Social Context, Community Norms, and Adolescent Girls' Sexual Health and Wellbeing
openNICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development
Project Summary
Sexual agency among adolescent girls and young women (AGYW), or an individual’s ability to make decisions
about engaging in sexual activity independently, fully informed, and free from coercion, has become a topic of
interest in sexual and reproductive health and rights. However, readiness to initiate sexual activity, itself a
reflection of sexual agency, has been less studied. To advance the understanding of sexual readiness, its causes,
and associated sexual and reproductive health (SRH) outcomes in low- and middle-income countries (LMICs),
this study will explore the cross-cultural applicability of a measure of sexual readiness, examine its social
determinants, assess its predictive value on SRH outcomes across LMICs, and evaluate the adaptation of the
measure in humanitarian settings. Specifically, Aim 1 analyses will examine the construct of readiness at sexual
debut Sub-Saharan Africa (SSA), identify profiles of adolescents’ readiness at sexual debut, and compare the
measures of age at sexual debut and readiness in predicting SRH outcomes. Using Performance Monitoring for
Action (PMA) surveys with national longitudinal data about fertility and contraceptive behaviors among women
ages 15-49 in five SSA countries, this analysis involves using latent class analysis to identify readiness profiles
and assess their predictive effect on subsequent SRH outcomes. Secondly, using multilevel structural equation
models, Aim 2 analyses will examine the association between social norms, individual attitudes, and sexual
readiness as well as the association between sexual readiness and SRH outcomes and the moderating role of
social norms. Finally, Aim 3 analyses will adapt this research and model to humanitarian settings with data on
marriage and SRH outcomes among AGYW from the “Early Marriage and Fertility Decision Making Among
Conflict-affected and Displaced Adolescents in Bangladesh and Yemen” (EMEC) study. Using multilevel
multivariate logistic regression, the analysis will evaluate the influence of social norms on adolescents’ readiness
in marriage in humanitarian settings in South and Western Asia and examine the effect of readiness in marriage
on subsequent SRH outcomes and the moderating role of social norms. To support this dissertation research,
the applicant has brought together a group of faculty with extensive subject-matter and methodological expertise
related to the research proposal to serve as her mentorship team, led by Dr. Caroline Moreau. The training plan
includes coursework, research, conferences, and other opportunities that will deepen the applicant’s conceptual
understanding and subject matter expertise in adolescent SRH and social norms, strengthen her advanced
methodological skills in statistics, including structural equation modeling, and expand her research experience
addressing SRHR issues in humanitarian contexts. This research aligns with the NICHD 2020 Strategic Plan to
“characterize typical and atypical physical, social, and emotional development in adolescence”. This training plan
and research project will enable the applicant to build the skillset critical to becoming an independent researcher
with expertise in applying a life course framework to issues of adolescent development and SRH.
Up to $50K
health research