Changing the Script: Intergenerational Communication about Sexual and Reproductive Health in Niamey, Niger

ABSTRACT

Most strategies to reduce adolescent pregnancies have been designed to educate adolescents directly about family planning (FP), while adolescents often cite peers and parents as their primary sources of sexual health information. Yet parents’ lack of knowledge about sexual and reproductive health (SRH), low self-efficacy to initiate conversations, and adverse social norms act as barriers to open intergenerational communication. To better understand the normative environment influencing communication between parents and youth about FP/SRH in francophone West Africa, the USAID supported Breakthrough RESEARCH project conducted a multi-stage qualitative study in Niger. During Stage 1, the research team developed a screening tool (based on a literature review) to categorize research participants into those who practiced open intergenerational communication about FP/SRH, and those who did not. Stage 2 consisted of 40 in-depth interviews with young people (ages 15–24) and adults (≥25 years old), stratified by whether they practiced open intergenerational communication. Results showed restrictive social norms related to youth SRH and access to information and services. However, particularly among participants classified as open-communicators, there is a hierarchy of norms and normative beliefs, with abstinence as the most virtuous decision for youth, but approving communication about and access to SRH services in order to minimize harm. Participants rely on values such as the protection of youth, protection of family honor and promotion of well-being as means to act in counter-normative ways and communicate about FP/SRH. Implications for the field include demystifying and destigmatizing SRH topics, increasing adults’ communication skills, and changing the “script” to a more life-affirming view of SRH.

Niger is one of only two countries in West Africa that have not seen a decline in adolescent birth rates over the past fifty years, and has among the highest adolescent fertility rates in the region (Garbett, Perelli‐Harris, & Neal, 2021; World Bank, n.d.). Adolescent pregnancy continues to be a major contributor to maternal and child mortality and to intergenerational cycles of ill-health and poverty (World Health Organization, 2020). The causes of these high birth rates include several factors that lead to both low demand for, and lack of access to, family planning (FP) and sexual and reproductive health (SRH) services. Factors affecting low demand include low levels of education, lack of FP-specific knowledge, misinformation and negative attitudes about the use and side effects of FP. For example, in Niamey 70% of female adolescents 15–19 years old agree that adolescents who use FP are promiscuous, while 77% agree that FP is only for married women (Performance Monitoring for Action, 2021). Challenges in accessing FP services include weak health infrastructure, poor provider training, financial impediments, and social and religious norms supportive of high fertility and early marriage (Global Impact Advisors, n.d.; World Health Organization, 2010). In Niger, these barriers have resulted in only 15.2% of all women, and 18.1% of married women using modern contraceptive methods (Performance Monitoring for Action, 2017). Additionally, young women are not routinely screened for FP needs when visiting health facilities (IntraHealth, 2019; Samandari, Grant, Brent, & Gullo, 2019). Nonetheless, in Niamey, the median age at first sex is 18.4, while the median age at first marriage is 20.6 (Performance Monitoring for Action, 2021). The delay between sexual initiation and uptake of contraception is higher among rural and less educated women than among urban and more educated women, indicating a need to address unmarried women and girl’s FP/SRH needs (Olakunle & Banougnin, 2019). Notably, male engagement objectives, strategies and key indicators are missing from Niger’s FP costed implementation plan, which further reinforces limiting notions that FP rests in the domain of women’s health (Hook, Hardee, Shand, Jordan, & Greene, 2021).

Previous research from Sub-Saharan Africa and other regions has found that effective parent-adolescent communication is relatively rare, yet is associated with increased condom use, reduction in number of partners, and abstinence among adolescents (Babalola, Tambashe, & Vondrasek, 2005; Coetzee et al., 2014; Namisi et al., 2013; Thurman, Nice, Visser, & Luckett, 2020; Widman, Choukas-Bradley, Helms, Golin, & Prinstein, 2014; Widman, Choukas-Bradley, Noar, Nesi, & Garrett, 2016). Open and supportive communication between adults and youth on FP/SRH motivates adolescents to internalize the values and norms rooted in the parents’ messages, consequently influencing adolescents’ sexual decision making (Sales et al., 2008).

Parent-adolescent communication involves complex dynamics necessitating not only knowledge, skills and self-efficacy to communicate but also an environment conducive for open discussion (Adeyemo & Brieger, 1994; Jaccard, Dodge, & Dittus, 2002; Motsomi, Makanjee, Basera, & Nyasulu, 2016). Previous literature has emphasized how parents tend to lecture adolescents when discussing dating and sex topics (Adeyemo & Brieger, 1994; Rogers, Ha, Stormshak, & Dishion, 2015). Embarrassment and low self-efficacy are two major predictors of why some parents withhold engaging in honest and supportive conversations about relationships and sex with adolescents (Adeyemo & Brieger, 1994; Widman et al., 2016). Cultural and religious taboos in some contexts further restrict topics discussed between parents and adolescents (Vilanculos & Nduna, 2017). Adolescents feel more comfortable discussing sex-related topics with friends or peers than they do with their parents, (Lefkowitz & Espinosa-Hernandez, 2007) and peers and the school system have become important sources when it comes to discussing sex-related matters (Kawai et al., 2008; Omoti & Omoti, 2007). Nonetheless, adolescents have expressed that their parents tend to have a much greater influence over their decision about sex than siblings, peers or the media (Centers for Disease Control and Prevention, 2014). Even when communication about sexual abstinence and sexual debut happens between parents and their adolescents, it differs by gender. For instance, parents tend to talk to their sons about sex only after signs of sexual activity have become visible and may be more likely to encourage them to engage in sexual intercourse than their daughters (Babalola et al., 2005).

Social norms are informal and often unspoken rules by which a given group understands what appropriate behavior is and can be divided into descriptive norms (i.e. perceived typical behavior) and injunctive norms (i.e. perceived appropriate behavior) (The Learning Collaborative to Advance Normative Change, 2019). The theory of normative social behavior describes how behavior is influenced by descriptive and injunctive social norms, and posits that when people perceive that a behavior is common, they are more likely to engage in the behavior, while also proposing that people’s perceptions of approval or disapproval, group identity and the perceived benefits of a behavior moderate the influence of descriptive norms (Rimal & Real, 2005; The Learning Collaborative to Advance Normative Change, 2019). In other words, adults’ perceptions of others’ approval of discussing FP/SRH topics with young unmarried people, the perceived benefits, or sanctions of discussing such topics would influence their communication behavior. This theory does not, however, discuss how underlying values (understood as principles that help you decide what is right and what is wrong and are internal rather than external) interact with social norms (Frese, 2015). The diffusion of innovation theory describes how a behavior can spread from a small group of innovators to a large group and can be used to change behaviors that are influenced by social norms by identifying and understanding how early adopters create and embrace change and are open to new ideas and ways of thinking (The Learning Collaborative to Advance Normative Change, 2019).

Very little literature to date has focused on the normative environment influencing communication between parents and youth about FP/SRH, particularly in francophone West Africa (Bastien, Kajula, & Muhwezi, 2011). This paper explores: (1) the underlying values, normative barriers and enablers to intergenerational communication about FP/SRH among unmarried youth and adults in Niamey and, (2) how those who communicate about FP/SRH across generations and those who do not regularly communicate differ in how social norms and values are manifested in their actions.

Methods

Study Design and Methods

We conducted a narrative qualitative study in Niamey, Niger’s capital, as part of a larger suite of evaluation activities related to a mixed-media youth-led campaign (Silva et al., 2022). The study population included male and female adolescents and young adults aged 16–24, and adults (≥25 years old) who interact with young people (i.e., parents, older relatives, etc). The study took a two-staged approach. The objective of Stage 1 was to develop a screening tool to categorize research participants by communication type.

We developed a nine-item screening tool based on a review of the literature to recruit and categorize youth and adult research participants into those who practiced open intergenerational communication, and those who did not (Adeyemo & Brieger, 1994; Atienzo, Walker, Campero, Lamadrid-Figueroa, & Gutiérrez, 2009; Babalola et al., 2005; Barnes & Olson, 1985; Centers for Disease Control and Prevention, 2014; Jaccard et al., 2002; Lefkowitz & Espinosa-Hernandez, 2007; Rogers et al., 2015; Sales et al., 2008). This tool was developed in English and translated to French prior to field testing. Each item in the screening tool was accompanied by a five-point Likert scale with responses ranging from completely agree to completely disagree.

To test the validity of the screening tool, we conducted five interviews using a maximum variability sample. The sample included one teacher (male), one FP organization youth leader (male), one parent (female), one FP/SRH communication professional (female), and one young person (male). Seven items from the nine-item screening tool were retained based on findings from the validation interviews (see Table 1).

Table 1. Seven-item study participant recruitment screening tool

I can discuss anything without feeling held back or embarrassed I am very satisfied with the way my parent/child and I talk together If I was in trouble, I could tell my parent/child. When I ask questions, I get honest answers from my parents/children My parent/child tries to understand my point of view I think it’s easy to talk about my problems with my parents/children It is very easy for me to express all my true feelings to my parent/child.

Stage 2 of the research consisted of 40 individual in-depth interviews. Interviewees were stratified by age, sex and communication status based on the screening tool (see Table 2). Open communicators were defined as those agreeing with at least two screening items and discussed at least one SRH topic with a youth/adult (relationships, pregnancy prevention/contraception, sexually transmitted infection (STI) prevention). Eligibility criteria for adult participants included being a supportive adult for a young person aged 16–24, such as an adult that interacts and exerts influence over a young person’s life (e.g. parent, extended relative, teacher or mentor). Adult and youth participants were not paired (i.e. they were not related to each other). In-depth interview guides were pretested during field training, with a total of 8 pretest interviews conducted and assessed for quality.

Table 2. Number of people interviewed per strata

	Open communication	Non-open communication
Adult men (25+)	5	5
Adult women (25+)	5	5
Adolescents and young women (16–24)	5	5
Adolescents and young men (16–24)	5	5
Total	20	20

Procedures

Data collection took place between January and March of 2021. Unmarried youth participants were recruited through community-based youth associations who approached affiliated youth to invite them to participate in the study. Adult men were recruited via Fadas (social groups) while women were recruited via snowball sampling.

Selection criteria for youth participants included being 16–24 years old, unmarried, and living in Niamey. Adults were eligible to participate in this study if they were 25 years old or older and were parents or close trusted adults of young people 15–24 years old.

Once participants agreed to be approached by a member of the research team, they were contacted to schedule a meeting time to complete the written informed consent process and proceed with the interview. No incentives for participation were provided. Due to COVID-19 related risk-reduction strategies, individual interviews were conducted in open air spaces that could ensure privacy. All other risk-reduction strategies, including use of face masks and physical distance were followed. This study was provided exemption from seeking parental informed consent, and underaged participants consented to participation for themselves. All participants agreed to be audio recorded. Interviews lasted an average of 80 minutes and were conducted in a combination of French, Zarma and Hausa.

For both youth and adults, the guide asked about: (1) social norms related to communicating with youth/adults about FP/SRH; (2) beliefs, perceptions and social norms related to youth SRH and access to services; (3) motivations and barriers to communication about FP/SRH; and (4) self-efficacy for communication and FP/SRH service utilization. Audio recordings and field notes were transcribed into French and assessed for quality.

Analysis

A code book was developed and validated with a small sample of transcriptions. Data were then thematically coded by a team of 9 coders using the qualitative analysis software Dedoose (see supplemental file for coding tree). The coding team met regularly throughout the coding process to review code application and resolve inconsistencies in coding. Thematic content analysis, a research method for the subjective interpretation of the content of text data through the systematic classification process of identifying themes or patterns, was used (Hsieh & Shannon, 2005). Following thematic content analysis, emergent themes were refined using a constant comparative method in which themes were compared to assess whether the same concept emerged within and across communication status (Glaser & Strauss, 2009). Triangulation of data from different participant categories (i.e., using these data sources to understand the phenomenon under study) and analytic triangulation (i.e., using multiple analysts to understand different ways of looking at the data) contributed to analytical rigor (Patton, 2002). Interpretation of results was completed with the entire research team via data interpretation workshops, and with local stakeholders through a community event. The consolidated criteria for reporting qualitative studies (COREQ) checklist were applied to ensure rigor (see supplementary material) (Tong, Sainsbury, & Craig, 2007).

The study received ethical approval from Tulane University School of Public Health and Tropical Medicine (2019–1721) and the Ministry of Public Health in Niger (07/2020/CNERS).

Results

Social Norms Related to Youth SRH and Access to FP/SRH Services

Participants report that all members of their community only approve of sexual activity within the context of marriage, regardless of the age of those involved. Participants suggest that this social norm stems primarily from a religious perspective, although religion, tradition and culture are terms often intertwined in participants’ discourse. Sanctions to transgressing this norm go beyond the loss of respect within the community (the most commonly mentioned sanction) and, for some, continue beyond in the afterlife.

“In concrete terms, this religion, through the [teachings] of the marabouts¹; make it clear to young people that if you fornicate there will be sanctions. Once you die, you will be punished. Then, this religion shows young people that if you continue to engage in [sexual] activity you will be affected by sexually transmitted diseases, HIV/AIDS, Gonorrhea or Syphilis.” (Male adult, non-open communication).

In addition to the unanimous reported social norm restricting unmarried youth sexuality, we find limited variability related to reported social norms on access to FP information and services for youth. All participants expressed that most people in their community thought unmarried youth should not have access to FP services. To allow them to do so was perceived as sending a message of sexual permissiveness. Misinformation about FP methods and their perceived link to future infertility was also used as justification for denying young people access to FP.

“The problem with young people is that when they are given contraceptives, they will say they are free to sleep around, especially girls. They will think that in the end, they will not get pregnant.” (Female youth, open communication)

As was the case for social norms related to sexual activity among unmarried youth, religious arguments are strongly present in relation to why FP access should be restricted to married people. Once again, from participants’ perspectives, if young people should not be having sex outside of marriage, there is no reason for which they should be accessing FP methods or services.

“There are almost no circumstances under which society will accept a young unmarried person using contraception, because the very issue of sexuality is banned from society. It is not accepted and nobody wants it in society. “ (Male youth, non-open communication)

Social Norms Related to Intergenerational Communication about FP/SRH

Adult participants, whether open communicators or not, believe that it is the responsibility of religious men, to communicate with youth about FP/SRH in a specifically religious context such as wedding ceremonies or religious sessions. This is reflected in participants’ comments that not having discussions about sex with their children is a sign of respect between parents and young people.

“Some parents don’t even talk about it if [their child is] getting married. It’s a principle …, you can’t talk directly with your child, it’s a respect thing … For them, if we talk about sex, there is no more respect.” (Male adult, open communication)

Preaching sessions must emphasize the dangers of premarital sex and practices that are condemned not only by society but also by religion, and the promotion of chastity for both young men and women. Here, pregnancies out of wedlock and STIs are seen as divine punishment for transgressions of religious principles of chastity until marriage.

To a lesser degree, participants indicated that teachers and health professionals are also suited to address SRH issues with youth. NGO outreach is perceived as effective when it is done by people who are known and respected in the community. Apart from these institutional actors, communication between adults and youth remains challenging in Niger, particularly for youth.

“It is difficult because in our society it is taboo to talk about sex. In the Muslim community, it’s really taboo to come and talk about sex like that. So it’s really hard for a young person to come to a trusted adult to talk about sexuality with them.” (Male adult, non-open communication)

Restrictive social norms result in difficulty for youth to find people they trust to talk to about SRH. However, young participants identified four trusted individuals with whom they sometimes share their concerns and receive advice from: mothers, marabouts or preachers, cousins and uncles, and sometimes teachers. It is noticeable that contrary to adults, young people name closer sources to them, such as a parent or close relative as a desired source of information and communication.

Social Norms, Shame, and Fear

For both youth and adult participants, the two underlying sentiments that surface throughout the interviews related to youth SRH and intergenerational communication are shame and fear. These emotions are most evident among parents who report being uncomfortable talking about sex with their children. Because sexuality is taboo in their community, these parents do not want their children to suspect that they know anything about it, or risk being looked down upon. Communication with non-parent adults can at times be easier than communication with parents.

“Often, we have this impression that young people, [if I talk to them] will they understand my logic or will they take me for a sexologist? Yes, … often when we talk about such things, we take the person as a sexologist … or [they will think] ‘who told him that we do that?’ … “ (Male adult, non-open communication)

Adults are contending with fear of social and religious sanctions for themselves and their youth if their young people are (or perceived to be) sexually active, as well as fear of negative health outcomes such as STIs for their young people.

If adults are embarrassed to discuss sexuality with young people, the same is true for young people with respect to their elders. What prevents them from going to their parents to talk about sexuality, say the young people interviewed, is shame.

A Hierarchy of Normative Beliefs

Despite the generalized agreement about the restrictive social norms that influence youth sexual activity, some respondents felt that unmarried youth who are sexually active should be allowed access to FP information and services. These participants, most of which were open communicators, described a hierarchy of norms. According to them, abstinence from sexual activity is the best and most virtuous option. Yet, when abstinence is not attainable, the next best option is protection from unwanted health outcomes, such as STIs and unintended pregnancy. According to them, some parents agree to send their daughters to a health center as an act of responsibility.

“They have to have [FP] … I think it’s a heavy responsibility. When you know that you are sexually active, you might as well protect yourself. Protect yourself how? Protect yourself against unwanted pregnancies, protect yourself against HIV, STIs. It’s a way of being responsible, you take responsibility, you protect yourself, it’s better than doing things wrong. When I say wrong, you do things and you get pregnant or you get a disease, you know, the consequences will be huge. … So they have to have it” (Female adult, open communication)

This hierarchy of normative beliefs, therefore, play a central role in justifying an individual’s decisions and actions toward others, especially if they may lead to undesirable consequences. Young people who transgress the rules established by society suffer a loss of respect. For those young people who are sexually active, it is recommended that they protect themselves against STIs to stay healthy.

“Yes, even in society it is forbidden to have sex if it is not your wife, but in society young people even say that if we cannot control ourselves, we must protect ourselves by using condoms. Society doesn’t allow us to have sex, … but if it happens and we can’t control ourselves, we must always protect ourselves against the various diseases. (Male youth, open communication)

Of note is the fact that the young male participant frames engaging in sexual activity as an involuntary act stemming from a lack of control.

Social Values and Their Relation to Intergenerational Communication about FP/SRH

Three key social values emerge in this study: protecting youth, protecting family honor, and improving individual and family well-being. These values appear expressed by both open-communicators and non. However, different narratives emerge from open-communicators that support their intergenerational communication practice.

Protecting youth was expressed universally as a societal priority and underpinned participants’ actions: among open communicators to communicate with young people, and among non-open communicators to shield them from a perceived incentive to engage in sex. Youth protection was focused on the prevention of risks related to STIs, unwed pregnancies and clandestine abortions. Both communicators and non-communicators are ultimately motivated by the value of protecting youth yet result in different actions. Among those who communicate openly with young people, communication aims to make them aware of the dangers of sexual relations.

“It’s very important to save [the youth], because if this adult has knowledge, notions about reproductive health and sexuality, already knows all the dangers [associated with it], I think it’s more than imperative for him to chat with the youth to get their attention.” (Male adult, open communication).

Non-communicating participants expressed they were not always opposed to communication but tended to name others as being responsible for educating youth about SRH topics, even calling for a shared responsibility among a larger category of adults and the State, to feel invested in the education about FP/SRH of the youth in their communities.

Safeguarding social values contributes, according to participants, to the protection of family honor and dignity and saving face in front of their community. Thus, communicating about sexuality with young people, and emphasizing religious values, helps to avoid shame and humiliation of a family, and preserves the dignity of young people, by avoiding unwanted pregnancy, or contracting an STI in the case they were sexually active. Adult open communicators mentioned the need to be discrete but open in their communications to preserve family honor.

“It is very important to communicate between parents and children, because today if you have not advised your daughter to protect herself, the consequences are there, the girl can easily get pregnant, contract a disease and you as a mother, it is your name that will be tarnished, or the family name.” (Female adult, open communication).

However, participants continue to emphasize the prioritization of abstinence, followed by appropriate guidance to those who cannot abstain from sexual activities. In this sense, sexual activity remains a deviation from the norm that must be attenuated or accounted for but still carries social sanction and stigma.

“As young people today do not [abstain from sex]; to avoid sexually transmitted diseases, we must talk to them. But mostly we have to tell them to abstain. That’s what we have to tell them at the base: abstinence, abstinence, abstinence, abstinence. So we have to accompany them, because they don’t [abstain], in order to avoid diseases. It is better that they have access to [FP/SRH services] than to contract the diseases, as long as the person does not remain [abstinent]. But above all, abstinence must be promoted. That’s the best way” (Female adult open communication).

It should also be noted that not only does “tradition” not approve of adults and young people discussing sexual matters since they should not be sexually active, but proponents of “tradition” are very critical of those who talk about sex with their adolescent children. According to those citing “tradition,” adults who talk about sexuality with youth claim to be “modern” but are unaware of the consequences of their actions, as this is perceived to implicitly encourage sexual activity.

“It’s because of our upbringing. And a lot of times we have a hard time decanting what we inherited; that’s it. It is not our custom, it is not our tradition. It’s true that this can lead people to think that we don’t want to evolve, that we don’t want to be modern … for [parents] who [promote FP], I don’t think they take responsibility. They think they are intellectual, modern. There are even some who give their children condoms. What is this? And often it’s not because they say, “Be careful! You mustn’t get me into trouble … you mustn’t bring me diseases … ”. But is this one hundred percent positive? That’s not what I see. I will never tell my son to use condoms. If I see that [he’s sexually active] I’ll tell him: “Be careful! God sees you. You’d better be [abstinent]. If you want to get married, you have to tell us, we’ll see how we’re going to handle it.” It’s clear. “ (Male adult, non-open communication)

The third emerging value that manifested differently among participants was the promotion of well-being. Proponents of intergenerational communication about sexual health topics thought that this communication contributed to improved wellbeing, not only for the young person but for society as a whole.

“I think it’s for their well-being. You really have to talk to them to get them to protect themselves. And if they protect themselves, we will have won everything; because when they contract a disease, it is the family that loses, it is the society that loses.” (Female adult, open communication).

The lack of communication can leave young girls especially vulnerable, as participants mentioned topics such as menstruation which are also typically difficult to discuss even within families, and leave young girls unprepared for the onset of puberty.

Participants classified as practicing open communication expressed empathy toward young people, realizing that support of youth must not be contingent on their behavior, however foolish or counter normative it may seem.

“This is important. Because the young people there are our children, our brothers, our sisters. So as long as we live in community, we have to help each other. You can draw them to you. And it is your behavior that will make them come to you. The young person doesn’t want to be pushed away despite his or her foolishness. So when you understand him, you can take measures to help him and advise him” (Female adult, open communication)

Table 3 summarizes the themes related to social values and normative beliefs about FP/SRH, by communication status.

Table 3. Summary of themes related to social values applied to intergenerational communication about FP/SRH, by communication status

		Summary of normative beliefs
Social Values	Protection of youth	Both “Youth these days” are out of hand Open Communicators Communicate to protect them from harm in case they are sexually active Non-open Communicators Other adults (religious leaders and teachers) should be responsible to talk to youth about SRH
	Protection of family honor	Both They shouldn’t be having sex Open Communicators Acknowledge young people have sex even if not socially sanctioned Need to be discrete but can openly discuss SRH to avoid negative outcomes Combine communication about SRH with communication of safeguarding social values Non-open Communicators Communication dishonors our traditions in favor of a westernized view
	Promotion of well-being	Open Communicators Society loses when young people have negative health outcomes Demonstrate empathy toward youth Non-open Communicators Postponement until you see evidence that they need guidance

Discussion

The social norms that influence youth SRH in Niger focus primarily on deterrence of sexual activity and promotion of chastity until marriage. Within this context, the normative environment surrounding intergenerational communication about FP/SRH is not conducive to open communication. This study used a stratified sample, pre-identifying youth and adults who exercised open intergenerational communication to understand how people living under the same normative environment could behave differently, with half the sample engaging in counter-normative behavior. Study findings show that all participants express a hierarchy of desired behavior for unmarried youth, with abstinence as the most desired behavior. Anyone in need of accessing FP services is already falling short of this societal expectation. However, our findings also suggest that adults who have open communication with young people about FP/SRH overtly or covertly support their actions with three social values that help them deviate from the norm of not talking to young people about FP/SRH. The values of protection of youth, protection of family honor and promotion of well-being help adults justify discussing openly with them about FP/SRH and primarily about abstinence, even if discreetly to avoid social sanctions. Through a deep sense of empathy toward young people, they acknowledge that society loses when young people have negative health outcomes due to being unaware or unprepared for sexual activity, and thus are willing to go against social norms by talking openly about FP/SRH, including the importance of abstinence which continues to be the most valued behavior for unmarried youth. Thus, participants in this study are implicitly adopting a harm reduction strategy commonly used in public health (Ashton & Seymour, 2010). The findings from this study show that even in a normative environment that is unfavorable to intergenerational communication, adults who are early adopters can use shared social values to justify and recognize that communicating about FP/SRH with young people is protective.

This study confirms other findings related to the relevance of religious leaders as references for social norms. A study about social norms related to birth spacing showed that for non-religious women, other women around her were the most important reference group, while for religious women, their husbands and their religious leaders were the most important reference groups (Nouhou, 2016). Although in Niger, marriage legitimizes the need for SRH information and services, it is important to note that even married girls face significant barriers in accessing SRH information and services, facing stigma and misinformation due to pronatalist and religious norms (Samandari et al., 2019). Programs working to promote intergenerational communication should consider working with religious leaders, potentially using a human-centered-design approach to develop ways to enhance compatibility between the stigmatizing truth that not all youth abstain from sexual activity, while upholding the value of protection of youth and promotion of well-being.

Consistent with previous studies, our study finds the prevailing sentiments from both adults and youth related to FP/SRH intergenerational communication are shame and fear (Maina, Ushie, & Kabiru, 2020; Motsomi et al., 2016; Mullis, Kastrinos, Wollney, Taylor, & Bylund, 2021; Usonwu, Ahmad, & Curtis-Tyler, 2021; Yibrehu & Mbwele, 2020). Programs should consider advocating for intergenerational communication that works to demystify and destigmatize talking to youth about SRH thereby normalizing the fact that most people are scared and embarrassed, as well as creating a sense of community. Programs should likewise build skills among parents to “change the script” that adults use to communicate with youth from fear-based communication (i.e., if you have sex, bad things will happen) to positive, values based, life-affirming communication, promoting the advantages of intentionally taking care of their SRH throughout their life (Bastien et al., 2011; Usonwu et al., 2021). Promoting parent-adolescent communication should encompass changing social norms about sex education and empower both youth and adults to communicate effectively with each other (Babalola et al., 2005). Scaling up successful programs in Niger such as the Safe Spaces approach can provide adolescent girls with a tailored curriculum that improves their knowledge and attitudes related to reproductive health including appropriate family planning techniques to delay pregnancy (MercyCorps, 2015). The approach also gives adolescent girls an opportunity to share positive messages related to reproductive health with their peers. Developing similar Safe Space programs for adolescent boys can also create an opportunity for young boys to increase their awareness about reproductive health issues and empower them in their role as responsible partners in sexual relationships and would contribute to the addressing the lack of focus on male engagement for FP (Hook et al., 2021). Finally, it is crucial to design interventions that can create awareness for parents and other influential adults on the current developmental needs and sexual behavior of adolescents in order to promote not only open but also accurate communication (Kamala et al., 2017; Mpondo, Ruiter, Schaafsma, van den Borne, & Reddy, 2018; Usonwu et al., 2021).

Findings related to shame and fear in communicating about FP/SRH also influence adults’ self-efficacy that they can communicate with youth. Programs should also aim to increase adults’ skills and confidence level of when, how, and what to talk about with youth and tap into adults’ motivation to want to protect youth and the social values that help them to do so (Bastien et al., 2011; Downing, Jones, Bates, Sumnall, & Bellis, 2011). More research is needed specific to this context on the best approaches for promoting positive and constructive intergenerational communication about FP/SRH, as there is a particular dearth of relevant research in francophone West Africa (Bastien et al., 2011; Usonwu et al., 2021). Implementation science approaches for how to build communication skills about FP/SRH among adults in this normative environment are urgently needed as well.

Three study limitations are worthy of note. Firstly, the study location was limited to Niamey, Niger’s capital. Secondly, we did not collect information related to participants’ education level and income, which limits interpretation of data. Thirdly, while the data from this study provided in-depth insights into intergenerational communication about FP/SRH, limitations inherent to qualitative methods include the inability to generalize study findings beyond the study geography and participants.

Despite these limitations, understanding societal norms related to youth SRH as well as intergenerational communication about FP/SRH, and how people are already acting in a counter-normative way holds clues to creating programs that can broach these subjects in a culturally appropriate way and helps recognize the complexity of youth FP/SRH promotion in a context such as Niger’s.

Acknowledgments

The authors would like to thank Althess Slameur, MMH consultant, Niamey’s Youth Ambassadors for Family Planning, and community Fadas for their support in identifying and recruiting study participants. We also thank Laura Reichenbach and Amanda Kalamar for their reviews of this manuscript.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Supplementary Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10810730.2022.2160527

Additional information

Funding

The United States Agency for International Development (USAID) under the terms of the Cooperative Agreement AID-OAA-A-17-00018 provided funding and a technical review of the draft of the manuscript. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government.

Notes

¹ Marabout in Muslim religion is a spiritual master.