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Initiation rituals such as hazing, bullying, and ragging, as it is referred to in Sri Lanka, is a global phenomenon and has become a serious public health problem. Students are bullied and harassed by senior students causing them to suffer severe adverse consequences including depression, increased university dropouts and suicide. Although this has led to a significant burden on the country, research on ragging is scarce. The aim of this study was to explore the perceptions of students concerning the phenomenon of ragging and to understand how ragging affects student life and culture at the University of Jaffna, Sri Lanka. This paper is based on 17 focus group discussions with male and female students of Sinhalese, Tamil, and Muslim ethnicity. Thematic analysis was employed to navigate through the theoretical lenses of structural violence, intersectionality, and social dominance. The findings revealed how students perceived ragging differently; as an expression of power to initiate order and as a way to express dissatisfaction towards social inequalities occurring within the larger society or to facilitate bonds between university students. Students trivialized violence related to ragging and accepted it as a part of the university subculture despite being aware of the dire consequences. There was a described cyclical nature to ragging whereby victims become perpetrators. The student’s perspective appeared to be a missed opportunity in finding feasible solutions to a societal problem that must take all parties involved, into consideration.

Background The prevalence of mental health disorders is known to be high among university students globally. Currently there are only a few studies on depression among university students in Sri Lanka. The aim of this study was to screen for the prevalence of Major Depressive Disorder (MDD) and other forms of depression, and to evaluate the factors associated with MDD. Methods A cross sectional survey using the Patient Health Questionnaire (PHQ-9) was conducted among 637, second-year students from the faculties of Management Studies & Commerce, Science and Medicine at the University of Jaffna, during the Coronavirus (COVID-19) pandemic. Bivariate associations were assessed using chi-squared tests. Logistic regression was used to evaluate factors associated with any type of ragging. Results MDD was considered to have been experienced by 31% of the students. From all three faculties, 70% of the students claimed to have experienced some form of depression ranging from mild to severe. The factor associated with MDD was the students’ ethnicity. Conclusion Due to the high MDD risk among university students, it is imperative to develop psychosocial interventions to ensure early detection of mental health disorders and provide adequate support to safeguard this vulnerable population.

Background It is widely recognized that migrant women from low-income countries are considered to be a group with increased obstetric challenges. To address these challenges, cultural doulas were introduced to provide continuous emotional and practical support during childbirth in Sweden. Leveraging their shared cultural background, language skills, and understanding, the idea behind these doulas was supposed to facilitate effective communication between the woman, her partner, and healthcare staff, with the assumption that this would lead to better maternity care for migrants. The aim of this study was to explore healthcare providers reflections on the role of cultural doulas and to explore their perceptions of cultural doulas’ impact on childbirth. Methods A qualitative study was conducted in 2022, involving semi-structured interviews with 18 healthcare providers; obstetricians and midwives from two Swedish counties. The data was analyzed using reflexive thematic analysis and discourse analysis, guided by Bacchi’s ‘What Is the Problem Represented to Be?’ approach. Results Using Bacchi’s ‘What Is the Problem Represented to Be?’ approach, the analysis highlights how healthcare providers interpreted cultural doulas as an asset in relation to problems in migrants’ maternity care. Three key discourses that emerged were: underlying social and cultural factors, assumptions of improved outcomes and integration, and cultural doulas as informal interpreters. Instead of emphasizing medical risks, healthcare providers focused on social risks and overlooked the importance of professional training. Conclusions Cultural doulas are recognized as valuable in addressing gaps in migrant maternity care, yet their role presents a paradox. Entrusting the care of high-risk migrant women to minimally trained non-medical professionals paradoxically risks miscommunication and compromised care quality. Insufficient training, unclear roles, and the overextension of cultural doulas further exacerbate this issue, underscoring the need for systemic reforms. To resolve this paradox and improve maternal outcomes, the maternity care system must redefine the role of cultural doulas, prioritize professional interpretation services, and implement integrated care models tailored to the evidence based medical needs of migrant women.

Ragging is an initiation ritual practiced in Sri Lankan universities for generations, although research is scarce. This practice has several adverse consequences such as physical, psychological, and behavioral effects and increased university dropouts. The aim of this study was to investigate the prevalence of different types of ragging: emotional/verbal, physical and sexual ragging, self-perceived health consequences, help-seeking behavior, and factors associated with the experience of ragging. A cross-sectional study was conducted among 623, second- and third-year students from the medical, and technology faculties in Jaffna University. Bivariate associations were assessed using chi-squared tests. Logistic regression was used to evaluate factors associated with any type of ragging. Ragging was experienced by 59% of the students, emotional/verbal ragging being the most common. A total of 54% of students suffered one or more health consequences and mainly sought help from friends and family, with few seeking formal help. Factors associated with any type of ragging were faculty and year of study. This study emphasizes the urgent need to address this public health problem. It is important that there are adequate student support services, planning and implementation of effective interventions, as well as ensuring that existing policies are strengthened, to reduce or eliminate ragging in Sri Lanka.

Ragging is an initiation ritual carried out in Sri Lankan universities, where new students are harassed by senior students. This practice has severe adverse consequences including depression, increased university dropouts and suicide. Although this is a significant public health problem and a burden on the country, research on ragging is scarce.This thesis aimed to investigate and gain a deeper understanding of the phenomenon of ragging, through the various perspectives of students and individuals attached to the University of Jaffna, Sri Lanka. The prevalence of Major depressive disorder (MDD) among the students was also examined.Paper I, a cross-sectional survey, demonstrated that 59% of the students from the faculties of Medicine and Technology experienced ragging. Health consequences were experienced by 54% and help was mainly sought from friends and family. The student’s faculty and year of study was associated with ragging.In Paper II, 17 focus group discussions (FGD) were conducted with students representing all faculties. Thematic analysis was employed to navigate through the theoretical lenses of structural violence, intersectionality, and social dominance. Findings revealed students used ragging as an expression of power to initiate order and express dissatisfaction towards social inequalities. Students trivialized violence despite being aware of the dire consequences.In Paper III, 11 semi-structured interviews and seven FDGs were conducted with staff and work-affiliated individuals at the university. Foucauldian Discourse Analysis and Bandura’s Moral Disengagement theory were utilized to interpret the findings. The main discourses were; Ragging as normal and necessary, Insecurity and fear of reprisal, and Voices of resistance. Participants felt unsupported and in order to survive in this insecure environment, they adapted their moral judgments.In Paper IV, Patient Health Questionnaires (PHQ-9) were used to screen for MDD among students (n=637), from Faculties of Management, Science and Medicine. MDD was experienced by 31% of students. Among all the student participants, 70% had experienced some form of depression ranging from mild to severe. MDD was associated with the student’s ethnicity.Interventions targeting both individual and multisectoral levels are needed in order to curb ragging, and create a safe and nurturing environment for all.

Initiation rituals such as hazing, bullying, and ragging, as it is referred to in Sri Lanka, is a global phenomenon and has become a serious public health problem. Students are bullied and harassed by senior students causing them to suffer severe adverse consequences including depression, increased university dropouts and suicide. Although this has led to a significant burden on the country, research on ragging is scarce. The aim of this study was to explore the perceptions of students concerning the phenomenon of ragging and to understand how ragging affects student life and culture at the University of Jaffna, Sri Lanka. This paper is based on 17 focus group discussions with male and female students of Sinhalese, Tamil, and Muslim ethnicity. Thematic analysis was employed to navigate through the theoretical lenses of structural violence, intersectionality, and social dominance. The findings revealed how students perceived ragging differently; as an expression of power to initiate order and as a way to express dissatisfaction towards social inequalities occurring within the larger society or to facilitate bonds between university students. Students trivialized violence related to ragging and accepted it as a part of the university subculture despite being aware of the dire consequences. There was a described cyclical nature to ragging whereby victims become perpetrators. The student's perspective appeared to be a missed opportunity in finding feasible solutions to a societal problem that must take all parties involved, into consideration.