The sample included a wide range of participants from public institutions, faith-based organizations, and non-governmental organizations (NGOs) operating in the field of adolescent sexual and reproductive health and rights. In total, sixteen key informants participated in the study. There were nine participants (6 females and 3 males) from public institutions, six participants from FBOs (five males and one female) and one female participant from NGO.
Perceived determinants of early adolescents’ access to SRHR information
Need for information
Participants discussed several factors related to early adolescents’ access to SRHR information at the individual level. Need for SRHR information, the participants reported that early adolescents are curious and seek information from various sources including their parents. Nevertheless, the study noted that early adolescents are often not able to satisfy their curiosity through their parents and thus harbour misconceptions. Early adolescents feel shy to ask questions and think their parents would consider them disrespectful. In addition, participants felt that early adolescents do not know where to obtain the right information about gender and sexuality despite their curiosity about SRHR.
“They [early adolescents] do not know that they need information. When we talk to them at school, we find out that they are curious, but give us some wrong information about sexual and reproductive health. They do not know that they need the right information”. (P16, Male, Public Institution).
“They are not comfortable discussing their reproductive issues. They believe that parents would consider them as disrespectful, bad-mannered people, uneducated”. (P10, Female, Public Institution).
Age of initiating SRHR education
Participants indicated that the age of initiating gender and sexuality education is crucial. Nevertheless, they did not agree about the age. Some participants felt that such education should be delivered at a young age without indicating the exact time and according to children’s age. While other participants felt that ten years should be the age of initiating SRHR education.
“Even before they grow in early adolescents, they should be taught about gender and sexuality according to their developmental age”. (P01, Female, Public Institution)
“We realized that at 10 years, children are curious and start being exposed to those challenges of sexual and reproductive health information. Parents can prepare their children by starting to talk to them about sexuality.” (P16, Male, Public Institution).
Finally, the participants felt that early adolescents’ behaviours (like kissing and hugging) may have implications for their sexual health, including early pregnancy. Furthermore, some participants from FBOs and public institutions perceived that early adolescents learn some behaviours from music celebrities and renowned journalists who serve as their role models. Learned behaviours sometimes inspire early adolescents’ identity, behaviours and sexual experience.
“We teach them but we cannot say that we have reached a point where our children do not do those bad things. They tend to hug and kiss each other, which might lead to more actions. Some of them get pregnant earlier in primary, or secondary school, even in church choirs.” (P11, Male, FBO)
“They [Early adolescents] search for information about football or movies celebrities to know them more and choose those who can be their role models”. (P01, Female, Public Institution)
The findings indicated that sexuality is not a topic for discussion with children at the family level. The participants indicated that parents instead refer girls to other family members, such as aunties for specific sexuality information. In this perspective, aunties focus on sexual and reproductive health, norms, preparation for marriage, and good motherhood. On the other hand, boys have no specific sources for such information and figure out their sources of information. Furthermore, recognizing that parents’ knowledge and attitudes play a key role in delivering gender and sexuality education to early adolescents, participants noted that some parents lack adequate knowledge to deliver gender and sexuality information to early adolescents. Participants felt that educated parents are more likely to provide SRHR information.
“Parents do not have enough information. It might be that we are asking parents to teach children while they don’t have that knowledge as well.” (P14, Female, Public Institution).
Furthermore, participants noted that parental reluctance to engage with their children is due to the belief that their children may start behaving badly once informed. According to the participants, such belief is rooted in the cultural beliefs that gender and sexuality education induces children in sexual activity.
“People think that giving information to children means encouraging them to have sex”. (P16, Male, Public Institution)
Changes in family living conditions have resulted in absence of parents from their homes and the use of housekeepers who cannot adequately address children’s education needs. All participants noted that parents lack adequate time to care for their children. According to them, parents can introduce sexuality topics when spending more time with their children. Furthermore, participants highlighted that parents may be negative role models, who keep blaming early adolescents for their mistakes rather than preaching by good examples of their actions.
“I have noticed that different topics can come up when parents talk to children for a long time. However, when time is short, they do not. Parents reach home tired, asking if children did their homework and if they had appropriate meals. That is it”. (P08, Male, FBO)
“There are some parents, teachers, relatives of those adolescents who teach them what they do not do and who keep giving advice that does not turn into actions.” (P01, Female, Public Institution).
Language is a concern in that there is a lack of appropriate language about genital parts in Kinyarwanda. The participants noted that words on this topic are very rude, uncommon, and hard to say to children. They indicated that they use alternative words in Kinyarwanda. Nevertheless, the participants said they were comfortable talking about sexuality in foreign languages such as French or English. Findings further suggested that challenges related to the language can be addressed by using a guide entitled ‘Tuganire Mwana Wanjye’ [Let’s Talk My Child]. The purpose of the guideisto help parents to find the appropriate word to facilitate parent-child discussion on sexuality education in the local language, Kinyarwanda.
“For instance, saying the word ‘penis’ in Kinyarwanda is considered a problem; but it sounds fine in French or English”. (P16, Male, Public Institution).
In addition, the findings revealed that it is culturally inappropriate that parents to deliver gender and sexuality information to children. Accordingly, sexuality is a taboo topic and has been that way from generation to generation.
The Rwandan culture influences parents to not talk to their children about reproductive health. Many people don’t talk about it. It is a taboo subject. It is due to the way people are raised.” (P10, Female, Public Institution).
The findings indicated that early adolescents receive some normative information from their peers which has implications on their sexual health outcomes. One of these norms is the general expectation that girls should not talk about having sex, leaving the decision-making power to boys. Accordingly, girls remain silent about their sexual needs. The participants noted that this silence compromises girls’ rights, especially those related to access to information on safe sexual relationships with peers. The study also highlighted the existence of other harmful sexual norms. While boys perceive girls as money eaters, girls believe that boys are providers and hunters for sex. According to participants, the consequence of these norms is that girls need to have sex if they get any money/presents from boys.
“They [boys and girls] never set a talk on whether the boy wants to have sex. In some cases, the girl also wants it and it is her right to say she wants it. The problem is that general expectation that a girl should never talk about having sex”. (P02, Female, NGO)
“Girls grow up shy because culture expects them not to speak in public. Therefore, it is easy for anyone to deviate or fool them because they cannot speak up as the society expects them to always be quiet”. (P14, Female, Public Institution)
“Boys should always pay everything for the girl. This is associated with the idea that if he spends money on a girl according to the norm, she should also pay him back. Therefore, he expects that pay like to have sex.” (P02, Female, NGO)
Finally, there are peer pressures that contradict the social expectation of remaining virgin for girls until marriage, sticking to one girlfriend, proving love through sexual intercourse, and keeping sexual relationships with boy/girlfriends.
“Peers spread messages that are in contrast with the social culture or expectation of being virgin until marriage. For example, a real boy has sex with multiple girls; or similarly for a girl: you’re not a real girl until you lose your virginity”. (P13, Female, Public Institution)
Content of the curriculum
Although most participants delivered SRHR information to early adolescents, there was disagreement about the content of the information. While churches focus on the ‘Word of God’ that prohibits premarital sexual activity, participants from public institutions suggested that churches should go further and teach early adolescents about having safe sex. They indicated that SRHR education should also encompass modern contraceptive methods in addition to the natural ones promoted by FBOs. The participants from FBOs focus on the moral values of virginity and chastity while government education introduces condom use.
“The church education focuses on moral values. We teach them by good examples of their grandparents, parents, elder brothers, and sisters who resisted rape until they died for it; they refused to break their virginity. We teach them about virginity and chastity.” (P07, Male, FBO).
“ There are people who only teach that having sex is a sin without explaining more. They do not go beyond that to suggest means for safe sex.” (P16, Male Public Institution)
“We need to avail emergency contraceptives to early adolescents who fail to abstain from sexual intercourse to prevent unplanned pregnancy. (P16, Male, Public Institution)
The findings noted the patriarchial culture, where children belong to their fathers, imposes differences in gender roles and responsibilities between girls and boys. Such disparities favour boys more than girls. The study indicated girls are supposed to perform mainly home activities while boys are assigned manly tasks that generate income. Despite equality of men and women in law, some participants indicated that gender equality is not achievable given their differences in nature and cultural expectations. The study also highlighted that both boys and girls face a different kind of pressure related to social expectations, mainly those related to marriage.
“Men and women cannot be equal by nature, image and powers. I do not deny their equality by law. However, family responsibilities make them unequal”. (P09, Male, FBO)
“For example …, boys have to handle all problems. They have to work hard and build a house, then get married. Girls face a cultural challenge of early marriage. It is believed that when girls do not get married earlier they will not survive. They marry husbands they have never thought of.” (P08, Male, FBO)
“You find a boy is given freedom, while the girl is denied freedom. To boys having sex is not a big concern, which is different for girls. However, it is a concern to both of them as they are all affected by having sex”. (P16, Male, Public Institution).
The findings also indicated that the culture contributes to uneven gender considerations in terms of decision-making power. The participants depicted men or boys as owners of power and decisions to initiate sexual relationships while women or girls were subject to submission. Accordingly,boys tend to appear as protectors of girls while the latter act as weak even when they are strong, avoiding boy-like behaviours.
“Culturally… it is well known that husbands are strong to protect their wives. Even if a wife is strong, she has to act simply and flexibly. She expects and enjoys protection from her husband (P01, Female, Public Institution)
In addition, the study noted that compared to girls, boys enjoy more power over their sexual health. However, participants recognized that women have the right to make sexual decisions to avoid related health risks. Given this unequal decision-making power, boys might abuse these powers through initiating early sexual intercourse. The study also indicated that it is taboo for women and girls to express their sexual desires.
“Men are entitled to making decisions about their sexual health while women are not. … from culture to reality, everyone who has a normally functioning brain has the right to take decisions mainly those health-related ones.” (P01, Female, Public Institution)
“Boys are expected to initiate of relationships with girls. They may fall into early sexual intercourse with young girls because of the perception that being a man is showing their strength to girls”. (P05, Male, Public Institution).
“It is taken as a taboo [for a woman] to tell her husband that she wants sexual intercourse while as a human being, she might also wish to have sex”. (P01, Female, Public Institution).
Finally, the culture maintains some sayings that nourish imbalances in sexual decision-making powers. One of these sayings is about the irresistibility of men towards their sexual drive and their entitlement to multiple sexual partners. Such a saying has some implications for young boys and girls’ behaviours who grow in an environment where such beliefs still hold.
“A Rwandan proverb says that bulls are irresistible whenever they want sex (‘Imfizi ntiyimirwa’). Boys grow up as such and behave like their father with such beliefs.” (P01, female, Public Institution).
The findings indicated that religions have a role in delivering gender and sexuality information to early adolescents. The study indicated that some churches deliver gender and sexual and reproductive health information which influences early adolescents’ knowledge, beliefs, and behaviours. However, some churches are reluctant to teach about sexuality, regarding it as a sin. According to the findings, FBOs consider that providing sexual and reproductive health education to early adolescents promotes immorality and violates God’s commandment of abstaining from sex. Furthermore, FBO participants indicated that delivering such information may encourage early adolescents to have premarital sex.
“The church education focuses on moral values. We teach by good examples of their grandparents, parents, elder brothers, and sisters who resisted rape and refused to break their virginity. We teach early adolescents to abstain from having sex, remain virgin and chaste using examples of the Virgin Mary and other Saints who died because of protecting their virginity.” (P07, Male, FBO)
“Teaching children to use a condom means inviting them to have protected sex. If the commandment says not to abstain from sex, it would be a contradiction because whether sex is protected or not, that commandment would be violated. This is immoral, misbehaving”. (P11, Male, FBO)
Some participants highlighted that the misunderstanding of the Holy Scriptures contributes to gender inequality. They believe that some church members misinterpret the Holy Bible by saying that men have authority over women and take it as a rule.
“Some of us who are not able to explain well the Bible tells you that a husband has authority over his wife and take this as their guiding principle. Even their wives accept it as such. It is taken as a rule set by God while this is a misinterpretation of the Holy Scriptures.” (P07, Male, FBO)
According to participants, economic factors such as financial means were related to early adolescents’ access to gender and sexuality information. The study specifically highlighted that inadequate financial resources to generate information tools such as books and training modules were an important challenge to enable early adolescents’ access to gender and sexuality information. They also noted that even the existing teaching materials were not adequately designed for local realities. They further noted issues of shortage of skilled and qualified personnel, as well as the inability to exploit available communication channels including social media in delivering SRHR information.
“It also requires financial means. Books are expensive... Modules require time to generate.” (P17, Female, Public Institution)
“There are no materials unless those found in biology but it’s not also from our culture. They are most often brought from different NGOs. The package from NGOs is always wrong. You may find in the preparation a white woman sitting around, and it is a problem.” (P08, Male, FBO)
“We have a shortage of employees to deliver sexuality information….Another barrier is technology use. We would like to send that information using WhatsApp and other social media but it is still expensive and children do not access it on phones.” (P16, Male, Public Institution).
Policies and laws
Participants also raised discrepancies in policy-makers views about instilling family values in early adolescents. To illustrate this, one participant gave an example that some policy-makers support women’s dressing styles and their rights to dress the way they wish; while some others believed that women’s dressing styles sometimes compromise the ideals of the family through exhibiting “their private parts” to other people, especially children. According to that participant, while children need a family that serves them as a model, some policy-makers believed that letting people (especially women) dress the way they want does not serve this purpose. The participant raised the need to address this confusion in family ideals and the respect of rights to dressing styles.
“Even family policy-makers have a divided perspective on the ideal family. One says that parents should be exemplary to children by their dressing styles. Another says that culture evolves; people have the right to dress the way they want and to display their beautiful body parts, including their breasts. Commenting on women who are ‘naked’ in front of their children means violating their human rights, especially women’s rights. There is confusion in our society!” (P05, Male, Public Institution).
Furthermore, the participants criticized the processes of setting gender and sexuality policies as inadequate, as they do not involve people from all layers of the community including the elderly people. The findings indicated the need to set evidence-based policy through research. They noted that some of these policies were imported from the Western World and rapidly implemented in settings where they sometimes have no relevance. Participants also noted that policy content should reflect community members’ perspectives.
“The family members, especially elderly people from the villages, are not consulted. If they [policy-makers] could approach them, they would learn about what used to happen 20 years ago, how women behaved towards their husbands and how the husbands behaved towards their wives, and what made them keep their family secrets.” (P05, Male, Public Institution)
“Policy content should not be imposed. Policy-makers abruptly come up with content from European countries. They do not research to get informed about the local context to include community members’ cultural perspectives.” (P08, Male, FBO)
Concerning laws, participants from public institutions noted the need to solve specific reproductive health problems and revise laws to allow children to make use of emergency contraceptives when needed.
“We should also revise current laws to support children who have difficulty to abstain from sex and need emergency contraceptives.” (P16, Male, Public Institution).
Participants’ views and perceptions on SRHR information
The participants reflected on the role of gender and sexuality education in moulding early adolescents’ behaviours and their future life, stating that knowing that their bodies are changing, give them opportunities to manage those changes through appropriate decision-making. The participants also indicated that SRHR education has the potential to facilitate early adolescents’ positive attitudes towards their sexuality, enabling them to better manage their sexual instincts, the relationships between boys and girls, as well as dynamics associated with mutual sexual attraction. The SRHR information was perceived by participants, not only as means to promote the well being of early adolescents, but that of their families and wider society. Participants stated that sexuality education is meant to enable recipients to plan for their health, particularly their sexual and reproductive health. Hence the view that it is crucial for the general wellbeing of the wider society, as it is believed that such education enables people better plan when to have offsprings.
The participants noted the role of gender and sexuality education in creating awareness of similarities and differences between boys and girls, suggesting that such self-awareness increases recipients’ ability to exercise their rights in the context of culturally accepted inequalities between boys and girls.
“Gender education increases early adolescents’ self-awareness and the knowledge of their rights. Our culture imposes inequality between a boy and a girl. Changing that mindset is a journey to equality”.(P15, Male, Public Institution)
“Adolescents face many challenges that they can solve only if they know. They can be aware of the right time to do sex and how to protect themselves against sexually transmitted diseases, as well as other consequences. Teaching them earlier helps them to make informed decisions”. (P16, Male, Public Institution)
The participants further noted how gender and sexuality education contribute to increased knowledge of SRHR related needs and rights among adolescents while providing the necessary support.
“During menstruation, some adolescent girls fall sick, and school performance slows down. A society that is aware of this provides special support to that adolescent girl. They know specific needs and challenges associated with this developmental stage including sanitary pads” (P03, Female, FBO)
Providing sexuality and gender education was also viewed as an opportunity to start early to prepare adolescents for marriage and family life.Correspondingly gender issues were considered a concern for both boys and girls, hence the proposal to educate adolescents about teamwork and building strong family relations when they get married.
“This education help early adolescents to apply these principles in their daily life as we prepare them for marriage during this period of early adolescence. Gender introduces teamwork and is key in building a strong family when married”. (P03, Female, FBO)
The need for gender education specifically to address unequal distribution of tasks between boys and girls was highlighted. Participants felt that it was important to get early adolescents aware that no specific domestic task should be devoted to boys or girls, arguing that gender education is needed to address the issues of boys’ sexual harassment and lack of respect towards girls.
“Sometimes boys harass girls because they were not given lessons about respecting their colleagues [girls]. When boys are not timely educated about respecting girls, they may induce them in sexual intercourse, which may result in early pregnancy and school dropout”. (P12, Male, FBO)
Concerning the concept of gender, the participants were of the view that this concept remains obscure in the context of Rwanda, due to the lack of its standard definition. They noted that the community does not clearly understand the meaning and dimensions of gender. Participants felt that the concept of gender has several ideological meanings that are not translatable to Kinyarwanda. The concept was therefore found to be difficult to teach to early adolescents who learn better from things that can be verified, rather than ideologies. This lack of a standard definition of gender hampers the selection of gender content to be taught to early adolescents.
“There is still a problem of lack of standard definition of gender. What is the appropriate subject to teach about it? It is still a problem as long as there is no clear definition of gender in our context”. (P08, Male, FBO)
Sources of gender and SRHR information
The participants indicated that early adolescents access SRHR information through multiple sources. The findings indicated that these sources have diversified because of technological advancement. Some of the sources that have emerged include mobile phones and television. These sources inform early adolescents in many ways. However, given the diversification of sources of information on gender and sexuality for early adolescents, especially online sources, participants noted that the Government of Rwanda has established a policy to regulate the use of these online sources by children to prevent access to harmful content. A participant from an FBO indicated these various sources as follows:
I think they [early adolescents] get such information from their friends, parents. Schools deliver such information as well. They also access information through information and communication technology, the internet, mobile phones, YouTube, and others. (P03, Female, FBO)
There is a policy called ‘Child Online Protection Policy’ to protect children from using the internet abusively (P01, Female, Public Institution).
Furthermore, the participants noted the schools as the sources of SRHR information through the comprehensive sexuality education (CSE), whereby gender and sexuality are taught as crosscutting courses with a different weight in the curriculum. According to the participants, the school setting also offers an opportunity to early adolescents to learn about gender and sexuality through gender and health clubs. Gender clubs teach about gender issues including gender equality; while health clubs are concerned with many health issues including sexual and reproductive health issues, prevention of HIV/AIDS, hepatitis, and nutrition among others. Nevertheless, the content of the CSE remains a concern for some participants. Participants noted that the selection of CSE requires the respect of culture and inputs from education stakeholders. They indicated that some aspects of the CSE curriculum such as the dating scenarios might have consequences on early adolescents’ behaviours. Participants believe that dating activities may result in sexual activities if children are not adequately overseen in both the school and family environments. In addition, participants were concerned that involving students in scenes of dating each other and doing some discoveries is against morals and culture.
“Some lessons may invite students into early sexual activity and/or early pregnancy when it comes to in-class dating exercises and reaching an agreement on having safe sex using a condom. It becomes hard to continue protecting them from sexual activity on their way back to their families or later.” (P08, Male, FBO)
Despite reporting that adequate SRHR information should be delivered in schools, the findings indicated that teachers face some challenges including their personal beliefs and attitudes, and lack of skills to deliver such education.
“We know in many schools, this is not implemented the way it should, because personal beliefs of teachers, because of lack of skills”. (P02, Female, NGO)
In addition to schools, the participants highlighted health facility-based SRHR information delivery to early adolescents through youth corners:
“We trained at least two people in every health centre. The program is in place. Early adolescents receive information on sexual and reproductive health from the youth corner, at the health facility level.” (P16, Male, Public institution).
Radio and television and the use of mobile phones were reported as important means to deliver SRHR information to early adolescents in general. These radio programs include “Urunana” and “Ni Nyampinga”. Urunana targets the general population while Ni Nyampinga focuses on delivering SRHR information to young girls. Ni Nyampinga focuses on girls’ abstinence and/or use of a condom. This program calls young girls to use abstain from sex or use condoms in case abstention fails. Furthermore, “Mobile for Reproductive Health” (m4RH) is another program through which adolescents, including the younger ones, access SRHR. Using mobile phones, m4RH sends SRHR messages to children.
Furthermore, the participants reported that early adolescents seek SRHR information from social media, including YouTube, Facebook, WhatsApp, and the internet. However, they noted that some of these internet sources spread incorrect SRHR information. The participants highlighted disparities in SRHR sources between rural and urban settings. They revealed that early adolescents from the urban setting have social media as their main sources of information while those from rural settings rely on schools as their main sources of gender and sexuality information.
“Concerning reproductive health, they may get wrong information that may lead them to early sexual intercourse. I have heard about two bad women who always teach about the labia elongation culture on the internet”. (P03, Female, FBO)
The participants noted the role of various governmental, local, and non-governmental leaders in delivering gender and sexuality information to early adolescents. They however noted the need to harmonize delivered SRHR information and consider their audiences, namely their age.
Furthermore, the participants indicated that the churches delivered SRHR information to early adolescents on a part-time basis and about the “Word of God” and avoiding premarital sex.
Churches organize seminars for young children and early adolescents, but not regularly. As churches focus on the Word of God, they call them not to have illegal sexual activity. (P03, Female, FBO)