« Éloigne cette honte de moi! »: une étude qualitative des normes sociales entourant les expériences d’avortement chez les adolescentes et jeunes femmes au Bénin Translated title: “ Take this shame away from me!”: a qualitative study of the social norms surrounding abortion experiences among adolescent girls and young women in Benin

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Résumé

En Afrique, les droits des adolescentes et des jeunes femmes en matière de santé sexuelle et reproductive sont fortement influencés par les normes sociales. Cet article se penche sur le rôle crucial que jouent ces normes dans les décisions et les parcours d’avortement des jeunes femmes âgées de 15 à 24 ans au Bénin. Une approche ethnographique a été adoptée pour la collecte des données auprès des jeunes femmes ayant eu recours à l’avortement, de leurs proches, ainsi que d’autres membres de la communauté.

Les résultats révèlent que ces jeunes femmes se retrouvent confrontées à une triple charge normative dans leur environnement social. Elles doivent jongler avec des normes contradictoires qui stigmatisent à la fois les grossesses précoces, entravent une éducation sexuelle adéquate, et condamnent fermement l’avortement. Ces pressions normatives sont souvent le moteur de leur recours à des avortements, généralement effectués dans des conditions précaires. L’étude met également en évidence le rôle majeur des parents dans les décisions et les démarches d’avortement des adolescentes de moins de 20 ans. Lorsque les hommes sont impliqués dans la recherche de soins pour l’avortement, les adolescentes et les jeunes femmes ont généralement accès à des procédures sécurisées. Cependant, leur accès aux soins de suivi et à la contraception après un avortement est entravé par les normes sociales des professionnels de la santé.

En plus de l’élargissement des conditions d’accès à l’avortement au Bénin en octobre 2021, il est impératif de mettre en œuvre des interventions axées sur la clarification des valeurs, la sensibilisation aux droits des adolescentes, la lutte contre les violences obstétricales et la stigmatisation sociale. Ces mesures sont essentielles pour alléger le poids des normes sociales qui pèsent sur ces jeunes femmes.

Abstract

In Africa, the rights of adolescent girls and young women in terms of sexual and reproductive health are strongly influenced by social norms. This article delves into the pivotal role these norms play in the abortion decisions and experiences of young women aged 15–24 in Benin. An ethnographic approach was adopted for data collection among young women who have undergone abortion, their confidants, and other community members. The findings reveal that these young women face a threefold normative burden in their social environment. They juggle contradictory norms that simultaneously stigmatise early pregnancies, hinder proper sexual education, and strongly condemn abortion. These normative pressures often drive their resort to abortions, typically carried out under unsafe conditions. The study also highlights the significant role parents play in the abortion decisions and processes of teenagers under 20. When men are involved in seeking care for abortion, adolescents and young women usually access safer procedures. However, their access to aftercare and contraception following an abortion is hindered by the social norms of healthcare professionals. In addition to broadening the conditions of access to abortion in Benin in October 2021, it is imperative to implement interventions centred on value clarification, raising awareness of adolescents’ rights, combating obstetric violence, and social stigmatisation. These measures are crucial to alleviate the weight of social norms bearing down on these young women. DOI: 10.1080/26410397.2023.2294793

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Gender norms and social norms: differences, similarities and why they matter in prevention science

Beniamino Cislaghi, Lori Heise (2019)

Abstract Two streams of theory and practice on gender equity have begun to elide. The first is work conducted to change social norms, particularly using theory that emerged from studies in social psychology. The second is work done on gender norms, emerging historically from feminist scholars working to counter gender inequality. As these two streams of work intersect, conceptual clarity is needed to understand differences and similarities between these two traditions. Increased clarity will improve efforts to address harmful norms and practices. In this article, we review similarities and differences between social and gender norms, reviewing the history of the concepts and identifying key tension points of contrast. We identified six areas of comparison that might be helpful for practitioners working for the promotion of global health as they make sense of social and gender norms. We then offer a definition of gender norms for practitioners and researchers working at the intersection between these two theories. Our definition draws from the two different streams of thought of how norms influence people's actions, acknowledging the double nature of gender norms: beliefs nested in people's minds and embedded in institutions that profoundly affect health‐related behaviours and shape differential access to health services.

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Proposing a Conceptual Framework to Address Social Norms That Influence Adolescent Sexual and Reproductive Health

Julie Pulerwitz, Robert Blum, Beniamino Cislaghi … (2019)

Setting the Stage With 1.8 billion young people aged 10–24 years in the world today, the cohort of adolescents and youth is the largest in history. Concurrently, millions of adolescents are confronting sexual and reproductive health (SRH) challenges, including high rates of unmet need for contraception, unintended pregnancy, and clandestine and unsafe abortion [1]. Social norms—or shared understandings of how oneself and others should behave—can alleviate or exacerbate these challenges. Rapid global changes over the past 25 years have increased the spotlight on the interrelationships between social norms, health, and development [2], [3], [4]. Across diverse disciplines (e.g., anthropology, psychology, and economics), there has been an explosion of research exploring the relationships between social norms and SRH. In particular, this body of research has examined the role of gender norms or the subset of social norms that reflect understandings of how women compared with men should behave. There has also been a proliferation of frameworks designed to articulate the relationships between social changes, social norms, our evolving understanding of the gender continuum, and the contexts in which young people come of age (e.g., the studies by McCleary-Sills et al. [5], John et al. [6], and Van Eerdewijk et al. [7]). Programmers have started to apply these insights to intervention design, and evaluations that explicitly assess if and how programs can influence gender and other social norms and related SRH outcomes are underway. To strengthen these efforts, the Theory Working Group of the Social Norms Learning Collaborative (Social Norms Theory-LC) currently proposes a tailored conceptual framework that articulates the relationship between social norms and adolescent SRH outcomes. Our goal is to increase the clarity and rigor of the design, implementation, monitoring, and evaluation of programs that address the social context of adolescent SRH. By heightening awareness of the intersections of norms with other key contextual factors operating at multiple levels, the Social Norms Theory-LC framework highlights the larger forces that can lead to a shift in norms (and related outcomes) and provides insights for program development. Although our efforts have focused on programmatic implications such as how social norms persist or can change, we acknowledge the substantial body of theoretical work that has come before to understand why and under which circumstances social norms influence behaviors of specific individuals (e.g., the studies by Azjen [8], Bicchieri [9], Cialdini et al. [10], and Rimal and Lapinski [11]). The current framework views socialization as a centrally important process of learning, challenging, and enacting social norms that dramatically affects young people's sense of self and their place in the world. Many young people grow up in hegemonic societies where gender norms reinforce ideals of male strength and control as well as female vulnerability and need for protection. These notions often create boundaries of appropriate dress, education, behavior, and occupations for girls and boys alike. With the onset of puberty, adolescents are exposed to new expectations from adults and peers that, in turn, shape their expectations of themselves and those around them. Evidence suggests that this reciprocal set of relationships evolves throughout adolescence and is heavily influenced by gender norms [12]. These shifts can lead to opportunities and behaviors that promote or inhibit SRH. For example, given limited social and economic power of young people, family members often influence SRH decisions about the age of first sex or early marriage. And, even if families and government policies support different social norms, communities often continue to enforce traditional norms (as in early marriage). Given increasing interest in social norms and their influence on adolescent SRH and well-being, there is a need to articulate and develop consensus around a unifying conceptual framework that draws on multiple disciplinary approaches. We propose that such a conceptual framework (1) recognizes the relational nature of social norms processes, (2) highlights how norms fit within a larger sociostructural system, and (3) provides insight into how to promote norms that foster positive SRH and address norms leading to negative outcomes. Such a framework would enable us to highlight, for example, the role of power in maintaining gender norms, the identity function that norms play for young adolescents, and the special importance of peers in influencing norms for adolescents. The Conceptual Framework The proposed conceptual framework (Figure 1) is an adaptation of one developed by Cislaghi and Heise [13]. The original framework builds on Bronfenbrenner's ecological model of human development [14], which points out the relationships between multiple levels of the socioecological system. Our adaptations included putting social and gender norms in the inner circle where the four domains intersect around the pivot of power and denoting the interaction between gender dynamics and health outcomes. These changes highlight our understanding that social norms exist within—and shape and concurrently are shaped by—the social system in which they are embedded. Central to our framework are four elements: 1. The role of power in decisions to adhere to (or not to adhere to) existing norms, and in identifying who benefits from retaining conventional norms, as central to understanding how norms develop and persist. Norms “compliance” and “deviance” are central components of social norms theory, yet the role of power has often been overlooked in the applications of social norms theory for health promotion. In the present framework, power is a central feature underlying and enforcing social norms, as well as behavior and health outcomes. 2. Gender norms (i.e., shared beliefs about the behaviors—and related roles and responsibilities—deemed appropriate for boys/men compared with girls/women) as essential to understanding gender dynamics and SRH outcomes. This subset of social norms defines appropriate rules of interaction, relationships, and roles at all levels of the socioecological framework. They help shape power relationships, which lead to different risks and opportunities for interventions seeking to improve SRH. 3. An emphasis on the multiple relationships between domains (individual, social, resources, and institutional). The intersections of these domains represent opportunities to disrupt, develop, or transform outcomes. In other words, multilevel approaches that target these intersecting opportunities may be able to leverage norm change for improved SRH outcomes. 4. Social norms at the center of the model because of their powerful influence on SRH outcomes. This demonstrates the pivotal role of norms while acknowledging that structural factors are fundamental in developing and maintaining power [15], shaping gender and other social dynamics, and influencing health outcomes. Figure 1 Conceptual framework highlighting centrality of social and gender norms, and power, for ASRH. Applying Social Norms Theory to Improve Adolescent SRH By heightening awareness of the intersection of norms with other key contextual factors operating at multiple levels, the framework proposed by the Social Norms Theory-LC framework can, in turn, help us understand the larger forces that lead to shifts in norms (and related outcomes) and provide insights for program development. The multiple influencing factors portrayed in the framework highlight the complexities of adolescent decision-making. For example, a young person may concurrently be influenced by peer group norms supporting use of contraception and prohibitions on such use put forth by faith leaders. As another example of complexities, social norms can be shifting differently for boys and girls; a recent qualitative cross-cultural study in four countries found that there was a growing acceptability for girls to engage in stereotypical masculine activities (e.g., playing soccer/football), but the same was not found for boys [16]. And finally, endorsement of specific norms can vary by different age bands of young people; for example, a recent study in Uganda found that younger adolescents (aged 10–14 years) more strongly adhered to inequitable gender norms than did their older counterparts (aged 15–19 years) [17]. This framework can inform programmatic considerations, such as who to turn to as “change agents” and where to seek evidence of attitudinal change as a precursor to desired behavior change. Moreover, it encourages an explicit examination of power, including identifying power holders and how they enforce adherence to norms, as an essential component of intervention design. A unifying and context-sensitive conceptual framework of social norms in adolescent sexual and reproductive health has the potential to inform program design to better meet the needs of young people across the globe, while also facilitating learning by providing a common language and set of concepts to ground our work in social norms theory.

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Factors associated with abortion-seeking and obtaining a safe abortion in Ghana.

Aparna Sundaram, Fatima Juarez, Akinrinola Bankole … (2012)

Although Ghana's abortion law is fairly liberal, unsafe abortion and its consequences remain among the largest contributors to maternal mortality in the country. This study analyzes data from the 2007 Ghana Maternal Health Survey to identify the sociodemographic profiles of women who seek to induce abortion and those who are able to obtain safe abortion services. We hypothesize that women who have access to safe abortion will not be distributed randomly across different social groups in Ghana; rather, access will be influenced by social and economic factors. The results confirm this hypothesis and reveal that the women who are most vulnerable to unsafe abortions are younger, poorer, and lack partner support. The study concludes with policy recommendations for improving access to safe abortion for all subgroups of women, especially the most vulnerable. © 2012 The Population Council, Inc.

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Author and article information

Journal

Journal ID (nlm-ta): Sex Reprod Health Matters

Journal ID (iso-abbrev): Sex Reprod Health Matters

Title: Sexual and Reproductive Health Matters

Publisher: Taylor & Francis

ISSN (Electronic): 2641-0397

Publication date (Electronic, pub): 10 May 2024

Publication date (Electronic, collection): 2023

Publication date PMC-release: 10 May 2024

Volume: 31

Issue: 5

Electronic Location Identifier: 2294793

Affiliations

[a ]Assistante de recherche, African Population and Health Research Center (APHRC), Nairobi, Kenya; Assistante de recherche, Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD) , Cotonou, Bénin.

[b ]Chercheure Senior, Rutgers , Utrecht, The Netherlands

[c ]Research Scientist, African Population and Health Research Center (APHRC) , Nairobi, Kenya

[d ]Assistant Professor, Center for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene and Tropical Medicine , London, UK; Senior Researcher, Center for Global Health, Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich , Munich, Germany

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Correspondence:, dossisekpon@ 123456gmail.com

Supplemental data for this article can be accessed online at https://doi.org/10.1080/26410397.2023.2294793.

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Publisher ID: 2294793

DOI: 10.1080/26410397.2023.2294793

PMC ID: 11089912

PubMed ID: 38727684

SO-VID: 98cdd473-812f-46ce-a8eb-b7c5739033af

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This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.

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Figures: 4, Tables: 6, Equations: 0, References: 34, Pages: 45

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Special feature: Methodological Innovations in Qualitative Educational Research

Most cited references 21

Gender norms and social norms: differences, similarities and why they matter in prevention science

Proposing a Conceptual Framework to Address Social Norms That Influence Adolescent Sexual and Reproductive Health

Factors associated with abortion-seeking and obtaining a safe abortion in Ghana.

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