Sexual Health

Experiences of drought, heavy rains, and flooding and linkages with refugee youth sexual and reproductive health in a humanitarian setting in Uganda: qualitative insights.

TL;DR

Extreme weather events (drought, heavy rains, and flooding) in Bidi Bidi Refugee Settlement contribute to resource insecurities that increase sexual and gender-based violence risks, transactional sex, menstruation insecurity, and broader sexual and reproductive health harms among refugee youth, particularly young women.

Key Findings

Drought contributed to food and water resource scarcities that increased sexual and gender-based violence (SGBV) risks among refugee youth in Bidi Bidi.

  • Study conducted in Bidi Bidi Refugee Settlement, Uganda, one of the world's largest refugee settlements.
  • Participants included 32 youth (mean age 20.0, SD 2.4; 50% men, 50% women) and 12 key informant service providers (mean age 37.0, SD 5.8; 75% men, 25% women).
  • Drought-driven food and water scarcity was described as a contextual driver pushing young women into situations of increased vulnerability to SGBV.
  • Walk-along individual interviews were used to capture lived spatial experiences within the settlement.

Drought-related resource scarcity was linked to increased engagement in transactional sex among refugee young women.

  • Resource scarcity framework was used to analyze how socioeconomic and ecological risks interact with SRH outcomes.
  • Transactional sex was described as a coping mechanism when food and water resources were depleted due to drought.
  • This was identified as a pathway to increased STI/HIV acquisition risk and unplanned pregnancy.
  • Young women were disproportionately affected by these dynamics compared to young men.

Drought contributed to menstruation insecurity among refugee young women in the settlement.

  • Menstruation insecurity was identified as a distinct SRH outcome linked to drought-driven resource scarcity.
  • Scarcity of water and related materials was described as undermining the ability of young women to manage menstruation safely and hygienically.
  • Menstruation insecurity was framed as both a health and dignity concern within the humanitarian context.
  • This finding emerged through thematic analysis of walk-along interviews and key informant interviews.

Heavy rains and flooding contributed to resource scarcities that increased SGBV risks and exacerbated menstruation insecurity through sanitation insecurity.

  • Flooding was described as disrupting sanitation infrastructure, which compounded menstruation insecurity.
  • Heavy rains and flooding were identified as a separate but related pathway to SGBV risk, distinct from drought-related pathways.
  • Sanitation insecurity during flooding events was specifically identified as worsening conditions for menstrual hygiene management.
  • Both drought and flooding were described by participants as increasingly frequent or severe, consistent with climate change patterns.

Participants reported that climate change contributed to water scarcity, extreme heat, and changing rain patterns in and around Bidi Bidi Refugee Settlement.

  • These environmental changes were described as altering daily life and resource availability in the settlement.
  • Changing rain patterns were noted as disrupting agricultural activities that households depended on for food security.
  • Extreme heat was identified alongside drought and flooding as a climate-related stressor affecting the settlement.
  • These findings were drawn from qualitative thematic analysis of 44 participant interviews.

The study used walk-along individual interviews as its primary qualitative data collection method with refugee youth.

  • Walk-along interviews involve participants guiding the interviewer through their environment while discussing experiences, capturing spatial and contextual dimensions.
  • A total of 32 youth participated in walk-along interviews and 12 key informant interviews were conducted with service providers.
  • Key informants were service providers working in the settlement, with a mean age of 37.0 years (SD 5.8).
  • Thematic analysis was informed by the resource scarcity framework, which explores socioeconomic and ecological risks for resource insecurity.

Extreme weather event-related resource insecurities were associated with poor SRH outcomes including STI/HIV acquisition risks, unplanned pregnancy, and SGBV.

  • The paper identifies a multi-step pathway: extreme weather events → resource insecurity → increased SRH risk behaviors and vulnerabilities → poor SRH outcomes.
  • STI/HIV acquisition risk was linked primarily to transactional sex driven by resource scarcity.
  • Unplanned pregnancy was identified as an SRH outcome connected to these dynamics.
  • Authors conclude findings 'should be addressed in multi-level climate-informed humanitarian programmes.'

What This Means

This research suggests that climate-related extreme weather events — including drought, heavy rains, and flooding — have direct and indirect consequences for the sexual and reproductive health of young refugees living in Bidi Bidi Refugee Settlement in Uganda. The study interviewed 32 young people aged 16–24 and 12 service providers through in-depth, walk-along interviews, where participants guided researchers through their living environment while discussing their experiences. The researchers found that when drought reduces food and water supplies, young women in particular face greater pressure to engage in transactional sex to survive, face higher risks of sexual and gender-based violence, and struggle to manage menstruation safely. When heavy rains and flooding occur, damaged or overwhelmed sanitation facilities make menstrual hygiene even more difficult to maintain, and violence risks also increase. The study highlights that refugee settlements are particularly exposed to these climate-related stressors, yet they are rarely included in research on climate change and health. The findings map out a clear chain of harm: extreme weather events reduce access to food, water, and sanitation, which in turn forces difficult choices and increases vulnerability, ultimately raising risks of STIs, HIV, unplanned pregnancy, and gender-based violence — especially for young women. This research suggests that humanitarian programs operating in refugee settings need to account for climate change when designing health and protection services. Addressing only immediate health needs without tackling the resource insecurities driven by extreme weather events may leave young refugees, and particularly young women, without adequate support. The authors call for multi-level, climate-informed approaches that integrate sexual and reproductive health, gender-based violence prevention, and environmental resilience.

Have a question about this study?

Citation

Logie C, Loutet M, MacKenzie F, Okumu M, Leggett R, Akinwande F, et al.. (2025). Experiences of drought, heavy rains, and flooding and linkages with refugee youth sexual and reproductive health in a humanitarian setting in Uganda: qualitative insights.. Global public health. https://doi.org/10.1080/17441692.2025.2503863