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J Pediatr. 2019 May;208:265-272.e1. doi: 10.1016/j.jpeds.2018.12.066. Epub 2019 Feb 6.

Childhood Violence Is Associated with Forced Sexual Initiation Among Girls and Young Women in Malawi: A Cross-Sectional Survey.

Author information

1
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address: eswedo@cdc.gov.
2
Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA.
3
Health Services Branch, Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA.
4
Malawi Ministry of Gender, Children, Disability and Social Welfare, Lilongwe, Malawi.
5
Office of the Global AIDS Coordinator, Washington, DC.
6
Centers for Disease Control and Prevention Malawi, Lilongwe, Malawi.
7
Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; Office of the Global AIDS Coordinator, Washington, DC.

Abstract

OBJECTIVE:

To describe associations between childhood violence and forced sexual initiation in young Malawian females.

STUDY DESIGN:

We analyzed data from 595 women and girls who were 13-24 years old who ever had sex and participated in Malawi's 2013 Violence Against Children Survey, a nationally representative household survey. We estimated the overall prevalence of forced sexual initiation and identified subgroups with highest prevalences. Using logistic regression, we examined childhood violence and other independent predictors of forced sexual initiation.

RESULTS:

The overall prevalence of forced sexual initiation was 38.9% among Malawian girls and young women who ever had sex. More than one-half of those aged 13-17 years at time of survey (52.0%), unmarried (64.6%), or experiencing emotional violence in childhood (56.9%) reported forced sexual initiation. After adjustment, independent predictors of forced sexual initiation included being unmarried (aOR, 3.54; 95% CI, 1.22-10.27) and any emotional violence (aOR, 2.47; 95% CI, 1.45-4.24). Those experiencing emotional violence alone (aOR, 3.04; 95% CI: 1.01-9.12), emotional violence in combination with physical or nonpenetrative sexual violence (aOR, 2.50; 95% CI, 1.23-5.09), and emotional violence in combination with physical and nonpenetrative sexual violence (aOR, 2.61; 95% CI, 1.20-5.67) had an increased independent odds of forced sexual initiation.

CONCLUSIONS:

Experiences of forced sexual initiation are common among Malawian females. Emotional violence is strongly associated with forced sexual initiation, alone and in combination with other forms of childhood violence. The relationship between emotional violence and forced sexual initiation highlights the importance of comprehensive strategies to prevent childhood violence.

KEYWORDS:

adolescence; coerced sex; emotional violence; sexual violence

PMID:
30738660
PMCID:
PMC6486860
[Available on 2020-05-01]
DOI:
10.1016/j.jpeds.2018.12.066

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