“As a Young Pregnant Girl… The Challenges You Face”: Exploring the Intersection Between Mental Health and Sexual and Reproductive Health Amongst Adolescent Girls and Young Women in South Africa

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.

“In this place we have found sisterhood”: perceptions of how participating in a peer-group club intervention benefited South African adolescent girls and young women

“…Emotional support is the most appreciated kind of support for adolescents, the feeling of being listened to is valued more than receiving actual advice (Camara et al, 2015). The perception of being able to share one's emotions in the context of a supportive relationship, as felt by the AGYW club members in our study, is a critical component for good mental health (Duby et al, 2020;Meyer & Kruger, 2015). Emotional support encompassing behaviours such as listening, expressing love, and appreciation is the most beneficial type of support for people suffering from depression, helping to alleviate depressive symptoms, and engender a sense of acceptance that reinforces self-esteem (Camara et al, 2015;Meyer & Kruger, 2015).…”

“…Participation in the peer-group club components of the combination intervention was perceived to improve AGYW's self-esteem, self-worth, and well-being, foster a sense of empowerment, and perceived ability to access emotional support, which in turn contributed to overall improved wellbeing and mental health. Given the protective role of self-esteem, well-being, and perceived social support for positive SRH outcomes for AGYW (Duby et al, 2020), it is critical that combination interventions incorporate social support and mental health components.…”

“…The South African intervention formed part of The Global Fund's 2017-2022 strategy, which in recognition of the role of gender inequalities in AGYW HIV risk, focused on gender-sensitive programming and interventions with the aim of transforming gender relations, empowering AGYW and addressing factors that contribute to gender inequities which impede AGYW access to health services (The Global Fund, 2018b). Following the trend of increased recognition of the importance of including mental health and psychosocial support components in combination interventions for AGYW sexual and reproductive health (Docrat et al, 2019;Duby et al, 2020), the Global Fund identified psychological support, peer to peer counselling and integrated social support for inclusion in their combination intervention approach (The Global Fund, 2018b).…”

“…The sense of a 'sisterhood' of peers, with which to share feelings and be part of a reciprocal social support network, was created amongst members of the AGYW peer-group clubs. Social support, a form of social capital individuals can draw upon to help them cope with daily stressors, significantly affects a mental health, and therefore sexual and reproductive health, outcomes during adolescence (Cheng et al, 2014;Colarossi, 2001;Duby et al, 2020). In relation to health, social support includes supportive relationships that provide emotional, informational or instrumental assistance required for someone to remain healthy or adapt to stress (Casale et al, 2019).…”

“…In fact, the perception of the availability and adequacy of support is more important for mental health than actual support received (Casale et al, 2019). Social support, real or perceived, given by social networks, may be an important psychosocial buffer in the face of other risk factors, and serves as a protective mechanism in mitigating psychological distress and ensuring good mental health (Camara et al, 2015;Casale et al, 2019;Cheng et al, 2014;Duby et…”