ArticleBMC public health2026
Contradictions in value systems, social norms, and the disconnect between expectations and reality of sexuality and contraceptive use among youth in Karamoja, Uganda.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSocial norms are known to have a powerful influence on health-related behaviors including sexuality and uptake of contraceptives among different population categories. Globally and in sub-Saharan Africa, millions of young people experience challenges related to sexual and reproductive health (SRH) such as unintended pregnancies, HIV/ Sexually Transmitted Infections (STIs), and limited access to services, which are exacerbated by negative social norms. Using Social Norms Theory, this study explored how social norms affect young people's attitudes, perceptions, and behavior regarding sexuality and contraceptive use in the Karamoja region, Uganda.
methodsThis qualitative study involved 12 focus group discussions (FGDs), eight in-depth interviews (IDIs), and 8 key informant interviews (KIIs). Participants were purposively selected, and data were coded using Dedoose and analyzed thematically. The FGDs comprised 6-12 participants each (N = 80; 42 females and 38 males), with eight conducted among young people aged 15-24 years and four with community members aged 25 years and older. The IDIs included youth (4 males and 4 females, aged 15-24 years), while the KIIs engaged parents (n = 4) and community leaders (n = 4). Social norms that were examined were related to sexuality and contraceptive use.
resultsContradictory and shifting social norms shaped youth sexuality and contraceptive use in Karamoja. Premarital sex was discouraged and sanctioned, yet engagement sex (rape) is legitimized as a pathway to marriage. Gendered expectations restricted girls more severely, linking their value to virginity and bride price, while early and forced marriages were common, driven by paternal authority and cattle wealth. Norms varied by context: rural and less‑educated youth faced tighter regulation, while urban, educated peers reported greater freedom and covert contraceptive use. Fertility was celebrated as a measure of women's respect and marital value, tied to bride price, with strong pressure to bear children immediately after marriage. Contraceptive use was stigmatized as "addictive" and incompatible with marital expectations as a girl who starts using contraceptives would continue with that habit even when married.
conclusionContradictory and gendered social norms, combined with misconceptions about modern contraceptives, constrain youth agency and reinforce gendered control over reproduction. This limits women's autonomy to use contraceptives in Karamoja, underscoring the need for culturally sensitive, gender‑responsive interventions.
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