| Issue/Objective |
In the Anglophone regions of Cameroon, armed conflict has moved beyond episodic disruption to a sustained breakdown of systems that support adolescent health. Health facilities operate intermittently, most schools remain closed or unsafe, and entire communities function under conditions of fear, displacement, and economic strain. Within this environment, adolescents face an urgent and largely invisible crisis in sexual and reproductive health. They are not only unable to reach services, but are increasingly unable to seek them without social consequence. Fear of exposure, moral judgment, and community surveillance has intensified, particularly for girls, making the act of seeking care itself a risk. This study examines how systemic collapse and social constraint combine to suppress adolescent access to sexual and reproductive health services, and assesses whether alternative delivery pathways can reverse this trend. |
| Methodology/Approach |
A mixed methods study was conducted in conflict affected communities in Bamenda between 2023 and 2024. The study combined a quasi experimental evaluation of a community based intervention with in depth qualitative inquiry. The intervention introduced mobile service delivery, peer led support spaces, and confidential referral mechanisms targeting adolescents aged 15 to 24. A total of 412 adolescents were included across intervention and matched comparison communities. Difference in differences analysis was used to estimate changes in contraceptive uptake and service utilization. Qualitative data from focus group discussions and life history interviews were used to examine decision making under conditions of risk. |
| Results |
Adolescent use of facility based services declined sharply in conflict exposed communities, driven by insecurity, cost, and fear of social visibility. Following the intervention, modern contraceptive uptake increased by 31 percentage points among exposed adolescents, while overall service utilization was 2.5 times higher than in comparison communities. Findings show that adolescents did not avoid services because they were unavailable, but because accessing them carried social consequences. Uptake was highest in delivery channels that reduced visibility and protected confidentiality. However, gains were unstable and declined during periods of heightened violence. |
| Discussion/Conclusion |
The crisis has transformed adolescent sexual and reproductive health from a question of access into a question of survival within constrained social environments. Interventions that rely on static, facility based models fail to reach those most at risk. Effective responses must align with how adolescents navigate risk, prioritizing discretion, mobility, and peer mediated entry into care. These findings highlight an urgent need to redesign sexual and reproductive health systems for conflict settings where both infrastructure and social safety have broken down. |
| Presenters and Affiliations |
Wacha Roosevelt Wacha Youth 2 Youth Cameroon |
