Examining the Influence of Agency and Role Models on Sexual and Reproductive Health among Adolescent Girls in Ethiopia
Open AccessDespite gains in women and girls’ empowerment and health outcomes in low- and middle-income countries in recent decades, improved sexual and reproductive health continues to elude many adolescent girls due to constrained control over critical decisions and resources to act, agency, and lack of development assets such as role models. While the last decade has witnessed an increased interest in the sexual and reproductive health needs and empowerment of adolescent girls in low- and middle-income countries, there is an increasing focus on adolescent girls’ agency. However, measuring agency continues to be a challenge, limiting the ability to evaluate the impact of programs on agency. This dissertation aimed to address the gap in the literature by constructing and validating a measure of agency among adolescent girls in Ethiopia. This dissertation also examined the relationship between agency, role models and two sexual and reproductive health outcomes - ideal age at childbirth and attitude towards gender-differentiated parental control of adolescent behaviors - among the adolescent girls in Ethiopia. The first paper of this dissertation applied exploratory and confirmatory factor analyses to data from 3,033 Ethiopian adolescent girls from two age cohorts (10-12 years and 15-17 years) to construct a measure of adolescent girls’ agency and evaluated both known-groups and convergent validity of the scale. The second paper evaluated the relationship between agency, role models and sexual and reproductive health outcomes using multiple regression models. The first paper found that two domains, decision-making on sexual and reproductive health issues and mobility define adolescent girls’ agency, confirming the multidimensionality of the measure in the study context. Known-groups validity of the scale was established with older adolescent girls (15-17 years) reporting higher scores on the scale compared to the younger girls (10-12 years), and younger girls from urban locations reporting higher scores on the scale compared to younger girls from rural locations. The agency scale was also positively associated with favorable gender attitudes, descriptive and injunctive social norms, establishing the convergent validity of the scale. The second paper found that agency and role model presence were positively associated with ideal age at childbirth (β=0.23, p<.01 and β =0.77, p<.001, respectively). Further, having family members, friends and famous individuals as role models were significantly associated with an increase of 1.45years (p<.01), 1.32years (p<.05) and 1.01 years (p<.01) in ideal age at childbirth, respectively. Agency was also positively associated with attitude towards gender-differentiated parental control of adolescent behaviors (OR=1.18, p<0.001). This dissertation advances adolescents sexual and reproductive health practice by providing a validated measure of adolescent girls’ agency, which can serve as a useful tool to practitioners in designing and evaluating the impact of interventions aimed at building agency as an enabler of positive sexual and reproductive health outcomes among adolescents in later years. This dissertation also expands the evidence base for including agency enhancement and role modeling as core components of interventions designed to foster positive adolescent sexual and reproductive health outcomes among adolescent girls who are still on a sexual and reproductive health growth trajectory.
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Ogunbiyi_gwu_0075A_16106.pdf | 2022-10-04 | Open Access |
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