Structural interventions to reduce harms & promote the capabilities of girls experiencing multiple complexities: A scoping review

Background: Structural interventions have the potential to reduce complexity in the lives of marginalised cis girls/young women and promote their health and well-being so that they have improved chances to reach their potential. However, most interventions available for this group focus on the micro/psychological level of wellness, risks associated with sexualized violence, and behaviour -based interventions which do little to address the root causes of complexity in their lives. Our scoping study was conducted to identify structural interventions, those that improve the environmental contexts within which health is produced and reproduced, that exist and have been evaluated for marginalised girls around the globe. Methods: The scoping review methodology was based on the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. Six databases were searched up to November 16, 2021. Results: The search strategy yielded 2,009 unique articles, of which 45 met the criteria for final inclusion. Studies included were from the United States (34), Canada (2), Australia (1), Italy (1), Norway (1), Portugal (1), Scotland (1), Wales (1), and Sub-Saharan Africa (1; Rwanda, South Africa, Ghana). Twenty family -level, 13 child -level, seven youth -level, and three community -level interventions were identified. Evidence from this scoping review suggest that early interventions, especially for disadvantaged mothers from low socioeconomic and racialized backgrounds, that support their parenting capabilities and empower them through equalizing material supports like housing, food, and clothing, have positive outcomes for children's development and holistic health across the life course. Conclusions: Few structural interventions were identified that focus specifically on cis girls/young women, suggesting the systems that are in place are currently failing them. Our findings nevertheless contribute to an improved understanding of ways trauma -informed and culturally appropriate structural interventions can address complexity in their lives. This work will inform ways that policy makers can improve access to equitable, inclusive, culturally safe, harmonized, and adaptable services for marginalised girls in Canada and elsewhere.