'If her body responds then you know she wants it': a qualitative study on how young people in Ecuador and Uganda understand and practice consent.

Background: Although progress has been made, adolescent sexual and reproductive health and rights (ASRHR) remain a global public health concern and continued investments are necessary. The way young people perceive, and experience sexual consent is at the centre of free and informed decision-making, a critical element of ASRHR. Nevertheless, the evidence on young people's views of sexual consent remains limited, especially in low- and middle-income countries.

Objectives: To explore how young people (aged 18 to 26) understand and practice sexual consent in low- and middle-income countries.

Methods: Qualitative in-depth interviews and focus group discussions were conducted among 173 young people in Ecuador (Guayaquil) and Uganda (Kampala city), involving young people in data collection and analysis. The Hickman and Muehlenhard's (1999) framework was used to categorize the ways young people express sexual consent: direct and indirect verbal and nonverbal signals.

Results: We found that reflecting on sexual consent was relatively new for many participants and challenging to define. Few young people seemed to know how to apply consent in their daily lives, explaining that asking consent was often not possible in their relationships and sexual encounters. Influencing factors such as gender norms, the type of relationship and age were mentioned. Non-direct, non-verbal consent were the most commonly used strategies, meaning that sexual consent was mostly interpreted from body language or indirect questions - opening a window for sexual risks.

Conclusion: Our findings call for SRHR programming that promotes communication and equality and supports skills in recognizing, giving and receiving sexual consent.