Adolescent Sexual and Reproductive Health in Ethiopia and Rwanda: A Qualitative Exploration of the Role of Social Norms

Abstract

This article seeks to address the dearth of evidence on early adolescent understandings and experiences of sexual and reproductive health (SRH) in Ethiopia and Rwanda, drawing on a multisite qualitative research study with 10-to 12-year-old and 14-to 15-year-old male and female adolescents and a range of adult participants. The article is informed by a conceptual framework that draws on Amartya Sen's capability approach, which calls for investments in a broad set of assets that expand individuals' capacity to "be" and to "do." Using SRH as a focal lens, the article considers the role played by gendered social norms in adolescents' experiences of SRH-related understandings and experiences. Three key interrelated gender themes emerge from our thematic analyses of qualitative evidence generated by our multimethods approach: puberty transitions, sexuality, and victim blaming. In our analyses, we pay attention to diversity (e.g., age, gender, place of residence) among adolescents within and across the two focal countries and consider how discriminatory gendered social norms play a role in hindering the effective uptake of expanding health services. We conclude by emphasizing the need for program designers and implementers to address the role of underlying social norms in a more strategic and context-specific way to help young people navigate their sexual and reproductive lives.

What do Service Providers in Southern Ethiopia Think About Barriers to using Youth-Friendly Sexual and Reproductive Health Services for Adolescents?: Qualitative Study

“…Awkwardly, majority of providers in the study were mentioning the above challenges as limiting factors for utilization of the service. The ndings of this study were also congruent with studies done in Ethiopia [24], Ghana [25] and Nepal [26]. In addition, according to our ndings, adolescents wanted to be served by providers of older age and same sex.…”

“…Under the theme of community level, participants raised many perceived and actual barriers to accessing sexual and reproductive health services. Although related studies are di cult to obtain, this nding seems to be consistent with other ndings in Ethiopia [24] and Rwanda [24] and Ghana [25]. This nding implies that community sexual and reproductive health promotion is required to support friendly-services among general population, teachers, religious follower, and other stakeholders.…”

“…All the above challenges negatively impact principles of adolescentfriendly services that may lead to ineffective delivery of services. Although the circumstances vary, the ndings are consistent with the study conducted in Ethiopia [24] and Tanzania [27,28].…”

“…Because, I see that adolescents are in uenced by peers not by theirs own decision." [Female, Age:[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Health Extension] Another participant witnessed disclosing secrecy of adolescents from his experience. "Healthcare providers have a problem of keeping secrets about adolescent and sexual issues.…”

Perceptions and barriers toward sexual reproductive health services accessibility, availability and quality among adolescents in selected cities of Rwanda

“…Adolescents' health is important to every society as it is one of the tools for economic development, and public health [1]. About one fifth of the global population is made up of adolescents.…”