Key Social Norms Take-aways In Accra, Ghana, gendered and cultural norms deeply influence adolescents’ access to sexual and reproductive health (SRH) services. Social expectations stigmatize sexuality, especially for girls, who are often judged harshly for seeking contraception or information. Boys face pressure to perform masculinity through sexual activity. These norms contribute to shame, misinformation, and silence, deterring adolescents from openly discussing or accessing SRH services. Such stigma is reinforced at home, in schools, and within healthcare settings, limiting the impact of existing policies and education initiatives. Shifting these norms is critical to improving adolescent SRH outcomes.
Objectives This study explored how social, cultural, and institutional factors affect adolescents’ knowledge of, access to, and experiences with SRH services in Accra, Ghana. It aimed to identify barriers and enablers across different levels of the health and social system.
Methods The researchers conducted 12 focus group discussions with 96 adolescents aged 15–24 (in-school and out-of-school, boys and girls), and 13 key informant interviews with stakeholders from government, education, and NGOs. Thematic analysis was guided by the Dahlgren-Whitehead Rainbow Model, examining micro (individual), meso (community and service), and macro (policy and societal) level influences.
Results At the micro level, adolescents felt unable to talk with parents about SRH, relying on peers or religious groups—often receiving abstinence-only messages. At the meso level, schools delivered Ghana’s Comprehensive Sexuality Education, but adolescents viewed the curriculum as inadequate, poorly delivered, and overly focused on abstinence. Healthcare providers were described as judgmental, especially toward girls seeking contraception or abortion. Some adolescents were unaware of existing adolescent-friendly services. At the macro level, gender and cultural norms contributed to stigma, limiting girls’ autonomy and shaping boys’ behaviors. Poverty and underfunded policies further restricted access, particularly for out-of-school youth.
Conclusions While Ghana has ASRH policies and school-based curricula, implementation challenges and pervasive stigma limit their effectiveness. Adolescents face judgment from families, teachers, and providers, creating a hostile environment for accessing SRH information and care. A coordinated, multisectoral approach is needed to reform education delivery, train non-judgmental providers, and promote community-level norm change. Engaging parents, religious leaders, and educators in open dialogue can help reduce stigma and support adolescents’ rights to informed, confidential, and respectful SRH services.