Addressing the Sexual Health Needs of Adolescents During Humanitarian Crises

By Selah Agaba, MA, MEd | August 8, 2017
Kirby Summer Intern, ETR

Sit with this for a minute…

There are currently 65.6 million people worldwide who have been violently displaced from their homes by conflict. Refugees makeup about 34% of this number and more than half of this refugee population are individuals under 18 years of age.

To put this last figure into perspective, the number of young people under 18 who have been violently displaced from home is more than the number of people in the whole state of North Carolina or the entire nation of Greece.

Though there’s minimal data on the number of adolescent boys forced into marriage before they age 18, we know that 40 million adolescent girls are currently married. This number is higher during humanitarian crises.

In addition, adolescents, and especially adolescent girls, are at a disproportionately higher risk of contracting HIV/AIDS. UNICEF estimates that, globally, 2 million adolescents have HIV/AIDS. That is, 5% of the population living with the disease are adolescents. The organization also notes that more than half of the 18.7million people affected by the recent (2015) Ebola outbreak in western Africa are adolescents.

Governance

In an increasingly capitalist, globalized and unstable world, those with the most bargaining power dictate the policies and practices that affect everyone else. The further people are removed from this power, the less control they have over their lives and bodies.

This is especially true among individuals who have been displaced from their homes and particularly so for the young people.

Even in times of relative peace, our purposes, themes and methods of talking about sexuality—let alone adolescent sexuality—are complex and contradictory. As stakeholders in this space, we know this too well. This complexity is enormously heightened during humanitarian crises and when governance of a population falls under several different polities.

During humanitarian crises (emergencies), the lives of those affected are governed by several distinct entities including:

1. The international community under the guidance of the United Nations.
2. The laws of the country and society they flee to.
3. The individual, familial and cultural principles they bring with them.
4. The dictates that come to govern new allegiances formed with the refugees with whom they now live.

As these different actors respond quickly to save lives, meet basic needs, and ensure protection of the basic human rights of displaced people, we often see comprehensive, evidence-based sexual and reproductive health (SRH) services left on the back burner. There are few services and almost no research or literature on the SRH needs for adolescents during times of humanitarian crises.

The Inter-Agency Working Group on Reproductive Health in Crises (IAWG), was formed in 1995 to provide guidance and consolidate the sexual and reproductive health services of people affected by conflict and natural disaster. They published a report in 2014 emphasizing the vulnerability of adolescents during emergencies as comprehensive services and information remain out of their reach. The fact that we have barely begun to address these vulnerabilities is a disservice to the young people whose well-being we purport to care about.  

Young people are in a unique minority cohort here because they are faced with several perils of displacement atop rapid physical and emotional growth. They also have to contend with often conflicting and yet influential familial, cultural, national and international messages about their bodies and sexuality.

We Must Pay Attention

Because I know that we can do something about this, I want to put forward a case for urgent and comprehensive attention to the SRH needs of these adolescents. And by comprehensive, I mean going beyond the moralizing, interventionist, condescending, victimizing and shaming discourses on adolescent sexuality that often populate this space.

Carol Vance, in Pleasure and Danger: Exploring Female Sexuality, noted that “sexuality is simultaneously a domain for restriction, repression, and danger as well as a domain of exploration, pleasure, and agency… The hallmark of sexuality is its complexity: its multiple meanings, sensations, and connections. It is all too easy to cast sexual experiences as either wholly pleasurable or dangerous; our culture encourages us to do so.”

This was true in 1984 when the book first came out and still holds true today.

We have to move beyond this and provide accessible, friendly and comprehensive services—protection from exploitation, physical and psychological services for survivors of sexual violence, sanitary products, together with treatment for HIV and other STDs, maternal and newborn care, contraceptives and safe post abortion care.

We also must engage all aspects of sexuality in the information that we provide, i.e. the negative—such as unintended pregnancy, exploitation, violence, disease—as well as the positive—intimacy, self-identity, agency, vulnerability, and pleasure, among others. Not addressing the positive aspects of sexuality doesn’t erase them. We know this. Instead, it leaves young people confused and vulnerable.

Comprehensive Sexual Health Belongs Up Front

It is high time we devoted resources to critically understand how adolescent sexuality, in times of emergencies, intersects or coincides with and parallels the governing polities. How do the individuals then make sense of their lives amidst all this? What needs to be done to consolidate and extend the desperately needed comprehensive information and services?

We need to start by having the conversation and acknowledging the perils of young people during these hard times. Here is a growing list of the steps that we can take to to extend our focus into this area:

• Advocate for and ensure comprehensive adolescent sexuality information and services at all times. The biases, stigma and misinformation that shroud adolescent sexuality in times of peace permeate responses during crises to an even greater effect.
• Enhance the capacity of the Inter-Agency Working Group on Reproductive Health in Crises. Join the organization to keep abreast with different issues in this area. There are options for individual and organizational memberships.
• Create and support measures to facilitate research during humanitarian crises that will inform policies and practices. This research has to be informed by critical cross-cultural social justice frameworks. We must, in the words of Chandra Mohanty, be “attentive to the micropolitics of context, subjectivity, and struggle, as well as to the macropolitics of global economic and political systems and processes.”

The services and policies should continually come out of this understanding, because to act foolishly and cause additional harm is a luxury that we cannot afford.

 

Selah Agaba is a PhD student in Cultural Anthropology & Educational Policy Studies at the University of Wisconsin-Madison. She has an MA in Public Elementary Education and an MEd in International Education Development. She has done research and work in Uganda, Kenya, and the U.S. She can be reached at selah.agaba@gmail.com