Key Social Norms Take-aways This study illustrates how deeply entrenched gender norms in Burundi shape adolescent sexual and reproductive health outcomes. Eight social norms emerged as having the greatest influence: sexuality and reproductive health are not discussed openly in households or the community, and it is not considered socially acceptable to do so; it is not socially acceptable to show any evidence of menstruation; girls are expected to behave differently after they begin menstruating; sexual activity among unmarried adolescent girls and young women appears common but not socially approved of; having sex in exchange for gifts or money appears common; instances of coerced sex appear common and girls who experience sexual violence are typically socially shamed; it is becoming less socially acceptable to have more children than one can care for; and adolescent girls and young women do not typically use contraception and it is not considered appropriate for them to use contraception.
Objectives The study aimed to document social norms that impact reproductive health behaviors among unmarried adolescent girls and young women in Burundi, with a specific focus on understanding the lived experiences of adolescents and community perspectives to inform the design of future social norms interventions.
Methods This was a qualitative study wherein 12 focus group discussions were conducted with unmarried adolescent girls and young women, and 18 focus group discussions were conducted with other influential community members in four provinces (Bujumbura Mairie, Bururi, Gitega, Muyinga). The focus group discussions focused on four domains of inquiry: 1) menstruation and menstrual hygiene management, 2) sexual risk behaviors, 3) sexual violence, and 4) fertility and voluntary family planning use. Data were analyzed using thematic analysis, focusing on empirical expectations, normative expectations, sanctions, and reference groups.
Results Based on social norms findings, the study identifies five strategic entry points for future interventions. These include promoting open family communication about sexuality and reproductive health, creating safe and accessible spaces for girls to access accurate information, addressing gender and power imbalances that increase sexual risk, engaging religious leaders as allies in advocating for family planning, and investigating the root causes of health worker bias to improve service delivery.
Conclusions The study concludes that adolescent SRH in Burundi is shaped by powerful, gendered social norms that disadvantage girls and limit their autonomy. However, pockets of change suggest potential for norm-shifting interventions. Programs that engage multiple community actors and support adolescent agency could play a key role in transforming the social norms landscape.