Between Silence and Survival: Trauma, Pregnancy, and Post Traumatic Stress Disorder (PTSD) Among Adolescent Survivors of Sexual Violence in Kiambu County, Kenya

Abstract

Sexual violence–related pregnancy among adolescent girls in peri-urban Kenya produces layered biological, psychological, and structural vulnerabilities that standard PTSD frameworks only partially address. In Kiambu County, where poverty, gender inequality, and fragmented service systems converge, existing clinical approaches remain largely decontextualized, attending inadequately to structural determinants and the cultural landscapes through which trauma is experienced and expressed. This practice-based integrative review draws on clinical psychology, global mental health, and medical anthropology to develop a Structural-Intersectional Formulation (SIF) model for understanding and treating PTSD among low-income pregnant adolescent survivors of sexual violence in Kiambu County. Grounded in intersectionality theory, the social defeat hypothesis, and postcolonial critiques of psychiatric universalism, the SIF model re-orders traditional biopsychosocial formulations by placing structural conditions and cultural meaning-making at the centre of clinical reasoning, with individual cognitive and biological processes nested within them rather than treated as primary. This model is translated into concrete, actionable recommendations: idiom-sensitive and developmentally attuned assessment tools; structurally informed case formulation and care planning; culturally adapted Trauma-Focused CBT and Narrative Exposure Therapy within perinatal contexts; trauma-informed supervision frameworks; and integrated GBV and mental health service pathways embedded within antenatal care systems. Implications for practitioner training and policy reform are also addressed. The SIF framework aims to support more accurate identification of PTSD presentations and more ethically grounded, contextually responsive care for pregnant adolescent survivors in Kiambu and comparable low-resource settings, contributing to a broader shift away from individualised models of trauma toward approaches that genuinely reckon with structural violence, cultural context, and developmental vulnerability.