An assessment of attitudes toward gender inequitable sexual and reproductive health norms in South Sudan: a community-based participatory research approach

Abstract

BackgroundCommunities in South Sudan have endured decades of conflict. Protracted conflict exacerbated reproductive health disparities and gender inequities. This study, conducted prior to the country’s 2011 independence, aimed to assess attitudes toward gender inequitable norms related to sexual relationships and reproductive health and the effects of sex, age, and education on these attitudes.MethodsApplying a community-based participatory research approach and quota sampling, 680 adult male and female respondents were interviewed in seven sites within South Sudan in 2009–2011. The verbally administered survey assessed attitudes using the Gender Equitable Men scale. Data were stratified by sex, age (≤35 years and >35 years), and education.ResultsOf 680 respondents, 352 were female, 326 were male, and 2 did not indicate their sex. The majority of women (77%) and men (74%) agreed “a man needs other women, even if things with his wife are fine”. Respondents who reported no education (60%) were more likely than those who reported any education (45%) to agree “if a woman is married, she should have sex with her husband whenever he wants to, even if she doesn’t want to” (p = 0.002). The majority of women (74%) and men (73%) agreed “it is a woman’s responsibility to avoid getting pregnant”. Respondents who reported no education (81%) were more likely than those who reported any education (72%) to agree with this statement (p = 0.04). When asked about condom use, the majority of respondents, across both sexes and both age groups, agreed “it would be outrageous for a wife to ask her husband to use a condom” and “women who carry condoms are easy”. There were no statistically significant differences between the two age groups for any of the assessed gender inequitable norms.ConclusionThe study reveals differences in attitudes toward gender inequitable sexual and reproductive health norms among those surveyed in South Sudan when stratified by sex and education. As a new nation seeks to strengthen its health system, these data can inform sexual and reproductive health policies and programming in South Sudan.

Influences of sex, age and education on attitudes towards gender inequitable norms and practices in South Sudan

“…In our previously published study, there was an acceptance of violence against women among both women and men surveyed, and in many circumstances, women were in greater agreement than men with gender inequitable statements related to violence against women (Scott et al, 2013). In the current study, half of surveyed women agreed that women should have the ‘same’ or ‘less’ power within the community than they currently have.…”

“…The majority of respondents were married (70%), Christian (62%), and represented the major ethnic groups. The median age was 34.0 years (25.0–45.0) (Scott et al, 2013). Self-reported education and literacy level are described in Table 2.…”

“…The methods of this study are described in detail elsewhere (Scott et al, 2013) and are outlined below. The study applied a community-based participatory research model in which a community steering committee participated in the study design, survey development, and data collection with the goal of informing community health (Faridi, Grunbaum, Gray, Franks, & Simoes, 2007).…”

“…Respondents were asked whether women should have ‘more’, ‘the same’, or ‘less’ power within the community compared to their current level of power. Detailed demographic characteristics and attitudes toward norms regarding violence and sexual and reproductive health were previously assessed (Scott et al, 2013). …”

“…Understanding these attitudes and any differences among sex, age, and education could allow for more effective and targeted programming and support a gendered statebuilding strategy. This assessment of attitudes toward gender inequitable norms and practices was part of a larger study that also evaluated attitudes toward gender-based violence (Scott et al, 2013) and sexual and reproductive health norms (Scott et al, 2013) in South Sudanese communities. Both assessments revealed that the majority of women and men in the sampled communities agreed with inequitable norms regarding violence and sexual and reproductive health and that there were differences in select attitudes when stratified by sex, age, and education.…”