Socio-Ecological Associations of the Development of Sexual Behavior in Young Adolescent Girls in the Rural Southern Region of Malawi

Abstract

Adolescent girls are more likely to experience early sexual debut than boys. However, the developmental context of their sexual behaviors is under-investigated. Using the socio-ecological model and Malawi Schooling and Adolescent Survey, we investigated factors crucial in determining the development of sexual behaviors of 416, 14-year-old girls in rural southern Malawi. We applied Bivariate Logistic Regression analysis to determine associations. Results showed that 353 (84.9%) experienced sexual intercourse, 60 (18.4%) had multiple sexual partners, and 32 (9.1%) used condoms or hormonal contraceptives. Participants’ educational background, desire for higher education, reproductive health knowledge, and being monitored by teachers in school were positively associated with healthy sexual behaviors. Having a boyfriend, lack of schooling support, and being invited to teachers’ homes were positively associated with risky sexual behaviors. Therefore, promoting adolescents’ formal education, sexual health literacy, and safety in schools should be essential components of research and biobehavioral interventions targeting young adolescents in Malawi.

Keywords

sexual behavior socio-ecological factors young adolescent girls Malawi

Get full access to this article

View all access options for this article.

References

Adamek

Meckstroth

Inanc

Ochoa

O’Neil

McDonald

Zaveri

(2019). Conceptual models to depict the factors that influence the avoidance and cessation of sexual risk behaviors among youth. US Department of Health and Human Services. https://www.acf.hhs.gov/opre/report/conceptual-models-depict-factors-influence-avoidance-and-cessation-sexual-risk

Alawode

O. A.

Ogunwemimo

Bolorunduro

M.-E.

Awoleye

A. F.

(2021). Age at sexual debut and multiple sexual partnerships among adolescents in Nigeria: An assessment of the mediating role of the knowledge of sexually transmitted infections. Adolescents, 1(4), 421–432. https://doi.org/10.3390/adolescents1040032, https://mdpi-res.com/d_attachment/adolescents/adolescents-01-00032/article_deploy/adolescents-01-00032.pdf?version=1634035988

Amoo

E. O.

Adebayo

M. E.

Owoeye

M. O.

Egharevba

M. E.

(2022). To save a girl-child, you must train a boy-child: A note on situational irony. International Journal of Environmental Research and Public Health, 19(23), 16313. https://doi.org/10.3390/ijerph192316313

Auerbach

J. D.

Parkhurst

J. O.

Caceres

C. F.

(2011). Addressing social drivers of HIV/AIDS for the long-term response: Conceptual and methodological considerations. Global Public Health, 6(Suppl 3), S293–S309. https://doi.org/10.1080/17441692.2011.594451

Birhanu

Tushune

Jebena

M. G.

(2018). Sexual and reproductive health services use, perceptions, and barriers among young people in Southwest Oromia, Ethiopia. Ethiopian Journal of Health Sciences, 28(1), 37–48. https://doi.org/10.4314/ejhs.v28i1.6

Bisika

Ntata

Konyani

(2009). Gender-violence and education in Malawi: A study of violence against girls as an obstruction to universal primary school education. Journal of Gender Studies, 18(3), 287–294. https://doi.org/10.1080/09589230903057183

Center for Disease Control and Prevention . (2018). Parent engagement in schools. CDC. https://www.cdc.gov/healthyyouth/protective/parent_engagement.htm

Centers for Disease Control and Prevention . (2021). Preventing violence against children and youth globally. CDC. https://www.cdc.gov/violenceprevention/childabuseandneglect/vacs/fastfact.html

Chikhungu

Kadzamira

Chiwaula

Meke

(2020). Tackling girls dropping out of school in Malawi: Is improving household socio-economic status the solution? International Journal of Educational Research, 103(16), 101578. https://doi.org/10.1016/j.ijer.2020.101578

10.

Chimombo

Chibwanna

Dzimadzi

Kadzamira

Kunkwenzu

Kunje

Namphota

(2000). Classroom, school and home factors that negatively affect girls education in Malawi. UNICEF. https://www.unicef.org/spanish/evaldatabase/files/MLW_2000_005.pdf

11.

Choby

A. A.

Dolcini

M. M.

Catania

J. A.

Boyer

C. B.

Harper

G. W.

(2012). African American adolescent females' perceptions of neighborhood safety, familial strategies, and sexual debut. Research in Human Development, 9(1), 9–28. https://doi.org/10.1080/15427609.2012.654430

12.

Clifton

Trinh

Woods

(2016). Improving safe sex practices in adolescents and young adults. Academic Pediatrics, 16(6), Article e16–e17. https://doi.org/10.1016/j.acap.2016.05.037

13.

Costa

E. C. V.

McIntyre

Ferreira

(2018). Safe-sex knowledge, self-assessed HIV risk, and sexual behaviour of young Portuguese women. Portuguese Journal of Public Health, 36(1), 16–25. https://doi.org/10.1159/000486466

14.

Curtis

E. A.

Comiskey

Dempsey

(2016). Importance and use of correlational research. Nurse Researcher, 23(6), 20–25. https://doi.org/10.7748/nr.2016.e1382

15.

Dancy

B. L.

Jere

D. L.

Kachingwe

S. I.

Kaponda

C. P.

Norr

J. L.

Norr

K. F.

(2014). HIV risk reduction intervention for rural adolescents in Malawi. Journal of HIV/AIDS and Social Services, 13(3), 271–291. https://doi.org/10.1080/15381501.2013.864173

16.

Dancy

B. L.

Kaponda

C. P.

Kachingwe

S. I.

Norr

K. F.

(2006). Risky sexual behaviors of adolescents in rural Malawi: Evidence from focus groups. Journal of National Black Nurses' Association, 17(1), 22–28.

17.

Darroch

J. E.

Woog

Bankole

Ashford

L. S.

(2016). Adding it up: Costs and benefits of meeting the contraceptive needs of adolescents. New York: Guttmacher Institute. https://www.guttmacher.org/report/adding-it-meeting-contraceptive-needs-of-adolescents

18.

Decker

M. R.

Wood

S. N.

Ndinda

Yenokyan

Sinclair

Maksud

Ross

Omondi

Ndirangu

(2018). Sexual violence among adolescent girls and young women in Malawi: A cluster-randomized controlled implementation trial of empowerment self-defense training. BMC Public Health, 18(1), 1341. https://doi.org/10.1186/s12889-018-6220-0

19.

Elflein

(2020). Ranking of countries with the highest prevalence of HIV in 2000 and 2019. UNAIDS. https://www.statista.com/statistics/728248/global-distribution-of-new-hiv-infections-by-key-population/

20.

Ellsberg

M. V. A.

Madrid

Quintanilla

Zelay

Stöckl

(2017). Violence against adolescent girls: Falling through the cracks? Background paper. Ending violence in childhood globally. Know violence in childhood (pp. 1–24). New Delhi, India: Global Learning Initiative.

21.

Epstein

Bailey

J. A.

Manhart

L. E.

Hill

K. G.

Hawkins

J. D.

Haggerty

K. P.

Catalano

R. F.

(2014). Understanding the link between early sexual initiation and later sexually transmitted infection: Test and replication in two longitudinal studies. Journal of Adolescent Health, 54(4), 435–441. https://doi.org/10.1016/j.jadohealth.2013.09.016

22.

Feyisetan

Munthali

Benevides

Kazembe

Mutombo

(2014). Evaluation of youth friendly health services in Malawi (pp. 14–189). Washington, DC: Ministry of Health & Evidence to Action Project. https://www.e2aproject.org/wp-content/uploads/evaluation-yfhs-malawi.pdf

23.

Finer

L. B.

Philbin

J. M.

(2014). Trends in ages at key reproductive transitions in the United States, 1951-2010. Women's Health Issues, 24(3), Article e271–e279. https://doi.org/10.1016/j.whi.2014.02.002

24.

Finlay

J. E.

Assefa

Mwanyika-Sando

Dessie

Harling

Njau

Chukwu

Oduola

Shah

Adanu

Bukenya

(2020). Sexual and reproductive health knowledge among adolescents in eight sites across sub-Saharan Africa. Tropical Medicine and International Health, 25(1), 44–53. https://doi.org/10.1111/tmi.13332

25.

Foster

Child

(2020). Does my child’s educational success depend on me? A qualitative analysis of parents and teachers addressing barriers to education throughout Malawi. The national conference on undergraduate research (NCUR). Bozeman. MT, March 26-28, 2020. Montana State University. http://libjournals.unca.edu/ncur/wp-content/uploads/2021/03/Foster-Kathryn-FINAL.pdf

26.

Ganchimeg

Ota

Morisaki

Laopaiboon

Lumbiganon

Zhang

Yamdamsuren

Temmerman

Say

Tunçalp

Ö.

Vogel

J. P.

Souza

J. P.

Mori

WHO Multicountry Survey on Maternal Newborn Health Research Network . (2014). Pregnancy and childbirth outcomes among adolescent mothers: A world health organization multicountry study. BJOG: An International Journal of Obstetrics and Gynaecology, 121(Suppl 1), 40–48. https://doi.org/10.1111/1471-0528.12630

27.

Goodall

(2018). Parental engagement in children’s learning: Moving on from mass superstition. Creative Education, 09(11), 1611–1621. https://doi.org/10.4236/ce.2018.911116

28.

Government of Malawi . (2018). National strategy for adolescent girls and young women 2018–2022. Ministry of Finance Economic Planning and Development. Retrieved from.https://npc.mw/wp-content/uploads/2020/07/National-Strategy-for-Adolescent-Girls-and-Young-Women.pdf

29.

Greenberg

J. S.

Bruess

C. E.

Oswalt

S. B.

(2017). Exploring the dimensions of human sexuality (6th ed.). Jones and Bartlett Learning.

30.

Hall

(2023). Statistics on Children in South Africa: Children living far from school. Children's Institute, University of Cape Town. http://childrencount.uct.ac.za/indicator.php?domain=6&indicator=46#3

31.

Harper

G. W.

Riplinger

A. J.

Neubauer

L. C.

Murphy

A. G.

Velcoff

Bangi

A. K.

(2013). Ecological factors influencing HIV sexual risk and resilience among young people in rural Kenya: Implications for prevention. Health Education Research, 29(1), 131–146. https://doi.org/10.1093/her/cyt081

32.

Hervish

Clifton

(2012). Adolescents and young people in sub-saharan Africa: Opportunities and challenges. P. R. Bureau. https://www.adeanet.org/en/system/files/status_report_adolescents_and_young_people_in_sub-saharan_africa.pdf

33.

Hewett

Mensch

B. S.

(2009). Malawi schooling and adolescent survey (V2, UNF:6:Fz772WnOd71yKyt/e2XY+w== [fileUNF]). Population Council. https://doi.org/10.7910/DVN/V4C81G

34.

Hewett

P. C.

Chimombo

Mensch

B. S.

Lloyd

C. B.

(2006). Plotting a safe, healthy and productive path to adulthood: A longitudinal study of schooling quality and experience in Malawi. In (pp. 4–28). Population Council.

35.

Idele

Gillespie

Porth

Suzuki

Mahy

Kasedde

Luo

(2014). Epidemiology of HIV and AIDS among adolescents: Current status, inequities, and data gaps. Journal of Acquired Immune Deficiency Syndromes, 66(Suppl 2), S144–S153. https://doi.org/10.1097/QAI.0000000000000176

36.

Kadzamira

Moleni

(2008). The safe schools prgram: A qualitative stusy to examine school-related gender-based violence in Malawi. United States Agency for Internatinal Development. https://pdf.usaid.gov/pdf_docs/PNADK759.pdf

37.

Kaphagawani

N. C.

Kalipeni

(2017). Sociocultural factors contributing to teenage pregnancy in Zomba district, Malawi. Global Public Health, 12(6), 694–710. https://doi.org/10.1080/17441692.2016.1229354

38.

Kar

S. K.

Choudhury

Singh

A. P.

(2015). Understanding normal development of adolescent sexuality: A bumpy ride. Journal of Human Reproductive Sciences, 8(2), 70–74. https://doi.org/10.4103/0974-1208.158594

39.

Kaufman-Parks

A. M.

Longmore

M. A.

Manning

W. D.

Giordano

P. C.

(2023). The influence of peers, romantic partners, and families on emerging adults' sexual behavior. Archives of Sexual Behavior, 52(4), 1561–1573. https://doi.org/10.1007/s10508-022-02489-z

40.

Kemigisha

Bruce

Nyakato

V. N.

Ruzaaza

G. N.

Ninsiima

A. B.

Mlahagwa

Leye

Coene

Michielsen

(2018). Sexual health of very young adolescents in south western Uganda: A cross-sectional assessment of sexual knowledge and behavior. Reproductive Health, 15(1), 148. https://doi.org/10.1186/s12978-018-0595-3

41.

Kim

S. W.

(2019). Meta-analysis of parental involvement and achievement in East Asian countries. Education and Urban Society, 52(2), 312–337. https://doi.org/10.1177/0013124519842654

42.

Kyilleh

J. M.

Tabong

P. T.-N.

Konlaan

B. B.

(2018). Adolescents' reproductive health knowledge, choices and factors affecting reproductive health choices: A qualitative study in the west gonja district in northern region, Ghana. BMC International Health and Human Rights, 18(1), 6–6. https://doi.org/10.1186/s12914-018-0147-5

43.

Lara

L. A. S.

Abdo

C. H. N.

(2016). Age at time of initial sexual intercourse and health of adolescent girls. Journal of Pediatric and Adolescent Gynecology, 29(5), 417–423. https://doi.org/10.1016/j.jpag.2015.11.012

44.

Leone

Brown

L. J.

(2020). Timing and determinants of age at menarche in low-income and middle-income countries. BMJ Global Health, 5(12), Article e003689. https://doi.org/10.1136/bmjgh-2020-003689

45.

Lessard

L. M.

Wang

E. Y.

Watson

R. J.

(2021). School safety among sexual and gender minority adolescents: Implications for eating and weight control behaviors. Journal of School Health, 91(10), 788–795. https://doi.org/10.1111/josh.13069

46.

Madley-Dowd

Hughes

Tilling

Heron

(2019). The proportion of missing data should not be used to guide decisions on multiple imputation. Journal of Clinical Epidemiology, 110(2019), 63–73. https://doi.org/10.1016/j.jclinepi.2019.02.016

47.

Makwemba

Chinsinga

Kantukule

C. T.

Munthali

Woldegorgis

Haenni

Lin

(2019). Traditional practices in Malawi. N. S. Office. https://www.unicef.org/malawi/media/1546/file/Traditional/Practices/in/Malawi:/Survey/Report.pdf

48.

Malawi Ministry of Gender Community Development and Social Welfare and UNICEF . (2020). Improving educational outcomes among children in Malawi’s social cash transfer programme: A summary of research findings and policy options. Lilongwe, Malawi: Malawi Ministry of Gender Community Development and Social Welfare and UNICEF. https://www.unicef.org/malawi/media/3481/file/Improving/educational/outcomes/among/children/in/Malawi's/social/cash/transfer/programme/a/summary/of/research/findings/and/policy/options.pdf

49.

Malawi Ministry of Health . (2015a). National youth friendly health services strategy 2015-2020. Adolescent sexual and reproductive health behavioural statistics (pp. 6–69). Ministry of Health.

50.

March

A. L.

Serdar Atav

(2010). Social environment and problem behavior: Perceived school safety, gender, and sexual debut. The Journal of School Nursing: The Official Publication of the National Association of School Nurses, 26(2), 121–130. https://doi.org/10.1177/1059840509343112

51.

Maswikwa

Richter

Kaufman

Nandi

(2015). Minimum marriage age laws and the prevalence of child marriage and adolescent birth: Evidence from sub-Saharan Africa. International Perspectives on Sexual and Reproductive Health, 41(2), 58–68. https://doi.org/10.1363/4105815

52.

Mbadu Muanda

Gahungu

N. P.

Wood

Bertrand

J. T.

(2018). Attitudes toward sexual and reproductive health among adolescents and young people in urban and rural DR Congo. Reproductive Health, 15(1), 74. https://doi.org/10.1186/s12978-018-0517-4

53.

McClinton

A. T.

Jonas

Beauclair

Lombard

Duby

Cheyip

Maruping

Dietrich

Mathews

(2022). Early sexual debut and the effects on well-being among South African adolescent girls and young women aged 15 to 24 years. International Journal of Sexual Health, 34(2), 242–253. https://doi.org/10.1080/19317611.2021.1979162

54.

McLeroy

K. R.

Bibeau

Steckler

Glanz

(1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401

55.

McManus

Dhar

(2008). Study of knowledge, perception and attitude of adolescent girls towards STIs/HIV, safer sex and sex education: A cross sectional survey of urban adolescent school girls in south Delhi, India. BMC Women's Health, 8(1), 12. https://doi.org/10.1186/1472-6874-8-12

56.

Michelle

J. K.

Osterman

M. H. S.

Hamilton

B. E.

Martin

J. A.

Driscoll

A. K.

Valenzuela

C. P.

(2022). Births: Final data for 2020. National Vital Statistics Reports, 70(17), 1–50. https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-17.pdf

57.

Ministry of Gender Children Disability and Social Welfare [MoGCDSW], UNICEF, Center for Social Research, and CDC (2014). Violence against children and young women in Malawi: Findings from a national survey, 2013. Ministry of Gender, Disability and Social Welfare of the Republic of Malawi. http://evaw-global-database.unwomen.org/-/media/files/un/women/vaw/full/text/africa/malawi/violence/against/children/survey/2013.pdf?vs=1244

58.

Muchimba

(2019). Social ecological predictors of risky sexual behavior among young adults. Journal of Social, Behavioral, and Health Sciences, 13(1), 1–14. https://doi.org/10.5590/JSBHS.2019.13.1.01

59.

Muheriwa Matemba

S. R.

Cianelli

Leblanc

N. M.

Zhang

De Santis

Villegas Rodriguez

McMahon

J. M.

(2022). Associations between home- and school-based violent experiences and the development of sexual behavior in young adolescent girls in the rural Southern region of Malawi. International Journal of Environmental Research and Public Health, 19(10), 5809. https://doi.org/10.3390/ijerph19105809

60.

Munthali

A. C.

Kok

Kakal

(2018). YES I DO. Initiation ceremonies in traditional authority Liwonde in Machinga District in southern Malawi: What do they look like now and before; and do they people’s behaviour influence young regarding sex and relationships? Center for Social Research. https://www.chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.kit.nl/wp-content/uploads/2019/03/Study-report-initiation-ceremonies-YID-FINAL.pdf

61.

Munthali

A. C.

Mbendela

Mezuwa

Banda

(2015). Final evaluation of the joint programme on adolescent girls in Malawi. Center for Social Research. https://www.svri.org/sites/default/files/attachments/2016-12-12/Munthali/et/al/2015_FINAL/EVALUATION/OF/THE/JOINT/PROGRAMME/ON/ADOLESCENT/GIRLS/IN/MALAWI.pdf

62.

Mwale

Muula

A. S.

(2018). Effects of adolescent exposure to behaviour change interventions on their HIV risk reduction in northern Malawi: A situation analysis. SAHARA J: Journal of Social Aspects of HIV/AIDS Research Alliance, 15(1), 146–154. https://doi.org/10.1080/17290376.2018.1529612

63.

Nash

O’Malley

Geoffroy

Schell

Bvumbwe

Denno

D. M.

(2019). Our girls need to see a path to the future”. Perspectives on sexual and reproductive health information among adolescent girls, guardians, and initiation counselors in Mulanje district, Malawi. Reproductive Health, 16(1), 8. https://doi.org/10.1186/s12978-018-0661-x

64.

National Statistical Office and ICF . (2017). Malawi demographic and health survey 2015-16. National Statistical Office. https://dhsprogram.com/pubs/pdf/FR319/FR319.pdf

65.

Park

Yang

T. C.

(2017). The long-term effects of self-esteem on depression: The roles of alcohol and substance uses during young adulthood. The Sociological Quarterly, 58(3), 429–446. https://doi.org/10.1080/00380253.2017.1331718

66.

Perianes

M. B.

Ndaferankhande

(2020). Becoming female: The role of menarche rituals in “making women” in Malawi. In Bobel

Winkler

I. T.

Fahs

Hasson

K. A.

Kissling

E. A.

Roberts

T.-A.

(Eds.), The palgrave handbook of critical menstruation studies (pp. 423–440). Springer Singapore. https://doi.org/10.1007/978-981-15-0614-7_33

67.

Poulin

(2007). Sex, money, and premarital partnerships in southern Malawi. Social Science and Medicine, 65(11), 2383–2393. https://doi.org/10.1016/j.socscimed.2007.05.030

68.

Pringle

Mills

K. L.

McAteer

Jepson

Hogg

Anand

Blakemore

S. J.

(2017). The physiology of adolescent sexual behaviour: A systematic review. Cogent Social Sciences, 3(1), 1368858–1368858. https://doi.org/10.1080/23311886.2017.1368858

69.

Ravishankar

El-Kogali

S. E.

Sankar

Tanaka

Rakoto-Tiana

(2016). Primary education in Malawi: Expenditures, service delivery, and outcomes. International Bank for Reconstruction and Development/The World Bank.

70.

Sangala

(2019). Schools keep children away from school. The Times Group. https://times.mw/schools-keep-children-away-from-school/

71.

Schvaneveldt

Miller

Berry

Lee

(2001). Academic goals, achievement, and age at first sexual intercourse: Longitudinal, bidirectional influences. Adolescence, 36(144), 767–787.

72.

Seff

Steiner

J. J.

Stark

(2021). Early sexual debut: A multi-country, sex-stratified analysis in sub-saharan Africa. Global Public Health, 16(7), 1046–1056. https://doi.org/10.1080/17441692.2020.1814833

73.

Serovich

J. M.

Craft

S. M.

McDowell

T. L.

Grafsky

E. L.

Andrist

(2009). Methods of promoting safer sex behaviors utilized by men who have sex with male casual sex partners. AIDS Education and Prevention: Official Publication of the International Society for AIDS Education, 21(1), 1–13. https://doi.org/10.1521/aeap.2009.21.1.1

74.

Sokhanvar

Matthews

Yarlagadda

(2014). Importance of knowledge management processes in a project-based organization: A case study of research enterprise. Procedia Engineering, 97(2014), 1825–1830. https://doi.org/10.1016/j.proeng.2014.12.336

75.

Stampfel

(2014). Life course indicator: Early sexual intercourse. Association of Maternal and Child Health Programs. http://www.amchp.org/programsandtopics/data-assessment/LifeCourseIndicatorDocuments/LC-50/Early/Sexual/Intercourse_Final_9-15-2014.pdf

76.

Szumilas

(2010). Explaining odds ratios. Journal of the Canadian Academy of Child Adolescent Psychiatry, 19(3), 227–229. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938757/pdf/ccap19_3p227.pdf

77.

The World Bank . (2022). Children (ages 0-14) newly infected with HIV-Malawi. Washington, DC: The World Bank Group. https://data.worldbank.org/indicator/SH.HIV.INCD.14?locations=MW

78.

UNAIDS . (2016a). Comprehensive sexuality education in Zambia. http://www.unaids.org/en/resources/presscentre/featurestories/2016/november/20161109_zambia

79.

UNAIDS . (2016b). HIV prevention among adolescent girls and young women: Putting HIV prevention among adolescent girls and young women on the Fast-Track and engaging men and boys. http://www.unaids.org/sites/default/files/media_asset/UNAIDS_HIV_prevention_among_adolescent_girls_and_young_women.pdf

80.

UNICEF . (2016). Stopaids: Adolescents and young people and HIV. https://stopaids.org.uk/wp/wp-content/uploads/2017/06/STOPAIDS-Factsheet-Adolescents-and-young-people-and-HIV.pdf

81.

United Nations . (2020). Fertility among young adolescents at ages 10-14 Years: A global assessment (pp. 1–20). New York, NY: United Nations. http://creativecommons.org/licenses/by/3.0/igo/

82.

Vanoss Marín

Coyle

K. K.

Gómez

C. A.

Carvajal

S. C.

Kirby

D. B.

(2000). Older boyfriends and girlfriends increase risk of sexual initiation in young adolescents. The Journal of adolescent health: Official Publication of the Society for Adolescent Medicine, 27(6), 409–418. https://doi.org/10.1016/s1054-139x(00)00097-5

83.

Wamoyi

Wight

Remes

(2015). The structural influence of family and parenting on young people's sexual and reproductive health in rural northern Tanzania. Culture, Health and Sexuality, 17(6), 718–732. https://doi.org/10.1080/13691058.2014.992044

84.

Wasserstein

R. L.

Schirm

A. L.

Lazar

N. A.

(2019). Moving to a world beyond “p < 0.05”. The American Statistician, 73(sup1), 1–19. https://doi.org/10.1080/00031305.2019.1583913

85.

Wilder

(2014). Effects of parental involvement on academic achievement: A meta-synthesis. Educational Review, 66(3), 377–397. https://doi.org/10.1080/00131911.2013.780009

86.

World Health Organization . (2018). Adolescent pregnancy. http://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy

87.

Zuilkowski

Jukes

M. C. H.

(2011). The impact of education on sexual behavior in sub- saharan Africa: A review of the evidence. AIDS Care, 24(5), 562–576. https://doi.org/10.1080/09540121.2011.630351