This study aimed to explore how young people exercise agency in rural Malawi, Mozambique and Zambia in relation to sex, relationships and marriage, to inform local programmes aiming to prevent teenage pregnancy and child marriage. In each country, focus group discussions with young people and parents, in-depth interviews with young people and a variety of other participants, and a household survey with young people (15-24 years) were conducted. We found that (child) marriage was often a response to teenage pregnancy, which was highly prevalent in all study areas. Young people's aspirations to enter adulthood were influenced by their life circumstances. Initiation ceremonies symbolised the transition to adulthood and gave social endorsement to young people to start engaging in (often unprotected) sexual activity. Given the uncertain socioeconomic context, resource constraints led families to marry off their daughters; or girls themselves to marry early to relieve the burden on their families, but also to get pregnant as a 'next step' towards adulthood. Transactional sex was common. These intersecting cultural, social and economic contextual factors constrained young women's agency, more as compared to young men. However, young women did manoeuvre within contextual constraints to exercise a degree of agency.

Background Young people in Uganda face challenges in achieving their sexual and reproductive health and rights (SRHR), such as lack of information, limited access to services, teenage pregnancy and sexually transmitted infections. To address this, their empowerment – including their ability to express themselves and make decisions, is a key strategy. This study assessed how young people’s voice and choice concerning sex and relationships changed over the period of 3 years of implementation of the Get Up Speak Out! programme. Methods Data were collected through a household survey with young people (15-24 years) and through focus group discussions, in-depth interviews and key informant interviews with youth and community stakeholders in 2017 for the baseline and 2020 for the end-line. Using the difference-in-difference technique and thematic analysis, changes in key outcomes were assessed over time between intervention and control area. Results There were limited changes over time in the intervention area, which did not differ from changes in the control area. Young people were able to express themselves and expand their decision-making space on sex and relationships, in particular if they were older, male and in a relationship. Young women negotiated their agency, often by engaging in transactional sex. However, youth were still restricted in their self-expression and their choices as speaking about sexuality was taboo, particularly with adults. This was influenced by the political and religious climate around SRHR in Uganda, which emphasised abstinence as the best option for young people to prevent SRHR-related problems. Conclusions Young people’s SRHR remains a challenge in Uganda in the context of a conservative political and religious environment that reinforces social and gender norms around youth and young women’s sexuality. The limited effect of the programme on increasing young people’s voice and choice concerning relationships in Uganda can be understood in the context of a ban on comprehensive sexuality education (CSE) and the COVID-19 pandemic. These structural and emerging contextual factors enforce the taboo around youth sexuality and hinder their access to SRHR information and services. Multi-component and targeted programmes are needed to influence changes at the structural, community and individual level.

Background: Female genital cutting/mutilation is a harmful traditional practice that violates women’s rights and has adverse health consequences. This paper presents the reasons for and circumstances of female genital mutilation/ cutting (FGM/C) in specific settings of three countries – Indonesia, Ethiopia and Kenya.Methods: Data were collected through a household survey with young people (15-24 years) and through focus group discussions, in-depth interviews and key informant interviews with youth and community stakeholders in 2016 and 2017. Descriptive statistics and thematic content analysis were conducted.Results: The study findings confirm some of the reasons for FGM/C documented by previous studies, noting that these reasons are strongly interconnected, and gender norms are the underlying driver. In all three settings, these reasons drive the alterations of female bodies to result in a ‘cultured’ body that is acceptable to the patriarchal status quo. This results in the ‘pure body’ in Indonesia, the ‘tame’ body in Ethiopia and the ‘adult body’ in Kenya. Health workers and parents play an important role in decision-making around FGM/C in all settings. In Kenya, in particular, young women negotiate their role in decision-making around FGM/C as they are older at the time of circumcision. The study reveals how the changing legal and social contexts in each setting bring about changes in the tradition of FGM/C resulting in medicalization of FGM/C in Indonesia, a lowered age of cutting for girls in Kenya and the increasingly underground practice of FGM/C in Ethiopia.Conclusions: The three cases demonstrate the huge variation in the practice of FGM/C and the social meaning attributed to it by young women and their communities. There is a need to further explore the role of parents in decision-making. Due to the links between the different drivers of FGM/C within each context, the study concludes that context-specific strategies need to be adopted by interventions to create long-lasting change.

Background Child marriage persists in many countries and has severe impacts on health, education, economic and social status of girls. Child marriage has many interlinked causes. This study aimed to explore the drivers of child marriage in specific contexts in Ethiopia, Indonesia, Kenya, Malawi, Mozambique and Zambia. Methods The study combined a household survey among youth (15-24 years) with focus group discussions and interviews conducted with youth (15-24 years) and parents. A variety of community stakeholders were interviewed as well. Logistic regression was done to explore associations between individual and family-level characteristics of young women and the occurrence of child marriage. Transcripts were analysed using an inductive approach. Narratives on the main drivers of child marriage across study contexts were written and inspired by the theory of normative spectrum. Results A lack of education was associated with the occurrence of child marriage in Ethiopia, Kenya and Zambia. In all countries, teenage pregnancy was associated with child marriage. In Ethiopia, Kenya and Mozambique, fathers’ education seemed a protective factor for child marriage. Narratives of study participants showed that in Ethiopia, Indonesia and (to a lesser extent) Kenya, child marriage was perceived as an ‘appropriate practice’ to avoid premarital sex or pregnancy, whether it involved sex with or without consent. In all countries, child marriage was driven by difficult economic circumstances, which were often intertwined with disapproved social circumstances, in particular teenage pregnancy, in case of Kenya, Malawi, Mozambique and Zambia. These circumstances made child marriage an ‘acceptable practice’. Some youth, particularly in Indonesia, made their own choices to marry early, making child marriage a ‘possible practice’. Conclusions Multiple intersecting drivers, which were present in different degrees in each country setting, influenced the occurrence of child marriage. We found that child marriage is a manifestation of social norms, particularly related to girls’ sexuality, which are intersecting with other factors at individual, social, material, and institutional level – most prominently poverty or economic constraints. Child marriage was, in some cases, a result of girls’ agentic choices. Efforts to prevent child marriage need to take these realities of girls and their families into account.

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