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

Plain language summary Studies suggest that adolescent Syrian refugee girls in Lebanon are at risk of early marriage and related poor sexual and reproductive health outcomes, yet little is known about this population's specific sexual and reproductive health needs and care-seeking practices. To help fill this gap, we conducted a qualitative study with healthcare providers and educators who provide adolescent Syrian refugee girls with sexual and reproductive health services and education. The study aimed to better understand this population's health needs and behaviors to aid in the development of a sexual and reproductive health program for Syrian refugee girls that seeks to reduce early marriage. Respondents identified adolescent pregnancy, reproductive tract infections and sexual and gender-based violence as major health issues in this population. Early marriage, disruption of education, restrictive gender roles and men's detachment from healthcare were all recognized as potential risk factors. Stigma and bias, even among the study participants themselves, were also found to be potential barriers to care. We adapted a behavioral model for healthcare-seeking practices among vulnerable populations to categorize these risks and develop recommendations for health interventions in this community. Sexual and reproductive health initiatives in this population should be multi-faceted, community-based and aimed not only at adolescents but also their spouses and parents, who hold decision-making power. 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.