That’s your way, this is ours: Yao women’s perspectives on sexual and reproductive health knowledges, rituals and traditions in a rural community of Balaka, Malawi

Background Young people continue to experience negative sexual and reproductive health (SRH) outcomes, despite the availability of government funded SRH services. The literature suggests that communication about sex is helpful in encouraging good decision making and positive sexual behaviours, among youth, when the message is appropriate and comprehensive. While the importance of this interaction is globally recognised, in the promotion of healthy sexual behaviours, very little is known about intergenerational SRH communication in developing countries such as Malawi, notably in rural areas, where access to health facilities and mass media is very limited and young people rely on extended family members for SRH information. Aim This Ethnographic and Participatory Action Research aimed to: (a) explore the views of rural women (young women, mothers and grandmothers) and influencing factors on SRH communication practices, (b) consider the broader historical, economic, and socio-political contexts that shape the intergenerational SRH communication experiences, (c) assist the rural women to act in solving SRH problems and issues among themselves. Methods Adopting a participatory ethnographic approach, a total of 27 participants were recruited comprising of 10 young women aged 18 - 24 years, 4 mothers, 4 grandmothers, 2 key informants, 4 traditional and 3 religious SRH counsellors. Data were collected through face-to-face interviews, focus group discussions, participant observation in SRH rituals for young women and field notes. A comparative data analysis and an inductive Thematic approach by Braun and Clarke (2006) was used to analyse the data and triangulate the shared narratives. Results Five overarching themes were identified: learning about SRH issues; the role of rituals and ceremonies; gender and power dynamics; impact of colonisation; tension between older and younger generations. The findings showed the flexibility of personal constructions of SRH communication practices, the meanings attached to initiation ceremonies mainly the puberty rite, and how the transition from childhood to adulthood leads young women to new and or (re) negotiated social identities in the context of their sexual and reproductive lives. Intergenerational perspectives on SRH communication practices emerged consistently throughout the thesis and thus provided evidence of the pollination of views and experiences across the generations. The initial findings led to the development of a culturally congruent health improvement intervention, focusing on menstrual cycle, contraceptives and SRH rights, which aimed to empower the women on SRH matters, and give them a voice in traditional community practices. Conclusion and Recommendations The thesis concludes that the socio-cultural contexts of the three generations of the rural women in the study, and my unique position of being from the area and trained in western biomedicine, afforded me insight into how the women drew on both traditional and biomedical understandings of SRH, with the balance changing a little with each generation, occasionally leading to tension between younger and older women. It recommends that future intergenerational SRH communication research, undertaken in the rural communities, is rooted in nuanced socio-cultural perspectives of SRH communication practices that can inform policy and practice. The study further recommends the recognition and valuing of the existing cultural structures, rituals and associations to reach young women with a holistic view of sexual matters and programmes.