Journal of Community Medicine & Health Education
Open Access

Premarital sex is sexual activity practiced by persons who are unmarried. It is considered taboos in Nepalese Culture and prohibited in Hindu religion. Despite this fact, an increasing number of sexual activities are being reported by Nepalese student [1]. In the context of a global decline in the age of sexual maturation and rising age of marriage, the window of opportunity for young people to engage in premarital sexual relations in the opening [2].

Young people aged 10-24 years constitute 32.5% of the total population of Nepal [3] and have been identified as one of the groups most vulnerable to the growing HIV/AIDS pandemic [4]. In Nepal, the issue of sexuality still remains taboos. Sexual activity begins early for young people in Nepal [5]. The median age at first sexual intercourse for females (17.5) is identical to that of the median age of marriage (17), suggesting that women have their first sexual intercourse within marriage [6]. It is reverse in the case of males indicating that their first sexual intercourse begins outside of marriage. The proportion of nevermarried men and women aged 15-19 is steadily increasing. This leads to more unmarried adolescents, particularly young men becoming sexually active outside of marriage [5].

Adolescents in Nepal cover 23.62 percent of the total population i.e. nearly a quarter of the population. In general, young people (10-24 years) constitute of almost 32.5% of the total population of Nepal [7]. Growing expansion of communication and transportation networks, urbanization and in-migration of the population to urban areas created a different sociocultural environment, which is conducive to more social interactions between young girls and boys in Nepal. In the context of a global decline in the age of sexual maturation and rising age of marriage, the window of opportunity for young people to engage in premarital sexual relations in the opening [7]. Sexual activity begins early for young people in Nepal. Unsafe sexual activities before marriage make adolescents and youths more prone to unwanted pregnancies, unsafe abortions, pregnancy-related complications, and sexually transmitted infections (STI) including HIV/AIDS. Modernization and social transformation are occurring rapidly in Nepalese society. Increasing number of mobility and increased accessibility on and development of Nepalese Growing communication and transportation networks is creating a different sociocultural environment, which is favorable to more social interactions between young girls and boys in Nepal [8].

The Nepal Adolescent and youth survey of 2010/11 reported that 17 percent of young unmarried people ever fell in love [9]. The average age of first love found to be 16 years for both boys and girls [9]. This is the time period that most of the adolescent spend at higher secondary school. As above mentioned adolescent have more interactions their opposite sex in this period and can engage in the premarital sexual activity.

Sexually active adolescents (school students) are faced with pregnancy and sexually transmitted disease problems because they are usually not protected. Issues such as unwanted teenage pregnancy and abortion tend to be a major area of concern areas that arise due to early initiation sexual activities among higher secondary school students. On the other hand, there are community members who are more concerned about social problems related to norms and moral values than health risks.

Premarital sex is taboo in Nepal so the limited study has been conducted to study understand the attitude of an adolescent on premarital sex This study will help to policymakers to understand factor affecting attitude towards premarital sex among youth.

This research adopted institution based cross-sectional studies and conducted between September and December 2012. The study populations for this research were students’ age between 14 and 19 years of higher secondary schools of Pokhara Sub-Metropolitan City. Multistage proportionate simple random sampling technique was adopted for this research as shown in (Figure 1). At first, sixteen higher secondary schools were selected randomly from the sampling frame.

Figure 1: Sampling flowchart.

Second, all the selected higher secondary schools were divided into public and private on the basis of the proportion of public and private. Third, one faculty and the classroom were selected randomly from each selected schools. Pretested structured questionnaire was distributed among all consenting (522) adolescent of aforementioned grades in a sealed envelope. They were also instructed to return their response in a sealed envelope without any identity. Instructions were given at the time of dispatch of the envelope containing questionnaire and they were assured of the confidentiality of information. The filled questionnaire was collected on the next two consecutive days.

Sample size calculation

= NZ²PP -1)/d² (N-1) + NZ²P (P -1)

Where,

n=sample size correction with finite population

N=total number of population

d=precision

p=expected proportion

Z=Z statistic at level of confidence

Assuming the non-response rate of 10% the sample size will be 237+24=261

Adjusting the sample size with design effect the final sample size will be 261 × 2=522

Thus, total same size =522

Scoring of the instrument

To measure the attitude of the respondent, the primary data is in the form of responses to one of the five categories (i.e. SA - Strongly Agree; A - agree; A - Agree; U - uncertain; D - disagree and SD - Strongly Disagree). Each respondent had to categorize the response he/she made in relation to each statement. The favorable types of statements are coded as follows: SA=5; A=4; U=3; D=2; SD=1. These scores were reversed for unfavourable type statements.

Scores of the responses to each of the five categories were calculated (secondary data) by scanning the number of responses to each response category of the completed questionnaire. The highest anticipated score was 12 × 5=60 and the lowest score was 12 × 1=12. The cutoff point was calculated by dividing the highest possible score (60) by 2. The cutoff point, therefore, was 60/2=30.The score equal to or above the cutoff score indicates an unfavorable attitude and a score below the cutoff score indicates a favorable attitude. Sibaya; Majova [10] used this method of scoring successfully with their studies.

Validity and reliability

The questionnaire of the article named "Premarital sexual behavior among male college students of Kathmandu, Nepal” is taken as reference for the questionnaire. The questionnaire was pretested and modifications were done for needed. Expert’s opinions were incorporated in every aspect of the study.

The reliability of the questionnaire was calculated by using Cronbach Alpha coefficient. The reliability measurement for the attitude towards premarital sex was 0.705.

Of the 522 students requested a total of 386 students responded questionnaire and returned and makes about 74% response rate. Among all the respondent 62% were male where their female counterparts account about 38%. The most of the respondents (59.1%) were in late adolescent stage i.e. age group 17-19, 39.4% respondents were in early adolescent stage i.e. age group of 14-16. Only 1.6 percent respondents were youths as shown in (Table 1).

Table 1: Age and sex distribution of respondents.

Premarital sexual experience

Table 2 shows the prevalence of premarital sex among higher secondary student of Pokhara. Among totals of 354 students, almost twenty-five percent (24.6%) student have had premarital sex. It is reported that the main reason for having sex was sexual desire (33.3%) followed by, by chance (27.2%) due they were in love (23.5%), curiosity (13.67%) and due to friend pressure (2.5%) respectively. It is seen that there is a significant association between sex of respondent and experience of premarital sexual experience. It is seen that male are 1.64 times more likely to involve in premarital sex compared to their female counterparts.

Table 2: Premarital sexual experience.

Attitude towards premarital sex

Tables 3 and 4 shows frequency and percentage of student responses which reveals the student's attitude toward premarital sex. A total of 12 statement was used to measure the attitude, among these statements number one, two, three, four and eleven were consider as unfavorable and rest of statement were favorable statements. For measurement of attitude, this statement was measured on a five-point Likert scale.

Table 3: Attitude towards different premarital sex related statements.

Table 4: Attitude towards premarital sex.

Respondent's attitude towards premarital sex

The totals of 362 respondents respond to the premarital sex-related statements. Among those respondents, eighty percent respondent favors the premarital sex and remaining twenty per thought premarital sexual activities shouldn’t be performed. There was significant difference in attitude towards premarital sex with respect to academic level of students (χ² (1)=8.13, P ≤ 0.05), and pornography exposure (χ² (1)=21.23, P ≤ 0.05) of respondent Tables 5 and 6.

Table 5: Association between attitude and respondent's exposure to pornography and level of study.

Table 6: Respondent's attitude in relation to their sex and conversation with peer group.

A respondent who had pornography exposure had four times higher chance of having a favorable attitude towards premarital sex.

The above table illustrated the attitude towards premarital sex with respect to gender of respondent, their conversation on sexuality with the peer group. Gender of the respondent (χ² (1)=31.56, P ≤ 0.05) and their conversation on sexuality with their peer group (χ² (1)=4.17, P ≤ 0.05) had a significant association with the attitude of respondents towards premarital sex. Female had more favorable attitude towards premarital sex than male respondent. The conversation in sexuality with peer group also affects the attitude towards premarital sex of respondent (χ² (1)=4.17, P ≤ 0.05) Table 7.

Table 7: Attitude with respect to respondent's age.

The above table showed that the age (χ² (2)=15.56, P ≤ 0.05) of respondent influenced the attitude towards premarital sex. The age groups of late adolescence were more liberal toward premarital sex than middle adolescences age group.

Although premarital sex is socially unacceptable in Nepal, the study has shown that the proportion of students having sexual intercourse before marriage is considerably high. Due to the sensitive nature of the issue, this proportion may still be under-reported. The overall prevalence of premarital sex in the study population was 24.5% which has been increased by six percent in two years. The previous study conducted by Niranjan et al. in Pokhara reported that the prevalence of premarital sex was 18.76 percent [3]. The mean age at first sex was 16 years for male and 16.4 for female which is slightly different to other study but the NDHS 2011 reported there is a low prevalence of premarital sex. Though conventional Nepalese society doesn’t accept premarital sexual activities, the new generation seems more open towards premarital sexual activities including sex before marriage. It important to notice that adolescent’s age between 17 and 19 are more liberal towards their sexual behaviors. This study doesn’t explore the reason behind why young people of this age group are more sexually active, however, it might be because adolescent finds the way to break conventional obstacles and looks for the information by themselves on the issues which have significant influence in their life as well on their sexuality. It is also interesting to see that, females are more favorable towards premarital sex than their male counterparts, however, regarding study find that more male is more likely to involve in premarital sexual behaviors. It is interesting to further explore the reason behind this paradox.

Although adolescents’ sexuality is often affected by hormonal influence, the role of psychological factors is not insignificant. In this study, the main reasons claimed by the adolescents for the start of first sex sexual was desired, followed by chance, curiosity, fun, and love. This finding is quite different with the study conducted in South Africa reported that the cause for first sex was falling in love [10]. This is also similar to the study conducted by Pramod et al. study reported that boys and girls engage in premarital sex to strengthen their partnership.

Most girls have a belief that they become ready to do anything to make their love succeed [4]. The study conducted in Kathmandu valley shown that Males consistently seemed more likely than females to have reported having premarital sex which is similar to this study finding that male has 8 times higher chances of engaging in premarital sex. It is well documented that males tend to exaggerate the sexual encounters and females tend to underreport them due to the dual social norms.

Findings of this study indicate that many young people of Nepal are very curious towards the issues related to sex and sexuality. They also have a belief that sex-play gives maximum pleasure. Young people also have opportunities to watch pornographic films to fulfill their desires to learn about these issues. It becomes more feasible particularly when young people stay away from their home or have less parental supervision. A similar pattern was found in other geographical settings too. For example, Abraham [11] reported that boys tend to watch pornographic films in a friend’s residence or at a video parlor. A study of Chinese women found that they gain information about opposite sex and sexual intercourse from pornographic magazines and videos and that young boys and girls watch such videos together and which is often followed by sexual activities.

This study was subjected to adolescents the higher secondary schools so the result may not represent the sexual behaviors and attitude of other adolescents' group.

Though Nepalese society doesn’t accept the sexual activities outside marriage young people are challenging these social norms and values. There are various factors which influence favorable attitude and increasing sexual activities especially among young people in Nepal. Among various reasons young people’s curiosity and desire about sex and sexuality and opportunity to involve in such activities play significant roles. Furthermore, changed or less parental control, more access to technology allows having more interaction with opposite sex and initiate sexual relations before marriage.