Risk, power, and knowledge: exploring adolescent girls’ sexual and reproductive health in Kenya

Helping adolescent girls grow up to be healthy, resilient women is an ongoing mission around the world. Adolescence is a period marked by rapid physical, emotional, and social changes. Research shows that when young receive proper support and access to education and health services, it can be a time of immense opportunity during this life phase. In my dissertation, I discuss factors that shape adolescent girls’ transition to adulthood and those that might predispose them to risky behaviors or lifestyles. I shed light on these influences by looking at a wide range of factors operating at multiple levels--individual, peer, family, school, community, and society. The aim of this dissertation, I will highlight three papers that describe the link between social and behavioral risk and reproductive health outcomes among adolescent girls living in low-income areas. The first paper is The Determinants of Sexual Risk Factors among Adolescent Girls in Kenya Using a Social-Ecological Model. In this paper, I focus on predicting cumulative risk using each social dimension (i.e., individual, peer, family, community, and society) to show how these social factors surrounding adolescent girls can lead to higher risk for contracting HIV or unplanned pregnancy. I use a multi-level, social-ecological model developed by Bronfenbrenner (1979) to evaluate the association between each level and cumulative risk. I propose a new level for measuring the influence and opportunities created by virtual networks or connections established by technology. In this paper, I show that the probability of a girl being defined as at-risk for adverse health outcomes is (i) negatively associated with factors at the family level and (ii) positively associated with a girl's physical and virtual network. The second paper is The Determinants of and Associations with Power in the Sexual Relationships of Adolescent Girls in an Urban and Informal Settlement in Nairobi, Kenya. I investigate economic empowerment as a mechanism for increasing sexual relationship power among adolescent girls. I show that a higher sexual relationship power score is associated with (i) fewer reports of intimate partner violence, (ii) greater financial knowledge and savings behavior, and (iii) increased self-efficacy. The evidence suggests that building economic empowerment is an effective approach for increasing sexual relationship power. The third paper is Game Changer? Phones and Sexual and Reproductive Health Knowledge among Adolescent Girls in Kenya. Mobile phone ownership among adolescent girls is growing rapidly in Kenya, yet, documentation or evidence about their virtual life is largely undocumented. The United Nation's suggests that mobile phones could be a game-changer for adolescent girls in low-to-middle income countries, allowing them to become more independent in their choices and control of information. I explore some of the benefits to adolescent girls who own a mobile phone. I show that mobile phone ownership is associated with (i) higher levels of sexual and reproductive health knowledge measured by contraceptive and HIV knowledge scores and (ii) a higher probability of testing for HIV. All three papers use data from the Population Council's Adolescent Girls' Initiative in Kenya, a 2-year intervention focused on empowering girls and reducing the rate of irreversible events related to sex, such as HIV infection and unplanned pregnancy. A cohort of 3,052 adolescent girls was enrolled and interviewed in 2015 and followed up in 2017 and 2019. Participants completed a survey that included questions about their sexual behaviors and reproductive health knowledge at each time point. In my dissertation, I provide perspective on the impact of knowledge, power, and risk on sexual and reproductive health outcomes among adolescent girls in Kibera and Huruma, Kenya.