The association between violence victimization and subsequent unplanned pregnancy among adolescent girls in Uganda: Do primary schools make a difference?
The association between violence victimization and subsequent unplanned pregnancy among adolescent girls in Uganda: Do primary schools make a difference?
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DOI：
10.1371/journal.pgph.0001141
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Devries KM
中科院分区：
文献类型：
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作者：
Merrill KG;Knight L;Nakuti J;Mirembe A;Allen E;Bhatia A;Parkes J;Naker D;Devries KM
在高收入、低暴力发生率的国家，暴力受害是少女怀孕的一个风险因素，但缺乏暴力和少女怀孕常见的环境，包括撒哈拉以南非洲的纵向数据。我们也知道很少的语境因素，修改这种关联。我们分析了乌干达卢韦罗地区青少年群体暴力背景（CoVAC）研究的数据。42所学校的小学生在2014年（第一波）和2018年（第二波）完成了调查。我们的结果是意外怀孕。我们的暴露是暴力受害，包括任何暴力，暴力类型（身体，情感，性），犯罪者群体（教师，同伴，家庭成员）和多重受害。我们拟合了混合效应逻辑回归模型，并检查了学校因素（例如，连通性，缺勤）作为效果修饰符，使用来自42所学校的学生（n = 3，431）和工作人员（n = 591）的数据。1，449名女孩被纳入分析（78%随访）。在第1波，88%（n = 1，281/1，449）报告了任何暴力行为（平均年龄= 12.73，SD = 1.44岁）。在第2波，13.9%（n = 201/1，449）报告了计划外妊娠。在调整后的模型中，与无暴力相比，（p<0.05）观察到任何暴力行为（OR = 1.99，95%CI = 1.03-3.85），肢体暴力（OR = 1.96，95%CI = 1.02-3.79），教师暴力（OR = 1.96，95%CI = 1.01-3.79），同伴暴力（OR = 2.00，95%CI = 1.00-4.03），家庭暴力（OR = 2.23，95%CI = 1.07-4.65），来自一个施暴者群体的暴力（OR = 2.04，95%CI = 1.01-4.15），以及来自三个施暴者群体的暴力（OR = 2.21，95%CI = 0.99-4.95）。性暴力和情感暴力在粗略但未经调整的分析中是相关的。学校和同伴的联系改变了这种关联（p<0.05）;在联系较低的学校，经历过暴力的女孩意外怀孕的几率高于联系较高的学校。在乌干达，青春期早期的暴力受害与青春期少女随后的意外怀孕密切相关，但上学时学校或同伴联系更多会削弱这种联系。干预措施应力求减少暴力侵害女孩行为，以防止意外怀孕。促进与学校建立积极联系的干预措施可能对暴力受害者特别重要。
Violence victimization is a risk factor for adolescent pregnancy in high-income, low violence prevalence countries, but longitudinal data are lacking from settings where violence and adolescent pregnancy are common, including sub-Saharan Africa. We also know little about contextual factors which modify this association. We analyzed data from the Contexts of Violence in Adolescence Cohort (CoVAC) study in Luwero District, Uganda. Primary students in 42 schools completed surveys in 2014 (Wave 1) and 2018 (Wave 2). Our outcome was unplanned pregnancy. Our exposure was violence victimization, including any violence, type of violence (physical, emotional, sexual), perpetrator group (teacher, peer, family member), and polyvictimization. We fit mixed-effects logistic regression models and examined school factors (e.g., connectedness, absenteeism) as effect modifiers, using data from students (n = 3,431) and staff (n = 591) at the 42 schools. 1,449 girls were included in analyses (78% follow-up). At Wave 1, 88% (n = 1,281/1,449) reported any violence (mean age = 12.73, SD = 1.44 years). At Wave 2, 13.9% (n = 201/1,449) reported an unplanned pregnancy. In adjusted models, compared to no violence, significant associations (p<0.05) were observed for any violence (OR = 1.99, 95%CI = 1.03–3.85), physical violence (OR = 1.96, 95%CI = 1.02–3.79), teacher violence (OR = 1.96, 95%CI = 1.01–3.79), peer violence (OR = 2.00, 95%CI = 1.00–4.03), family violence (OR = 2.23, 95%CI = 1.07–4.65), violence from one perpetrator group (OR = 2.04, 95%CI = 1.01–4.15), and violence from three perpetrator groups (OR = 2.21, 95%CI = 0.99–4.95). Sexual and emotional violence were associated in crude but not adjusted analyses. School and peer connectedness modified the association (p<0.05); girls who experienced violence had higher odds of unplanned pregnancy in schools with lower versus higher connectedness. Violence victimization in early adolescence is strongly associated with subsequent unplanned pregnancy among adolescent girls in Uganda but attending schools with more school or peer connectedness attenuated this link. Interventions should seek to reduce violence against girls to prevent unplanned pregnancy. Interventions promoting positive connections to school may be especially important for violence victims.