Behavioral Determinants of Urban Youth Sexual and Reproductive Health: A Secondary Analysis of DHS Data for Benin and Madagascar

Investing in young people's health and wellbeing is critical to promoting growth and development, not only for individuals but also for communities and nations. The majority of today's youth are living in urban areas, where opportunities for jobs, education, better housing, and health care are often more widely available than in rural areas. However, these benefits are usually unevenly distributed, and urban poor have limited or no access to many urban amenities. Urban youth may be exposed to greater sexual freedoms, more liberal and diverse ideas about sexual relationships, and more occasions for engaging in unhealthy sexual behaviors. While harmful traditional practices like early marriage may dissipate in the urban environment, protective traditional values, such as social cohesion and accountability, can also give way. For many urban youth, this shift in values and increased freedom collides with a trying developmental life-stage: adolescence. Adolescence is characterized by physical, emotional, cognitive, and social changes that are both positive and negative. An analysis of DHS data from Benin and Madagascar was conducted to examine how socioeconomic status, education levels, marital status, media use, or other factors might influence urban youth SRH behaviors and outcomes within and between countries. Data was obtained from USAID-funded MEASURE Demographic Health Surveys (DHS), which are based on nationally representative samples and use standard procedures for collecting and handling data. Two DHS surveys were chosen due to partner interest, data availability, and programmatic relevance—Benin DHS 2006 and Madagascar DHS 2008. The analysis found that urban youth are more likely to get married later than rural youth, and male youth are more likely to get married later than female youth. However, age at first sex was relatively similar across all groups. The difference between median age at first marriage and median age at first sex is much greater for urban youth as compared to rural youth. Urban male youth also marry much later than urban female youth, even though age at first sex is relatively similar for both groups. Current contraceptive use varies by parity and socioeconomic status. In both countries, a significantly higher proportion of sexually active urban female youth who have given birth reported using a contraceptive method than those who have not given birth. In Benin, a significantly higher proportion of female urban youth who were educated reported using a contraceptive method than those who had no education. No such difference was found among men in Benin or either gender among urban youth in Madagascar.