Makerere University, Kampala, Uganda.
Dev-Com Consult Ltd, Juba, South Sudan.
Glob Health Sci Pract. 2024 Jun 27;12(3). doi: 10.9745/GHSP-D-23-00489.
Social norms are the shared expectations about behaviors that are held within collective groups. These differ from attitudes and beliefs, which are individually held. In South Sudan, social norms can affect the use of voluntary family planning and reproductive health (FP/RH); some of these norms even present risks for women seeking FP/RH care and their FP/RH providers. This cross-sectional, descriptive study conducted in 5 counties in South Sudan used vignettes as a qualitative method to explore social norms related to FP/RH and decisions related to contraceptive use and gender-based violence. Participants were asked to respond to vignettes about a fictional couple during various life stages of care-seeking. Vignettes allow respondents to share their opinions and feelings without directly speaking about their own experiences. Respondents included community members, FP/RH providers, and key influencers (e.g., religious leaders, traditional leaders, elders). The study identified restrictive social norms related to FP/RH, including entrenched, dominant gender roles (i.e., requiring male consent to use contraceptives) and risk for the woman and her provider if she accesses FP/RH services. Of note, supportive social norms are gaining acceptance regarding women's voice and agency; it was found that some women can negotiate their reproductive choice with their partners and participate in planning their families, which has not always been a widely accepted norm. The use of vignettes can lead to a better understanding of the challenges and provide insights on effective implementation approaches. It is essential for programs working to promote the use of FP/RH services in South Sudan to consider the challenges presented by social norms. Findings from this study were shared with stakeholders and communities to codesign interventions aimed at increasing the use of FP/RH services. Additionally, the dialogue stimulated by this study should lead to an organic transformation toward supportive social norms through collective agency.
社会规范是集体群体内部对行为的共同期望。这些规范与个人持有的态度和信念不同。在南苏丹，社会规范会影响人们对计划生育和生殖健康服务（FP/RH）的自愿使用；有些规范甚至会对寻求 FP/RH 护理的妇女及其 FP/RH 提供者带来风险。本横断面描述性研究在南苏丹的 5 个县进行，使用情景模拟作为一种定性方法，探讨与 FP/RH 相关的社会规范，以及与避孕使用和性别暴力相关的决策。参与者被要求对虚构夫妇在不同求医阶段的情景模拟做出回应。情景模拟允许受访者在不直接谈论自己经历的情况下分享他们的意见和感受。受访者包括社区成员、FP/RH 提供者和主要影响者（例如，宗教领袖、传统领袖、长者）。研究确定了与 FP/RH 相关的限制社会规范，包括根深蒂固的、占主导地位的性别角色（即需要男性同意使用避孕药具），以及如果妇女获得 FP/RH 服务，她和她的提供者将面临的风险。值得注意的是，关于妇女的声音和代理权的支持性社会规范正在得到认可；发现一些妇女可以与她们的伴侣协商她们的生殖选择，并参与家庭规划，这并不总是一个广泛接受的规范。使用情景模拟可以更好地了解挑战，并为有效实施方法提供见解。在南苏丹推广计划生育和生殖健康服务的项目必须考虑到社会规范带来的挑战。本研究的结果与利益攸关方和社区共享，旨在共同设计旨在增加计划生育和生殖健康服务使用的干预措施。此外，这项研究引发的对话应该会通过集体行动，促使支持性社会规范向有机转变。
