Qualitative Study of SKILLZ to Prevent Gender-Based Violence and Improve SRHR among Adolescent Girls and Young Women in Zambia

Brief Summary

Background

Adolescent girls and young women in rural Zambia face high rates of early pregnancy, HIV risk, and gender-based violence, driven by poverty, peer pressure, and limited access to youth-friendly health services.

What Grassroot Soccer did

Grassroot Soccer and local partners conducted a baseline qualitative assessment across three rural districts in Zambia. The assessment engaged adolescents, parents, community leaders, and health workers to understand barriers to sexual and reproductive health and rights before launching the Leveling the Field Phase 2 program.

What the study found

Key drivers of early sexual activity included peer pressure, poverty, and lack of information at home. Adolescents (particularly girls) faced significant barriers at health facilities, including unwelcoming staff, stigma, and confidentiality fears. Parents recognized the importance of open conversations but often felt ill-equipped to have them.

Why this matters

These findings reveal the multi-level barriers that programs must address to improve adolescent girls' health outcomes. Centering adolescent voices in program design and improving the quality of health services are essential steps toward meaningful and lasting change.

DETAILED SUMMARY

Importance

Adolescent girls and young women (AGYW) ages 15-24 years in Zambia face poor sexual reproductive health and rights outcomes. According to the 2018 Zambia Demographic Health Survey, 69% of women began sexual activity before 18 years, 29% of women aged 15-29 years were already mothers or pregnant, and rural young women aged 15-19 were twice as likely to have begun childbearing as urban peers.

Objective

To conduct a baseline qualitative assessment of the barriers and facilitators to sexual and reproductive health and rights (SRHR) and gender-based violence (GBV) prevention services among adolescent girls and young women in rural Zambia, informing the design of the Levelling the Field Phase 2 program

Study details

Study design: Qualitative study; no control group
Data collection tools: 17 key informant interviews with program implementers, health staff, and community leaders. 12 focus group discussions with adolescent girls and boys as well as parents and community members
Participants: Adolescent boys and girls aged 10-24 living with HIV, parents, community members, community leaders, health facility and school staff, Ministry of Health and Ministry of General Education officials, and GRS coaches and partner staff
Implementation setting: Community and health facility settings in 3 rural districts (Nakonde Mongu, and Chipata) in Zambia (rural)
Study period: April 2022

Intervention

Other (Levelling the Field Phase 2): A girl-centered, sport-based GBV prevention and advocacy program targeting 10,125 AGYW aged 15-24 years, including those at risk of or who are survivors of violence. Implemented by GRS in partnership with Muchinga Corridors (MC) and Adolescent Reproductive Health Advocates (ARHA).

Results

Focus group discussions suggest that early sexual debut was driven by peer pressure, poverty, transactional sex, curiosity, hormonal factors, and exposure to sexual content through social media and films. One adolescent explained: “There is a lot of pressure from friends since everyone is doing it.” (adolescent participant)
One parent acknowledged: “It is uncomfortable but experience has taught me that silence is worse.” (parent participant)
Barriers to accessing SRHR services included distance to facilities, inconvenient hours, lack of youth-friendly spaces, fear of breach of confidentiality, and stigma.
“When we go to the clinic the main challenge is how we are received. Some are not very welcoming.” (adolescent participant)
Peer influence was the dominant driver of adolescent sexual behavior, with social comparison and material pressure playing key roles, especially for girls.

Conclusions and implications

Cultural norms, limited parental engagement, inadequate health service quality, and exclusion of adolescents from program design are the multi-level barriers to adolescent SRHR and GBV outcomes in rural Zambia Cultural norms.

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Citation

Year: 2022

Authors: Grassroot Soccer

Grassroot Soccer. Baseline evaluation report of the Levelling the Field Phase 2 Project using a girl-centred approach [report]. Zambia: Grassroot Soccer; 2022.