BackgroundIn the Democratic Republic of Congo (DRC), onset of sexual intercourse is initiated during adolescence, however only two in ten sexually active unmarried women are using modern contraception. Improving adolescents’ and young peoples’ knowledge and practices related to sexual and reproductive health (SRH) is necessary to improve health outcomes. However, little is known about the SRH attitudes and needs among young people in the DRC. The study aims to contribute to the available evidence by examining adolescents’ and young people’s insights on their cultural norms, practices and attitudes towards SRH services.MethodsFourteen focus group discussions were conducted with a total of 224 adolescents and young people aged 15–24 years in urban and rural areas of the DRC. The topics discussed and age groups of participants differed somewhat in the urban and rural areas. Data were analyzed to identify themes in the participants’ discussion of their attitudes towards SRH.ResultsRegardless of age differences, common themes emerged. Both in rural and urban areas premarital sex was largely sanctioned by peers but not adults; adolescents feared pregnancy and had limited knowledge of contraceptive methods. Many were misinformed that certain common pharmaceutical products (e.g., decaris) prevent pregnancy. Key barriers to accessing contraception from health facilities and pharmacies included shame and stigma; urban participants also cited cost and judgmental attitudes of health providers.ConclusionAddressing the SRH needs of adolescents and young people can have life-long protective benefits. Increasingly decision-makers and gatekeepers in the DRC are accepting the concept of providing SRH services and information to young people. This study shows the pressing need for information and services for young people in both urban and rural areas. The continued expansion SRH programming to all health zones and the developed of the National Strategic Plan for Health and Wellbeing of Adolescents and Youth 2016–2020 are steps toward that goal.

Background For optimal growth and development, the World Health Organization recommends that children be exclusively breastfed for the first 6 months of life. However, according to the nationally-representative 2013–2014 Demographic and Health Survey, under 50% of babies in the Democratic Republic of Congo are exclusively breastfed. Although breastfeeding was common in the capital city of Kinshasa, one in five newborns received alternatives to breastmilk during the first 3 days of life. This analysis aimed to identify social norms influencing exclusive breastfeeding, the role of a young first-time mother’s (FTM’s) social network for her choice to exclusively breastfeed, and perceived social sanctions associated with breastfeeding practices in Kinshasa. Methods The qualitative analysis was based on a vignette presented during 14 focus group discussions, with a purposively selected sample (n = 162) of FTMs age 15–24, and the male partners, mothers and mothers-in-law of FTMs age 15–24 in three health zones in Kinshasa in 2017. Thematic content analysis was performed to identify concepts and patterns in the participants’ discussions. Results Overall, community norms were not supportive of exclusive breastfeeding. The main barriers to exclusive breastfeeding were the belief held by most FTMs that exclusive breastfeeding was an uncommon practice; the desire to avoid negative sanctions such as name-calling and mockery for refusal to give babies water in the first 6 months of life; the desire to please key members of their social networks, specifically their mothers and friends, by doing what these influencers expected or preferred them to do; FTMs’ own lack of experience with infant feeding; and trust placed in their mothers and friends. Conclusion Social norms can be maintained by the belief about what others do, perceived expectations about what individuals ought to do, the negative sanctions they can face and their preference to conform to social expectations. Thus, addressing cultural beliefs and targeting sensitization efforts to key influencers that provide support to FTMs are needed to promote exclusive breastfeeding in Kinshasa. In doing so, strategies should address the barriers to exclusive breastfeeding including related misconceptions, and improve FTMs’ self-efficacy to overcome the influence of others.

Unintended pregnancy is an important global health problem and frequently occurs during the immediate postpartum period. However, few studies have examined postpartum family planning (PPFP) intentions among adolescent girls and young women. This study assessed whether perceived norms and personal agency predicted PPFP intentions among first-time mothers age 15–24 in Kinshasa, the Democratic Republic of Congo. Data were derived from the 2018 Momentum Project baseline survey. Analysis was based on 2,418 nulliparous pregnant women age 15–24 who were approximately six months pregnant with their first child in six health zones of Kinshasa. Overall PPFP intentions were low and ten to thirteen percent of women stated they were very likely to discuss PPFP next month with (a) their husband/male partner and (b) a health worker, and to (c) obtain and (d) use a contraceptive method during the first six weeks following childbirth. The results of multivariable linear regression models indicated that the PPFP intention index was predicted by description norms, perceptions of the larger community’s approval of PPFP, normative expectations, perceived behavioral control, self-efficacy, and autonomy. Rejection of family planning myths and misconceptions was also a significant predictor. Interaction terms suggested that the association of normative expectations with PPFP intentions varied across ethnic groups and that the positive association of injunctive norms with PPFP intentions was significantly increased when the larger community was perceived to disapprove of PPFP use. Normative expectations and PPFP-related self-efficacy accounted for two-thirds of the variance in PPFP intentions. The results suggested that understanding different normative influences may be important to motivate women to use contraception in the immediate postpartum period. In addition to addressing institutional, individual, and social determinants of PPFP, programs should consider integrating norm-based and empowerment strategies.

Background Given the long-term health effects of smoking during adolescence and the substantial role that tobacco-related morbidity and mortality play in the global burden of disease, there is a worldwide need to design and implement effective youth-focused smoking prevention interventions. While smoking prevention interventions that focus on both social competence and social influence have been successful in preventing smoking uptake among adolescents in developed countries, their effectiveness in developing countries has not yet been clearly demonstrated. SKY Girls is a multimedia, empowerment and anti-smoking program aimed at 13–16-year old girls in Accra, Ghana. The program uses school and community-based events, a magazine, movies, a radio program, social media and other promotional activities to stimulate normative and behavioral change. Methods This study uses pre/post longitudinal data on 2625 girls collected from an interviewer-administered questionnaire. A quasi-experimental matched design was used, incorporating comparison cities with limited or no exposure to SKY Girls (Teshie, Kumasi and Sunyani). Fixed-effects modeling with inverse probability weighting was used to obtain doubly robust estimators and measure the causal influence of SKY Girls on a set of 15 outcome indicators. Results Results indicate that living and studying in the intervention city was associated with an 11.4 percentage point (pp) (95% CI [2.1, 20.7]) increase in the proportion of girls perceiving support outside their families; an 11.7 pp. decrease (95% CI [− 20.8, − 2.6]) in girls’ perception of pressure to smoke cigarettes; a 12.3 pp. increase (95% CI [2.1, 20.7]) in the proportion of girls who had conversations with friends about smoking; an 11.7 pp. increase (95% CI [3.8, 20.8]) in their perceived ability to make choices about what they like and do not like, and 20.3 pp. (95% CI [− 28.4, − 12.2]) and 12.1 pp. (95% CI [− 20.7, − 3.5]) reductions in the proportion agreeing with the idea that peers can justify smoking shisha and cigarettes, respectively. An analysis of the dose-effect associations between exposure to multiple campaign components and desired outcomes was included and discussed. Conclusion The study demonstrates the effectiveness of a multimedia campaign to increase perceived support, empowerment and improve decision-making among adolescent girls in a developing country.

Background The World Health Organization recommends that programs that seek to improve maternal and newborn health outcomes actively involve men during pregnancy, childbirth, and postpartum. However, there is little evidence on what strategies work to increase male knowledge of and involvement in antenatal and postnatal care. This study assessed the impact of the Momentum project on male involvement in maternal health and newborn care. The project involved monthly home visits to a cohort of first-time mothers aged 15–24 recruited at six-months gestation and group education sessions for their male partners using the Program P toolkit. Participants were followed-up for 16 months. Methods The study used a quasi-experimental design with three intervention and three comparison health zones. Baseline data were collected in 2018 and endline data in 2020. Exploratory factor analysis was used to develop scales of male involvement. We measured the causal influence of Momentum using an intent-to-treat analysis at the health-zone level and a dose–response analysis at the individual level. We used random-effects probit and linear models for outcomes measured at baseline and endline, and treatment effects models with inverse-probability weighting for outcomes measured only at endline. The impact analysis involved 1,204 male partners of first-time mothers with live births. Results Intervention health zones were associated with an 18.1 percentage point (95% CI [(10.6, 25.6]) increase in knowledge of three or more obstetric danger signs and a 13.9 percentage point (95% CI [6.3, 21.6]) increase in knowledge of newborn danger signs. Significant increases in male involvement in antenatal care (average treatment effect (ATE) = 0.728, 95% CI [0.445, 1.010]), birth planning (ATE = 0.407, 95% CI [0.157, 0.657]), and newborn care (ATE = 0.690, 95% CI [0.359, 1.021]) were found. The magnitude of Momentum’s impact increased steadily with the number of prenatal home visits and was statistically significant for all behavioral outcomes except shared decision making. Exposure to both home visits and group education sessions during the prenatal period had a significant impact on all outcomes relative to no exposure. Conclusions The study demonstrated the effectiveness of Momentum on male involvement in maternal health and newborn care.