A Longitudinal Analysis of Agency and Structural Determinants of Adolescent Sexual and Reproductive Health Outcomes in Ethiopia

Silinganisiwe Dzumbunu, University of Cape Town

Adolescents in Ethiopia face significant challenges to their sexual and reproductive health (SRH) and well-being. Most of these barriers are deeply rooted in their social, economic, and environmental contextual factors however, research on how these multidimensional factors impact ASRH outcomes over time remains limited. Using multi-level modeling and longitudinal data from Ethiopia's Gender and Adolescence: Global Evidence (GAGE) survey, we explored the dynamics and impact of agency and structural factors on two SRH outcomes: early marriage and adolescent pregnancy among adolescent girls in Ethiopia. Findings show that despite most girls' intentions to postpone marriage and childbearing until after adolescence, many marry and begin having children before the age of 20. At the individual level, girls who had ever discussed their career aspirations with caregivers and those who perceived that their community offered gender-equitable employment opportunities were at lower risk of early marriage and adolescent pregnancy. At the structural level, living in a community with more prevalent perceptions that culture favors boys' success over girls' is associated with an increased risk of adolescent pregnancy. Multidimensional and gender-sensitive interventions that can support individual agency and simultaneously shift social norms may be particularly effective in improving SRH outcomes in Ethiopian adolescent girls.

Keywords: Children, Adolescents, and Youth, Sexual and Reproductive Health and Rights, Multi-level modeling , Longitudinal studies

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