Changing climates, compounding challenges: a participatory study on how disasters affect the sexual and reproductive health and rights of young people in Fiji.

Pacific youth are at the forefront of the climate crisis, which has important implications for their health and rights. Youth in Fiji currently bear a disproportionate burden of poor experiences and outcomes related to their sexual and reproductive health and rights (SRHR). There is limited information about how the increasing climate impacts may affect their SRHR, and what the implications may be for climate action and disaster risk reduction. We aimed to explore the experiences of 21 Fijian youth in fulfilling their SRHR when living through multiple natural hazards. We conducted 2 workshops and 18 individual semistructured interviews using visual and storytelling methods. Irrespective of the type of hazard or context of disasters, participants identified limited agency as the main challenge that increased SRHR risks. Through reflexive thematic analysis, we identified four themes centred around 'youth SRHR agency'; (1) information and knowledge, (2) community and belonging, (3) needs and resources, and (4) collective risks. These themes encompassed multiple factors that limited youth agency and increased their SRHR risks. Participants highlighted how existing challenges to their SRHR, such as access to SRHR information being controlled by community gatekeepers, and discrimination of sexual and gender diverse youth, were exacerbated in disasters. In disaster contexts, immediate priorities such as water, food and financial insecurity increased risks of transactional early marriage and transactional sex to access these resources. Daily SRHR risks related to normalisation of sexual and gender-based violence and taboos limited youth agency and influenced their perceptions of disasters and SRHR risks. Findings offer important insights into factors that limited youth SRHR agency before, during and after disasters. We underscore the urgency for addressing existing social and health inequities in climate and disaster governance. We highlight four key implications for reducing youth SRHR risks through whole-of-society approaches at multiple (sociocultural, institutional, governance) levels.

Using social capital to address youth sexual and reproductive health and rights in disaster preparedness and response: A qualitative study highlighting the strengths of Pacific community organisations and networks.

In the Pacific region, youth sexual and reproductive health and rights (SRHR) are strongly influenced by sociocultural and structural factors, which limit access to SRHR information and services for youth. As climate-related disasters intensify in the Pacific, existing challenges to youth SRHR may increase the risk of worse SRHR experiences and outcomes for youth before, during and after disasters. Community-based models of SRHR service provision models increase accessibility for youth in non-disaster times, but there is limited evidence of how community organisations address youth SRHR in disaster contexts. We conducted qualitative interviews with 16 participants from community organisations and networks in Fiji, Vanuatu, and Tonga following the 2020 Tropical Cyclone (TC) Harold. Guided by the Recovery Capitals Framework (natural, built, political, cultural, human, social, and financial capitals), we explored how community organisations addressed challenges to facilitate access to youth SRHR information and services. Social capital in the form of peer networks and virtual safe spaces was used to navigate challenges in political, financial, and natural capitals. Existing relationships and trusted collaborations were crucial to address cultural taboos related to youth SRHR. Previous experiences of disasters and knowledge of contexts enabled participants to provide sustainable solutions to identified SRHR needs. The work conducted by community organisations and networks pre-disaster made it easier to identify and address youth SRHR risks following disasters. Our research offers a unique perspective into how social capitals were used to mitigate challenges to youth SRHR across natural, human, financial, cultural, built, and political capitals. Findings offer important opportunities to invest in existing community strengths, for transformative action to advance the SRHR of Pacific youth.

Health Synergies across International Sustainability and Development Agendas: Pathways to Strengthen National Action.

Since 2015 there has been a surge of international agendas to address a range of global challenges: climate change (Paris Agreement), sustainable development (Agenda 2030), disaster risk reduction (Sendai Framework) and sustainable urban transformation (New Urban Agenda). Health is relevant to all of these agendas. Policymakers must now translate these global agendas into national level policies to implement the agreed goals in a coherent manner. However, approaches to synergise health activities within and across these agendas are needed, in order to achieve better coherence and maximise national level implementation. This research evaluated the framing of human health within these agendas. A content analysis of the agendas was conducted. Findings indicate (i) the importance of increased awareness of health systems strengthening as a helpful framework to guide the integration of health issues across the agendas, (ii) only two health themes had synergies across the agendas, (iii) the lack of a governance mechanism to support the integration of these four agendas to enable national (and sub-national) governments to more feasibly implement their ambitions, and (iv) the vital component of health leadership. Finally, planetary health is a relevant and timely concept that can support the urgent shift to a healthy planet and people.

Condom use in young women using long-acting reversible contraception (LARC): a qualitative study.

Young women in Australia disproportionately experience unintended pregnancy and sexually transmissible infections (STIs). As the promotion of highly effective pregnancy prevention methods such as long-acting reversible contraception (LARC) increases, concurrent use of condoms with LARC remains optimal for pregnancy and STI prevention. There is little data exploring condom use behaviour in young Australian women using LARC. In this qualitative study we interviewed twenty women using LARC about their experiences of making decisions regarding condom use. We used inductive thematic analysis to identify factors influencing participant decision-making. We found that while LARC had an impact on condom use and sexual practices, decisions regarding condom use were influenced by multiple factors including mood, menstrual changes related to LARC, and relationship dynamics. Participants' views of 'safe sex' extended beyond pregnancy and STI protection, to include desired outcomes such as pleasure, consent and communication. Access to STI testing and treatment was key to how participants managed STI risk. Findings highlight the need for a more comprehensive approach to safer sex health promotion, and the importance of ensuring STI testing and treatment services continue to be available and accessible to all young people.