A review of the literature on sexual and reproductive health of African migrant and refugee children

Abstract

Background Migration and involuntary displacement of children and young people have recently become common features of many African countries due to widespread poverty, rapid urbanization, joblessness, and instability that motivate them to seek livelihoods away from their places of origin. With limited education and skills, children become vulnerable socioeconomically, thereby exposing themselves to sexual and reproductive health (SRH) risks. Methods Against this background, the authors undertook a scoping review of the existing literature between January and June 2019 to highlight current knowledge on SRH of African migrant and refugee children. Twenty-two studies that met the inclusion criteria were reviewed. Results The results identified overcrowding and sexual exploitation of children within refugee camps where reproductive health services are often limited and underutilized. They also reveal language barriers as key obstacles towards young migrants’ access to SRH information and services because local languages used to deliver these services are alien to the migrants. Further, cultural practices like genital cutting, which survived migration could have serious reproductive health implications for young migrants. A major gap identified is about SRH risk factors of unaccompanied migrant minors, which have received limited study, and calls for more quantitative and qualitative SRH studies on unaccompanied child migrants. Studies should also focus on the different dimensions of SRH challenges among child migrants differentiated by gender, documented or undocumented, within or across national borders, and within or outside refugee camps to properly inform and situate policies, keeping in mind the economic motive and spatial displacement of children as major considerations. Conclusion The conditions that necessitate economic-driven migration of children will continue to exist in sub-Saharan Africa. This will provide fertile grounds for child migration to continue to thrive, with diverse sexual and reproductive health risks among the child migrants. There is need for further quantitative and qualitative research on child migrants’ sexual and reproductive health experiences paying special attention to their differentiation by gender, documented or undocumented, within or across national borders and within or outside refugee camps.

The Sexual and Reproductive Health Context of an Internally Displaced Persons' Camp in Northeastern Nigeria: Narratives of Girls and Young Women

“…The pregnancies among younger unmarried women and girls brought shame due to their age and marital status, thus they were reluctant to go to camp clinics for pregnancy services. The underutilization of health services by girls and young women due to shame, embarrassment, fear of retribution, and social rejection has been documented in other refugee and IDP camps in Africa ( 22 ). There were no induced abortion services available in the camp (only post-abortion care), so young women instead turned to providers outside the camp or to unproved or dangerous methods, such as salt or Flagyl, and to keep their abortion secret.…”

“…Conflicts constrain access to services and supplies; damage health facilities; elevate exposure to sexual violence and unsafe abortion; and increase risks for early and forced marriage, early childbearing, trafficking, and sexual exploitation, among other poor SRH outcomes (5)(6)(7). In humanitarian settings, ∼35 million girls and young women of reproductive age (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) are in urgent need of SRH information and services (8). While the minimum health care package in humanitarian settings requires the inclusion of SRH services, use of and access to SRH services in many refugee contexts and situations of internal displacements in sub-Saharan Africa remains sub-optimal, especially for women and girls (6,9,10).…”

“…

In humanitarian settings, ∼35 million girls and young women of reproductive age (15)(16)(17)(18)(19)(20)(21)(22)(23)(24) are in urgent need of sexual and reproductive health (SRH) information and services. Young women and girls in humanitarian contexts are particularly vulnerable to unwanted pregnancies, unsafe abortion, gender-based violence, and early and forced marriage.

…”

International migrants' right to sexual and reproductive health care

“…Refugee and asylum‐seeking women fleeing armed conflict are especially vulnerable to sexual violence, which is often used as a weapon of war 10 . While in transit, migrant girls and women, notably those traveling alone or through clandestine channels, are susceptible to sexual exploitation and abuse as they struggle to meet their material needs and find ways to continue their journey 11,12 . Even after reaching countries of destination, migrant women may still face gender‐based violence due to legal and/or economic precarity that causes them to depend on others for support and security 1,10 .…”

“…10 While in transit, migrant girls and women, notably those traveling alone or through clandestine channels, are susceptible to sexual exploitation and abuse as they struggle to meet their material needs and find ways to continue their journey. 11,12 Even after reaching countries of destination, migrant women may still face gender-based violence due to legal and/or economic precarity that causes them to depend on others for support and security. 1,10 These risks of genderbased violence have increased during the COVID-19 pandemic, when public health restrictions have added to migrant women's isolation and forced the closure of support programs.…”