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Developing Experimental Vignettes to Identify Gender Norms Associated With Transactional Sex for Adolescent Girls and Young Women in Central Uganda.

ABSTRACT: PURPOSE:Transactional sex or informal sexual exchange relationships increase adolescent girls' and young women's (AGYW) HIV and pregnancy risk in sub-Saharan Africa. These relationships are grounded in the shared expectation that men should provide financial support to their partners. We built a vignette experiment to assess whether gender norms influenced by expectations of provision help to explain how transactional sex increases AGYW's sexual and reproductive health risks. METHODS:We used mixed methods to develop a vignette experiment in Central Uganda with AGYW including 10 focus group discussions, 32 cognitive interviews, and a pilot survey experiment with 108 sexually active unmarried AGYW. Respondents were randomly assigned to one of the two manipulations for three vignettes. The vignettes examined whether the amount a man provided changed perceived social approval of men's authority in relationships, sexual decision-making power, or women having multiple partners. RESULTS:We find that a higher level of male provision is associated with higher levels of perceived community approval for his sexual decision-making power (p < .001) and lower levels of perceived peer approval for AGYW's to seek a second partner (p < .05). We also find that higher levels of male provision are associated with respondent's own approval of male authority and sexual decision-making. CONCLUSION:Our findings suggest that approval of men's sexual decision-making power increases when they provide more and that girls who seek a second partner find higher levels of social approval for this behavior when their primary partner provides less. Vignette experiments may be valuable for identifying social norms that put AGYW's sexual and reproductive health at risk.

SUBMITTER: Stoebenau K

PROVIDER: S-EPMC6426717 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Developing Experimental Vignettes to Identify Gender Norms Associated With Transactional Sex for Adolescent Girls and Young Women in Central Uganda.

Stoebenau Kirsten K Kyegombe Nambusi N Bingenheimer Jeffrey B JB Ddumba-Nyanzi Ismael I Mulindwa Josephine J

The Journal of adolescent health : official publication of the Society for Adolescent Medicine 20190320 4S

<h4>Purpose</h4>Transactional sex or informal sexual exchange relationships increase adolescent girls' and young women's (AGYW) HIV and pregnancy risk in sub-Saharan Africa. These relationships are grounded in the shared expectation that men should provide financial support to their partners. We built a vignette experiment to assess whether gender norms influenced by expectations of provision help to explain how transactional sex increases AGYW's sexual and reproductive health risks.<h4>Methods< ...[more]

PMID: 30914170

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Project description:BACKGROUND:Definitions of child sexual exploitation vary. Sexual exploitation violates children's rights and exposes them to mental and physical harm. There exist differences in views of behaviour that is considered exploitative, including transactional sex. This paper explores community perspectives on the extent to which transactional sex is considered exploitative. METHODS:In 2014, we conducted 19 focus group discussions and 44 in-depth interviews with young people and adults in two communities in Uganda. Participants were presented with vignettes describing sexual encounters between adolescent girls and young women and men to explore under what conditions participants considered the scenario to be exploitative and why. Interviews were conducted in Luganda using a semi-structured tool, audio recorded and transcribed verbatim. Analysis was thematic and complemented by constant comparison and deviant case analysis techniques. RESULTS:Definitions by multilateral, bilateral, and non-governmental organisations of the sexual exploitation of children shared similarities with community conceptualisations of wrong or unfair sex. Although in community conceptualisations there was no consensus on what constituted sexual exploitation, transactional sex was condemned to the extent to which it involved sex with a minor or misled a naïve or immature girl; involved lack of consent, particularly in relationships characterised by power differentials; or worsened the pre-existing status of the girl. Also relevant was the extent to which a man's intentions were considered inappropriate; the adolescent girl or young woman was considered vulnerable; and the adolescent girl or young woman was considered responsible for 'her situation'. CONCLUSIONS:Existing social norms that condemn sex with a minor or sex that involves deception, sexual coercion or misleading an immature girl, present opportunities to mobilise communities to protect adolescent girls and young women at risk. Any intervention must, however, be designed with full cognisance of the social and structural drivers that underlie transactional sex and limit adolescent girls' and young women's opportunities to provide for themselves without recourse to sexual relationships with men. Interventions must also be designed to recognise that girls in transactional sex relationships may not consider themselves as exploited, thus requiring engagement with them based on their own concerns, aspirations, and expectations.

Project description:BackgroundBullying is an understudied global social problem. While school-level factors are a recognized influence on bullying victimization, the elements of a 'girl-friendly' school that may reduce the risk of bullying victimization among girls and prevent dropout is understudied in lower- and middle-income countries (LMICs). This study used baseline data from the evaluation of the Room-to-Read (RtR) Girls' Education Program (GEP) in Nepal to assess the relationship of a conceptually grounded gender-equitable school (GES) index with girls' risk of direct and relational bullying victimization, adjusted for potential confounders at the individual and school levels.MethodsThe school sample included all 24 RtR GEP schools and 25 community schools attended by girls in a comparison cohort, representing 729 grade six girls with complete outcome data. We employed multilevel negative binomial regression to assess the relationship between the GES score (higher scores indicate greater support for girls), and girls' risk of peer victimization, controlling for individual- and school-level covariates.ResultsOn average, girls reported 2.84 direct victimizations and 0.27 relational victimizations in the prior week. The first component of the GES index, a generalized measure of school-level support for girls, showed a significant negative relationship with weekly relational bullying victimization in models with all school- and individual-level covariates. In the full model, a one-point higher score on the generalized GES component accounted for a 26% lower risk of relational bullying victimization in the prior week.ConclusionSchool-level policies, practices, and pedagogy designed to support girls may reduce their exposure to relational aggression, a form of bullying that girls most often perpetrate. In LMICs, the school may be an ideal place to raise awareness about the types and effects of peer bullying and to promote prosocial bystander behavior. Further research is needed to identify factors related to other forms of bullying.

Project description:BackgroundDespite strides towards gender equality, inequalities persist or remain unstudied, due potentially to data gaps. Although mapped, the effects of key data gaps remain unknown. This study provides a framework to measure effects of gender- and age-imbalanced and missing covariate data on gender-health research. The framework is demonstrated using a previously studied pathway for effects of pre-marital sex norms among adults on adolescent HIV risk.MethodsAfter identifying gender-age-imbalanced Demographic and Health Survey (DHS) datasets, we resampled responses and restricted covariate data from a relatively complete, balanced dataset derived from the 2007 Zambian DHS to replicate imbalanced gender-age sampling and covariate missingness. Differences in model outcomes due to sampling were measured using tests for interaction. Missing covariate effects were measured by comparing fully-adjusted and reduced model fitness.FindingsWe simulated data from 25 DHS surveys across 20 countries from 2005-2014 on four sex-stratified models for pathways of adult attitude-behaviour discordance regarding pre-marital sex and adolescent risk of HIV. On average, across gender-age-imbalanced surveys, males comprised 29.6% of responses compared to 45.3% in the gender-balanced dataset. Gender-age-imbalanced sampling significantly affected regression coefficients in 40% of model-scenarios (N = 40 of 100) and biased relative-risk estimates away from gender-age-balanced sampling outcomes in 46% (N = 46) of model-scenarios. Model fitness was robust to covariate removal with minor effects on male HIV models. No consistent trends were observed between sampling distribution and risk of biased outcomes.InterpretationGender-health model outcomes may be affected by sampling gender-age-imbalanced data and less-so by missing covariates. Although occasionally attenuated, the effect magnitude of gender-age-imbalanced sampling is variable and may mask true associations, thus misinforming policy dialogue. We recommend future surveys improve balanced gender-age sampling to promote research reliability.FundingBill & Melinda Gates Foundation grant OPP1140262 to Stanford University.

Dataset Information

Developing Experimental Vignettes to Identify Gender Norms Associated With Transactional Sex for Adolescent Girls and Young Women in Central Uganda.

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Developing Experimental Vignettes to Identify Gender Norms Associated With Transactional Sex for Adolescent Girls and Young Women in Central Uganda.

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