Displacement Stressors and Sexual and Reproductive Health Challenges for Internally Displaced Young Adults in Northern Mozambique: A Qualitative Study Using the Socio-ecological Framework for Refugee Distress.

An ongoing insurgency in Cabo Delgado, Mozambique, has displaced over one million people since 2017. Young adults in Mozambique have the greatest risk for HIV. Young adults can be impacted by a host of sexual and reproductive health (SRH) challenges and poor access to care yet less is understood about how exposure to conflict and forced displacement affects SRH. Our qualitative study facilitated focus groups and stakeholder interviews to query urban internally displaced persons, including young adults, and stakeholders involved in the humanitarian response to understand views on the impact of displacement stressors on internally displaced young people's SRH. Using an adapted socio-ecological model of refugee distress, we examined how displacement stressors due to the insurgency shaped SRH outcomes among internally displaced youth in Nampula, Mozambique. We conducted a thematic analysis to interpret themes and organize them by level of the model. Participants (n = 53; 30.2% women, ages 19-80, mean age = 44.5, SD = 18.3), reported that stressors like food insecurity, limited housing, integration challenges such as school discontinuation and perceived discrimination, and cultural changes were related to increased instances of transactional sex, early pregnancy, early marriage, gender-based violence, disinterest in SRH services, and changing cultural norms related to sexual practice. Results showed that internally displaced young adults in Mozambique faced multiple displacement stressors and struggled attending to their SRH needs due to challenges experienced in their new environment. Findings indicate that efforts to address displacement stressors should be prioritized in work to improve SRH outcomes among displaced Mozambican young adults.