What Makes People Tick? Understanding Adolescent Sexual and Reproductive Behavior

#InternationalYouthDay

By Courtney Helfrecht, Anthropologist, Adolescents 360

Around the world, millions of dollars and hours of debate are spent on addressing the problem of unintended teen pregnancy, with mixed results at best. Although rates are declining, the World Health Organization reports that several countries still have relatively high numbers of teenagers who became mothers before they were ready. Why has this been an ongoing issue in public health? What has been missing from efforts to reduce unintended teen pregnancy?

Anthropology.

Anthropology is, quite literally, the study of humans. From birth practices to death rituals, anthropological research examines all aspects of human life. As an inherently multi-disciplinary field, anthropologists study why people do what they do—as well as when and how they do it—across the entirety of the lifespan. This includes the exploration of traditions and ideas that are as specific as pubertal rituals to as broad as the evolution of human childhood. Key to all these research areas is culture. This is because, regardless of what may appear biologically driven, our cultures shape every aspect of our behavior.

Our environments, both material (such as the homes we live in) and social (such as who we live with), are culturally constructed. These environments interact with our biology (our genes) to create our phenotypes, the physical and behavioral expressions of ourselves. Culture thus plays a key role in our development, and is responsible for not only how we grow, what we believe, and the actions we take in regard to sexual behavior and reproduction, but also the way we perceive these things. We absolutely cannot understand why people make the choices they do without understanding the culture in which they developed.

A problem faced by many disciplines, including public health, is that much of what is considered “normal” is based on research that has taken place almost entirely among American and European populations. Although much work has been conducted among non-Western populations, the resultant data are usually compared to Western research, with non-Western patterns considered variations from normal. This has been a particular problem in research among children and adolescents, especially when the influence of culture is ignored.

Perceptions of adolescents greatly differ from culture to culture.  Hunter-gatherers in central Africa, for instance, enjoy much more freedom during childhood than children in the West. From birth, children are considered autonomous and allowed to make their own decisions, including when to start having sex and whether or not they want to make a commitment to a relationship. In contrast, premarital sex is taboo among Sidama agro-pastoralists in Ethiopia. Perhaps even more challenging for Sidama girls is the cultural belief that sexual activity triggers menstruation (traditionally, age at marriage was around the same age that menstruation started). Because of that belief, an unmarried girl who has started menstruating has no one to talk to about her sexual and reproductive health—even her family would find it shameful. These two examples show just some of the cultural differences in the world, yet we’ve traditionally approached public health without taking culture into account.

Adolescents 360’s multi-disciplinary approach presents a novel solution to the problem of adolescent sexual and reproductive health (ASRH). By including an anthropological lens, A360 has the potential to provide deeper insights into why adolescents make the choices they do and how the risks associated with adolescent pregnancy can be reduced in a way that accounts for, and is sensitive to, culture’s powerful influence.

Adolescents 360

Photo credit (banner): Ollivier Girard

We begin this process with an exploration of what is already known about the regions and cultures where A360 will be implemented. Ranging from national and regional level rates of contraceptive use and need, to more detailed data on girls’ social roles, A360 is building knowledge on the communities where we’ll be working in Ethiopia, Nigeria, and Tanzania. Anthropological research is helping to develop a cultural framework that can be used to inform and support the project goals. For instance, we already know that many sub-Saharan populations link motherhood to status, meaning that adolescent pregnancy may not always be considered a problem. What we need to find out is how that belief shapes adolescent girls’ behavior, and the way their behavior is influenced by those around them (e.g. parents, peers, health providers, community and religious leaders).

We are simultaneously reviewing our research methods for their cultural appropriateness. How can we ask about ASRH in cultures where these topics are taboo? Do these questions create any social risk for our participants? Do these questions have meaning in the contexts where we are working? Do young people from these communities understand the data in the same way that we do? Engagement with local culture – which includes local youth culture – is critical at every step of the project’s process.

Understanding cultural norms and how those norms have evolved over time, is key to designing transformative programs that are going to break the mold in ASRH.