Who’s got the power? Expressions of empowerment among in-school adolescents enrolled in the Girls Achieve Power (GAP Year) trial in three peri-urban settings of South Africa

Introduction

Empowerment is a process of change where a person gains mastery over their life and environment^1,2. Gender empowerment is understood as the increase in women and girls’ capacities to make and influence choices that affect their lives³ and is a concept acknowledged to be fluid and subject to social norms⁴. The nature and process of this empowerment should be defined and driven by women and girls themselves, therefore paths to empowerment are contextual, idiosyncratic and organic^3,5.

Globally, empowerment has been studied in the context of human immunodeficiency virus (HIV) prevention with a focus on equipping adolescent girls and young women with knowledge and skills to remain HIV-free⁶. Other studies view education as a form of empowerment for girls⁷. Furthermore, evidence shows that a majority of interventions for adolescent empowerment provide information on sexual and reproductive health (SRH) issues including HIV and AIDS, education, and adolescent self-efficacy⁷.

Adolescence (ages 10–19 years) is a period of rapid and critical human development⁸, creating opportunities to discover new things, form relationships with peers and adults, and explore one’s developing identity⁹. During early adolescence, males’ and females’ lives start to diverge sharply in terms of independence, mobility, schooling, and domestic responsibilities¹⁰. In sub-Saharan Africa, half of the population is estimated to be under 18 years old¹¹. Fast-paced urbanization in Africa has led to increased demand for resources such as health care services, employment and social welfare services for informal settlements and peri-urban areas⁶. The limited resources are stretched, which can result in some population groups, such as adolescents and young women, being excluded from accessing these resources.

Women and girls’ empowerment has been associated with several positive economic and health indicators. Societies where girls and women are empowered tend to have accelerated economic development and higher Gross Domestic Products (GDPs)^12,13, and empowerment can be protective against gender-based violence, especially in societies where gender equality is accepted¹⁴. Dimensions of empowerment such as positive self-esteem have also been shown to be protective against HIV acquisition and unintended pregnancy^15,16. Empowerment of women and girls should not take place in isolation, as men and boys also experience the negative consequences of gender inequality¹⁷, and can make powerful contributions to the achievement of equality³. Thus, including men and boys in empowerment efforts is integral to achieving sustainable change for society as a whole¹⁸.

Gender empowerment therefore has significant and measurable impact upon public health and is an effective and needed area of intervention. In South Africa (SA), the need for such intervention is strengthened further, particularly in the context of patriarchal gender norms¹⁹ placing females at risk because of the imbalance of power^15,20, high rates of gender-based violence (GBV) and high rates of HIV among adolescent girls and young women (AGYW)^4,21–24. An estimated 40% of South African women have experienced intimate partner violence and 12–28% have been raped^25–27. In 2019, new HIV infections among women (15 years and over) in SA were more than double than those among their male counterparts²⁸.

This paper used a model of women and girls’ empowerment as constructed by the Bill and Melinda Gates Foundation⁵ as a theoretical basis, wherein empowerment consists of three central elements: agency (decision-making, collective action, leadership), resources (control over resources, gender-based violence, mobility, self-esteem) and institutional structures (norms) (Figure 1). This model of empowerment was developed in partnership with the Gender Team at the Royal Tropical Institute of the Netherlands (KIT)³. We have applied this empowerment model to both boys and girls.

Figure 1. Model of women and girls’ empowerment, adapted from the Bill and Melinda Gates Foundation⁵.

Agency refers to an individual’s power to take action to pursue goals^3,5. This power depends partly on decision-making power, or how independently the person can make decisions and act on them. Collective action is when people stand together, mobilise and exercise their voice collectively to transform institutions and power relations: this is a powerful tool for social transformation⁵. Leadership is another powerful expression of agency as people lead and inspire social change to improve the status of women and girls⁵.

Resources focuses on an individual's access to, and power to use, what is in their environment^3,5. Self-efficacy/self-esteem determines one’s level of empowerment, since being able to conceptualise a better future and feeling confident in one’s ability to take steps toward this future are integral to the ability to act. This also includes control over assets such as finances, means of communication, and the means to gain knowledge. There are contextual influences which may constrain one’s access to resources: for example, gender-based violence may function as a threat, a consequence, or a deterrent to taking certain actions. Connected to this is mobility, or the ability to move freely through spaces without the risk of violence.

Institutional structures are the broader social structures, both formal (e.g. school systems, community forums) and informal (e.g. cultural and media discourses) which empower or disempower an individual^3,5. The norms which originate in culture or religion may be difficult to contradict as they stem from deeply held beliefs. If someone does not conform to the norms of that community, their expressions of empowerment would be constrained.

This paper contributes to the growing body of evidence by describing the domains of empowerment expressed at baseline by adolescents enrolled in the GAP Year trial and discusses implications of these findings for strengthening adolescent SRH, HIV and violence prevention programming.

Methods

Results

Overall, 3432 eligible learners across 26 schools participated in the baseline survey: 2383 are included in this analysis as they completed both components of the survey³⁰. In some cases, due to lack of time, some learners were unable to complete both components. The n value varies for each of domains as this reflects those who answered all the questions in that domain. For example, for decision-making, only 1 316 learners responded to all 5 questions in this domain. Table 2 provides the socio-demographic characteristics of the participants by empowerment scores: the majority (63.1%) were female, 81.4% were aged 12 – 14 years and 96.9% were Black African. Approximately one-fifth (18.6%, n=443) were aged 15–18 years, 76% (n=337) of which have repeated a grade. Overall, 41% lived with both parents while the majority (68.8%) had at least one parent/guardian employed, and 67.3% of households received a government grant. We will reflect on the three central elements in turn (Table 2).

Discussion

In this exploration of in-school adolescent expressions of empowerment across Gauteng and Western Cape, South Africa, we found that there were sex, age, parental/guardian employment and provincial differences in expressions of empowerment. Each of these will be discussed in turn.

Males in this study expressed a greater sense of empowerment around decision-making, GBV and mobility, while females expressed a greater sense of collective action and leadership. The sex differences we noted can be confirmed by other studies, indicating that females are less empowered than their male counterparts^35–37. Of note, females indicated higher anxiety and threat of GBV compared to males. This confirms recent findings from other South African literature, detailing the multiple risks and experiences of violence that women face daily^38–42. In contrast, females noted stronger collective action and leadership confidence. Collectively, adolescents showed high levels of empowerment; however, for almost 20% of participants, feelings of self-worth and future aspirations were low across both sexes. Whilst low self-esteem can be temporary, analysis has shown that it can have long-lasting impacts on their resilience, mental health, risky sexual behaviours^43–45 and performance at school^46,47, especially for South African adolescents who face many health and well-being challenges³⁸. This indicates the urgent need for mental health and psychosocial services for adolescent males and females in high schools to support them through this stage of adolescence, giving them a hope for the future. Career guidance could also be strengthened at school level as research suggests that having career aspirations can have a positive impact on adolescent health and wellbeing⁴⁸.

Expressions of empowerment varied across the different stages of adolescence: most significantly, younger adolescents (aged 12–14 years) expressed stronger collective action, leadership and self-esteem than their older counterparts. These findings suggest that future empowerment interventions should target the full spectrum of adolescents aged 10–19 years, to ensure that the physical, cognitive, emotional and social changes of early adolescent development are taken into consideration when developing empowerment interventions⁴⁹.

Interesting provincial differences were also noted; WC learners were found to have stronger expressions of empowerment, compared to GP learners, specifically around decision-making and collective action. GP learners indicated greater mobility compared to WC learners: this is confirmed by Burton and Leoschut⁵⁰ in their study on school and community violence. They found that 18.5% of learners in WC reported threats of violence restricting their mobility: Gauteng was ranked the lowest at 9.0%⁵⁰. Moreover, the WC is known for its high rates of gang violence, impacting safety and mobility particularly within the study site of Khayelitsha⁵¹. One explanation for this provincial difference could be that Gauteng townships, specifically Soweto, were more formally planned and urbanised, with more formal infrastructure, compared to that of Khayelitsha, WC⁵².

We also found that parental employment, and if parent/guardian received a government grant, impacted adolescent empowerment in a variety of different ways; however, these results are conflicting. National government-led developments and interventions addressing parental unemployment and economic constraints at a household level may be one vital way to increase expressed adolescent empowerment⁵³. Parent and guardian interventions should also be prioritised so adolescents can be supported at home, positively impacting their health and wellbeing.

Overall, there were only significant differences in institutional structures in relation to population group. However, we know that the structure of persistent gender relations and ensuing power dynamics means that some people, particularly women, are less empowered and capable of negotiating protection with partners than others. Whilst it is encouraging that adolescents in this cohort display some positive norms, further work is needed to tackle harmful, deeply rooted gender and cultural norms to ensure greater empowerment for females across South Africa^54–56.

Future research should explore why adolescent males and females feel worthless and lack hope, so interventions can address the root causes of these feelings. Learners and their guardians can then be formally linked to relevant support interventions (such as social or community support, grants, or work readiness training to increase employment opportunities), which have the potential to increase their school completion and future aspirations. Evidence-based GBV prevention interventions for adolescents and children should be researched and implemented to tackle gender norms at an individual, community and societal level, starting from a young age. Also recommended are interventions for adolescent females that improve their decision-making capacity, collective action, self-esteem and continue to develop their leadership skills as these would be critical to narrow the empowerment gender gap. These components could be strengthened in the Life Orientation curriculum in schools. We analysed all domains of empowerment equally, however, future analysis could explore a weighted analysis, ensuring more important domains are weighed more heavily.

Existing school and community interventions seeking to create a more enabling environment⁵⁷ should be intensified to create safer spaces and improve adolescents’ mobility in community and public spaces. Future interventions should adopt gender-transformative approaches, seeking to reshape gender relations to be more gender equitable, freeing adolescents, including LGBTIQ+ individuals, from the impact of destructive gender and sexual norms⁵⁸. All genders need to be included in efforts to reach the United Nations’ Sustainable Development Goal number 5^{35,59 3}, and to reduce the empowerment gender gap displayed here and in other research^7,60–62.

Conclusions

These results provide important contributions to understanding adolescent empowerment. Findings suggest that interventions tackling unequal gender norms, GBV prevention, self-esteem and self-worth should target both males and females from a young age. Addressing sex differences in empowerment and parent unemployment issues that are pervasive in South Africa, may strengthen expressions of empowerment for adolescents, especially adolescent females. The Life Orientation curriculum for very young adolescents should include key messaging to improve dimensions of empowerment at this foundation phase where the constructs of empowerment are laid. Working across all levels of the ecological model, these interventions would improve adolescent’s safety, mobility, future aspirations, and their hope for the future.

Data availability

Consent

Written informed consent for publication of the participants’ details was obtained from the participants and their parents/guardian.

Notes

¹ Quintile 1–3 schools are non-fee-paying schools, serving the poorest communities. Quintile 1 is the group of schools in each province catering for the poorest 20% of learners and receiving the highest allocation of Government funding per learner to support these poorer schools.

² Described as someone, usually an older man with a lot of money, who provides things like money, expensive gifts and luxurious trips to young women in exchange for company or sexual favours. 33. Choma. What is a blesser? 2020 [Available from: https://choma.co.za/articles/284/what-is-a-blesser.

³ Achieve gender equality and empower all women and girls.