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Generalisation of sexual behaviour, including early sexual initiation, does not provide comprehensive knowledge of young people's sexual attitudes, behaviours and challenges, given the high sociocultural diversity and economic inequalities within countries. This study examines geographical hotspots of early sexual initiation, at the district level in Ghana and the factors associated with the observed spatial patterns.Data was derived from the 2017 Ghana Maternal Health Survey, covering 21,392 women aged 15-49 years. Early sexual debut denotes first sexual intercourse before attaining the legal age of sexual consent, which in Ghana, is 16 years. The Bayesian geoadditive semiparametric regression technique was used to examine geographical hotspots and correlates of the observed spatial patterns, classified into demographic, socioeconomic and pregnancy outcome factors.The results show that 26.7% (95% CI = 26.1-27.3) of women had their first sexual intercourse before attaining the age of 16 years. Hotspots of early sexual debut was observed predominantly among districts along the mainstream of the Volta Lake, which are also reported hotspots of child trafficking, labour and slavery. Demographic, socioeconomic and pregnancy related factors were identified to be correlated with the observed spatial clustering.Policies and interventions such as sexual and reproductive health education should target at-risk population, simultaneously addressing other child abuses perpetuating the practice.Ghana operates a decentralised health system, where health policies and interventions, including those for sexual and reproductive health are implemented at the district level. Yet, there are no studies that systematically identify districts where sexual behaviours, such as early sexual debut, require attention. This study uses spatial models and data from the 2017 Ghana Maternal Health Survey to identify areas (districts) with high concentration of women who initiated sex before the legal age of consent. Early sexual debut refers to first sexual intercourse before attainment of the legal age (16 years) of sexual consent. Early sexual initiation has been associated with adverse sexual and reproductive health outcomes such as unwanted pregnancies and STIs. The results show that about one in four women reported having early sexual intercourse. High early sexual intercourse was observed to be particularly concentrated among districts along the mainstream of the Volta Lake. With regards to the spatial correlates, for the districts in the Oti region, high early sexual debut was associated with low educational attainment and inability to read. For those in the Bono East and Eastern regions, women who had early sexual debut were more likely to have had a miscarriage, abortion or stillbirth. Younger women, those in co-habiting relationships and those not in union were more likely to have had early sexual debut in the districts in the Ashanti, Central and Northern regions. The findings call for intensification of sexual and reproductive health education in districts along the mainstream of the Volta Lake. |
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