Sexual and reproductive health of adolescent Syrian refugee girls in Lebanon: a qualitative study of healthcare provider and educator perspectives

Abstract

Background Adolescent Syrian refugee girls in Lebanon are thought to experience a disproportionate risk of poor sexual and reproductive health, related in part to conflict and displacement. The purpose of this qualitative study was to explore healthcare provider and educator perceptions of the sexual and reproductive health determinants and care-seeking behaviors of this vulnerable population. The findings of the study will inform a health intervention that aims to reduce early marriage and improve access to sexual and reproductive health information and services. Methods In-depth interviews and focus group discussions were conducted with stakeholders who work with adolescent Syrian refugee girls in an under-resourced area of eastern Lebanon bordering Syria. Data analysis followed principles of Clarke and Braun’s thematic analysis. Results Study participants perceived adolescent pregnancy, reproductive tract infections, and sexual- and gender-based violence as major population health needs. The study also identified a number of influencing structural and sociocultural determinants of health, including early marriage, adolescent disempowerment, and men’s disengagement from care. A conceptual framework based upon the Gelberg–Andersen Behavioral Model for Vulnerable Populations was developed to relate these determinants and guide pathways for potential interventions. Conclusions Adolescent sexual and reproductive health interventions among Syrian refugees in Lebanon should adopt a multi-pronged, community-based approach to address underlying health determinants and engage with men and parents of adolescents. Special attention should be given to provider biases in healthcare settings accessible to adolescents, as these may reflect underlying tensions between host and refugee populations and discourage adolescents from seeking care.

Maternal mortality in Lebanon: Increased vulnerability among Syrian refugees

“…16 The increased risk of maternal deaths among Syrian refugees in Lebanon indicate to differential vulnerabilities in this population in terms of inadequate access to health care, specifically antenatal, contraceptive, and postnatal services. 17 Lebanon has universal coverage of facility-based birth with skilled attendants and high utilization of antenatal care. 18 For the Syrian refugee population in Lebanon, coverage of skilled attendance at birth is reported to be 87%-91% 19 to 99.4%.…”

Developing a sexual and reproductive health educational intervention for adolescent Syrian refugee girls: Challenges and lessons learned

“…Evidence from a number of sources has shown that early marriage is high among adolescent Syrian refugees in Lebanon and qualitative studies suggest an unmet need for SRH information and services in this community ( 7 , 17 ). An estimated 35% of 20–24-year-old Syrian women in Lebanon married prior to reaching 18 years of age, a figure that is higher as compared with pre-conflict Syria, though nationally representative data are lacking ( 28 , 29 , 35 , 38 ).…”

“…Pregnancy is common among married Syrian girls, with one study demonstrating that 61% of married adolescent girls younger than 18 had experienced at least one pregnancy, while over two thirds of married Syrian refugee women ages 18–24 reported not using any form of contraception ( 39 ). Despite this need, cultural norms and gender roles generally restrict adolescent girls' accessibility to SRH information ( 7 , 17 ). These norms extend even to parent-child communication, with mothers in multiple settings throughout the MENA region expressing that cultural taboos and their own insufficient knowledge of these topics discourage them from participating in open discourse on SRH matters with their daughters ( 7 , 40 – 42 ).…”

“…There is a high need for SRH education among adolescent Syrian refugee girls in Lebanon ( 7 , 17 ). While schools have been shown to be an ideal setting for SRH education ( 1 , 2 ), in Lebanon, school-based SRH curricula are largely insufficient and oftentimes not delivered altogether ( 1 , 7 ).…”

“…This curriculum is being administered through the Amenah Project, a community-based, multi-component intervention that aims to reduce early marriage and improve SRH among adolescent Syrian refugee girls displaced in Lebanon ( 22 ). The curriculum is based on extensive formative research conducted in this community during the Amenah pilot and the preparation phase for the actual intervention ( 7 , 17 ), as well as adaptations of programs implemented in low-resource settings. To our knowledge, the Amenah Project is the first intervention offering a data-driven, contextualized approach to adolescent SRH education in this post-conflict setting of forced displacement.…”