Adolescent perspective on sexual debut in the South-West Indian Ocean: a regional study.

Although more and more reproductive health interventions in the South-West Indian Ocean, including those targeting adolescents, are performed on a regional basis, information on sexual initiation is scattered and difficult to compare. This study used unique qualitative data from 116 focus groups conducted in 2007 among in-school and out-of-school, younger and older, male and female adolescents in urban and rural areas of Comoros, Madagascar, Mauritius, Réunion, and Seychelles to provide a regional portrait of adolescent perceptions on sexual debut. The data show that premarital sexual activity during adolescence, especially after age 15 years, is viewed as normal and acceptable in Réunion and Seychelles, whereas such activity remains stigmatized, especially for adolescent girls, in Comoros, Madagascar, and to a lesser extent in Mauritius. However, in all five islands, traditional norms of masculinity and double sexual standards prevailed. Female premarital virginity was portrayed as an ideal that is increasingly in conflict with adolescents' contemporary life, and in Madagascar, Mauritius, and Comoros, and sexually active female adolescents are facing high social risks. Early childbearing and sexually transmitted diseases also emerged as important concerns for adolescents in Madagascar, Mauritius, and Seychelles. Lack of access to reproductive health information and services seemed particularly serious among out-of-school and rural adolescents, especially in Comoros and Madagascar. Regional and gender differentials in norms surrounding sexual debut should be considered when developing reproductive health programs. Programs and services have to be strengthened throughout the region to address adolescent reproductive health concerns and better serve the needs of out-of-school and rural adolescents.