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Uganda is the largest refugee-hosting nation in sub-Saharan Africa, with 1.5 million refugees forcibly displaced in the country. The effects of forced displacement include extreme poverty, psychological trauma, and poor access to social services, further exacerbating food insecurity and poor well-being. Adolescent and young mothers living in forced displacement are at the nexus of social and health disparities, they are usually burdened with the challenges of transitioning to motherhood at a key developmental life stage, may experience interrupted school education, and often have few employment opportunities. This study aimed to explore if motherhood was associated with food insecurity and psychological wellbeing among Adolescent and young women (AGYW) (16-24 year) living in informal settlements in Kampala, Uganda. We hypothesis that motherhood among AGYW will be associated with higher food insecurity and poor psychological wellbeing compared to AGYW who are not parenting.
Methods:
We collected survey data with refugee AGYW living in informal settlements Kampala, Uganda. In June 2022, peer researchers recruited refugee youth aged 16–24 years living in informal settlements in Kampala to participate in this study. Participants were selected through purposive sampling from five informal settlements (Nsambya, Katwe, Kabalagala, Kansanga and Rubaga) and were enrolled following written informed consent. Food insecurity was assessed using US household food security survey module and psychological well-being was measured using the 5-item World Health Organization Well-Being Index. We performed descriptive analysis to examine sociodemographic characteristics of the participants. Binomial regression models were fitted for all variables by motherhood status and associations with significant level of p < .05 were included in the age and employment-adjusted multivariable logistic regression model.
Results:
Our analysis included 147 AGYW with a mean age of 20.8 years (Standard Deviation (SD): 2.05), participants with children had a mean age of 22.6 (SD: 1.66) while participants without children had a mean age of 20.5 (SD: 1.97). About one-tenth (15.3 percent; number (n)=17) of AGYW had children, and of the AGYW with children, the majority had one child (76.4%, n=13). Over 80% (n=27) of AGYW without children were employed which was significantly higher than the almost one-fifth (18%, n=5) of AGYW with children who were employed (Chi squared test=11.6, p<0.05). Having children was associated with greater likelihood of reporting poor psychological well-being in the bivariate model (Odds Ratio (OR): 1.07, 95 percent confidence interval (CI): 1.06–1.12) but in the adjusted multivariate model the association was not significant. Food insecurity remained statistically significant in both bivariate and multivariate analysis. Having children was associated with over twice the odds of being food insecure (adjusted OR: 2.63, 95 percent CI: 1.03–6.75) compared to not having children.
Conclusions and Implications:
We found a range of social inequities with parenting refugee AGYW, including lower employment and increased food insecurity. Findings suggest the urgent need for food insecurity interventions for refugee young adolescent mothers in Kampala. Future studies should explore the context-specific food insecurity drivers and interventions tailored for young refugee parents in Kampala’s informal settlements.