Online Program

Impact of Kenya's free primary education on the transactional sex behavior of mothers of school-age children

Wednesday, November 6, 2013

Felix Muchomba, MPH, Columbia University, New York, NY
Background: Transactional sex is a recognized factor in HIV transmission and acquisition. The need to provide for one's children is a particularly strong motivator for poor women to engage in transactional sex. Kenya introduced free primary education (FPE) in January 2003, which reduced parents' education expenses. However, it is not known whether reductions in financial obligations decreased transactional sex among mothers who benefited from FPE.

Methods: The study used a quasi-experimental, difference-in-differences design to compare the risk of engaging in transactional sex, pre- and post-FPE, among women affected by FPE (i.e., mothers of primary school-age children) and a comparison group of women who did not have a primary school-age child. A nationally-representative sample of 15-49 year-old women (N=11,265) was obtained from the 1998 and 2003 Kenya Demographic Health Surveys. Crude risk differences (RD) and relative risks (RR) of engaging in transactional sex were calculated and adjusted for age, marital status, education, household wealth, urban residence, and province of residence using generalized linear models.

Results: After introduction of FPE, the proportion of women in the affected group reporting past-year transactional sex declined from 5.0% pre-FPE to 3.3% post-FPE (aRD=-1.6%;p<0.01), while the proportion in the comparison group remained unchanged (aRD=-0.5%;p=0.55). The relative risk comparing pre- and post-FPE transactional sex behavior also showed a decline among the affected group (aRR=0.70;p<0.01) but not in the comparison group (aRR=0.90;p=0.32).

Conclusion: Kenya's FPE appears to have reduced transactional sex among mothers of primary school-age children. FPE is a valuable structural approach for sexual risk behavior change.

Learning Areas:

Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Evaluate the impact of a national free primary education policy on sexual risk behavior. Discuss the impact of Kenya's free primary education on the transactional sex behavior of mothers.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been involved in the design, implementation and evaluation of several studies focusing on HIV/AIDS prevention, care, and treatment among marginalized populations in the US and around the world.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.