Capitalising on aspirations of adolescent girls and young women to reduce their sexual health risks: Implications for HIV prevention

ABSTRACT

This paper explores adolescent girls’ and young women’s (AGYW) aspirations, factors that influence aspirations, and how their aspirations inform their sexual decision-making and behaviour. This study employed a qualitative design involving six participatory focus group discussions and 17 in-depth interviews with AGYW in – and out-of-school. Fieldwork was undertaken in rural and urban Tanzania. Thematic analysis was conducted using NVIVO software. Aspirations of AGYW’s were categorised as short and long-term. Short-term aspirations were associated with the social status derived from obtaining trendy items such as nice clothing, or smart phones. Long-term aspirations included completing secondary education, having a professional job, being respected, getting married and having children. Aspirations were influenced by aspects of the social context, such as peers and structural factors that dictated what was acceptable for respectable AGYW. AGYW lacked the independent capabilities to meet long-term aspirations such as completing education. In pursuit of their short – and long-term aspirations, AGYW engaged in higher risk sexual behaviours such as transactional sex, age-disparate sex and condomless sex. AGYW’s aspirations were important in determining their sexual decision making. Interventions should capitalise on AGYW’s aspirations when addressing their SRH risks by finding innovative ways of engaging them based on their circumstances and aspirations.

KEYWORDS:

• Aspirations
• sexual and reproductive health
• transactional sex
• adolescent girls
• young women

Introduction

Adolescent girls and young women (AGYW) experience rapid changes, both physical and psychosocial, during the transition into adulthood. Gendered differences in health outcomes arise, in part due to new sexual and reproductive health risks and opportunities (Kågesten et al., 2016). Adolescent girls and young women are 2.5 times more likely to contract HIV than their male peers (Muthoni et al., 2020) and account for 26% of new HIV infections in Southern and Eastern Africa (UNAIDS, 2020). Youth sexual and reproductive health risk-reduction programmes tend to focus on youth’s negative behaviours and vulnerabilities, however there is increasing evidence that promoting protective factors is effective to prevent risk behaviours (Benson et al., 2011). Self-efficacy and hope for the future have been associated with reduced sexual risk behaviours (Abousselam et al., 2016; Gloppen et al., 2010), and better health and wellbeing among adolescents (Dudovitz et al., 2017).

Top-down sexual and reproductive health (SRH) programming approaches often fail to consider the social identities and aspirations of local AGYW, which partly explains the failure of many to achieve their intended outcomes (Gibbs et al., 2010). Evidence on the relationship between structural factors, aspirations and sexual decision-making is limited. Little is known of the goals – or aspirations – that are important to AGYW and mechanisms of how and if aspirations impact girls’ sexual behaviours and sexual and reproductive health. Aspirations theory is most often employed in the fields of education and economics, but we have applied it here to better understand adolescent girls’ and young women’s SRH decision-making.

Theoretical framework: Aspirations theory and agency

Aspirations, the conscious and unconscious motivations that determine an individual’s commitment towards a particular goal or future (Hart, 2016), are socially determined. Individuals’ perceptions about which aspirations are acceptable and achievable for them are influenced by people in their ‘aspirations window’: their peers, immediate social circles, and their families (Appadurai, 2004; Boateng & Löwe, 2018). The ‘aspirations gap’ is the difference between an aspirational standard of living, and an individual’s current life circumstances. Aspirations which closely resemble an individual’s living standards can disincentivise change, while aspirations too far removed from current living standards can disempower individuals to change (Appadurai, 2004; Ray, 2006). Adolescents’ aspirations and hopes (realistic plans/expectations) evolve and increasingly shape their life choices (Appadurai, 2004; Davids et al., 2017) including those related to their sexual behaviours (Kagan et al., 2012), as they are exposed to various structural factors (Mojola & Wamoyi, 2019) and through social interactions with peers (Appadurai, 2004).

Structural restraints, and prohibitive social norms, influence young people’s agency – their intentionality and forethought, self-regulation, and self-reflectiveness about their capabilities and the meaning of their life pursuits – to achieve their aspirations (Bandura, 2001). Individuals’ agency to achieve their aspirations can be ‘thinned’ or ‘thickened’ by structures, contexts and relationships (Giddens, 1984). Individuals have thick agency in situations where they can act within a broad range of options, or thin agency when their actions and decisions are constrained by an environment with few alternatives (Klocker, 2007). Adolescents and young people often occupy a ‘liminal space’ between childhood and adulthood, (Sommers, 2012) forcing them to engage in creative ways to earn their upkeep in the short term, with less clarity about how to access opportunities to allow them to take up more adult responsibilities in the longer term (Boateng & Löwe, 2018).

The authors aim to describe the aspirations of AGYW aged 14–24 years, and to explore the extent to which aspirations are related to their sexual decision making in Tanzania. We also highlight how structural forces such as gender, social norms and economic abilities shaped aspirations, and consider implications for SRH intervention design.

Methods

This study employed a cross-sectional qualitative design conducted between January and November 2015 as part of the LINEA formative research, aiming to gain insight on emic perspectives on sexual exploitation, and transactional sex in particular (Howard-Merrill et al., 2020; J. Wamoyi et al., 2018; Wamoyi et al., 2019). For this paper we draw on six participatory focus group discussions (FGDs) with 66 participants, and 17 in-depth interviews (IDIs) with AGYW aged 14–24 years. Fieldwork was undertaken in two sites in the Mwanza region (one rural and one urban) of Tanzania.

Sampling and data collection

Sampling was designed to elicit a broad range of experiences and demographic profiles. Initial meetings with ward and village authorities, enabled researchers to purposively sample six unmarried young women, three in school, and three out of school. Using snowball sampling, the initial contacts introduced researchers to other girls in their network of friends to participate in FGDs. IDI participants were sampled from among the FGD participants based on their willingness to participate and their level of participation (enthusiastic or not) during the FGDs.

FGDs explored group-level views on AGYW’s aspirations as well as readiness for sex, understanding of sexual consent and sexual decision-making. No personal experiences were discussed, unless participants volunteered the information, which some did. The IDIs expanded on the topics covered in the FGDs, to gain a rich understanding of personal experiences, as well as providing a safe space to discuss personal issues. Participants were asked about what it means to be a popular girl; AGYW’s desires and hopes and; AGYW’s sexual decision making and behaviour. FGDs and IDIs followed semi-structured topic guides allowing for questions not included in the guide but of relevance to the study to be explored as they emerged. This open-ended, discursive approach allowed for an iterative process of refinement, whereby lines of thought identified by earlier participants were taken up and discussed with later participants (Mason, 2006).

Both the IDIs and FGDs were conducted in a private place selected by the participants in collaboration with the researcher. IDIs and FGDs were conducted by a researcher of the same sex and were audio recorded. IDIs took approximately one and half hours while FGDs took a maximum of two hours. The interviewers were trained social scientists with bachelor’s or master’s degrees and who had experience collecting sexual behaviour data.

The Medical Research Coordination Committee of the National Institute for Medical Research and the London School of Hygiene & Tropical Medicine provided ethical clearance for the study. All participants provided oral and written informed consent prior to participation in the study. Participants aged 18 and above provided informed consent while those aged 14-17provided informed written assent in addition to parental consent. Participants were informed of their rights to stop taking part at any time or skip any questions they preferred not to answer. All participants were provided with refreshments.

Data analysis

Data were transcribed verbatim, translated from Swahili into English, entered into QSR NVIVO 10 software, and coded by two researchers involved in the data collection, using a combination of a priori and grounded codes. The anticipated a priori codes were developed from the research objectives, prior knowledge, and repeated reading of the data during the early stages of the analysis, and then they were refined in light of further data. Two researchers in consultation with the data collection team thoroughly read the data to develop grounded codes that reflected the participants’ language and ways of expressing ideas. The researchers examined the coded data for emerging patterns. For example, the connection between aspirations and sexual decision making was examined by exploring codes on how participants talked about their hopes and desires for the future and missed opportunities in the past. Theories were formulated and widespread views supporting the emerging theories were examined alongside the outlier cases which were counter to the main theories.

Results

All the participants were single and lived with either parents or relatives. Most had completed primary school, and few had some secondary school education. AGYW from the rural setting were engaged in peasant farming while those from the urban setting were petty traders. A few did not have any source and income earning activity.

Aspirations that emerged as important in the lives of AGYW were categorised as short – and long-term. The short-term aspirations reflected the immediate hopes and desires of AGYW and were often driven by social norms, peer pressure, technology (e.g. mobile phones) and the globalisation of fashion trends. Long-term aspirations such as completion of education and marriage were influenced by social structures that shaped what AGYW considered salient goals to pursue. In what follows we describe how these aspirations influenced AGYW’s sexual decision making notwithstanding the influence of structural factors in shaping these aspirations.

Short-term aspirations and influence on sexual decision making

AGYW were aware of what it meant to live in poverty and aspired to have what they termed as ‘a good life’ free of poverty. Both in – and out-of-school girls equated a ‘good life’ to affording material items when they needed them and living in nicely built homes.

Sometimes you long for that home where your friend lives … they are well off … but where you live it is just poverty. You sometimes decide to stay at your friend’s place. (FGD, adolescents 14–17 years, in-school)

AGYW expressed strong aspirations for possessing what their peers had and commonly talked about wanting to be like other girls. They were under strong peer pressure to conform to a ‘modern’ lifestyle, commonly referred to as kwenda na wakati (going with the times). Examples of popular items that most girls aspired to have were: smart phone, food/snack during break time at school, and latest fashion clothing. To keep up with fashion and satisfy their desire to be like their peers, many girls reported having sexual partners who could provide for their needs, which often meant selecting older partners and engaging in transactional sex.

For example, someone might tell her boyfriend “I have seen so and so with a phone, I need a phone like that” … Also clothes. She has seen her peer with certain clothes that she has never owned … she asks herself, “why should she manage and not me?” … He [boyfriend] tells her, let us meet somewhere private … when the two meet they must have sex and he provides that thing. (FGD, adolescents 14–17 years in-school)

AGYW’s desire to meet their short-term material aspirations, weakened their power in sexual relationships, making them no longer able to successfully negotiate protection during sex. This seemed to be particularly apparent when those negotiations happened in the context of relationships where other power imbalances-besides the economic – were present, such as age-disparate relationships.

But as he gives you that money and other things that you want … it is him who decides on whether to use a condom or not because you can’t force him to use protection yet he is the one who buys it, “what if he refuses and says he doesn’t have money to buy it, what will you do? … Besides, he is older than you and you can’t stop him” (IDI, 17 year old school girl)

Long-term aspirations and influence on sexual decision making

The aspiration for a ‘good life’ was both a short – and long-term aspiration and was shared similarly among the in – and out-of-school AGYW. Considering it as a long-term aspiration, AGYW discussed completing school and having a career that could lead to a ‘good life’ and having a good social standing (respect) that was often linked to the aspiration of marriage.

Aspirations for a good education and career

Both in – and out-of-school AGYW thought that completing secondary school education and having a good career would lead to a ‘good life’. Interestingly, the out-of-school AGYW expressed an aspiration for education in stronger terms than those in school.

When an educated girl with employment comes back to the village, other girls aspire to be like her. They say, “at least so and so is educated. If I would have worked hard, I would be like her” (FGD, young women,18-24 year, out-of-school)

Many girls talked about career aspirations as something that develops from an early age. They reported that children start having ambitious ideas for their lives when they reach school grade three (at the age of 9–11 years) with role models playing an important part in influencing their career aspirations. AGYW described wanting to be like their teachers, musicians, nurses, and peers who were popular and successful. Role models also included groups out of their immediate social environment such as female politicians.

Now when they reach standard three or four, they start aspiring for something they would like to become … She wishes to be a teacher, a nurse like so and so … me too … or a singer … maybe a msanii [artist] like so and so. (FGD, young women ages 18-24-year-out-of-school)

Reflecting on education as a gateway to a better life, an out-of-school young woman reported:

Sometimes, I find myself wishing to be like an educated person, like a member of parliament or a minister. I say to myself, “If I would have gone to school, I would be like this woman” (IDI, 18 years, out-of-school)

While aspiring for education was common, not achieving it did not mean failure if one had accomplished other long-term aspirations, such as becoming married. A group of out-of-school girls reported:

There are others who have not gone to school but have been lucky to be married … they are also successful. (FGD, young women 18-24-year out-of-school).

Recognising that engagement in premarital sex could jeopardise the achievement of their long-term aspiration for education and a good career, a few schoolgirls talked about their desire to remain abstinent to maintain a good reputation in their communities and school. Showing her admiration for other girls, a schoolgirl reported:

You are attracted by her character and want to be like her, that girl who is a “superstar” at school … the way she is neat, she respects herself and does not engage in sex [abstinence],” (IDI, 16-year-old schoolgirl)

Many AGYW had limited capabilities to achieve some of the long-term life goals and aspirations. Out-of-school AGYW linked their inability to meet their career aspirations to poverty and thus not being able to complete their education. Failure to meet one’s aspirations about a career and/or school resulted in regret with many girls reflecting that they could have done better if they had completed secondary school. Many young single mothers, who had dropped out of school due to unplanned pregnancy, blamed themselves for not doing their best when they had the opportunity.

I too would have liked to continue with school because I can see my friend doing well [employed]. Considering that life is changing, I regret that I did not complete school. I wish I stayed in school to be like her and to know what she knows (FGD adolescents, 14–17 years out-of-school)

Aspirations for good social standing (e.g. respect, marriage)

Social aspirations for AGYW included heshima (respect), marriage and having children. Having heshima was a key social expectation shaped by social norms about acceptable behaviour for girls. Heshima determined a girl’s reputation and ultimately her marriageability. Respectful girls were those who behaved well, greeted adults respectfully by kneeling, obeyed adults, dressed in clothes that did not reveal their bodies, arrived home early, abstained from sex, and were quiet/settled (mtulivu).

I usually admire my friends that have good behaviour … I mean she has good morals … she is just calm. She is respected. (FGD 18-24-years, out-of-school women)

While the main reason AGYW selected older sexual partners was to meet their short-term material aspirations (e.g. keeping up with fashion), out-of-school AGYW described their main hope for relationships with agemates was their long-term aspiration for marriage and children.

When I start a relationship with my peer, I have good intention … the intention is that he would be my husband in future … but I can’t get into relationship with an older married man and have similar expectations for marriage … He [older partner] is mainly for fun (IDI, 18-year-old out-of-school)

Since the aspiration for marriage was salient for many girls, men used this to manipulate them into agreeing to have sex with them. A 17-year-old schoolgirl reported:

There are some who use deceitful means, he tells you I will buy you this and that, I will do this for you. He comes with things to convince you so that you can agree … He pretends to have a house … He takes you to the house of any of his friends … and you find that the room is actually good … But still you don’t know that it is his friend’s room, he promises to marry you … And when many girls are given hopes for marriage, they get very excited and confused. (IDI, 17-year-old schoolgirl)

Aspiration for freedom and independence

Despite the benefits of living in line with societal expectations for respect, many in-and out-of-school AGYW talked about their desire to develop their own personalities without interference from families and communities. Girls described their aspirations for freedom to do what they desired. Drawing on the aspiration to be like peers who enjoyed their freedom, schoolgirls reported:

Other things that will make you long to be like someone else is the freedom she has. You find that your friend has excess freedom and goes anywhere, including any entertainment joint that she wants. But you have never been allowed to go out even for a day … that contributes to girls running away from their homes to go stay with friends. I mean you long to be like her … .to walk around until the time you feel like going back home. Many girls long for freedom. (FGD adolescents, 14.17 years, in-school)

Most out-of-school AGYW were unemployed and depended on their parents and or partners to meet their material needs; as a result, they remained trapped in ‘child-like roles’ of dependence and lack of freedom. They described themselves as adults who needed to be independent but had limited capabilities to do so without employment or support from others usually sexual partners through transactional sex. An out-of-school AGYW reported:

To be honest, most youth don’t have jobs at the moment. Most parents look at them and think, “this is an adult and needs to be independent” but you find that she is still dependant. Most youth wish they could get a job … but getting a job has become very difficult. (FGD18-24-year-old out-of-school young women)

Discussion

We explored aspirations of AGYW and how these aspirations shaped their sexual decision-making. Generally, the short and long-term aspirations were similar among the in-and out-of-school AGYW. Many AGYW had ‘thin’ agency and while many were able to meet short-term aspirations, they struggled with the long-term aspirations. Although education is a prominent aspiration (Frye, 2012), our findings show that other immediate but important short-term aspirations could jeopardise AGYW’s achievement of this long-term goal. Many AGYW acknowledged that having a good education was important, but they still prioritised immediate and more easily achievable short-term aspirations such as dressing well, making themselves attractive to potential sexual partners and being valued by peers.

Due to the aspirational gap (Appadurai, 2004) that existed in the lives of AGYW, many aspired for similar-aged partners for marriage, but engaged in sexual relationships with older partners as a means of meeting short-term aspirations. The role of older sexual partners in adolescent girls’ sexual relationships and sexual health is well-documented (Longfield, 2004; Joyce Wamoyi et al., 2018) with epidemiological evidence showing an increase in SRH risks including unplanned pregnancy and HIV among AGYW women who engage in age-disparate sex (Jewkes et al., 2012; Pettifor et al., 2005a; Rositch et al., 2012; Steffenson et al., 2011). In order to address the risk of girls pursuing older partners for material benefits, programmes should address issues related to the aspirations window and the resulting aspirational gap (Appadurai, 2004), as well as social norms that put AGYW under pressure to consume trendy items.

Social aspirations on marriage and respect appeared more salient and realistic for many AGYW than individual level agentic aspirations related to educational achievement. The desire to be married was driven by the traditional gendered social expectations of a ‘good girl’, as other authors have also noted (Wight et al., 2006). Contrasting the aspiration for education and aspiration for marriage, that of marriage seemed more salient, achievable and socially binding compared to that of pursuing one’s education, especially for the out-of-school girls. Thus, achieving in education and failing to get married was frowned upon while, the reverse faced less disapproval.

As observed in our results and noted by others (Frye, 2012; Hart, 2012; Leclerc-Madlala, 2003), aspirations are relational, dynamic and are often connected to other aspirations held by the individual as well as by people influential to that individual within their context. The fact that the out-of-school girls aspired to be like educated girls in their community, shows how in-school girls have become aspirational role models to the out-of-school girls, whereas the aspirational window for the in-school girls is less clear.

AGYW’s perceptions of local formal employment opportunities influenced their aspirations, with many aspiring to be teachers and nurses. Although AGYW’s aspirations were largely shaped by peers, role models beyond their immediate social circles also played a role and reflected their aspirational window (Appadurai, 2004). For example, AGYW in a rural setting a thousand miles away from their communities, aspiring to be popular like a musician (in the city) or to be like a female member of parliament. Given the ‘thin’ agency reflected among many AGYW, achievements of such aspirations may be unrealistic. As noted by others (Appadurai, 2004; Ray, 2006), AGYW aspiring far beyond their current living conditions disincentivises change as they may lack power to enact the change.

Our findings showed that in as much as short – and long-term aspirations were interrelated in some ways they were also at times in conflict. One key example is that while ‘respectable’ behaviour involved being quiet and obedient and completing school, pressure from peers to make themselves attractive through obtaining items of modernity, pushed girls to behaviours (such as sex with older men) that led to them being disrespected by others. When aspirations conflicted with each other, AGYW prioritised those that were easily achievable at a particular point in time, which in most cases happened to be the short-term aspirations. As noted by others, in as much as AGYW might have their views of a particular imagined future, this is not equivalent to rational choice (Frye, 2012) and structural factors may be a major influence on their lives and imagined future and resulting to conflicting aspirations and increased sexual risk taking (Longfield et al., 2004; Wamoyi et al., 2016) in the pursuit of short-term goals.

In as much as long-term aspirations such as education and employment are key to achieving progress (United Nations, 2018), the lives of AGYW reflected an aspirational gap. AGYW were restricted by structural factors within their families and settings that limited their individual capabilities. The context of poverty and limited material resources affected AGYW’s life choices and outcomes as manifested in their portrayal of ‘thin’ agency. While many wished to pursue further education and vocational training and ultimately find employment, they were very much limited by what they could afford and what their parents were willing to invest, as well as by their current situations such as being an unmarried adolescent mother. Therefore, many of the long-term aspirations remained dreams that were unlikely to be realised.

Limitations

Since the theme on aspirations emerged from the data and was not directly included in the research questions, there was little data from boys to include in this analysis. We acknowledge that a focus on boys is worth investigating in further research, in particular their own aspirations as well as their influence on the aspiration of girls. Our analysis is not able to account for the changes in aspirations as adolescent girls’ transition into adulthood as it was a cross-sectional qualitative study.

Conclusion

Aspirations of AGYW were important in determining their sexual decision-making. Depending on the goals for particular AGYW, aspirations could both protect AGYYW and predispose them to risk. It is important that interventions capitalise on AGYW’s aspirations by developing innovative ways of engaging with them, based on their circumstances. Raising AGYW’s aspirations through education and employment are key in improving future outcomes. Group-based interventions supporting girls in reaching for education-related aspirations, supporting this protective norm and ideally shifting the focus from peer expectations for mobile phones and nice clothes is crucial. However, there are social and structural restrictions that ‘thin’ the agency of AGYW and hinder them from achieving their aspirations.

There were disconnects between short-term and long-term aspirations. Interventions need to have a strong local focus appropriately tailored to AGYW and in-line with their views of the future. Interventions should also find a common ground in the short and long-term aspirations and capitalise on them or on the aspirations themselves when addressing AGYW’s SRH risks and achievement of future goals. This could be achieved by supporting AGYW through a critical reflection process and in prioritising steps towards the long-term aspirations over short-term aspirations whilst addressing the structural constraints that would limit the achievement of goals. Failure to recognise these aspirations may lead to failure in the opportunities that interventions offer to AGYW as they may not resonate with their social identities and aspirations of local AGYW in Tanzania and elsewhere in sub-Saharan Africa. Finally, interventions should include role models within AGYW’s close aspirational window to provide SRH education and promote an alternate vision to adolescent motherhood by fostering girls’ desire to complete school and get a job, and access other income generating opportunities while also reflecting on the different needs of in and out-of-schoolgirls.

Acknowledgement

We are grateful to all the young people and adults who participated in this study. We benefited enormously from the work of four research assistants and acknowledge their contribution. This work was part of the LINEA initiative and the STRIVE Research Programme Consortium working group on transactional sex. The study was funded by OAK Foundation.

Disclosure statement

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

Additional information

Funding

The study was funded by OAK Foundation. The funder had no role in the design, analysis and write up of these results.