Addressing Social Norms for Adolescent Timing and Spacing of Pregnancy in Low and Middle-Income Countries: Developing a Global Research Agenda

"The social norms research agenda described here offers consensus-based global priorities for research investment in social norms research in the area of adolescent and youth healthy timing and spacing of pregnancy."

Social norms shape sexual and reproductive health (SRH) behaviours globally, including contributing to the unmet need for contraception and unintended pregnancy among adolescents in low- and middle-income countries (LMICs). Evidence is building on the power of norm-shifting interventions (NSIs), an emerging focus within social and behaviour change (SBC) programmes focused on healthy timing and spacing of pregnancy, to improve contraceptive outcomes. This paper describes the process and results of developing a global public health social norms research agenda to improve adolescent healthy timing and spacing of pregnancy in LMICs. The goal is to reach a broad range of stakeholders, including funders, researchers, implementers, and policymakers, to crystalise and catalyse the next phase of social norms implementation research to achieve improvements in youth SRH by 2030.

This initiative constitutes the concluding deliverable of The Passages Project, an implementation research project spanning from 2015-2022 that aimed to address a broad range of social norms, particularly among adolescents and youth, to sustainably improve reproductive health and gender equality at scale. See Related Summaries to access some of the materials that emerged from this project.

To develop this research agenda, the researchers adapted and applied the Child Health and Nutrition Research Initiative (CHNRI) method, which empirically crowdsources global stakeholder opinions through online surveys to systematically set research agenda priorities based on stakeholders' ratings. Research questions for prioritisation were developed and proposed based on the results of an unpublished scoping review, conducted as part of a separate activity under the Passages project. The 185 survey participants (global stakeholders) responded to 21 research questions via an online survey. They scored each research question according to four criteria (fills key gap, feasible, impactful, equitable). Research priority scores (RPS) and average expert agreement (AEA) statistics were calculated for each question and analysed overall and by stakeholder region and profession.

The RPS ranged from 52 to 81% (74% median), and the AEA ranged from 49 to 70% (58% median). Nearly 70% of stakeholders gave the same score to each of the top five research questions. The top five research priorities focused on effective NSI strategies, processes and indicators to NSIs, and NSI adaptation and scale-up. Thus, a large and diverse group of global stakeholders agreed that the priority is to conduct research on "what works" to design, implement, and scale effective NSIs, rather than to generate exploratory or descriptive knowledge of social norms generally. 

In the final webinar and on the research question priority scoring survey, the researchers asked participants for suggestions to improve the research agenda or process of developing the research agenda. Suggestions received included: focusing on youth participation in research, avoiding specialist terminology, and, in future initiatives, improving the equity scoring criteria, which some found confusing. Others found some of the research questions too general and in need of cultural contextualisation. To address these concerns, two cross-cutting questions were added to: better understand cultural considerations; and better understand approaches and the impact of involving young people in designing and implementing research.

In conclusion: "Vetted across regions and disciplines, these research priorities provide a roadmap for researchers who wish to advance knowledge and, subsequently practice, of the design, implementation, monitoring, adaptation and scale of norm-shifting interventions in ways which resonate with global and local stakeholders."