Gender Differences in the Timing of First Intercourse: Data from 14 Countries

By Susheela Singh, Deirdre Wulf, Renee Samara and Yvette P. Cuca

http://www.agi-usa.org/pubs/journals/2602100.html

Context: Early initiation of intercourse and the context within which sexual activity begins are key indicators of adolescents' potential risk for unplanned pregnancy, abortion and sexually transmitted diseases. Comparative information on the sexual behavior of male and female adolescents in different countries assists health planners and service providers in meeting adolescents' needs.

Methods: Data from the most recent nationally representative surveys of reproductive behavior in 14 countries throughout the world were used to assess regional variations in young people's sexual behavior. Analyses focus on 15-19-year-olds, but also use data from 20-24-year-olds to provide a more complete picture of gender differences in behavior during adolescence.

Results: In most countries, roughly one-third or more of teenage women have had intercourse; in four countries (Ghana, Mali, Jamaica and Great Britain), about three in five are sexually experienced. Between about one-half and three-quarters of adolescent males in seven countries have ever had intercourse, but the proportion is one-third or less in Ghana, Zimbabwe, the Philippines and Thailand. In most countries, sexual intercourse during the teenage years occurs predominantly outside marriage among men but largely within marriage among women. Never-married young people are considerably less likely to be currently sexually active than to be sexually experienced. For example, in Ghana, 49% of never-married adolescent women have had intercourse, but only 23% have done so within the past month.

Conclusions: In most of these countries, a high proportion of adolescents are potentially at risk for a range of poor reproductive health outcomes. Program planners must find ways to help sexually active adolescents consistently use effective means of protection against both pregnancy and sexually transmitted diseases.

International Family Planning Perspectives, 2000, 26(1):21-28 & 43

The initiation of sexual intercourse is a milestone in the physical and psychological development of men and women in all societies, and both the timing of this event and the context within which it occurs can have immediate and longer term consequences for the individual. There are possibly serious health and social consequences for women who begin to have intercourse while very young or not yet married, especially if they become pregnant and have either an unplanned birth or, in some settings, an unsafe abortion. Some instances of very early sexual intercourse are involuntary--for example, when a young person is raped, is the victim of incest or turns to prostitution because of financial need. Moreover, first intercourse marks the beginning of young people's possible exposure to the risk of contracting sexually transmitted diseases (STDs).

Analysts have commented on differences in expectations and values regarding male and female sexual behavior. For example, in many societies, it is excusable for men to become sexually active at a significantly earlier age than women, and even expected that they will do so.¹ Similarly, women but not men are commonly expected to be sexually inexperienced when they marry. Until recently, however, most surveys on sexual behavior and fertility--including almost all fertility surveys conducted in developing countries from the 1960s through the early 1980s--focused only on women.² Consequently, knowledge about sex-based differences in age and marital status at first intercourse has been derived largely from qualitative research and anecdotal evidence, rather than from empirical, quantitative data.

In some industrialized countries, starting in the mid-1970s, as researchers became concerned about patterns of adolescent childbearing and abortion--and, later, about the spread of STDs--they began to examine the sexual attitudes, knowledge and practices of both male and female adolescents.³ However, until the 1980s, the study of male sexual behavior was still rare, even in the industrialized world.⁴

Whatever the reasons for this limited focus, the substantial neglect of men's sexual behavior did not begin to change until realization of the scale and seriousness of the global HIV and AIDS epidemic became widespread. By the mid-1980s, changing epidemiologic concerns and an increased awareness of the importance of men's reproductive role and health needs led to heightened interest in including men in family planning and fertility surveys, and various surveys began to interview men as well as women.

In addition to large-scale surveys conducted at the national or city level, a number of smaller scale studies and country or regional reviews of male and female adolescent sexual behavior have contributed to a growing understanding of the complex social issues that influence early sexual behavior.⁵ Some of these studies and reviews focus on issues of particular relevance in certain parts of the world: young women's participation in commercial or informal prostitution in Asia and elsewhere; very early and sometimes forced marriages of women in South Asia; the phenomenon known in parts of Sub-Saharan Africa and the Caribbean as "sugar daddies"; and patterns of casual dating in Western countries that might involve an individual in sporadic sexual encounters or many consecutive short-term relationships. These inquiries are valuable because they increase our understanding of the possible circumstances surrounding the sexual behavior of adolescents; however, they do not yield quantitative information on behavior among the youth population as a whole.

While acknowledging the valuable contribution of qualitative research on young people's sexual and reproductive behavior, this article takes a different approach. It presents quantitative, population-level information from 14 countries on male-female differences in age and marital status at the time of first sexual experience. The countries included here represent all of the world's major geographic regions (Sub-Saharan Africa, Asia, Latin America and the Caribbean, and the developed world); all had national surveys containing comparable information on the sexual activity of young men and young women.

MEASUREMENT OF SEXUAL ACTIVITY

Despite the progress made in increasing the representation of both sexes in national and community-level surveys on sexual and reproductive behavior, accurate measurement in this area remains beset with difficulties. Many survey respondents do not or cannot always openly or truthfully answer questions dealing with the intimate topic of their sexual behavior and practices. Understandably, adolescents, especially if they are unmarried or live in settings where sexual relationships outside marriage are censured, are probably even more likely than adults to be reticent about this area of their behavior. And very young teenagers, who are only just beginning to develop a sense of their sexuality, may be especially unlikely to want to discuss this part of their lives. However, the opposite problem also may be encountered; some young men overreport their sexual activity to give the impression that they are conforming to what they think society expects of them.⁶ These differential biases increase the difficulty of accurately comparing the experiences of males and females.

The fact of involuntary intercourse may also affect accuracy; misreporting is more likely when an individual's experience includes nonconsensual sex. Finally, methodological issues, including some that are linguistic or semantic, may play a role.⁷ For example, it is not always clear how respondents define for themselves terms used in studies of sexual behavior, such as "sexual intercourse."

It is difficult for researchers to evaluate the extent to which biases occur, but their concern is evidenced by the substantial literature dealing with these issues.⁸ Clearly, any interpretation of the data presented here must take into account that inaccuracies exist; whether the measures used are valid overall, and equally reliable for both sexes, can be tested only by more in-depth studies.

Nevertheless, the information in this article provides the best recent, nationally representative measures of sexual intercourse among young people in a range of countries. And since this analysis includes young adults aged 15-24, who are reporting on recent experience, the results should be little affected by respondents' ability to recall the dates of events or their age when particular events occurred.

DATA SOURCES

The data were obtained from a variety of nationally representative sample surveys of men and women (Table 1). Eight of the countries participated in the Demographic and Health Survey (DHS) program, which collected information from men and women of reproductive age (15-44 or 15-49). Two had data on 15-24-year-olds from a Young Adult Reproductive Health Survey (YARHS), for which it was possible to obtain special tabulations; another two had information from independent national youth surveys with designs similar to that of the YARHS. Data for Great Britain came from the 1990-1991 National Survey of Sexual Attitudes and Lifestyles (NSSAL), which included men and women aged 16 and older. For the United States, data were from the 1991 National Survey of Men, which included 20-39-year-olds; the 1995 National Survey of Adolescent Men (NSAM), which covered 15-19-year-olds; and the 1995 National Survey of Family Growth (NSFG), which interviewed women aged 15-44.

Even though these surveys used somewhat different questions, their research protocols were generally similar enough that we could create comparable measures of age at first intercourse and of current sexual activity. The YARHS asked respondents in what month and year they first had intercourse; those who could not provide the date were asked their age at first intercourse. The DHS design generally requested only the age at first intercourse. The DHS and YARHS included very similar questions about recent sexual activity. Currently sexually active is defined as having had intercourse in the month before the interview, except for women in the United States, for whom the measure is based on intercourse in the three months before the interview.

Two of the U.S. surveys focused more specifically on heterosexual intercourse. The NSFG asked: "Think back to the very first time in your life that you ever had sexual intercourse with a man. In what month and year was that?" Likewise, the NSAM question on first intercourse was: "When did you have sexual intercourse with a female for the first time, in what month and year?" In Great Britain, the NSSAL took a similar approach: "How old were you when you first had sexual intercourse with someone of the opposite sex, or hasn't this happened?" In all other countries, an unknown, though probably small, proportion of reported sexual activity may be with same-sex partners.

Some differences in the design and execution of surveys may have had small effects on the quality of data. The British survey is likely to provide the best, most accurate source of information on sexual behavior, because this was its only focus; the researchers made intensive efforts to design a questionnaire that would maximize the quality of the data. By contrast, the other surveys covered a much broader range of topics, and questions on sexual behavior made up a relatively small part of the interview. The YARHS took steps to improve the quality of response--for example, by matching the sex of the interviewers with that of the respondents. In Ghana, however, interviewers were primarily male, and in other DHS surveys, they were mixed or primarily female.

All the surveys sampled unmarried and married persons, and asked all respondents, regardless of their marital status, questions about sexual behavior. (Marriage is defined to include consensual, or cohabiting, unions and, in Jamaica, visiting unions.) The surveys also asked the date of first marriage; premarital sexual intercourse could thus be measured by comparing respondents' dates or ages at first intercourse and at first marriage. A sexual relationship is classified as premarital only if it began at least one year prior to marriage. This strategy allows for inaccuracies that might result from respondents' reporting rounded ages. At the same time, this approach is conservative because it excludes sexual relationships that begin a few months prior to marriage.

Levels of nonresponse to questions on age at first intercourse and on patterns of recent sexual intercourse were quite low--typically less than 5%.⁹ This suggests that in general, respondents are not as uncomfortable discussing these issues as had been believed.

RESULTS

Marital and Nonmarital Sexual Initiation

In all of the study countries except the Philippines, Thailand and Peru, roughly one-third or more of young women 15-19 have had sexual intercourse; in four countries (Ghana, Mali, Jamaica and Great Britain), about three in five are sexually experienced (Figure 1). Between about one-half and three-quarters of young men aged 15-19 in seven countries (Brazil, the Dominican Republic, Haiti, Jamaica, Peru, Great Britain and the United States) have ever had intercourse, but one-third or fewer in Ghana, Zimbabwe, the Philippines and Thailand have done so.

The surveys reveal that the context of early sexual experience is often very different for young men and for young women, especially in developing regions. In all represented countries, sexually experienced adolescent women are much more likely ever to have been married than are sexually experienced adolescent men. For example, in Zimbabwe, where about one-third of both female and male 15-19-year-olds have had intercourse, two-thirds of these young women (21% overall) have been married, compared with almost no adolescent men.

The same pattern holds in most of the developing countries studied, regardless of gender differences in the proportions sexually experienced. Only Jamaica differs, in that relatively high proportions of both male and female sexually experienced teenagers have ever been in a union. The explanation for this surprising finding lies in a category of union in Jamaica that is not found elsewhere, the "visiting" relationship, in which partners have regular sexual relations but do not cohabit. This type of union is common and broadly approved by social custom in Jamaica, but is not equivalent to being in union, as defined in other countries, where only legal marriages and cohabiting unions are socially recognized.

In Great Britain and the United States, overall levels of sexual experience among young men are about as high as those in Brazil and Jamaica; levels for young women are comparable to those in Ghana, Mali and Jamaica. However, the vast majority of British and U.S. sexually experienced adolescents of both sexes have never been married (and most ever-married adolescent women became sexually active before marriage¹⁰).

When young adults reach their early 20s, their marital and sexual situations change dramatically (Figure 2). Overall levels of sexual experience rise to about 80% or more for women in seven countries (the four Sub-Saharan countries, Jamaica, Great Britain and the United States) and for men in all but two countries (the Philippines and Thailand). The Philippines is distinctive because of the low overall reported levels of sexual experience among both young men and young women--no more than around 50% of 20-24-year-olds of either sex are sexually experienced.

As is the case among teenagers, the context of sexual intercourse among those in their early 20s tends to be very different for men and women. Most sexual relationships among men remain nonmarital (again except in Jamaica), and most sexual intercourse among young women continues to occur within marriage. Young adult women in the Philippines and Thailand report extremely low levels of nonmarital sexual intercourse.

The Pace of Sexual Initiation

The survey data permit us to examine the pace at which men and women in their early 20s initiated their sexual lives. This analysis provides a more complete picture of adolescent sexual behavior than can be drawn using data collected from teenagers (who are, on average, about 17.5 years old at interview).

Among women, sexual experience before age 15 is rare.* In Ghana, Mali, Tanzania, Jamaica and the United States, at least one in seven women aged 20-24 had had sex before their 15th birthday; about three in 10 had done so before age 16, as had more than half in Mali (Table 2). Levels are lower--for the most part considerably so--in the remaining countries.

Very early sexual experience appears to be somewhat more common among men than among women in all countries except Ghana, Mali, the Philippines and Tanzania. More than four in 10 Jamaican men aged 20-24 had had intercourse before their 15th birthday, as had one-third of their counterparts in Brazil and the United States, and about one-quarter in Costa Rica and the Dominican Republic. Men in several other countries reached these levels of sexual experience by age 16, but in Zimbabwe, the Philippines and Thailand, even by their 16th birthday, no more than 15% of men had initiated intercourse.

In Ghana and Mali, substantially higher proportions of women (88% and 94%, respectively) than of men (70% and 64%, respectively) are sexually experienced by age 20. By contrast, in Thailand, Brazil, the Dominican Republic and Peru, the proportion of men with sexual experience by their 20th birthday is 18-28 percentage points higher than the proportion among women. In most of the remaining countries, gender differentials are very small, despite gender differences in marriage levels.

Country-level differences in the pace of sexual initiation can also be captured by comparing the median age at first intercourse (the age by which 50% of all individuals in the group had begun sexual relations). The median age for women ranges from 15.8 in Mali to 19.6 in Peru and exceeds 20 in the Philippines and Thailand. Contradicting the widely accepted view that males are generally more sexually precocious than females, a similar range is found among men--from 15.4 in Jamaica to 19.0 in Thailand and more than 20 in the Philippines. In Latin America and the Caribbean, men typically initiate sex at a younger age than women; the largest differentials (more than two years) are found in Brazil and Peru. Only in Ghana and Mali do women first have intercourse at a substantially younger age than men; in the remaining countries, men and women first have sex at roughly the same age.

Patterns of early sexual initiation (i.e., before age 17) vary widely by country and gender (Figure 3). Among women, the proportion having sex by age 17 in Mali, Jamaica, Ghana, the United States and Tanzania is 7-10 times that in Thailand and the Philippines. The proportion of men with sexual experience before their 17th birthday in Jamaica, the United States and Brazil is 9-10 times the level in the Philippines. The gender gap is very large in Mali and Ghana (where higher proportions of women than of men become sexually active early) and in the Dominican Republic, Brazil, Costa Rica, Peru and Thailand (where the reverse is true).

Premarital Intercourse Before Age 20

Table 3 examines levels of premarital sexual intercourse by the end of the adolescent years. The rates are also calculated by urban-rural residence, in an attempt to explore possible differences in sexual behavior related to modernization and to rapid social change, or its absence.