Displaced Population Groups' Access to Mental Health Services in Bangladesh and Uganda

The psychosocial vulnerabilities of refugees and significant need for mental health services in humanitarian settings have received increased attention in recent years. Based on qualitative research with Rohingya refugees in Bangladesh and South Sudanese refugees in Uganda, and service providers in each context, this paper identifies hitherto underexplored factors that shape access to mental healthcare, as well as barriers and opportunities for improving mental health support. The paper finds multiple barriers that limit access to formal care, including distance, cost, lack of family support, poor health, communication challenges, perception of service propriety, and poor quality of services. Tensions between cultural understandings of mental health and shifting gender norms and roles in displacement also shape mental health vulnerability and service access in each setting. Gaps in existing services are identified, as are recommendations as to how community expertise and knowledge might be integrated within formal psychosocial support services for refugee

Intersectionality as a framework for understanding adolescent vulnerabilities in low and middle income countries: Expanding our commitment to leave no one behind

Given increasing policy attention to the consequences of youth marginalisation for development processes, engaging with the experiences of socially marginalised adolescents in low- and middle-income countries (including those who are out of school, refugees, married, with disabilities or adolescent parents) is a pressing priority. To understand how these disadvantages—and adolescents’ abilities to respond to them—intersect to shape opportunities and outcomes, this Special Issue draws on the Gender and Adolescence: Global Evidence conceptual framework which accounts for gender roles and norms, family, community and political economy contexts in shaping adolescents’ capabilities. Implicitly critiquing a focus within youth studies on individual agency, the articles advance our understanding of how adolescents’ marginalisation is shaped by their experiences, social identities and the contexts in which they are growing up. An analytical framework foregrounding intersectionality and collective capabilities offers a means to politicise these findings and challenge uncritical academic celebration of individual agency as the means to address structural problems

No one left behind: Using mixed-methods research to identify and learn from socially marginalised adolescents in low- and middle-income countries

This article describes the mixed-methods approach used by the Gender and Adolescence: Global Evidence (GAGE) research programme. It discusses how qualitative and quantitative methods can be used both in isolation and combined to learn about the lives of adolescents in low- and middle-income countries (LMICs), focusing on the methodological and ethical approaches used to reach socially marginalised adolescents (including adolescents with disabilities, adolescents not in school, adolescent refugees, adolescents living in urban slums, adolescents who married as children, and adolescent mothers). We reflect on the implementation of the GAGE conceptual framework, discussing its strengths and weaknesses, and the challenges to promoting inclusive and genuinely mixed-methods research practices. While these methods have been adapted in the countries where research was undertaken, the conceptual framework provides a common methodological approach, utilising an intersectional lens. We show how mixed-methods approaches can contribute to the knowledge base on research with socially marginalised adolescent girls and boys globally, serving as an important resource for future research with young people in LMICs

Section overview:Young people’s voice, agency and participation ‘beyond borders’

In this introduction, the concept of citizenship ‘beyond borders’ is used to reflect on the participation, voice and agency of adolescents and young people in ways that transcend and challenge traditional notions of citizenship, particularly in relation to the role of the state: migration, online participation, climate activism and counter-politics. This offers a framework for reading chapters in this section of the book, which explore how adolescents and young people in the Global South exercise voice and agency through ways of ‘being political’ that explicitly decentre the state and formal, traditional expressions of civic participation such as voting and joining parties. A key observation is that even through alternative modes of participation, gender and age norms often reinforce patterns of inclusion and exclusion that are central to institutional politics - problematising the avenues which exist for ‘citizenship’ beyond borders.</p

Refugee-led social protection: reconceiving refugee assistance

The help and assistance that refugees offer each other is central to the lives of many displaced people. Recognising this allows support for displaced people to be reconceived in more sustaining and empowering ways

Introduction:Adolescent and young people’s voice, agency and citizenship in the Global South

The introduction to this volume establishes a conceptual framework for understanding the voice, agency and citizenship of adolescents and young people in the Global South. It reflects upon key knowledge and policy gaps in relation to young women and girls and younger adolescents’ citizenship, and how to understand the nuances of voice and agency in contexts of inequality, marginalisation and precarity. Of particular emphasis is how voice and agency are expressed at different levels and in different spaces by young people, particularly those who are marginalised on the basis of gender and/or sexual identity, age, disability, citizenship status or geographical location. The conceptual framework presented here draws on intersectional approaches, the notion of collective agency, and the concept of ‘everyday politics’ to present a new lens on adolescent and young people’s voice, agency and citizenship in the Global South.</p

Refugee-led responses in the fight against COVID-19: building lasting participatory models

The formal structures of humanitarian aid are struggling to respond to the consequences of COVID-19. The work of refugee-led organisations is now more relevant than ever, and they need to be far better supported – both now and in the longer term

Final reflections and next steps for policy, programming and research

The concluding chapter reflects upon the key themes that have emerged across the case studies and contributions of this edited collection, which collective illustrate the importance of a relational, contextualised and intersectional lens on adolescents and young people’s citizenship. Key conceptual and empirical contributions to understanding adolescent and young people’s civic and political voice and agency are identified, as well as the implications for research, policy and programming with adolescents and young people in the Global South. Finally, the chapter asks ‘where next?' for work in this field.</p

Intersecting inequalities, gender and adolescent health in Ethiopia

© 2020 The Author(s). Background: Until recently, global public health initiatives have tended to overlook the ways that social factors shape adolescent health, and particularly how these dynamics affect the specific needs of adolescents in relation to information about puberty, menstruation and sexual health. This article draws on mixed methods data from rural and urban areas of Ethiopia to explore how access to health information and resources - and subsequently health outcomes - for adolescents are mediated by gender and age norms, living in different geographical locations, poverty, disability and migration. Methods: Data was collected in 2017-2018 for the Gender and Adolescence: Global Evidence (GAGE) mixed-methods longitudinal research baseline in three regions of Ethiopia (Afar, Amhara and Oromia). Quantitative data was collected from over 6800 adolescents and their caregivers, with qualitative data obtained from a sub-sample of 220 adolescents, their families and communities. Adolescent participants shared their experiences of health, illness and nutrition over the previous year; their knowledge and sources of information about sexual and reproductive health and puberty; and their attitudes toward sexual and reproductive health. Regression analysis was used to explore differences by gender, age, rural/urban residence, and disability status, across a set of adolescents\u27 health knowledge and other outcomes in the quantitative data. Intersectional analysis was used in analysing the qualitative data. Results: Analysis suggested that gender inequality intersects with age, disability and rural/urban differences to shape young people\u27s access to information about puberty, with knowledge about this topic particularly lacking amongst younger adolescents in rural areas. Drought and lack of access to clean water exacerbates health challenges for adolescents in rural areas, where a lack of information and absence of access to preventive healthcare services can lead to permanent disability. The research also found that gaps in both school-based and alternative sources of education about puberty and menstruation reinforce stigma and misinformation, especially in rural areas where adolescents have higher school attrition rates. Gendered cultural norms that place high value on marriage and motherhood generate barriers to contraceptive use, particularly in certain rural communities. Conclusions: As they progress through adolescence, young people\u27s overall health and access to information about their changing bodies is heavily shaped by intersecting social identities. Structural disadvantages such as poverty, distress migration and differential access to healthcare intersect with gender norms to generate further inequalities in adolescent girls\u27 and boys\u27 health outcomes