Sexual and Reproductive Health Needs of Adolescent Girls and Young Women in Sub-Saharan Africa: Research,Policy,and Practice

Introduction

Of the approximately 1.8 billion people aged 10 to 24 years who live across the globe, 89% live in developing countries (Braeken & Rondinelli, 2012; Delany-Moretlwe et al., 2015; Patton et al., 2016). It is projected that by 2050, the number of young people aged 10 to 24 living in sub-Saharan Africa (SSA) will be 605 million (United Nations Population Fund, 2012). The issues affecting the daily lives, health, and social statuses of adolescents are varied and complex, requiring a close scrutiny of historical legacies, social and cultural contexts, and institutional frameworks. In African countries generally, adolescent friendly sexual and reproductive health services have grown, but are in need of improvement, support, and technological sophistication (Dellar, Dlamini, & Karim, 2015; Sheehan et al., 2017). Where services and forms of intervention are lacking, adolescents face great risk of unintended pregnancies, sexually transmitted infections (STIs), HIV, and exposure to violence (Naidoo, 2015; Yah et al., 2017).

Gender differentials are significant to note, as adolescent girls and young women (AGYW) are at higher risk of HIV infection than their male counterparts in the region. A 2010 report by the Guttmacher Institute shows that 7% of young people aged 15 to 24 in SSA are currently living with AIDS (this age group accounts for almost half of all new HIV infections across the globe). In South Africa, for example, young people between 15 and 24 years have the highest rate of HIV acquisition despite the large number of HIV intervention programs in the country. Of the 88,000 new HIV infections in South Africa among young people aged 15 to 24 years in 2017, 66,000 were women (Human Sciences Research Council [HSRC], 2018). Condom use among women aged 15 to 24 years has dropped significantly from 66.5% in 2008 to 49.8% in 2017, while age-disparate sex with older males (including multiple sexual partners) is increasing among the same cohort (HSRC, 2018). The above realities suggest that AGYW sexual and reproductive health needs require urgent attention and continuing analysis in SSA (Mindry et al., 2018). There is currently much research being done on young women, and specifically adolescents in Africa. However, it could be argued that the susceptibilities and difficulties of young African women are often not fully comprehended, nor adequately addressed in policies and programs in the region.

The Special Collection Themes

This special collection brings together contemporary research, thinking, and critical scholarship on AGYW (both empirical and theoretical) in SSA. Seventeen articles on African adolescents, girls and young women, reflecting five broad themes are included. The themes speak to research and topics that the authors have found compelling and in need of special focus. In Theme 1, “Gender Rights, Culture and Forms of Resistance,” Taiwo Afolabi discusses the Skul Konekt project in Nasarawa, Nigeria, which probes the tendency of secondary school learners to engage in self-stigmatization. It is shown how theater strategies could be drawn upon to encourage reflection and shift self-perceptions to improve the self-esteem of young people. In an article focusing on Zimbabwean adolescents, Deevia Bhana and Vimbai Matswetu offer insights into rural adolescents and the way in which meaning is attributed to virginity, and how virginity can be viewed as a marker of status. By consciously conforming to dominant cultural norms (rather than overtly resisting them), the adolescents appear to be subordinated, but simultaneously empowered. Godfrey Kangaude and Ann Skelton’s article links with this theme and addresses the topic of the age of consent laws imposed in Eastern and Southern Africa since the days of colonialism. In advocating for decriminalizing adolescent sex, they show how these laws in Rwanda and Ethiopia have affected mainly girls, thus denying them rights, sexual autonomy, and agency.

The focus of Theme 2 is “Social Inequalities, Coercion and Gender-Based Violence (GBV).” In their article, Amanda Selin, Stephanie DeLong, Aimee Julien, Catherine MacPhail, Rhian Twine, James Hughes, Yaw Agyei, Erica Hamilton, Kathleen Kahn, and Audrey Pettifor offer valuable data on the prevalence and associated factors of intimate partner violence among AGYW (disaggregated by age) in South Africa. Sumayya Ebrahim offers an analysis of stealthing, a form of gender-based violence entailing nonconsensual condom removal. Ultimately, this action in sexual intercourse deprives young women of their rights to sexual autonomy and undermines their abilities to control their sexual and reproductive lives. Sunday Fakunmoju and Shahana Rasool discuss the transmission of pro-violence-against-women beliefs in an effort to consider the effects on adolescents. The study compares adolescents in Nigeria and South Africa and their exposure to IPV, family violence, and beliefs about VAW. In studying the results of an online survey, Xitsakisi Mahlori, Deidre Byrne, and Lungise Mabude reflect on perceptions and responses to violence. Although awareness of GBV is generally strong at a South African university, feelings of insecurity debilitate efforts at reporting this violence.

In Theme 3, “Engaging Vulnerabilities, Interventions, and Shifting Practices,” Ali Abdullahi advocates theoretical pluralism to offer understandings of the media’s role in shaping the sexual behaviors and sociopsychological states of Nigerian adolescents. Somefun Oluwaseyi, Stephen Wandera, and Clifford Odimegwu’s analysis connects with that of Abdullahi’s in the way emphasis is placed on the potentially interventionist role of the media. In their article, they use Demographic and Health Survey (DHS) data to show that assertive media movements could encourage a diffusion of ideas among youth which could meaningfully encourage HIV testing. In examining the narratives of gender and sexuality of young people in a low-income South African area, Lauren Graham and Memory Mphaphuli reveal the pathologizing that often occurs, as well as the spaces for vulnerabilities to be engaged and alternative discourses to emerge. Vulnerabilities are also evident in relationships in which primacy is placed on financial and material gains in exchange for sex. Johannes Mampane focuses in his article on the “blesser-blessee” issue which has been prominent in the South African media as a key factor setting back HIV-interventions designed for young women.

The three articles in Theme 4, “Adolescent Motherhood, Exploitative Relations and Respectability” all urge rethinking about the motives and representations of young women who bear children very early, and in difficult circumstances. Pranitha Maharaj and Nokuthula Ngubane tackle the question of the child support grant (CSG) and its link to high levels of teenage pregnancy in South Africa. They suggest that young women are not bearing children to access the grant, and instead identify a set of sociological factors relevant to understanding this issue. In her article on unplanned motherhood, Josephine Adeagbo discusses the challenges of HIV-positive adolescent mothers. She argues for new, more positive, images of the adolescent HIV-positive mother. In another article that looks at childbearing, Oluwatobi Alabi offers insight into, and takes a stand against what he describes as “baby factories” thriving in Nigeria. He suggests that the practice is expanding and is akin to exploitative relations and human trafficking.

In the last theme, Theme 5, attention is paid to “Counter-acting Discriminations: Strategies and Frameworks.” Ernestina Coast, Nicola Jones, Umutoni Francoise, Workneh Yadete, Roberte Isimbi, Kiya Gezahene, and Letisha Lunin offer evidence from a multisite qualitative research study on adolescent sexual and reproductive health in Ethiopia and Rwanda to make claims about the role of discriminatory and gendered norms in affecting the lives of adolescents. In her article, Sylvia Gyan writes about the strategies that Ghanaian adolescents engaging in premarital sex or having experienced a premarital pregnancy draw on to avoid being stigmatized. These strategies highlight unmet needs that need to be addressed. Alison Kutywayo, Clarence S Yah, Nicolette Naidoo, Malotana Mbulelo, Siphokazi Dyani, and Saiqa Mullick discuss the way in which the Good Participatory Practice Framework (GPP) could be adapted to incorporate and utilize stakeholder engagement in the Girls Achieve Power (GAP) trials in South Africa.

Conclusion

Adolescence is a critical life developmental pathway to adulthood that requires special attention and careful study. For all adolescents, whether in Africa or elsewhere, this life stage entails various rapid and unpredictable changes that, to a large extent, inevitably impact on health and well-being. As the articles of this special collection generally suggest, the disease burden for adolescents and young women in SSA is high and driven by complex and evolving social, cultural, political, and historical problems. The five broad themes capture the spirit and central concerns of the 17 articles. They challenge readers to reflect on the constraints framing African adolescents’ and young women’s vulnerabilities, but they also point to the spaces that enable meaningful intervention and create opportunities for policy revisions and larger transformations. The authors look forward to readers’ comments and feedback.