Working document- Please do not circulate or quote without N’weti permission
Audience Research Study on Sexual and Reproductive Health in Maputo, Manica and Nampula Provinces
Maputo, August 2011
N’weti reference group
Denise Namburete
Eduardo Costa
Sansão Dumangane
Research team
Emídio Gune (Principal Investigator)
Aurelio Miambo, Fernando Tivane & Emídio Gune (Researchers-Maputo)
Farook Aboobakar (Researcher- Manica)
João Nobre & Aurélio Miambo (Nampula-Researcher)
Preliminary report prepared by:
Rua das Mahotas n° 132, 2° floor, door No 6,
Fax & Phone n°21304144
Mobile phone n°823141760
Maputo-Mozambique
Maputo, August 2011
Contents
I. Introduction
III. Method
2.2. Ethical considerations
2.3. Data processing and analysis
III. Audience main characteristics
3.1. Young adults
3.2. Parents, relatives and high mobility groups
3.2. Health providers
IV. Formal and traditional providers of sexual and reproductive health services
V. Knowledge, attitudes and practices regarding sexuality and pregnancy
5.1. Promotion of sexual and reproductive health at community level
5.2. Reasons enabling healthy sexual and reproductive practices
5.3. Barriers to healthy sexual and reproductive health
5.4. Gender norms and the promotion of healthy sexual practices
VI. The influence of high mobily population on sexual and reproductive health
VII. Conclusions and recommendations
Working document- Please do not circulate or quote without N’weti permission
I. Introduction
Recent figures, by the Ministry of Health of Mozambique (MISAU), show that STI’s and HIV rates are higher among young and educated people living in urban areas and lower among young and uneducated people living in rural areas (MISAU 2009). The presence of high mobility groups facilitated by the presence of corridors is pointed as one of the main causes fuelling the raise of STI’s and HIV in the urban areas. Conversely, the existence of community structures in charge for sexual and reproductive maters and issues is pointed as one of the reasons that explain low rates of STI’s and HIV in rural areas (N′weti[1] 2011a; N 'weti 2011b). Additionally, contraception usage levels among young people are very low leaving girls exposed to unintended pregnancies and abortions with foreseeable birth complications most of them leading to maternal and newborn mortality (Forum Mulher 2009; UNFPA2005)
Contributing in the ongoing efforts to tackle STI’s and HIV and to promote sexual and reproductive health, N’weti defined young people as its main target group for future interventions. N’weti’s intervention goes in line with its new strategic plan 2011-2015 that focus on social interventions for behaviour change in the area of sexual and reproductive health.
In working with young people N’weti aims at contributing to increase the quality of available information on sexual and reproductive matters and issues so that people can make informed choices that will work in favor of their sexual and reproductive health. However, before initiating its interventions N’weti decided to elaborate a communication strategy that will guide its future work that will address young adults’ specific needs. Thus, and in order to get access to such specific needs N’weti conducted an audience research to get a clear picture of the characteristics of young people in the provinces where the intervention will be held as well as to understand the context and groups influencing these young adults sexual and reproductive behaviour.
Such picture seems contradictory considering the fact that urban areas have more health facilities and services dealing with Sexual and Reproductive Health issues whereas rural areas due rely sole on traditional institutions.
III. Method
This is a qualitative study that draws from data collected fromthree Mozambican provinces, each one in representation of one of the country’s three regions. Thus, Maputo was selected in representation of the south region, Manica in representation of the central region and Nampula in representation of the northern region. Per province, a district was covered as following. In Maputo province the research covered Magude and Namaacha district;in Manica province Chimoio and Machipanda districts and finally Nampula city and Nacala-Porto districts in Nampula province (See table 1).
Table 1. Characteristics of districts covered
Region / Province / Urban area / Rural area / High mobility (Borders/Corridor area)South / Maputo / - / Magude / Namaacha (Border area)
Centre / Manica / Chimoio / - / Machipanda (Border/Corridor are)
North / Nampula / Nampula city / - / Nacala Porto (Corridor area)
Districts were selected to represent urban and rural areas as well spaces of high mobility that according to mozambican epidemiological fact sheet are influencing differently STI’s and HIV trends.
2.1. Data collection
This study builds from a combination of focus groups discussions, semi-structured interviews, direct observation and informal conversations.
2.1.1. Focus group discussions
A total of 20 focusgroup discussionswere held, being 15 with young people, four with adults and one with population from groups of high mobility, as shown in the following tables,
Table 2. Focus group discussions-Nampula
Category / Nampula / Nacala / TotalF / M / FM (Mixed group) / F / M / FM
Young people (15-24 years) / 1 / 1 / 1 / 1 / 1 / - / 5
Adults / - / - / 1 / - / - / 1 / 1
Pop. High Mobility / - / - / - / - / - / - / -
Total / 1 / 1 / 2 / 1 / 1 / 1 / 7
Working document- Please do not circulate or quote without N’weti permission
Table 3. Focus group discussions-Maputo
Category / Magude District / Namaacha / TotalF / M / FM / F / M / FM
Young people (15-24 years) / 1 / 1 / 1 / 1 / 1 / - / 5
Adults / - / - / 1 / - / - / - / 1
Pop. High Mobility / - / - / - / - / - / - / -
Total / 1 / 1 / 2 / 1 / 1 / 0 / 6
Table 4. Focus group discussions-Manica
Category / Chimoio / Machipanda / TotalF / M / FM / F / M / FM
Young people (15-24 years) / 1 / 1 / 1 / 1 / 1 / - / 5
Adults / - / - / 1 / - / - / 1 / 2
Pop. High Mobility / - / - / 1 / - / - / - / 1
Total / 1 / 1 / 3 / 1 / 1 / 1 / 8
Each group was composed by an average of eight (8) participants.Each discussion group session lasted two hours on average. Goup discussions were conducted in Portuguese.
Organizing and conducting focus group discussions was not without challenges. For instances organize and conduct focus group discussions in a urban environment proved very difficult as people are busy trying to gain their livelihoods, otherwise they might end up losing their clients and having no money to pay for they needs for the following days. Therefore, it became very difficult to convince them to make time to participate in the discussion sessions. Alternativelly, group interviews were conducted with an average of four participants.
A similar situation was faced when organizing group discussions with people from high mobility groups such as sex workers, trans-border informal merchants, street vendors and currency exchangers. Due to the nature of their activities they keep running up and down all day long chasing clients or border official, a situation that leaves no room to arrange a discussion group with members from such groups. Again in became difficult them to join the discussion groups. Alternativelly, group interviews were conducted with an average of four participants.
Working document- Please do not circulate or quote without N’weti permission
2.1.2. Individual in depth interviews
A total of fifty-nine interviews were conducted as shown in the table bellow,
Table 2. Distribution of interviews by province and district]
Professional membership category / Nampula / Manica / Maputo / TotalNPL / NPT / CHM / MCH / MGD / NMC
Sexual and Reproductive Health providers / - / 1 / 1 / 1 / - / - / 3
School representatives / - / 1 / 1 / - / - / 1 / 3
Traditional healers / - / - / 1 / - / 1 / - / 2
Traditional midwife / - / - / - / - / - / - / -
Foreigners residing / - / - / - / 1 / - / - / 1
MSM / 1 / - / - / - / - / - / 1
Sex worker / 2 / - / 2 / 2 / - / 1 / 7
Taxi driver / - / 1 / - / - / 1 / - / 2
Truck driver / - / - / 1 / 2 / - / 2 / 5
Currency exchangers / - / - / - / 1 / - / 2 / 3
Shabben vendors / 1 / - / - / - / 1 / 2 / 4
Trans-border informal merchants / - / - / - / - / - / 2 / 2
Customs officers / - / 2 / - / 1 / - / 1 / 4
Border officers / - / - / - / - / - / 1 / 1
Prison officers / 1 / - / - / - / - / - / 1
Masters of initiation rites / 1 / 2 / - / - / - / - / 3
Religious leaders / - / 2 / 2 / - / 2 / - / 6
Community health volunteers / 2 / 1 / 1 / 1 / 2 / 1 / 8
Radio, television, newspapers or theater staff members / - / 1 / - / - / 1 / 1 / 3
Total / 8 / 11 / 9 / 9 / 7 / 15 / 59
Study participants were selected in collaboration with local authorities (administrative, traditional and religious), school representatives and at times representatives from the health sector.Each interview lasted on average ninety minutes, and a vast majority of them were recorded (51) against only eight (8) that were not. Interviews were not recorded when held in noise environments such as shabbens or busy streets.
The majority (54) of the interviews were conducted in the Portuguese language, and only having were conducted in other languages namely one in E-makuwa (Nampula), one in Ci-shona and another in English (Machipanda) and two in Ci-changana (Magude district). Where Portuguese was not the language used researchers used their linguistic competence in such languages and that was not the case an interpreter was hired to help with the job. When an interpreter was involved, prior to the interview or the group discussion, the researcher introduced him to the research topic and how to behave throughout the interview or discussion session.
2.2. Ethical considerations
Prior to data collection oral informed consent was obtained from participants after being informed of the study objectives. Participants were also made aware to the fact that they were free to reject participate in the study, that they could interrupt the interview or discussion at any moment to pose a question as well as that they were free not answer the questions with which they feel uncomfortable with.
While collecting data some sex workers conditioned their participation against a payment of an amount, proposal promptly refused by the team of researchers. On another occasion an interviewee living with HIV raised question on whether he and his wife should have a baby or not. He also raised question on whether was it possible to him to get re-infected. Faced with such questions the researcher in charge directed him to the nearest Health facility for better information and counseling.
Throughout this preliminary report, the collected data is treated anonymously to protect participants from undue exposition. However, considering that the recordings, transcripts and databases to be delivered to N ' weti contains participants names it is up to the institution to avoid leaking such information by finding additional protective measures to preserve the issue of confidentiality and protection of the identities of the study participants.
2.3. Data processing and analysis
A code was created to identify each interview or focal group discussion.Thus, each interview or discussion group got a unique code that identifies the province, the district, the group interviewed of participating in the discussion session and the data in which the interview or discussion was held.
Recorded interviews and focus group discussions were transcribed verbatim.Each transcript was ascribed the same code as the one from record. Additionally, notes from not recorded interviews and discussion groups were also digitalized and ascribed a code.
Categories were established in line with the study objectives. Such categories were used to read and map the transcripts. Based on such mapping relevant excerpts were taken from the transcripts to feed a data base from which trends were identified and this preliminary report generated.
III. Audience main characteristics
This research has identified three main target groups’ each of them with its own specific sexual and reproductive patterns and characteristics and needs. Young adults compose the first target group and the their parents, guardians and other community institutions in charge for sexual and reproductive such as traditional birth attendants, traditional healers, masters of initiation rites, comprise the second target group is comprised by those issues. The last target group is comprised by formal Sexual and Reproductive Health services providers, such as health providers and volunteers.
3.1. Young adults
Young adults can be divided in two main groups’ namely young heterosexuals and MSM. Heterossexuals interviewed are aged between 15 to 24 years and most of them declared to be single with no children. Out of those who declared to be single the majority declared to have multiple sexual partners and some of them declared to have multiple and co-ocurrent sexual partners. On their turn MSM are aged 18 to 24 years old who declared to have multiple and co-occurrent partners and no children. Both groups have a wide range of occupations such as students,trans-border merchants, street vendors, trans-border currency exchangers, drives, sex workers and merchants.
In terms of linguistics, these young adults do speak and read Portuguese as well as do speak local languages (Ci-changane in Magude and Namaacha, E-makuwa in Nampula city and Nacala-Porto and Ci-tewe in Chimoio) and English (Machipanda and Namaacha) and Ci-shona and Ci-manica(Machipanda). However, while some of them are able to articulate fluently Portuguese, local languages and English others only speak fluently local languages and English (Machipanda, Manica and Namaacha). Among those young adults only those who speak fluently Portuguese can read it.
Speakers of Portuguese, local languages and English, use local languages mainly as a mean to communicate with parents, guardians and other relatives and community members who are not able to communicate in Portuguese. The use of local languages to communicate with elders not only is a form of showing respect to them but it is also a formo f showing that one is connected with local traditions. Portuguese is usedto communicate with public officers, including health providers and at times with peers. Finally English is used to communicate with foreigners, normally clients (Machipanda, Manica and Namaacha).
During the day, young people are more likely to be found at schools, local markets, at informal markets,barracas (shabeens) and bars. Excluding the schools, in those places boys rather than girl are to be found.During the nights specially during the weekends, girls and boys are more likely to be found at local clubs & discos, barracas (shabeens) and bars. During the weekends girls are more likely to be foud at borewhores or wells, at hair dressers, whereas boys are more likely to be found at barber shops and soccer pitches.
In a digital era, tha majority of youg adults do have access to celphones, watch national TV programs (TVM in all visited sites and STV in some of them). Additionally, some of them do also listen to national and community radio programs (Chimoio, Namaacha, Nacala-Porto). Nights are the moment when radio and TV programs have more audience. Opera soaps are the programs that most attention gets from young people from both sexes.
For the majority of the girls and boys interviewed for this study, sex equals to penile-vaginale penetration involving opposite sex partners, a perception shared even among some sex workers (Magude, Namaacha, Chimoio, Machipanda, Nacala-Porto). However, for others, inclunding sex workers sex not only involves penile-vaginale penetration, it is also perceived and practiced as oral and anal provided that it is between opposite sex partners (Manica, Nampula city and Nacala-Porto). On their turn, for MSM sex involves oral and anal sex (Nampula, Nacala-Porto and Chimoio).
In terms of sexual health, levels of knowledge are high regarding HIV means of transmission and prevention with emphasis on penile -vaginale penetration. In general, oral sex and anal sex are not known as means through which STI’s and HIV might be transmissible. Moreover young adults do not know much about STI’s, little is known about existing STI’s, its signals and symptoms nor about what to do in event of emerging signals.
In general reproductive matters as well as reproductive health issues are womens territory. From their girlhood onward, girls are taugh about reproductive matters and health. They are taught about their bodies, its reproductive functions, how to go about sex and how to manage menstrual periods. While in some places the teachings take place in secluded places during the rites of initiation to womanhood (Nampula, Nacala-Porto) or with parents and other relatives at home, in other places girls do learn about reproductive matters and health at school. Still in other places they learn through schools, rites of initiation, friends, health volunteers (peer educators) and friends (Nampula, Nacala-Porto).
Working document- Please do not circulate or quote without N’weti permission
3.2. Parents, relatives and high mobility groups
Adults can be divided in two main groups’ namely parents and relatives and young peoples’ [potential] sexual partners. Their ages range from 30 to 60 years old for parents. While most of relatives and parents, do live in the same comunities with the young people interviewed in this study, some of the partners of those young people live or stay for short periods of time in such comunities.
Most of them are men working as trans-border merchants, street vendors, trans-border currency exchangers, drivers, merchants, custom officers and border officers. The majority of these men are aged 25 to 60 years old. They are married, have kids back home but and multiple and co-occurrent partners.
Young people interviewed for this study also do have sex with women from outside other communities and places e.g. sex works. Sex work is attracting foreigners in some areas (Machipanda and Chimoio) whereas in other areas the majority of sex workers are local girls and women. However, while in some places sex workers identify themselves as such and are easily spoted on the streets (Nampula, Chimoio, Manica and Machipanda) in other sites they do not identify themselves as sex workers and are not easily spotted in the streets, despite being involved in comercial sex (Namaacha, Magude, Nacala-Porto but also Manica). While some sex workers are single with no children others are married with children.