Gendered power dynamics and threats to sexual and reproductive autonomy among adolescent girls and young adult women: A cross-sectional survey in three urban settings

• Published in: PloS one Vol. 16; no. 11; p. e0257009
• Main Authors: Decker, Michele R, Wood, Shannon N, Byrne, Meagan E, Yao-N'dry, Nathalie, Thiongo, Mary, Gichangi, Peter, M OlaOlorun, Funmilola, Koffi, Alain K, Radloff, Scott, Ahmed, Saifuddin, O Tsui, Amy
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 29.11.2021; Public Library of Science (PLoS)
• Subjects: Adolescent; Adolescent girls; Adolescents; Age; Aggression; Autonomy; Biology and Life Sciences; Birth control; Coercion; Coercivity; Condoms; Contraception; Contraceptives; Cote d'Ivoire; Cross-Sectional Studies; Datasets; Demographic aspects; Domestic violence; Economic systems; Engineering and Technology; Family violence; Fear & phobias; Female; Gender; Girls; Health aspects; Health risks; Humans; Intimate partner violence; Intimate Partner Violence - psychology; Kenya; Medicine and Health Sciences; Nigeria; Partnerships; People and Places; Personal Autonomy; Polls & surveys; Population; Power structure; Power, Psychological; Pregnancy; Psychological aspects; Public health; Regression analysis; Regression models; Reproductive Health; Risk factors; Sex; Sexual Behavior; Sexual intercourse; Sexual Partners; Social power; Social Sciences; Social systems; Statistical analysis; Teenage girls; Teenagers; Threats; Urban areas; Urban environments; Venn diagrams; Women; Womens health; Young Adult; Young adults; Young women; Kenya; Nigeria; Cote d'Ivoire; Côte d'Ivoire; Nairobi Kenya; United States > US; Maryland; Baltimore Maryland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0257009

Gendered economic and social systems can enable relational power disparities for adolescent girls and young women (AGYW), and undercut autonomy to negotiate sex and contraceptive use. Less is known about their accumulation and interplay. This study characterizes relationship power imbalances (age disparity, intimate partner violence [IPV], partner-related fear, transactional sex, and transactional partnerships), and evaluates associations with modern contraceptive use, and sexual/reproductive autonomy threats (condom removal/"stealthing", reproductive coercion, ability to refuse sex, and contraceptive confidence). Cross-sectional surveys were conducted with unmarried, currently-partnered AGYW aged 15-24 recruited via respondent-driven sampling in Abidjan, Côte d'Ivoire (n = 555; 2018-19), Nairobi, Kenya (n = 332; 2019), and Lagos, Nigeria (n = 179; 2020). Descriptive statistics, Venn diagrams, and multivariate regression models characterized relationship power imbalances, and associations with reproductive autonomy threats and contraceptive use. Relationship power imbalances were complex and concurrent. In current partnerships, partner-related fears were common (50.4%Nairobi; 54.5%Abidjan; 55.7%Lagos) and physical IPV varied (14.5%Nairobi; 22.1%Abidjan; 9.6%Lagos). IPV was associated with reproductive coercion in Nairobi and Abidjan. Age disparate relationships undermined confidence in contraception in Nairobi. In Nairobi and Lagos, transactional sex outside the relationship was associated with condom stealthing. AGYW face simultaneous gendered power differentials, against the backdrop of gendered social and economic systems. Power imbalances were linked with coercive sexual/reproductive health experiences which are often underrecognized yet represent a potent link between gendered social systems and poor health. Pregnancy prevention efforts for AGYW must address reproductive autonomy threats, and the relational power imbalances and broader gendered systems that enable them.