Barbara S. Mensch

The Reporting of Sensitive Behavior by Adolescents: A Methodological Experiment in Kenya

Does audio computer-assisted self-interviewing (ACASI) produce more valid reporting of sexual activity and related behaviors than face-to-face interviews or self-administered interviews? This analysis, based on data collected from over 6,000 unmarried adolescents in two districts of Kenya—Nyeri and Kisumu—indicates substantial and significant differences in reported rates of premarital sex across interview modes, although not always in the expected direction. Our assumption that girls underreport sexual activity in face-to-face interviews by comparison with ACASI is not confirmed by the Nyeri data, but our results from Kisumu are considerably more promising. As for boys, who we believe exaggerate their level of sexual activity in face-to-face interviews, a more nuanced set of expectations regarding the reporting of sensitive behaviors was offered; our results from Kisumu, although not always significant, by and large conform to expectations.

Consistency in the reporting of sexual behaviour by adolescent girls in Kenya: a comparison of interviewing methods

Objectives: To investigate in a district in Kenya the level and consistency of reporting of sexual behaviour among adolescent girls randomly assigned to two modes of survey interview: face to face interview and audio computer assisted self-interview (ACASI). Methods: The analysis is based on a subsample of over 700 never married girls aged 15–21 years in Kisumu, Kenya, drawn from a population based survey of over 2100 respondents. A questionnaire with 69 questions was used, two thirds of which were considered sensitive, including questions about risky sexual behaviour, alcohol and drug use, contraceptive practice, pregnancy, induced abortions, and births. Results: ACASI produced significantly higher reporting of sex with a relative, stranger, or older man, and higher reporting of coerced sex. However, differences by mode for ever had sex and sex with a boyfriend were not significant. Relative to ACASI, the interviewer administered mode produced highly consistent reporting of sexual activity, both within the main interview and between the main and exit interviews. Conclusions: Both the mode of survey administration and the probing for various behaviours significantly affect the observed prevalence of sexual activity. The ACASI results suggest that adolescent girls in Kenya have more complex and perilous sex lives than traditional face to face surveys of sexual activity indicate. The level of consistency in the interviewer mode is argued to be suspect, particularly given the much lower levels of reporting, relative to ACASI, for types of sexual partners and coerced sexual activity.

Marriage and childbirth as factors in dropping out from school: An analysis of DHS data from sub-Saharan Africa

Leaving school prematurely is often claimed to be among the most negative consequences of early marriage and pregnancy for girls in less developed countries. However, an analysis of the relative frequency with which these events actually occur or are named as reasons for leaving school reveals that, at least in the case of francophone Africa, they explain no more than 20 per cent of dropouts. To the extent that demographic events trump school or family factors as determinants of school-leaving, our data indicate that it is union formation—defined by the DHS as first marriage or cohabitation—rather than childbirth that is more likely to have this effect. ‘Schoolgirl pregnancy’ typically accounts for only between 5 and 10 per cent of girls’ departures from school. Furthermore, the risks of leaving school because of pregnancy or marriage have declined over time with the decline in rates of early marriage and childbearing.

The effects of primary school quality on school dropout among Kenyan girls and boys

This article begins with a broadened framework for the measurement of school quality which includes both the more traditional elements identified in the school-effectiveness literature related to the development of cognitive competencies as well as some additional elements hypothesized by the authors to be important to retention. This framework is then applied empirically using our Kenyan data. Data on patterns of school dropout by sex age and district as well as data on various dimensions of the school environment provide a background for the presentation of the multivariate results. The many methodological issues pertinent to the implementation of our empirical models are addressed fully as part of the presentation of our results.

Using Sexually Transmitted Infection Biomarkers to Validate Reporting of Sexual Behavior within a Randomized, Experimental Evaluation of Interviewing Methods

This paper examines the reporting of sexual and other risk behaviors within a randomized experiment using a computerized versus face-to-face interview mode. Biomarkers for sexually transmitted infection (STI) were used to validate self-reported behavior by interview mode. As part of a parent study evaluating home versus clinic screening and diagnosis for STIs, 818 women aged 18-40 years were recruited in 2004 at or near a primary care clinic in São Paulo, Brazil, and were randomized to a face-to-face interview or audio computer-assisted self-interviewing. Ninety-six percent of participants were tested for chlamydia, gonorrhea, and trichomoniasis. Reporting of STI risk behavior was consistently higher with the computerized mode of interview. Stronger associations between risk behaviors and STI were found with the computerized interview after controlling for sociodemographic factors. These results were obtained by using logistic regression approaches, as well as statistical methods that address potential residual confounding and covariate endogeneity. Furthermore, STI-positive participants were more likely than STI-negative participants to underreport risk behavior in the face-to-face interview. Results strongly suggest that computerized interviewing provides more accurate and reliable behavioral data. The analyses also confirm the benefits of using data on prevalent STIs for externally validating behavioral reporting.

The impact of the quality of family planning services on contraceptive use in Peru

Through linkage of a Demographic and Health Survey to a situation analysis, this article explores whether current contraceptive use in Peru is affected by the service environment in which a woman resides. The investigation focuses explicitly on the impact of the quality of family planning services and finds that, net of personal and household characteristics, a significant, albeit small, effect exists for one specification of quality in the total sample and for the other specification a nearly significant (p = .053) effect exists. The analysis reveals that contraceptive prevalence would be 16 to 23 percent greater if all women lived in a cluster with the highest quality of care compared with the lowest. Methodological problems that arise in measuring quality of care at the cluster level and in linking quality to individual contraceptive use are also addressed.

Drug Use as a Risk Factor for Premarital Teen Pregnancy and Abortion in a National Sample of Young White Women

The relationship between adolescent drug use and premarital teen pregnancy and abortion as a pregnancy outcome among sexually active women is investigated in a sample of white women from the National Longitudinal Survey of Youth. Event history analysis is used to explore whether prior drug use has a unique effect on premarital teen pregnancy, with controls for personality, lifestyle, and biological factors. Logistic regression is used to estimate whether drug use affects the decision to terminate a premarital teen pregnancy. The results show that the risk of premarital teen pregnancy is nearly four times as high for those who have used illicit drugs other than marijuana as for those with no history of any prior substance involvement. Furthermore, illicit drug use increases the likelihood of an abortion by a factor of 5. Policy implications of the findings are discussed.

Indicators for measuring the quality of family planning services in Nigeria.

This article presents the Situation Analysis approach as a means of collecting data that can be used to assess the quality of care provided by family planning service-delivery points (SDPs), and describes the quality of services offered in Nigeria. Elements of the quality of services provided at 181 clinical service-delivery points in six states of Nigeria are described. The substantive results from the study suggest that although most of the 181 service points sampled are functional, the quality of care being provided could be improved. Illustrative scores for these indicators and elements of the Bruce-Jain framework are given. By comparison with contraceptive prevalence surveys, the Situation Analysis approach is still in its early stages. Some methodological issues are raised here and future directions for strengthening the validity and applicability of the approach are discussed.

Rethinking Postpartum Family Planning

This article examines the rationales for commonly advocated postpartum family planning services and challenges the behavioral and biological assumptions on which they are based. An alternative approach to service delivery is suggested. Services should be designed to incorporate breastfeeding and to increase their acceptability to postpartum women.

Assessing the reporting of adherence and sexual activity in a simulated microbicide trial in South Africa: an interview mode experiment using a placebo gel.

Misreporting of adherence undermines detection of an association between product use and HIV infection in microbicide trials. This study investigates whether, in a placebo trial, audio computer-assisted self-interviewing (ACASI) produces more accurate reporting of adherence and sexual behavior than a face-to-face interview (FTFI). At three South African clinics, 849 women were enrolled and instructed to use applicators filled with placebo gel; participants were randomly assigned to FTFI or ACASI. Behavioral reports were validated through two biomarkers that detect product usage and unprotected sex. For most behaviors, ACASI generated significantly higher reporting, although differences by interview mode appeared to diminish over time. ACASI participants were more likely to report having had sex without gel, but reported and tested applicators did not indicate greater honesty about gel insertion with ACASI. While comparisons of reported unprotected sex with the validated biomarker revealed more agreement with ACASI than with FTFI, differences were small.