The framework of this study builds on the principles and goals of the ICPD in addition to the IAFM and its Adolescent Sexual and Reproductive Health Toolkit for Humanitarian Settings delivered by IAWG (21–23). The ICPD’s Programme of Action, which was held in Cairo in 1994 and attended by 179 countries, not only firmly placed Reproductive Health and Rights on the international agenda but also presented a major development in considering SRH care and services fundamental for all married and unmarried individuals, including adolescents and youth (21). In the section VII of its Programme of Action, the ICPD determines SRH care for people of suitable age groups, which covers different services including: i) Information, education and counseling on human sexuality and reproductive health; ii) Prevention and surveillance of violence against women, care for survivors of violence and other actions to eliminate traditional harmful practices. Moreover, the ICPD highlights the particular challenges faced by migrants and displaced people in general, and women and adolescents specifically, when accessing SRH services and how these services should complement their precise SRH needs (21).

In its 2018 version of IAFM, IAWG acknowledges sexual and reproductive health and rights (SRHR) as a key element in accomplishing human rights goals such as the right to health, ill-treatment, privacy, and education, in addition to protection from discrimination, specifically that which is based on sex and gender. This version of IAFM underlines the importance of individuals affected by crises and living in humanitarian settings obtaining comprehensive SRH knowledge and services in order to improve SRHR worldwide. Additionally, the manual focuses on those individuals’ ability to make informed decisions regarding their SRH without being subjected to intimidation, intolerance, and violence (22). IAWG gives further explicit focus on adolescent sexual and reproductive health (ASRH) through a toolkit that guides IAFM. IAWG is a humanitarian mandate, in which the promotion and delivery of knowledge and accessible services are important components. On the one hand, the toolkit shows the potential harmful consequences if adolescent sexual and reproductive health and rights (ASRHR) in emergency settings continue to be overlooked. On the other hand, it draws attention to ASRHR and the positive health and societal outcomes of providing adequate ASRH information and services for refugee adolescents in general, and refugee adolescent girls in particular, in coordination with them (23).

Since the main aim of this study was to learn about refugee adolescent girls’ SRH perceptions and experiences, we employed a generic qualitative research approach (29–31). Focus group discussions (FGDs) were chosen for this study, as they give the opportunity for participants to share their knowledge, beliefs, and experiences within a discussion that is shaped by their own concerns and preferences (32, 33). The flexibility of this research method not only allows participants’ reflexivity during the description and interpretation of their own views and practices, but also flattens the power hierarchy between the participants on the one hand, and the researcher on the other hand, since the focus is on the participants’ thoughts and expressions (34–36). What makes FGDs a unique dialogical qualitative research method is the interaction between the participants, which allows both similar and diverse contributions to the discussion to develop, and a richer interpretation of these contributions (37, 38). FGDs were found to be a preferable research method for adolescents compared to interviews, since FGDs involve participants’ peers in an informal and less intimidating environment (39, 40). For comparing FGDs and centering them around important items, as mentioned above, we used a semi-structured guide with questions on specific themes: menstruation, puberty, SRH awareness, and sexual harassment. These health issues and SRH topics were chosen as the main themes to be examined, based on the tool validated by UNFPA and Save the Children: Adolescent Sexual and Reproductive Health Toolkit for Humanitarian Settings (41).

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