Key Social Norms Take-aways In South Kivu, Democratic Republic of Congo, social norms deeply shape reproductive choices, with high fertility linked to social personhood, kinship obligations, and economic hope. Modern contraception introduces new possibilities—but also new uncertainties—as women navigate entrenched gender hierarchies, religious discourses, and fears of social or physical repercussions. Contraceptive use is often covert, contested, and negotiated, reflecting how norms are not fixed but actively reinterpreted and redefined. These findings show that social norms are central not only to shaping fertility expectations but also to how new reproductive technologies are accessed, understood, and embodied.
Objectives This study examined how women in a high-fertility, post-conflict context engage with modern contraception, focusing on how socio-cultural norms, gender dynamics, institutional structures, and embodied experiences shape reproductive navigation.
Methods The study used an inductive, grounded theory approach to analyze 78 in-depth interviews collected from 2014 to 2016 in three health districts in South Kivu. Participants included pregnant women aged 15–49, older women, traditional birth attendants, husbands, health workers, and religious leaders. Interviews explored fertility norms, power dynamics, and perceptions of contraception. Data collection also included informal interviews and participant observation in health facilities, maternity waiting homes, and villages. Maternity waiting homes—group lodgings near referral health centers—enabled researchers to observe women’s lived realities in late pregnancy. Interviews were conducted in local languages, transcribed into French, and analyzed collaboratively by the research team throughout the data collection period.
Results Despite increasing availability of family planning services, modern contraceptive use remained low due to structural barriers, social expectations, and fear of side effects. Fertility was closely tied to women’s social status and perceived security, often overriding personal health concerns or preferences for smaller families. Women’s narratives showed how reproductive decisions were embedded in negotiations with male partners, in-laws, religious leaders, and healthcare providers. Even when women attempted to assert reproductive agency—often through covert use—they faced significant social and physical risks. Religious teachings and service limitations further complicated contraceptive uptake.
Conclusions Reproductive choices in South Kivu are shaped by a web of social, cultural, institutional, and embodied factors. Social norms not only constrain contraceptive use but also mediate how women interpret and navigate fertility, often with high stakes. Sustainable shifts in reproductive behavior will require norm-sensitive approaches that address gendered power structures, religious influences, and the uncertain lived realities of reproductive health.