Elevating Married Adolescents' Voices for Responsive Reproductive Healthcare in Syria.

Pari Chowdhary,Ihlas Altinci,Anushka Kalyanpur,Feven Tassaw Mekuria

doi:10.3389/frph.2022.780952

Abstract

Increases in early marriage and pregnancy resulting from Syria's humanitarian crisis highlight a critical gap in adolescents' access to life-saving sexual and reproductive health information and services, and a larger need for adolescent-specific interventions grounded in gender transformative approaches. Seeking to address this, CARE, UNFPA and Syria Relief and Development adapted global evidence-based approaches to humanitarian contexts to create the Adolescent Mothers Against all Odds (AMAL) Initiative for pregnant girls and first-time mothers aged 10 to 18 years. Designed to improve the lives of young girls through responsive health systems and enabling environments, AMAL includes three components: a Young Mothers Club for first-time mothers and pregnant girls, participatory dialogues with health providers, and reflective dialogues with girls' marital family and community members. The AMAL Initiative intends to ensure responsiveness to the unique vulnerabilities of adolescent sub-groups by co-implementing with them. Select girls undergo additional leadership training and serve as adolescent representatives on community advisory groups sharing feedback for program improvement. One hundred-four first-time mothers and pregnant girls, 219 community members, and 120 health providers participated in AMAL in northwest Syria. In a mixed methods evaluation, facilitators administered monitoring tools to identify program improvements, pre-post surveys to assess outcomes, and end-line discussions to gather perceptions of impact. Girls reported a 47% overall increase in self-esteem, confidence, health-seeking capacity, and communication ability. Community support for girls' use of family planning increased by 27% and girls' equal access to services by 35%. Findings across all participant groups demonstrate decreased expectations of early marriage and increased acceptance of family planning post-marriage. Areas that participants cited for potential improvement included programming for girls/women above the age of 18 years, and additional training for health providers on long-acting contraceptive methods. These results show that participatory adolescent-centered sexual and reproductive health programming is not only feasible in crisis settings but can improve the self-efficacy of vulnerable adolescents to overcome barriers to accessing healthcare and improving well-being. The AMAL Initiative is now being scaled up through local partners in Syria and piloted in northern Nigeria.

Highlights

Working in crisis settings requires an understanding of the lived experiences of people, the power dynamics, and micro-politics that inform humanitarian response approaches
To be effective and equitable toward global populations, humanitarian organizations must adhere to core standards, and carry out their efforts in a manner that is inclusive of the communities they are seeking to serve
Over 1 year of implementation in northwest Syria, 104 firsttime mothers and pregnant girls, 219 family and community members, and 120 health providers participated in the AMAL Initiative

Summary

Introduction

Working in crisis settings requires an understanding of the lived experiences of people, the power dynamics, and micro-politics that inform humanitarian response approaches. Of UNICEF’s nine Core Humanitarian Standards, three refer to ensuring accountability toward affected peoples [1]. In practice this could include centralizing the voices of affected peoples by engaging communities in needs and performance assessments and decision-making. While there is consensus across global humanitarian and development actors of the need for unique programmatic focus on adolescents, there is a dearth of interventions that effectively consider and elevate adolescent voices and lived experiences [2]. To be effective and equitable toward global populations, humanitarian organizations must adhere to core standards, and carry out their efforts in a manner that is inclusive of the communities they are seeking to serve

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Results

Discussion

Conclusion