Key Social Norms Take-aways This study illustrates how gendered social norms shape women’s and girls’ sexual and reproductive health (SRH) empowerment by influencing both their internal motivations and external constraints. Women’s roles as primary childbearers are reinforced by community expectations, partner dynamics, and health provider interactions, while societal pressures undermine their autonomy, particularly around contraceptive use. Yet, many women find covert ways to exercise agency, illustrating how empowerment is negotiated even in restrictive normative environments. The study underscores the importance of distinguishing between existence and exercise of choice and challenges programs to address both structural and relational power dynamics.
Objectives The study aimed to assess and refine a conceptual framework on women’s and girls’ SRH empowerment across four sites in sub-Saharan Africa. It sought to understand how preferences for childbearing and contraception are shaped and how women navigate external pressures to exercise and achieve reproductive goals.
Methods Researchers employed a qualitative, cross-cultural design involving 120 in-depth interviews and 38 focus group discussions with 440 women and men in Ethiopia, Uganda, and Nigeria. Thematic analysis was guided by the framework, with data coded deductively and analyzed using Atlas.ti.
Results The study found that internal motivations such as the joy of motherhood and aspirations for education and economic advancement shaped women’s reproductive goals. However, social norms—such as expectations to prove fertility post-marriage, stigma around premarital pregnancy, and fears about contraceptive side effects or infertility—significantly constrained the existence of reproductive choice. Exercise of choice was often achieved through covert contraceptive use, negotiation with partners, or support from third parties like family and community leaders. Women were frequently the ultimate decision-makers regarding contraception, though often navigating complex gender power dynamics to do so.
Conclusions The framework effectively captures the dynamic, multilevel nature of SRH empowerment. The study highlights that empowerment is not just about having options (existence of choice) but also the capacity and support to act on them (exercise of choice). Programs should address both levels by challenging harmful gender norms, involving male partners, and promoting respectful, woman-centered healthcare. Normative expectations about gender roles, particularly those reinforcing male authority and female reproductive responsibility, remain core barriers to SRH autonomy.