\u201cAs a Young Pregnant Girl\u2026 The Challenges You Face\u201d: Exploring the Intersection Between Mental Health and Sexual and Reproductive Health Amongst Adolescent Girls and Young Women in South Africa

Zoe Duby,Kealeboga Maruping,Lieve Vanleeuw,Caroline Kuo,Ashleigh Lovette,Kim Jonas,Tracy Mcclinton Appollis,Janan Dietrich,Catherine Mathews

doi:10.1007/s10461-020-02974-3

Abstract

In South Africa, adolescent girls and young women (AGYW) are at risk of poor mental health, HIV infection and early pregnancy. Poor mental health in AGYW is associated with increased sexual risk behaviours, and impeded HIV testing and care. Using in-depth interviews and focus group discussions, we explored subjective experiences of mental health and sexual and reproductive health (SRH) amongst 237 AGYW aged 15–24 years in five South African districts. Respondents shared narratives of stress, emotional isolation, feelings of depression, and suicidal ideation, interconnected with HIV, pregnancy and violence in relationships. Findings show that AGYW in South Africa face a range of mental health stressors and lack sufficient support, which intersect with SRH challenges to heighten their vulnerability. Framed within the syndemic theory, our findings suggest that South African AGYW’s vulnerability towards early pregnancy, HIV infection and poor mental health are bidirectional and interconnected. Considering the overlaps and interactions between mental health and SRH amongst AGYW, it is critical that mental health components are integrated into SRH interventions.

Highlights

Poor mental health, including depressive disorders and stress, contributes significantly to the burden of disease in South Africa, and other parts of sub-Saharan Africa, and is associated with negative sexual and reproductive health (SRH) outcomes for women, such as ‘unintended’ or early pregnancy, and increased risk behaviours for HIV [1,2,3]
It would make sense that the emotional aspects related to the discovery of an unexpected pregnancy or an HIV positive status would act as a stressor and have potentially negative mental health outcomes [16]
The framing of pregnancy during adolescence as a social problem means that pregnant teens receive limited social support, which in turn is linked to poor mental health outcomes [2]

Summary

Introduction

Poor mental health, including depressive disorders and stress, contributes significantly to the burden of disease in South Africa, and other parts of sub-Saharan Africa, and is associated with negative sexual and reproductive health (SRH) outcomes for women, such as ‘unintended’ or early pregnancy, and increased risk behaviours for HIV [1,2,3]. AGYW in South Africa are more susceptible to depressive symptoms than their male counterparts, and are likely to remain underdiagnosed and untreated [7,8,9]. Their vulnerability lies at a biological, social, and environmental nexus.

Methods

Results

Discussion

Conclusion