Background Adolescent girls in humanitarian settings are especially vulnerable as their support systems are often disrupted. More than 20 years of violence in the Democratic Republic of the Congo (DRC) has weakened the health system, resulting in poor sexual and reproductive health (SRH) outcomes for women. Little evidence on adolescent contraceptive use in humanitarian settings is available. CARE, International Rescue Committee (IRC), and Save the Children, in collaboration with the Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative, Columbia University, have supported the Ministry of Health (MOH) since 2011 to provide good quality contraceptive services in public health facilities in conflict-affected North and South Kivu. In this study, we analyzed contraceptive use among sexually active young women aged 15-24 in the health zones served by the partners' programs. Methods and findings The partners conducted cross-sectional population-based surveys in program areas of North and South Kivu using two-stage cluster sampling in six health zones in July-August 2016 and 2017. Twenty-five clusters were selected in each health zone, 22 households in each cluster, and one woman of reproductive age (15-49 years) was randomly selected in each household. This manuscript presents results from a secondary data analysis for 1,022 women aged 15-24 who reported ever having sex: 326 adolescents (15-19 years) and 696 young women (20-24 years), 31.7% (95% confidence interval [CI] 29.5-34.1), of whom were displaced at least once in the previous five years. Contraceptive knowledge was high, with over 90% of both groups able to name at least one modern contraceptive method.

Patient and public involvement statement This research was done without patient involvement. Patients were not invited to comment on the study design and were not consulted to develop patient relevant outcomes or interpret the results. Patients were not invited to contribute to the writing or editing of this document for readability or accuracy. Therefore, dissemination to patients or study participants is not applicable. Patient consent for publication Not required. Provenance and peer review Not commissioned; externally peer reviewed. data availability statement No additional data are available.

SummaryWe find no evidence to support a difference in the risk of death among pregnant women with suspected or confirmed Ebola virus disease (EVD) as compared to nonpregnant women. Limited data suggest poor fetal and neonatal outcomes in EVD-affected pregnancies.

Increases in early marriage and pregnancy resulting from Syria's humanitarian crisis highlight a critical gap in adolescents' access to life-saving sexual and reproductive health information and services, and a larger need for adolescent-specific interventions grounded in gender transformative approaches. Seeking to address this, CARE, UNFPA and Syria Relief and Development adapted global evidence-based approaches to humanitarian contexts to create the Adolescent Mothers Against all Odds (AMAL) Initiative for pregnant girls and first-time mothers aged 10 to 18 years. Designed to improve the lives of young girls through responsive health systems and enabling environments, AMAL includes three components: a Young Mothers Club for first-time mothers and pregnant girls, participatory dialogues with health providers, and reflective dialogues with girls' marital family and community members. The AMAL Initiative intends to ensure responsiveness to the unique vulnerabilities of adolescent sub-groups by co-implementing with them. Select girls undergo additional leadership training and serve as adolescent representatives on community advisory groups sharing feedback for program improvement. One hundred-four first-time mothers and pregnant girls, 219 community members, and 120 health providers participated in AMAL in northwest Syria. In a mixed methods evaluation, facilitators administered monitoring tools to identify program improvements, pre-post surveys to assess outcomes, and end-line discussions to gather perceptions of impact. Girls reported a 47% overall increase in self-esteem, confidence, health-seeking capacity, and communication ability. Community support for girls' use of family planning increased by 27% and girls' equal access to services by 35%. Findings across all participant groups demonstrate decreased expectations of early marriage and increased acceptance of family planning post-marriage. Areas that participants cited for potential improvement included programming for girls/women above the age of 18 years, and additional training for health providers on long-acting contraceptive methods. These results show that participatory adolescent-centered sexual and reproductive health programming is not only feasible in crisis settings but can improve the self-efficacy of vulnerable adolescents to overcome barriers to accessing healthcare and improving well-being. The AMAL Initiative is now being scaled up through local partners in Syria and piloted in northern Nigeria.

Background – Access to modern family planning methods, including long-acting and reversible contraceptives (LARCs), to prevent unplanned pregnancy is critical to avert maternal deaths in humanitarian and fragile settings, where clinicians often have limited LARC competencies. This paper explores the perspectives and recommendations of providers and trainers involved in piloting the Clinical Outreach Refresher Training for Sexual and Reproductive Health module (S-CORT) on LARCs in Nepal.Methods – Qualitative data from end-of-training evaluations, which were self-filled by 15 trainees, a focus group discussion involving 11 of them, and written feedback from five co-trainers were transcribed, coded, and thematically analyzed. Results were intersected with those from pilots held in Bangladesh and the Democratic Republic of Congo.Results – Results suggest that the module could increase participants’ counseling and clinical skills, help anchor readiness for family planning and LARC provision before humanitarian emergencies, and reinforce informed consent, service privacy and confidentiality, and access for underserved populations, including adolescents. Recommendations for improvement included the advanced provision of the learning resources for self-study to promote blended learning and avail more clinical practice time.Conclusions – When the lack of skilled human resources is a barrier to LARC services in humanitarian and fragile settings, the S-CORT strategy could offer a rapid hands-on refresher training opportunity for clinicians requiring knowledge and skills update. Such a capacity-development approach could be valuable not only for emergency response but also in contexts prioritizing disaster preparedness planning.