How social norms hinder uptake of contraceptives among youth

Adolescence is a transformative phase of life, marked by physical, emotional and social changes. For millions of adolescent girls and young women (AGYW) in Kenya, this period is clouded by systemic barriers that limit access to Sexual and Reproductive Health Rights (SRHR). Social norms contribute to the creation of these barriers by defining what is considered "acceptable," which in turn fosters harmful practices, limits personal freedom, and reduces access to necessary health services. According to United Nations International Children's Emergency Fund (UNICEF-Kenya), a significant percentage of adolescent girls aged 15 and 19 years have experienced pregnancy, with rates in some counties reaching as high as 50 per cent. This highlights the prevalence of early sexual activity among Kenyan adolescents, compounded by limited access to contraceptive methods and reproductive health education. Furthermore, Kenya Medical Research Institute (KEMRI) has found that even adolescents who have never had sexual intercourse can test positive for sexually transmitted infections (STIs), suggesting that sexual health risks are prevalent even before sexual debut. These findings emphasise the need for early intervention and comprehensive sexual and reproductive health education to reduce the risks of unintended pregnancies and STIs among Kenya's youth. A Social Norms Diagnosis (SND) in Nairobi, Siaya and Garissa counties, part of the SHE SOARS project funded by CARE and the Centre on Gender Equality and Health (GEH), highlights these challenges. The study explores how societal expectations influence adolescent sexuality, family planning decisions, and health outcomes. Isabella Mwangi, Project Officer at Centre for Rights Education and Awareness (CREAW), notes, "Culture can be both an impediment and an accelerator to development, depending on how you want to take it, change it and also promote a part of the culture that is good within the society." In patriarchal societies, norms often limit young women's choices, particularly regarding sexuality. In many Kenyan communities, discussions about Sexual Reproductive Health (SRH) with parents or partners are taboo, perpetuating misinformation and leaving girls vulnerable to unplanned pregnancies, unsafe abortions and sexually transmitted infections (STIs), including HIV. According to the Kenya Demographic and Health Survey (KDHS) 2022, 15 per cent of women aged 15 to 19 years old have experienced pregnancy, with the numbers rising among those from lower wealth quintiles. These figures not only highlight economic inequalities, but also the pervasive influence of norms that discourage open SRH conversations. Despite the increasing need for family planning services among adolescents, access remains a challenge, especially for married adolescents. Kennedy Odhiambo Oreunjo, Director of Public Health in Siaya County, says, "Engaging men has not been an easy task due to the lack of clear mechanisms for meaningful engagement. We need to create social norms that allow free interaction and discussions about SRHR within families." In the study, many girls expressed fear of violence or judgment if they sought family planning services without their husbands' consent, reflecting broader societal norms that prioritise male authority. Kenya has made strides in addressing HIV, but adolescents remain disproportionately affected. With over two million adolescents living with HIV/AIDS being the leading cause of death among this group, the data is alarming. Dr Juliah Chege, Social Entrepreneur and Mentor from Muranga County, states, "Despite massive donor funding and years of research on women's economic empowerment, we are still lagging behind due to deeply rooted social norms and a patriarchal society." Addressing these deeply entrenched barriers is vital for empowering adolescent girls to take control of their sexual health. Recognising these challenges, the government and development partners have initiated interventions to improve SRHR for adolescents. The National Adolescent Sexual and Reproductive Health (ASRH) Policy 2015 aims to enhance access to information and services while promoting gender equality. However, implementation gaps persist, particularly in rural areas, such as Siaya and Garissa, where cultural conservatism poses additional hurdles. One promising initiative is the establishment of youth-friendly services (YFS), offering adolescents a safe space to access care and information without fear of judgment. Roselyne Kabana, Chief Medical Social Worker at Nairobi County and Head of the GBV Unit at Nairobi Metropolitan Services, highlights, "We've established adolescent-responsive clinics in Nairobi County to provide family planning services in a way that is accessible and non-stigmatising. Ensuring the availability of commodities and referral pathways has been key." To improve SRHR outcomes for AGYW, a multi-faceted approach is needed to dismantle harmful social norms. Integrating Comprehensive Sexuality Education (CSE) into school curricula can equip adolescents with accurate knowledge about their bodies, rights and health. Actively involving youth in designing health programmes ensures they address adolescents' unique needs. Expanding youth-friendly services to underserved areas and adapting clinic hours is essential. Isabella Mwangi adds, "We need to ensure that policies are not just written in documents, but that they are also translated into actions that benefit communities, especially young people. This requires a more inclusive approach to policy-making." Bernard Moseti, CARE Kenya Director of Strategic Partnerships and Resource Mobilisation, says, "The challenge we face is not just about access to resources, but about the social and cultural structures that reinforce gender inequalities. Men must be meaningfully engaged to support SRHR initiatives." The silence surrounding SRHR discussions often start at home. Adolescents report fear of discussing SRHR with parents, largely due to authoritarian parenting styles, judgmental attitudes, and cultural taboos. Many parents delegate this responsibility to schools, leaving adolescents ill-equipped to navigate sensitive issues. Dr Juliah Chege shares, "Education is key to dismantling harmful social norms, particularly those around gender and SRHR. Our young people are exposed to so much, yet there's a disconnect in how we educate them about these important issues." Jacqueline Odhiambo, Coordinator of Reproductive Health Services for Kisumu West, says, "Engaging male clergy in SRHR education has been crucial. They influence communities deeply, and when they become advocates for SRHR, they help shift the cultural norms that limit women's health and rights." Addressing these barriers requires community-level advocacy and partnerships with local leaders to challenge cultural taboos and promote reproductive autonomy for girls.

How social norms hinder uptake of contraceptives among youth

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