Psychosocial support for adolescent girls in post-conflict settings: beyond a health systems approach

Abstract

Adaptive and adequately resourced health systems are necessary to achieve good health outcomes in post-conflict settings, however domains beyond the health system are also critical to ensure broader wellbeing. This paper focuses on the importance of psychosocial support services for adolescent girls in fragile contexts. Its starting point is that adolescence is a pivotal time in the life course but given the physical, cognitive and emotional changes triggered by the onset of puberty, it can also be a period of heightened sensitivity and vulnerability to trauma, social isolation, bullying by peers, a lack of supportive adults and gender-based and sexual violence. Our findings highlight why humanitarian and biomedical approaches in their current form are inadequate to address these complexities. Drawing on qualitative fieldwork (consisting of in-depth and key informant interviews as well as group discussions in Gaza, Liberia and Sri Lanka involving a total of 386 respondents across the three countries), we argue that going beyond biomedical approaches and considering the social determinants of health, including approaches to tackle discriminatory gendered norms and barriers to service access, are critical for achieving broader health and wellbeing. While all three case study countries are classified as post-conflict, the political economy dynamics vary with associated implications for experiences of psychosocial vulnerabilities and the service environment. The study concludes by reflecting on actions to address psychosocial vulnerabilities facing adolescent girls. These include: tailoring services to ensure gender and age-sensitivity; investing in capacity building of service providers to promote service uptake; and enhancing strategies to regulate and coordinate actors providing mental health and psychosocial support services.

Intersecting Vulnerabilities: The Impacts of COVID-19 on the Psycho-emotional Lives of Young People in Low- and Middle-Income Countries

“…Despite this high burden, relatively little research has unpacked this among adolescents. Notable exceptions exist and include Samuels et al ( 2017 ) who note the need to go beyond the health system to ensure broader well-being for adolescent girls in fragile contexts. The findings highlight the challenges of humanitarian and biomedical models to address such complexities.…”

Gender disparity as a threat to the mental well-being of young Sri Lankan women

“…Currently poverty is the main contributor of psychosocial vulnerability in adolescent girls in post-conflict settings in northeastern parts of the country (Samuels et al , 2017). In the 1990s, many men were at the war front and the government had to create employment opportunities for young women (Lynch, 2007).…”

“…Many apparel factories were established in free-trade zones and this industry has remained the country's largest net foreign exchange earner since 1992 (Dheerasinghe, 2009). Despite families valuing education, a significant number of young women dropped out from secondary education due to poverty, romantic relationships or early marriage (Samuels et al , 2017). Many in this group ended up as garment workers living away from their traditional social networks.…”

The importance of gender analysis in research for health systems strengthening

“…In Uganda, Morgan et al (2017) show how mothers reported a lack of control over financial resources and how they are used, as well as lack of male support when purchasing items for delivery or hiring transportation to the health facility. In Gaza, Samuels and Jones (2017 ) demonstrate how access to counselling following violence or trauma is mediated by gendered cultural norms. Witter et al (2017b ) demonstrate how across four different fragile contexts access to training—and especially in-service training and upgrading—was particularly difficult for women, especially when it involved travel and time away from households and gendered caring responsibilities.…”

“…Although not an explicit focus of any of the papers; gendered violence emerges as a clear theme. Adolescent girls experience sexualised violence in Liberia where hyper-masculinity has become the norm following years of conflict ( Samuels and Jones 2017 ); in Tanzania PMTCT processes can put women at risk of violence if they are seen as having brought HIV into the marriage ( Nyamhanga et al 2017 ); and in Uganda pregnant women experience violence from their husbands and from health workers during delivery ( Morgan et al 2017 ). Health workers themselves are also at risk of violence, particularly in times of conflict where they can be a deliberately targeted; with female health workers at increased risk of sexual violence ( Witter et al 2017b ).…”