The study, led by Jamilah Sherally of the Athena Institute at VU Amsterdam together with colleagues from Leiden University Medical Centre, KIT Royal Tropical Institute, Radboud University, and the University of Amsterdam, was built on an unusual foundation. Nine refugee women living in the camp were trained and employed as co-researchers. They helped develop the research questions, recruited participants, collected data, and took part in collective analysis of the findings. Between August and October 2023, the team conducted six focus group discussions and 27 peer-to-peer interviews, in which women from the community spoke with one another rather than with external investigators. In total, 67 women from nine nationalities took part, with seven women contributing to both methods.

The participatory design was not merely a matter of convenience. Research with displaced populations has long been criticized for extracting information without returning any control over how it is framed or used. By using approaches drawn from Participatory Ethnographic and Evaluative Research, the team employed creative techniques such as body mapping, in which participants draw their experiences onto an outline of a human body; storytelling; photovoice; guided visualization; and a world café format of rotating small-group conversations. These methods are designed to allow women to express experiences that may be traumatic, taboo, or difficult to articulate in a conventional interview, and to position them as agents of change rather than passive subjects of research.

The title of the paper itself captures a recurring grievance. One participant’s words, quoted in the study, describe clinical encounters in which examinations were performed without explanation: women submitted to pelvic examinations without being told what was being looked for or why. That single complaint crystallizes a broader finding. What the women described as missing from their healthcare was not only access to services but respect, information, and autonomy. They wanted timely and equitable care, but they also wanted to understand their own bodies, to make informed decisions, and to be treated as competent adults rather than as bodies to be processed.

Using a socio-ecological model combined with an intersectional lens, the researchers organized the findings across multiple levels, from individual wellbeing to camp conditions to the structures of European migration governance. At the individual level, women emphasized mental health and health literacy as core components of sexual and reproductive health. Many described the psychological toll of prolonged uncertainty, and the way that anxiety, depression, and trauma shaped their capacity to care for themselves, their pregnancies, and their children. Information emerged as a recurring demand: women wanted to understand contraception, pregnancy, menstruation, infections, and their legal rights, in languages they could actually read and hear.

At the level of daily life, the study found that sexual and reproductive health was inseparable from material living conditions. The quality of accommodation, access to sanitation, and the adequacy of nutrition all shaped health outcomes in ways that no clinic could compensate for. Women described how inadequate food supplies affected pregnancies and breastfeeding, how shared and unsafe sanitation facilities compromised privacy and hygiene, and how the physical environment of the camp made it difficult to maintain basic reproductive health. Relational and religious support networks, the researchers found, served as important coping resources, but they operated within conditions that no amount of community solidarity could fully offset.

Safety emerged as a central and multidimensional concept. For the women in the study, safety meant far more than the absence of violence. It encompassed physical protection from assault and harassment, legal stability regarding their asylum status, food security, and access to reliable information. Protection from gender-based violence was a persistent concern, particularly for women traveling alone or heading single-parent households. The researchers note that needs were shaped by intersecting identities: legal status, single motherhood, and gender combined to produce distinct patterns of vulnerability and resilience among the women interviewed.

Perhaps the most striking analytical contribution of the study is its account of justice. The women articulated a demand for fairness that extended across the entire system they inhabited: asylum procedures conducted without arbitrary delay, non-discriminatory treatment within the camp, equitable access to healthcare, protection from gender-based violence, and an end to pushbacks, the forcible return of migrants across borders without any opportunity to apply for asylum, a practice that contravenes the principle of non-refoulement under the 1951 Refugee Convention. The authors frame this as reproductive justice in the fullest sense: reproductive autonomy, dignified conditions during pregnancy, safety for newborns, and even birthright citizenship for children born in displacement.

This framing matters because it reframes what health interventions should aim at. If the health needs of refugee women are produced by securitized migration governance, border violence, and precarious camp conditions, then distributing more contraceptives or adding antenatal appointments, while valuable, cannot address the root causes of poor outcomes. The authors argue that improving sexual and reproductive health in such settings requires tackling structural constraints on self-determination, information, food security, safety, legal stability, and dignified healthcare, and that this demands interdisciplinary and justice-oriented approaches rather than purely clinical ones. The study contributes to ongoing debates in reproductive and gender justice by demonstrating, in the authors’ words, how justice is lived rather than externally defined.

The methodological lessons may prove as influential as the substantive findings. The research received ethical approval from the Hellenic National Public Health Organization and was funded by the Dutch Research Council, and its design shows that rigorous qualitative research can be conducted with, rather than merely on, displaced communities, even in one of the most heavily controlled migration environments in Europe. The nine co-researchers are listed as authors, an acknowledgment that the knowledge produced belongs to the community that generated it. For policymakers and humanitarian organizations, the message is uncomfortable but clear: refugee women on Lesbos do not need to be studied again so much as listened to, and what they are asking for is not charity but the conditions under which health, autonomy, and justice become possible.

Subject of Research: Sexual and reproductive health needs of refugee women in the Mavrovouni camp on Lesbos, Greece

Article Title: “They looked at our vaginas but didn’t tell us why”: a participatory study on sexual and reproductive health needs of refugee women on Lesbos, Greece

Article References: Sherally, J., Grossek, G. M., Alshamari, Z., Bari, L. B., Beshir, E., Hosseini, Z., Jafari, H., Jafari, M., Mohamed, K., Mohammadyasin, S., Mobaki, K., van den Akker, T., Le Mat, M. L. J., & van den Muijsenbergh, M. (2026). “They looked at our vaginas but didn’t tell us why”: a participatory study on sexual and reproductive health needs of refugee women on Lesbos, Greece. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03024-5

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03024-5

Keywords: sexual and reproductive health, refugee women, participatory action research, Lesbos, Mavrovouni camp, reproductive justice, intersectionality, gender-based violence, migration governance, health literacy, Greece, qualitative research

Generalized anxiety disorder, or GAD, is characterized by excessive, difficult-to-control worry that interferes with daily functioning. Rates of anxiety have been rising in the United States, particularly among adults under fifty and among women, whose risk exceeds that of men. Worsening mental health among pregnant and parenting women of low socioeconomic status has raised alarms in the maternal health community, because untreated anxiety threatens both mothers and children. Yet scientists have struggled to identify modifiable, upstream drivers of anxiety in marginalized groups, and research explicitly linking manifestations of structural racism to GAD has remained rare. The SECURE investigators argued that residential eviction, which disproportionately affects Black women and children, is one such discernible consequence of structural racism, and that the specific experiences of Black women have been largely absent from the scientific record, a gap the researchers attribute in part to misogynoir, or the systematic dismissal of Black women’s testimony.

The SECURE Study recruited self-identified Black women aged eighteen to forty-five who were parents or had a parenting role and lived in Wayne, Oakland, or Macomb counties in Michigan. Between July 2021 and July 2024, participants completed online or telephone surveys, yielding a final sample of 1,428 women, a remarkable 91.1 percent response rate among confirmed eligible participants. Crucially, the study was designed as participatory action research: a Community Advisory Board of Black women local, national, and international leaders helped shape the survey questions in culturally appropriate language, interpreted the findings, and are named coauthors on the paper. This structure was not merely symbolic; it shaped how eviction itself was measured, distinguishing five separate exposures: eviction during childhood, ever experiencing a court-ordered eviction, ever experiencing an illegal eviction, a court-ordered eviction in the past two years, and an illegal eviction in the past two years.

In Michigan, a lawful eviction requires written notice of a lease violation, a court filing, a judicial eviction order, and a physical removal carried out by a court officer or sheriff. An illegal eviction bypasses all of these protections: the landlord or their representative simply forces a resident out. Anxieties were assessed with the GAD-7, a validated seven-item scale on which participants rated how often they were bothered by symptoms such as nervousness, uncontrollable worrying, restlessness, irritability, and fear that something awful might happen. The scale showed excellent internal consistency in this sample, and scores of fifteen or above, indicating severe symptoms, were analyzed as the outcome. Roughly one in three participants screened positive for moderate or severe anxiety symptoms in the previous two weeks, with about sixteen percent falling into the severe category.

The headline result emerged with striking clarity. In unadjusted analyses, all five eviction measures were associated with elevated risk of severe anxiety symptoms, with relative risks ranging from roughly 1.3 to 2.0. After statistical adjustment for age, income, marital status, education, employment, enrollment year, current housing tenure, and prior clinician-diagnosed anxiety and depression, most associations attenuated. But one held firm: women who reported an illegal eviction in the past two years had 46 percent higher risk of severe GAD symptoms than women with no such experience, a finding that remained statistically significant with a confidence interval of 1.03 to 2.07. A sensitivity analysis comparing women illegally evicted more than two years earlier against those with no lifetime history found no elevated risk, while recent illegal eviction conferred fifty-two percent higher risk, sharpening the picture of a potent, time-sensitive association that resembles an acute threat response rather than a lasting scar of past displacement.

The study’s design cannot prove causation, and the authors are careful on this point, acknowledging possible recall bias and the cross-sectional nature of the data. Yet they argue the estimate is likely conservative, given that half of the sample reported some eviction experience, that prior mental health diagnoses may themselves lie on the pathway between eviction and anxiety, and that self-report is the only feasible way to measure illegal eviction, since such displacements never enter court records. Notably, the researchers found no evidence that Black women are more likely to misremember major life events than other groups, undermining a common methodological objection to within-group research built on lived experience.

The qualitative arm of the study adds the texture that numbers alone cannot supply. Of the ninety-five women reporting a recent illegal eviction, seventy-seven also answered open-ended questions about why they were put out and what their landlords did. Thematic analysis of their responses revealed seven recurring themes. Reasons for illegal eviction included landlord conflict, abuse, and fraud, such as retaliation against tenants who filed discrimination complaints or who knew their rights; landlord neglect, including refusal to repair infestations and dangerous conditions; gentrification, property sales, and unaffordable rent increases; and family or neighborhood conflict. One participant described being deceived by a landlord who ‘came and lied to the police to remove us’ after a court had failed to displace her. Another, seven days late on rent, received a fraudulent notice that mimicked a court document and left within a week, unaware she had a right to stay.

The methods of displacement were often overtly coercive, fitting what researchers call ‘self-help’ eviction: changing the locks while tenants were away, shutting off water and utilities, removing belongings to the street, sending threats by text and email, calling police with false reports, and arriving with groups of people to intimidate. Participants described daily harassment, destroyed property, and inspections they could not refuse. The authors contend that such experiences produce exactly the cognitive conditions that sustain generalized anxiety: anticipatory worry, hypervigilance, an inability to plan, and a pervasive sense of ongoing threat. Because illegal evictions are sudden, violent, unpredictable, and offer no immediate legal recourse, they may generate an intolerable level of uncertainty, a known driver of GAD. The researchers go further, framing the incomplete enforcement of tenant protections as a form of state-sanctioned violence, and drawing a parallel to police brutality, which has likewise been linked to hypervigilance and anxiety in Black communities.

The implications reach well beyond psychology clinics. More than one in three participants carried a prior diagnosis of anxiety or depression, and even after adjusting for those diagnoses, the association between recent illegal eviction and severe symptoms remained strong. People with GAD face elevated risks of additional mental and physical health conditions, and identifying modifiable upstream causes is therefore a public health priority. The authors argue that addressing the dual crises of eviction and poor mental health among reproductive-age Black women is essential to maternal and child health equity, and they call for a layered response: emergency support and mutual aid for those experiencing illegal eviction, trauma-informed interventions, stronger enforcement of tenant rights, and structural solutions including policy change and government-funded reparations for descendants of enslaved people in the United States. As the first and most comprehensive study of its kind, built with rather than merely about the women it studied, the SECURE investigation transforms a largely invisible form of housing violence into measurable scientific evidence, and sends a clear signal that where eviction law ends and landlord whim begins, the mental health consequences are anything but abstract.

Subject of Research: Associations between illegal residential eviction and severe generalized anxiety disorder symptoms among reproductive-age Black women

Article Title: Illegal eviction and risk of severe anxiety disorder symptoms: Qualitative and quantitative data from the Social Epidemiology to Combat Unjust Residential Evictions (SECURE) study

Article References: Sealy-Jefferson, S., Ross, L. J., Mishra, S., Sanders, K., Anderson, T., Anderson-Mays, T., Oneal, R., & Jones-McBryde, C. (2026). Illegal eviction and risk of severe anxiety disorder symptoms: Qualitative and quantitative data from the Social Epidemiology to Combat Unjust Residential Evictions (SECURE) study. SSM – Mental Health, 10, Article 100699. https://doi.org/10.1016/j.ssmmh.2026.100699

Image Credits: AI Generated

DOI: 10.1016/j.ssmmh.2026.100699

Keywords: illegal eviction, generalized anxiety disorder, Black women, structural racism, housing instability, maternal health, SECURE study, GAD-7, self-help eviction, tenant rights, reproductive justice, Michigan