Adolescent Sexual and Reproductive Health in Humanitarian Settings

By Kerner, Brad; Manohar, Seema et al. | Forced Migration Review, August 2012 | Go to article overview

Adolescent Sexual and Reproductive Health in Humanitarian Settings


Kerner, Brad, Manohar, Seema, Mazzacurati, Cécile, Tanabe, Mihoko, Forced Migration Review


Particular vulnerabilities for adolescents during times of crisis and emergency are exacerbated by lack of access to sexual and reproductive health services. Greater attention to adolescents' needs - and the use of innovative approaches to engage them - can help mitigate often life-threatening impacts.

Imagine a 12-year-old girl recently settled in a refugee camp with her family. She is the eldest daughter and has five siblings. She tries to help her mother every day with cooking, collecting water, taking care of her younger brothers and sisters. She has none of her friends there and feels like she has no one to play with or talk to. Sometimes, she feels like she wants to be alone, where no one is asking her to do anything. At first, she thought she could go to the field where the latrines are located. But there are many men around, soldiers too, and they say things to her, whistling, making gestures she knows are bad. She liked going to school and knows there is a school in the camp where she sees others her age going every day. However, she does not know how she can attend. She wants to have a friend or a teacher or an older sister to talk to and make her feel less vulnerable.

In the transition from childhood to adulthood, adolescents normally benefit from the influence of adult role models, social norms and structures, and community groups (peer, religious or cultural). When people are displaced, however, family and social structures are disrupted. Adolescents may be separated from their families or communities, while formal and informal educational programmes are discontinued, and community and social networks break down. Adolescents may be fearful, stressed, bored or idle. They may find themselves in risky situations that they are not prepared for dealing with and they may suddenly have to take on adult roles without preparation, positive adult role models or support networks.

Adolescents who live through crises may not be able to visualise a positive outlook for themselves, and may develop fatalistic views about the future. The loss of livelihood, security and protection provided by the family and community places adolescents at risk of poverty, violence, and sexual exploitation and abuse. In particular:

* Displaced very young adolescents (10-14 years), especially girls, are at risk of sexual exploitation and abuse. Because of their limited life experience, they may not recognise the sexual nature of abusive or exploitative actions in strange settings.

* Pregnant adolescent girls, particularly those under 16, are at increased risk of obstructed labour, a lifethreatening obstetric emergency that can develop when the immature pelvis is too small to allow the passage of a baby through the birth canal. Delay in treatment can lead to obstetric fistula or uterine rupture, haemorrhage and death of the mother and child.

* Adolescents separated from their families and adolescent heads of household lack the livelihood security and protection afforded by the family structure, and are therefore more at risk from poverty and sexual exploitation and abuse. Separated adolescents and adolescent heads of household may be compelled to drop out of school, marry or sell sex in order to meet their needs for food, shelter - or protection.

* Adolescent girls selling sex are at risk of unwanted pregnancy, unsafe abortion, STIs and HIV, and sexual exploitation and abuse.

* Survivors of sexual and gender-based violence are at risk of unwanted pregnancy, unsafe abortion, STIs including HIV, as well as mental health and psychosocial problems and social stigmatisation. In post-earthquake Haiti, a significant proportion of survivors of sexual violence treated by the NGOs GHESKIO and Médecins du Monde were adolescent and prepubescent girls.

* Children Associated with Armed Forces and Armed Groups, both boys and girls, are often sexually active at a much earlier age and face increased risk of sexual violence and abuse, mental health and psychosocial problems, unwanted pregnancy, unsafe abortion, STIs and HIV infection. …

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