Photo: Community activists in a training session. Africa Renewal 8 March 2021 by LUARTE/Etevaldo Orlando Jack
by Sally Griffin, Málica de Melo, Joelma Joaquim Picardo, Grace Sheehy, Emily Madsen, Jorge Matine, Sally Dijkerman, 14 June 2023
Adolescents 2023;3(2):343-65 (Open access)
Abstract
Adolescents and young women in Mozambique experience high levels of unintended pregnancies, with induced abortion being a common outcome. Stigma and gender norms are likely to negatively impact experiences of pregnancy and abortion, and hamper access to information and services. We assessed knowledge, attitudes, practices, and experiences around pregnancy and abortion in six communities in Nampula and Zambézia provinces. We conducted 19 triad interviews with young women and girls, 19 focus group discussions with male and female adult community members, and 15 in-depth interviews with young women with abortion experience. Participants described how gender values, norms, and practices affect girls’ risk of unintended pregnancy and their experiences of pregnancy and abortion. The drivers of adolescent pregnancy included transactional sex and gender-based violence, including early marriage, and gender roles and expectations that lead parents and others to oppose contraception. Stigma around abortion, early or unintended pregnancy, and adolescent sexuality is fuelled by gender norms and contributes to girls seeking unsafe abortions. Pregnancy and abortion decision making often involves male partners and family members. In conclusion, gender norms strongly influence the occurrence and outcome of unintended pregnancies and abortion in Mozambique. While abortion legislation was recently liberalized, gender values, norms, and practices inhibit young women’s and girls’ access to services and need to be addressed in policy and programming.
Definition of gender norms used in this paper: from the Introduction:
“Gender inequality is an important social determinant of health and strongly influences sexual and reproductive health (SRH) outcomes. Social norms, including gender norms, are a key driver of gender inequality and are a significant barrier to SRH choices and care, particularly when interacting with other determinants, such as age, disability, and poverty. Gender norms are “the often unspoken rules that govern the attributes and behaviours that are valued and considered acceptable for men, women, and gender minorities”. They are learned in childhood and maintained in the family and broader social context, through real or perceived social rewards and sanctions. Gender norms are based on underlying values (such as ideologies of men’s superiority), and result in many harmful practices, such as early marriage and gender-based violence (GBV). Examples of gender values and norms that can affect women’s and girls’ SRH decisions and experiences include gendered cultural expectations around childbearing and motherhood, stigma around premarital sex and adolescent pregnancy, and beliefs and expectations around men’s and women’s sexuality. Gender norms such as these have been shown to impact a wide range of SRH issues, including contraception, safe abortion, HIV, and GBV.
“In the case of adolescents and young women, gender inequality interacts with inequalities and norms relating to age. Social and gender norms around sexual activity and pregnancy in adolescence work together to limit access to SRHR (sexual and reproductive health and rights) education and contribute to poor communication between adolescents and parents about sexuality and SRHR. These norms also restrict adolescents’ access to SRH services, including due to privacy concerns and provider bias, for example, denial of contraception for adolescents. These gender and age barriers contribute to high levels of unintended pregnancy in sexually active adolescents and, consequently, a high demand for abortion in this age group.”