The impact of education and globalization on sexual and reproductive health: retrospective evidence from eastern and southern Africa.
The objective of this study is to qualify the relationship between sexual and reproductive health (SRH) and educational attainment in eastern and southern Africa (ESA). We hypothesize that the regional level of globalization is a moderating factor in the relationship between SRH and educational attainment. Using retrospective data from Kenya, Malawi, Tanzania, and Zambia, the associations between SRH (eight indicators), educational attainment, and globalization were examined using multilevel logistic regression analysis. It was found that the model fit for every SRH outcome indicator increased significantly after including the interaction between globalization and educational attainment, supporting the hypothesis. Depending on the level of globalization, three types of relationships between education and SRH were found: (1) for the indicators "more than four children," "intercourse before 17 years," "first child before 20 years," and "one or more child died" education is risk-decreasing, and the reduction is stronger in more globalized regions; (2) for the indicators "condom use at last intercourse" and "current contraceptive use" education is risk-decreasing, and the reduction is stronger in less globalized regions; (3) for the indicators "HIV positive" and "more than four lifetime sexual partners" education is risk increasing, but only in less globalized regions. In conclusion, these effects are related to three types of access: (1) access to services, (2) access to information, and (3) access to sexual networks. The findings highlight the relevance of globalization when analyzing the association between SRH and education, and the importance of structural factors in the development of effective SRH promotion interventions.
a Department of Child Development and Education , University of Amsterdam , Amsterdam , The Netherlands.
Marie-Anne
MA
Van Stam
Kristien
K
Michielsen
Koen
K
Stroeken
Bonne J H
BJ
Zijlstra
D022126:Access to Information / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000351:Africa, Eastern / Q000453:epidemiology; D000353:Africa, Southern / Q000453:epidemiology; D016000:Cluster Analysis; D003075:Coitus; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D060728:Reproductive Health / Q000208:ethnology / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012736:Sex Education / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners; D011795:Surveys and Questionnaires