RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, B2, New York, NY, USA.
Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad.
BMC Public Health. 2024 Nov 19;24(1):3217. doi: 10.1186/s12889-024-20581-y.
In humanitarian settings, refugee girls' vulnerability to negative sexual and reproductive health (SRH) outcomes and the barriers they face to access to SRH services increase. Despite global guidelines on adolescent sexual and reproductive health and rights (SRHR) in humanitarian settings, evidence on the diverse knowledge, attitudes, and behaviors of refugee adolescents are limited.
This mixed methods study used a cross-sectional survey and participatory research activities to explore the knowledge, attitudes, and behaviors of 12-19 year old refugee girls from Darfur living in two refugee camps in Wadi-Fira, Chad. Focus group discussions with parents of adolescents and in-depth interviews with health workers were conducted to better understand community attitudes toward adolescent SRHR and barriers to accessing services.
Overall, SRH knowledge, including of contraceptive methods, was mixed, but older girls had better knowledge than younger girls. Despite stigma around adolescent sexual activity expressed in this community, 20.9% of girls had already had sex. The majority of girls believed that health workers would maintain confidentiality if they sought contraception. Among girls who had ever had sex, 18.0% were currently using a modern contraceptive. None were using a long-acting method, but most obtained their method at the camp health center. Parents and health workers described how social stigma toward premarital sex and unintended pregnancy impeded adolescent access to SRHR information and services, although the midwives described helping girls to seek contraception.
Despite community stigma towards premarital sex and contraception for adolescents, some girls in the camps successfully managed to receive a contraceptive method, demonstrating both their interest in and need for contraception. Although midwives were largely supportive of adolescent access, expanding contraceptive service delivery channels and making services more adolescent-responsive would further increase adolescent access. Gender transformative programming engaging girls and boys, should be expanded to improve adolescent knowledge and self-efficacy with respect to SRHR. These efforts must also engage parents and community members to create an enabling environment for adolescent SRHR and reduce stigma.
在人道主义环境中，难民女孩面临着负面的性健康和生殖健康（SRH）结果，以及她们获得 SRH 服务的障碍增加。尽管全球有关于青少年性健康和生殖健康权利（SRHR）的指南，但关于难民青少年多样化的知识、态度和行为的证据有限。
本混合方法研究使用横断面调查和参与式研究活动，探索来自达尔富尔的 12-19 岁难民女孩在乍得瓦迪菲拉的两个难民营中的知识、态度和行为。对青少年的父母进行焦点小组讨论，并对卫生工作者进行深入访谈，以更好地了解社区对青少年 SRHR 的态度和获得服务的障碍。
总的来说，SRH 知识，包括避孕方法，参差不齐，但年龄较大的女孩比年龄较小的女孩有更好的知识。尽管在这个社区中表达了对青少年性活动的污名化，但 20.9%的女孩已经有过性行为。大多数女孩认为，如果她们寻求避孕，卫生工作者会保守秘密。在曾经有过性行为的女孩中，18.0%目前使用现代避孕药具。没有人使用长效方法，但大多数人在营地卫生中心获得避孕方法。父母和卫生工作者描述了对婚前性行为和意外怀孕的社会污名如何阻碍青少年获得 SRHR 信息和服务，尽管助产士描述了帮助女孩寻求避孕的情况。
尽管社区对青少年婚前性行为和避孕存在污名化，但营地中的一些女孩成功地获得了避孕方法，这表明她们对避孕既感兴趣又有需求。尽管助产士普遍支持青少年获得，但扩大避孕服务提供渠道并使服务更能满足青少年的需求，将进一步增加青少年的获得。扩大性别赋权计划，让女孩和男孩都参与其中，以提高青少年对 SRHR 的知识和自我效能感。这些努力还必须让父母和社区成员参与进来，为青少年的 SRHR 创造一个有利的环境，并减少污名化。
