Toward a Historical Perspective on Sexuality in Uganda: The Reproductive Lifeline Technique for...

Are Ugandan youth sexually

active earlier than their

parents a generation ago?

Data collected using a new

qualitative research tech-

nique suggests “no.” This

anthropological analysis

explains why Ugandan

adults hold negative stereo-

types of adolescent sexuality

in this time of HIV-AIDS.

Toward a HistoricalPerspective on Sexuality in Uganda:The Reproductive Lifeline Techniquefor Grandmothers and their DaughtersKearsley A. Stewart

Current health research on HIV-AIDS in Uganda is predomi-nantly ahistorical and acultural. This is an inadequate analy-sis of a profoundly social epidemic, especially as the burdenof disease shifts from adults to adolescents. As well, manyUgandan adults hold unexamined attitudes about adoles-cent sexuality, often declaring that today’s youth are reck-lessly sexually active at a much younger age than in thepast. This paper presents new data on sexuality reachingacross three generations of Ugandans. These data were col-lected with an original qualitative social scientific researchmethod—the reproductive lifeline technique. Building on thefocus group method, this exercise is designed to produce fer-tility data with historical depth of several generations ofwomen, and to encourage parents to speak more openly withtheir own children about reproduction and sexuality. Thispaper analyzes one particular demographic variable, age atfirst live birth, in an effort to theorize about change overtime in another important variable, age at sexual debut. Theresults were surprising: age at first live birth has not changedsignificantly over the past forty years in western Ugandaand some evidence suggests that age at sexual debut hasnot changed much either. Several explanations are offeredto explain the discrepancy between the demographic evi-dence and the cultural norms held by adults about adoles-cent sexual behaviors.

Introduction

The scope and urgency of the HIV-AIDS epidemic in Uganda shapes thestudy of sexual behavior in Africa in two important ways. First, it encour-

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ages researchers to situate their work in the present, with the goal of chang-ing current behaviors and preventing future disease transmission; second,it necessarily favors public health as the primary research discipline of theepidemic, relying on its central methodology, epidemiology, to understandthe changing patterns of sexually transmitted diseases (STDs) at the popu-lation level. Fifteen years into the epidemic, there are only two major suc-cess stories from the African continent: Senegal, where the rate of newHIV-1 and HIV-2 infections remains virtually constant (Meda et al. 1999),and Uganda, which reported the first plateau ever in HIV incidence in acountry with an estimated overall seroprevalence of more than 10% (STD/AIDS Control Programme 1996a; Asiimwe-Okiror et al. 1997). That themedical data behind the Ugandan success story are reported with an un-usually high degree of confidence is testimony to the importance of on-going population-based epidemiological studies, such as those in Rakai andMasaka (Nunn et al. 1997; Wawer et al. 1999), and other large-scale clinic-based biomedical studies of HIV-AIDS in Kampala (Guay et al. 1999; Musokeet al. 1999). However, the dominance of the public health paradigm in thestudy of sexual behaviors in Uganda, especially since the emergence of theHIV-AIDS epidemic, relegates the contributions of social scientists to themargins of basic research (Huygens et al. 1996; Packard and Epstein 1991).As a result, the bulk of current health research on HIV-AIDS in Ugandacontinues to be ahistorical and acultural, clearly an inadequate responseto a profoundly social epidemic with historical precedents (e.g., Vaughan1991).

Equally flawed are some of the basic social scientific methods for thestudy of sexual behaviors, such as standardized interviews for knowledge,attitude, and behavior (KAB) data (Cleland and Ferry 1995). In an attemptto overcome some of these deficiencies, social scientists rely on the focusgroup method to contextualize self-reported data with the relatively spon-taneous conversation that unfolds naturally during open, but focused, groupdiscussions. These discussions also produce large quantities of data for arelatively small cost and within a short period of time—an appealing char-acteristic for research projects struggling with limited resources (Scrim-shaw and Hurtado 1984; Scrimshaw et al. 1991). Consequently, the focusgroup discussion is now a standard feature of almost all HIV-AIDS behav-ioral research projects worldwide, and even more so in Africa, where com-plex field logistics sometimes preclude conducting even the most basicbaseline demographic survey. Despite these obvious advantages, the focusgroup method has not promoted a more complex cultural, or even vaguelyhistorical, understanding of the relationship between sexual behaviors andthe HIV-AIDS epidemic in Uganda (e.g., Konde-Lule, Musagara, and Mus-grave 1993).

How can we develop a historical framework for understanding thecultural meanings of generational changes in sexual behaviors? How canwe move beyond standardized survey questions to promote reflection, byUgandans, on the meaning of changes in their own intimate lives? How

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125can we reorient the research process to produce data with both immediateand long-lasting significance for the participants first, and the researcherssecond? And finally, what kind of contribution will such an approach maketo the reduction of current prevalence and incidence of HIV-AIDS in Uganda?This paper discusses a novel combination of the focus group method withthe life history technique to create an original research tool: the reproduc-tive lifeline. The data presented here focus on change in one particulardemographic variable, age at first live birth, across three generations ofwomen. These data allow us to consider change over time of another im-portant, but more difficult to assess, demographic variable: age at sexualdebut. As a conclusion, I offer some insights into larger generational issuesthat relate to representations in popular culture in Africa and changingideas about adolescent sexuality in western Uganda.

Assessing the Focus Group Discussion Method

This paper is based on fourteen months of research in western Ugandafrom 1996 to 1997.1 My primary research goal was to investigate the rela-tionship between school status and HIV status among fifteen to nineteen-year-olds. The working hypothesis held that these variables were inverselyrelated; that is, the more school experience a young person had, the lesslikely they were to engage in “risky” behaviors. Consequently, I predictedthat, as a group, school goers would have a lower rate of HIV-AIDS thanschool leavers or those with no formal education at all. To test this as-sumption, I maintained a rigorously stratified, multistage probability sample,and collected three types of data: quantitative (survey n=550), qualitative(individual and focus group interviews n=60), and epidemiological (HIV-1/2 serologic test n=193) (Stewart 2000). My research assistants and I con-ducted focus group discussions with a variety of youth and adults in HoimaDistrict. We interviewed young people in classrooms, churches, and com-munity halls. We conducted single sex and mixed sex discussions. We hadexperienced and inexperienced leaders conduct the interviews. We experi-mented with the effect of a male leader on a group of girls or women, andof a female leader on a group of boys or men. We had a variety of “warm-up” exercises, and offered refreshments and small thank-you gifts. Eachgroup had a secretary taking notes, plus backup tape recorders. In short, wefollowed the rules for success, but were treated to it less often than wewould have predicted.

When queried about strategies for HIV-AIDS prevention in their com-munity, both adolescent and adult responses were more often repetitionsof public health messages than reflections on their own experiences of theepidemic. However, some of the focus group discussions did produce occa-sional moments of insight, reflection, or surprise. Below is a sampling ofsome of the more interesting comments offered during our focus groupdiscussions. The frankness of children surprised this man.

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If you tell the child that, “please be careful with the AIDSdisease,” the child will answer and say that, “can’t you alsobring AIDS? You sleep with mummy and you have sex withother women so let me do what I want.” And then you havenothing to answer.

Hoima town market man (Group Interview 1997b)

Even those adults who continue to try to communicate with their childrenare often stymied.

Map 1: Uganda and major roads

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127When we tell some of our children to be careful about AIDS,they answer and say that we don’t want them to have chil-dren. Then you feel defeated.

Kabaale village grandmother (Group Interview 1997h)

Sometimes the atmosphere of the discussions allowed participants to bevery honest with the group.

The time that AIDS started showing up is the time I alsostarted playing sex, and when I think and remember that, Isee that I am dead. Then I decided to just go because there isnobody who is sure of himself. Madam, that’s how things are.


If you ask us to leave women, it is impossible. During theday we say one thing, and during the night we do another.


Young people offered different perspectives on why sexual behavior hadchanged since their parents’ generation.

Scientifically we are being told that a girl is likely to beginplaying sex at 12 years old. And a girl may be 12 years andlooks as if she is 20 years due to good feeding, and that girl islikely to begin practicing sex at an early age.

Hoima town schoolboy (Group Inteview 1997d)

The actual behavior has changed due to current living. In thepast, people could do without sex until marriage because theywere respecting their elders’ advice not to play sex beforemarriage. But nowadays, youths want to find out why they[elders] should not do it and why they have stopped them[youth] from doing it while they learn in school all about sex.

Hoima town schoolboy (Group Interview 1997d)

Perhaps more so than the adults, the youth are clear about the new sexuality.

In the past when HIV-AIDS came, people were dying rapidly.But these days, death is not so rampant because of introduc-tion of ways of prevention. In the past, people were not awarehow to use condoms, but these days even a Primary Sevenpupil knows how to use a condom.

Hoima town out-of-school boy (Group Interview 1997e)

In the past, sex was respected highly. A boy or girl could getmarried before they played sex. But nowadays, sex is takenas nothing or something to play with.

Hoima town out-of-school boy (Group Interview 1997e)

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Apart from these particular statements, why such predictable results?Many of the key adult informants we gathered were very familiar with thisformat. Some had been the “participants of choice” for several focus groupdiscussions on HIV-AIDS previously conducted in Hoima town by Swed-ish researchers and several nongovernmental organizations. I soon realizedthat there was a standard group of women who were called to participatein these discussions whenever a researcher, foreign or Ugandan, came totown. The head of the town market, the women’s representative to theRed Cross, and the director of the orphanage had heard it all before, and theresult was often a discussion that yielded little insightful data. Even ingroups comprised of rural farmers or nonprofessionals who were less likelyto be part of town politics, the results were similarly disappointing. Thefarmers (often women) and fishermen reported that in the past they hadleft their fields or canoes to respond to a call from Ugandan officials. Theywere met with urban elite professionals who had driven into their villagefor a morning or afternoon of government-sponsored “sensitization” pro-grams; for example, with lectures about minimizing the risk of cholera intheir communities or maximizing farm yields. The rural adults returnedto their work without, in their opinion, any immediate or beneficial re-sults worthy of such an interruption to their day. Similarly, they oftenexpressed frustration as to why our project sought them out only to asktheir opinions instead of dispensing the basic resources they so desperatelyneeded. In my view, it is not that these rural farmers and fishermen couldnot understand the abstract ideals of a large-scale research project, or visu-alize potential long-term benefits, but their own experience of unfulfilledpromises by researchers had made them wary of participating in the pro-cess with any enthusiasm.

How do we explain the lukewarm success of the youth focus groupdiscussions? Young people are not yet so inured to the process, either byrepeated participation or continual disappointment, to give such results. Itcannot be explained from disinterest either, as we often had many morewilling focus group participants than we had time or space to accommo-date. To my mind, the answer is simple: focus group discussions are boringfor these young people because they are too much like their school system,which remains largely unchanged from the British colonial era. For theyoung people, it was a familiar format where the leader posed a question tothe group and then individual members of the group responded directly tothe leader (for example, see Stambach 2000: 111–33). In our experience,very few groups offered answers or comments that went beyond the literalsense of the questions, and almost none of the groups broke off into theirown discussions.

Perhaps if the group interviewers had possessed more subtle skillsfor leading discussions, then the results might have been more satisfac-tory. However, after observing several discussions, I concluded that re-peated focus group discussions with approximately the same group of par-ticipants would have had a better chance of gradually shifting the focus

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129away from the leader and onto the informants themselves, and most likelywould have yielded the best results. But the constraints of time and re-sources did not permit such an experiment. Instead, I decided to try toimprove the process for both adults and youth by making the discussionsmore participatory and relevant to local needs and interests. For the youthin secondary school, that interest turned out to be an elaborate collectionof plays, debates, and songs captured on video (Stewart 2000). For the adults,increased participation was achieved through a new group interview tech-nique, the reproductive lifeline. This opened up group discussions well be-yond the literal boundaries of the leader’s questions, and led to a level ofself-awareness and questioning not exhibited in the previous focus groupdiscussions.

Challenging “Common Sense” Ideas about Adolescent Sexuality

About halfway through the field research project, as I became more famil-iar with adolescents’ perspectives on sexuality, I noticed how poorly mis-understood adolescent experiences were by adults, both parents and policymakers. It seemed clear to me that conditions for the emergence of theHIV epidemic among adolescents in western Uganda were shaped not onlyby the actual sexual behaviors of the youths themselves, but by the oftenmistaken ideas adults had of adolescent sexuality today. I became moreinterested in exploring those “common sense” ideas about adolescent sexu-ality that appeared in casual adult conversations, ministers’ sermons, andpoliticians’ speeches given at the inauguration of health clinics. For ex-ample, two such deeply held and often invoked adult positions are: (1) theyouth are having sex at a much younger age now than in the past, and (2)sending girls off to boarding school is dangerous because they become moresexually active away from their homes. These statements are offered byadults as obvious truths, “common sense” descriptions of the behavior oftoday’s youth, and plain-as-day facts that are easily verified by anybodywho cared to look around at what was happening.

Yet according to my data, neither position is true. The first “com-mon sense” idea is that young people are sexually active much earlier to-day than were their parents. If we compare mean age at sexual debut asreported in the survey by female youth (15.4 years, Table 1, Question 808)with mean age at sexual debut as reported in the reproductive lifeline dis-cussion group by grandmothers (16.0 years, Table 5), we see a change overtwo, perhaps three, generations of less than 1 year, from 16.0 years in the1960s and 1970s to 15.4 years in the 1990s. While these data, especially thedata from the focus group discussions, are not from large samples, Demo-graphic and Health Surveys (DHS) data typically are drawn from samplesgreater than 5,000. DHS data collected from all regions of Uganda, but par-ticularly from the western region of Uganda, show a similar trend over thepast thirty years: no significant change in age at sexual debut for women

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over the last two generations. For example, in 1995 in the western regionof Uganda, DHS data report that the median age at first intercourse forwomen aged 25 to 29, versus their mothers’ generation aged forty to forty-four, was unchanged at 16.5 years (Statistics 1996: 79). It is important tonote that my argument is based on comparing the similarity of trends withinsamples, not comparing mean or median values across samples; in otherwords, both samples demonstrate nonsignificant change in age at sexualdebut between two generations of women within the same sample, eventhough the actual age at sexual debut appears to be significantly differentbetween the two samples.

The second “common sense” idea holds that unchaperoned youngwomen at boarding schools are more likely to engage in sexual activitythan young women who stay at home in the villages. This idea can bebroken into two components: (1) while at boarding school, girls are moresexually active than while at home, and (2) boarding school girls are moresexually active than village girls. First, to analyze the effect of attendingboarding school on the sexual behavior of students, we must disaggregatethe survey data and look only at those youths who were enrolled in board-ing school when they experienced their sexual debut (Table 1, Question809). The evidence demonstrates that both boys and girls who becomesexually active while enrolled in boarding school have their first sexualexperiences at home, not while away from home attending boarding school.This is a significant finding that suggests that even youths sent awayto boarding school experiment with sexual intercourse with close village

TABLE 1

Mean age and location of sexual debut for Hoima youth aged 15 to 19.(See Appendix A for translation of survey questions into Runyoro.)

Males andFemales

Females Males

Age at first sex

Question 808: How old were youwhen you first played sex; that is,the first time you had penetrativesexual intercourse?

n=368

15.2 (11–19)

n=187

15.4 (12–19)

n=181

15.0 (11–18)

When first sex occurred whileinformant was enrolled in school,location was:

Question 809: Was your first gameof penetrative sexual intercourse:(1) Away from home at a boardingschool?(2) At home from boarding schoolduring a long school holiday?

n=100

23%

77%

n=52

27%

73%

n=48

19%

81%

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friends from home who are well known to them, not with acquaintances atschool. Second, a direct comparison of the sexual activity of female board-ing students and female village residents disproves the belief that schoolgirls are more sexually active than other girls (Table 2, Question 807). Infact, both groups are similarly divided between girls reporting the onset ofsexual activity and girls reporting no sexual activity, although female vil-lage residents report experiencing sexual debut about six months earlierthan female boarding students (Table 2). Furthermore, two-thirds of villagegirls have their first sexual experience either in their own home or in thehome of their partner (Table 2, Question 809). The implications are clear:sexual debut for the majority of youth occurs most often in the homes ofparents, relatives, and guardians, not at boarding schools or while unchap-eroned at discos. If parents, relatives, and guardians became more aware ofand involved in the activities of the youth directly under their supervision,perhaps the early sexual behavior of young people, particularly the age atonset of sexual activity, could be delayed. However, convincing adults totake such action is another challenge altogether, as evidenced by some ofthe focus group testimony reported above and below.

I wondered how such opposite conclusions could coexist betweenthe demographic truth as reported by over 550 youth in my survey dataand the “common sense” truth which adults constructed from observa-tions of their own children’s behavior. And furthermore, I wondered how Icould elicit discussion about, and consideration of, this gap without set-ting the two domains against each other in an artificial dialectical opposi-

TABLE 2

Sexual activity of Hoima female boarding students and Hoima female villageresidents, aged 15 to 19.(See Appendix A for translation of survey questions into Runyoro.)

Female BoardingStudents

Female VillageResidents

Question 807: Have you ever playedsex; that is, have you ever engaged inpenetrative sexual intercourse?

n=104

yes: 56% no: 44%

n=66

yes: 59% no: 41%

Mean age at first sexn=5815.7 (13–19)

n=3915.0 (12–17)

Question 809: Was your first game ofpenetrative sexual intercourse:(1) Away from home at a boardingschool?(2) At home from boarding schoolduring a long school holiday?Or(1) In my parent’s or relative’s home(2) In my partner’s home(3) In my friend’s home(4) Outside in the bush

n=52

27%

73%

n/an/an/an/a

n=39

n/a

n/a

26%41%5%28%

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tion. I realized that merely raising the common sense statements withinthe focus group format might further reinforce them and preclude any con-sideration by the participants of their possible falsehood. I needed a moredynamic method for interrogating and challenging these common sensenotions about adolescent sexuality. As a researcher, the complex questionI wanted to ask, but could not directly pose to the focus group, was: Re-searchers have strong evidence that most young people in western Ugandaare not experiencing their sexual debut at a significantly earlier age thandid their parents, yet many Ugandan adults believe otherwise. How hasthe experience of coming of age changed from the time of your youth,before AIDS, and now, for today’s youth during this time of AIDS? Andhow can the answers to that question help today’s youth mature intoadulthood more safely?

Developing Something New

To answer those questions I realized that I needed qualitative data aboutchanges in sexual practices over the past thirty or forty years, but this in-formation was not available in the published literature. The current del-uge of behavioral data on sexual practices in Uganda dates back only to themid-to-late 1980s, when international public health agencies and Ugan-dan, British, and American public health researchers (e.g.,: Berkley et al.1990; Serwadda et al. 1985; Wawer et al. 1991) were first invited by Presi-dent Museveni to study the epidemic. Before the HIV-AIDS epidemic, mar-riage, reproduction, and sexual behavior in Uganda were studied mainly bythe colonial-era missionary John Roscoe (1923), an occasional British an-thropologist (Beattie 1957, 1965), and a handful of Ugandan researchers(Kisekka 1974; Nyakatura 1970; Obbo 1980). Some relevant indicators, suchas female fertility levels and age at first birth, were probably gathered asearly as 1948 in the first Ugandan nationwide census, or by 1957 by theFamily Planning Association of Uganda, but these types of data were notsystematically collected until the 1988/89 Demographic and Health Sur-vey (Statistics 1989: 2–4). Student theses from Makerere University offerglimpses of these variables as well, but are not readily available and sufferfrom uneven quality of data collection and analysis (e.g., Baganizi 1991;Nabbosa-Nalugwa 1991; Najjumba-Kibira 1991; Nakamyuka 1982).

Without any significant baseline behavioral data from which to be-gin, researchers relied on standardized sexual behavior surveys developedin Europe and the USA (e.g., World Health Organization 1990). This recallsthe earlier practice of colonial missionaries, travelers, and administratorscarrying James G. Frazer’s standardized questionnaire with them into thefield as they systematically attempted to study all aspects of native lifebased on western cultural categories (Frazer [1887]1889, cited in Ray 1991:23). Without question, the use of standardized sexual behavior surveys dur-ing the early days of the HIV-AIDS epidemic in Uganda was vital for policy

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133decisions and program implementation, but it set a narrow course for thestudy of sexual behavior over the next decade. It is regrettable that littlesystematic social scientific knowledge is available about the sexual prac-tices of even a generation ago, yet the continued standardization of currentsurvey research means that our awareness of any changes that might haveoccurred during the HIV-AIDS epidemic will continue to be limited to un-complicated, and possibly incorrect, ideas about sexual behavior in Uganda.The Demographic and Health Survey recognized this problem, and in 1995they conducted an additional survey in Uganda intended to supplementstandard fertility and sexual behavior data with more qualitative, open-ended questions broadly related to the HIV-AIDS epidemic (Blanc et al.1996). This important report is one of only three “in-depth” research projectsconducted by DHS in sub-Saharan Africa since 1988 (Macro International1999). As well, some anthropologists and sociologists managed to promotecontext-sensitive research on sexual behavior relatively early in the studyof the epidemic (e.g., Ankrah 1993; McGrath et al. 1993; Ntozi and Kabera1991; Obbo 1993; Olowo-Freers and Barton 1992; Seeley et al. 1991), butthe majority of these studies are without much historical depth. Recently,some historians have begun to analyze sexual behavior in Uganda (Lusembo1990), but many of these historical studies focus on colonial policy andsocial control programs implemented during epidemics of sexually trans-mitted infections such as syphilis (Lyons 1994; Setel et al. 1999; Lewis andLyons 1999; Tuck 1997; Vaughan 1992).

I next turned to Robert Chambers’ work in participatory research(1984, 1997) for inspiration in developing the reproductive lifeline tech-nique. My primary research goal was to examine the demographic basisfor the “common sense” idea that today’s youth, and in particular youngwomen, were having sexual relations earlier than their parents or grand-parents. The most straightforward way to answer this question, of course,was to ask the same question of two or three generations of women andcompare the reported ages at sexual debut. My interest in focusing on youngwomen stemmed from the increased biological vulnerability of adolescentgirls to the HIV virus (Moss et al. 1991; Hankins 1996) and the shockinglydisproportionate ratio of HIV positive adolescents (6 females: 1 male) inthe early 1990s in Uganda (STD/AIDS Control Programme 1996b: 3). How-ever, I wanted to avoid collecting more survey data; I needed qualitativedata from a focus group setting that could suggest a historical context forthe abundance of survey data I had already collected. Yet I suspected thatmost grandmothers probably did not know with much certainty when theirdaughters first became sexually active. In fact, this topic is traditionallyavoided between parent and child; discussion about sexual matters ideallyoccurs between a male youth and his mother’s brother, or a female youthand her father’s sister (Nyakatura 1970: 24–5; Roscoe 1923: 269–73). To-day, however, sexual education, when offered at all to young people, ismore likely to come from someone other than parents or older relatives(Table 3).

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I decided the solution was to work with a carefully chosen group ofsenior women whose own firstborn daughters already had given birth. Itwas critical that each participant be a grandmother by her own firstborndaughter. Ensuring this fact had two advantages. First, the demographicsimilarity of the group would increase the likelihood that the participantsfelt at ease and could speak freely. Senior women are often cast as asexualsince they are unlikely to conceive, so discussing sexual issues in public ismore acceptable for these women. Most importantly, however, in this ru-ral environment it meant that most of these senior women probably hadattended the birth of their firstborn daughter’s child and most likely hadintimate knowledge about the progress of the daughter’s pregnancy. I couldbe very confident of the reproductive information that the grandmothersreported about their daughters. Therefore, in my assessment of change insexual behavior over time, I could reasonably replace data on the critical

TABLE 3

Sources of sexual health information for youth aged 15 to 19.(See Appendix A for translation of survey questions into Runyoro.)

Males andFemales

Question 601: Who first talked to you about sex and marriage?

Parent, older relative, or guardianFriend or same-age relativeTeacherOther

n=560

30%41%11%18%

Question 610: From whom did you first learn about how to avoidpregnancy and sexually transmitted disease?


n=544

37%21%21%21%

Question 611: With whom do you most discuss sex and marriagenow?


n=559

15%65%1%19%

Question 612: Who or what would you say is your main source ofinformation about your sexual health?

Parent, older relative, or guardianFriend or same-age relativeTeacherMedia (print, radio, television)Other

n=559

15%36%6%17%26%

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135variable—age at sexual debut—with data on another variable—age at firstlive birth. Although age at sexual debut is a more important variable thanage at first live birth when assessing risk of HIV transmission for today’syouth, I settled for the more knowable variable. Finally, there are no pub-lished data that directly assess changes in sexual behavior in Uganda be-tween actual mother and daughter.

The Reproductive Lifeline Technique

First, the women are invited to join a general discussion about all the im-portant factors related to becoming a woman and a mother as they experi-enced the process in their own lives. The group facilitator makes notecardsof these important events as they are raised by the women during the groupdiscussion and tacks them on a wall or places them on the floor. The top-ics from our seven group discussions ranged from the expected—menstrua-tion, schooling, dating, pregnancies, marriage, divorce—to the poignantand unexpected—death of own mother, chronic illness, first trip in a car,political events, and the deaths of two children in one day. If they were notraised independently by the group, the facilitator makes an announcementthat the two variables, age at sexual debut and age at first live birth, shouldbe included on everyone’s lifeline. After the discussion is completed, largesheets of newsprint and pens are distributed to the women. They are askedto review the events on the notecards and write down on their sheet ofpaper only those events that they experienced directly in their lives. Theythen organize these events from earliest to most recent along a timeline.One actual lifeline of a mother is reproduced in Table 4. We ask them, tothe best of their memory, to date the events. We then ask them to do thesame for their own firstborn daughters. The final product is two separatepieces of newsprint with two different reproductive lifelines, one for thegrandmother and one for her daughter, constructed from each woman’sunique experiences. For those women who were illiterate or uncomfort-able with pen and paper, we worked directly with them to create theirlifelines.

The next step is another discussion based directly on the lifeline evi-dence on the newsprint in front of each woman. The goal of this portion ofthe exercise is to encourage the women to take a moment and reflect onthe reproductive events in their own and their firstborn daughters lives’.The group facilitator suggests to the participants that they compare theirown memories of their youthful sexual experiences with what they knowof their own daughter’s sexual lives. Participants are then asked to reflecton the differences, but more importantly, the similarities, between theirown experiences of sexual debut and those of their children. Many womenwere visibly unsettled to realize that they had little knowledge about someof the most important events in their own daughters’ lives. About half ofthe women exclaimed that they did not even know when their own daugh-

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ters started to menstruate, and fewer knew anything at all about theirdaughters’ first sexual experiences. Blame for the sexual misconduct oftoday’s youth was often placed on the shoulders of “them:” the auntiesand uncles who had failed to offer any sexual education at all to theirnieces and nephews. The women agreed that, in the past, girls receivedtheir sexual education from their father’s sisters or the father’s other fe-male relatives (baisenkati), or from elders if aunties were not available.Today that tradition more or less has been abandoned.

Grandfathers, grandmothers, aunties. There were some whoused to talk nonsense to you and there were some who usedto talk sense. Even neighbors used to talk to the youth. If theyouth failed to listen or change, you might call even the step-mother or any other person to talk to the youth.

Hoima town market woman (Group Interview 1997a)

They used to talk to the youth while collecting water or whileharvesting millet.

Kigarama grandmother (Group Interview 1997c)

Some women even noted with irony that they were complaining aboutderelict aunties, when in fact they were also the same aunties who hadfailed to properly educate the children of their own sisters. These commonrevelations inspired lively discussion about how little today’s parents knowabout their own children’s lives; this usually led to a conversation aboutwhat parents should do to improve the situation. Almost all the groups

1957 1962 1970 1972 1973Born Primary Secondary Menstruation Change of

School School Behavior

1974 1975 1976

1st dance 1st kiss 1st pregnancy (out-of-wedlock)1st love letter 1st romance Disappointed, no engagement1st steady boy 1st employment Complications with pregnancy

1st sexual experience 1st visit to antenatal clinic

1977 1977 1978 19801st labor pains 1st breast feeding 1st immunization Introduction (bride

meets in-laws)

1981 1985 1986 10/97Marriage Death of mother Divorce from abusive husband Today’s

Date

TABLE 4

Reproductive lifeline diagram of forty-year-old professional woman.

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137came to similar conclusions: as parents, they needed to break the prohibi-tion against speaking directly with their own children about sex. This wasoften a shocking conclusion for the more senior women, but in almostevery focus group discussion there were women who spoke directly to theissue and lobbied the group to be more open with their own children, espe-cially, they gravely noted, in this time of AIDS.

New Data, New Questions

From September through November 1997, over seventy senior women fromvillages near Hoima (Kabaale, Bujwahya, Rusembe II, Butema, Bujumbura,Kyarwabuyamba: see Map 2 above) plus a group of market women fromHoima town, participated in reproductive lifeline focus group discussions(see Appendix B). The discussions with these senior rural women fromwestern Uganda were conducted in Runyoro, transcribed, and then trans-lated into English. Table 5 presents some of the demographic data extractedfrom these exercises. What is most striking is how little the critical vari-able, age at first birth, has changed over forty years. Most of the grand-mothers in this sample would have had their first live births between 1955and 1980, and most of their daughters would have delivered from 1975 tothe present. There is no clear trend in age at first birth over the past fortyyears in these data. As noted above, DHS data show similar results for thepast 30 years in the western region of Uganda (Statistics 1996: 79). In our

TABLE 5

Demographic data as reported by grandmothers on actual reproductive lifelinediagrams.

Age (Mean)

CurrentAge

Menstruation SexualDebut

1st LiveBirth*

1st FormalMarriage

Grandmother n=71

46.5(32–80)

n=63

14.1(10–20)

n=26

16.0(11–29)

n=66

18.1*(12–30)

n=45

18.7(14–33)

Firstborn daughter n=67

25.8(14–60)

n=29

14.1(12–18)

n=187

15.4(12–19)data in thiscell fromTable 1

n=54

17.5*(12–25)

n=29

17.8(14–21)

*Difference in mean age at first live birth between grandmothers and their daughtersis not statistically significant. p=.326 in 2-tailed paired samples t test; p=.428 in 2-tailed nonparametric Wilcoxon signed ranks test for two related samples.

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data, there is no statistically significant difference in mean age at first livebirth between grandmothers and their daughters by both parametric (pairedsamples t test) and nonparametric (Wilcoxon signed ranks test for tworelated samples) statistical tests (Table 5). Even when disaggregated byquartiles (Table 6), our data show remarkably robust normal distributionsfor both grandmothers and daughters. Further, if we compare the ages ofthe grandmothers and their own firstborn daughters, we find that the age

Map 2: Interview sites around Hoima town and in Buhimba sub-county

TABLE 6

Frequency distribution by quartiles of age at first live birth for grandmothersreporting age at first live birth of firstborn daughters.

Age at 1st Live Birth (%)

12–15 16–17 18–19 20–30

Grandmothers (n=54) 25.9% 27.8% 24.1% 22.2%

Firstborn daughters (n=54) 25.9% 22.2% 29.7% 22.2%

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139

of today’s young mothers at first birth is not predicted by, or related to, theage at which their own mother gave birth (Table 7). In other words, it isclear that for those grandmothers who gave birth at ages between 12 and15, 16 and 17, 18 and 19, or 20 and 30, the average or mean age for theirdaughters’ first birth is closely equivalent. The conclusion—no significantchange in age at first live birth over at least two generations in westernUganda—is consistently demonstrated in various ways by these data.

How can we explain these unexpected data? No matter how theyare analyzed, these data clearly demonstrate that the age at which youngwomen first get pregnant in western Uganda has changed little over thepast four decades. So, is it reasonable to assume that the age of sexual de-but has not changed much either? Of course, the use of condoms or thepractice of abortion would challenge this conclusion by allowing earliersexual activity without pregnancy, but regular and reliable use of contra-ception typically does not occur until after the first pregnancy or marriage,so it is not likely to have a significant effect. I believe it is reasonable toassume that, both on the average and as a group, today’s youth are notexperiencing sexual debut much earlier than their parents. The questionthen remains: why do adults continue to believe that young people arehaving sex at an earlier age now than in the past?

Let me offer two possible explanations for this controversial finding.First, although less prevalent than the Ugandan media would have it,2

some older men are having sex with younger and younger girls. This trendis fueled by the belief in the late 1980s and early 1990s that AIDS could becured through sexual relations with sexually naïve young girls. More cen-tral to this argument, however, is the fact that the increasing gap in agebetween the sugar daddy and the school girl emphasizes the youth of thegirl, not the age of the man or his behavior. The obsession with the youthof the girl in a relationship with an older man might explain the stubbornpersistence of the idea that young people, especially girls, are experiencingtheir sexual debut much earlier than their mothers and grandmothers.3

Does age of grandmother at 1st live birth predict age of ownfirstborn daughter at first live birth? NO

Age at 1st live birth

Grandmothers n=1412–15

n=2816–19

n=1220–30

Own firstborn daughters n=1418.0 (14–25)

n=2817.1 (14–23)

n=1217.9 (12–24)

Overall meann=5417.5 (12–25)

TABLE 7

Mean age of first live birth for firstborn daughters disaggregated by age of grand-mothers at first live birth.

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A more subtle analysis, however, might resist the fascination withsugar daddies and experiment with these adult complaints from withintheories of popular culture or culture change. According to Fabian (1998),one of the most distinctive elements of popular culture is its relationshipto, and assertion of power. The dominant metaphor in the grandmothers’focus group discussion about adolescent sexuality was their loss of controlover the youth. This is reflected in statements about the lack of respectyouth have for their elders, how the youth rebuff their parents’ attempts atguidance and advice, the incomprehensibility of the cultures and morali-ties of the youth sexual world, and so on. The most common complaintsconcerned the breakdown of communication between parents and chil-dren, and the ineffectiveness of parental discipline strategies.

In our days, when our parents saw you moving or playing inbad groups, they used to stop you from playing with themand you would listen. But the youth of today, however muchyou talk, they don’t listen.


Long ago, parents used to talk to children about sex, but theparents these days don’t talk to children about sex. And wefind that the children are more clever than us. If you try totalk to them, they just run away and disappear. We mustknow how to rule children in a home.


The time we grew up, we had life. We used to go for discos,but listened (to our parents). But the youth of today don’tlisten. When you tell them not to go, they pass though thewindow and get the AIDS disease.

Hoima town grandmother (Group Inteview 1997f)

Parents agonize about balancing their desire to advise their children withallowing them to make their own decisions independently.

However much you try to talk to the children, they don’tlisten. They answer you things which are beyond [our] con-trol. The child will answer you and say you are telling me orpreventing me to go my own way because you are old andyou cannot enjoy yourself. They say, “give me what I wantto eat.” Then you will just have to keep quiet with nothingmore to add on.

Kyarwabuyamba village grandmother(Group Interview 1997g)

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141Life these days is very bad, you have to protect yourself. Whenyou tell the child, “take this path, don’t take that one,” thenthe child will think that the parent is trying to tell him orher in a bad way and the child will not follow.

Kyarwabuyamba village grandmother(Group Interview 1997g)

More than frustration with the rudeness of today’s youth, there is also asense of incredulity at the brazen and public nature of their sexual behav-iors.

The boys of today don’t fear, even if the father is in the house,he will not fear to get into the house and will insist on spend-ing the night.


There are times when girls don’t fear when it comes to nighttime. When a girl passes a group of boys, you hear the boysgiving themselves numbers on how they are going to takerounds, 1,2,3,4,5. Another one will tell his friends to hurryup, that he is still watching! That one I will never forget!(nervous laughter in the group)


Many adults mourn the loss of “peace” and “freedom” which they felt intheir youth, but which they believe is not present in their children’s inti-mate lives. For these adults, AIDS is not only a medical catastrophe fortheir children’s generation, but narrows their social options and contrib-utes to a loss of personal joy.

During our time we had a lot of time for enjoying ourselves.We used to go for dances (ebikiri) and you would play sexwith your partner without fear of STDs or AIDS. My daugh-ter really has not enjoyed herself as I did. Because of fear ofAIDS, she has had to have only one sexual partner.


By the time we grew we really enjoyed ourselves. When youloved somebody, you would become very happy, but the youthdon’t enjoy themselves when they get a partner. They just goto get the AIDS disease. We just bury them.

Butema village grandmother (Group Interview 1997i)

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Conclusion

The popularity of the “common sense” idea that youth are having sex at ayounger and younger age now, is not a reflection of demographic reality,but instead an indication of the chaos and helplessness elders feel in theface of the new technology of sex—where achieving adulthood now meansmanaging to avoid a fatal sexually transmitted disease while successfullyrealizing one’s own fertility. The older generation is silenced while healthcare providers, teachers, and print and radio media—financed and distrib-uted by NGOs—replace kinship influence with the sanitized stuff of safersex. For young Ugandans, the legitimacy of public health messages ulti-mately resides in the authority of the biomedical language of HIV/AIDS;while the authority of parents, aunties, and uncles continues to erode be-cause they did not negotiate their own reproductive lives within the bio-medical reality of the AIDS epidemic. HIV/AIDS has precipitated not onlya generation gap but has made strangers of Ugandan adults and adolescentsliving together in the same home. Even if young people sought out advicefrom their elders, the elders “have to keep quiet with nothing more to addon.” Yet both realms of authority are essential if today’s generation is toachieve its greatest potential. Adults need to regain confidence about coun-seling their young people and public health programs can help that effortby redefining their mandate to educate groups, not merely individuals, andby shifting their focus from the mere delivery of health “facts” to encour-aging a dialogue across generations. Furthermore, as social scientists ofeastern Africa, we should be mindful of the unique historical specificity ofthis moment of HIV/AIDS and build on an unprecedented body of epide-miologic and behavioral data about sexuality. The actions of today’s youngpeople, whose own sexual coming of age is so profoundly shaped by bothlocal and global ideas about sex, will determine how they educate theirown children about reproduction, family, and intimacy in the future.

ACKNOWLEDGEMENTS

This research was supported by dissertation grants from the National Institutes of Mental

Health (RO3-MH56294) and the National Science Foundation (9632207). Supplemental grants

were awarded by the Wenner-Gren Foundation, the Woodrow Wilson—Johnson & Johnson

Foundation, the Central States Anthropology Society, and the Society for the Scientific Study

of Sex.

Special thanks are due to Margaret Rwabugahya who conducted and transcribed most of the

reproductive lifeline group discussions. Thanks also to the other members of the Hoima re-

search team: Robert Kaahwa, Margaret Kajumba, Rosette Kamanyi, Joel Kibonwabake, Sarah

Kyalisiima, Roggers Musinguzi, Faith Ochieng, Deborah Rwahwire, Solomon Turumanya, and

Enid Turumanya-Wamani. My sincerest thanks to the many residents of Hoima District, both

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143young and old, in town and in the villages, who participated in the group discussions.

The final version of this paper greatly benefited from comments by Leslie Lieberman, Helen

Mugambi, Elisha Renne, David Schoenbrun, and Mikael Whyte; I thank them all for their im-

portant insights.

In memory of an extraordinary person, Musinguzi Roggers.

NOTES

1. All aspects of this research project, including informed consent documents in both English

and Runyoro (Stewart 2000), were reviewed and approved by the following authorities: (1)

Department of Health and Human Services Office for Protection Against Research Risks,

Washington, DC (2) University of Florida Institutional Review Board (3) Government of Ugan-

da, AIDS Research Sub-Committee Institutional Review Board (4) Makerere Institute of So-

cial Research, Kampala (5) AIDS Information Centre, Kampala (6) Hoima District Hospital.

2. Weekly glossy English language magazines, such as Chic, as well as daily newspapers such

as the English language New Vision and the Luganda language Bukedde, frequently have

stories on sugar daddies and sugar mommies—adults who lure young people into sexual

relations for money, clothing, shoes, watches, etc. Suggestively posed photographs and

headlines such as, “Hanging out with a sugar daddy,” “Sugar Mom gave me the bomb and

fled,” and “Confessions of a gold digger student” leave little to the imagination of the reader

and amplify public concerns about the corruption of Ugandan youth. But the end result is

not a censoring of reckless adult behaviors, but a vilification of young women, particularly

educated young women. This was the case for a Makerere University female student who,

after appearing on a local magazine cover (Chic, Vol 2, No.4, Jan 24–30, 1997) with her pink

underwear slightly exposed for the camera from under a short skirt, was promptly expelled.

A furious public outcry immediately erupted, and letters appeared in all the newspapers

for months afterwards, most in favor of the girl’s expulsion.

3. As recently as this year, the iconoclastic Ugandan vice-president, Dr. Specioza Wandira Kazib-

we, was advising a group of female college students “to avoid being tempted by rich men”

(New Vision, 19 January 2000). See her website : http://www.ovpuganda.net/

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APPENDIX A: TRANSLATION OF SURVEY QUESTIONS INTO RUNYORO

Question 601: Oha yabandize kukubaliza hakuterana kw’omusaija n’omukazi, n’ebyokuswerangana?

Nukwo kugamba, oha yabansize kwikaara naiwe omubutongole kuhanurra habyokusweranga n’okuter-

ana kw’omusaija n’omukazi?

Question 610: Oha yabandize kukugambira rundi oketegereza ota habyokwerinda oruzaaro n’endwaara

eziraba omubusihani?

Question 611: Ebyokuterana kw’omusaija n’omukazi neby’okuswerangana okira kubihanurra noha?

Question 612: Ebikukwata habwomeezi bwokuterana kw’omusaija n’omukazi obimanya ota?

Question 807: Wakatahahoga omukazi rundi wakatahawahoga omusaija nimukora eby’ensoni?

Question 808: Okaba oina emyaaka eingaha obuwabandize kutaaha omukazi rundi kutaahwa omu-

saija nimukora eby’ensoni?

Question 809: Okaba oli nkaha obuwabandize kutaaha omukazi rundi kutaahwa omusaija. Kukira

muno omurundi gwaawe ogwokubanza oguwataahire omukazi rundi ogubakutaahire? (1) Nkaba

ndi ha Isomero eriina oburaaro (2) Nkaba ndi omuka omuaruhumura.

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Reference Original

Interview

number

Date Interviewer Location Participants Language(s)

of interview

Type of interview

1997a 8 3 Sept. 1997 Female Hoima town

market

Adult market

women

Runyoro Focus group

1997b 32 4 Sept. 1997 Female Hoima town

market

Adult market

men

Runyoro Focus group

1997c 30 9 Sept. 1997 Female Kigarama village Grandmothers Runyoro Reproductive

lifeline

1997d 18a 10 Sept. 1997 Male Hoima Modern

Secondary School

School boys English Focus group

1997e 18b 11 Sept. 1997 Male Near Hoima town

(Mparo)

Out-of-school

boys

English and

Runyoro

Focus group

1997f 25 4 Oct. 1997 Female Hoima town Grandmothers Runyoro Reproductive

lifeline

1997g 36 11 Oct. 1997 Female Kyarwabuyamba

village

Grandmothers Runyoro Reproductive

lifeline

1997h 21 13 Oct. 1997 Female Kabaale village Grandmothers Runyoro Reproductive

lifeline

1997i 42 2 Nov. 1997 Female Butema village Grandmothers Runyoro Reproductive

lifeline

APPENDIX B: GROUP INTERVIEWS

(All interviews and group discussions recorded on tape, transcribed in Runyoro and then translated

into English)

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