MGHD 2022

Introduction Adolescents experience exacerbated vulnerability in refugee settings, where there is often an increase in sexual violence and a deficient emphasis on their right to access SRH services. Mugombwa refugee camp in Rwanda is home to 11,304 refugees from the DRC, of which 18.4% are between the ages of 12-17. In 2021, there were 47 adolescent childbirths, and in 2022, five positive cases of HIV between the ages of 12-17. This study aimed to understand the knowledge, perceptions, and utilization of SRH services among female and male adolescents following the health belief model via a feminist intersectional approach. This study also centers on the voices of adolescents to explore their barriers and recommendations. Methods This study employed a convergent parallel mixed-methods study design. Simple random and purposive sampling methods were used to select 422 quantitative and 32 FGD participants, respectively. A semi-structured questionnaire was used to collect quantitative data on knowledge, perceptions, and utilization of SRH services, while FGD guide collected information on barriers and recommendations. Descriptive statistical analysis, bivariate analysis, and multinomial logistic regression were performed on quantitative data. Qualitative data were transcribed, translated, and analyzed using deductive thematic content analysis. Results Under half of all adolescents had low SRH knowledge, and males had higher SRH knowledge than females. Predictive factors of high SRH knowledge among males were being 15-19 years old, ever having sex, and not being disabled, and among females, being 15-19 and having a child. The vast majority of adolescents had high knowledge of SRH services in Mugombwa camp. Predictive factor of high service knowledge among females was a high level of SRH knowledge. Most adolescents had positive perceptions toward contraceptive services; however, some felt service providers were judgmental. Of the participants who had ever had sex, 38.3% had never utilized contraceptives, mainly due to fear of side effects. Predictive factors of contraceptive utilization among males were high SRH knowledge and being out of school. More males had ever been tested for STIs than females, and while 91.0% of adolescents reported the desire to know their HIV status, only 48.1% had ever tested. Common predictive factors of testing for HIV and STIs were being out of school, being 15-19 years old, and having high SRH knowledge. The five major themes surrounding barriers and recommendations were: 1) socio-cultural factors; 2) the need for improved SRH service delivery; 3) parents as SRH stakeholders; 4) lack of knowledge preventing contraceptive utilization; and 5) negative perceptions preventing STI and HIV utilization. Conclusion Many adolescents have low SRH knowledge, positive perceptions of SRH services, and yet sub-optimal utilization of contraceptive, STI, and HIV services. The intersectional identities and socio-cultural factors associated with being an adolescent refugee impact the knowledge, perceptions, and utilization of contraceptive, STI, and HIV services and must be further prioritized to curb teenage pregnancy, STIs, and HIV among adolescent refugees. Increasing the regularity of SRH training and human resource capacity and training youth and parents as champions of SRH in Mugombwa Refugee camp are recommended.

Background: Access to contraceptives by adolescents has become a global health concern. According to WHO, 12 million adolescents aged 15-19 years give birth each year, mainly in low and middle income countries with at least 10 million of these pregnancies unintended. Despite FP2020’s commitment to provide 120 million women and girls an opportunity to use life-changing modern contraceptives by the end of 2020, 23 million adolescents still have an unmet need for contraceptives. In Mahama refugee camp, there has been observed an increase in teenage pregnancy despite the presence of various campaigns aimed at reducing these pregnancies. There are no studies that explored the lived experiences of adolescent refugee girls in Mahama camp, highlighting barriers and enabling factors influencing their accessibility to contraceptive services. Such a study is vital for informing interventions aimed at reducing teenage pregnancies in the camp. This study adopts the social cognitive theory, highlighting the environment, behavioral, and cognitive determinants influencing adolescent access to contraceptive services. This study aimed at exploring community-level factors influencing the accessibility of contraceptive services among adolescent girls aged (10-19 years) in Mahama camp and proffer recommendations by August 2022. Methods: This was a qualitative study to explore lived experiences of adolescent refugee girls, and sexual and reproductive health service providers to inform interventions to curb teenage pregnancy and promote the sexual and reproductive health of adolescent girls in the camp. With informed consent from parents or guardians and ascents adolescents under age 18, 25 in-depth interviews were conducted with adolescent girls and service providers using a semi-structured interview guide. Interviews were conducted and recorded in Kinyarwanda, and further transcribed and translated into English. The transcripts were read in detail followed by the development of a codebook. The coding of transcripts was done using Dedoose software version 9.0.54 and emerging themes were identified and categorized. Results: The results showed that the enablers for contraceptive use among adolescent refugee girls were majorly environmental determinants and these were influenced by cost of service, sufficient support from service providers, frequent community awareness campaigns, location and setting of service centers, as well as knowledge on contraception. The main barriers to accessibility of contraceptive use by adolescent refugee girls were based on environmental and behavioral determinants. These barriers were influenced by cultural and religious norms, fear, and misconceptions about contraception. Out-of-stock of contraception, paucity of funds to provide services, and as well as the shortage of service providers also contributed to the barriers faced by adolescents in accessing contraceptives. The study recommended intensifying awareness on the availability of contraceptives in the camp, having sufficient health care workers to provide SRH services and more youth centers that would offer services to adolescents. Conclusion: The findings suggest the need for a joint effort by all stakeholders to ensure that contraceptives are constantly available at the service points while amplifying community awareness programmes where the community is educated on the need for contraceptive use among adolescent refugee girls. Increasing the number of health care workers would also improve access to contraceptives to these girls. The study findings also recommend that there should be revision and amendment of laws that pose age-based restriction for adolescents to access contraceptives.