Adolescent & social norms

Mozambique has some of the world’s worst social indicators on children and adolescents, particularly girls, largely due to limited access to resources and services as well as harmful socio-cultural practices. 

More focus now needs to be placed on supporting adolescents, who are the fastest growing population group in Mozambique; an estimated 45 per cent of the population is under 15 years of age and 52 per cent below 18 years. 

The population group has some disturbing indicators. For example, almost one in two girls were reported to be married or in a union before reaching 18 years of age. Child marriage is a human rights violation that denies millions of girls their childhood and puts them at risk of early pregnancy, violence, abuse and neglect. Linked to this, is the rate of early onset of sexual intercourse, with 22 per cent of girls and 17 per cent of boys aged 15–19 years initiating sexual activity before the age of 15. Moreover, 9 per cent of girls and 3 per cent of boys aged 15–19 reported experiencing sexual violence. Intergenerational and transactional sex practices are prevalent throughout the country.

The early onset of sexual relations has also contributed to the high level of HIV among adolescents. Epidemiological models estimate that 120,000 adolescents in the country live with HIV, of whom 80,000 are girls. Moreover, estimates for 2014 show that 18,000 adolescents aged 15–19 became infected with HIV that year, most of whom (14,000) were girls compared to boys (4,000). HIV prevalence is significantly higher in girls than boys in the 15–19 age group, 6.5 per cent for girls compared to 1.5 per cent for boys. In the 20–24 age group the disparity is 13.3 per cent compared to 5.3 per cent. It is estimated that of all girls living with HIV, 60 per cent were infected in their second decade through sexual transmission versus 19 per cent of their male counterparts. Of particular concern is the fact that HIV testing among adolescents and young people (15-24) is low at 32 per cent for girls and 15.5 per cent for boys.

Most young people’s beliefs, attitudes and behaviour on health, nutrition, gender roles and HIV are shaped by local cultures and traditions and transmitted and sustained by community institutions, religious leaders and opinion-leaders such as the madrinhas (godmothers) and matronas (traditional birth attendants) who are involved in girls’ initiation rites. Low levels of literacy, especially among females, mean that access to information is mainly oral, highlighting the importance of community-level communication, especially radio broadcasts in local languages and face-to-face communication. 

Overall, there is better coordination for adolescent action within and across government and non-government sectors. But still, current monitoring and evaluation systems and platforms do not appropriately capture adolescents, lacking age disaggregation of the 10–14 and 15–19-year-old age groups, thereby making it difficult to ensure relevant and quality adolescent programming. 

The focus is on promoting and protecting the rights of adolescents, particularly girls, to enable them to adopt healthy behaviours that promote well-being. Strategic behaviour and social change programming will cut across all sectoral areas, notably health, nutrition, water, sanitation and hygiene, education and protection, using community-based platforms and media. 

HIV will receive special attention with the goal of reducing the risk of HIV infection and stepping up efforts towards an HIV-free adolescent generation. At the same time, UNICEF will encourage efforts to ensure that adolescents and young people have the space, voice and influence their need to make a difference in their world.

UNICEF will build on past successes to increase participation by encouraging positive behavioural change among adolescents and young people as well as leveraging national and local partnerships to create synergies for change. This will involve multi-sectoral coordination around policies and strategies relevant to adolescents; leveraging domestic and partner resources; promoting institutional capacity-building in communication for development; and fostering adolescent engagement and participation.

The main areas of support are:

Eva, 19, who lives with her grandmother in the heart of the capital Maputo, says she only feels able to discuss sexual reproductive health with her “best friend”.

She discovered her “best friend” when a youth activist came to her school to give a talk about SMS BIZ/U-Report, a programme providing peer counselling over the phone that is supported by the government, through the national Geração BIZ programme, and by UNICEF, UNFPA, the youth association Coalizão and other partners.

The SMS BIZ /U-Report platform (www.smsbiz.co.mz) targets adolescents and young people aged 10–24, allowing them to receive counselling from trained peers, respond to polls and report issues related to sexual reproductive health, HIV, violence and sexual abuse, and child marriage.

Eva (whose name has been changed to protect her privacy) says, “SMS BIZ is like a best friend as I can ask those things I’m unable to talk about with my grandmother.” 

Eva gives the example of when she was confused about whether to start a sexual relationship. “I felt pressurized by my boyfriend; I didn’t know what to do, so I sent a text to SMS BIZ. The counsellor informed me that I should only have sexual relations when I was ready, and it was better to wait. He also advised me to attend an adolescent and youth-friendly health service clinic.” Eva adds that she has received advice from SMS BIZ on other occasions too, “on HIV testing and condom use and once when I had a vaginal discharge.”

Following the initial counselling session, Eva says she felt more confident to negotiate with her boyfriend about delaying sexual relations. And when Eva was ready, she followed the youth counsellor’s advice: she and her boyfriend had HIV tests and also use condoms. 

Eva is just one of tens of thousands of young people who use SMS BIZ. Since its launch in October 2015 until end-2017, over 130,000 adolescents and youth aged 10–24 registered to use SMS BIZ either for counselling services or in polls. The programme is now expanding nationally.

SMS BIZ is especially relevant for a country like Mozambique, where adolescents are the fastest growing section of the population, with an estimated 23 per cent aged 10–19.

Yet, they are particularly vulnerable. The country has one of the world’s highest rates of child marriage (the tenth highest rate of child marriage globally) affecting almost one in every two girls; 48 per cent of girls marry before the age of 18 (DHS 2011). Additionally, an estimated 120,000 adolescents are living with HIV, of whom 80,000 are girls. In 2014, an estimated 18,000 adolescents aged 15–19 were newly infected with HIV, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS) Global AIDS Report (2014).

Despite this, adolescents and youth find it difficult to talk openly about sexual reproductive health, including HIV. As SMS BIZ counsellor, 20-year-old Celestina Buques explains, “Although there is information out there, I think in our culture it’s taboo to talk about these issues.”
SMS BIZ, however, manages to overcome this, as Salvadore Tsobo, a 20-year-old student in Maputo, observes: “You don’t feel embarrassed or even scared about seeing how the person is going to react as it is over the phone. It makes me feel free to talk.”

Moreover, UNICEF Chief of Communication for Development in Mozambique, Yolanda Corriea, says, “SMS Biz/U-Report also allows for meaningful participation and engagement of both adolescents and young people on critical issues that affect them, including early marriage and pregnancy, gender-based violence, and HIV.” 

Aida Novela, the coordinator of the SMS BIZ counselling hub, who has been a youth activist since 2007, says “sexuality, family planning and pregnancy, and HIV prevention, transmission and treatment are the top three most-discussed topics.”
 

She points out that about 44 per cent of SMS Biz users are female. “We try new ways to encourage girls and young women to use the service, especially in rural areas; for example, we have had polls on female issues, like menstruation.” A girl-to-girl invitation system is also being developed by UNICEF to increase the number of girls registered to the platform. Novela adds that as they expand nationally, they will also need more trained counsellors. 

Presently, there are 48 counsellors that work in three shifts. They sit in one room using phones which are linked to laptops. Custodio Vilanculos, 25, is on the morning shift. “I became a counsellor as I want to help young people and give them information so they can make the right decisions about their health and well-being,” he says enthusiastically.

Vilanculos explains that although there are health services for young people, sometimes they get bad experiences, like one girl with whom he interacted. “She told me that she had attended a health centre for a consultation about a possible sexually transmitted infection. But the nurse was critical of her asking, ‘who told you to have sex without a condom?’ They should be helping her not judging her. So, I advised her that she shouldn’t have had that experience and I recommended a different clinic where I knew she would get good care.” He adds that, although the service is anonymous and they never meet the client personally, as “each case has a code they follow up until it is resolved.”

Meanwhile, Eva says that aside from being her best friend, SMS BIZ has also made her decide on a vocation in life. “I want to be a nurse. I find sexual and reproductive health interesting and I have already learnt a lot,” she says, smiling confidently.