Gender norms in sexual and reproductive health and rights: Insights from young Angolan women and the development of a context-specific questionnaire

Gender norms in sexual and reproductive health and rights: Insights from young Angolan women and the development of a context-specific questionnaire | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Method Article Gender norms in sexual and reproductive health and rights: Insights from young Angolan women and the development of a context-specific questionnaire Gunilla Priebe, Arciolanda Macama, Francisca Van Dunem dos Reis, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7037473/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Dec, 2025 Read the published version in Archives of Public Health → Version 1 posted 12 You are reading this latest preprint version Abstract Background Sexual and reproductive health and rights (SRHR) are fundamental to human dignity, well-being, and sustainable development. Despite strong international and national commitments, young women in Angola continue to face critical SRHR challenges, including high rates of adolescent pregnancy and limited access to contraception and maternal healthcare. These challenges are understood to be shaped, in part, by gender norms that influence social expectations, behaviours, and access to services. Addressing SRHR thus requires not only expanded healthcare provision but also strengthened normative support and attention to the power dynamics that underpin gender inequality. Measuring gender norms, however, remains methodologically complex. Existing tools often conflate personal attitudes with perceived social expectations or rely on indirect proxies, limiting their capacity to reflect the social and context-specific nature of norms. Results To address this gap, a mixed-methods study was conducted. Contextually relevant SRHR-topics were identified through a literature review, key informant interviews, and participatory workshops, resulting in the development of an eleven-item gender norms questionnaire. The questionnaire was used in a cross-sectional study including 2,081 young women aged 16–24 across urban and rural settings in three Angolan provinces and evaluated using Rasch analysis. Quantitative data revealed regional and socio-economic disparities, with early pregnancy and intimate partner violence more prevalent in less resourced settings. Perceived normative support was stronger for issues related to education and bodily autonomy than for reproductive maturity and equality within intimate relationships. While some provincial variation in item functioning was noted, the questionnaire demonstrated sound psychometric properties overall. Conclusions Gender norms remain central to SRHR experiences, marked by notable thematic and geographical variations. Divergent levels of normative support across SRHR domains reflect underlying tensions between entrenched social expectations and evolving values related to gender equality. Socio-economic disparities appear to intersect with these normative dynamics, potentially compounding structural disadvantage. The integration of both summary and item-level measures enables a more comprehensive understanding of the complex, layered nature of gender norms and the environments in which they operate. Continued research is essential to refine measurement and support the development of gender-responsive programmes that meaningfully support young women in realising their SRHR. Angola cross-sectional study gender norms intersectionality questionnaire young women Figures Figure 1 Figure 2 Figure 3 Contributions to the literature A new questionnaire was developed to measure SRHR-related gender norms from Angolan young women’s perspectives, aligning well with theory and local realities. Some topics, including gender identity and health system gaps, proved challenging to measure, emphasising the value of combining surveys with qualitative methods. Findings showed normative support for rights like relationship autonomy, but more resistance to delaying motherhood and decision-making equality. Psychometric analysis confirmed good questionnaire properties and shed light on both shared beliefs and underlying tensions within gender norms. The study signal potential links between socio-economic challenges and weak normative support, emphasising the need for intersectional, equity-focused strategies. Background Sexual and reproductive health and rights as a cornerstone of human rights and development Sexual and reproductive health and rights (SRHR) is widely recognised as integral to the advancement of human well-being, the achievement of sustainable development, and the realisation of fundamental human rights. This centrality is well established in both academic discourse and international policy frameworks [1-5]. It is articulated notably in the work of the Guttmacher–Lancet Commission on SRHR [1], and reflected in the integration of numerous SRHR-related targets within the United Nations Sustainable Development Goals (SDGs) [5]. Regionally, the importance of SRHR is underscored in legal instruments such as the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa–commonly referred to as the Maputo Protocol [4,6]. In Angola, the contextual focus of this study, international and regional commitments are mirrored in national legislation, strategic development plans, and the ongoing efforts of civil society organisations (CSO). The Angolan National Development Plan for 2023-2027 identifies gender equality and SRHR as key pillars of national progress [7,8]. Alongside formal policy initiatives, the women’s rights movement in Angola has consistently highlighted SRHR as a critical means of addressing the gendered legacies of colonialism and entrenched social and economic inequalities [2,9-11]. Human rights organisations have likewise offered compelling ethical and legal arguments for the protection and promotion of women’s reproductive rights [2,12,13]. As the leading Angolan human rights organisation Mosaiko poignantly affirms, “valuing human life begins precisely where life is generated” [13]. SRHR comprises a complex and multidimensional domain, intricately linked to physical, mental, and emotional well-being. This field engages with deeply personal aspects of identity and interpersonal relationships, while also intersecting with broader socio-cultural and institutional systems. At its core, SRHR is underpinned by fundamental principles of privacy, bodily autonomy and respect; the right to safe, consensual, and secure intimate relationships and reproductive decision-making; freedom from violence and coercion; and the capability to prevent illness and promote holistic health [1,4,14,15]. In recent years, growing attention has been paid to the rights, needs, and lived experiences of adolescent girls and young women. Their meaningful inclusion is increasingly recognised not only as a moral imperative, but also as a strategic priority for advancing maternal and child health and achieving broader public health and development goals [1,16-18]. Despite these commitments, young women continue to bear a disproportionate burden of SRHR-related challenges, including early and unintended pregnancies, sexually transmitted infections (STIs), and gender-based violence [1]. Unintended pregnancies, in particular, are frequently linked to school drop-out, social stigma, and long-term economic insecurity. Limited access to comprehensive SRHR information and services constrains young women’s ability to make informed decisions about their bodies and life trajectories [1]. This has far-reaching implications for their personal health, and the well-being and resilience of their families and wider communities. These global challenges are particularly acute in the Angolan context, where demographic factors amplify their relevance: over half of the population is under the age of 25 [19]. Yet, significant SRHR needs remain unmet: nearly half of pregnancies occur during adolescence [14,19,20]; contraceptive coverage extends to just over one-third of women [20-23]; approximately 50% of births take place outside formal health facilities [20,24-28]; and intimate partner violence (IPV) affects an estimated 38% of women [29]. Social norms and their role in SRHR In response to the complex and interrelated challenges surrounding SRHR and broader gender inequalities, there is a growing recognition of the need for multidimensional, cross-sectoral strategies [1-8,16,30,31]. These approaches commonly converge around several interdependent priority areas, including: expanding access to affordable, high-quality reproductive healthcare and family planning services; preventing IPV; providing counselling and rehabilitation services for survivors of abuse and sexual harassment; and challenging harmful social norms, such as the normalisation of child marriage and constraints on women’s agency within the domestic sphere [1-8,16,30,31]. Each of these components is recognised as integral to advancing SRHR goals, as they address not only immediate health concerns but also the underlying structural conditions that influence women’s agency and well-being. Crucially, such approaches move beyond purely biomedical frameworks and the operational capacities of health systems to underscore the decisive role of societal beliefs, practices, and values in shaping health-related behaviours and access to services. There is a growing recognition that barriers to SRHR are not solely the result of material or institutional limitations but are deeply embedded within normative systems that shape expectations and behaviours in everyday life [30-43]. While gender norms vary across cultural, social, and economic contexts, certain patterns recur globally [30,44]. Masculinity is frequently associated with strength and independence, while femininity is linked to vulnerability and a need for protection. These gendered constructions tend to reinforce male privilege and establish distinct, hierarchical gender roles that assign lower value to women and feminised identities [44]. Paradoxically, despite being cast as vulnerable, women are frequently expected to take responsibility for both their own and men’s sexual conduct. In many settings, female identity remains closely tied to motherhood, whereas male identity is commonly linked to financial provision and public authority [30,31]. Data from the World Values Survey illustrate the persistence of such attitudes; while discriminatory views concerning women’s right to education were expressed by 28% of respondents, a substantially larger proportion (58%) held prejudicial views regarding women’s reproductive rights [31]. These findings point to a widespread resistance to SRHR, reflecting deeper patterns of gender-based discrimination. At the heart of these patterns lie social norms that both mirror and perpetuate restrictive understandings of gender roles and entitlements. Although social norms are a fundamental part of any society—helping to establish shared understandings and promote cohesion—they can also perpetuate harm when they legitimise exclusion, reinforce unequal power relations, or devalue certain identities [34,39,45,47]. Within the SRHR domain, restrictive gender norms can have profound and, at times life-altering consequences. These include limiting women’s autonomy in deciding whether, when, and with whom to have children, as well as discouraging male engagement in reproductive health–both of which can compromise the effectiveness of family planning and maternal health services [47,48]. Social norms are also recognised as shaping institutional arrangements and may restrict access to legal protections, educational and economic opportunities, and healthcare services [30,49]. When embedded within broader structures of power and inequality, such norms may contribute to cycles of disempowerment, deprivation, and social exclusion–dynamics that tend to reinforce one another over time [34,36-39]. As such, normative frameworks may create intersecting barriers to the realisation of SRHR, while simultaneously sustaining patterns of marginalisation and structural disadvantage. In this context, many of the health challenges faced by women are thus increasingly recognised not as isolated issues, but as symptoms of wider structural inequities, influenced by discriminatory attitudes and norms concerning women’s rights and roles [1,3,32-42]. Addressing these inequities therefore requires more than expanding services, infrastructure, or legal protections. It necessitates sustained, collective efforts to transform the social norms and power relations that underlie gender-based disadvantage. Such transformation is increasingly viewed not only as a catalyst for systemic change but as a vital outcome in itself—central to the realisation of human rights and the advancement of well-being for women and girls across all domains of life [50,51]. Challenges in measuring norms within SRHR While the central role of gender norms in shaping lived experiences is widely recognised—and supported by well-established theoretical frameworks—empirical approaches to measuring these norms remain relatively underdeveloped [15,39,42,52]. Within the field of SRHR, the breadth and complexity of the subject matter pose particular challenges for measuring associated gender norms in a clear and precise manner. Notably, several indicators for SDG5–which target gender discrimination and harmful practices–still lack methodologically robust tools for reliable assessment [48]. Existing measurements of gender norms typically fall into two broad categories. Some are highly context-specific, addressing issues such as household responsibilities or interpersonal dynamics unique to particular settings [50,52,53]. Others conflate personal attitudes with collective social norms, thereby reducing conceptual clarity and obscuring the socially embedded nature of normative influence [39,41,48]. In some cases, indirect proxies–such as disparities in health outcomes or divergent survey responses by gender–are used to infer the presence of norms [34,36,37,52,54]. While these approaches offer valuable insights, they often lack the theoretical precision and contextual nuance needed to uncover the mechanisms through which norms shape behaviour [32,41,48]. Moreover, many available tools have either not been formally evaluated or have been assessed using limited methodology [48,53]. Advanced modelling techniques–such as those derived from Item Response Theory (IRT), including Rasch analysis–have rarely been applied in this domain, despite their potential to strengthen measurement validity and provide deeper insights into the relationship between observed responses and underlying constructs [55,56]. There remains, therefore, a need for further empirical work to explore how gender norms are constituted, experienced, and measured across different contexts [32,36]. One promising avenue involves shifting the analytical focus beyond individual attitudes to include perceptions of societal expectations across specific domains of life. In the context of SRHR, this may encompass norms governing sexual and reproductive decision-making, perceptions of safety and bodily integrity, and the ways in which social expectations contribute either stigma and discrimination or to the advancement of rights and health equity. It is also important to assess the extent to which such norms are widespread and firmly established, in order to better understand their weight and influence [39]. Such an approach could offer a more nuanced and contextually grounded understanding of the normative dynamics outlined in the theoretical literature. It could help reduce the risk of conceptual distortion and uncover the structural conditions that sustain specific gendered experiences. Ultimately, such insights have the potential to inform the development of more effective, equitable, and contextually appropriate interventions [31,33,37,57,58]. Methods Aims Despite growing global attention to gendered inequalities, empirical research examining gender norms in relation to SRHR remains limited. In Angola, the lack of context-specific research on women’s social conditions has been identified as a barrier to national development [2,19]. This study seeks to contribute to addressing this knowledge gap. It pursues three primary objectives. First, it seeks to deepen the understanding of how various aspects of SRHR are perceived to be influenced by gender norms within the Angolan context. Second, it aims to explore the extent to which young women perceive these norms as being socially embedded in their everyday environments–that is, the degree to which they encounter prevailing beliefs that either support or constrain their SRHR. Third, the study endeavours to identify both challenges and opportunities involved in developing a contextually grounded questionnaire to assess gender norms within this complex and sensitive domain. Together, these aims seek to generate insights that may inform future research on gender norms, including their potential links to health outcomes, and support the development of targeted interventions to advance young women’s SRHR in Angola and similar settings. Study setting Angola, located on the southwest coast of Africa, is a country of striking geographic and economic diversity. Since gaining independence from Portugal in 1975, it has made important strides in post-conflict recovery following a long civil war that ended in 2002. Although rich in oil and diamond resources, development remains uneven, with nearly half of the population living in extreme poverty [59-62]. This study focuses on three provinces that reflect broader disparities [63-65]. Luanda, the capital province, is the country’s economic and political centre, characterised by rapid urbanisation and stark socio-economic divides. Huambo and Lunda Sul, both predominantly rural provinces, face distinct yet interconnected challenges [21]. Huambo has a strong agricultural base but continues to face barriers in poverty reduction and service delivery [63]. Lunda Sul, known for its diamond mining industry, illustrates the paradox of resource wealth coexisting with underdeveloped infrastructure and economic hardship [64,65]. Across all the provinces, disparities in healthcare, education, and social services highlight persistent structural inequities that impact much of the population [19-28,58-66]. SRHR outcomes are further influenced by gender-based inequalities. Research and national data consistently show that women face disadvantages in multiple domains [13,19,21,28,66-71]. Angola ranks 28th out of 36 sub-Saharan African countries for gender equity, with women 36% less likely than men to access opportunities [69]. While women’s parliamentary representation is comparatively high at 39.1% [70], inequalities remain across other sectors. According to the latest Demographic Health Survey (DHS), 44.7% of women reported little or no formal schooling, compared with 29.7% of men [28]. Financial autonomy is similarly gendered, with 22.3% of women reporting ownership of a bank account, compared to 36.1% of men. Women are more likely to experience food insecurity (66% vs. 53.4% for men), and face continued challenges in accessing accurate HIV/AIDS prevention information, particularly among youth (50.7% of young women vs. 69.9% of young men) [28]. Study design The research is part of the SADIMA project (an abbreviation of the Portuguese Saúde e Direitos das Mulheres em Angola) which seeks to examine social determinants of young Angolan women’s SRHR, as well as their psychological well-being [65]. The present study combined quantitative and qualitative methods to explore gender norms, support the development of a questionnaire, and implement it within a study involving young women in Angola. The identification of SRHR topics and the subsequent development of corresponding gender norm items followed three main steps: (1) topic identification and initial item development, (2) refinement and piloting, and (3) assessment of measurement properties. The initial stages (steps 1 and 2) were conducted alongside the broader questionnaire development for the SADIMA project. SRHR topic identification and initial item development This phase combined a literature review with key informant interviews to identify priority SRHR topics. Through a participatory process oscillating between inductive and deductive reasoning, specific questionnaire items were developed, and the initial content validity of emerging constructs were assessed. The process began with a review of relevant empirical, theoretical, and applied literature, which informed the design of the overarching SADIMA survey instrument. The literature underscored the critical role of SRHR in shaping women’s broader living conditions [1,], and highlighted persistent and unmet SRHR needs of young women in Angola [12,20-24]. The emphasis on gender norms within the SADIMA project was informed by the priorities articulated by Angolan CSOs [2,13,72,73]. A review of established gender-related scales [53], alongside key theoretical contributions on gender and intersectionality [45,75-79], contributed further to the conceptual development of the gender norms questionnaire. To ensure contextual relevance, key informant interviews were conducted between July and September 2021 with representatives of governmental health institutions ( n =10), national CSOs ( n =8), as well as international governmental and non-governmental organisations ( n =7) operating in Angola (an additional file shows this in more detail [see Additional file 1]. A snowball sampling strategy was employed, initiated through contacts within national and provincial public health units. Interviews were conducted by a team of five researchers–four Angolan and one Swedish–with interdisciplinary expertise in public health, gender studies, and sociology. A semi-structured interview guide, informed by [79-81], facilitated discussion on key challenges to women’s health and rights in Angola, ongoing initiatives in this field, and perceived gaps in current efforts [see Additional file 1]. These insights were instrumental in assessing the extent to which SRHR topics identified in the literature were also prioritised–or not–by participants as critical issues affecting young women’s SRHR in the Angolan context. Questionnaire item refinement and piloting This phase involved the iterative development, refinement and piloting of questionnaire items designed to reflect gender norms related to SRHR. Drawing on relevant theoretical literature and informed by participatory engagement with members of the target population, key SRHR topics were translated into questionnaire items. These were reviewed for conceptual relevance, linguistic clarity, and cultural appropriateness, with revisions made to improve accessibility and ensure contextual alignment. Two participatory workshops were conducted to assess the relevance of proposed SRHR topics in relation to prevailing gender norms: one with young female university students ( n =8) and another with young female data collectors ( n =12). Based on participants’ feedback, certain topics were excluded if they were perceived as unrepresentative of widely shared social expectations, or if they addressed issues unlikely to be meaningful or recognisable to a broader group of young women. Themes that were viewed as reflecting commonly held beliefs about appropriate or expected behaviours of girls and women within their social environment were reformulated as injunctive norm statements. These formulations were guided by the conceptual framework developed by Cislaghi and Heise [41], who define gender norms as “social norms defining acceptable and appropriate actions for women and men in a given group or society. They are embedded in formal and informal institutions, nested in the mind, and produced and reproduced through social interaction. They play a role in shaping women and men’s (often unequal) access to resources and freedoms, thus affecting their voice, power and sense of self.” The workshops also included reflections on ethical considerations, the use of inclusive and appropriate language, and the conceptual clarity of the items for the intended respondent group. To support participants in distinguishing between personal attitudes and shared social expectations, a standardised introduction was developed. This introduction encouraged participants to respond based on what they believed best reflected “the ideas of people in this neighbourhood, village, or community.” This phrasing was repeated before each item to reinforce the intended normative framing. An additional file shows this in more detail [see Additional file 2]. Within this framework the surveyed young women’s perceptions were interpreted as meaningful expressions of prevailing gender norms. This approach rested on two key premises: first, that young women are active social agents capable of reflecting on and articulating the normative expectations around them; and second, that even if individual perceptions do not fully represent wider community views, they nonetheless influence self-concept, decision-making, and behaviour. As such, the gender norms questionnaire aimed to capture participants’ perceptions of SRHR-related expectations within their everyday environments. The revised items were subsequently field-tested within the broader SADIMA survey. Following each interview ( n =66), structured feedback was gathered from both interviewers and respondents, and reviewed by two researchers. Daily debriefing sessions with the interview team further enabled reflection on field experiences, identification of challenges, and refinement of data collection procedures. The piloting phase extended over a two-week period and continued until interviewers confirmed that all questionnaire items and response options were clearly understood by participants. This process also explored the most appropriate phrasing of items—specifically, whether statements should be framed positively or negatively, i.e. expressing support for or opposition to SRHR principles. Attention was likewise given to ensuring participants’ understanding of the Likert scale and the distinction between personal opinions and perceived community beliefs. Visual aids and supplementary explanatory materials were developed to support participant comprehension, and minor linguistic adjustments were made to improve clarity. No additional items were proposed during this phase, and none of the existing items were judged to be redundant or irrelevant. An additional file shows this in more detail [see Additional file 2]. Assessment of measurement properties In the third, and final phase, measurement properties of the proposed gender norm questionnaire were evaluated using a polytomous Rasch model (the partial credit model), drawing on data from the cross-sectional component of the SADIMA project. Sampling and data collection Details on the SADIMA study design, including sampling procedure, sample size, and data collection protocols, are provided in Priebe et al. [65]. This cross-sectional study included women aged 16-24. Sampling was informed by the latest DHS survey [21], and aimed to capture at least 1,885 young women across socio-economically diverse rural and urban settings in Luanda, Huambo and Lunda Sul [21,65]. Data were collected between February and May 2022 by trained female interviewers with university-level education. Interviewers had undergone a project-specific, one-week training programme covering questionnaire content, interviewing techniques, and research ethics. Participants received study information prior to giving informed consent. Each interviewer conducted approximately four interviews per day. To support data quality, daily consistency checks were performed, and weekly reviews were undertaken to detect and mitigate potential interviewer bias [65]. In addition to responses on gender norm items which were recorded using a five-point Likert scale (totally agree/agree/it depends, neither agree nor disagree/disagree/totally disagree), the analysis included background characteristics and general SRHR indicators. Thirty questions from the broader SADIMA survey were used to construct relevant variables. Several of these were adapted from the Angolan DHS [82], including literacy (yes/no), formal education (high/medium/low), work (yes, permanent/yes, temporary/no), household wealth tertiles (3d/2d/1st), fertile period knowledge (yes/no), modern family planning awareness (yes/no), and modern family planning use (yes/no). Additional variables, such as household night hunger (no/yes) [83] and exposure to intimate partner violence (no/yes) [84], were derived from established scales. Other variables were developed specifically for the SADIMA study, drawing conceptually on the DHS framework. These included provinces (Luanda/Huambo/Lunda Sul), area of residence (urban/rural), pregnancy history, categorised by age at first pregnancy (no/yes ≥18 years/yes, <18 years), menstrual autonomy (yes/no), and acquired information about pregnancy and childbirth complications (yes/no). [see Additional file 2]. Psychometric analysis The polytomous Rasch model was fitted to data from participants who responded to at least three quarters (at least 9) of the gender norms statements, which were considered as providing sufficient information on their perception of gender norms. Following Johansson et al [85], assessments were conducted of unidimensionality (including local response dependence, and item fit), the ordering of response categories, invariance, targeting, and reliability of the proposed questionnaire. For unidimensionality, principal component analysis was applied to the covariance matrix of (unconditional) standardized residuals, constructed elementwise using pairwise complete observations. Support for unidimensionality was inferred when the first eigenvalue was below 2 and the explained variability by the individual components was low. Item fit was assessed visually through CICC (conditional item characteristic curve) plots [86], in which participants were grouped into deciles based on total scores. These plots contrasted, for each item and conditional on total score, the expected score with the observed average score. This visual assessment was supplemented by outfit and infit statistics based on unconditional standardised residuals, estimated through subsampling (350 participants per sample, 100 repetitions) [87]. A rule of thumb was applied to judge whether the infit and outfit statistics averaged over the subsamples indicate a misfit (1.3 for mean square infit and outfit statistics, and 2 for normalized infit and outfit statistics). Local dependence was investigated using Yen’s Q3 statistic, and item pairs were considered dependent when the Q3 value exceeded the average by more than 0.2 [88]. The ordering of response categories--reflected in the ordering of the estimated threshold values–was evaluated through visual inspection of item characteristic curves. When the curves indicated that each response option was the most likely to be selected in the expected sequence across the latent trait continuum, the categories were considered to be ordered [89]. Measurement invariance was examined with respect to province, household wealth, literacy, and area of residence. Differential item functioning (DIF) was explored using partial credit trees [90], with a stopping rule applied to avoid subgroup sizes smaller than 350. The magnitude of DIF was assessed visually through a modified version of the CICC plot, comparing the expected scores under the common model with observed scores conditional on total score, within groups identified as exhibiting DIF. Threshold instability was visualised by plotting item thresholds across the DIF-identified subgroups. The impact of DIF on person locations was evaluated by identifying items judged to function comparably across subgroups. Then person locations from a model with all other items resolved were compared with those obtained from a common model disregarding DIF, with scale alignment achieved by fixing the first threshold of the first common item to zero. Agreement between person estimates was examined using Bland-Altman plots [91], histograms were constructed to visualise differences in trait distributions among DIF groups, and differences in person estimates were interpreted relative to the standard deviation of the location estimates. Targeting was assessed by comparing the distribution of estimated person locations with the distribution of item thresholds. Good targeting was considered present when item thresholds covered a similar range to that of person estimates on the latent scale. Reliability was evaluated using the test information function. Participants (with complete data) for whom the test information exceeded a value of 3.33–corresponding to a person separation index of 0.7 [85,92]–were considered to have been measured with satisfactory precision. All analyses were carried out using SPSS (version 29.0.0.0) and R (version 4.3.3) [93]. The psychometric analysis was conducted using eRm package (version 1.0-5) [94], psychotree package (version 0.16-0) [90], customized functions from RASCHplot package (version 0.1.0) [95] and RISEkbmRasch package (version 0.1.34.1) [85] was used for visualizations. Final processing of the figures was done using the cowplot (version 1.1.3) [96] and patchwork (version 1.3.1) [97] packages. Results Identification of SRHR topics and development of gender norm items Table 1 presents the SRHR topics identified through qualitative analysis of relevant literature and interviews with key informants as particularly salient within the Angolan context. It also indicates which of these topics were deemed sufficiently linked to prevailing gender norms—understood as socially embedded influences in this context—to warrant inclusion in the questionnaire. Topics excluded following participatory workshop discussions are listed in the lower section of the table. The final selection comprised eleven SRHR topics considered to reflect a clear and contextually grounded connection to prevailing gender norms. The priorities identified through the workshops broadly aligned with key themes found in international scientific and human rights literature. The selected topics represented a relatively balanced mix of the two core domains of SRHR: ‘sexual’ and ‘reproductive’. Health was predominantly framed as an outcome of the realisation of rights. Accordingly, rights-related dimensions were more explicitly articulated, while health-related aspects were often implicit and tended to intersect with broader rights-based concerns. Topics related to sexual health and rights included relationship autonomy, bodily autonomy, non-stigmatisation, and consent within marriage. Topics in the reproductive health and rights domain encompassed identity diversity, reproductive maturity, and maternal health. Foundational concerns—such as girls’ right to education and broader aspects of women’s status within intimate relationships, including freedom from violence, freedom of expression, and equality in decision-making—were retained due to their perceived centrality to the realisation of SRHR in the local context. Four topics were excluded due to conceptual overlap, perceived redundancy, or limited resonance across diverse social and geographical contexts in Angola. In particular, some SRHR interventions were viewed by participants as overly aspirational in a context where education and healthcare remain severely under-resourced. Consequently, topics related to access to specific SRHR information and services were seen as reflecting wider systemic challenges rather than gender-specific barriers. [Table 1] Characteristics of study participants Table 2 summarises the socio-demographic characteristics and selected SRHR indicators of the young women who participated in the study (n=2,081 of 2,109 recruited, an additional file shows this in more detail [see Additional file 3]. The data revealed notable disparities in participants’ living conditions across the three provinces. In general, respondents in Luanda reported more favourable living conditions, whereas those in Lunda Sul experienced most pronounced challenges, with Huambo positioned between the two. For instance, literacy rates varied substantially, with 85.7% of women in Luanda being literate, compared to 53.7% in Huambo and 41.5% in Lunda Sul. Similarly, household food security was reported to be highest in Luanda (71.8%), but substantially lower in Huambo (49.9%) and Lunda Sul (40.7%). These disparities correspond with the wealth distribution observed in the study population, whereby the highest wealth tertile was predominantly composed of participants from Luanda. In contrast, a large part of participants from Huambo and Lunda Sul belonged to the lowest wealth tertile (47.8% and 63.2%, respectively). Challenges related to SRHR were also evident across all provinces, although they appeared most acute in Lunda Sul. Early pregnancy was notably high in Lunda Sul (53.2%) and Huambo (43.6%), and comparatively lower in Luanda (18%). Experiences of IPV were widespread, with the highest prevalence in Lunda Sul (66.1%), followed by Huambo (43.0%) and Luanda (37.1%). A comparable pattern was observed with respect to menstrual autonomy, defined here as the ability to continue usual daily activities outside the home during menstruation. While a majority of participants in Huambo (69.6%) and Luanda (61.9%) reported having this autonomy, only 27.5% of respondents in Lunda Sul indicated the same. Awareness of key reproductive health topics were relatively high in Luanda and Huambo. For example, 72.2% of respondents in Huambo and 67.9% in Luanda correctly identified the fertile period, compared to 33.1% in Lunda Sul. Awareness of modern family planning methods was high in all provinces–97.7% in Luanda, 89.0% in Huambo, and 72.3% in Lunda Sul. However, this awareness did not consistently translate into use: 55.7% of women in Luanda reported ever using a modern contraceptive method, compared to 39% in Huambo and 30.2% in Lunda Sul. [Table 2] Prevalence of SRHR supportive gender norms Table 3 presents the proportion of respondents who perceived community support for selected SRHR topics, based on questionnaire responses. The topics, related to gender norms and women’s SRHR, are listed in descending order according to the overall percentage of participants who selected 4 or 5 on the Likert scale—responses interpreted as indicating normative support. Results are stratified by province. A broadly consistent pattern emerged across provinces in terms of which rights were perceived to have the strongest and weakest normative support. The right to education, along with certain sexual rights—particularly relationship autonomy and bodily autonomy—were most frequently identified as socially endorsed, with 60–70% of respondents indicating perceived community support. Respondents in Luanda generally reported higher levels of normative support for these SRHR topics compared to those in Huambo and Lunda Sul. With regard to the right to freedom from violence, 67.3% of respondents in Luanda stated that they believed their community does not expect women to remain in violent relationships for the sake of family cohesion. This view was shared by 54.4% of respondents in Huambo and 48.3% in Lunda Sul. Approximately half of all respondents reported that it was not considered shameful in their community for women to speak about experiences of sexual abuse, suggesting a degree of normative support for non-stigmatisation within the domain of sexual health and rights. The most marked regional differences were observed in relation to reproductive health and rights. In Lunda Sul, only 23.8% of respondents reported perceived community support for the right to reproductive maturity—defined as delaying childbearing until at least 18 years of age—compared with 46.8% in Huambo and 61.0% in Luanda. A similar gradient was observed regarding support for female identity diversity: just 31.6% of respondents in Lunda Sul stated that their communities recognised women’s value beyond their role as mothers, compared to 47.4% in Huambo and 61.9% in Luanda. Topics concerning gender equality within intimate relationships—such as freedom of expression, consent within marriage, and equal decision-making—were among those least frequently associated with perceived social support. Across all three provinces, fewer than half of the young women surveyed reported that these principles were widely accepted within their communities. Psychometric assessment of the questionnaire The majority of participants completed the gender norms questionnaire in its entirety. Only a small proportion had one or two missing responses: 22 out of 910 in Luanda, 38 out of 684 in Huambo, and 7 out of 487 in Lund Sul. Application of the polytomous Rasch model to the original 5-point Likert scale revealed no evidence of strong structure in the residuals or local dependence (An additional file shows this in more detail [see Additional file 4]). Nonetheless, some item misfit was observed for bodily autonomy, freedom from violence, identity diversity, marital consent, and decision equality. Among these, marital consent exhibited underfit to the model; so that respondents with a high total score tended to endorse this item less than expected [see Additional file 4 ]). [FIGURE 1] A primary concern emerged regarding the functioning of the middle response category, “it depends (neither agree nor disagree)”. This category was never the most likely response at any point along the latent continuum for any of the 11 items, i.e. the categories were disordered (Figure 1, and [Additional file 4]). This raised questions concerning usefulness and conceptual justification of the middle response category. Thus, the decision was made to merge this category with the adjacent lower response option, thereby converting the original 5-point scale into a 4-point one. This adjustment was based on the view that indeterminate responses such as “it depends” may not meaningfully reflect endorsement of fundamental human rights. It is noteworthy that most participants selected “it depends” for few items. Specifically, 77% of respondents in Luanda, 78% in Huambo, and 80% in Lunda Sul chose this option for no more than two of the eleven statements. The highest percentage of “it depends” responses were recorded for maternal health in Huambo (25%), marital consent in Luanda (21%), and bodily autonomy in Lunda Sul (20%). When the analysis was repeated using the modified 4-point scale, the ordering of response categories improved for all items, and item fit statistics also demonstrated overall improvement [see Additional file 4]. Nevertheless, visual inspection of the CICC indicated that the item of marital consent continued to discriminate somewhat less effectively than predicted (see Fig 1). The reduction in response categories led to fewer thresholds per item and introduced two broader gaps in coverage along the latent trait continuum (see Fig 2 Item targeting and test information function). However, for more than 98% of participants with complete responses, the test information function remained above 3.33 (Fig 2), a threshold for fair reliability. At the same time, the test information never exceeded 5 (corresponding to a person separation index of 0.8), which is a more stringent lower limit commonly used as indicating good reliability [85]. This was reflected also in the relatively large uncertainties accompanying the persons’ locations estimates. The middle 50% of the respondents were estimated to be between 0.43 to 1.46 on the latent scale, but each estimated position had an uncertainty of about 0.5. [FIGURE 2] The automatically identified DIF groups corresponded closely with provincial divisions (see Additional file 4). Closer examination of the DIF plots (see Fig 3) indicated that the largest degree of DIF was observed for identity diversity and reproductive maturity. Respondents in Lunda Sul endorsed these items less than what would be expected based on respondents’ total score under the assumption of no DIF and also less than what was observed in the other two provinces. A slight opposite tendency was noted for relationship autonomy and non-stigmatisation. For the item on marital consent, the observed mean scores, disaggregated by province and conditional on total score, showed a general misfit relative to model expectations, particularly in Huambo. The respondents there seemed to be reluctant to endorse this item despite higher total scores, i.e. despite indicated perception of community gender norms more supportive of women’s SRHR. [FIGURE 3] However, the impact of DIF on the estimated persons locations was limited. Differences between estimates obtained with and without accounting for DIF remained within the standard deviation of the estimates [see Additional file 4]. As the presence of DIF suggested differential functioning of items across provinces, model fit was also examined separately for each province using the partial credit model. The results were satisfactory and broadly consistent with those of the overall analysis. Some variation between provinces was observed in the hierarchical ordering of the items [see Additional file 4]; however, the three items positioned lowest in the hierarchy–the “easiest” items–were the same across all provinces and matched the first three items listed in Table 3. Discussion Key findings This study makes three primary contributions. First, it reaffirms the central importance of gender norms as a foundational organising framework for SRHR within the Angolan context. The findings also illuminate areas where theoretical assumptions align with—or diverge from—empirical realities, prompting critical reflection on how both entrenched local norms and those that are less clearly articulated may be meaningfully identified, interpreted, and studied. Second, while a relatively high degree of normative support was observed for certain aspects of SRHR across the study population, notable variations emerged. Specifically, the research identified tensions between SRHR topics that were widely regarded as socially acceptable and those perceived to lack normative legitimacy. These disparities suggest strategic entry points for rights-based interventions, while also underscoring the challenges posed by uneven normative landscapes for the full realisation of young women’s SRHR. Third, the study documented inter-provincial differences in perceived normative support, which appear to mirror broader socio-economic disparities. These findings highlight how young women’s ability to claim and exercise their SRHR is mediated not only by prevailing gender norms but also by their specific geographical and socio-economic contexts [ 2 , 10 , 51 , 77 , 79 ]. Taken together, these findings emphasise the value of granular, contextually grounded approaches to the study and measurement of gender norms. They point to the need for policy and programmatic responses that are both equitable and attuned to the lived experiences of young women in diverse settings. The challenge of capturing socially visible and hidden norms The findings suggest that many dimensions of SRHR prioritised within international frameworks are also regarded as normatively salient in the Angolan context [ 1 – 13 ]. Key aspects such as bodily and relational autonomy, freedom from violence, decision-making equality, and reproductive maturity were widely recognised by participants as meaningful, and were therefore incorporated into the questionnaire. This alignment with theoretical expectations offers support for the construct validity of the questionnaire [ 36 , 39 ]. In addition, the Rasch analysis indicated good item targeting, with item difficulty levels closely corresponding to participants’ perceptions of normative support. The absence of floor or ceiling effects further suggests that the questionnaire was appropriately calibrated to the study population. Moreover, no substantial item clustering was observed, indicating that the scale captured a coherent underlying construct. Collectively, these findings point to the value of an iterative development process that, while grounded in theory, remained responsive to contextual insights and produced a set of distinct and locally relevant items [ 85 ]. Nonetheless, the scope of the questionnaire was necessarily selective. Certain internationally recognised SRHR dimensions were not included, primarily due to difficulties in generating contextually meaningful survey items. For instance, while gendered structural inequalities are widely acknowledged to influence national health priorities [ 5 , 37 , 40 , 49 , 80 ], both key informants and workshop participants tended to frame barriers to SRHR-related education and services primarily as general resource constraints, rather than as explicitly gendered phenomena. This reflects a broader analytical challenge in disentangling proximal from distal determinants of norms and behaviours, as noted in existing scholarship [ 38 , 48 ]. It also underscores the importance of engaging with gender equality in ways that are deeply attuned to lived realities–ensuring that the diverse needs of different groups are not perceived as competing or mutually exclusive [ 30 , 36 ]. Further complexity emerged in relation to gender identity and sexual orientation. Gender identity was most commonly articulated through dominant expectations related to motherhood, while sexual orientation was often rendered socially invisible or remained unspoken. These omissions reflect both methodological challenges in capturing stigmatised topics and under-articulated topics and a wider tension between the need for contextual sensitivity and the imperative to include marginalised dimensions of SRHR [ 4 ]. In this regard, while survey-based methods offer valuable insights, they may be less well suited to capturing sensitive or less visible aspects of social life. Qualitative approaches that foster trust and allow for deeper reflection may therefore represent a more appropriate means of exploring these critical dimensions [ 39 ]. Navigating normative tensions in support for SRHR The study identified both areas of convergence and divergence in normative support for various dimensions of SRHR. Consistent patterns emerged across descriptive analysis and Rasch modelling, indicating that rights related to education, bodily autonomy, and relationship autonomy enjoyed the highest levels of normative endorsement. When considering these results through the lens of their thematic alignment with either sexual or reproductive rights [ 1 , 4 ], the findings suggest a comparatively stronger normative support for sexual rights. This is particularly evident in the greater endorsement of bodily autonomy and freedom from violence. By contrast, domains associated with reproductive rights–especially maternal health and reproductive maturity–were described as receiving lower levels of normative backing. These patterns carry important implications for the lived experiences of young women, particularly in light of the well-documented influence of social norms on behaviour, decision-making, and self-perception [ 15 , 34 , 42 ]. The broader normative acceptance of sexual rights may contribute to an increased sense of agency among young women in deciding whether–and with whom–to engage in intimate relationships, while also offering strategic entry points for rights-based interventions [ 4 , 5 , 31 , 33 , 37 ]. However, the comparatively limited support for reproductive maturity—especially in more rural provinces—suggests a continued societal tendency to prioritise young women’s reproductive roles [ 72 ]. Such expectations may restrict young women’s ability to delay or decline these roles, irrespective of personal aspirations [ 39 ]. The relatively weak normative support for reproductive maturity–and by extension, for girls’ right to a protected and autonomous childhood–coupled with limited backing for maternal health, reveals a concerning disconnect between normative frameworks and the structural conditions required to safeguard women’s holistic well-being, including equitable access to quality maternity care [ 20 – 24 , 38 ]. Furthermore, rights pertaining to intimate partnerships—such as freedom of expression, marital consent, and decision equality—emerged as the least supported across all provinces. Psychometric findings further indicated that items related to marital consent and decision-making equality were particularly difficult for respondents to perceive as socially supported, with the notable exception of Lunda Sul, where motherhood-related items appeared more salient. In the broader context of prevailing expectations around motherhood, these findings suggest a persistent normative belief that women should prioritise the needs and preferences of others [ 12 , 30 ]. While such expectations may be associated with pride and a sense of purpose, they also risk imposing considerable emotional and practical burdens. Given the relatively young age of participants, these responsibilities may limit their ability to fully exercise their SRHR and pursue long-term personal and socio-economic well-being [ 1 , 16 – 18 ]. Despite the formal commitments to gender equality and SRHR within national policy frameworks, the findings indicate that many young women continue to navigate social environments in which substantial elements of their SRHR lack widespread normative legitimacy. Survey responses suggest persistent expectations for young women to shoulder substantial emotional and caregiving responsibilities from an early age, often without corresponding decision-making power or systemic support for their own well-being or that of their families. Such social norms, shape attitudes and behaviours—even in cases where individuals may not personally endorse them, through mechanism including community endorsement and the potential for social sanctions in the case of non-conformity [ 34 , 39 , 41 ]. These findings illuminate the deeply interwoven symbolic and structural dimensions of motherhood and partnership, and the continuous negotiation between adherence to traditional gender roles and evolving aspirations for gender equity [ 2 ]. The cumulative weight of these normative tensions shapes not only individual life paths, but also sustains collective perceptions of women’s roles, worth, and entitlements within society. Addressing such tensions is essential to support the positive transformation of social norms. Yet, this must be pursued with cultural sensitivity, recognising that long-standing norms often serve as vital sources of social cohesion, identity, and provide a sense of community order [ 74 – 80 ]. Even where certain norms have exclusionary or harmful implications, they may simultaneously offer shared frameworks for meaning-making and community stability. Meaningful engagement with such norms thus demands a careful and balanced approach: one that seeks to redress inequalities and challenge discriminatory practices, while also honouring the social fabrics that underpin collective well-being and social harmony [ 2 , 43 – 45 ]. From a methodological standpoint, these findings illustrate the value of mixed-methods approaches in capturing the multifaceted and, at times, contradictory nature of gender norms [ 39 ]. Normative resistance, for instance, may manifest not only in qualitative narratives but also in the psychometric properties of survey items–particularly in terms of their relative difficulty to endorse. This points to the importance of viewing questionnaire items not merely as neutral indicators but also as culturally situated expressions that may reflect deeper social contestation and normative ambivalence. Contextual and normative variation in SRHR support The observed variations in normative support for SRHR extended beyond differences across thematic distinctions, revealing pronounced subnational disparities. While certain aspects—such as access to education, non-stigmatisation, equality in decision—elicited relatively consistent support across provinces, other domains showed more substantial divergence. For instance, approximately 60% of respondents in Luanda stated normative support for reproductive maturity and identity diversity, in contrast to only 20–30% in Lunda Sul, with Huambo occupying an intermediate position. The final Rasch model, adapted to a four-point Likert scale derived from the original five-point format, further illuminated provincial variation in item performance. Most items demonstrated acceptable fit; however, the item concerning marital consent displayed underfit, particularly among respondents in Huambo. Notably, even individuals who largely reported community normative support for other SRHR aspects appeared hesitant in relation to this particular item. Similarly, reproductive maturity and identity diversity emerged as among the most difficult items to agree with in Lunda Sul, in terms of perceived community support. DIF analyses confirmed systematically lower endorsement of these items in Lunda Sul compared to the other two provinces when considering respondents indicating similar overall normative support. These findings suggest potential context-specific conceptual ambiguities or entrenched social norms, and highlight the need for further exploration of the historical, legal, and cultural narratives that shape these constructs [ 2 , 12 , 13 ]. Positioning respondents along a latent continuum of SRHR-related norms also presented methodological challenges. Although DIF did not substantially distort total score estimates, its presence implies that comparable aggregate scores may conceal meaningful differences in the configuration of normative beliefs across settings. This has important implications for interpreting associations between normative environments and health outcomes. One high score might reflect strong social support for bodily autonomy, another for reproductive maturity–yet only one of these may be relevant to a specific health outcome [ 34 , 42 ]. These insights point to the complementary value of summary indicators and disaggregated analyses. Composite scores provide useful approximations of the general normative climate surrounding young women, but item-level disaggregation is essential to identify which specific dimensions of SRHR are more or less socially accepted in a given context. Rasch modelling proved especially instructive in this regard, enabling the identification of items that were either difficult to endorse (e.g., reproductive maturity and identity diversity in Lunda Sul), or yielded unexpected patterns (e.g., marital consent in Huambo). Such insights underscore the value of advanced psychometric techniques in revealing not only the strength but also the texture of normative support, including fine-grained intra-country variation. Adopting such a nuanced analytical lens enhances both the methodological robustness and the practical relevance of SRHR norm assessments. Summary and item-level analyses should be viewed as complementary: together, they provide a more comprehensive understanding of normative environments and are vital for guiding the development of interventions that are contextually tailored and responsive to local realities. Furthermore, regional differences in participants’ perceptions of social support for SRHR closely mirrored broader disparities in socio-economic development and access to essential public services, as reflected in national statistics [ 16 – 23 ] and corroborated by the present findings. Respondents in Lunda Sul and Huambo, the provinces registering the lowest levels of normative support, also reported elevated levels of economic insecurity and substantial barriers to accessing SRHR services. Of particular concern were the high rates of teenage pregnancy and IPV, affecting over half of respondents in Lunda Sul and nearly half in Huambo, in stark contrast to approximately one-fifth and two-fifths, respectively, in Luanda. When considered alongside known gaps in access to modern family planning and maternal healthcare in these provinces [ 21 – 28 ], these findings reflect yet another aspect of the entrenched structural barriers that continue to undermine young women’s SRHR. The apparent convergence between limited normative support and broader structural disadvantage resonates with global evidence showing that restrictive gender norms often intersect with socio-economic marginalisation, compounding the risks and vulnerabilities faced by young women [ 1 , 3 , 5 , 16 – 18 ]. This reading also aligns with intersectional frameworks long advanced by the Angolan women’s movement, which have situated gender inequality within broader struggles against economic injustice, ethnic discrimination, and the enduring legacies of colonialism [ 2 , 9 – 12 , 72 ]. From this vantage point, gender norms cannot be meaningfully analysed in isolation from the wider systems of power and exclusion that shape everyday life. While measurement tools may not yet fully capture these intersecting layers, recognising their significance adds critical depth to calls for SRHR strategies that are both contextually grounded and oriented towards social justice [ 3 , 37 , 51 , 47 , 75 , 79 ]. In sum, while gender norms may exhibit certain universal features, their local expressions are diverse, deeply embedded, and shaped by distinct social, economic, and historical conditions. This calls for caution against the uncritical application of standardised measurement tools or uniform, one-size-fits-all interventions. Rather, it highlights the need for participatory and reflexive approaches that are attuned to both the structural and normative dimensions of inequality. Strategies grounded in such approaches hold considerable promise–not only for strengthening SRHR outcomes, but also for contributing to broader efforts to advance justice, dignity, and the realisation of rights for young women across a range of settings. Limitations and generalisability This study benefited from a high response rate, the inclusion of participants from diverse backgrounds, and a study design that was carefully adapted to the local context and rigorously pre-tested. Nevertheless, several limitations must be acknowledged to ensure a balanced interpretation of the findings. The use of self-reported data collected through interviews provided a valuable opportunity to explore young women’s perspectives on normative beliefs within a safe and familiar setting. However, the interview format may have introduced social desirability bias, potentially influencing participants’ responses. Additionally, the focus on a specific age cohort of young adults, combined with a non-random sampling strategy, constrains the generalisability of the findings to the wider Angolan population. That said, the demographic profile of the sample is broadly consistent with those in comparable studies and reflects known national and regional socio-economic patterns [ 21 , 25 , 60 , 61 , 68 , 71 ], suggesting the findings may be transferable to similar settings. The development and application of a tailored questionnaire represent an important step forward in measuring gender norms related to SRHR in Angola. However, this approach also has limitations. While the study accounts for participants’ socio-economic characteristics and regional differences, it does not fully engage with the complex intersections of systemic inequality. As such, it risks reproducing an analytical approach that treats gender as a static or isolated category. Scholars have emphasised the need to situate gender within broader socio-economic and political structures [ 2 , 74 – 80 ]. Critical and postcolonial theorists further challenge universalist assumptions and the dominance of Eurocentric epistemologies in global health research, warning that such paradigms may obscure the nuanced and intersecting realities of women’s lived experiences [ 10 , 76 ]. While this study endeavours to contribute to a more multifaceted understanding of gender norms, it is ultimately for the reader to judge whether it succeeds in this aim. Another noteworthy limitation is the study’s use of binary gender categories. By classifying participants as ‘women’ and ‘men’, there is a risk of reinforcing reductive and homogenising assumptions, despite attempts to reflect the diversity of those who identified as women during recruitment [ 32 ]. Neither the sampling approach nor the questionnaire explicitly accounted for the complexity and fluidity of gender identities. The study proceeded on the assumption that the categorisation of individuals as ‘women’ and ‘men’ remained relevant to SRHR research, particularly in settings where expectations around early pregnancy and high fertility among young women intersect with pressing public health concerns such as maternal mortality and limited access to maternal care [ 19 – 29 , 67 – 69 ]. In this context, research focused on individuals assigned female at birth remains essential, even as it acknowledges that gendered experiences are not monolithic. Methodologically, certain measurement challenges also warrant consideration. Although the questionnaire demonstrated acceptable psychometric properties following adjustments to the response scale, issues such as DIF across provinces and only moderate test information values suggest some uncertainty in accurately capturing individual normative perceptions. Future research might explore the development of a more nuanced tool, potentially comprising thematically organised subscales, to enhance analytical specificity and support more effective monitoring, policy development, and intervention design in SRHR. It is also important to note that the middle response category (‘it depends’) was infrequently selected and thus merged with adjacent categories for analysis. While this improved model fit, such a response may nonetheless reflect meaningful ambivalence or conditionality—elements that are often central to how gender norms are negotiated in practice. Excluding or reconfiguring this category in future applications should be carefully reconsidered, as it may offer important qualitative insights. These limitations underscore the need for continued refinement of measurement approaches and greater integration of participatory, intersectional, and context-sensitive frameworks in SRHR research. They also point to critical avenues for future investigation. Readers are encouraged to interpret the findings with these considerations in mind. Conclusions This study highlights the central role of gender norms in shaping young women’s SRHR in Angola, revealing ongoing tensions, particularly around reproductive autonomy in intimate relationships. Subnational variations in normative support for SRHR reflected broader socio-economic inequalities, with provinces such as Lunda Sul and Huambo experiencing greater vulnerability and weaker endorsement. Notably, fewer than half of the SRHR-aspects were perceived as normatively supported by a majority, underscoring the urgent need to strengthen both formal and informal support systems. The use of mixed methods and locally adapted tools enhanced the study’s relevance, especially for under-articulated issues. Psychometric analysis revealed significant variation in how norms are expressed across contexts, demonstrating challenges in consistent measurement. DIF and local deviations caution against over-reliance on aggregate scores, while item-level analysis provided valuable insight into thematic differences. Future measurement efforts should build on intersectional and participatory principles to more fully reflect the lived realities of young women and advance socially just interventions. Encouragingly, shared concern among state and civil society actors regarding young women’s vulnerabilities offers a promising basis for coordinated, context-sensitive action. While social change is gradual and deeply rooted in local realities, collective efforts can foster environments where SRHR are not only recognised in law but truly realised in everyday life. Meaningful progress requires strategies that address the social and institutional conditions shaping rights, supporting individual agency and equitable, rights-based health systems. Ultimately, transformative progress requires inclusive, locally grounded strategies that address both structural and normative dimensions of inequality. Furthermore, ongoing research is essential to deepen understanding of how gender norms are perceived, reinforced, challenged, and sanctioned within specific contexts, thereby advancing measurement methods and informing the design of socially just and contextually sensitive interventions. Abbreviations CSO: civil society organisations IPV: intimate partner violence PCA: principal component analysis SADIMA: saúde e direitos das mulheres em Angola (Angolan women’s health and rights) SRHR: sexual and reproductive health and rights Declarations Ethics approval and consent The study was carried out in accordance with the ethical principles outlined in the Declaration of Helsinki [85]. Ethical approval was obtained from the Ethics Committee Institutional Review Board of the Angolan Ministry of Health (24/C.E./2021), the Ethics Committee at the Universidade Católica de Angola (Approvação 153, CEIH 230) and the Swedish Ethics Review Authority (Dnr 2022-06393-01). Verbal informed consent was obtained from all participants, following the approach used in DHS [82], which is considered appropriate in settings with high-levels of illiteracy. Participants were given the option to skip any question they preferred to not answer. Ethical principles–specifically beneficence, respect for autonomy, justice, and non-maleficence–guided all phases of the research process, including the development of data collection tools, the conduct of fieldwork, and the subsequent analysis and interpretation of data. Consent for publication Not applicable Availability of data and materials The qualitative interview data generated during the current study are not publicly available in order to protect participant confidentiality. All quantitative data generated or analysed during this study are included in this published article and its supplementary information files. Competing interests The authors declare that they have no competing interests. Funding GP and AM received grant no. 2020-03102 from the Swedish Research Council. FVDR was funded through a Calouste Gulbenkian Foundation PALOP and East Timor PhD scholarship (process number: 1445517). The funding agencies did not influence the design, conduct or analysis of the study. Authors’ contributions GP, the principal investigator, led the coordination and implementation of the SADIMA project. Together with AM, GP conceptualised the project and applied for research funding. The questionnaire was developed by GP, AM, and FVDR, who also formulated the ethics applications. GP, AM and MM designed the data collection strategy and oversaw the data collection process. GP, BK, and JM contributed to data management. BK conducted the statistical analyses with input from JM and GP. All authors contributed to the summarisation of the analyses, discussion, and conclusions. The manuscript was written by GP and BK, with input and feedback from all coauthors until the final version was submitted. Acknowledgements We would like to extend our sincere gratitude to the data collectors and drivers in each province for their dedication to ensuring the quality of the work and the well-being of the participating women. 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Women’s decision-making power within a relationship is a key factor in facilitating their meaningful participation in decisions that promote health and well-being, while also enhancing household planning and long-term family resilience. decision equality ...men should have more influence than women over important family and household decisions.* Although sexual consent is not legally required within marriage, it remains central to the promotion of gender equality and the prevention of intimate partner violence. marital consent ...a woman has the right to decline sex with her partner for whatever reason. Fostering supportive environments that enable women to express themselves freely and share diverse perspectives without fear of punishment or stigmatization is essential for advancing their rights, well-being, and meaningful participation in family and societal life. freedom of expression ...a good woman does not question her partner’s opinion, even if she does not agree with him.* Childbearing is frequently valued as a source of joy, strength, and social significance for women; however, this emphasis may be experienced by some as pressure to have children, potentially impacting the self-worth of those who do not. identity diversity ...a woman is a "real woman" only after becoming a mother.* Acknowledging women who have experienced sexual abuse as entitled to support, dignity, and justice is crucial for creating a safe environment that encourages disclosure, facilitates help-seeking from trusted sources, and ensures access to the healthcare, counselling, and legal services necessary for healing and recovery. non-stigmatisation ...it is shameful to talk about experiences of sexual abuse, even with close family and friends.* Promoting girls’ right to a safe and healthy childhood—free from the adult responsibility of motherhood—alongside gender balanced responsibility for pregnancy prevention, is essential for supporting adolescent health, gender equality, and the realisation of their rights. reproductive maturity ...it is normal for girls to have children before the age of 18.* Acknowledging intimate partner violence as a health and rights issue—and ensuring it is treated as such by all sectors, including law enforcement—is essential for protecting the well-being of women and children, promoting justice, and strengthening coordinated responses and prevention efforts. freedom from violence ...women should tolerate violence from her partner/husband to keep the family together.* Upholding women’s rights to bodily autonomy, integrity and dignity—free from coercion or harassment—is fundamental to fostering safe environments across societal settings, where opportunities are equitably determined by merit rather than by deference to gendered authority. bodily autonomy ...a woman has to accept that men in positions of power (teachers, chiefs, police officers etc) demand sexual favours from them.* Promoting shared responsibility for family planning and women’s reproductive health between women and their male partners is critical for achieving optimal pregnancy spacing and enhancing maternal and child health outcomes. maternal health ...a couple should limit the number of pregnancies for the sake of the woman’s health. Supporting girls’ autonomy to choose if, when, and whom to marry empowers them to make decisions that promote their health and rights, helping to reduce risks associated with early pregnancy, sexually transmitted infections, and intimate partner violence. relationship autonomy ...a woman should be able to decide for herself who to marry or have a close relationship with. SRHR topics excluded as a result of qualitative evaluation Rationale Strengthening health literacy in SRHR empowers individuals to make informed decisions and protects them from abuse and disease, promoting their overall well-being and autonomy. sufficiently covered by ‘education access’ Promoting more equitable sharing of caregiving responsibilities supports women’s access to healthcare, rest, economic opportunities, and self-care, thereby enhancing their overall health and well-being. sufficiently covered by ‘decision equality’ Shared responsibility in preventing unwanted pregnancies contributes to improved contraceptive uptake and more consistent use. sufficiently covered by ‘decision equality’ and ‘maternal health’ Men’s supportive involvement in women’s health during pregnancy and childbirth can help advance maternal healthcare participation, improve health outcomes, and contribute to healthier family life for all members. sufficiently covered by ‘decision equality’ and ‘maternal health’ Access to youth-friendly, adequately equipped health facilities that provide family planning and maternal care, plays a critical role in preventing disability, serious illness, and associated socio-economic impacts. partly covered by ‘decision equality’; limitations in healthcare access viewed as a systemic rather than gender-specific issue Equally valuing girls and boys is fundamental to ensuring their future equal rights, opportunities, and protections. not regarded as a local priority, as the number of children takes precedence over their gender The ability to self-define one’s gender identity and sexual orientation is vital to SRHR, given its ties to identity and the risk for significant stigmatisation when prevailing social norms are challenged. limited definition clarity across study contexts (better suited to qualitative research) *Statements marked with an asterisk (*) carried a negative connotation in relation to women’s rights as presented in the survey. However, for the purposes of this table, the corresponding SRHR concepts are framed in a rights-promotive manner to enhance clarity. For analysis, the Likert scale for these items was reverse-coded. Table 2. Socio-demographic and SRHR characteristics (in %) of the study population by province. Variable Category Luanda n=910 Huambo n=684 Lunda Sul n=487 Total n=2081 Socio-demographic characteristics Literate Yes 85.7 53.7 41.5 64.8 No 13.8 44.9 58.3 34.5 Missing 0.4 1.5 0.2 0.7 Formal education High 61.0 32.0 19.5 41.8 Middle 28.2 35.8 32.0 31.6 Low 10.8 31.9 48.5 26.5 Missing 0.0 0.3 0.0 0.1 Work Yes, permanent 18.6 17.4 6.0 15.2 Yes, temporary 31.8 29.4 15.0 27.1 No 49.3 52.9 79.1 57.5 Missing 0.3 0.3 0.0 0.2 Household night hunger No 71.8 49.9 40.7 57.3 Yes 28.0 49.4 59.1 42.3 Missing 0.2 0.7 0.2 0.4 Household wealth tertile 3d (better off) 60.3 16.5 4.7 32.9 2d 33.0 33.9 31.4 32.9 1st 5.4 47.8 63.2 32.9 Missing 1.0 1.8 0.6 1.3 Area of residency Urban 94.0 44.3 26.3 61.8 Rural 6.0 55.7 73.7 38.2 General SRHR characteristics Pregnancy No 56.4 26.6 20.5 38.2 Yes, 1st >18 24.9 28.8 25.9 26.4 Yes, 1st <18 18.0 43.6 53.2 34.6 Missing 0.7 1.0 0.4 0.7 Menstrual autonomy Yes 61.9 69.6 27.5 56.4 No 37.1 28.4 71.7 42.3 Missing 1.0 2.0 0.8 1.3 Intimate partner violence No 58.8 54.5 33.3 51.4 Yes 37.1 43.0 66.1 45.8 Missing 4.1 2.5 0.6 2.7 Fertile period knowledge Yes 67.9 72.2 33.1 61.2 No 31.1 26.5 66.1 37.8 Missing 1.0 1.3 0.8 1.1 Acquired information about pregnancy or childbirth complications Yes 66.9 67.8 29.4 58.4 No 32.7 31.3 69.8 40.9 Missing 0.3 0.9 0.8 0.6 Modern family planning awareness Yes 97.7 89.0 72.3 88.9 No 1.4 9.8 26.9 10.1 Missing 0.9 1.2 0.8 1.0 Modern family planning use Yes 55.7 39.0 30.2 44.3 No 34.1 56.6 67.4 49.3 Missing 10.2 4.4 2.5 6.5 Table 3. Perceived normative support for SRHR topics by province, percentages responding to 4-5 on Likert scale. SRHR topic Luanda n=888 Huambo n=646 Lunda Sul n=480 Total n=2081 The right to… % % % % education access 74.3 82.3 70.4 76 relationship autonomy 78.7 59.9 66.9 69.8 bodily autonomy* 73.3 69.3 54.4 67.6 freedom from violence* 67.3 54.4 48.3 58.6 non-stigmatisation* 51.4 58.2 51.7 53.7 identity diversity* 61.9 47.7 31.6 50.1 reproductive maturity* 61 46.8 23.8 47.6 maternal health 50.1 50.3 38.6 47.5 freedom of expression* 49.9 47.1 37.6 46.1 marital consent 44.3 37.4 48.9 43.1 decision equality* 35.2 39.6 34.7 36.5 *Statements marked with an asterisk (*) carried a negative connotation in relation to women’s rights as presented in the survey. However, for the purposes of this table, the corresponding SRHR concepts are framed in a rights-promotive manner to enhance clarity. For analysis, the Likert scale for these items was reverse-coded. Additional Declarations No competing interests reported. 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08:54:28","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":211343,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile5Dataset.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7037473/v1/d0b90a77d6ccfaac39327e8e.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Gender norms in sexual and reproductive health and rights: Insights from young Angolan women and the development of a context-specific questionnaire","fulltext":[{"header":"Contributions to the literature","content":"\u003cul\u003e\n \u003cli\u003eA new questionnaire was developed to measure SRHR-related gender norms from Angolan young women\u0026rsquo;s perspectives, aligning well with theory and local realities.\u003c/li\u003e\n \u003cli\u003eSome topics, including gender identity and health system gaps, proved challenging to measure, emphasising the value of combining surveys with qualitative methods.\u003c/li\u003e\n \u003cli\u003eFindings showed normative support for rights like relationship autonomy, but more resistance to delaying motherhood and decision-making equality.\u003c/li\u003e\n \u003cli\u003ePsychometric analysis confirmed good questionnaire properties and shed light on both shared beliefs and underlying tensions within gender norms.\u003c/li\u003e\n \u003cli\u003eThe study signal potential links between socio-economic challenges and weak normative support, emphasising the need for intersectional, equity-focused strategies.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Background","content":"\u003ch2\u003eSexual and reproductive health and rights as a cornerstone of human rights and development\u003c/h2\u003e\n\u003cp\u003eSexual and reproductive health and rights (SRHR) is widely recognised as integral to the advancement of human well-being, the achievement of sustainable development, and the realisation of fundamental human rights. This centrality is well established in both academic discourse and international policy frameworks [1-5]. It is articulated notably in the work of the Guttmacher–Lancet Commission on SRHR [1], and reflected in the integration of numerous SRHR-related targets within the United Nations Sustainable Development Goals (SDGs) [5]. Regionally, the importance of SRHR is underscored in legal instruments such as the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa–commonly referred to as the Maputo Protocol [4,6].\u003c/p\u003e\n\u003cp\u003eIn Angola, the contextual focus of this study, international and regional commitments are mirrored in national legislation, strategic development plans, and the ongoing efforts of civil society organisations (CSO). The Angolan National Development Plan for 2023-2027 identifies gender equality and SRHR as key pillars of national progress [7,8]. Alongside formal policy initiatives, the women’s rights movement in Angola has consistently highlighted SRHR as a critical means of addressing the gendered legacies of colonialism and entrenched social and economic inequalities [2,9-11]. Human rights organisations have likewise offered compelling ethical and legal arguments for the protection and promotion of women’s reproductive rights [2,12,13]. As the leading Angolan human rights organisation Mosaiko poignantly affirms, “valuing human life begins precisely where life is generated” [13].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSRHR comprises a complex and multidimensional domain, intricately linked to physical, mental, and emotional well-being. This field engages with deeply personal aspects of identity and interpersonal relationships, while also intersecting with broader socio-cultural and institutional systems. At its core, SRHR is underpinned by fundamental principles of privacy, bodily autonomy and respect; the right to safe, consensual, and secure intimate relationships and reproductive decision-making; freedom from violence and coercion; and the capability to prevent illness and promote holistic health [1,4,14,15].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn recent years, growing attention has been paid to the rights, needs, and lived experiences of adolescent girls and young women. Their meaningful inclusion is increasingly recognised not only as a moral imperative, but also as a strategic priority for advancing maternal and child health and achieving broader public health and development goals [1,16-18]. Despite these commitments, young women continue to bear a disproportionate burden of SRHR-related challenges, including early and unintended pregnancies, sexually transmitted infections (STIs), and gender-based violence [1]. Unintended pregnancies, in particular, are frequently linked to school drop-out, social stigma, and long-term economic insecurity. Limited access to comprehensive SRHR information and services constrains young women’s ability to make informed decisions about their bodies and life trajectories [1]. This has far-reaching implications for their personal health, and the well-being and resilience of their families and wider communities. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese global challenges are particularly acute in the Angolan context, where demographic factors amplify their relevance: over half of the population is under the age of 25 [19]. Yet, significant SRHR needs remain unmet: nearly half of pregnancies occur during adolescence [14,19,20]; contraceptive coverage extends to just over one-third of women [20-23]; approximately 50% of births take place outside formal health facilities [20,24-28]; and intimate partner violence (IPV) affects an estimated 38% of women [29].\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eSocial norms and their role in SRHR\u003c/h2\u003e\n\u003cp\u003eIn response to the complex and interrelated challenges surrounding SRHR and broader gender inequalities, there is a growing recognition of the need for multidimensional, cross-sectoral strategies [1-8,16,30,31]. These approaches commonly converge around several interdependent priority areas, including: expanding access to affordable, high-quality reproductive healthcare and family planning services; preventing IPV; providing counselling and rehabilitation services for survivors of abuse and sexual harassment; and challenging harmful social norms, such as the normalisation of child marriage and constraints on women’s agency within the domestic sphere [1-8,16,30,31].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEach of these components is recognised as integral to advancing SRHR goals, as they address not only immediate health concerns but also the underlying structural conditions that influence women’s agency and well-being. Crucially, such approaches move beyond purely biomedical frameworks and the operational capacities of health systems to underscore the decisive role of societal beliefs, practices, and values in shaping health-related behaviours and access to services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere is a growing recognition that barriers to SRHR are not solely the result of material or institutional limitations but are deeply embedded within normative systems that shape expectations and behaviours in everyday life [30-43]. While gender norms vary across cultural, social, and economic contexts, certain patterns recur globally [30,44]. Masculinity is frequently associated with strength and independence, while femininity is linked to vulnerability and a need for protection. These gendered constructions tend to reinforce male privilege and establish distinct, hierarchical gender roles that assign lower value to women and feminised identities [44].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParadoxically, despite being cast as vulnerable, women are frequently expected to take responsibility for both their own and men’s sexual conduct. In many settings, female identity remains closely tied to motherhood, whereas male identity is commonly linked to financial provision and public authority [30,31]. Data from the World Values Survey illustrate the persistence of such attitudes; while discriminatory views concerning women’s right to education were expressed by 28% of respondents, a substantially larger proportion (58%) held prejudicial views regarding women’s reproductive rights [31]. These findings point to a widespread resistance to SRHR, reflecting deeper patterns of gender-based discrimination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt the heart of these patterns lie social norms that both mirror and perpetuate restrictive understandings of gender roles and entitlements. Although social norms are a fundamental part of any society—helping to establish shared understandings and promote cohesion—they can also perpetuate harm when they legitimise exclusion, reinforce unequal power relations, or devalue certain identities [34,39,45,47].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWithin the SRHR domain, restrictive gender norms can have profound and, at times life-altering consequences. These include limiting women’s autonomy in deciding whether, when, and with whom to have children, as well as discouraging male engagement in reproductive health–both of which can compromise the effectiveness of family planning and maternal health services [47,48]. Social norms are also recognised as shaping institutional arrangements and may restrict access to legal protections, educational and economic opportunities, and healthcare services [30,49]. When embedded within broader structures of power and inequality, such norms may contribute to cycles of disempowerment, deprivation, and social exclusion–dynamics that tend to reinforce one another over time [34,36-39].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs such, normative frameworks may create intersecting barriers to the realisation of SRHR, while simultaneously sustaining patterns of marginalisation and structural disadvantage. In this context, many of the health challenges faced by women are thus increasingly recognised not as isolated issues, but as symptoms of wider structural inequities, influenced by discriminatory attitudes and norms concerning women’s rights and roles [1,3,32-42].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAddressing these inequities therefore requires more than expanding services, infrastructure, or legal protections. It necessitates sustained, collective efforts to transform the social norms and power relations that underlie gender-based disadvantage. Such transformation is increasingly viewed not only as a catalyst for systemic change but as a vital outcome in itself—central to the realisation of human rights and the advancement of well-being for women and girls across all domains of life [50,51].\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eChallenges in measuring norms within SRHR\u003c/h2\u003e\n\u003cp\u003eWhile the central role of gender norms in shaping lived experiences is widely recognised—and supported by well-established theoretical frameworks—empirical approaches to measuring these norms remain relatively underdeveloped [15,39,42,52]. Within the field of SRHR, the breadth and complexity of the subject matter pose particular challenges for measuring associated gender norms in a clear and precise manner. Notably, several indicators for SDG5–which target gender discrimination and harmful practices–still lack methodologically robust tools for reliable assessment [48].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExisting measurements of gender norms typically fall into two broad categories. Some are highly context-specific, addressing issues such as household responsibilities or interpersonal dynamics unique to particular settings [50,52,53]. Others conflate personal attitudes with collective social norms, thereby reducing conceptual clarity and obscuring the socially embedded nature of normative influence [39,41,48]. In some cases, indirect proxies–such as disparities in health outcomes or divergent survey responses by gender–are used to infer the presence of norms [34,36,37,52,54]. While these approaches offer valuable insights, they often lack the theoretical precision and contextual nuance needed to uncover the mechanisms through which norms shape behaviour [32,41,48].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoreover, many available tools have either not been formally evaluated or have been assessed using limited methodology [48,53]. Advanced modelling techniques–such as those derived from Item Response Theory (IRT), including Rasch analysis–have rarely been applied in this domain, despite their potential to strengthen measurement validity and provide deeper insights into the relationship between observed responses and underlying constructs [55,56].\u003c/p\u003e\n\u003cp\u003eThere remains, therefore, a need for further empirical work to explore how gender norms are constituted, experienced, and measured across different contexts [32,36]. One promising avenue involves shifting the analytical focus beyond individual attitudes to include perceptions of societal expectations across specific domains of life. In the context of SRHR, this may encompass norms governing sexual and reproductive decision-making, perceptions of safety and bodily integrity, and the ways in which social expectations contribute either stigma and discrimination or to the advancement of rights and health equity. It is also important to assess the extent to which such norms are widespread and firmly established, in order to better understand their weight and influence [39].\u003c/p\u003e\n\u003cp\u003eSuch an approach could offer a more nuanced and contextually grounded understanding of the normative dynamics outlined in the theoretical literature. It could help reduce the risk of conceptual distortion and uncover the structural conditions that sustain specific gendered experiences. Ultimately, such insights have the potential to inform the development of more effective, equitable, and contextually appropriate interventions [31,33,37,57,58].\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eAims\u003c/h2\u003e\n\u003cp\u003eDespite growing global attention to gendered inequalities, empirical research examining gender norms in relation to SRHR remains limited. In Angola, the lack of context-specific research on women’s social conditions has been identified as a barrier to national development [2,19]. This study seeks to contribute to addressing this knowledge gap.\u003c/p\u003e\n\u003cp\u003eIt pursues three primary objectives. First, it seeks to deepen the understanding of how various aspects of SRHR are perceived to be influenced by gender norms within the Angolan context. Second, it aims to explore the extent to which young women perceive these norms as being socially embedded in their everyday environments–that is, the degree to which they encounter prevailing beliefs that either support or constrain their SRHR. Third, the study endeavours to identify both challenges and opportunities involved in developing a contextually grounded questionnaire to assess gender norms within this complex and sensitive domain.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTogether, these aims seek to generate insights that may inform future research on gender norms, including their potential links to health outcomes, and support the development of targeted interventions to advance young women’s SRHR in Angola and similar settings.\u003c/p\u003e\n\u003ch2\u003eStudy setting\u003c/h2\u003e\n\u003cp\u003eAngola, located on the southwest coast of Africa, is a country of striking geographic and economic diversity. Since gaining independence from Portugal in 1975, it has made important strides in post-conflict recovery following a long civil war that ended in 2002. Although rich in oil and diamond resources, development remains uneven, with nearly half of the population living in extreme poverty [59-62].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study focuses on three provinces that reflect broader disparities [63-65]. Luanda, the capital province, is the country’s economic and political centre, characterised by rapid urbanisation and stark socio-economic divides. Huambo and Lunda Sul, both predominantly rural provinces, face distinct yet interconnected challenges [21]. Huambo has a strong agricultural base but continues to face barriers in poverty reduction and service delivery [63]. Lunda Sul, known for its diamond mining industry, illustrates the paradox of resource wealth coexisting with underdeveloped infrastructure and economic hardship [64,65]. Across all the provinces, disparities in healthcare, education, and social services highlight persistent structural inequities that impact much of the population [19-28,58-66].\u003c/p\u003e\n\u003cp\u003eSRHR outcomes are further influenced by gender-based inequalities. Research and national data consistently show that women face disadvantages in multiple domains [13,19,21,28,66-71]. Angola ranks 28th out of 36 sub-Saharan African countries for gender equity, with women 36% less likely than men to access opportunities [69]. While women’s parliamentary representation is comparatively high at 39.1% [70], inequalities remain across other sectors. According to the latest Demographic Health Survey (DHS), 44.7% of women reported little or no formal schooling, compared with 29.7% of men [28]. Financial autonomy is similarly gendered, with 22.3% of women reporting ownership of a bank account, compared to 36.1% of men. Women are more likely to experience food insecurity (66% vs. 53.4% for men), and face continued challenges in accessing accurate HIV/AIDS prevention information, particularly among youth (50.7% of young women vs. 69.9% of young men) [28].\u003c/p\u003e\n\u003ch2\u003eStudy design\u003c/h2\u003e\n\u003cp\u003eThe research is part of the SADIMA project (an abbreviation of the Portuguese Saúde e Direitos das Mulheres em Angola) which seeks to examine social determinants of young Angolan women’s SRHR, as well as their psychological well-being [65].\u003c/p\u003e\n\u003cp\u003eThe present study combined quantitative and qualitative methods to explore gender norms, support the development of a questionnaire, and implement it within a study involving young women in Angola. The identification of SRHR topics and the subsequent development of corresponding gender norm items followed three main steps: (1) topic identification and initial item development, (2) refinement and piloting, and (3) assessment of measurement properties. The initial stages (steps 1 and 2) were conducted alongside the broader questionnaire development for the SADIMA project.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eSRHR topic identification and initial item development\u003c/h3\u003e\n\u003cp\u003eThis phase combined a literature review with key informant interviews to identify priority SRHR topics. Through a participatory process oscillating between inductive and deductive reasoning, specific questionnaire items were developed, and the initial content validity of emerging constructs were assessed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe process began with a review of relevant empirical, theoretical, and applied literature, which informed the design of the overarching SADIMA survey instrument. The literature underscored the critical role of SRHR in shaping women’s broader living conditions [1,], and highlighted persistent and unmet SRHR needs of young women in Angola [12,20-24]. The emphasis on gender norms within the SADIMA project was informed by the priorities articulated by Angolan CSOs [2,13,72,73]. A review of established gender-related scales [53], alongside key theoretical contributions on gender and intersectionality [45,75-79], contributed further to the conceptual development of the gender norms questionnaire.\u003c/p\u003e\n\u003cp\u003eTo ensure contextual relevance, key informant interviews were conducted between July and September 2021 with representatives of governmental health institutions (\u003cem\u003en\u003c/em\u003e=10), national CSOs (\u003cem\u003en\u003c/em\u003e=8), as well as international governmental and non-governmental organisations (\u003cem\u003en\u003c/em\u003e=7) operating in Angola (an additional file shows this in more detail [see Additional file 1]. A snowball sampling strategy was employed, initiated through contacts within national and provincial public health units. Interviews were conducted by a team of five researchers–four Angolan and one Swedish–with interdisciplinary expertise in public health, gender studies, and sociology.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA semi-structured interview guide, informed by [79-81], facilitated discussion on key challenges to women’s health and rights in Angola, ongoing initiatives in this field, and perceived gaps in current efforts [see Additional file 1]. These insights were instrumental in assessing the extent to which SRHR topics identified in the literature were also prioritised–or not–by participants as critical issues affecting young women’s SRHR in the Angolan context.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eQuestionnaire item refinement and piloting\u003c/h3\u003e\n\u003cp\u003eThis phase involved the iterative development, refinement and piloting of questionnaire items designed to reflect gender norms related to SRHR. Drawing on relevant theoretical literature and informed by participatory engagement with members of the target population, key SRHR topics were translated into questionnaire items. These were reviewed for conceptual relevance, linguistic clarity, and cultural appropriateness, with revisions made to improve accessibility and ensure contextual alignment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTwo participatory workshops were conducted to assess the relevance of proposed SRHR topics in relation to prevailing gender norms: one with young female university students (\u003cem\u003en\u003c/em\u003e=8) and another with young female data collectors (\u003cem\u003en\u003c/em\u003e=12). Based on participants’ feedback, certain topics were excluded if they were perceived as unrepresentative of widely shared social expectations, or if they addressed issues unlikely to be meaningful or recognisable to a broader group of young women.\u003c/p\u003e\n\u003cp\u003eThemes that were viewed as reflecting commonly held beliefs about appropriate or expected behaviours of girls and women within their social environment were reformulated as injunctive norm statements. These formulations were guided by the conceptual framework developed by Cislaghi and Heise [41], who define gender norms as “social norms defining acceptable and appropriate actions for women and men in a given group or society. They are embedded in formal and informal institutions, nested in the mind, and produced and reproduced through social interaction. They play a role in shaping\u0026nbsp;women and men’s (often unequal) access to resources and freedoms, thus affecting their voice, power and sense of self.”\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe workshops also included reflections on ethical considerations, the use of inclusive and appropriate language, and the conceptual clarity of the items for the intended respondent group. To support participants in distinguishing between personal attitudes and shared social expectations, a standardised introduction was developed. This introduction encouraged participants to respond based on what they believed best reflected “the ideas of people in this neighbourhood, village, or community.” This phrasing was repeated before each item to reinforce the intended normative framing. An additional file shows this in more detail [see Additional file 2]. Within this framework the surveyed young women’s perceptions were interpreted as meaningful expressions of prevailing gender norms. This approach rested on two key premises: first, that young women are active social agents capable of reflecting on and articulating the normative expectations around them; and second, that even if individual perceptions do not fully represent wider community views, they nonetheless influence self-concept, decision-making, and behaviour. As such, the gender norms questionnaire aimed to capture participants’ perceptions of SRHR-related expectations within their everyday environments.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe revised items were subsequently field-tested within the broader SADIMA survey. Following each interview (\u003cem\u003en\u003c/em\u003e=66), structured feedback was gathered from both interviewers and respondents, and reviewed by two researchers. Daily debriefing sessions with the interview team further enabled reflection on field experiences, identification of challenges, and refinement of data collection procedures.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The piloting phase extended over a two-week period and continued until interviewers confirmed that all questionnaire items and response options were clearly understood by participants. This process also explored the most appropriate phrasing of items—specifically, whether statements should be framed positively or negatively, i.e. expressing support for or opposition to SRHR principles. Attention was likewise given to ensuring participants’ understanding of the Likert scale and the distinction between personal opinions and perceived community beliefs. Visual aids and supplementary explanatory materials were developed to support participant comprehension, and minor linguistic adjustments were made to improve clarity. No additional items were proposed during this phase, and none of the existing items were judged to be redundant or irrelevant. An additional file shows this in more detail [see Additional file 2].\u003c/p\u003e\n\u003ch3\u003eAssessment of measurement properties\u003c/h3\u003e\n\u003cp\u003eIn the third, and final phase, measurement properties of the proposed gender norm questionnaire were evaluated using a polytomous Rasch model (the partial credit model), drawing on data from the cross-sectional component of the SADIMA project.\u0026nbsp;\u003c/p\u003e\n\u003ch4\u003eSampling and data collection\u003c/h4\u003e\n\u003cp\u003eDetails on the SADIMA study design, including sampling procedure, sample size, and data collection protocols, are provided in Priebe et al. [65]. This cross-sectional study included women aged 16-24. Sampling was informed by the latest DHS survey [21], and aimed to capture at least 1,885 young women across socio-economically diverse rural and urban settings in Luanda, Huambo and Lunda Sul [21,65].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData were collected between February and May 2022 by trained female interviewers with university-level education. Interviewers had undergone a project-specific, one-week training programme covering questionnaire content, interviewing techniques, and research ethics. Participants received study information prior to giving informed consent. Each interviewer conducted approximately four interviews per day. To support data quality, daily consistency checks were performed, and weekly reviews were undertaken to detect and mitigate potential interviewer bias [65].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition to responses on gender norm items which were recorded using a five-point Likert scale (totally agree/agree/it depends, neither agree nor disagree/disagree/totally disagree), the analysis included background characteristics and general SRHR indicators. Thirty questions from the broader SADIMA survey were used to construct relevant variables. Several of these were adapted from the Angolan DHS [82], including literacy (yes/no), formal education (high/medium/low), work (yes, permanent/yes, temporary/no), household wealth tertiles (3d/2d/1st), fertile period knowledge (yes/no), modern family planning awareness (yes/no), and modern family planning use (yes/no). Additional variables, such as household night hunger (no/yes) [83] and exposure to intimate partner violence (no/yes) [84], were derived from established scales. Other variables were developed specifically for the SADIMA study, drawing conceptually on the DHS framework. These included provinces (Luanda/Huambo/Lunda Sul), area of residence (urban/rural), pregnancy history, categorised by age at first pregnancy (no/yes ≥18 years/yes, \u0026lt;18 years), menstrual autonomy (yes/no), and acquired information about pregnancy and childbirth complications (yes/no). [see Additional file 2].\u003c/p\u003e\n\u003ch4\u003ePsychometric analysis\u003c/h4\u003e\n\u003cp\u003eThe polytomous Rasch model was fitted to data from participants who responded to at least three quarters (at least 9) of the gender norms statements, which were considered as providing sufficient information on their perception of gender norms. Following Johansson et al [85], assessments were conducted of unidimensionality (including local response dependence, and item fit), the ordering of response categories, invariance, targeting, and reliability of the proposed questionnaire.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor unidimensionality, principal component analysis was applied to the covariance matrix of (unconditional) standardized residuals, constructed elementwise using pairwise complete observations. Support for unidimensionality was inferred when the first eigenvalue was below 2 and the explained variability by the individual components was low. Item fit was assessed visually through CICC (conditional item characteristic curve) plots [86], in which participants were grouped into deciles based on total scores. These plots contrasted, for each item and conditional on total score, the expected score with the observed average score. This visual assessment was supplemented by outfit and infit statistics based on unconditional standardised residuals, estimated through subsampling (350 participants per sample, 100 repetitions) [87]. A rule of thumb was applied to judge whether the infit and outfit statistics averaged over the subsamples indicate a misfit (\u0026lt;0.7 or \u0026gt;1.3 for mean square infit and outfit statistics, and \u0026lt;-2 or \u0026gt;2 for normalized infit and outfit statistics).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLocal dependence was investigated using Yen’s Q3 statistic, and item pairs were considered dependent when the Q3 value exceeded the average by more than 0.2 [88].\u003c/p\u003e\n\u003cp\u003eThe ordering of response categories--reflected in the ordering of the estimated threshold values–was evaluated through visual inspection of item characteristic curves. When the curves indicated that each response option was the most likely to be selected in the expected sequence across the latent trait continuum, the categories were considered to be ordered [89].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMeasurement invariance was examined with respect to province, household wealth, literacy, and area of residence. Differential item functioning (DIF) was explored using partial credit trees [90], with a stopping rule applied to avoid subgroup sizes smaller than 350. The magnitude of DIF was assessed visually through a modified version of the CICC plot, comparing the expected scores under the common model with observed scores conditional on total score, within groups identified as exhibiting DIF. Threshold instability was visualised by plotting item thresholds across the DIF-identified subgroups. The impact of DIF on person locations was evaluated by identifying items judged to function comparably across subgroups. Then person locations from a model with all other items resolved were compared with those obtained from a common model disregarding DIF, with scale alignment achieved by fixing the first threshold of the first common item to zero. Agreement between person estimates was examined using Bland-Altman plots [91], histograms were constructed to visualise differences in trait distributions among DIF groups, and differences in person estimates were interpreted relative to the standard deviation of the location estimates.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTargeting was assessed by comparing the distribution of estimated person locations with the distribution of item thresholds. Good targeting was considered present when item thresholds covered a similar range to that of person estimates on the latent scale.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReliability was evaluated using the test information function. Participants (with complete data) for whom the test information exceeded a value of 3.33–corresponding to a person separation index of 0.7 [85,92]–were considered to have been measured with satisfactory precision.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll analyses were carried out using SPSS (version 29.0.0.0) and R (version 4.3.3) [93]. The psychometric analysis was conducted using eRm package (version 1.0-5) [94], psychotree package (version 0.16-0) [90], customized functions from RASCHplot package (version 0.1.0) [95] and RISEkbmRasch package (version 0.1.34.1) [85] was used for visualizations. Final processing of the figures was done using the cowplot (version 1.1.3) [96] and patchwork (version 1.3.1) [97] packages. \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eIdentification of SRHR topics and development of gender norm items\u003c/h2\u003e\n\u003cp\u003eTable 1 presents the SRHR topics identified through qualitative analysis of relevant literature and interviews with key informants as particularly salient within the Angolan context. It also indicates which of these topics were deemed sufficiently linked to prevailing gender norms\u0026mdash;understood as socially embedded influences in this context\u0026mdash;to warrant inclusion in the questionnaire. Topics excluded following participatory workshop discussions are listed in the lower section of the table.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe final selection comprised eleven SRHR topics considered to reflect a clear and contextually grounded connection to prevailing gender norms. The priorities identified through the workshops broadly aligned with key themes found in international scientific and human rights literature. The selected topics represented a relatively balanced mix of the two core domains of SRHR: \u0026lsquo;sexual\u0026rsquo; and \u0026lsquo;reproductive\u0026rsquo;.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHealth was predominantly framed as an outcome of the realisation of rights. Accordingly, rights-related dimensions were more explicitly articulated, while health-related aspects were often implicit and tended to intersect with broader rights-based concerns. Topics related to sexual health and rights included relationship autonomy, bodily autonomy, non-stigmatisation, and consent within marriage. Topics in the reproductive health and rights domain encompassed identity diversity, reproductive maturity, and maternal health. Foundational concerns\u0026mdash;such as girls\u0026rsquo; right to education and broader aspects of women\u0026rsquo;s status within intimate relationships, including freedom from violence, freedom of expression, and equality in decision-making\u0026mdash;were retained due to their perceived centrality to the realisation of SRHR in the local context.\u003c/p\u003e\n\u003cp\u003eFour topics were excluded due to conceptual overlap, perceived redundancy, or limited resonance across diverse social and geographical contexts in Angola. In particular, some SRHR interventions were viewed by participants as overly aspirational in a context where education and healthcare remain severely under-resourced. Consequently, topics related to access to specific SRHR information and services were seen as reflecting wider systemic challenges rather than gender-specific barriers.\u003c/p\u003e\n\u003cp\u003e[Table 1]\u003c/p\u003e\n\u003ch2\u003eCharacteristics of study participants\u003c/h2\u003e\n\u003cp\u003eTable 2 summarises the socio-demographic characteristics and selected SRHR indicators of the young women who participated in the study (n=2,081 of 2,109 recruited, an additional file shows this in more detail [see Additional file 3]. The data revealed notable disparities in participants\u0026rsquo; living conditions across the three provinces. In general, respondents in Luanda reported more favourable living conditions, whereas those in Lunda Sul experienced most pronounced challenges, with Huambo positioned between the two.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor instance, literacy rates varied substantially, with 85.7% of women in Luanda being literate, compared to 53.7% in Huambo and 41.5% in Lunda Sul. Similarly, household food security was reported to be highest in Luanda (71.8%), but substantially lower in Huambo (49.9%) and Lunda Sul (40.7%). These disparities correspond with the wealth distribution observed in the study population, whereby the highest wealth tertile was predominantly composed of participants from Luanda. In contrast, a large part of participants from Huambo and Lunda Sul belonged to the lowest wealth tertile (47.8% and 63.2%, respectively).\u003c/p\u003e\n\u003cp\u003eChallenges related to SRHR were also evident across all provinces, although they appeared most acute in Lunda Sul. Early pregnancy was notably high in Lunda Sul (53.2%) and Huambo (43.6%), and comparatively lower in Luanda (18%). Experiences of IPV were widespread, with the highest prevalence in Lunda Sul (66.1%), followed by Huambo (43.0%) and Luanda (37.1%). A comparable pattern was observed with respect to menstrual autonomy, defined here as the ability to continue usual daily activities outside the home during menstruation. While a majority of participants in Huambo (69.6%) and Luanda (61.9%) reported having this autonomy, only 27.5% of respondents in Lunda Sul indicated the same.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAwareness of key reproductive health topics were relatively high in Luanda and Huambo. For example, 72.2% of respondents in Huambo and 67.9% in Luanda correctly identified the fertile period, compared to 33.1% in Lunda Sul. Awareness of modern family planning methods was high in all provinces\u0026ndash;97.7% in Luanda, 89.0% in Huambo, and 72.3% in Lunda Sul. However, this awareness did not consistently translate into use: 55.7% of women in Luanda reported ever using a modern contraceptive method, compared to 39% in Huambo and 30.2% in Lunda Sul.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Table 2]\u003c/p\u003e\n\u003ch2\u003ePrevalence of SRHR supportive gender norms\u003c/h2\u003e\n\u003cp\u003eTable 3 presents the proportion of respondents who perceived community support for selected SRHR topics, based on questionnaire responses. The topics, related to gender norms and women\u0026rsquo;s SRHR, are listed in descending order according to the overall percentage of participants who selected 4 or 5 on the Likert scale\u0026mdash;responses interpreted as indicating normative support. Results are stratified by province.\u003c/p\u003e\n\u003cp\u003eA broadly consistent pattern emerged across provinces in terms of which rights were perceived to have the strongest and weakest normative support. The right to education, along with certain sexual rights\u0026mdash;particularly relationship autonomy and bodily autonomy\u0026mdash;were most frequently identified as socially endorsed, with 60\u0026ndash;70% of respondents indicating perceived community support. Respondents in Luanda generally reported higher levels of normative support for these SRHR topics compared to those in Huambo and Lunda Sul.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWith regard to the right to freedom from violence, 67.3% of respondents in Luanda stated that they believed their community does not expect women to remain in violent relationships for the sake of family cohesion. This view was shared by 54.4% of respondents in Huambo and 48.3% in Lunda Sul. Approximately half of all respondents reported that it was not considered shameful in their community for women to speak about experiences of sexual abuse, suggesting a degree of normative support for non-stigmatisation within the domain of sexual health and rights. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe most marked regional differences were observed in relation to reproductive health and rights. In Lunda Sul, only 23.8% of respondents reported perceived community support for the right to reproductive maturity\u0026mdash;defined as delaying childbearing until at least 18 years of age\u0026mdash;compared with 46.8% in Huambo and 61.0% in Luanda. A similar gradient was observed regarding support for female identity diversity: just 31.6% of respondents in Lunda Sul stated that their communities recognised women\u0026rsquo;s value beyond their role as mothers, compared to 47.4% in Huambo and 61.9% in Luanda.\u003c/p\u003e\n\u003cp\u003eTopics concerning gender equality within intimate relationships\u0026mdash;such as freedom of expression, consent within marriage, and equal decision-making\u0026mdash;were among those least frequently associated with perceived social support. Across all three provinces, fewer than half of the young women surveyed reported that these principles were widely accepted within their communities.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003ePsychometric assessment of the questionnaire\u003c/h2\u003e\n\u003cp\u003eThe majority of participants completed the gender norms questionnaire in its entirety. Only a small proportion had one or two missing responses: 22 out of 910 in Luanda, 38 out of 684 in Huambo, and 7 out of 487 in Lund Sul.\u003c/p\u003e\n\u003cp\u003eApplication of the polytomous Rasch model to the original 5-point Likert scale revealed no evidence of strong structure in the residuals or local dependence (An additional file shows this in more detail [see Additional file 4]). Nonetheless, some item misfit was observed for bodily autonomy, freedom from violence, identity diversity, marital consent, and decision equality. Among these, marital consent exhibited underfit to the model; so that respondents with a high total score tended to endorse this item less than expected [see Additional file 4 ]).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[FIGURE 1]\u003c/p\u003e\n\u003cp\u003eA primary concern emerged regarding the functioning of the middle response category, \u0026ldquo;it depends (neither agree nor disagree)\u0026rdquo;. This category was never the most likely response at any point along the latent continuum for any of the 11 items, i.e. the categories were disordered (Figure 1, and [Additional file 4]). This raised questions concerning usefulness and conceptual justification of the middle response category. Thus, the decision was made to merge this category with the adjacent lower response option, thereby converting the original 5-point scale into a 4-point one. This adjustment was based on the view that indeterminate responses such as \u0026ldquo;it depends\u0026rdquo; may not meaningfully reflect endorsement of fundamental human rights. It is noteworthy that most participants selected \u0026ldquo;it depends\u0026rdquo; for few items. Specifically, 77% of respondents in Luanda, 78% in Huambo, and 80% in Lunda Sul chose this option for no more than two of the eleven statements. The highest percentage of \u0026ldquo;it depends\u0026rdquo; responses were recorded for maternal health in Huambo (25%), marital consent in Luanda (21%), and bodily autonomy in Lunda Sul (20%).\u003c/p\u003e\n\u003cp\u003eWhen the analysis was repeated using the modified 4-point scale, the ordering of response categories improved for all items, and item fit statistics also demonstrated overall improvement [see Additional file 4]. Nevertheless, visual inspection of the CICC indicated that the item of marital consent continued to discriminate somewhat less effectively than predicted (see Fig 1). The reduction in response categories led to fewer thresholds per item and introduced two broader gaps in coverage along the latent trait continuum (see Fig 2 Item targeting and test information function).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, for more than 98% of participants with complete responses, the test information function remained above 3.33 (Fig 2), a threshold for fair reliability. At the same time, the test information never exceeded 5 (corresponding to a person separation index of 0.8), which is a more stringent lower limit commonly used as indicating good reliability [85]. This was reflected also in the relatively large uncertainties accompanying the persons\u0026rsquo; locations estimates. The middle 50% of the respondents were estimated to be between 0.43 to 1.46 on the latent scale, but each estimated position had an uncertainty of about 0.5.\u003c/p\u003e\n\u003cp\u003e[FIGURE 2]\u003c/p\u003e\n\u003cp\u003eThe automatically identified DIF groups corresponded closely with provincial divisions (see Additional file 4). Closer examination of the DIF plots (see Fig 3) indicated that the largest degree of DIF was observed for identity diversity and reproductive maturity. Respondents in Lunda Sul endorsed these items less than what would be expected based on respondents\u0026rsquo; total score under the assumption of no DIF and also less than what was observed in the other two provinces. A slight opposite tendency was noted for relationship autonomy and non-stigmatisation. For the item on marital consent, the observed mean scores, disaggregated by province and conditional on total score, showed a general misfit relative to model expectations, particularly in Huambo. The respondents there seemed to be reluctant to endorse this item despite higher total scores, i.e. despite indicated perception of community gender norms more supportive of women\u0026rsquo;s SRHR.\u003c/p\u003e\n\u003cp\u003e[FIGURE 3]\u003c/p\u003e\n\u003cp\u003eHowever, the impact of DIF on the estimated persons locations was limited. Differences between estimates obtained with and without accounting for DIF remained within the standard deviation of the estimates [see Additional file 4]. As the presence of DIF suggested differential functioning of items across provinces, model fit was also examined separately for each province using the partial credit model. The results were satisfactory and broadly consistent with those of the overall analysis. Some variation between provinces was observed in the hierarchical ordering of the items [see Additional file 4]; however, the three items positioned lowest in the hierarchy\u0026ndash;the \u0026ldquo;easiest\u0026rdquo; items\u0026ndash;were the same across all provinces and matched the first three items listed in Table 3.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eKey findings\u003c/p\u003e\u003cp\u003eThis study makes three primary contributions. First, it reaffirms the central importance of gender norms as a foundational organising framework for SRHR within the Angolan context. The findings also illuminate areas where theoretical assumptions align with\u0026mdash;or diverge from\u0026mdash;empirical realities, prompting critical reflection on how both entrenched local norms and those that are less clearly articulated may be meaningfully identified, interpreted, and studied.\u003c/p\u003e\u003cp\u003eSecond, while a relatively high degree of normative support was observed for certain aspects of SRHR across the study population, notable variations emerged. Specifically, the research identified tensions between SRHR topics that were widely regarded as socially acceptable and those perceived to lack normative legitimacy. These disparities suggest strategic entry points for rights-based interventions, while also underscoring the challenges posed by uneven normative landscapes for the full realisation of young women\u0026rsquo;s SRHR.\u003c/p\u003e\u003cp\u003eThird, the study documented inter-provincial differences in perceived normative support, which appear to mirror broader socio-economic disparities. These findings highlight how young women\u0026rsquo;s ability to claim and exercise their SRHR is mediated not only by prevailing gender norms but also by their specific geographical and socio-economic contexts [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTaken together, these findings emphasise the value of granular, contextually grounded approaches to the study and measurement of gender norms. They point to the need for policy and programmatic responses that are both equitable and attuned to the lived experiences of young women in diverse settings.\u003c/p\u003e\u003cp\u003eThe challenge of capturing socially visible and hidden norms\u003c/p\u003e\u003cp\u003eThe findings suggest that many dimensions of SRHR prioritised within international frameworks are also regarded as normatively salient in the Angolan context [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Key aspects such as bodily and relational autonomy, freedom from violence, decision-making equality, and reproductive maturity were widely recognised by participants as meaningful, and were therefore incorporated into the questionnaire.\u003c/p\u003e\u003cp\u003eThis alignment with theoretical expectations offers support for the construct validity of the questionnaire [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In addition, the Rasch analysis indicated good item targeting, with item difficulty levels closely corresponding to participants\u0026rsquo; perceptions of normative support. The absence of floor or ceiling effects further suggests that the questionnaire was appropriately calibrated to the study population. Moreover, no substantial item clustering was observed, indicating that the scale captured a coherent underlying construct. Collectively, these findings point to the value of an iterative development process that, while grounded in theory, remained responsive to contextual insights and produced a set of distinct and locally relevant items [\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNonetheless, the scope of the questionnaire was necessarily selective. Certain internationally recognised SRHR dimensions were not included, primarily due to difficulties in generating contextually meaningful survey items. For instance, while gendered structural inequalities are widely acknowledged to influence national health priorities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e], both key informants and workshop participants tended to frame barriers to SRHR-related education and services primarily as general resource constraints, rather than as explicitly gendered phenomena. This reflects a broader analytical challenge in disentangling proximal from distal determinants of norms and behaviours, as noted in existing scholarship [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. It also underscores the importance of engaging with gender equality in ways that are deeply attuned to lived realities\u0026ndash;ensuring that the diverse needs of different groups are not perceived as competing or mutually exclusive [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurther complexity emerged in relation to gender identity and sexual orientation. Gender identity was most commonly articulated through dominant expectations related to motherhood, while sexual orientation was often rendered socially invisible or remained unspoken. These omissions reflect both methodological challenges in capturing stigmatised topics and under-articulated topics and a wider tension between the need for contextual sensitivity and the imperative to include marginalised dimensions of SRHR [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In this regard, while survey-based methods offer valuable insights, they may be less well suited to capturing sensitive or less visible aspects of social life. Qualitative approaches that foster trust and allow for deeper reflection may therefore represent a more appropriate means of exploring these critical dimensions [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNavigating normative tensions in support for SRHR\u003c/p\u003e\u003cp\u003eThe study identified both areas of convergence and divergence in normative support for various dimensions of SRHR. Consistent patterns emerged across descriptive analysis and Rasch modelling, indicating that rights related to education, bodily autonomy, and relationship autonomy enjoyed the highest levels of normative endorsement. When considering these results through the lens of their thematic alignment with either sexual or reproductive rights [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], the findings suggest a comparatively stronger normative support for sexual rights. This is particularly evident in the greater endorsement of bodily autonomy and freedom from violence. By contrast, domains associated with reproductive rights\u0026ndash;especially maternal health and reproductive maturity\u0026ndash;were described as receiving lower levels of normative backing.\u003c/p\u003e\u003cp\u003eThese patterns carry important implications for the lived experiences of young women, particularly in light of the well-documented influence of social norms on behaviour, decision-making, and self-perception [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The broader normative acceptance of sexual rights may contribute to an increased sense of agency among young women in deciding whether\u0026ndash;and with whom\u0026ndash;to engage in intimate relationships, while also offering strategic entry points for rights-based interventions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. However, the comparatively limited support for reproductive maturity\u0026mdash;especially in more rural provinces\u0026mdash;suggests a continued societal tendency to prioritise young women\u0026rsquo;s reproductive roles [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. Such expectations may restrict young women\u0026rsquo;s ability to delay or decline these roles, irrespective of personal aspirations [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. The relatively weak normative support for reproductive maturity\u0026ndash;and by extension, for girls\u0026rsquo; right to a protected and autonomous childhood\u0026ndash;coupled with limited backing for maternal health, reveals a concerning disconnect between normative frameworks and the structural conditions required to safeguard women\u0026rsquo;s holistic well-being, including equitable access to quality maternity care [\u003cspan additionalcitationids=\"CR21 CR22 CR23\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, rights pertaining to intimate partnerships\u0026mdash;such as freedom of expression, marital consent, and decision equality\u0026mdash;emerged as the least supported across all provinces. Psychometric findings further indicated that items related to marital consent and decision-making equality were particularly difficult for respondents to perceive as socially supported, with the notable exception of Lunda Sul, where motherhood-related items appeared more salient. In the broader context of prevailing expectations around motherhood, these findings suggest a persistent normative belief that women should prioritise the needs and preferences of others [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. While such expectations may be associated with pride and a sense of purpose, they also risk imposing considerable emotional and practical burdens. Given the relatively young age of participants, these responsibilities may limit their ability to fully exercise their SRHR and pursue long-term personal and socio-economic well-being [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite the formal commitments to gender equality and SRHR within national policy frameworks, the findings indicate that many young women continue to navigate social environments in which substantial elements of their SRHR lack widespread normative legitimacy. Survey responses suggest persistent expectations for young women to shoulder substantial emotional and caregiving responsibilities from an early age, often without corresponding decision-making power or systemic support for their own well-being or that of their families. Such social norms, shape attitudes and behaviours\u0026mdash;even in cases where individuals may not personally endorse them, through mechanism including community endorsement and the potential for social sanctions in the case of non-conformity [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese findings illuminate the deeply interwoven symbolic and structural dimensions of motherhood and partnership, and the continuous negotiation between adherence to traditional gender roles and evolving aspirations for gender equity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The cumulative weight of these normative tensions shapes not only individual life paths, but also sustains collective perceptions of women\u0026rsquo;s roles, worth, and entitlements within society. Addressing such tensions is essential to support the positive transformation of social norms. Yet, this must be pursued with cultural sensitivity, recognising that long-standing norms often serve as vital sources of social cohesion, identity, and provide a sense of community order [\u003cspan additionalcitationids=\"CR75 CR76 CR77 CR78 CR79\" citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e]. Even where certain norms have exclusionary or harmful implications, they may simultaneously offer shared frameworks for meaning-making and community stability. Meaningful engagement with such norms thus demands a careful and balanced approach: one that seeks to redress inequalities and challenge discriminatory practices, while also honouring the social fabrics that underpin collective well-being and social harmony [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFrom a methodological standpoint, these findings illustrate the value of mixed-methods approaches in capturing the multifaceted and, at times, contradictory nature of gender norms [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Normative resistance, for instance, may manifest not only in qualitative narratives but also in the psychometric properties of survey items\u0026ndash;particularly in terms of their relative difficulty to endorse. This points to the importance of viewing questionnaire items not merely as neutral indicators but also as culturally situated expressions that may reflect deeper social contestation and normative ambivalence.\u003c/p\u003e\u003cp\u003eContextual and normative variation in SRHR support\u003c/p\u003e\u003cp\u003eThe observed variations in normative support for SRHR extended beyond differences across thematic distinctions, revealing pronounced subnational disparities. While certain aspects\u0026mdash;such as access to education, non-stigmatisation, equality in decision\u0026mdash;elicited relatively consistent support across provinces, other domains showed more substantial divergence. For instance, approximately 60% of respondents in Luanda stated normative support for reproductive maturity and identity diversity, in contrast to only 20\u0026ndash;30% in Lunda Sul, with Huambo occupying an intermediate position.\u003c/p\u003e\u003cp\u003eThe final Rasch model, adapted to a four-point Likert scale derived from the original five-point format, further illuminated provincial variation in item performance. Most items demonstrated acceptable fit; however, the item concerning marital consent displayed underfit, particularly among respondents in Huambo. Notably, even individuals who largely reported community normative support for other SRHR aspects appeared hesitant in relation to this particular item. Similarly, reproductive maturity and identity diversity emerged as among the most difficult items to agree with in Lunda Sul, in terms of perceived community support. DIF analyses confirmed systematically lower endorsement of these items in Lunda Sul compared to the other two provinces when considering respondents indicating similar overall normative support. These findings suggest potential context-specific conceptual ambiguities or entrenched social norms, and highlight the need for further exploration of the historical, legal, and cultural narratives that shape these constructs [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePositioning respondents along a latent continuum of SRHR-related norms also presented methodological challenges. Although DIF did not substantially distort total score estimates, its presence implies that comparable aggregate scores may conceal meaningful differences in the configuration of normative beliefs across settings. This has important implications for interpreting associations between normative environments and health outcomes. One high score might reflect strong social support for bodily autonomy, another for reproductive maturity\u0026ndash;yet only one of these may be relevant to a specific health outcome [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese insights point to the complementary value of summary indicators and disaggregated analyses. Composite scores provide useful approximations of the general normative climate surrounding young women, but item-level disaggregation is essential to identify which specific dimensions of SRHR are more or less socially accepted in a given context. Rasch modelling proved especially instructive in this regard, enabling the identification of items that were either difficult to endorse (e.g., reproductive maturity and identity diversity in Lunda Sul), or yielded unexpected patterns (e.g., marital consent in Huambo). Such insights underscore the value of advanced psychometric techniques in revealing not only the strength but also the texture of normative support, including fine-grained intra-country variation. Adopting such a nuanced analytical lens enhances both the methodological robustness and the practical relevance of SRHR norm assessments. Summary and item-level analyses should be viewed as complementary: together, they provide a more comprehensive understanding of normative environments and are vital for guiding the development of interventions that are contextually tailored and responsive to local realities.\u003c/p\u003e\u003cp\u003eFurthermore, regional differences in participants\u0026rsquo; perceptions of social support for SRHR closely mirrored broader disparities in socio-economic development and access to essential public services, as reflected in national statistics [\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20 CR21 CR22\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and corroborated by the present findings. Respondents in Lunda Sul and Huambo, the provinces registering the lowest levels of normative support, also reported elevated levels of economic insecurity and substantial barriers to accessing SRHR services. Of particular concern were the high rates of teenage pregnancy and IPV, affecting over half of respondents in Lunda Sul and nearly half in Huambo, in stark contrast to approximately one-fifth and two-fifths, respectively, in Luanda. When considered alongside known gaps in access to modern family planning and maternal healthcare in these provinces [\u003cspan additionalcitationids=\"CR22 CR23 CR24 CR25 CR26 CR27\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], these findings reflect yet another aspect of the entrenched structural barriers that continue to undermine young women\u0026rsquo;s SRHR.\u003c/p\u003e\u003cp\u003eThe apparent convergence between limited normative support and broader structural disadvantage resonates with global evidence showing that restrictive gender norms often intersect with socio-economic marginalisation, compounding the risks and vulnerabilities faced by young women [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This reading also aligns with intersectional frameworks long advanced by the Angolan women\u0026rsquo;s movement, which have situated gender inequality within broader struggles against economic injustice, ethnic discrimination, and the enduring legacies of colonialism [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. From this vantage point, gender norms cannot be meaningfully analysed in isolation from the wider systems of power and exclusion that shape everyday life. While measurement tools may not yet fully capture these intersecting layers, recognising their significance adds critical depth to calls for SRHR strategies that are both contextually grounded and oriented towards social justice [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn sum, while gender norms may exhibit certain universal features, their local expressions are diverse, deeply embedded, and shaped by distinct social, economic, and historical conditions. This calls for caution against the uncritical application of standardised measurement tools or uniform, one-size-fits-all interventions. Rather, it highlights the need for participatory and reflexive approaches that are attuned to both the structural and normative dimensions of inequality. Strategies grounded in such approaches hold considerable promise\u0026ndash;not only for strengthening SRHR outcomes, but also for contributing to broader efforts to advance justice, dignity, and the realisation of rights for young women across a range of settings.\u003c/p\u003e\u003cp\u003eLimitations and generalisability\u003c/p\u003e\u003cp\u003eThis study benefited from a high response rate, the inclusion of participants from diverse backgrounds, and a study design that was carefully adapted to the local context and rigorously pre-tested. Nevertheless, several limitations must be acknowledged to ensure a balanced interpretation of the findings.\u003c/p\u003e\u003cp\u003eThe use of self-reported data collected through interviews provided a valuable opportunity to explore young women\u0026rsquo;s perspectives on normative beliefs within a safe and familiar setting. However, the interview format may have introduced social desirability bias, potentially influencing participants\u0026rsquo; responses. Additionally, the focus on a specific age cohort of young adults, combined with a non-random sampling strategy, constrains the generalisability of the findings to the wider Angolan population. That said, the demographic profile of the sample is broadly consistent with those in comparable studies and reflects known national and regional socio-economic patterns [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e], suggesting the findings may be transferable to similar settings.\u003c/p\u003e\u003cp\u003eThe development and application of a tailored questionnaire represent an important step forward in measuring gender norms related to SRHR in Angola. However, this approach also has limitations. While the study accounts for participants\u0026rsquo; socio-economic characteristics and regional differences, it does not fully engage with the complex intersections of systemic inequality. As such, it risks reproducing an analytical approach that treats gender as a static or isolated category. Scholars have emphasised the need to situate gender within broader socio-economic and political structures [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR75 CR76 CR77 CR78 CR79\" citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e]. Critical and postcolonial theorists further challenge universalist assumptions and the dominance of Eurocentric epistemologies in global health research, warning that such paradigms may obscure the nuanced and intersecting realities of women\u0026rsquo;s lived experiences [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]. While this study endeavours to contribute to a more multifaceted understanding of gender norms, it is ultimately for the reader to judge whether it succeeds in this aim.\u003c/p\u003e\u003cp\u003eAnother noteworthy limitation is the study\u0026rsquo;s use of binary gender categories. By classifying participants as \u0026lsquo;women\u0026rsquo; and \u0026lsquo;men\u0026rsquo;, there is a risk of reinforcing reductive and homogenising assumptions, despite attempts to reflect the diversity of those who identified as women during recruitment [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Neither the sampling approach nor the questionnaire explicitly accounted for the complexity and fluidity of gender identities. The study proceeded on the assumption that the categorisation of individuals as \u0026lsquo;women\u0026rsquo; and \u0026lsquo;men\u0026rsquo; remained relevant to SRHR research, particularly in settings where expectations around early pregnancy and high fertility among young women intersect with pressing public health concerns such as maternal mortality and limited access to maternal care [\u003cspan additionalcitationids=\"CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan additionalcitationids=\"CR68\" citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. In this context, research focused on individuals assigned female at birth remains essential, even as it acknowledges that gendered experiences are not monolithic.\u003c/p\u003e\u003cp\u003eMethodologically, certain measurement challenges also warrant consideration. Although the questionnaire demonstrated acceptable psychometric properties following adjustments to the response scale, issues such as DIF across provinces and only moderate test information values suggest some uncertainty in accurately capturing individual normative perceptions. Future research might explore the development of a more nuanced tool, potentially comprising thematically organised subscales, to enhance analytical specificity and support more effective monitoring, policy development, and intervention design in SRHR.\u003c/p\u003e\u003cp\u003eIt is also important to note that the middle response category (\u0026lsquo;it depends\u0026rsquo;) was infrequently selected and thus merged with adjacent categories for analysis. While this improved model fit, such a response may nonetheless reflect meaningful ambivalence or conditionality\u0026mdash;elements that are often central to how gender norms are negotiated in practice. Excluding or reconfiguring this category in future applications should be carefully reconsidered, as it may offer important qualitative insights.\u003c/p\u003e\u003cp\u003eThese limitations underscore the need for continued refinement of measurement approaches and greater integration of participatory, intersectional, and context-sensitive frameworks in SRHR research. They also point to critical avenues for future investigation. Readers are encouraged to interpret the findings with these considerations in mind.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study highlights the central role of gender norms in shaping young women\u0026rsquo;s SRHR in Angola, revealing ongoing tensions, particularly around reproductive autonomy in intimate relationships. Subnational variations in normative support for SRHR reflected broader socio-economic inequalities, with provinces such as Lunda Sul and Huambo experiencing greater vulnerability and weaker endorsement. Notably, fewer than half of the SRHR-aspects were perceived as normatively supported by a majority, underscoring the urgent need to strengthen both formal and informal support systems.\u003c/p\u003e\u003cp\u003eThe use of mixed methods and locally adapted tools enhanced the study\u0026rsquo;s relevance, especially for under-articulated issues. Psychometric analysis revealed significant variation in how norms are expressed across contexts, demonstrating challenges in consistent measurement. DIF and local deviations caution against over-reliance on aggregate scores, while item-level analysis provided valuable insight into thematic differences. Future measurement efforts should build on intersectional and participatory principles to more fully reflect the lived realities of young women and advance socially just interventions.\u003c/p\u003e\u003cp\u003eEncouragingly, shared concern among state and civil society actors regarding young women\u0026rsquo;s vulnerabilities offers a promising basis for coordinated, context-sensitive action. While social change is gradual and deeply rooted in local realities, collective efforts can foster environments where SRHR are not only recognised in law but truly realised in everyday life. Meaningful progress requires strategies that address the social and institutional conditions shaping rights, supporting individual agency and equitable, rights-based health systems.\u003c/p\u003e\u003cp\u003eUltimately, transformative progress requires inclusive, locally grounded strategies that address both structural and normative dimensions of inequality. Furthermore, ongoing research is essential to deepen understanding of how gender norms are perceived, reinforced, challenged, and sanctioned within specific contexts, thereby advancing measurement methods and informing the design of socially just and contextually sensitive interventions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCSO: civil society organisations\u003c/p\u003e\n\u003cp\u003eIPV: intimate partner violence\u003c/p\u003e\n\u003cp\u003ePCA: principal component analysis\u003c/p\u003e\n\u003cp\u003eSADIMA: sa\u0026uacute;de e direitos das mulheres em Angola (Angolan women\u0026rsquo;s health and rights)\u003c/p\u003e\n\u003cp\u003eSRHR: sexual and reproductive health and rights\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent\u003c/h2\u003e\n\u003cp\u003eThe study was carried out in accordance with the ethical principles outlined in the Declaration of Helsinki [85]. Ethical approval was obtained from the Ethics Committee Institutional Review Board of the Angolan Ministry of Health (24/C.E./2021), the Ethics Committee at the Universidade Cat\u0026oacute;lica de Angola (Approva\u0026ccedil;\u0026atilde;o 153, CEIH 230) and the Swedish Ethics Review Authority (Dnr 2022-06393-01).\u003c/p\u003e\n\u003cp\u003eVerbal informed consent was obtained from all participants, following the approach used in DHS [82], which is considered appropriate in settings with high-levels of illiteracy. Participants were given the option to skip any question they preferred to not answer. Ethical principles\u0026ndash;specifically beneficence, respect for autonomy, justice, and non-maleficence\u0026ndash;guided all phases of the research process, including the development of data collection tools, the conduct of fieldwork, and the subsequent analysis and interpretation of data.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe qualitative interview data generated during the current study are not publicly available in order to protect participant confidentiality. All quantitative data generated or analysed during this study are included in this published article and its supplementary information files.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eGP and AM received grant no. 2020-03102 from the Swedish Research Council. FVDR was funded through a Calouste Gulbenkian Foundation PALOP and East Timor PhD scholarship (process number: 1445517). The funding agencies did not influence the design, conduct or analysis of the study.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; contributions\u003c/h2\u003e\n\u003cp\u003eGP, the principal investigator, led the coordination and implementation of the SADIMA project. Together with AM, GP conceptualised the project and applied for research funding. The questionnaire was developed by GP, AM, and FVDR, who also formulated the ethics applications. GP, AM and MM designed the data collection strategy and oversaw the data collection process. GP, BK, and JM contributed to data management. BK conducted the statistical analyses with input from JM and GP. All authors contributed to the summarisation of the analyses, discussion, and conclusions. The manuscript was written by GP and BK, with input and feedback from all coauthors until the final version was submitted.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe would like to extend our sincere gratitude to the data collectors and drivers in each province for their dedication to ensuring the quality of the work and the well-being of the participating women. Our thanks also go to ADRA and Mwana Pwo for assuming operational responsibilities during the data collection in Huambo and Lunda Sul. Additionally, we wish to acknowledge Francisco Quemba (UCAN) for digitising the questionnaire, as well as Jo\u0026atilde;o Van D\u0026uacute;nem and Jos\u0026eacute; Katito (UCAN), Karin Engstr\u0026ouml;m and Lucie Laflamme (Karolinska Institute), and Nawi Ng (UGOT) for their valuable input and support throughout various stages of the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStarrs AM, Ezeh AC, Barker G, Basu A, Bertrand JT, Blum R, et al. Accelerate progress\u0026mdash;sexual and reproductive health and rights for all: report of the Guttmacher\u0026ndash;Lancet Commission. Lancet. 2018;391(10140):2642\u0026ndash;92.\u003c/li\u003e\n\u003cli\u003eMouzinho \u0026Acirc;, Cutaia S. Reflections on feminist organising in Angola. Feminist Africa. 2017 Dec 1(22):33-51.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO). World report on social determinants of health equity. Geneva: World Health Organization. 2025. 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Critical values for Yen\u0026rsquo;s \u003cem\u003eQ\u003c/em\u003e\u003csub\u003e3\u003c/sub\u003e: Identification of local dependence in the Rasch model using residual correlations. Appl Psychol Meas. 2017 May;41(3):178-194. doi: 10.1177/0146621616677520.\u003c/li\u003e\n\u003cli\u003eTutz G. On the structure of ordered latent trait models. \u003cem\u003eJ Math Psychol\u003c/em\u003e. 2020;96:102346. https://doi.org/10.1016/j.jmp.2020.102346.\u003c/li\u003e\n\u003cli\u003eKomboz B, Strobl C, Zeileis A. Tree-based global model tests for polytomous Rasch models. \u003cem\u003eEduc Psychol Meas\u003c/em\u003e. 2018;78(1):128\u0026ndash;66. https://doi.org/10.1177/0013164416664394.\u003c/li\u003e\n\u003cli\u003eBland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. \u003cem\u003eLancet\u003c/em\u003e. 1986;327(8476):307\u0026ndash;10. https://doi.org/10.1016/S0140-6736(86)90837-8.\u003c/li\u003e\n\u003cli\u003eMallinckrodt B, Tekie YT. Item response theory analysis of working alliance inventory, revised response format, and new brief alliance inventory. \u003cem\u003ePsychother Res\u003c/em\u003e. 2016;26(6):694\u0026ndash;718. https://doi.org/10.1080/10503307.2015.1061718.\u003c/li\u003e\n\u003cli\u003eR Core Team. \u003cem\u003eR: A language and environment for statistical computing\u003c/em\u003e [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2024. https://www.R-project.org/. Accessed 17 June 2025.\u003c/li\u003e\n\u003cli\u003eMair P, Hatzinger R. Extended Rasch modeling: the eRm package for the application of IRT models in R. \u003cem\u003eJ Stat Softw\u003c/em\u003e. 2007;20. doi:10.18637/jss.v020.i09.\u003c/li\u003e\n\u003cli\u003eBuchardt A, Jensen SN, Christensen KB. \u003cem\u003eRASCHplot: Visualisation tool for validity of Rasch models\u003c/em\u003e. R package version 0.1.0. 2022 https://github.com/ERRTG/RASCHplot/. Accessed 17 June 2025.\u003c/li\u003e\n\u003cli\u003eWilke CO. cowplot: Streamlined plot theme and plot annotations for\u0026rsquo;ggplot2\u0026rsquo;. CRAN: Contributed Packages. 2015 Jun 3.\u003c/li\u003e\n\u003cli\u003ePedersen TL. Patchwork: The composer of plots. CRAN: Contributed Packages. 2019 Dec 1.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. SRHR topics in gender norm questionnaire by SADIMA survey order; excluded items listed separately.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eSRHR topics emphasised in the literature and key informant interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eItem label\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eItem wording in questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eThe right to\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIn this neighbourhood, village or community people think that\u0026hellip;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eEducation is a foundation for empowerment and informed decision-making, and supporting girls\u0026rsquo; continued learning\u0026mdash;by creating conditions that reduce their household labour and enable families to prioritise their education\u0026mdash;is vital for advancing their health and rights.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eeducation access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e...it is important for girls to study.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWomen\u0026rsquo;s decision-making power within a relationship is a key factor in facilitating their meaningful participation in decisions that promote health and well-being, while also enhancing household planning and long-term family resilience.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003edecision equality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e...men should have more influence than women over important family and household decisions.*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAlthough sexual consent is not legally required within marriage, it remains central to the promotion of gender equality and the prevention of intimate partner violence.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003emarital consent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e...a woman has the right to decline sex with her partner for whatever reason.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFostering supportive environments that enable women to express themselves freely and share diverse perspectives without fear of punishment or stigmatization is essential for advancing their rights, well-being, and meaningful participation in family and societal life.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003efreedom of expression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e...a good woman does not question her partner\u0026rsquo;s opinion, even if she does not agree with him.*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eChildbearing is frequently valued as a source of joy, strength, and social significance for women; however, this emphasis may be experienced by some as pressure to have children, potentially impacting the self-worth of those who do not.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eidentity diversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e...a woman is a \u0026quot;real woman\u0026quot; only after becoming a mother.*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAcknowledging women who have experienced sexual abuse as entitled to support, dignity, and justice is crucial for creating a safe environment that encourages disclosure, facilitates help-seeking from trusted sources, and ensures access to the healthcare, counselling, and legal services necessary for healing and recovery.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003enon-stigmatisation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e...it is shameful to talk about experiences of sexual abuse, even with close family and friends.*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePromoting girls\u0026rsquo; right to a safe and healthy childhood\u0026mdash;free from the adult responsibility of motherhood\u0026mdash;alongside gender balanced responsibility for pregnancy prevention, is essential for supporting adolescent health, gender equality, and the realisation of their rights.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ereproductive maturity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e...it is normal for girls to have children before the age of 18.*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAcknowledging intimate partner violence as a health and rights issue\u0026mdash;and ensuring it is treated as such by all sectors, including law enforcement\u0026mdash;is essential for protecting the well-being of women and children, promoting justice, and strengthening coordinated responses and prevention efforts.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003efreedom from violence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e...women should tolerate violence from her partner/husband to keep the family together.*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eUpholding women\u0026rsquo;s rights to bodily autonomy, integrity and dignity\u0026mdash;free from coercion or \u0026nbsp;harassment\u0026mdash;is fundamental to fostering safe environments across societal settings, where opportunities are equitably determined by merit rather than by deference to gendered authority.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ebodily autonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e...a woman has to accept that men in positions of power (teachers, chiefs, police officers etc) demand sexual favours from them.*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePromoting shared responsibility for family planning and women\u0026rsquo;s reproductive health between women and their male partners is critical for achieving optimal pregnancy spacing and enhancing maternal and child health outcomes.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ematernal health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e...a couple should limit the number of pregnancies for the sake of the woman\u0026rsquo;s health.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSupporting girls\u0026rsquo; autonomy to choose if, when, and whom to marry empowers them to make decisions that promote their health and rights, helping to reduce risks associated with early pregnancy, sexually transmitted infections, and intimate partner violence.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003erelationship autonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e...a woman should be able to decide for herself who to marry or have a close relationship with.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eSRHR topics excluded as a result of qualitative evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRationale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eStrengthening health literacy in SRHR empowers individuals to make informed decisions and protects them from abuse and disease, promoting their overall well-being and autonomy.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003esufficiently covered by \u0026lsquo;education access\u0026rsquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003ePromoting more equitable sharing of caregiving responsibilities supports women\u0026rsquo;s access to healthcare, rest, economic opportunities, and self-care, thereby enhancing their overall health and well-being.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003esufficiently covered by \u0026lsquo;decision equality\u0026rsquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eShared responsibility in preventing unwanted pregnancies contributes to improved contraceptive uptake and more consistent use.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003esufficiently covered by \u0026lsquo;decision equality\u0026rsquo; and \u0026lsquo;maternal health\u0026rsquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eMen\u0026rsquo;s supportive involvement in women\u0026rsquo;s health during pregnancy and childbirth can help advance maternal healthcare participation, improve health outcomes, and contribute to healthier family life for all members.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003esufficiently covered by \u0026lsquo;decision equality\u0026rsquo; and \u0026lsquo;maternal health\u0026rsquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eAccess to youth-friendly, adequately equipped health facilities that provide family planning and maternal care, plays a critical role in preventing disability, serious illness, and associated socio-economic impacts.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003epartly covered by \u0026lsquo;decision equality\u0026rsquo;; limitations in healthcare access viewed as a systemic rather than gender-specific issue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eEqually valuing girls and boys is fundamental to ensuring their future equal rights, opportunities, and protections.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003enot regarded as a local priority, as the number of children takes precedence over their gender\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eThe ability to self-define one\u0026rsquo;s gender identity and sexual orientation is vital to SRHR, given its ties to identity and the risk for significant stigmatisation when prevailing social norms are challenged.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003elimited definition clarity across study contexts (better suited to qualitative research)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Statements marked with an asterisk (*) carried a negative connotation in relation to women\u0026rsquo;s rights as presented in the survey. However, for the purposes of this table, the corresponding SRHR concepts are framed in a rights-promotive manner to enhance clarity. For analysis, the Likert scale for these items was reverse-coded.\u003c/p\u003e\n\u003cp\u003eTable 2. Socio-demographic and SRHR characteristics (in %) of the study population by province.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eLuanda\u003cbr\u003e\u0026nbsp;n=910\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eHuambo\u003cbr\u003e\u0026nbsp;n=684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eLunda Sul\u003cbr\u003e\u0026nbsp;n=487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003cbr\u003e\u0026nbsp;n=2081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003eSocio-demographic characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eLiterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e85.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e53.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e64.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e44.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e34.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eFormal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e61.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e32.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e41.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e28.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e35.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e32.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e31.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e48.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e26.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eWork\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eYes, permanent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eYes, temporary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e49.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e52.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e79.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e57.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eHousehold night hunger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e71.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e49.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e40.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e57.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e28.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e49.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e59.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e42.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eHousehold wealth tertile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3d (better off)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e60.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e32.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2d\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e33.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e33.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e31.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e32.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1st\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e47.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e63.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e32.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eArea of residency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e94.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e44.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e61.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e55.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e73.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e38.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"bottom\"\u003e\n \u003cp\u003eGeneral SRHR characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003ePregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e56.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e26.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e38.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eYes, 1st \u0026gt;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e28.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e25.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e26.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eYes, 1st \u0026lt;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e43.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e53.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e34.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eMenstrual autonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e61.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e69.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e27.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e56.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e37.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e71.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e42.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eIntimate partner violence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e58.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e54.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e51.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e37.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e43.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e66.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e45.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eFertile period knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e67.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e72.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e33.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e61.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e31.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e26.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e66.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e37.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eAcquired information about pregnancy or childbirth complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e66.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e67.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e58.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e32.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e31.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e69.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e40.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eModern family planning awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e97.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e89.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e72.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e88.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e26.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eModern family planning use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e55.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e39.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e30.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e44.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e34.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e56.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e67.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e49.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 3. Perceived normative support for SRHR topics by province, percentages responding to 4-5 on Likert scale.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"413\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSRHR topic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLuanda\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=888\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHuambo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=646\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLunda Sul\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=480\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=2081\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe right to\u0026hellip;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003eeducation access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e74.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e82.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e70.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003erelationship autonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e78.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e59.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e66.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e69.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003ebodily autonomy*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e73.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e69.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e54.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e67.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003efreedom from violence*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e67.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e54.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e48.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e58.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003enon-stigmatisation*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e51.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e58.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e51.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e53.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003eidentity diversity*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e61.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e47.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e50.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003ereproductive maturity*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e46.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e23.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e47.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003ematernal health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e50.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e50.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e38.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003efreedom of expression*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e49.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e47.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e37.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e46.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003emarital consent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e44.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e37.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e48.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e43.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003edecision equality*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e35.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e39.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e34.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e36.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Statements marked with an asterisk (*) carried a negative connotation in relation to women\u0026rsquo;s rights as presented in the survey. However, for the purposes of this table, the corresponding SRHR concepts are framed in a rights-promotive manner to enhance clarity. For analysis, the Likert scale for these items was reverse-coded.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Angola, cross-sectional study, gender norms, intersectionality, questionnaire, young women","lastPublishedDoi":"10.21203/rs.3.rs-7037473/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7037473/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSexual and reproductive health and rights (SRHR) are fundamental to human dignity, well-being, and sustainable development. Despite strong international and national commitments, young women in Angola continue to face critical SRHR challenges, including high rates of adolescent pregnancy and limited access to contraception and maternal healthcare. These challenges are understood to be shaped, in part, by gender norms that influence social expectations, behaviours, and access to services. Addressing SRHR thus requires not only expanded healthcare provision but also strengthened normative support and attention to the power dynamics that underpin gender inequality. Measuring gender norms, however, remains methodologically complex. Existing tools often conflate personal attitudes with perceived social expectations or rely on indirect proxies, limiting their capacity to reflect the social and context-specific nature of norms.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo address this gap, a mixed-methods study was conducted. Contextually relevant SRHR-topics were identified through a literature review, key informant interviews, and participatory workshops, resulting in the development of an eleven-item gender norms questionnaire. The questionnaire was used in a cross-sectional study including 2,081 young women aged 16\u0026ndash;24 across urban and rural settings in three Angolan provinces and evaluated using Rasch analysis. Quantitative data revealed regional and socio-economic disparities, with early pregnancy and intimate partner violence more prevalent in less resourced settings. Perceived normative support was stronger for issues related to education and bodily autonomy than for reproductive maturity and equality within intimate relationships. While some provincial variation in item functioning was noted, the questionnaire demonstrated sound psychometric properties overall.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eGender norms remain central to SRHR experiences, marked by notable thematic and geographical variations. Divergent levels of normative support across SRHR domains reflect underlying tensions between entrenched social expectations and evolving values related to gender equality. Socio-economic disparities appear to intersect with these normative dynamics, potentially compounding structural disadvantage. The integration of both summary and item-level measures enables a more comprehensive understanding of the complex, layered nature of gender norms and the environments in which they operate. Continued research is essential to refine measurement and support the development of gender-responsive programmes that meaningfully support young women in realising their SRHR.\u003c/p\u003e","manuscriptTitle":"Gender norms in sexual and reproductive health and rights: Insights from young Angolan women and the development of a context-specific questionnaire","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-16 08:54:23","doi":"10.21203/rs.3.rs-7037473/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-03T13:12:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-28T15:13:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"40585325852662276426056265849821912272","date":"2025-08-16T13:03:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-29T20:40:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63109987265026984053066115336847638932","date":"2025-07-23T13:59:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-19T17:09:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"67658065575847273188581478915482897200","date":"2025-07-16T21:00:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"160603353522052746460712548548331200090","date":"2025-07-14T17:50:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-14T14:58:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-09T08:15:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-09T08:12:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Public Health","date":"2025-07-03T11:04:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6dc54d7e-f6e6-4df0-b089-20c5682e1561","owner":[],"postedDate":"July 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T15:59:55+00:00","versionOfRecord":{"articleIdentity":"rs-7037473","link":"https://doi.org/10.1186/s13690-025-01820-z","journal":{"identity":"archives-of-public-health","isVorOnly":false,"title":"Archives of Public Health"},"publishedOn":"2025-12-23 15:57:17","publishedOnDateReadable":"December 23rd, 2025"},"versionCreatedAt":"2025-07-16 08:54:23","video":"","vorDoi":"10.1186/s13690-025-01820-z","vorDoiUrl":"https://doi.org/10.1186/s13690-025-01820-z","workflowStages":[]},"version":"v1","identity":"rs-7037473","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7037473","identity":"rs-7037473","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}