title: Staying healthy "under the sheets": Inuit youth experiences of access to sexual and reproductive health and rights in Arviat, Nunavut, Canada.
abstract: Inuit youth are reported to experience considerably worse sexual and reproductive health and rights (SRHR) outcomes than Canadian youth in general, as evidenced through public health data on sexually transmitted infections, unintended young pregnancies and rates of sexual violence in Nunavut compared to national averages. Existing literature on Inuit SRHR has identified the impact of westernization and colonialism on health outcomes, though gaps remain in addressing youth- and community-specific experiences of SRHR.
  
  
  
  This study aims to generate youth-focused evidence on experiences of SRHR relating to access to care in Arviat in order to better inform locally authored interventions geared towards improving youth SRHR.
  
  
  
  ThePiliriqatigiinniqPartnership Community Health Research Model (PRM) developed by the Qaujigiartiit Health Research Centre was followed to generate data on youth experiences of SRHR support access in Arviat. In-depth interviews were conducted with 9 male youth (ages 17-22 years), 10 female youth (ages 16-22 years) and 6 community leaders (aged 25+). Snowball sampling was used to engage informants, and data analysis followed an approach similar to conventional content analysis, where emphasis was placed on "immersion and crystallization" of data, corresponding to the Inuit concept ofIqqaumaqatigiinniqin the PRM. Findings were continuously checked with community members in Arviat during the analysis phase, and their feedback was incorporated into the report.
  
  
  
  Youth in Arviat were found to face significant barriers to SRHR care and support. Three major themes emerged as important factors conditioning youth access to SRHR resources in the community: trust of support workers in the community; stigma/taboos surrounding SRHR topics; and feelings of powerlessness impeding female and lesbian/gay/bisexual/transgender/queer youth in particular from accessing care.
  
  
  
  The locally specific ways these themes emerged revealed important structural factors at play in the community, which seem to persistently work against youths' abilities to achieve good SRHR outcomes. To address poor micro-level health outcomes in Arviat, it thus appears that locally authored programming must take into account broader structural factors at the root of SRHR access barriers.
authors.affiliation: Faculty of Medicine and Dentistry, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Corosky
authors.affiliation: Faculty of Medicine and Dentistry, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Astrid
authors.initials: A
authors.lastname: Blystad
mesh_terms: D000293:Adolescent; D005260:Female; D006297:Health Services Accessibility; D006806:Human Rights; D006801:Humans; D007407:Interviews as Topic; D004930:Inuit; D008297:Male; D020957:Nunavut; D060728:Reproductive Health / Q000208:ethnology*; D000074384:Sexual Health / Q000208:ethnology*; D000072339:Sexual and Gender Minorities; D055815:Young Adult
keywords: Inuit youth; access to care; community-driven; health and rights; prevention; reproductive health; sexual health; structural barriers; structural factors; youth health