How do social norms influence the sexual and reproductive health-related attitudes and behaviours of very young adolescents in Sub- Saharan Africa? A scoping review

Background
In Sub-Saharan Africa (SSA), very young adolescents (aged 10–14 years) have the worst sexual and reproductive health (SRH) outcomes of this age group worldwide due to a range of factors, including social and gender norms. However, in this setting, SRH programming often focuses on older adolescents (aged 15–19 years), overlooking very young adolescents. This scoping review sought to explore how social and gender norms influence very young adolescents’ SRH-related attitudes and behaviours in SSA and draw inferences for culturally sensitive, gender-responsive interventions.

Methods
The review followed the five-step framework developed by Arksey and O’Malley: (1) defining the research question, (2) identifying relevant studies, (3) selecting studies, (4) charting the data, and (5) collating, summarising, and reporting the results. We searched four databases (MEDLINE, CINAHL, Global Health, and Web of Science) for peer-reviewed articles published between January 1, 2000 and December 31, 2024.

Results
We identified 24 studies: n = 11 (46%) were entirely qualitative, n = 8 (33%) exclusively quantitative, and three other quantitative studies incorporated qualitative components. Two studies used participatory techniques. Studies were from nine countries in SSA. Identified norms included those relating to menstruation, puberty, circumcision, romantic relationships and gender stereotypes. Social norms led to very young adolescents’ limited SRH knowledge and access, and behaviours and practices that heightened very young adolescents’ vulnerabilities and poor SRH outcomes. Evaluations of interventions to shift these norms reported mixed results, and highlighted the importance of adapting gender-responsive/gender-transformative interventions to the local context.

Conclusions
Scoping review findings affirm the importance of intervening in very young adolescence to positively influence social and gender norms. The review underscores the importance of tailored, multifaceted, culturally sensitive, gender-responsive/gender-transformative interventions to improve young adolescents’ SRH-related attitudes and behaviours in Sub-Saharan Africa.