Understanding how social norms influence access to and utilization of adolescent sexual and reproductive health services in Northern Nigeria
Outcomes: Child, Early, and Forced Marriage, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Social norms in Northern Nigeria strongly enforce early marriage, high fertility expectations, and male authority over reproductive decisions, significantly limiting adolescents’ access to and utilization of modern contraceptive services. Norms around chastity, family honor, and fertility not only stigmatize unmarried adolescents who seek contraception but also render married adolescents—especially girls—powerless to make independent reproductive health decisions. The study underscores the urgent need for norm-shifting interventions that target influential social networks, including husbands, mothers-in-law, and community leaders.
Objectives To understand how social norms influence adolescent access to and utilization of sexual and reproductive health services in Northern Nigeria, and to identify key reference groups who influence adolescents’ contraceptive decisions.
Methods This qualitative study employed focus group discussions (FGDs) with 188 adolescents (both married and unmarried, aged 10–19) and in-depth interviews (IDIs) with 69 adult reference group members (e.g., parents, husbands, community elders). The study was conducted in 18 communities across Gombe, Katsina, and Zamfara states in October–November 2019. Data collection used the ALIGN Social Norms Exploration Tool (SNET), including participatory methods such as vignettes, “5 Whys,” and “My Social Network.” Transcripts were thematically analyzed using an inductive coding approach.
Social Norms Measures and Methods Social norms were explored through qualitative tools designed to capture beliefs, sanctions, reference groups, and expected behaviors. The SNET tool provided structured yet flexible approaches to investigate normative beliefs across different adolescent groups. Reference groups were identified and interviewed to explore their role in enforcing or challenging these norms.
Results Key findings revealed that social norms prioritize female chastity and early marriage as safeguards for family honor, with adolescents expected to begin childbearing soon after marriage. Contraceptive use is widely stigmatized and discouraged, especially among married adolescents, with husbands and mothers-in-law acting as key gatekeepers. Fertility is framed as a divine blessing, and having many children—especially sons—is culturally valued. Adolescents reported limited autonomy, misinformation about contraceptives, and fear of social sanctions for non-conformity.
Conclusions Adolescents’ reproductive health decisions are deeply embedded in social networks that enforce traditional gender roles and fertility norms. Interventions must engage influential community actors—particularly husbands and mothers-in-law—and promote adolescent agency. Shifting these norms is essential for improving contraceptive uptake and advancing sexual and reproductive health outcomes in Northern Nigeria.
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