“Condoms are not a family planning Method”: Why efforts to prevent HIV have failed to comprehensively address adolescent sexual and reproductive health

1. “CONDOMS ARE NOT A FAMILY PLANNING METHOD”:
Why efforts to prevent HIV have failed to comprehensively
address adolescent sexual and reproductive health
Melissa K. Adams 1, Hilary Johnson 2, Rebecka Lundgren1
1 Georgetown University, Institute for Reproductive Health
2 Georgetown University, Conflict Resolution Program
GENDER ROLES, EQUALITY AND TRANSFORMATIONS PROJECT
INSTITUTE FOR REPRODUCTIVE HEALTH GEORGETOWN UNIVERSITY
PATHFINDER INTERNATIONAL
SAVE THE CHILDREN
International AIDS Conference July 24, 2012

2. The GREAT Project: Overview
 Goal: Improve gender equity and
reproductive health outcomes in Northern
Uganda
 5-year USAID funded project
 Phase 1: 2010-2011
 Phase 2: 2011-2015
 Location: Northern Uganda
 Prime: Georgetown University’s Institute for
Reproductive Health (IRH)
 Partners:
 Pathfinder International
 Save the Children
 Beneficiary Population: Adolescent boys and
girls, ages 10-19

3. Why Gender Norms?
 STIs/HIV/AIDS
 Use of family planning
 RH decision-making
 Parenting practices
 Health seeking behaviors
 Gender-based violence
 Unintended/unplanned Photo Credit: Save the Children/Chad Stevens
pregnancy

4. ASRH in Northern Uganda
 Recovering from more than 20 years of
conflict
 6.9% HIV prevalence (UAIS, 2011)
 51.7% of women have experienced IPV Photo Credit: Pathfinder
(Stark, 2010)
 Low rates of adolescent condom and
contraceptive use
 High rates of unintended pregnancy,
transactional sex, GBV, and induced
abortion among adolescent girls

5. Ethnographic Research Objectives
 Understand how gender norms are learned, internalized and
passed on;
 why individuals would be motivated to change these norms;
 and how these norms shape GBV, SRH, and FP behaviors in
post-conflict Northern Uganda.

6. Research Design and Methodology
 Ethnographic, participatory, life course-tailored and activity-based
 Data collection designed with youth in mind and took place from March 2011-
October 2011
 40 Life Histories collected from adolescents & 40 in-depth interviews with
influencing adults
 All interviews were translated, transcribed, coded and analyzed using AtlasTi
Life histories with 40 adolescents at different stages in the life course
Life
Course Very Young Older Adolescents Newly Married Pregnant with 1st child/
Stages Adolescents Parenting 1 child
40 in-depth interviews with adults selected by life history participants and directly recruited:
Parents/Guardians Teachers Peers Siblings Religious/Community Leaders Extended Family

7. Outline of Key Findings
• Fertility viewed as essential component of masculinity and femininity
• Men are decision-makers and women are obedient
Norms
• Lack of support for youth access to FP services
• Limited power and decision-making abilities for young women
Barriers
• Limited access to FP services for young women
• Covert use of contraceptives
• Unplanned pregnancy
Outcomes • Unsafe abortions

8. Key Findings: Gender norms and
Fertility
 Traditional attitudes toward gender roles held
across the life course
 Fertility linked to ideal masculinity and femininity
 Strong norms for when and how pregnancy occur
 Prevailing gender norms significantly shape fertility
desires and intentions among young people

9. Hopes and Dreams
I: Among all your hopes, which one is the
greatest? You talked of education having a
job, and your ability to give birth.
P: Giving birth is the most important. In this
world if you don’t have a child then your
life is worthless and people will insult you.
Female, 16, older adolescent

10. Key Findings: Attitudes toward HIV Services
and Youth
 HIV prevention services appear widely available
 Strong community support for youth access to HIV
services
 Puberty brings fear of HIV and “falling in love”
 HIV testing has become a courting ritual and rite of
passage into sexual relationships

11. Entering relationships
“The girl should know the boy’s results and the same for the
boy; he should know the girl’s results and the test should be
done three times. Then they are free to have a relationship.
Female, 55, Community Member

12. Key Findings: Attitudes toward adolescent
contraceptive use
 Limited integration of pregnancy prevention into ASRH
services
 Condoms not associated with FP
 Limited community support for youth access to FP services
 Gendered barriers to adolescent use of FP include:
 Lack of support from male partners
 Fear of marital discord
 Concern over side effects
 Stigma
 Fear of sterility

13. Not Family Planning
P: Condom is good. It is because a condom will help your life.
Because, if you have sex with a boy with a condom it will
prevent the transmission of diseases. Family planning is the
one that is bad.
I: Condom is also among family planning.
P: No. That is not true.
Female, 19, Peer

14. Conclusion
 Severe social, economic, and health
consequences related to early pregnancy
 Failure to comprehensively address ASRH further
undermines HIV prevention efforts
 Results from study used to design, implement, and
test life-course specific interventions that promote
dialogue and reflection to challenge inequitable
gender norms and improve ASRH

15. The GREAT Intervention Model