The paper is based on a larger ethnographic study design using qualitative methods to obtain data. Data collection took place in Moroto District. The first phase of data collection was conducted between February 2018 and May 2018; the second phase was from November 2018 to February 2019. The sites for data collection were the villages of Nasigiria, Lomuriarangalem, Kadilakenyi, and Kidepo-lobunet, in the sub-counties of Katikekile and Rupa. Different qualitative methods were used to collect the data. Data were collected using five focus group discussions (FGDs) with adolescent girls. In three of the villages, one FGD was conducted in each village. However, in Kidepo-lobunet, two FGDs were conducted because at the time of research there was a traditional marriage ceremony taking place and adolescent girls from different married support groups were present. FGD participants were members of married groups in their communities that supported one another socially and economically. Each FGD was composed of seven to 10 adolescent girl participants. The study targeted married, Karamojong adolescent girls aged 15–19. All other adolescent girls that did not meet these characteristics for inclusion were left out of the study. Married adolescent girls were selected because it is at this stage that girls start to be sexually active, marry, and start child-bearing. They were also presumed to have the necessary information required for the study. These adolescent girls were either officially or unofficially married according to what they indicated. Ten key informant interviews (KIIs) were conducted. Key informants (KIs) were community leaders, district officials (technical and political), and leaders or key personnel from non-governmental organizations (NGOs) tackling issues affecting adolescent girls in the Karamoja sub-region. They were selected based on their knowledge, experience, and responsibility concerning issues of adolescent girls in the district. Twelve in-depth interviews (IDIs) were conducted: eight with adolescent girls and four with elderly women. The elderly women participated in the study because their insights and experiences were necessary for understanding the challenges girls encounter at this phase in life. The elderly women included in this study were either leaders or former leaders in their communities and were presumed to be conversant with cultural issues concerning adolescent girls. Their contribution was used to corroborate the information provided by the adolescent girls. Similarly, the adolescent girls selected for IDI were leaders of social groups of adolescent girls or promoters of SRH services such as contraception. The average time spent on each interview was approximately 40 min for individuals and 90 min for FGDs. Participants who gave their consent to participate in the interviews freely offered their time and the interviews took place in their chosen place of convenience.
Data was collected by a researcher with the help of two research assistants who translated the interviews into Ng’akarimojong, the language spoken by the participants. The research assistants were female parish chiefs in Rupa and Katikekile sub-counties who were knowledgeable in the traditions of the Karamojong and often aided NGOs in their work in the sub-counties. The research assistants were trained on what was required during data collection and what kind of data was needed before starting fieldwork. They also played the roles of interpreters and note-takers during interviews. To obtain unbiased information from participants on sensitive topics on sex and sexuality, the researchers used indirect questioning to increase the willingness of participants to provide accurate information. Also, as the research assistants were females, they had often interacted with the participants on different issues that affect them including SRH concerns in their communities. Triangulation of data was done to generate perspectives for constant data comparison. This generated a comprehensive set of findings. Interviews were audio-recorded for those who consented, in addition to the field notes taken. Participant observations were made by the researchers.
Analysis of data
Data transcription was done by two different people who were fluent in Ng’akarimojong. The transcripts were compared for consistency. Transcription was done to study details. Reading of the transcripts was done to familiarize with the data. Data were organized using the Atlas.ti computer software programme. Thematic analysis was used to analyse data. The researchers analysed verbatim statements from participants to form codes. The codes identified were of interest to the study and used to form categories which were later reduced to themes. Themes were checked for credibility and included perception of wealth and sexuality of adolescent girls, beliefs of sexuality influencing SRH, and influence of polygyny on SRH.
The study protocol was approved by the Research Ethics Committee of the School of Social Sciences, Makerere University. It was registered with the Uganda National Council of Science and Technology (UNCST) under registration number SS 4698. Clearance was also obtained from the local administration in Moroto District after presenting an introductory letter from Makerere University. Verbal and written consent to participate in the study was obtained from all participants after the form was read out to them. However, since all participants were emancipated and indicated as being independent, informed assent was not sought. Efforts were made to ensure privacy and confidentiality for both the data and participants.
This section presents the results and illustrates the extent that culture determines SRH. This is done by discussing the different themes that emerged from the analysis of the data. The themes included perception of wealth and sexuality of adolescent girls, beliefs of sexuality influencing SRH, and influence of polygyny on SRH.
Perception of wealth and sexuality of adolescent girls
Different ways were identified in which cattle is seen as wealth. This shaped the sexuality of females and affected the SRH of adolescent girls. A KI stated that:
The people in this place value cattle and look at it as wealth. This makes them to marry off their daughters at a young age which partly explains why adolescent pregnancies are common in our region. (KI, Straight Talk, Moroto)
The data from this theme provided other sub-themes which included bride wealth, forced marriages, and bride capture. Social support networks were another sub-theme closely linked with bride capture. The sub-themes on bride wealth and forced marriages were combined because forced marriages were seen to be a result of bride wealth. Each sub-theme is discussed in the subsequent paragraphs.
Bride wealth and sexuality
In the study, ownership of cattle was associated with prestige as this was traditionally seen as an important source of wealth that every family desires to possess. An older woman aged 59 from Kadilakenyi village remarked, ‘for us here…wealth is counted in form of cattle. A family without cattle is considered as poor’. In this regard, parents were reported to marry off their adolescent girls to obtain bride wealth which is paid in terms of cows. Adolescent girls in a FGD in Kidepo-Lobunet Village reported that: ‘parents prefer to marry off their daughters to wealthy men regardless of how many wives he already has. Sometimes they do not care to know about the man’s HIV sero status’. However, these men were more likely to be older and due to culture are already married to probably more than one wife. It was noted that girls from poorer families were more likely to find themselves in such unions. This risks their SRH and could result in poor outcomes since the man has multiple sexual partners and the girls are under pressure to bear children.
Further, cattle influenced the way the community perceived female sexuality. Females were valued for the potential to generate wealth for the family. It was remarked by one of the old women in the interviews that: ‘when you have many daughters, you are looked at as rich… especially when they start getting married’ (elderly woman aged 63, IDI, Lomuriarangalem Village. This revealed that the sexual unions of adolescent girls were determined by the cows. However, the perception of girls as wealth influenced them to begin courting men at a young age. A KI commented, ‘as soon as girls reach puberty, they want to date men; some of them engage in sex with older men for money without consideration of contraception’ (KI, Woman Councilor, Local Council 3, Moroto).
In a FGD, adolescent girls revealed how they end up in sexual unions they did not initiate because marriage negotiation and payments of bride wealth take place without their knowledge and input. They narrated:
Parents secretly marry off their daughters by making agreements with old men who have cows to pay for the bride’s wealth. Some parents receive part of the bride’s wealth without our (girls) knowledge. Then one day the man will come home and they will tell you…, that is your husband. If you refuse him, he waits for you in an isolated place, captures you, and carries you off to his house for sex and you become his wife. (FGD of adolescent girls, Kadilakenyi Village)
The adolescent girls interviewed for this study had either heard or witnessed such incidences in their communities or fallen victims of the same.
In a related sub-theme, the study participants talked about forced marriages. They reported that some adolescent girls in their communities found themselves in forced marriages. However, according to the adolescent participants, a girl may opt out of a forced marriage and elope with a man with whom she shares an emotional attachment. They explained:
A girl can run away with the man she loves and disappears for some years and return with children. If she elopes, she will be cursed by her parents and they can disown her. If the man she elopes with gives them the number of cows they want, they can forgive her and accept the man. (FGD of adolescent girls, Kadilakenyi Village)
Girls who elope were perceived as denying their parents wealth because usually the men they elope with are not in the position to pay the bride wealth as required by the girl’s family.
Another repetitive sub-theme that emerged out of this theme was bride capture. All participants involved in the study admitted that bride capture is a traditional practice by the Karamojong groups in the study area. In some instances, adolescent girls are likely to end up in ‘engagement sexFootnote 1’ as a result of the bride capture by these men. In an interview, adolescent girls reported that the practice of engagement sex is traditionally accepted in their communities. They explained:
If a man loves a girl or secretly admires her, he will keep monitoring her movements without her knowledge. One day when she is alone in an isolated place, he will capture her and have sexual intercourse (engagement sex) with her to mark her as his wife. (FGD of adolescent girls, Kidepo-Lobunet Village)
The old women in the interviews acknowledged that bride capture is an old tradition practised by the study communities. According to them, this is a traditionally acceptable practice which is seen as normal as long as the man has the intent of marrying the girl. If the boy captures the girl, he carries her to his home and locks her up if she is not willing to be his wife. In one of the interviews with an old woman, she said:
In our days, bride capture was a common practice accompanied by the sexual act. Many of those old women you see around were married as a result of bride capture. This practice is still common especially in village settings. The parents of the boy approach the parents of the girl for negotiations.
It was revealed that bride capture was not punishable by society except in circumstances where the boy failed to meet the requirements of marriage in terms of cows asked by the girl’s family. According to study participants, punishment was served by the girl’s family in the form of cattle raids. However, due to government intervention against this traditional practice that psychologically affects the girls and harms their SRH, the government and some NGOs are providing support for the victims.
Social support for sexual assault victims
Social support and medical help is provided to the girls who are victims of sexual or physical assault by men seeking to marry them. At times relatives too physically assault the girls to force them to marry the men. Recovery from the trauma is a process which starts from the time the girl arrives to the shelter of refuge at the police station or at the one provided by some Non-Governmental Organizations that support girls seeking help. According to a KI:
We work with the hospital to take them through medical examination after counselling to ascertain the extent of damage on their health. Those who have been raped are started on post exposure prophylaxis within 72 hours in case a girl has been infected with the HIV. If it is after 72 hours, we still examine them and put them on some treatment in case HIV infection has occurred. (KI, Department of Child and Family protection Unit, Uganda Police, Moroto District)
The victims of sexual and physical abuse are relieved by the counselling they receive from the place of refuge. The girls come when they have been traumatized and others are at the verge of committing suicide. An interview with a KI revealed that:
Some of these girls come when they want to commit suicide but we counsel them to help them understand the situation they are in, for example, if they have been assaulted and or raped, we tell them that it is not the end of life. If they have been sexually assaulted we take them to the main hospital for further management, and they are checked for HIV status and other infections they could have contracted. (KI, MIFUMI, Moroto District)
Immediately after the girls come to the shelter of refuge, they are given time to come to terms with the ordeal before they are asked to narrate their stories. The girls are offered shelter for about 2 weeks before the reconciliation process with their families can start. However, adolescent girls in remote villages and without any form of education were more likely not to find help after a sexual assault.
Beliefs and practices of sexuality
Beliefs were perceived to influence sexuality in two different ways; female’s sexual relationships and the practice of female genital circumcision (FGC). Each of these sub-themes is discussed in the subsequent paragraphs.
Sexual relationships of females
Interviews with old women revealed that according to traditional beliefs of sexuality, adolescent girls are not culturally permitted to have sexual relationships with more than one man as this is seen as bringing a curse. An older woman aged 56 in Nasigiria Village explained: ‘we have a belief that if an adolescent girl has sex with several men, her uterus will turn and she will not be able to conceive’.
Equally, fidelity was a requirement among married adolescent girls. In a FGD, adolescent girls were asked about infidelity in marriage. The participants perceived it as a shameful thing and a woman who engages in sexual intercourse with several partners was perceived as a disgrace to her husband. They explained:
Married women are not supposed to have sex with men who are not their husbands. If a woman does so, she will be looked at as a prostitute and a disgrace to her husband. She may bring STIs into the marriage. The husband will just abandon her. This behavior is believed to bring a curse in the family. (FGD of adolescent girls, Kidepo-Lobunet Village)
It was reported that a woman who has a man and continues to look for others is a prostitute. Other women in the community will ridicule her for the disgraceful behaviour.
The practice of FGC
FGC is one of the cultural practices that affect the SRH of adolescent girls in the study communities. Adolescent girls who had undergone this ritual were reported to have challenges at delivery. A KI at Moroto Regional Referral Hospital (MRRH) stated that:
The lady on that bed is 19 years old, she was operated upon. They referred her here from the health center because of complications at birth as a result of FGC. We receive many women especially those who have undergone FGC for emergency services at the time of birth. (Midwife in the maternity ward)
Complications at birth were associated with FGC. These adolescent mothers required emergency skilled assistance in delivery to save not only their lives but of the newborns too.
However, with the complications encountered by women at birth, FGC among the Tepeth ethnic group was linked to the marriageability of girls.
In support of FGC among the Tepeth, control of women’s sexuality is reflected as circumcised girls are perceived to easily find partners for marriage. They are believed to be clean and do not emit a foul smell. Also, they are believed to be faithful to their husbands. This makes circumcision to be associated with fidelity.
Furthermore, according to old women participants, FGC promoted self-esteem among those girls who had undergone the ritual. These girls are given unique names that identify them as circumcised. According to an elderly Tepeth woman and community leader aged 60 in Nasigiria Village: ‘once a girl is circumcised, she is named Kaparet or Sereteu. A girl ensures that she is known by her given name among her peers and the community’. According to participants, girls are proud to possess such names because they portray them as strong, courageous, sexually acceptable, and attractive to men having gone through a traditional ritual that represents their sexuality. They feel society accepts and approves them by applauding their courage.
Polygyny as a sexual practice
The study further showed that polygyny in the study population was linked to socio-cultural aspects that continue to make it desirable in the community. Polygyny was reported to be associated with wealth and prestige for men. Diverse reasons were given for polygyny, including the need for men to continue having sex when the wife is breastfeeding, infertility of a partner, and to enlarge the family and clan. Nonetheless, some participants were knowledgeable and aware of the consequences of polygyny on their SRH.
I know that polygyny may be associated with STIs but that is my culture. I cannot tell our men to marry only one wife, no one has the power to do that. I just pray that I do not acquire STIs especially HIV/AIDS. (Adolescent girl aged 18, Kadilakenyi Village)
Interviews with adolescent girls revealed that polygyny is a popular and culturally accepted practice in the community. Dialogues with some married adolescent girls in polygynous marriages showed that they do not consider it a problem. An adolescent girl aged 18 years in an IDI in Nasigiria Village observed: ‘we have grown up seeing polygyny as a norm in this society. Our mothers are in polygynous marriages…it is a normal thing to us’. Some of the adolescent girls interviewed were in such marriages. In another IDI, one of the adolescent girls aged 19 in Kidepo-Lobunet Village and in a polygynous marriage stated:
Polygyny prevents men from going to look for other women to have sex with, except his wives. I also get to rest from sexual activity when he is with my co-wife, a man’s demand for sex is continuous...yeah! If I have sex with my husband and I get pregnant before the baby can speak and run, my baby will die because the milk will have been contaminated. Even the people around me will ridicule me.
Also, an old woman in a dialogue revealed that she believed that polygyny was part of their society. According to her, men are proud to have many wives and children. Usually, the women provide the basic needs for themselves and the children they bear. Having a large family in this society is associated with the availability of labour in the home. According to the old woman:
Having a large family is prestigious for the man. He is respected for being able to father and take care of all those children. The wives compete among themselves to produce children for the husband because they believe that the more children one has, the more the love from the husband. (Old woman, aged 62, Kadilakenyi Village)
Polygyny is a way of life for the people in the study communities. A man keeps marrying wives for as long as he has enough cattle for bride wealth. According to study participants, in some circumstances, a man may marry off his daughter and use her bride wealth to marry another woman for himself.