Adolescents and Young People's Understanding and Negotiation of Sexual Consent in sub-Saharan Africa: A Systematic Review and Narrative Synthesis

Sexual consent is a critical component of healthy sexual relationships and essential for preventing intimate partner sexual violence (IPSV), a significant public health and human rights concern in sub-Saharan Africa (SSA). Evidence on how adolescents and young people (AYP) aged 15-24 years understand and negotiate consent, however, remains fragmented. This systematic review synthesizes evidence on how AYP in SSA perceived and communicate sexual consent and the key factors shaping sexual consent negotiation. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted across nine databases (e.g. PubMed, PsycINFO, Scopus). The review included 48 studies published between 1997 and 2023. Data were extracted using a structured template and narratively synthesized. Findings indicate that AYP conceptualized consent as an expression of willingness and a mutual agreement to engage in sexual activity, often communicated implicitly through non-verbal cues or contextual behaviors rather than explicit verbal agreement. Consent negotiation is shaped by the interplay of socio-cultural norms, gendered expectations, and power asymmetries related to gender, age, and economic status, alongside structural constraints. Additional influences include the type of relationship, nature of sexual activity, peer pressure, and alcohol use. Sexual compliance or consent without desire is frequently reported, reflecting significant limitations of individual agencies and the complex social and relational factors that shape consent. Emerging resistance and shifts toward affirmative consent highlight the potential for targeted interventions. Multi-level interventions are needed to promote affirmative consent, challenge harmful gender norms, and address structural and economic vulnerabilities that shape inequitable sexual relationships.