SRHR, adolescence, and displacement

SRHR are rooted in human rights, including the right to life, to health, to dignity, to education, to autonomy, to privacy, to family planning, to non-discrimination, to freedom from sexual and gender-based violence (GBV), and to access to effective remedy [9]. SRHR are protected through multiple treaties, codified in international, regional, and national laws, and in international political consensus documents [9–12]. States, therefore, carry a duty to promote and protect actions to change social norms, laws, and policies to uphold SRHR [1,9]. SRHR are also foundational to the Agenda 2030, Sustainable Development Goals 3 and 5, in ensuring health, promoting well-being, achieving gender equality, and empowering women and girls [13]. Crucially, universal access to SRHR requires integration into national strategies and programmes [13,14].

Promoting SRHR literacy is central in ensuring women and girls’ rights to freedom of choice in decisions that govern their bodily integrity, and access to adequate and adapted information and healthcare. As highlighted by Amanu et al. [15], sexual and reproductive health literacy is key in protecting and respecting SRHR, “especially among young people.” Sharma et al. [16] further emphasised SRHR literacy as essential in addressing inequities and mitigating power imbalances that impede the claiming and fulfilling of SRHR.

Social contexts also play a central role in realising SRHR, through sociocultural, institutional, and legal processes that shape individual experiences and relationships [17]. Norms about gender and sexuality shape in childhood, change over time, and vary between social contexts. Moreover, gender norms intersect with cultural perceptions on sex, ethnicity, migration status, social class, age, etc. [18]. Adolescence, defined as the developmental phase between ages 10–19 [19], commonly brings about ponderings on sexuality, identity, and sexual relationships. This phase is important in sexual development and exploration, and coincides with when expectations linked to gender norms intensify, and risks of harmful practises and experiences increase, particularly for girls [1].

Being displaced during adolescence compounds existing vulnerabilities [1]. Approximately one third of young people undergoing migration are estimated to have experienced sexual violence pre-migration [20,21]. Migrant youth with experiences of sexual violence also often refrain from reporting victimisation or seeking related healthcare [22]. Additionally, sexuality remains a topic surrounded by shame and taboo in many contexts, and speaking openly about SRHR, and accessing information, can be difficult [23].

Every child is protected under the Convention on the Rights of the Child (CRC) [24], and the United Nations (UN) has emphasised that specific and extended protections should be provided during displacement and unaccompanied migration [25]. Critically, risks of SRHR violations pre, during, and post-migration increase when children are unaccompanied [3]. Therefore, identifying factors that diminish these risks is essential in ensuring both SRHR and the CRC are upheld.

Understanding the dynamics of SRHR during unaccompanied migration

Unaccompanied children are exposed to acute risks, and simultaneously, public institutions struggle in reaching them in preventative SRHR measures [26]. Repeated exposure to traumatic events [20], poorer sexual health, and difficulties in having their health rights fulfilled have also been reported [27]. Moreover, sexual risk is compounded by multiple factors, including low socio-economic status, social taboo, and school disruption [28]. This impacts SRHR literacy, and risks resulting in increased transmissions of HIV/STIs and unintended pregnancies [28–30]. Sexual violence further increases these risks, and deteriorates both sexual and mental health [31]. Additionally, in Europe, poorer overall mental health, including depression and post-traumatic stress disorder (PTSD), have been reported among unaccompanied girls compared to boys [32,33].

Research from the United Kingdom accents how transitioning to a host country involves multiple life changes, alongside adapting to a new society, language, and norms [34]. A Norwegian qualitative study found that even five years after arrival, unaccompanied children struggle to find belonging despite efforts to adapt, and often face prejudice and discrimination [35]. Balancing new relationships and preserving cultural identity also proves challenging [35].

Furthermore, transitioning from adolescence to young adulthood in the host country is characterised by sudden shifts, including often losing support systems upon turning 18 [35,36]. The Council of Europe [37] has emphasised that young refugees struggles in this transition must be acknowledged, as their successful inclusion in society is important in protecting them against existing vulnerabilities and GBV. How unaccompanied girls’ SRHR are affected by these transitions remains under explored.

Structural vulnerabilities of being an unaccompanied girl

Primary reasons for fleeing unaccompanied include the death or persecution of a family member, war, trafficking, and violence [34]. Yet, some of the greatest threats to SRHR are structural, engrained in societal laws, norms, values, and institutions, and rooted in various forms of GBV [10,11,38]. GBV, and the term violence against women, are defined in Article 1 of the UN Declaration on the Elimination of Violence against Women as any act resulting in, or likely to result in, “physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life” [39]. It also includes sexual harassment, or other non-contact forms of sexual violence, regardless of the relationship to the victim [38]. Critically, the UN Committee on the Elimination of Discrimination against Women (CEDAW) [11] has accented that GBV constitutes human rights violations, and thus states must be accountable in eradicating it.

GBV also includes harmful practices prescribed by contextually accepted norms, such as forced marriage, child marriage, and female genital mutilation [40]. Other forms of GBV consist of restrictions or denials of resources, impeding or restricting access to service and information, and crimes committed under the guise of ‘honour’, commonly referred to as honour-related violence (HRV) [40]. Women and girls are particularly at risk of GBV, such as physical, emotional, or sexual abuse, various forms of intimate partner violence (IPV), and domestic violence; all consequential to their dignity and health [28,40,41]. From an intersectional perspective, they are at risk of being made vulnerable and discriminated against by structural responses to their overlapping social positioning [42]. In the case of unaccompanied girls, this position is defined by them being a child, a girl, often a person of colour, and a migrant and refugee [42,43]. As stated by the UN Committee on Economic, Social and Cultural Rights (CESCR) [10], these overlapping positions may lead to being “disproportionately affected by intersectional discrimination in the context of sexual and reproductive health.”

Although research on unaccompanied girls’ SRHR needs is lacking, barriers to SRHR-related services experienced by migrant women are well documented; including limited awareness of pathways to access, financial barriers, distrust, fear, discrimination, and mistreatment [28,43–46]. Consequentially, migrant women are at increased risk of not seeking needed services [47–50]. Moreover, when understood through the lens of intersectionality, in being confined to marginalised positions in society, with limited access to protective resources, such as police, social services, and healthcare, migrant women are structurally discouraged from reporting or escaping GBV-related conditions [42]. Thus, fully capturing the lived experiences of SRHR needs of unaccompanied girls requires acknowledging GBV in its social context, as well as recognising the overlapping societal positions these girls are confined to.

Knowledge gap on unaccompanied girls and their transition to adulthood

The lived experiences of unaccompanied girls and young women have been identified as an area in need of further research [51–53]. The present study builds on limited work exploring experienced conditions and, more specifically, addresses a research gap on the perceived SRHR needs of this population. Further knowledge is needed to contribute to a more comprehensive view of unaccompanied adolescent girls and young women’s possibilities for enjoyable, safe, and secure sexual experiences [1]. This is critical in ensuring experiences are free from oppression, discrimination, and violence, and based on informed decision-making [1].

Sweden has adopted a broad national strategy and plan for action aiming to fulfil good, equitable, and equal SRHR for all [53,54]. Swedish governmental agencies have also highlighted the importance of involving migrants, such as unaccompanied children, in investigating their SRHR needs; including in the design and implementation of preventative interventions [55,56]. Simultaneously, increasingly restrictive migration policies have been implemented across the European Union over the past decade [57]. In Sweden, among many other measures, this has manifested in standardising temporary (over permanent) resident permits, and stricter family reunification policies [58], significantly impacting the lives of unaccompanied children. Thus, exploring lived experiences during these legislative shifts is also important in understanding potential impacts on unaccompanied girls’ SRHR needs.

The overall aim of this study was to illuminate the lived experiences of SRHR needs of unaccompanied girls and explore how perceived needs are affected by the social contexts navigated in the pre, during, and post-migration phases of life, including in their transition to young adulthood in Sweden.

Sampling and participants

The complex recruitment process (conducted by MO and HA) was both broad and targeted. Initially, MO organised referral group meetings with various actors experienced in interacting with unaccompanied children and youth; representing youth clinics, maternal care, migrant health clinics, family centres, and non-governmental organisations (NGOs). Participants were also recruited through communities on social media, informal leaders, public schools, student health services, and legal guardians across Sweden.

Sixteen participants, self-identifying as women, took part in the study. All had sought asylum in Sweden (the host country), having migrated as unaccompanied girls (under age 18) from Somalia, Eritrea, Afghanistan, and Syria. At the time of interview, participants were aged 21–26, and resided in both urban and rural areas across Sweden.

A heterogeneity in ethnicity, sexual orientation, and language was represented, along with variations in levels of pre-migration school attendance (spanning 0–12 years), and duration of stay in the host country (spanning 3–12 years). Seven held permanent and nine temporary residence status. Some had also had their asylum claims rejected, and spent periods undocumented. All but two participants had finished upper secondary school in Sweden, and four held university degrees or were university students. Fourteen were employed. Relationship status varied among participants. Eight were mothers.

Data generation

Data generation spanned from June 2022-January 2024. MO conducted twenty-one interviews in total, with five participants taking part in follow-up interviews. Interview duration spanned from 47-138 minutes (average length: 72 minutes; total generated: 1445 minutes). All interviews were audio recorded and pseudonymised, before verbatim transcription (with the exception of one, where detailed notes were taken instead, upon the participant’s request).

CGT studies customarily employ unstructured interviewing, however, it was determined that developing a semi-structured interview guide minimised risks of posing questions that could be perceived as sensitive, difficult, excluding, or stigmatising. Applying the Guttmacher-Lancet Commission’s [1] definition of SRHR, and covering a broad variety of themes (see Fig 1), the guide was tested and refined. As a participatory component, referral group sessions were held with young adults who had experienced unaccompanied migration, professionals (including midwives, psychologists, cultural doulas, and counsellors), and NGO volunteers experienced in encountering unaccompanied girls. The guide was then continuously revisited and updated based on ongoing data generation and analysis, adding new questions to elaborate on unexplored areas, and test and validate potential theoretical findings.

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Fig 1. Initial themes explored in interviews.

https://doi.org/10.1371/journal.pgph.0005241.g001

Participants were free to choose interview format (eight chose in-person, three video call, and five via phone) and location. This was essential in respecting the need for confidentiality, while creating a safe and private space for sharing their experiences [62]. Consistent attention was given to signs of discomfort, facilitating pauses as needed. Participants were repeatedly reminded of their right to skip questions, or to retract or redact any answers given. To further promote safety, they were also offered to have a trusted person present during interviews (one participant chose her midwife).

All interviews were conducted in Swedish. Participants were offered an SRHR-trained interpreter, who was informed in advance on the interview’s aim and themes (three participants chose to have an interpreter present via phone).

Data analysis

Data analysis began during data generation; starting with initial reflection and memo writing after each interview, and followed by coding data, asking analytic questions, and comparing and categorising data [61]. Initial coding [63] was conducted manually by MO and JG, where line by line was read and coded. The first two interviews were coded independently, before being compared to observe consensus and difference. Initial interviews were then discussed in the research team, to consider interdisciplinary perspectives. Further and continuous coding was completed in a tandem process, comparing notes between MO and JG. This provided closeness to the data and led to new analytic questions needing exploration in further interviews [61]. Moving forward, focused coding [63] was conducted using NVivo, and a sketch model for plotting and synthesising codes was developed by MO and JG to visualise shifting SRHR needs pre, during, and post-migration. Plotting and synthesising was subsequently conducted both individually, and in the team by MO, JG, LD and HA. Regular methodological meetings were also essential in formulating additional questions to capture nuance in narratives. Theoretical coding followed [61], where identified patterns were further interpreted and elaborated on by MO and JG. Central patterns were then tested through further data generation. This process included theoretical sampling [61], which also involved returning to available participants with new theoretically grounded questions, and requesting elaboration on earlier responses. This served as a means of testing and validating the findings [61].

Finally, a storyline was conducted by MO, to reach a higher level of abstraction [64]. This involved moving away from the data, abstracting the stories from how they were told in interviews, and broadening explanations of codes and categorised data. The storyline was subsequently refined and enriched by the team’s interdisciplinary perspectives. Then, a comprehensive empirically grounded theoretical model was conceptualised by MO and JG, abductively reconstructing all empirical categories through the lens of intersectionality. This final step was guided by constant comparison, moving back and forth between codes, categories, and theoretical concepts, while remaining guided by analytical and theoretical questions [61].

Positionality and reflexivity statement

Our research team holds extensive experience engaging with questions of migration, sexual and reproductive health, paediatrics, socio-legal studies, and human rights - as researchers, lecturers, and clinicians. Therefore, positionalities held within the team have inevitably influenced methodological and analytical choices. Efforts to mitigate biases and strengthen validity were guiding in actively giving voice to the young women’s narratives. This involved continuously discussing data within the team, with a focus on how different positionalities offered different gazes and interpretations. Nonetheless, the team consists of European born, white (passing), academics, and thus, our lenses are inherently framed by these privileges.

Concerted efforts were made to apply an integrated interdisciplinary lens, requiring continuous individual and team reflection. Reflexivity was essential throughout this process in minimising disciplinary assumptions [61,65]. Further, practicing methodological self-consciousness was important; in reflecting on own beliefs and values, and maintaining awareness of one’s privileges, positions, and roles [66]. This also assisted in framing the researcher-participant relationship, and defining important intersecting factors, including power, identity, and marginality [66].

Ethical considerations

Continuous ethical reflection took place throughout the research process. All parts were conducted in accordance with the Declaration of Helsinki [67], and ethical approval was obtained from the Swedish Ethical Review Authority (ref: 2021-06983-01).

All participants were adults (over age 18) at the time of recruitment. Before consent was sought, detailed information about the study was provided repeatedly to all participants. First, professionals or volunteers informed potential participants about the study. If interest was expressed, a meeting with MO was arranged where further adapted information was elaborated on to ensure informed consent. All written information about the study was translated into four commonly spoken languages among unaccompanied children seeking asylum in Sweden.

All participants were reminded of their freedom to withdraw at any time, before, during, or after interviews, prior to the seeking of informed consent in written or verbal form. Following all interviews, participants were provided MO’s contact information, in case unwanted emotions arose and support was needed. Contact information to a registered nurse external to the research team, experienced in encountering migrant women, was also provided. Moreover, if healthcare needs were identified before or during interviews, healthcare access was facilitated. This assistance was provided regardless of whether study participation ensued.

Finally, confidentiality was prioritised in communicating this research. While excerpts from all participants are represented in the findings, all samples of data are presented without being linked to specific participants.

Experiencing structural hindrances to the fulfilment of SRHR needs pre, during, and post-migration

Being made a victim of violence

Most participants fled their countries of origin due to SRHR or GBV-related violations. One young woman shared what happened after she was raped as a girl: “[My parents] totally panicked. [A friend] said to leave fast […] ‘I’ll drive you, people are coming’ […] Commonly, they’ll stone the girl.” Several escaped forced marriages. Others received death-threats following being made victims of sexual violence, which was normalised, with victims often blamed. Additionally, reporting sexual violence to authorities entailed risks of further exposure: “[The police] wouldn’t help. Maybe they’d say, yes we can help but first [have sex] with me.” Some recalled being silenced when disclosing sexual assaults to their mothers: “Mum said […] ‘keep silent, don’t tell your father or anyone else.’” Others feared not being believed.

During migration, the girls’ experienced starvation, exploitation, and violence. Safety and support were absent. As one participant described: “I’d always been with family […] I wasn’t prepared to be alone, all alone, with strangers.” Trusting others was difficult, as even seemingly trustworthy people acted unpredictably. Everything felt like a surreal nightmare: “I landed in [transit country], and everything changed overnight.” They witnessed people die, younger children orphaned, drug use, prostitution, and people they loved being raped and murdered. Surviving the journey felt impossible and dependence on others became a matter of survival. Yet, dependence also increased risks of sexual exploitation, and objecting to exploitation could be dangerous. One participant shared how her employer became violent when she demanded her wages:

“One night, he unlocked our apartment and [raped] my friend […] It felt like chaos […] I couldn’t do anything because he [tied my hands and gagged me]. I couldn’t scream. She was bleeding heavily […] I didn’t know how to call the police, we didn’t have a phone. I didn’t know who could help us.”

Physical and sexual violence persisted post-migration in the host-country, including street harassment, groping, sexual assault, rape, and IPV. Disclosure, however, was rare: “[With my] psychologist, we talked about other stuff […] Sometimes you can’t tell anyone […] you’re ashamed.” A few filed reports, however, most cases were closed due to lack of evidence. One young woman who experienced HRV within her foster family said: “I was assaulted. I reported it to the police, but they did nothing […] My face was full of wounds, he nearly killed me, and threw me down the stairs […] They didn’t believe me.” Difficulties in meeting basic needs could also result in engaging in survival sex: “I was on the street. What could I do? […] He was very kind. I was grateful […] It wasn’t like he said I could live [at his place] without having sex with him.”

Challenges in claiming rights and the extinguishing of trust in public institutions

Barriers to SRHR-related services and support were apparent throughout narratives. All participants believed that, in their countries of origin, adolescents had no access to SRHR-related services, and gynaecological care was only available to married women. During migration, access was also difficult. Some became pregnant, in some cases due to rape, but with little knowledge on pregnancy symptoms, healthcare was sought relatively late. One girl discovered she was pregnant in a transit camp: “‘It’s impossible!’ They said ’no, you’re [eleven weeks] pregnant […] You only have one week to decide if you don’t want it.’” Dependence on others for healthcare access and covering costs while on the move was common: “They said, if I wanted [an abortion], I had to go to the hospital […] The smuggler paid for everything.”

Access to comprehensive sex education pre, during, and post-migration was extremely limited. Some had received SRHR information upon arrival in the host country. However, this focused primarily on anatomy, STIs, contraceptives, and reproduction. Moreover, mixed-gender groups in the learning environment made it feel unsafe to voice questions. Having never discussed sex and relationships before, these topics were strongly associated with shame and taboo, leading several girls to avoid attending. In hindsight, they wished they had received information about their rights in intimate relationships. As one young woman shared, knowing her right to autonomy and consent in sexual relationships was the most vital thing she learned in sex education: “That no one can force me.” They also wished they had received more information about the host country’s norms and values, as well as contraceptives, LGBTQ+ matters, STIs, handling emotions, biological, psychological, and social perspectives on lust and pleasure, pregnancy, infant care, and motherhood.

Participants shared how limited SRHR literacy had exposed them to risks; unplanned pregnancies, STIs, and being trapped in destructive relationships and IPV. One girl refrained from disclosing she had begun menstruating, as she feared sharing with adults could lead to forced marriage: “If you have your period […] you have to meet a boy […] I feared I’d have to meet a man.” Limited SRHR literacy meant that proactive decisions were rare, and situations were simply managed as they arose; sometime detrimentally redirecting their life course:

“To know your rights, it really matters […] If I’d known that I could use contraceptives before […] I didn’t know they existed […] It wasn’t appropriate to have children in my circumstances […] I wasn’t in a good relationship, I didn’t have residence status, my life was so chaotic. So had I known, I could’ve used it. But no one told me there was such protection.”

Broadly, the young women expressed a want for supportive SRHR-related services, but had never been asked about their SRHR needs. A lack of trust in public institutions also represented a significant barrier to accessing necessary services. Limited rights literacy among professionals often exposed them to mistreatment, and fears of discrimination, racism, and dismissal led to distrust and avoidance in seeking help. This also led to feelings of unworthiness, hopelessness, and, at extremes, suicidal thoughts. Contrary to Swedish law, one participant suffering long-term complications due to genital cutting was denied essential SRHR-related care: “I can’t urinate, I can’t live like this […] I’ve been to every youth clinic in town […] They said,’if you’re undocumented, we can’t help you.’ […] It’s good to follow the rules, but when it’s someone’s life?”

Knowing their SRHR needs and being able to advocate for their rights when facing different authorities was seen as crucial. However, claiming one’s rights represented a constant and exhausting struggle: “You must continuously be assertive […] to feel the safety others feel. I have the same rights, but don’t feel that safety. It’s really important to know your rights, and know how to speak up.”

Wading the acute uncertainties of the asylum process

During the asylum process, extended periods of uncertainty were experienced; due to rejected applications, temporary residence permits, or suddenly facing undocumentedness. Several girls struggled to survive daily. The asylum process itself deepened distrust, and sharing underlying reasons for seeking asylum, such as HRV, felt unsafe. Some girls were frequently relocated, preventing them from finding stability and establishing social bonds. Isolation further hindered them from seeking SRHR-related support. One participant shared: “I was silent the first five months […] I didn’t dare tell anyone [of severe menstrual pain]. I missed my mum.” Another said: “I don’t have anyone to talk to […]. First, I don’t know anyone, and second, I trust no one.”

Several experienced having their reproductive rights questioned due to their age and migration status, such as deciding if and when to have children. They felt deprived of rights others take for granted. One young woman shared how her right to have her partner’s support while giving birth was stripped from her when he was to be deported: “Doesn’t a child have a right to have their father there when they’re born […] Sometimes I think the rules are not for us [migrants] but for them [Swedes].”

Several of the young women had partners also in the asylum process. Some were detained in deportation centres, or had returned to countries of origin to apply for family reunification. Others, losing hope in Sweden, sought asylum elsewhere in Europe. Consequentially, families were split, significantly impacting the young women and their children.

Constructing pathways and strategies to remedy unfulfilled SRHR needs

Identifying strategies to minimise risks of bodily harm

As girls, many had identified strategies to protect themselves from physical and sexual violence. Early on, they learned to avoid certain streets, and always ensured someone knew of their whereabouts. Before migrating, they were aware of the risks of sexual violence along the journey: “The only danger I was prepared for […] on the way to Europe […] was the risk of someone raping me.” Yet, this risk was not new:

“If I stayed in [country of origin], I’d never be seen as fully human and would be raped. If not today, maybe tomorrow, maybe next week. The risk is constant […] It’s better to be moving toward your goal [if you’re anyway going to] get raped.”

During migration, economic means could help secure safer accommodation. However, a constant awareness of risks remained:”Even [with] higher economic status, it’s very vulnerable being the only women at the hotel […] with all the men […] and no one knows [we’re there].”

Even post-migration, perceiving safety was difficult. Some found that new strategies were needed, as previously identified strategies no longer applied:

“If a boy ran after me, [my] strategy [was] to run between cars [across the street]. It’s really dangerous […] but you take the risk […] When I came to Sweden, I thought ‘oh no, the streets are really broad here […] He’d catch me in the middle of the road.’”

Several were placed in youth homes for unaccompanied children, sometimes as the only girl there. Feeling unsafe, they developed strategies to protect themselves from unwanted attention and sexual harassment, including dressing and behaving more boyish, isolating oneself, avoiding male staff, or entering an intimate relationship with a housemate.

The protective nature of supportive social and intimate relationships and a need for caring role models

Throughout their lives, strong role models influenced their SRHR. Several participants describe their upbringing in their countries of origin as rather safe, surrounded by supportive parents, other meaningful adults, and friends. Some parents also publicly defended their daughters: “Every time I was hit [by teachers] at school, [my mother] went there and threatened [them].” Several girls witnessed adults questioning norms, and they were encouraged to marry for love, pursue education, and avoid financial dependence. Others felt parents feared for their safety due to their gender.

During migration, intimate relationships held great value and brought intense emotions. Some offered brief distraction, others longstanding solace and protection: “I was alone [and] it felt unsafe. What if I ended up somewhere […] But there, I met my husband.” A lust for experimentation relating to sexuality and intimacy was also expressed: “I was actually very curious, and wanted to do whatever I felt like. [I] wanted sexual freedom.”

Additionally, others offered key support along the way: “The interpreter gave me a business card, saying, ‘there’s an [abortion] doctor, he’s really nice […] He can help you.” In the host country, teachers, midwifes, foster parents, or legal guardians became meaningful role models: “She helped me a lot. She explained so much.”

Through conversations with friends and others, participants sought out support on sexual identity and orientation, sexual relationships, and handling unwanted advances. These discussions encouraged exploring one’s desires and body:

“My friend asked if I had masturbated […] ‘[If] you tell, I’ll tell!’ She said, ‘ok, I’ve done it a hundred times’ [laughs] and I said, ‘ok, I’ve done it too.’ My other friend said she hadn’t, but […] maybe she had, but felt ashamed […] I said, ‘try it, it feels good.’”

In the host country, conversations with others in marginalised positions, such as other girls of colour, and minority and activist communities (such as LGBTQ+ spaces), were also meaningful.

Needing time and space to recover and claim SRHR needs post-migration

Adapting to change and integrating new perspectives

Developing and integrating new SRHR-related perspectives required time. Landing, receiving support in handling trauma, and getting help with practical concerns were described as prerequisites to adapting. In most cases, this was delayed by asylum processes, as well as family reunification claims. While attempting to reunite with their partners (some, fathers to their children), family life felt suspended indefinitely. During these periods of existential uncertainty, their own SRHR needs were deprioritised and negatively affected.

As girls, some relied on their parents’ capacities in choosing a suitable partner. Post-migration this responsibility shifted: “I [still thought] parents decide who you [marry] […] Suddenly, I was responsible for deciding for myself.” Navigating new perspectives was a process, and with time, these were integrated. For example, many shared having shifted in their views regarding the freedom of all to choose their own identity, sexual orientation, and partner.

Distancing themselves from traumatic experiences required time and space. Trauma treatment and increased SRHR literacy facilitated this. Reading also helped in recognising feelings and interpreting experiences. One participant explained: “I read […] also to understand my own emotions […] I’d recognise myself in some article, or on YouTube […] It was so amazing to recognise myself in others.” Moreover, this also cultivated an awareness of contexts beyond their own. Some participants shared how being introduced to philosophical literature by their parents had also expanded their horizons: “I think it really came from the feminist literature and opinions, and a constant desire for justice and equality.”

Being given space, and the language to articulate what they had been through, they were able to reframe their traumatic experiences. As one young woman described, she could now shift blame away from herself for sexual abuse she had suffered: “If it happened again, I’d know it wasn’t my fault. I didn’t do [or choose] anything.” Moreover, when professionals asked about, and truly listened to what had happened to them, it eased the daily burdens of their past.

Striving for meaning and finding hope in community

Although struggle dominated all narratives, feeling welcomed provided moments of respite and recovery: “It gave me a lot of hope.” Some girls had arrived before more restrictive migration laws were implemented, affording them swifter pathways to asylum and permanent residence permits. This enabled them to pursue education and family reunification without extended uncertainty:

“They treated me very well. Not like they are treating others now […] I came in summer […] and got [asylum and residence permit] really fast […] in time to start school right away, as I had always wanted […] I said I needed my family […] and got started with everything for [reunification].”

Moreover, opportunities to explore their own SRHR views and needs, and shape their identities, were found in communities that welcomed their differences and allowed them to freely express themselves; cultivating a sense of meaning, joy, and belonging.

However, for many, loneliness, isolation, and uncertainties about asylum outcomes and residency permits suspended recovery. One participant described being housed alone in a hotel, in early pregnancy, without social network, while her partner sought asylum abroad. Imagining a future, then, seemed impossible. For others, living in the moment was the only means of coping with the past. Socialising was difficult, particularly when energy levels were low, and joy felt out of reach. Sharing their past also required a deep sense of trust, and was inhibited by desires to protect others from painful stories: “My friends […] they easily get upset over small stuff […] If I told them [about what I have been through], they’d feel very upset.”

No matter the life stage, all highly valued independence and a stable income. While some had been given opportunities to accomplish these, others dreamed of stability, safe accommodation, employment, and access to education. All aspired to further their education, and most had already finished an upper secondary degree. A few were students in universities, or had finished their degrees and joined the workforce. Moreover, with the passing of time, an increased level of agency was experienced, contributing to a belief that a desirable life could be created. Reflecting on what had been overcome could also give strength: “I feel like, wow, I’ve been through all this.”

Several described their experiences as offering them a unique perspective and desire to help others affected by war, conflict, and displacement. One young woman’s engagement sparked when she served as an interpreter for other unaccompanied children: “Back then […] they brought in [SRHR] but we didn’t listen […] But [later] I learned while interpreting for them. I think it’s extremely important information.” A commitment to social justice, human rights, and equal treatment was also present. One young woman aspired to empower girls to live free from oppression and sexual violence:

“I want them to feel that they’ll make it in life, without a man […] And even if problems arise, sexually, or with a man, or girl stuff […] the solution is in her daring to leave […] and that there is always a way out.”

Contributing to the well-being of others was also perceived as meaningful and identity-shaping: “Maybe the main reason I’m in medical school is to use this knowledge and education […] to lift a burden from another human being, and see the impact.”

Strengths and limitations

While this study contributes to an observed gap in the literature, several limitations must be addressed. The analysis relies on retrospective accounts. Memories are known to be reconstructed in relation to the present and future, and both deliberate and inadvertent misrepresentations can be included [77]. Narratives may also reflect participants’ self-image, and how they wish to represent themselves [78]. Yet, although younger individuals might have highlighted different experiences, this retrospective approach allowed for more developed perspectives and language in describing SRHR needs upon arrival.

Further, it is plausible that we failed in reaching the most isolated and at risk members of the included population. Sensitivities related to talking about SRHR also hindered some from taking part. Notwithstanding this, those we did reach showed a generous willingness to participate, and represent a diversity of backgrounds and experiences. Still, they may not be entirely representative. Most demonstrated high levels of agency. They sought independence, striving for financial autonomy and stability. Many also actively worked toward contributing to the wellbeing of others.

Conducting research with marginalised populations requires building trust, while mitigating inevitable power imbalances. Moreover, it has been argued that qualitative researchers in sexuality studies with marginalised populations take on a responsibility that spans beyond the scope of the study [79]. With recruitment and data generation in this study being conducted by MO, who is a doctoral candidate, a registered nurse, and a midwife, this entailed balancing both academic and clinical perspectives throughout. It also required an openness and sensitivity to the needs of participants, offering solicited advice and support where appropriate, as well as assisting them in accessing professional services when needed. All forms of support and assistance were discussed within the research team, with a focus on ethics, and offered before, in conjunction with, and after interviews.

While pre-existing knowledge on the phenomenon of focus may have resulted in a degree of bias within the research team, previously held expertise likely also benefitted the data generation process. The multidisciplinary and interdisciplinary competences within the research team allowed for observing the same phenomena from multiple perspectives, capturing aspects that might otherwise have gone unnoticed. Yet, being positioned as outsiders to the backgrounds and experiences of participants added complexity. Therefore, reflexivity and methodological self-consciousness [66] were guiding. This involved continued methodological and ethical discussions, debriefing of the interviewer, mapping identities of the researchers and participants, consideration of sensitivity, vulnerability, and cultural identity lenses, and addressing reflexive questions [65]. It also involved staying dedicated to flexible interview techniques, allowing for elaboration through participatory engagement while developing the interview-guide. Referral sessions with young adults with lived experience of unaccompanied migration ensured that the guide was grounded in perspectives from the population. This process also minimised the risk of posing questions that could be perceived as sensitive, difficult, excluding, or stigmatising. Furthermore, regular revisiting and refining of interview questions was conducted as long as data generation and analysis remained ongoing.

Finally, while participating in research has been found to be therapeutic for marginalised populations [3,79], talking about traumatic experiences can give rise to unwanted emotions and retraumatisation [80]. Notwithstanding this, several participants shared that taking part in this study and sharing their stories, in some cases for the first time, left them with a sense of relief.