Introduction: Child marriage, formal and informal unions when one or both spouses are under 18, disproportionately affects adolescent girls over boys. It has serious consequences for girls' health, wellbeing, and development. Little is known about the ways in which girls' agency and contextual social norms -unwritten rules of (un)acceptable behaviour in a group -intersect to affect child marriage practices. This paper investigates norms and agency as facilitators and obstacles to adolescent girls' marriage in Somaliland and Puntland. Methods: Participants (n = 156) were men and women living in Somaliland and Puntland. We conducted 36 qualitative semi-structured individual interviews (12 men and 24 women). We also held 15 focus group discussions (8 in Somaliland and 7 in Puntland) with 6-10 people each (n = 120). Mixed focus groups were conducted with men and women together, and were segregated by age. Results: Technology and economic deprivation were important contextual factors in explaining the prevalence of child marriage. Participants reported that adolescent girls' and boys' increased agency contributed to, rather than decreased, child marriage. Access to technology expanded adolescents' freedom from their parents' control. Adolescents used that freedom within the existing system of social norms that rewarded early (as opposed to later) marriage. Conclusions: Effective interventions that aim to reduce marriage among adolescents living in Somalia (where marriage can be a protective strategy) should integrate a social norms perspective to avoid increasing adolescent-led marriage.

There is increased recognition that incorporating a social norms approach provides insights for understanding corporal punishment and/or discipline (CPD). This review seeks to explore how the literature analyses social norms and CPD in low-and middle-income countries (LMICs). We searched eight electronic databases, Google Scholar, Google and institutional websites, including articles in LMICs which examined social norms and CPD perpetrated by family members or teachers. Data was extracted, assessed for quality and analyzed according to key themes. Of 21,708 articles from academic databases and 92 from other sources, 37 studies were included. We observed heterogeneity in study design, and in the definition and measurement of social norms. In the majority of studies, social norms supporting CPD were either harmful or, at times, protective. The review also finds that gender, age, power hierarchies and changes such as conflict, migration and modernization may influence norms on CPD. CPD interventions should be evaluated over longer periods and with consideration to the continuum of violence between homes and schools. Future research on CPD should (1) theorize and define social norms more clearly; (2) examine both harmful and protective norms linked to CPD; (3) explicitly examine perpetration of violence across the home-school continuum.

Cislaghi (2021): 'If she gets married when she is young, she will give birth to many kids': a qualitative study of child marriage practices amongst nomadic pastoralist communities in Kenya, Culture, Health & Sexuality,

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Background To our knowledge, no studies exist on the influence of nomadic pastoralist women’s networks on their reproductive and sexual health (RSH), including uptake of modern family planning (FP). Methods Using name generator questions, we carried out qualitative egocentric social network analysis (SNA) to explore the networks of four women. Networks were analyzed in R, visuals created in Visone and a framework approach used for the qualitative data. Results Women named 10–12 individuals. Husbands were key in RSH decisions and never supported modern FP use. Women were unsure who supported their use of modern FP and we found evidence for a norm against it within their networks. Conclusions Egocentric SNA proves valuable to exploring RSH reference groups, particularly where there exists little prior research. Pastoralist women’s networks likely change as a result of migration and conflict; however, husbands make RSH decisions and mothers and female neighbors provide key support in broader RSH issues. Interventions to increase awareness of modern FP should engage with women’s wider networks.

There exist significant inequities in access to family planning (FP) in Kenya, particularly for nomadic and semi-nomadic pastoralists. Health care providers (HCP), are key in delivering FP services. Community leaders and religious leaders are also key influencers in women's decisions to use FP. We found limited research exploring the perspectives of both HCPs and these local leaders in this context. We conducted semistructured interviews with HCPs (n=4) working in facilities in Wajir and Mandera, and community leaders (n=4) and religious leaders (n=4) from the nomadic and semi-nomadic populations the facilities serve. We conducted deductive and inductive thematic analysis. Three overarching themes emerged: perception of FP as a health priority, explanations for low FP use, and recommendations to improve access. Four overlapping sub-themes explained low FP use: desire for large families, tension in FP decision-making, religion and culture, and fears about FP. Providers were from different socio-demographic backgrounds to the communities they served, who faced structural marginalisation from health and other services. Programmes to improve FP access should be delivered alongside interventions targeting the immediate health concerns of pastoralist communities, incorporating structural changes. HCPs that are aware of religious and cultural reasons for non-use, play a key role in improving access.

There is growing recognition among global health practitioners of the importance of rights-based family planning (FP) programming that addresses inequities. Despite Kenya achieving its national FP target, inequities in access and use of modern FP remain, especially amongst marginalised nomadic and semi-nomadic pastoralist communities. Few studies explore norms affecting FP practices amongst nomadic and semi-nomadic pastoralists and how these can influence social and behaviour change (SBC) interventions. We carried out 48 in-depth interviews and 16 focus group discussions with women and men from pastoralist communities in North Eastern Kenya in November 2018. Data were analysed thematically. Results from focus groups and interviews confirmed themes, while allowing differences between the qualitative approaches to emerge. We found that large family size was a descriptive and injunctive norm in both nomadic and semi-nomadic communities. The desire for around 10 children was sustained by religious beliefs and pastoralist ways of living. Despite a desire for large families, maintaining child spacing was encouraged and practised through breastfeeding and sexual abstinence. Most participants viewed modern FP negatively and as something used by “others”. However, it was acceptable in order to prevent severe negative health outcomes. Future FP research to inform interventions should continue to consider community fertility preferences and the rationale for these, including norms, religion and power dynamics. Targeted qualitative social norms research could inform multi-component SBC interventions in this context.

BackgroundOverweight and obesity during pregnancy is associated with an increased risk of gestational diabetes mellitus (GDM), preeclampsia and macrosomia among other complications. Antenatal lifestyle interventions have been shown to be effective in this population however studies often fail to identify the mechanisms by which the intervention is expected to be effective. Our aim is to identify the barriers and enablers to behaviour change from the perspective of obese pregnant women and their healthcare providers (HCP), with a view to informing a lifestyle intervention to reduce the risk of GDM.MethodsSemi-structured interviews are being conducted with a purposive sample of doctors and midwives recruited from a large academic maternity hospital in the Republic of Ireland (n = 1–15). A purposive sample of obese women at different stages of pregnancy will also be recruited from public and private antenatal clinics (nn = 1–15). The Framework approach is being used during analysis, drawing on the Theoretical Domains Framework (TDF). The TDF identifies 12 domains which can act as barriers or facilitators to behaviour change.ResultsPreliminary analysis of HCP interviews suggests that pregnancy is ‘a wake-up call’ for some women as the risks of obesity are made explicit. Social influences were identified as a potential facilitator; HCP suggested behaviour change was easier for pregnant women when supported by their partners or when partners also engaged in healthy lifestyle behaviours. Healthcare professionals identified the environmental context and resources as barriers, particularly the lack of dedicated obesity clinics and the limited access to dietetic services.DiscussionHealthcare professionals believe pregnancy offers a window of opportunity to engage women in behaviour change as beliefs about consequences of overweight and obesity for the baby may trigger behaviour change in the pregnant woman. However, there are limited resources available to them to support women to make health behaviour changes.