How do social norms influence the sexual and reproductive health of very young adolescents in sub-Saharan Africa? A scoping review

In sub-Saharan Africa (SSA), very young adolescents (VYAs, aged 10-14 years) have the worst sexual and reproductive health (SRH) outcomes of this age group worldwide due to behavioural, structural, socioeconomic and sociocultural factors, including social and gender norms. SRH programming often focuses on older adolescents (aged 15-19 years), overlooking VYAs. This scoping review sought to explore how social and gender norms influence VYAs SRH in SSA and draw inferences for culturally sensitive, gender-responsive interventions. The review followed the five-step framework developed by Arksey and OMalley: 1) defining the research question, 2) identifying relevant studies, 3) selecting studies, 4) charting the data, and 5) collating, summarising, and reporting the results. We searched four databases (MEDLINE, CINAHL, Global Health, and Web of Science) for peer-reviewed articles published between January 1, 2000 and December 31, 2024. We identified 24 studies: n=11 (46%) were entirely qualitative, n=8 (33%) were exclusively quantitative, and three other quantitative studies incorporated qualitative components. Two studies used participatory techniques. Studies were from nine countries in SSA. Identified norms included those relating to menstruation, puberty, circumcision, romantic relationships and gender stereotypes. Social norms led to VYAs limited SRH knowledge and access, and behaviours and practices that heightened VYAs vulnerabilities and poor SRH outcomes. The review also highlighted the interlinkage of various factors that impact VYAs SRH, underscoring the need for multifaceted responses. This scoping review underscores the importance of culturally sensitive, gender-responsive interventions in improving the SRH of VYAs in sub-Saharan Africa. It calls for continued research and policy attention to address the complex interplay of social and gender norms, ensuring that VYAs have the necessary resources and support for healthy development. The review provides valuable insights for developing tailored interventions for this important group.