Measuring social norms endorsement and normative influence on contraceptive use among youth (15-24) in northeastern Uganda.
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Social norms are strongly associated with contraceptive use among youth in Karamoja, Uganda, suggesting that improving access to contraceptive services alone may be insufficient. Supportive reproductive health norms and young people’s self-efficacy were the strongest drivers of contraceptive uptake, while restrictive gender expectations, contraceptive myths, harmful cultural practices, stigma, and punitive sanctions created barriers. The authors emphasize that programs should actively reshape community attitudes, promote gender equity, engage men and boys, reduce stigma and sanctions, and strengthen young people’s agency to make reproductive health decisions.
Objectives To measure endorsement of social norms among youth aged 15–24 in northeastern Uganda and examine how these norms are associated with contraceptive use.
Methods This cross-sectional quantitative study included 448 youth aged 15–24 in three districts of Karamoja, including 409 who were sexually active. Social norms were assessed using a contextually developed Likert-scale tool informed by literature review and qualitative research. Eight domains assessed norms and related influences concerning provision of sexual education, family planning myths and misconceptions, reproductive health, couple communication, masculinity, sanctions, self-efficacy, and engagement sex/courtship. Scale scores were categorized as high or low agreement, and modified Poisson regression with robust variance estimation examined associations with contraceptive use; sensitivity analyses using continuous scores generated predicted probabilities.
Results Current contraceptive use was 11%. Positive reproductive health norms and self-efficacy showed the strongest associations with contraceptive use. Endorsement of positive reproductive health norms was associated with more than fourfold greater contraceptive use, while high self-efficacy was associated with nearly fourfold greater use. Rejecting negative masculinity norms was associated with 30% higher contraceptive use, rejecting contraceptive myths and misconceptions with 15% higher use, and rejecting harmful engagement-sex norms with approximately 12% higher use. Sanctions showed a negative association with uptake, although this relationship was not statistically significant. Gender differences were also apparent, including greater endorsement of some restrictive norms among women.
Conclusions Contraceptive uptake among youth is shaped by both individual agency and the broader normative environment. The authors recommend a multi-pronged approach that strengthens self-efficacy, promotes supportive reproductive health and gender-equitable norms, challenges harmful cultural practices and myths, reduces stigma and sanctions, expands comprehensive sexuality education, and strengthens couple communication. Integrating normative change into sexual and reproductive health programming may create more enabling environments for young people to use contraception.
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