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Gender role ideology, i.e. beliefs about how genders should behave, is shaped by social learning. Accordingly, if perceptions about the beliefs of others are inaccurate this may impact trajectories of cultural change. Consistent with this premise, recent studies report evidence of a tendency to overestimate peer support for inequitable gender norms, especially among men, and that correcting apparent ‘norm misperception’ promotes transitions to relatively egalitarian beliefs. However, supporting evidence largely relies on self-report measures vulnerable to social desirability bias. Consequently, observed patterns may reflect researcher measurement error rather than participant misperception. Addressing this shortcoming, we examine men's gender role ideology using both conventional self-reported and a novel wife-reported measure of men's beliefs in an urbanising community in Tanzania. We confirm that participants overestimate peer support for gender inequity. However, the latter measure, which we argue more accurately captures men's true beliefs, implies that this tendency is relatively modest in magnitude and scope. Overestimation was most pronounced among men holding relatively inequitable beliefs, consistent with misperception of peer beliefs reinforcing inequitable norms. Furthermore, older and poorly educated men overestimated peer support for gender inequity the most, suggesting that outdated and limited social information contribute to norm misperception in this context.

A global campaign to end “child marriage” has emerged over the last decade as part of growing international commitments to address gender inequities and improve female wellbeing. Campaigns typically assert that young brides have negligible autonomy in the marriage process and that marrying under 18 years has resolutely negative impacts on wellbeing. Yet, surprisingly few studies explore local attitudes towards marriage and its timing within contexts where early marriage is most common. As such our understanding of motivations and potential conflicts of interest leading female adolescents into marriage remain poorly informed by viewpoints of people purportedly at risk. We present an exploratory study of attitudes to early marriage in northwestern Tanzania where marriage before or shortly after 18 years is normative. We use focus group discussions, complimented by a survey of 993 women, to investigate local views on marriage. We explore (i) why people marry, (ii) when marriage is deemed appropriate, and (iii) who guides the marriage process. Contrary to dominant narratives in the end child marriage movement, we find that women are frequently active rather than passive in the selection of when and who to marry. Furthermore, marriage is widely viewed as instrumental in acquiring social status within one’s local community. Our conclusions illuminate why rates of early marriage remain high despite potential negative wellbeing consequences and increasingly restrictive laws. We discuss our results in relation to related qualitative studies in other cultural contexts and consider the policy implications for current efforts to limit early marriage in Tanzania and beyond.

Achieving gender equality fundamentally requires a transfer of power from men to women. Yet data on men's support for women's empowerment (WE) remains scant and limited by reliance on self-report methodologies. Here, we examine men's support for WE as a sexual conflict trait, both via direct surveys (n = 590) and indirectly by asking men's wives (n = 317) to speculate on their husband's views. Data come from a semi-urban community in Mwanza, Tanzania. Consistent with reduced resource competition and increased exposure to relatively egalitarian gender norms, higher socioeconomic status predicted greater support for WE. However, potential demographic indicators of sexual conflict (high fertility, polygyny, large spousal age gap) were largely unrelated to men's support for WE. Contrasting self- and wife-reported measures suggests that men frequently exaggerate their support for women in self-reported attitudes. Discrepancies were especially pronounced among men claiming the highest support for WE, but smallest among men who held a professional occupation and whose wife participated in wage labour, indicating that these factors predict genuine support for WE. We discuss the implications of these results for our understanding of both individual variation and patriarchal gender norms, emphasising the benefits of greater exchange between the evolutionary human sciences and global health research on these themes.

Abstract Background HIV risk remains unacceptably high among adolescent girls and young women (AGYW) in southern and eastern Africa, reflecting structural and social inequities that drive new infections. In 2015, PEPFAR (the United States President’s Emergency Plan for AIDS Relief) with private-sector partners launched the DREAMS Partnership, an ambitious package of interventions in 10 sub-Saharan African countries. DREAMS aims to reduce HIV incidence by 40% among AGYW over two years by addressing multiple causes of AGYW vulnerability. This protocol outlines an impact evaluation of DREAMS in four settings. Methods To achieve an impact evaluation that is credible and timely, we describe a mix of methods that build on longitudinal data available in existing surveillance sites prior to DREAMS roll-out. In three long-running surveillance sites (in rural and urban Kenya and rural South Africa), the evaluation will measure: (1) population-level changes over time in HIV incidence and socio-economic, behavioural and health outcomes among AGYW and young men (before, during, after DREAMS); and (2) causal pathways linking uptake of DREAMS interventions to ‘mediators’ of change such as empowerment, through to behavioural and health outcomes, using nested cohort studies with samples of ~ 1000–1500 AGYW selected randomly from the general population and followed for two years. In Zimbabwe, where DREAMS includes an offer of pre-exposure HIV prophylaxis (PrEP), cohorts of young women who sell sex will be followed for two years to measure the impact of ‘DREAMS+PrEP’ on HIV incidence among young women at highest risk of HIV. In all four settings, process evaluation and qualitative studies will monitor the delivery and context of DREAMS implementation. The primary evaluation outcome is HIV incidence, and secondary outcomes include indicators of sexual behavior change, and social and biological protection. Discussion DREAMS is, to date, the most ambitious effort to scale-up combinations or ‘packages’ of multi-sectoral interventions for HIV prevention. Evidence of its effectiveness in reducing HIV incidence among AGYW, and demonstrating which aspects of the lives of AGYW were changed, will offer valuable lessons for replication.

For girls and women, marriage under 18 years is commonplace in many low-income nations today and was culturally widespread historically. Global health campaigns refer to marriage below this threshold as ‘child marriage’ and increasingly aim for its universal eradication, citing its apparent negative wellbeing consequences. Here, we outline and evaluate four alternative hypotheses for the persistence of early marriage, despite its associations with poor wellbeing, arising from the theoretical framework of human behavioral ecology. First, early marriage may be adaptive (e.g., it maximizes reproductive success), even if detrimental to wellbeing, when life expectancy is short. Second, parent–offspring conflict may explain early marriage, with parents profiting economically at the expense of their daughter’s best interests. Third, early marriage may be explained by intergenerational conflict, whereby girls marry young to emancipate themselves from continued labor within natal households. Finally, both daughters and parents from relatively disadvantaged backgrounds favor early marriage as a ‘best of a bad job strategy’ when it represents the best option given a lack of feasible alternatives. The explanatory power of each hypothesis is context-dependent, highlighting the complex drivers of life history transitions and reinforcing the need for context-specific policies addressing the vulnerabilities of adolescence worldwide.

In high-income, low-fertility (HILF) settings, the mother’s partner is a key provider of childcare. However, it is not clear how mothers without partners draw on other sources of support to raise children. This paper reports the findings from a survey of 1532 women in the United Kingdom and the United States, in which women described who provided childcare for a focal child and how frequently they did so. We use multivariate Bayesian regression models to explore the drivers of support from partners, maternal kin, and other allomothers, as well as the potential impact of allomothering on women’s fertility. Relative to mothers who are in a stable first marriage or cohabitation, mothers who are unpartnered rely more heavily on fewer maternal kin, use more paid help, and have networks which include more non-kin helpers. Repartnered mothers received less help from their partners in the UK and less help from maternal kin in both countries, which US mothers compensated for by relying on other helpers. While repartnered mothers had higher age-adjusted fertility than women in a first partnership, allomaternal support was not clearly related to the mother’s fertility. These findings demonstrate the importance of partners but also of allomothering more broadly in HILF settings.

Variation in parental care by child's sex is evident across cultures. Evolutionary theory provides a functional explanation for this phenomenon, predicting that parents will favour specific children if this results in greater fitness payoffs. Here, we explore evidence for sex-biased parental care in a high-fertility, patriarchal and polygynous population in Tanzania, predicting that both mothers and fathers will favour sons in this cultural setting. Our data come from a cross-sectional study in rural northwestern Tanzania, which included surveys with mothers/guardians of 808 children under age 5. We focus on early childhood, a period with high mortality risk which is fundamental in establishing later-life physical and cognitive development. Examining multiple measures of direct/physical care provision (washing, feeding, playing with, supervising, co-sleeping and caring when sick), we demonstrate that fathers favour sons for washing, feeding and supervising, while maternal care is both more intensive and unrelated to child sex. We find no difference in parental care between girls and boys regarding the allocation of material resources and the duration of breastfeeding; or in terms of parental marital and co-residence status. This bias towards sons may result from higher returns to investment for fathers than mothers, and local gender norms about physical care provision.

Summary: Background: The roll-out of antiretroviral therapy (ART) has changed contexts of HIV risk, but the influence on HIV incidence among young women is not clear. We aimed to summarise direct estimates of HIV incidence among adolescent girls and young women since ART and before large investments in targeted prevention for those in sub-Saharan Africa. Methods: We did a systematic review and meta-analysis. We searched MEDLINE, Embase, Web of Science, Global Health, and CINAHL for studies reporting HIV incidence data from serological samples collected among females aged 15–24 years in ten countries (Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe) that were selected for DREAMS investment in 2015. We only included articles published in English. Our main outcome was to summarise recent levels and trends in HIV incidence estimates collected between 2005 and 2015, published or received from study authors, by age and sex, and pooled by region. Findings: 51 studies were identified from nine of the ten DREAMS countries; no eligible studies from Lesotho were identified. Directly observed HIV incidence rates were lowest among females aged 13–19 years in Kumi, Uganda (0·38 cases per 100 person-years); and directly observed HIV incidence rates were highest in KwaZulu-Natal, South Africa (7·79 per 100 person-years among females aged 15–19 years, and 8·63 in those aged 20–24 years), among fishing communities in Uganda (12·40 per 100 person-years in females aged 15–19 years and 4·70 in those aged 20–24 years), and among female sex workers aged 18–24 years in South Africa (13·20 per 100 person-years) and Zimbabwe (10·80). In pooled rates from the general population studies, the greatest sex differentials were in the youngest age groups—ie, females aged 15–19 years compared with male peers in both southern African (pooled relative risk 5·94, 95% CI 3·39–10·44) and eastern African countries (3·22, 1·51–6·87), and not significantly different among those aged 25–29 years in either region. Incidence often peaked earlier (during teenage years) among high-risk groups compared with general populations. Since 2005, HIV incidence among adolescent girls and young women declined in Rakai (Uganda) and Manicaland (Zimbabwe), and also declined among female sex workers in Kenya, but not in the highest-risk communities in South Africa and Uganda. Interpretation: Few sources of direct estimates of HIV incidence exist in high-burden countries and trend analyses with disaggregated data for age and sex are rare but indicate recent declines among adolescent girls and young women. In some of the highest-risk settings, however, little evidence exists to suggest ART availability and other efforts slowed transmission by 2016. Despite wide geographical diversity in absolute levels of incidence in adolescent girls and young women, risk relative to males persisted in all settings, with the greatest sex differentials in the youngest age groups. To end new infections among the growing population of adolescents in sub-Saharan Africa, prevention programmes must address gender inequalities driving excessive risk among adolescent girls. Funding: This work was conducted as part of a planning grant funded by the Bill & Melinda Gates Foundation.

Global health interventions increasingly target the abolishment of ‘child marriage’ (marriage under 18 years, hereafter referred to as ‘early marriage’). Guided by human behavioural ecology theory, and drawing on focus groups and in-depth interviews in an urbanising Tanzanian community where female early marriage is normative, we examine the common assumption that it is driven by the interests and coercive actions of parents and/or men. We find limited support for parent–offspring conflict. Parents often encouraged early marriages, but were motivated by the promise of social and economic security for daughters, rather than bridewealth transfers alone. Moreover, forced marriage appears rare, and adolescent girls and young women (AGYW) were active agents in the transition to marriage, sometimes marrying against parental wishes. Support for gendered conflict was stronger. AGYW were described as being lured into unstable relationships by men misrepresenting their long-term intentions. Community members voiced concerns over these marriages. Overall, early marriage appears rooted in limited options, encouraging strategic, but risky choices on the marriage market. Our results highlight plurality and context dependency in drivers of early marriage, even within a single community. We conclude that engaging with the importance of context is fundamental in forging culturally sensitive policies and programs on early marriage.

BackgroundThe concept of 'child marriage' in global health distinguishes ostensibly harmful from healthy ages to marry at a universally-applied threshold of 18-years. With intensifying efforts to end child marriage, targeted communities are increasingly asked to change their perception of such marriages from relatively benign to profoundly problematic. The objective of this study is to understand how this shift in perception is navigated by adolescent girls and young women (AGYW).MethodsUsing qualitative data collected in 2019 from a semi-urban community in Tanzania where marriage under 18-years is common and campaigns to end child marriage ongoing, we contrast reports of lived experiences of marriage under 18-years among AGYW to views of child marriage as an abstract concept. Thirteen in-depth interviews with AGYW, as part of a wider qualitative study, were recorded, transcribed, and analyzed using a framework analysis approach.ResultsWhile many AGYW had heard of child marriage, the concept was routinely conflated with forced marriage, which is rare in the community, and non-marital teenage sex and pregnancy, which are common. As a likely consequence, participants disagreed on whether or not child marriage occurs locally. Furthermore, accounts of real-life marriages under 18 sometimes aligned with, but often departed from, common narratives about the purported causes and harmful consequences inherent to the global health concept of child marriage.ConclusionsWe argue that engaging with diverse local views and experiences of marrying young is essential to producing culturally-sensitive, effective initiatives addressing the vulnerabilities of female adolescence.

Global efforts to eradicate 'child marriage' (