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Korri, Rayan; Hess, Sabine; Fröschl, Günter and Ivanova, Olena (2021): Sexual and reproductive health of Syrian refugee adolescent girls: a qualitative study using focus group discussions in an urban setting in Lebanon. In: Reproductive Health, Vol. 18, No. 1, 130

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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. Plain language summary After almost 10 years of war, Syria's neighboring countries are hosting millions of Syrians who were forcibly displaced. Most prominent among these countries is Lebanon. Adolescent refugee girls are exposed to precarious conditions, which make them more prone to sexual and reproductive health (SRH) problems. This qualitative study was performed in Bourj Hammoud, an urban setting in Lebanon, in order to explore Syrian refugee adolescent girls' SRH perceptions and experiences. The agenda of the International Conference on Population and Development (ICPD) in addition to the Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings (IAFM) and its Adolescent Sexual and Reproductive Health Toolkit for Humanitarian Settings issued by the Inter-Agency Working Group on Reproductive Health in Crises (IAWG) formed the framework of this study. Focus group discussions were performed with 40 Syrian Arab and Syrian Kurdish adolescent girls, each group consisting of five participants aged 13 to 17 years. Different themes were discussed within the groups including menstruation, puberty, and sexual harassment. The participants talked about the social stigma related to menstruation and the social link between puberty, a girl's readiness for marriage, and her need to be careful about sexual harassment. Most of the girls had insufficient information about the female reproductive system. The girls consulted their mothers to learn about SRH issues;however, they expressed a wish to receive well-informed advice from specialists in a safe atmosphere. All the girls reported incidents of sexual harassment, which happened either to them or to other girls they know;however, they were discouraged to report them because they feared other consequences, such as being blamed or not being allowed to go to school anymore. The outcomes of the study show the girls' urgent need to have adequate information about SRH issues and appropriate interventions to prevent sexual and gender-based violence within complex urban settings.

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