Rethinking: Timely Access to Comprehensive Sexual and Reproductive Health Education within the Context of Seasonal Migration in the Urban Slum of the Greater Accra Region, Ghana-A Qualitative Exploratory Design.

Migrant adolescents face limited access to sexual and reproductive health (SRH) education due to their physical absence from communities during seasonal migration.

• The study used a qualitative exploratory design guided by the socioecological model of health behavior.
• 15 migrant adolescents were recruited via convenience sampling in urban slum communities of the Greater Accra Region, Ghana.
• Urban slum communities were identified via criterion purposive sampling.
• Frequent movement between rural communities and the city was identified as the primary structural barrier to accessing SRH education.
• Adolescents reported being unaware of where to find accurate information or support.

Limited access to SRH education led to low confidence in SRH decision-making among migrant adolescents.

• Absence from communities during migration resulted in a 'lack of confidence in SRH decision-making.'
• Participants reported difficulty accessing timely and comprehensive sexuality education (CSE).
• The study specifically focused on out-of-school migrant adolescents, a subgroup largely overlooked in existing SRH education efforts.
• Data were collected through 10 in-depth interviews (IDIs) with migrant adolescents, two focus group discussions (FGDs), two key informant interviews (KIIs) with peer network leaders, and one interview with a migrant gatekeeper.

Peer networks played a significant role in shaping SRH choices among migrant adolescents, often reinforcing reliance on informal health providers for sexual information.

• Peer networks were found to influence SRH choices among migrant adolescents.
• These networks often reinforced reliance on informal health providers rather than formal or accurate sources of information.
• Peer networks also helped to address cultural barriers, though not always with accurate information.
• Key informant interviews with peer network leaders provided insight into the interpersonal-level influences on SRH behavior.

Existing community outreach programs primarily targeted young mothers attending child welfare clinics rather than the broader population of migrant adolescents.

• Community outreach programs were found to be narrowly focused on young mothers at child welfare clinics.
• Wider community migrant adolescents were not targeted by these programs.
• This gap left the majority of migrant adolescents without access to formal SRH education through community channels.
• The study noted that 'efforts to provide comprehensive sexuality education to out-of-school children have rarely focused on seasonal internal migrant adolescent young people.'

Seasonal migration was identified as a key social determinant of health that is not currently incorporated into national SRH policies in Ghana.

• The study concludes that seasonal migration should be 'acknowledged as a key social determinant of health and incorporated into national sexual and reproductive health (SRH) policies.'
• The study underscores the need to address individual-, interpersonal-, and community-level factors simultaneously.
• Existing CSE implementation gaps are particularly pronounced among out-of-school migrant adolescents affected by seasonal internal migration.
• The study calls for 'inclusive strategies that reach all adolescents, not just those who attend child welfare clinics.'

The study applied the socioecological model of health behavior as a theoretical framework to understand multilevel barriers to SRH education access among migrant adolescents.

• The socioecological model guided the study design and analysis.
• Barriers were identified at individual, interpersonal, and community levels.
• Urban slum communities in the Greater Accra Region of Ghana served as the study setting.
• Final sample size of 15 migrant adolescents was determined by data saturation.
• Participants were recruited through formal and informal social networks, including youth groups.