Sexual and reproductive health of Syrian refugee adolescent girls: a qualitative study using focus group discussions in an urban setting in Lebanon

Abstract

Background The war in Syria caused the forced displacement of millions of Syrians to neighboring countries. Lebanon is the host country with the largest overall number of Syrian refugees per capita. Adolescent refugee girls experience a unique level of vulnerability during human emergencies and are at increased risk of suffering from poor sexual and reproductive health (SRH) outcomes. We conducted an exploratory qualitative study to learn about the SRH perceptions and experiences of refugee adolescent girls living in Bourj Hammoud, an urban setting in Lebanon. Methods We employed a qualitative design with eight focus group discussions (FGDs) conducted with 40 Syrian Arab and Syrian Kurdish adolescent girls between January and March 2020. Every FGD consisted of five participants aged 13 to 17 years. A semi-structured guide was used covering multiple themes: menstruation, puberty, SRH awareness, and sexual harassment. FGDs were transcribed and analyzed using thematic analysis. Findings The participants discussed adolescent girls’ health and named six elements of good health, such as healthy activities and self-protection. The majority of the FGD participants reported a lack of awareness about menstruation when they experienced it for the first time and the social stigma associated with menstruation. When defining puberty, they indicated its social link to a girl’s readiness for marriage and her need to become cautious about sexual harassment. Most FGD participants had very poor knowledge of the female reproductive system. Mothers were the most approached persons to receive information on SRH issues; however, the girls indicated a wish to receive advice from specialists in a comfortable and private atmosphere. All the girls reported that either they themselves, or an acquaintance, had experienced some type of sexual harassment. The girls rarely reported those incidents due to fear of being blamed or subjected to mobility restrictions, or forced to drop out of school. Conclusions The findings show the refugee girls need for satisfactory knowledge on SRH issues and interventions to prevent sexual and gender-based violence that take into consideration the complexity of urban settings.

Reproductive health of Syrian refugee women in Lebanon: a descriptive analysis of the Sijilli electronic health records database

“…Our results were concordant with a study conducted by the United Nations Population Fund (UNFPA) found that one-third of SR women in Lebanon between the ages of 20-24 were married before the age of 18 [19]. Similar results were reported in other studies conducted in Lebanon, Jordan and Turkey as well [20][21][22]. Prior to the crisis in Syria, child marriage took place among 13% of girls under the age of 18, but since then, forced displacement has led to a major increase in this number [23][24][25].…”

A systematic review of menstrual hygiene management (MHM) during humanitarian crises and/or emergencies in low- and middle-income countries

“…Similarly, studies found that girls lacked adequate knowledge on the frequency of changing their pads and its disposal method ( 35 , 36 , 39 , 40 ). Participants also noted the problems they had while attempting to use disposable pads efficiently for the first time because of insufficient guidance ( 44 ). Due to lack of space and bin for disposal of menstrual products, some bury or flush their used pads ( 35 , 45 ).…”

“…Women had difficulty locating private spaces within their shelters to change, wash, and dry their reusable clothes ( 18 , 39 ). As a result, they had to use their menstrual products for long hours comprising hygiene and could change it while going for open defecation or bathing near water bodies or shrubs in the early morning or late at night ( 39 , 44 ).…”

“…“ The tent walls are often made of transparent plastic sheeting. Someone from the outside can see you in there ” ( 44 ).…”

“…In conflict contexts, lack of affordable menstrual products adversely affects girls' and women's menstrual hygiene (18,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44). Many Syrian refugees in Lebanon said they preferred disposable pads but those were expensive (18).…”