𝐑𝐞𝐩𝐫𝐨𝐝𝐮𝐜𝐭𝐢𝐯𝐞 𝐇𝐞𝐚𝐥𝐭𝐡 𝐂𝐨𝐧𝐬𝐞𝐪𝐮𝐞𝐧𝐜𝐞𝐬 𝐨𝐟 𝐈𝐧𝐭𝐞𝐫𝐠𝐞𝐧𝐞𝐫𝐚𝐭𝐢𝐨𝐧𝐚𝐥 𝐒𝐞𝐱𝐮𝐚𝐥 𝐏𝐚𝐫𝐭𝐧𝐞𝐫𝐬𝐡𝐢𝐩𝐬

🎓 𝐏𝐫𝐞𝐬𝐞𝐧𝐭𝐞𝐝 𝐨𝐫𝐢𝐠𝐢𝐧𝐚𝐥 𝐝𝐨𝐜𝐭𝐨𝐫𝐚𝐥 𝐫𝐞𝐬𝐞𝐚𝐫𝐜𝐡 𝐚𝐭 𝐭𝐡𝐞 𝐆𝐇𝐒 𝟐𝟎𝟐𝟔 𝐒𝐁𝐂 𝐄𝐯𝐢𝐝𝐞𝐧𝐜𝐞 𝐒𝐮𝐦𝐦𝐢𝐭, 𝐊𝐨𝐫𝐥𝐞-𝐁𝐮 I'm excited to share that I presented my poster, "𝐑𝐞𝐩𝐫𝐨𝐝𝐮𝐜𝐭𝐢𝐯𝐞 𝐇𝐞𝐚𝐥𝐭𝐡 𝐂𝐨𝐧𝐬𝐞𝐪𝐮𝐞𝐧𝐜𝐞𝐬 𝐨𝐟 𝐈𝐧𝐭𝐞𝐫𝐠𝐞𝐧𝐞𝐫𝐚𝐭𝐢𝐨𝐧𝐚𝐥 𝐒𝐞𝐱𝐮𝐚𝐥 𝐏𝐚𝐫𝐭𝐧𝐞𝐫𝐬𝐡𝐢𝐩𝐬," at this year's SBC Evidence Summit, and with it, a new theoretical framework I developed and tested: 𝐭𝐡𝐞 𝐑𝐞𝐩𝐫𝐨𝐝𝐮𝐜𝐭𝐢𝐯𝐞 𝐀𝐮𝐭𝐨𝐧𝐨𝐦𝐲 𝐂𝐨𝐧𝐬𝐭𝐫𝐚𝐢𝐧𝐭 𝐅𝐫𝐚𝐦𝐞𝐰𝐨𝐫𝐤 (𝐑𝐀𝐂𝐅). 𝐓𝐡𝐞 𝐪𝐮𝐞𝐬𝐭𝐢𝐨𝐧 𝐝𝐫𝐢𝐯𝐢𝐧𝐠 𝐭𝐡𝐢𝐬 𝐰𝐨𝐫𝐤: Across sub-Saharan Africa, intergenerational sexual partnerships (IGSPs) are consistently linked to elevated HIV/STI risk, unintended pregnancy, and psychosocial harm. But the dominant explanation; that age gaps alone are the mechanism, has never fully accounted for how that harm is actually produced. My doctoral research set out to close that gap. 𝐖𝐡𝐚𝐭 𝐑𝐀𝐂𝐅 𝐝𝐨𝐞𝐬 𝐝𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐭𝐥𝐲: Rather than treating reproductive autonomy as a background assumption, RACF operationalises it as a testable, measurable mediating construct. Using a community-based, sequential explanatory mixed-methods design across 5 clusters in Ho Municipality, Ghana (N=200 quantitative; n=38 in-depth interviews with the full IGSP-positive stratum), I traced the pathway from structural vulnerability → IGSP engagement → constrained reproductive autonomy (+ financial dependence) → adverse reproductive outcomes. 𝐓𝐡𝐞 𝐡𝐞𝐚𝐝𝐥𝐢𝐧𝐞 𝐟𝐢𝐧𝐝𝐢𝐧𝐠: Constrained reproductive autonomy and financial dependence; not age difference alone, explain 44.9% of the total association between IGSP engagement and unintended pregnancy (β=1.48, 95% CI 1.02–2.15, p=.039). Once autonomy entered the model, the direct effect of IGSP engagement on unintended pregnancy fell to non-significance (aOR 1.62, n.s.). That's the statistical signature of mediation, and it reframes IGSP-related harm as structurally produced and mechanistically traceable, not an inevitable by-product of age-asymmetric relationships. 𝐎𝐭𝐡𝐞𝐫 𝐟𝐢𝐧𝐝𝐢𝐧𝐠𝐬 𝐭𝐡𝐚𝐭 𝐬𝐭𝐨𝐨𝐝 𝐨𝐮𝐭: 📊 19.0% past-12-month IGSP prevalence among AGYW 15–24; sitting squarely within published sub-Saharan African and Caribbean estimates 📊 86.8% of IGSP-positive participants cited financial/material support as their primary motivation; yet household poverty was not the driver; income source (employment vs. family remittance) mattered far more (aOR 2.89) 📊 97.0% of IGSP-positive women reported experiencing stigma, even as 90.0% of community members endorsed livelihood-support programmes; disapproval that drives concealment, not protective deterrence. 𝐖𝐡𝐲 𝐭𝐡𝐢𝐬 𝐦𝐚𝐭𝐭𝐞𝐫𝐬 𝐟𝐨𝐫 𝐩𝐫𝐚𝐜𝐭𝐢𝐜𝐞: RACF points programming toward three underused levers: (1) structural: livelihood and economic empowerment; (2) relational: gender-transformative, partner-engagement strategies; and (3) individual: negotiation-skills and confidential, youth-friendly SRH services targeting the specific self-efficacy deficits this study identifies. It's a shift from individual behaviour-change models toward structural, agency-centred, multi-level intervention. This work sits at the intersection of social and behaviour change, adolescent and youth sexual and reproductive health, and structural violence; and I'd love to hear from researchers, implementers, and policymakers working in this space. I'm actively seeking collaboration, replication partners for larger multi-site samples, and conversations that push this framework further. Deep gratitude to my supervisors, Dr. Hubert Amu and Dr. David Adedia, and to the Fred N. Binka School of Public Health, University of Health and Allied Health Sciences (UHAS), Ho, for their guidance throughout this work. Full poster attached; happy to share the manuscript or discuss the methodology in the comments or via DM. #ReproductiveHealth #SocialAndBehaviourChange #AdolescentHealth #PublicHealth #SBCEvidenceSummit2026 #GhanaHealthService #UHAS #DoctoralResearch #HIVPrevention #GenderEquity #SRHR #ReproductiveAutonomy #MixedMethodsResearch #GlobalHealth See less