Climate change, resource insecurities and sexual and reproductive health among young adolescents in Kenya: a multi-method qualitative inquiry.

Climate change and extreme weather events increased existing resource insecurities that were linked both directly and indirectly with sexual and reproductive health vulnerabilities among young adolescents aged 10-14 in Kenya.

• Study involved 297 total participants across six diverse Kenyan sites: Nairobi's urban slum Mathare, Naivasha's flower farming community, Kisumu's fishing community, Isiolo's nomadic and pastoralist community, Kilifi's coastal smallholder farms, and Kalobeyei refugee settlement.
• Participants included elders (n=119; mean age 60.6 years, SD 7.9; 48.7% men, 51.3% women), young adolescent walk-along interview participants (n=60; mean age 13.4, SD 1.5; 51.4% boys, 48.6% girls), and young adolescent participatory mapping workshop participants (n=118; mean age 12.1, SD 1.3; 50.8% boys, 49.2% girls).
• Methods included 12 elder focus groups, 60 young adolescent walk-along interviews, and 12 two-day young adolescent participatory mapping workshops.
• Analysis used codebook thematic analysis informed by the resource insecurity framework.

Food and water insecurity linked to climate change contributed to young adolescents missing school, which in turn increased sexual and reproductive health vulnerabilities.

• Narratives across multiple sites connected climate-driven food and water scarcity to school absenteeism among young adolescents aged 10-14.
• School absence was identified as a pathway increasing exposure to sexual violence, transactional sex, and exploitative relationships.
• These pathways were identified across geographically and contextually diverse communities including urban slum, farming, fishing, pastoralist, coastal, and refugee settings.
• The resource insecurity framework was used to interpret how climate-related stressors cascaded into social and health vulnerabilities.

Food and water insecurity contributed to transactional sex and exploitative relationships among young adolescents, which were linked with unplanned pregnancy and sexually transmitted infection risks.

• Transactional sex was identified as a coping mechanism arising from climate-exacerbated food and water insecurity among young adolescents aged 10-14.
• Exploitative relationships entered due to resource insecurity were associated with risks of unplanned pregnancy and sexually transmitted infections.
• These pathways were identified through narrative accounts from both elder focus groups and young adolescent walk-along interviews and participatory mapping workshops.
• The multi-method qualitative approach captured these linkages across six distinct community contexts in Kenya.

Sanitation insecurity produced challenges regarding menstrual hygiene management, increased sexual violence risks, and contributed to transactional sex among young adolescents.

• Sanitation insecurity was identified as a distinct pathway from food and water insecurity linking climate change to sexual and reproductive health outcomes.
• Menstrual hygiene challenges arising from sanitation insecurity were specifically noted as a sexual and reproductive health vulnerability.
• Inadequate sanitation infrastructure was linked to increased exposure to sexual violence risks.
• Sanitation insecurity was also identified as a driver of transactional sex among young adolescents across the six study sites.

Gender inequities moderated the pathways between climate-related resource insecurity and sexual and reproductive health outcomes, with girls at higher risk for violence and sexual exploitation and boys more prone to running away.

• Girls faced disproportionate risks for sexual violence and exploitation within climate-exacerbated resource insecurity contexts.
• Boys were more likely to respond to resource insecurity by running away from home, representing a distinct but also harmful coping pathway.
• Gender inequities were identified as a cross-cutting factor shaping differential vulnerability across all six study sites.
• These gendered patterns were captured through young adolescent walk-along interviews and participatory mapping workshops, as well as elder focus group narratives.

The authors developed a conceptual model illustrating pathways linking climate change, extreme weather events, resource insecurities, and sexual and reproductive health outcomes among young adolescents in Kenya.

• The model was grounded in empirical findings from the six-site multi-method qualitative study.
• It was informed by the resource insecurity framework applied to young adolescents aged 10-14.
• The model situates these pathways within larger social environmental contexts including gender inequities.
• The conceptual model is intended to guide climate-informed interventions targeting young adolescent sexual and reproductive health in Kenya.