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Maternal and Child Health; Adolescents; Sub-Saharan Africa; Dipo; Puberty; Initiation; Nubility Rites


Affiliation: Department of Epidemiology and Biostatistics GW, School of Public Health and Health Services

Title: "Factors associated with early sexual debut among Ghanaian women from the Manya – Krobo district, – Ghana, 2011"

Background: The dipo, a Krobo puberty initiation rite practiced annually among an estimated 2,000 Ghanaian females ages 2–20, is a cultural rite of passage into womanhood that is intended to promote abstinence from sexual activity until marriage.

Objectives: This study examined the risk of early sexual debut among dipo-initiated Krobo females versus uninitiated Krobo females. This study also assessed Manya–Krobo societal opinions regarding the sexual health outcomes of initiates and existing modifications of the rite.

Methods: Mixed-methods. Utilizing a retrospective cohort study design, we surveyed 306 unwed Krobo females from Agormanya ages 13–20. We employed Cox proportional hazard regressions assessing the effects of model covariates upon sexual debut and age at sexual debut. Qualitative analysis included nine interviews conducted among Manya–Krobo district community members who either supported or opposed the dipo. Responses were analyzed using Dedoose QDA software to determine patterns in attitudes and opinions regarding initiates’ sexual behaviors and to identify current ceremonial changes.

Results: Dipo initiated participants had a 1.8 increased hazard rate of early sexual debut as compared to uninitiated participants after adjusting for covariates, however, results were not statistically significant (aHR: 1.8, 95% C.I: 0.8–4.0). Qualitative data indicated that some dipo opponents stated participation promotes promiscuity and teen pregnancy while select supporters asserted the rite protects participants from these outcomes. Key ceremonial changes included a reduction in age eligibility and length of dipo preparatory period.

Conclusions: These study findings do not offer conclusive evidence that participation in the dipo increases the risk of early sexual debut among initiated versus uninitiated Krobo females. Study findings suggest the reduction in age of dipo eligibility may increase the likelihood of sexual debut following the ceremony. Participants who received the rite as toddlers had a greater length of time between the dipo and adulthood to become sexually active post-initiation than females who were initiated during their late teens/early twenties.


Presented at: George Washington University Research Days 2013.

Open Access




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