Geographical hotspots and correlates of early sexual debut among women in Ghana

Ghana operates a decentralised health system, where health policies and interventions, including those for sexual and reproductive health are implemented at the district level. Yet, there are no studies that systematically identify districts where sexual behaviours, such as early sexual debut, require attention. This study uses spatial models and data from the 2017 Ghana Maternal Health Survey to identify areas (districts) with high concentration of women who initiated sex before the legal age of consent. Early sexual debut refers to first sexual intercourse before attainment of the legal age (16 years) of sexual consent. Early sexual initiation has been associated with adverse sexual and reproductive health outcomes such as unwanted pregnancies and STIs. The results show that about one in four women reported having early sexual intercourse. High early sexual intercourse was observed to be particularly concentrated among districts along the mainstream of the Volta Lake. With regards to the spatial correlates, for the districts in the Oti region, high early sexual debut was associated with low educational attainment and inability to read. For those in the Bono East and Eastern regions, women who had early sexual debut were more likely to have had a miscarriage, abortion or stillbirth. Younger women, those in co-habiting relationships and those not in union were more likely to have had early sexual debut in the districts in the Ashanti, Central and Northern regions. The findings call for intensification of sexual and reproductive health education in districts along the mainstream of the Volta Lake.