)
Sample 16.8 (2.8)
1
SD denotes standard deviation
F statistic = 47.3, P < 0.0001

27
Table 1.3. Multiple linear regression analyses: Explanatory variables of age at first sexual debut,
n = 5,732
Explanatory variable β Coefficient CI (95%) R2
Constant 8.377 7.852 - 8.903 NA
Age began using contraceptive method 0.266 0.250 - 0.283 0.179
Years of schooling 0.166 0.141 - 0.190 0.048
Lower class (reference group)
Upper class 0.560 0.385 - 0.735 0.021
Forced sexual relations (1= yes) -0.650 -0.820 - -0.481 0.009
Frequent church attendance (1= once or less per
week)
0.511 0.364 - 0.659 0.006
Crowding 0.409 0.240 - 0.579 0.005
Employment status (1= employed) 0.347 0.206 - 0.489 0.003
Age of first menarche 0.048 0.027 - 0.069 0.003
Shared sanitary convenience (1=yes) -0.325 -0.504 - -0.147 0.002
Married or common-law union -0.175 -0.315 - -0.035 0.001
Urban area (reference group)
Rural -0.654 -0.856 - -0.452 0.001
NA – Not applicable

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Chapter 2
Young males whose first coitus began at most 15 years old
Paul A. Bourne
Introduction
For decades, public health practitioners have been designing intervention programmes geared
towards addressing (1) teenage pregnancy, (2) high fertility, (3) HIV/AIDS epidemic, and (4) age
at first coitus in developing nations, particularly in Jamaica. Inspite of their efforts to make
behavioural changes in those societies, the aforementioned issues continue to linger and are still
public health problems [1-5], for policy makers. Thousands of dollars have been spent on
intervention programmes that are structured towards sexual behaviour modifications, but (1)
HIV/AIDS continue to increase [6, 7] and (2) age of sexual debut keeps on falling over the last
decade in Jamaica [8-12].
In 2002 statistics showed that the mean age at first coitus among females Jamaicans was
15.8 years and 13.5 years for males [8]. With 1 in every 50 people in the Caribbean being
infected with the HIV/AIDS virus; AIDS being the main cause of deaths among people aged 15-
44 years [7]; HIV virus being among the 5 leading cause of mortality of those aged 10-19 years
old in Jamaica; coupled with the promiscuous lifestyle of Caribbean males [13], in Jamaica, 3
out of every 4 males aged 15-24 years old had sexual intercourse at least once per week and that
11 out of every 50 young males aged 15-24 years old had have coitus in their lifetime [4], then
unsafe sexual practices are a major public health problem that cannot go unresearched.
The World Health Organization (WHO) opined that unsafe sexual practices are a part of
risk factors which account for increased mortality and morbidity in the world [14]. Clearly from
the aforementioned issues, the continuously lowering of the age of coitus and its association with

29
unsafe sexual behaviour, it is a cause for concern in public health. Many studies have
investigated age at sexual debut and factors associated with it in order to provide a
comprehensive framework for addressing those issues [9-12]. Coitus continues to commence
during the adolescence years in many developing nations as well as the United States [15], while
researchers understandably so continue to examine age at first sexual intercourse and multiple
sexual relationships among these individuals, no study has explored the reproductive health
practices of those aged ≤ 15 years who are having sexual relations.
While it is valuable to inquire the sexual behaviour of older aged males in a society to
provide information on unsafe sexual practices that can be used to guide public health policy
framework, understanding the aged ≤ 15 years may produce somewhat of different information
that other aged cohorts would have give. Thus, the current study seeks to elucidate information
on the reproductive health practices of males aged ≤ 15 years as this is the aged in which many
of them commenced sexual relations. The rationale of this paper is provide policy makers with
research evidence that can be used to structure framework for intervention programmes for those
males aged ≤ 15 years who are have sexual intercourse.
Methods
Sample
This descriptive cross-sectional study used a secondary dataset, 2002 Reproductive Health
Survey. Since 1997, the National Family Planning Board (NFPB) has been collecting
information from Jamaican men (ages 15-24 years) and women (ages 15-49 years) regarding
contraception usage and/or reproductive health for the purpose of aiding government policies. In
2002, the Reproductive Health Survey (RHS) collected data on Jamaican men ages 15-24 years

30
and women 15-49 years. For this research, there are two sets of inclusion criteria. These are male
and age of first coital activity by at most 15 years. The current study extracted a sample of 1,083
males who had their first sexual coital activity by at most 15 years old from the initial sample of
2,437 men aged 15-24 years old.
is classified into four health regions. Region 1 is composed of Kingston, St. Andrew, St. Thomas
and St. Catherine; Region 2 comprises Portland, St. Mary and St. Ann; Region 3 is made up of
Trelawny, St. James, Hanover and Westmoreland, with Region 4 being St. Elizabeth, Manchester
and Clarendon. The 2001 Census showed that Region 1 comprised 46.5% of Jamaica compared
to Region 2, at 14.1%; Region 3 at 17.6% and Region 4 at 21.8% [10]
In stage 2 the households were clustered into primary sampling units (PSUs), and each
PSU constituted an ED, which in turn was comprised of 80 households. The previous sampling
frame was in need of updating, and so this was performed between January and May 2002. On
completion of the exercise, the total number of households visited was 15,950 of which 17.5% of
the inhabitants dwelled in urban areas, 27.7% resided in semi-urban zones and 54.8% lived in
rural areas. Almost 18% of the households had eligible men (ages 15-24 years old, n = 2,795
men). Sixteen percent of the eligible men resided in urban areas, 27.7% lived in semi-urban areas
and 56.4% dwelled in rural areas. The new sampling frame formed the basis upon which the
sampling size was computed for the interviewers to use. The sample represents a response rate of

31
87.2%: 88.3% of eligible urban men, 88.0% of semi-urban and 86.7% of eligible rural
respondents.
Stage 3 was the final selection of one eligible male from each sampled household and this
was done by the interviewer on visiting the household.
The Statistical Institute of Jamaica (STATIN) provided the interviewers and supervisors,
who were trained by McFarlane Consultancy, to carry out the survey. The instrument
administered was a 35-page questionnaire [10]. The data collection began on Saturday, October
26, 2002 and was completed on May 9, 2003. Prior to the date of the final data collection, pre-
testing of the instrument was conducted between March 16 and 20, 2002. A total of 175
instruments were pre-tested, of which 40.6% were given to eligible men. Modifications were
made to the pre-tested instrument (questionnaire), after which the final exercise was carried out.
The data was weighted in order to represent the population of men ages 15 to 24 years in the
nation.
Statistical methods
For this paper, the Statistical Packages for the Social Sciences (SPSS) for Windows, Version
16.0 (SPSS Inc; Chicago, IL, USA) was used to examine the data. Frequencies and means were
computed on the sociodemographic characteristics. Chi-square (χ2
) tests and independent
sample-test were used to evaluate associations and differences among mean scores of variables,
respectively. Stepwise multiple logistic regressions were used to analyze factors that explain (1)
had sex, (2) frequency of church attendance, (3) in sexual union and (4) used a condom on the
last sexual encounter.

32
Odds ratios were determined from the use of a binary logistic regression model, and
Wald statistic will be used to determine the strength of variable. Where collinearity existed (r >
0.7), variables were entered independently into the model to determine those that should be
retained during the final construction of the model. To derive accurate tests of statistical
significance, we used SUDDAN statistical software (Research Triangle Institute, Research
Triangle Park, NC), and this was adjusted for the survey’s complex sampling design. A P-value
< 0.05 (two-tailed) was used to determine statistical significance.
Measure
Crowding is the total number of persons in a dwelling (excluding kitchen, bathroom and
verandah). Age is the number of years a person is alive up to his/her last birthday (in years).
Contraceptive method is any device or approach that is used to prevent pregnancy. These
methods include tubal ligation, vasectomy, implant (norplant), injection, emergency
contraceptive protection, pill, condom, foaming tablets, creams, jellies, diaphragm, abstinence,
withdrawal, the rhythm method, calendar or Billings (1= yes, 0 = otherwise). Non-steady sexual
partner denotes casual sexual relations with someone with whom the individual is not having a
common-law sexual relationship, visiting relationship or to whom the individual is legally
married (1 = yes, 0 = otherwise). Education is taken from the question, ‘How many years did you
attend school?’ Shared facility is taken from ‘Are these [sanitary conveniences] shared with
another household? The options are shared, not shared or not stated. This was coded as 1 =
shared and 0 = otherwise. Woman (female) pregnant for is taken from the question, “Is a women
pregnant for you?” (1= yes, 0 = otherwise). Had sex is taken from the question “Have you had
sexual intercourse in the last 30 days?” (1= yes, 0 = otherwise). Frequent church attendance is
derived from, “With what frequency do you attend religious services? The options are at least

33
once per week; at least once per month; less than once a month; only for special occasions
(wedding, funerals, christening, etc); doesn’t attend at all, and no response (1= at least once per
week, 0 = otherwise).
Model
Using logistic regression, this study seeks to examine factors associated with (1) had sex, (2)
frequency of church attendance, (3) in sexual union and (4) used a condom on the last sexual
encounter among Jamaican males whose first sexual coitus was ≤ 15 years. Different social
factors influence men’s choices, and their decision to (1) have sexual relations, (2) frequently
church attendance, (3) in sexual union and (4) used a condom on the last sexual encounter.
Bourne and Charles [16] have established a connection between particular social and
reproductive factors and contraceptive use among young males aged 15-25s. Econometric
analysis was used to establish multifactorial determinants. The current research will use the
theoretical framework of Bourne and Charles’ econometric analysis to examine factors that are
associated with (1) had sex, (2) frequency of church attendance, (3) in sexual union and (4) used
a condom on the last sexual encounter among males whose first sexual coital activity occurred at
most 15 years old in Jamaica. The variables used in this econometric model are based on the
literature as well as the dataset.
Based on the literature, the following variables were examined using logistic regression:
Dependent – (1) had sex, (2) frequency of church attendance, (3) in sexual union and (4) used a
condom on the last sexual encounter. Independent - age of respondents; educational level;
employment status of young adult man; social class of young adult man; area of residence;
someone currently pregnant for respondent; shared sanitary convenience with non-household
members; age of first sexual relations; currently had sexual intercourse in the last 30 days;

34
number of sexual partners; religiosity; currently in a sexual union; hearing family planning
message; extracurricular activities; crowding in household; condom usage; in sexual union,
frequency in church attendance, involvement in family planning programme and having had
sexual intercourse in the last 30 days with a non-steady partner.
Results
Demographic characteristic of studied population
Table 2.1 presents information on the demographic characteristics of the studied
population as well as particular reproductive health issues.
Bivariate analyses
Table 2.2 examines particular demographic characteristics as well as condom usage, non-
partner sex, involvement in extracurricular activities and involvement in family planning
education by had sex (in the last 30 days). The findings revealed a significant statistical
association between involvement in extracurricular activities and had sex (χ2
= 4.19, P = 0.041,
Table 2.2): Twenty-four percentages of those who had sex reported being engaged in
extracurricular activities compared with 29% of those who did not have sexual relations.
Eleven out of every 25 young adults aged ≤ 15 years were in multiple concurrent
relationships (44%).
Multivariate analyses
Six variables emerged as statistically significant predictors of had sex (in the last 30 days)
- Model chi-square = 225.28, P < 0.0001; -2 Log likelihood = 1130.62; Nagelkerke r-squared =

35
0.274 (Table 2.3). The data correctly classified 71.3% of those who had sexual relations in the
last 30 days.
Using logistic regression analyses, four variables emerged as statistically correlated with
frequency of church attendance among the studied population (Table 2.4, Model chi-square =
225.28, P < 0.0001; -2 Log likelihood = 1130.62; Nagelkerke r-squared = 0.274).
Table 2.5 presents information on factors which account for in sexual unions. Three
variables emerged as significant correlates of in sexual union (Model chi-square = 176.45, P <
0.0001, -2 Log likelihood = 1180.41, Nagelkerke r-squared = 0.219).
Table 2.6, using logistic regression analyses, non-partner sex, had sex and women being
pregnant for emerged as factors accounting for having used a condom on the last sexual
encounter (Model chi-square = 63.72, P < 0.0001; -2 Log likelihood = 686.18; Nagelkerke r-
squared = 0.119; Hosmer and Lemeshow test, χ2 = 0.62, P = 0.734).
Discussion
Sexual promiscuity is a feature of many developing nations, particularly in the English-speaking
Caribbean countries [13]. It is well documented in the literature that age at first sexual
intercourse is occurring during the adolescence years in many societies [9-12], and this is even
lower among males than females [8]. Chevannes opined that sexuality and sexual behaviour
among Caribbean males is partly owing to the traditional values of the society on masculine,
manhood and machoism [13]. The social setting of Caribbean societies is such that males are
expected to be promiscuous, but this is not equally defined for females. The culture and social
structure of Caribbean societies have it that “A man I not a real man unless he is sexually active”
[13, p. 217] which justifies first coitus at puberty and not adulthood. With 31% of the Jamaican

36
population being less than 15 years old [14] and about one half being males, the present study is
critical to public health initiatives and framework as it will unearth key research findings.
Another social reality in Caribbean societies is not merely multiple partnerships which are
engaged in more by younger than older males, but that “… sexual awareness begins quite early
in life.” [13, p.192]. According to Chevannes, “By the time small children reach the age of seven
or eight, and are in primary school, their sexual socialization would have begun in earnest,
though it is probably in the immediate prepubescent period that they begin to exhibit personal,
emotional interest in sex” [13, 193]. In a nationally representative probability survey of 2, 843
Jamaicans aged 15-74 years old, Wilks et al. [4] found that 96.2% of males had sex compared
with 93.3% of females; 40.9% of male sample had multiple sexual relationships (2+
partners)
compared to 8.4% of females; and of those aged 15-24 years old, 36.1% of males had multiple
partners to 15.4% of females. The aforementioned figures on Jamaicans may appear alarming,
but a study conducted by Santelli et al [15] noted that adolescents and young Americas are also
engaged in multiple relationships, particularly more males than females, 12.8% of females had
multiple partners compared with 26.2% of males.
Polygamy seems to be a male phenomenon across the world, which is supported by the
culture that men’s sexual drives indicate prowess and women’s sexual drive should be passive
and highly controllable [17]. Even among female undergraduate students in China, Yan [5]
found that 5.3% had multiple sexual partners and 38.1% inconsistently used a condom,
suggesting that risky sexual behaviour among adolescents in the world is a reality. The current
study found that 51.2% of Jamaicans males aged ≤ 15 years old had sex in the last 30 days,
53.7% were in sexual unions, 82.6% were had sexual relations with a non-steady partner, 55.5%
dwelled in rural zones and19% were frequent church attendees. Furthermore, 11 out of every 25

37
male adults who had their first sexual encounter did so ≤ 15 years old. This paper will
comprehensively examined the aforementioned aged cohort in order to provide public health
policy makers with useful research evidence that can be utilize to frame intervention
programmes.
Many factors have been identified in the literature as explaining age at first sexual
intercourse [9, 18-20], but no study specifically examined a sample of those at the mean age at
sexual debut and particular reproductive health matters. In this research, it was revealed that
frequency in church attendance, involvement in extracurricular activities, non-partner sexual
relations, in sexual union, employment status and age influence males who had sex in the last 30
days. The findings highlighted that those who are frequent church attendees were 47% less likely
to have reported having had sex, and involvement in extracurricular activities reduced sexual
relations by 32%. The cultural values of the churches continue to lower sexual relationships. This
finding concurs with literature which showed that protestants (similar to those of non-religion)
were more likely to have their first sexual initiation within their 16th
year, when compared to the
Catholics (within their 17th
year) and those of other religion (18th
year) [21]. While the difference
in age at first sexual intercourse among the aforementioned cohorts may not seems to be great,
the current research found that 6.4 times more sexual relations occurred by those who are
infrequent church attendees than frequent church attendees (sexual relations by frequent church
attendees, 13.5%).
Among the factors which reduce sexual relations is extracurricular involvement. This
paper found that those who are engaged in extracurricular activities were 32% less likely to have
had sex in the last 30 days compared with those who were no involved in extracurricular
measures. Clearly the church is not only a place for biblical teaching as in this research it was

38
discovered that extracurricular activities was 1.9 times more engaged in by frequent church
attendees and those who had sex were 41% less likely to be frequent attendees. The church is
acting as social agency against sexual involvement through its teaching and responsibilities that
it thrust on young males. The church is also imparting self-esteem which is allowing young
males to delay sexual intercourse, but that this garnered and practiced by frequent attendees.
Using a sample of 4,379 Scottish adolescents, Penfold et al. [9] found that family (parental
monitoring), school life (enjoyment), gender, self-esteem, religion, and informal sexual health
intervention were associated with self-reported first sexual intercourse. Another group of
scholars found that the perception of greater physical maturity, expectations of earlier autonomy
among gender, and the use of illicit drugs to be statistically associated with age at first sexual
debut among high schoolers [19]. The churches seem to embodying in young males who are
frequent attendees, greater self autonomy as well as self-esteem that they use to delay age at
sexual intercourse which is not the case among non-frequent attendees.
Embedded in the findings of this research is that frequent church attendees’ as well as
their families are less likely to share sanitary convenience, suggesting that the socioeconomic
status of this cohort is better than non-frequent attendees. The church is therefore an institution
which is frequent by the middle and upper class families of young males, indicating that it apart
of the socialization of those socioeconomic strata more than the lower socioeconomic stratum.
Those socioeconomic classes are more able to afford the other amenities such as golfing,
skeeing, swimming, badminton, chess, extra tutoring, as well as other programmes offered by the
church as extracurricular activities that become engaging for the young males, and so reduce the
likeliness of sexual involvement. Then, with increased probability of sharing sanitary

39
convenience for poor family, sexual activities are increased as they are introduced by other
individuals.
With the engagement in social activities, children are introduced to others who have been
socialized within a different sub-culture. It is the other agents of socialization, that when the
male children are exposed, he is likely to change from the teaching and values of the church or
the family. It emerged in this study that as males get older he is more likely to be involved in
sexual union and this is also foster by more years of schooling. While education provides greater
knowledge of issues including reproductive health matters, self-esteem, and an opportunity for
socioeconomic advancement, it increases sexual unions, sexual activities and risky sexual
practices. Those who engaged in sexual relations in the last 30 days were 3.9 times more likely
to be in a sexual union, which is a side effect of exposure to other agents of socialization such as
the peer groups and schools. It was revealed here that increased schooling is providing more than
education, as it opens social relationships and some of these are likely to sexual. Yan et al.
provide an understanding of the peer groups influence while at school, when they said that
“Students who agree or accept multiple sex partner behavior are 3 times more likely to report
more sex partners. Peer influences are important, and students whose friends live with boyfriends
and who work at places of entertainment (where alcohol and sex are likely present) are 2 times
more likely to report more sex partners” [5, p. 9].
One of the good issues which emerged from the current finding is that 41 out of every 50
of the studied population reported having used a condom the last time a sexual activity was
performed, which is greater than contraceptive prevalence, globally (65% or 23 out of every 50)
[14]. Those who reported having had sex (n = 554, 51.2%), were 1.6 times more likely to use a
condom and this even greater among non-steady sexual partners (2.3 times). Wilks et al. found

40
that among males aged 15-24 years old, condom usage was 65.8% [4], which means that young
males in this study were less of a sexual risk-taker compared with those aged 15-24 years old.
Although the sexual practice among young males ≤ 15 years old is the un-desirous event as it
contravenes the law of Jamaica, it opens young males to adult activities and responsibilities
before time such as the pregnancy of female partner(s). Condom usage is high among the studied
population, but with little information about consistent usage, it is difficult to rightfully
determine unsafe sexual practices. Using statistics from PAHO [6, pp. 452-453], HIV is the
fourth dealing cause of mortality among Jamaicans aged 10-19 years. Extrapolating from the
PAHO’s data, clearly ignorance about sexual practices, proper condom usage, and unfitted
condoms are accounts for the high prevalence of HIV virus and that there is high risk sexual
behaviour among the present study population. Multiple sexual relationships, therefore, are
account for the high prevalence of HIV among young male adolescents in Jamaica. By
extrapolation, this study is in agreement with researchers in Africa who argued that multiple
sexual relations are the root of the HIV epidemic in southern and eastern Africa [22].
The high sexual promiscuity among the studied population is embedded in the findings
which showed that 41 out of every 50 had sex with a non-steady partner, and 11 out of every 25
had multiple concurrent relationships, which is reinforcing Chevannes’ work that Caribbean
males are socialized to be sexually adventurous [13]. Chevannes captured this adequately when
he stated that we loose the bull and tie the heifer, meaning that we allow the males to be sexually
free and expects this not to be the case from the females. The promiscuity of males in the
Caribbean, particularly in Jamaica, appears to have some African antecedents [23-26] as we the
same lineage, cultural settings, and general cosmology. It must be modified that the Afro-
Caribbean peoples share some history of the European slave masters, this means for a melting

41
pot of cultures with the dominant one being from the African traditions. Even non-Afro-
Caribbean males, share the same sexual promiscuity cosmology as those in Caribbean [15, 27].
According to Santelli [15], “Adolescent males [Americans] are more likely than adolescent
females to report multiple sexual partners and multiple concurrent partners” [15, p. 271].
Globally, therefore, the cultural setting and socialization of males share similar tenants. Thus,
the findings of this paper have widely implications for public health intervention initiations and
policy framework.
Conclusion
Public health intervention programmes need to have a new thrust of extracurricular activities for
young males as a medium of increasing age at first coitus. The gains of extracurricular activities
for young males include (1) social engagement, (2) time consumption, (3) reduced sexual
involvement, (4) built self-esteem, and (5) social capital. The church, which is an agent of
socialization, provides young males with the aforementioned positives as well as ethics and
morals that justify the delay of coitus. The issues of ethics and moral coupled with
extracurricular activities are forging a self-confident, sexually autonomous and responsibility.
Young males, despite the cultural values of sexual freedom among males in Caribbean societies,
social engagement within educational advancements is not all positive. There is a negative side
to the social engagement which is accommodated by schooling, as peer groups are encouraging
sexual unions. These sexual unions are fostering sexual unions, sexual activities and the lowering
of age at coitus which must be taken into the intervention programmes and educational system to
lower the probability of sexual engagement. Furthermore, any new intervention programme must
include economic survivability of family, extracurricular activities, building self-esteem, social
capital, values and morals in order to effectively change the current state of first coitus among

42
young males. Because people are prisoners to the beliefs, practices, values and customs (vices or
otherwise), merely providing young males with knowledge about reproductive health matters
and/or abstinence will continue to be ineffective as this research showed those factors which are
likely to cause increased age at first coitus must take a multisectoral approach as the factors are
different and not focused on a single theme. Merely bombarding the airwave with middle class
values when young people have not absorbed these aspiring values, as is the case used by
traditional and contemporary public health practitioners, will be useless to direct health
educational programmes at these individuals.
In summary, the best public health intervention programmes to address the present
young male population away from first coitus before 16 years must include values from an early
age, games and other extracurricular activities and not the traditional outer-directed approach to
health education. While education, undoubtedly provide many positives for young males,
programmes must be geared towards peer pressure, social engagement, and sexual relationships
which are likely to occur in educational institutions. The research findings are in, and should be
use to frame health promotion that will aggressively address the current challenges which
emerged from this study. Using fear to sell sexual behaviour modifications may be dangerous
and counterproductive as positive ideas, messages and imagery are more effective than negative
ones. Using this study’s results, young males need opportunities, values, self-esteem and outlets
of releasing sexual urges which are likely during adolescents. Then, while health promotion is
good it must incorporate those issues within it policy framework. Otherwise, public health will
continue to ineffective and useless in address the lowering of age at first coitus among young
people, particularly males.
Disclosures

43
The authors report not conflict of interest with this work.
Disclaimer
The researchers would like to note that while this study used secondary data from the
Reproductive Health Survey, none of the errors in this paper should be ascribed to the National
Family Planning Board, but to the researchers.
Acknowledgement
The authors thank the Data Bank in Sir Arthur Lewis Institute of Social and Economic Studies,
the University of the West Indies, Mona, Jamaica for making the dataset (2002 Reproductive
Health Survey, RHS) available for use in this study, and the National Family Planning Board for
commissioning the survey.
References
1. Frederick J, Hamilton P, Jackson J, et al. Issues affecting reproductive health in
Caribbean. In: Morgan O. ed. Health issues in the Caribbean. Kingston: Ian Randle
Publisher; 2005: pp. 41-50.
2. McNeil P. Coping with Teenage pregnancy. In: Morgan O. ed. Health issues in the
Caribbean. Kingston: Ian Randle Publisher; 2005: pp. 51-57.
3. Bain B. HIV/AIDS – the rude awakening/stemming the tide. In: Morgan O. ed. Health
issues in the Caribbean. Kingston: Ian Randle Publisher; 2005: pp. 62-76.
4. Wilks R, Younger N, Tulloch-Reid M, McFarlane S, Francis D. Jamaica health and
lifestyle survey 2007-8. Kingston: Tropical Medicine Research Institute, University of
the West Indies, Mona; 2008.
5. Yan H, Chen W, Wu H, et al. Multiple sex partner behavior in female undergraduate
students in China: A multi-campus survey. BMC Public Health 2009; 9:305.
6. Pan American Health Organization (PAHO). Health in the Americas 2007 volume II –
Countries. Washington D.C.: PAHO; 2007.
7. Douglas DL. Perspectives on HIV/AIDS in the Caribbean. In: Morgan O. ed. Health
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8. Jamaica National Family Planning Board (NFPB). Reproductive Health Survey, 2002.
Kingston: NFPB; 2005.
9. Penfold SC, Teijlingen ERV, Tucker JS. Factors associated with self-reported first sexual
intercourse in Scottish adolescents. BMC Research Notes 2009; 2:42.
10. Santelli JS, Kaiser J, Hirsch L, Radosh A, Simkin L, Middlestadt S: Initiation of sexual
intercourse among middle school adolescents: the influence of psychosocial factors.
J Adolesc Health 2004, 34:200-208.
11. Slaymaker, E, Bwanika, J B, Kasamba, I, Lutalo, T, Maher, D, Todd, J (2009). Trends in
age at first sex in Uganda: evidence from Demographic and Health Survey data and
longitudinal cohorts in Masaka and Rakai. Sex. Transm. Infect. 85: i12-i19
12. Louie KS, de Sanjose S, Diaz M, et al. Early age at first sexual intercourse and early
pregnancy are risk factors for cervical cancer in developing countries. Br J Cancer 2009;
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13. Chevannes B. Learning to be a man: Culture, socialization and gender identity in five
Caribbean communities. Kingston, Jamaica: The Univer. of the West Indies Press; 2001.

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14. World Health Organization (WHO). World health statistics, 2009. Geneva: WHO; 2009.
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U.S. adolescents and young adults. Family Planning Perspectives 1998; 30:271-275.
16. Bourne PA, Charles CAD. Contraception usage among young adult men in a developing
country. Open Access J of Contraception 2010; 1:51-59.
17. Shelton JD. Why multiple sexual partners? Lancet 2009; 374: 367-369.
18. Fatusi AO, and Blum, RW. Predictors of early sexual initiation among a nationally
representative sample of Nigerian adolescents. BMC Public Health; 8, 2008.
19. Rosenthal DA, Smith AMA, De Visser R. Personal and social factors influencing age at
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20. Mardh PA, Creatsas G, Guaschino S, et al. Correlation between early sexual debut, and
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21. Sexual Initiation. American Sexual Behaviour.
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22. Halperin D, Epstein H. Concurrent sexual partnerships help explain Africa’s high HIV
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23. Tawfi k L, Watkins SC. Sex in Geneva, sex in Lilongwe, and sex in Balaka. Soc Sci Med
2007; 64: 1090–101.
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45
Table 2.1: Demographic characteristics of studied population, n = 1, 083
Characteristic n %
Had sex (in last 30 days)
No 529 48.2
Yes 554 51.2
In sexual union
No 501 46.3
Yes 582 53.7
Non-partner sexual relation
No 175 17.4
Yes 831 82.6
Frequent church attendance
No 877 81.0
Yes 206 19.0
Involvement in extra-curricular activities
No 796 73.8
Yes 283 26.2
Involvement in family planning education programme
No 995 91.9
Yes 88 8.1
Educational levels
Primary or below 82 7.6
Secondary 469 43.3
Tertiary 522 48.2
Female pregnant for
No 1040 97.0
Yes 32 3.0
Shared sanitary convenience
No 891 83.3
Yes 178 16.7
Employment status
Employed 448 41.6
Not working but have a job 2 0.2
Unemployed 276 25.6
Student 351 32.6
Used condom last time had sex
No 199 18.4
Yes 884 81.6
Area of residence
Urban 188 17.4
Semiurban 294 27.1
Rural 601 55.5
No. of child/ren want to have, median(range) 3 (0 – 10)
Crowding, median (range) 2 persons (1 – 2)

46
Table 2.2: Particular demographic and reproductive health variables by had sex (in last 30 days)
Characteristic
Had sex (in last 30 days)
χ2
, P valueNo Yes
n (%) n (%)
In sexual union 164.77, < 0.0001
No 350 (66.2) 151 (27.3)
Yes 179 (33.8) 403 (72.7)
Area of residence 1.48, 0.476
Urban 92 (17.4) 96 (17.3)
Semiurban 135 (25.5) 159 (28.7)
Rural 302 (57.1) 299 (54.0)
Involvement in extracurricular activities 4.19, 0.041
No 374 (71.0) 422 (76.4)
Yes 153 (29.0) 130 (23.6)
Involvement in family planning education 0.051, 0.821
No 485 (91.7) 510 (92.1)
Yes 44 (8.3) 44 (7.9)
Employed 57.68, < 0.0001
No 393 (74.3) 288 (52.0)
Yes 136 (25.7) 266 (48.0)
Frequent church attendance 22.14, < 0.0001
No 398 (75.2) 479 (86.5)
Yes 131 (24.8) 75 (13.5)
Used condom last time 13.96, < 0.0001
No 121 (22.9) 78 (14.1)
Yes 408 (77.1) 476 (86.9)
Shared sanitary convenience 0.450, 0.502
No 440 (84.1) 451 (82.6)
Yes 83 (15.9) 95 (17.4)
Marital status 171.88, < 0.0001
Common-law 5 (0.9) 38 (6.9)
Visiting 174 (32.9) 365 (65.9)
Previously in union 147 (27.8) 59 (10.6)
Single 203 (38.4) 92 (16.6)
Non-partner sex 15.87, < 0.0001
No 106 (22.5) 69 (12.9)
Yes 366 (77.5) 465 (87.1)
Years of education, mean (SD) 1.6 yrs (2.5) 12.8 yrs (2.6) t = -1.297, P = 0.195
SD denotes standard deviation

47
Table 2.3: Logistic regression analyses: Explanatory variable of had sex (in last 30 days), n =
981
Dependent: Had sex β coefficient
Std
error
Wald
statistic
Odds
ratio CI (95%)
Frequent church attendance (1=yes) -0.47 0.19 5.80 0.63 0.43 - 0.92
Non-partner sex 0.64 0.19 11.01 1.90 1.30 - 2.77
Involvement in extracurricular activities -0.39 0.16 5.61 0.68 0.49 - 0.94
In sexual union 1.35 0.15 84.25 3.85 2.89 - 5.14
Employment status (1=employed) 0.41 0.17 5.76 1.50 1.08 - 2.09
Age 0.16 0.03 25.76 1.18 1.10 - 1.25
Constant -4.18 0.60 48.57 0.02
Model chi-square = 225.28, P < 0.0001
-2 Log likelihood = 1130.62
Nagelkerke r-squared = 0.274
Hosmer and Lemeshow test, χ2 = 7.44, P = 0.49
Overall correct classification = 71.3%
Correct classification of cases that had sex = 75.9%
Correct classification of cases that did not have sex = 66.0%

48
Table 2.4: Logistic regression analyses: Explanatory variable of frequent church attendance, n =
946
Dependent: Frequent church attendance β coefficient
Std
error
Wald
statistic
Odds
ratio CI (95%)
Involvement in extracurricular activities 0.64 0.28 5.34 1.89 1.10 - 3.24
Shared sanitary facility -0.62 0.28 5.00 0.54 0.32 - 0.93
Age -0.11 0.04 9.01 0.90 0.84 - 0.96
Had sex -0.53 0.18 8.36 0.59 0.41 - 0.84
Constant 0.71 0.64 1.22 2.03
Correct classification of cases, frequent church attendance = 60.0%
Correct classification of cases, infrequent church attendance = 100.0%

49
Table 2.5: Logistic regression analyses: Explanatory variable of in sexual union, n = 990
Dependent variable: In sexual
union β coefficient
Std
error
Wald
statistic
Odds
ratio CI (95%)
Age 0.15 0.03 29.55 1.16 1.10 - 1.23
Years of schooling 0.31 0.11 7.64 1.36 1.09 - 1.69
Had sex (1=yes) 1.35 0.14 87.15 3.85 2.90 - 5.10
Constant -4.34 0.63 46.87 0.01
Correct classification of cases in sexual union = 74.1%
Correct classification of cases not in sexual union = 61.7%

50
Table 2.6: Logistic regression analyses: Explanatory variable of used condom on last sexual
encounter, n = 946
Dependent variable: Used condom on
last sexual encounter
β coefficient
Std
error
Wald
statistic
Odds
ratio CI (95%)
Non-partner sex 0.81 0.23 12.99 2.26 1.45 - 3.51
Had sex (1=yes) 0.47 0.21 4.97 1.60 1.06 - 2.40
Woman pregnant for me -3.06 0.46 45.00 0.05 0.02 - 0.12
Constant 1.15 0.20 32.32 3.16
Correct classification of cases in used condom on last sexual encounter = 99.0%
Correct classification of cases did not used a condom on last sexual encounter = 14.1%

51
Chapter 3
Factor Differentials in contraceptive use and demographic profile
among females who had their first coital activity at most 16 years
versus those at 16
+
years old in a developing nation
Paul A. Bourne
Introduction
For decades, the developing countries like the developed nations have been experiencing
lowered age at first coital activity, which commences during the adolescence years. Young
people (ie. adolescents) continue to be engaged in sexual activities outside of marriage and even
the statutes. The continuity of early sexual debut means that there are some health and social
matters that will face the society because of early sexual relationships. It is well documented that
early sexual initiation is associated with increased HIV, human papillomavirus (HPV), cervical
cancers, teenage pregnancy, unwanted pregnancies, abortion (safe and unsafe), and lowered
levels of education and financial opportunities [1-6]. While the developing nations have been
plagued by the HIV/AIDS epidemic and lowered age at sexual debut, the developed world is
more so experiencing lowered age at first sexual debut than the prevalence and incidence of
HIV/AIDS epidemic faced by the developing societies. A previous study established that the
lowering of the age of first coital activity has been so for the past 3 decades in developed nations,
and particularly in New Zealand [7]. Furthermore, Dickson et al.’s work [7]; using a longitudinal
study of a cohort born in Dunedin in 1972-3, found that there were young people who were
engaged in sexual activities before 13 years old. This concurs with a five community
ethnographic study carried out by Chevannes in the Caribbean [8], which found that sex among
adolescents’ starts as early as 14 years. The aforementioned early sexual debut in the Caribbean

52
and New Zealand is also obtained in the United States [9], and a group of researchers found that
almost 12 out of every 25 individuals aged 15-19 years in the United States reported having had
sexual intercourse at least once [10].
In United States, the median age at first sexual debut was 17 years, which is higher than
that in Jamaica (15.0 years) [11, 12]. Like United States, New Zealand and Jamaica, some
African nations (such as Uganda, Kenya, Ghana, Tanzania, Zambia and Zimbabwe) had a
median age which is statistical the same, suggesting that premarital sexual behaviour is similar in
many developing and particular developed societies. A previous study conducted by Wilks et al
[13], using a national probability same survey of 2,848 Jamaicans aged 15-74 years, found that
22 out of every 25 people aged 15-24 years have had sexual intercourse - 21 out of every 25
males aged 15-24 years and 19 out of every 25 females of the same age [13]. The sexual
expression and practices of young Jamaicans (aged 15-24 years) is embedded in the fact that 11
out of every 25 have sex at least once per week - 11 out of every 25 males and 10 out of every 25
females [13]. Statistics also showed that 2.6% of Jamaicans aged 15-24 years had a STI in the
last 12 months compared with 2.4% of Jamaicans aged 15-74 years old. Comparatively between
the United States and Jamaica, less Americans aged 14-22 years were sexually active compared
to Jamaicans aged 15-24 years [9, 13]. However, there were similarities between Jamaica and the
United States as the age at sexual debut for males and females was relatively close [9, 13],
suggesting congruency in sexual expressions.
Using dataset for the 2002 Reproductive Health Survey in Jamaica [12], the mean age at
first coitus was 14.7 years (SD = 3.1, median age at first intercourse = 15.0, range = 13 – 16
years) [14], and the median age of first coitus among females aged 16-49 years was 16.0 years in
2001, this fell from 17.3 years in 1997 [12]. The rationales for using < 16 years and 16+ are (1)

53
the age of individual sexual consent is 16 years, and (2) the median age of first coitus among
females aged 15-49 years was 16 years.
Inspite of public health campaigns to address (1) the lowering of age of sexual
intercourse, (2) HIV/AIDS among the population, particularly among adolescents and young
adults, (3) sexual promiscuity, (4) inconsistent condom usage, (5) unwanted pregnancies and (6)
better sexual practices in the world, particularly in Jamaica, the society has seen the continuous
erosion of values because the aforementioned matters continue unabated and there seems to be
no end in sight. Many developed nations such as New Zealand and the United States is
experiencing the early age of sexual debut epidemic like Jamaica. Apart of the justification of
this public health challenge is that lifestyle practices, cultural values and expectation as well as
orientations which are changing in the 21st
century.
Although females in world have been living longer than males (life expectancy or healthy
life expectancy), which is the case in Jamaica, statistics revealed that the incidence of STIs
among female for 2007/2008 in Jamaica were greater for them than their male counterparts [13].
This is within context of increased public health education campaigns on sexual responsibility
and the rise of HIV/AIDS in the nation. Embedded in the incidence of STIs are the cultural
values, lifestyle, norms, beliefs and sexual practices of females, which will not easily change
because external agents such as health educators and professionals say that they are to do this.
The literature on age at first sexual intercourse is extensive but recent and factors that
determine contraceptive use of female [2-7, 15, 16], but no research existed that examined
differentials in factors of contraceptive use between females whose first coital activity was < 16
years and 16+ years old. Bourne et al. [16] eight factors were statistical associated with
contraceptive use among females aged 15-49 years. The factors were age (OR = 0.95, 95%CI =

54
0.98 – 0.99); social class (upper class, OR = 0.83, 95%CI = 0.73 – 0.95); area of residence (rural,
OR = 1.16, 95%CI = 1.02 – 1.32); currently pregnant (OR = 0.01, 95%CI = 0.00 – 0.02); had sex
in last 30 days (OR = 2.29, 95%CI = 1.95 – 2.70); number of sexual partners (OR = 1.85, 95%CI
= 1.57 – 2.17); age began using method of contraception (OR = 0.99, 95%CI = 0.98 – 1.00), and
crowding (OR = 1.4, 95%CI = 1.21 – 1.60). If research provides an understanding of issues in
our physical and social milieu, then, a study on the aforementioned is critical and timely as it
would provide insights into their behaviour, thereby allowing health practitioners and educator to
better understand how to address the increasing HIV/AIDS virus and other public health
problems such as unwanted pregnancies and unsafe abortions. With previous studies having
demonstrated that early sexual activities are associated with increased HIV/AIDS infections,
cervical cancers and other health problems [1-6, 15], understanding early sexual activity (before
the statutory age 16 years in Jamaica) and post the statutory age will provide invaluable insights
into practices and measure that can be formulated to address the lifestyle of these individuals.
This current study, recognizing limitations of previous research on the aforementioned
issue within the context of the increased HIV/AIDS virus, unwanted pregnancy, abortions and
high fertility [17-19] coupled with the continuous lowering of age of sexual debut over the
decades, can add value to public health by studying factor differentials in contraceptive use
between females whose first coital activity was < 16 years and those 16+ years old as well as
their demographic profile. Such a research is timely and will guide policy formulation and
intervention programmes. The rationales for the study are primarily based on (1) females
vulnerability in contracting HIV/AIDS and other STI, (2) females being less economic
independent than their male counterparts, (3) the vetoing power of males over females’
reproductive health choices in developing nations, (4) income inequalities between the genders,

55
and (5) the issue of survivability. This research aims to elucidate information on the differentials
in factors of contraceptive use between females whose first coital activity was < 16 years and
16+ years old and to provide a socio-demographic and reproductive health profile of these
individuals.
Methods
Sample (participants) and procedures
A descriptive cross-sectional study was carried out by the National Family Planning Board
(Reproductive Health Survey or RHS). There are two sets of inclusion criteria, which are females
and ages. The eligibility criterion for age was 15 to 49 years at last birthday. In 2002, RHS
collected data on Jamaican men ages 15-24 years as well as women 15-49 years old. The current
study extracted only females aged 15-49 years from 2002 Reproductive Health Survey (RHS)
dataset to carry out this research. The female sample for the 2002 RHS was 7,168 women of the
reproductive ages, with a response rate of 77.6%. Of those who responded (n=5, 565), 32.5% had
first coitus before 16 years old compared with 67.5% who began at 16+ years old. Thus, the
entire female sample for the 2002 RHS that responded to the survey was used for this study.
is classified into four health regions, which constitute particular parishes (there are 14 parishes).
Region 1 is composed of Kingston, St. Andrew, St. Thomas and St. Catherine; Region 2
comprises Portland, St. Mary and St. Ann; Region 3 is made up of Trelawny, St. James, Hanover
and Westmoreland, with Region 4 being St. Elizabeth, Manchester and Clarendon. The 2001

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