‘Accept the fact that we get older’: adolescents’ and young people’s perspectives of sexual and reproductive health in Cape Town, South Africa

A Tale Of Two Epidemics Within TWO Countries

BackgroundThe number of young people utilising sexual and reproductive health services in Pacific Island Countries and Territories remains poor despite the availability and the existence of the fundamental rights to access these services. Adolescents and youth need accurate information and timely access to contraceptives to prevent adverse consequences associated with unintended pregnancies, abortion, childbirth and untreated sexually transmitted infections. This scoping review identifies and analyses factors contributing to young people’s low access to sexual and reproductive health information and services in this region.MethodsGuided by the PRISMA Scoping review guidelines, we searched three databases (Medline Ovid, Scopus and CINAHL Complete) for peer-reviewed articles published between 1st January 2000 and 31st August 2020 that reported on factors, including barriers and enablers, affecting access to sexual and reproductive health information and services by young people living in Pacific Island Countries and Territories. We assessed the quality of each study according to the study designs, methods of data collection, data analysis and ethical considerations. All information was sorted and organised using an Excel Spreadsheet. Text data from published articles were charted inductively using thematic analysis with no predetermined codes and themes.FindingsFive hundred eighty-nine articles were screened, and only eight met the inclusion criteria outlined in this scoping review protocol. These eight articles reported studies conducted in four Pacific Island Countries and Territories: Cook Islands, Fiji, Papua New Guinea, and Vanuatu. Factors such as lack of accurate sexual and reproductive health knowledge and social stigma were the leading causes of young people’s limited access to sexual and reproductive health services. Cultural and religious beliefs also invoked stigmatising behaviours in some family and community members.ConclusionThis scoping review revealed that social stigma and judgemental attitudes imposed by family and community members, including healthcare providers, hinder young unmarried individuals in Pacific Island Countries and Territories from accessing sexual and reproductive health information and contraceptives. Alternatively, a non-judgmental healthcare provider is perceived as an enabler in accessing sexual and reproductive health information and services. Moreover, given that only a few studies have actually focused on young people’s sexual and reproductive health needs in the region, more research is required to fully understand the health-seeking behaviours of young people in their specific contexts.

The number of young people utilising sexual and reproductive health services in Pacific Island Countries and Territories remains poor despite the availability and the existence of the fundamental rights to access these services. Adolescents and youth need accurate information and timely access to contraceptives to prevent adverse consequences associated with unintended pregnancies, abortion, childbirth and untreated sexually transmitted infections. This scoping review identifies and analyses factors contributing to young people's low access to sexual and reproductive health information and services in this region. Guided by the PRISMA Scoping review guidelines, we searched three databases (Medline Ovid, Scopus and CINAHL Complete) for peer-reviewed articles published between 1st January 2000 and 31st August 2020 that reported on factors, including barriers and enablers, affecting access to sexual and reproductive health information and services by young people living in Pacific Island Countries and Territories. We assessed the quality of each study according to the study designs, methods of data collection, data analysis and ethical considerations. All information was sorted and organised using an Excel Spreadsheet. Text data from published articles were charted inductively using thematic analysis with no predetermined codes and themes. Five hundred eighty-nine articles were screened, and only eight met the inclusion criteria outlined in this scoping review protocol. These eight articles reported studies conducted in four Pacific Island Countries and Territories: Cook Islands, Fiji, Papua New Guinea, and Vanuatu. Factors such as lack of accurate sexual and reproductive health knowledge and social stigma were the leading causes of young people's limited access to sexual and reproductive health services. Cultural and religious beliefs also invoked stigmatising behaviours in some family and community members. This scoping review revealed that social stigma and judgemental attitudes imposed by family and community members, including healthcare providers, hinder young unmarried individuals in Pacific Island Countries and Territories from accessing sexual and reproductive health information and contraceptives. Alternatively, a non-judgmental healthcare provider is perceived as an enabler in accessing sexual and reproductive health information and services. Moreover, given that only a few studies have actually focused on young people's sexual and reproductive health needs in the region, more research is required to fully understand the health-seeking behaviours of young people in their specific contexts.

While much research has documented unsatisfactory sexual and reproductive health (SRH) awareness among young people in South Africa, understanding of gender differences in access to and evaluation of SRH information is limited. This paper concerned itself with men and women's informal sources and content of SRH, and gendered divergences around accessibility, evaluation, and impact of such information. Fifty sexual history narrative interviews and twenty-five narrative interviews with women were conducted with participants purposively sampled from a range of ages, cultural and racial backgrounds, and in urban and rural sites across five provinces in South Africa. Data were analysed using thematic analysis. While young women were more likely to learn about SRH information from family members, they also reported greater regulation concerning their sexuality. This could enhance stigma surrounding women's sexuality and hinder open communication. Men predominantly learned about sex through pornography and peers, which was reported to encourage sexual prowess to the neglect of practising safer sex. Lack of adequate SRH instruction for young people as revealed through the narratives had significant and often negative implications for men and women's early safer sex behaviours. In response to these insights, recommendations are offered to strengthen informal sources of SRH awareness.

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BackgroundSexual and reproductive health is a key component of young people’s right to health during their development years. However, in the health policies of many low-to-middle-income countries such as Sri Lanka, sexual and reproductive healthcare is primarily conceptualised and implemented through the lens of family planning, which has resulted in a lack of awareness about the diverse sexual and reproductive health needs of the growing adolescent and young adult demographic. Therefore, this study aims synthesise and analyse the evidence on the sexual and reproductive health information and services needs and preferences of young people in Sri Lanka.MethodsA systematic review of quantitative, qualitative, and mixed-methods studies on the sexual and reproductive health information and services needs of young people aged 10–24 years was carried out according to the ‘Preferred Reporting Items for Systematic Reviews and Meta-Analysis’ guidelines. Electronic searches were conducted in Ovid Medline, Ovid Embase, Ovid Global Health, and Ovid PsycInfo, for peer reviewed articles. Two authors conducted the full text screening, data extraction, and quality assessment independently. Data were extracted and analysed thematically.ResultsThe database search yielded 1198 results, of which 16 papers met the inclusion criteria and were included in the review. Overall, young people face multiple barriers relating to availability, accessibility, and quality when accessing formal youth friendly sexual and reproductive health services. Some of these barriers included embarrassment, fear of stigma, and lack of knowledge about available services. Our findings indicate that young women preferred to receive sexual and reproductive health information from their mothers, while young men preferred to seek information from their peers. In contrast, young people in included studies were less likely to prefer more formal sources of information and care, such as resources at their schools (teachers and the school curriculum), and trained healthcare providers.ConclusionsPotential strategies to improve sexual and reproductive health information and services in Sri Lanka to better meet the needs of young people include the education of parents and teachers, increased partnerships with young people to develop effective healthcare interventions, and tailored promotion of available youth-friendly resources. More research is needed on how sexual and reproductive health needs vary between young people from different socio-demographic groups.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24324-5.

Introductionin the Gambia, adolescents and young people make up 32% of the national population. Observations indicate that this population group lack access to quality information and services on sexual and reproductive health. This systematic review explored some sexual and reproductive health indicators relevant to adolescents and young people in the Gambia.Methodspublished studies on some sexual and reproductive health indicators were searched in PubMed, Google Scholar and African Journals Online. Moreover, national reference documents containing relevant in-country data on adolescents and young people's sexual and reproductive health were also collected and reviewed. Search terms for published studies focused on modern contraceptives, sexually transmitted infections (STIs) prevalence rates, availability and accessibility to sexual and reproductive health (SRH) services and adolescents and young people’s satisfaction with SRH services among adolescents and young people (aged 10-24 years).Resultsthe review showed that contraceptive prevalence rates among adolescents and young people in Gambia ranged from 7% to 9%. Reasons for low contraceptive prevalence among adolescents and young people included limited knowledge and access to sexual and reproductive health information and services, provider attitudes, stigma, shame, lack of money, cultural and religious misconceptions associated with contraception. Overall, the review found limited information on STI prevalence among adolescents and young people, with a single published study reporting a prevalence rate of 8.4%. In addition, inadequate counseling, complaints related to physical environment as well as the process of providing sexual and reproductive health services and information were significant factors associated with satisfaction with SRH services among adolescents and young people.Conclusionthis review provides important baseline data that may be useful for policymakers and program managers to improve adolescents and young people's sexual and reproductive health in Gambia.

BackgroundThe sexual and reproductive health (SRH) information needs of adolescent girls in developing countries are not being met.AimThe study explored the sexual and reproductive health information needs, information-seeking behaviour and barriers among adolescent girls in the Western Cape, South Africa.SettingThe study was conducted in the South eastern sub district of Cape Town metropole.MethodsThe study was conducted at one of the high schools in a highly populated area in the Cape Town metropole. Semi-structured interviews were conducted with 17 adolescent girls aged 16–17 years, who were recruited using purposive sampling techniques. The interviews were audio recorded and transcribed verbatim. Data were analysed using an inductive thematic analysis framework.ResultsThree themes emerged from the data: (1) adolescent girls exhibit limited awareness and comprehension of sexual and reproductive health; (2) the information-seeking behaviours of adolescent girls regarding sexual and reproductive health and (3) barriers to seeking information.ConclusionThe establishment of primary healthcare facilities that are friendly to adolescents, combined with impactful reproductive health education and improved parent–adolescent girl relations, is crucial for promoting sexual and reproductive health among adolescent girls.ContributionThe study offered valuable insights into the SRH information needs, information-seeking behaviour and barriers faced by adolescent girls in accessing SRH information sources and services. These barriers include lack of knowledge about SRH and contraception, challenges within family dynamics, difficulties accessing friendly healthcare services and encountering negative attitudes from healthcare professionals.

What about access to birth control and emergency contraception now that abortion rights are overturned?

BackgroundIt is not known whether post-traumatic stress disorder (PTSD) increases HIV-risk behaviours among young people in sub-Saharan Africa. We assessed associations of PTSD symptoms with sexual behaviour, HIV risk perception, and attitudes towards PrEP among young people taking part in the CHAPS community survey. We hypothesised that PTSD symptoms would increase sexual behaviours associated with HIV risk, hinder PrEP uptake and influence preference for daily versus on-demand PrEP.MethodsYoung people without HIV, aged 13–24 years, were purposively recruited in Johannesburg and Cape Town in South Africa, Wakiso in Uganda, and Chitungwiza in Zimbabwe, and surveyed on socio-demographic characteristics, PrEP knowledge and attitudes, sexual behaviour, HIV perception and salience, and mental health. PTSD symptoms were measured using the Primary Care PTSD Screen for the Diagnostic and Statistical Manual of Mental Disorders 5 (PC-PTSD-5). Logistic and ordinal logistic regression was used to assess associations between PC-PTSD-5 score and socio-demographic characteristics, sexual behaviour, HIV risk perception, PrEP attitudes, and substance use, adjusting for age, sex, setting, depression and anxiety.ResultsOf 1330 young people (51% male, median age 19 years), 522 (39%) reported at least one PTSD symptom. There was strong evidence that having a higher PC-PTSD-5 score was associated with reported forced sex (OR 3.18, 95%CI: 2.05–4.93), self-perception as a person who takes risks (OR 1.12, 95%CI: 1.04–1.20), and increased frequency of thinking about risk of HIV acquisition (OR 1.16, 95%CI: 1.08–1.25). PTSD symptoms were not associated with willingness to take PrEP, preference for on-demand versus daily PrEP, or actual HIV risk behaviour such as condomless sex.ConclusionsSymptoms consistent with probable PTSD were common among young people in South Africa, Uganda and Zimbabwe but did not impact PrEP attitudes or PrEP preferences. Evaluation for PTSD might form part of a general assessment in sexual and reproductive health services in these countries. More work is needed to understand the impact of PTSD on HIV-risk behaviour, forced sex and response to preventive strategies including PrEP.

To assess the effectiveness of youth centers in reaching adolescents with reproductive health information, life skills, and services, the Reproductive Health Research Unit in KwaZulu Natal and the Population Council conducted an assessment of 12 youth centers and their affiliated peer education programs. The centers were run by the KwaZulu Natal Department of Health, the loveLife program, and the Youth and Adolescent Reproductive Health Program. Researchers also examined young people’s use of condoms as protection against pregnancy and HIV/AIDS. Data sources for this study, conducted in 2000, were an inventory of youth center services, interviews with center staff and clients, service statistics, and community surveys of 1,399 young people aged 12–24 and their parents. As noted in this brief, the study found that many sexually active young people in South Africa are knowledgeable about the sexual transmission of HIV/AIDS but do not use condoms consistently. Service providers can do more to promote condom use among youth by placing condom dispensers in private places and counseling youth on correct condom use and safer sexual practices.

An understanding of the association between adolescents' sexual and reproductive health knowledge and their use of relevant services is needed to improve young people's sexual and reproductive health. Data from the National Survey of Family Growth were used to examine associations between sexual and reproductive health communication (parental and formal) and service use among 2,326 U.S. women aged 15-19 in 2002 and 2006-2008. Chi-square tests and multivariate logistic regression were used to assess relationships between adolescents' receipt of sexual and reproductive health communication from parents and formal (school, church, community) sources and their use of sexual and reproductive health services. The majority of adolescents had received parental (75%) and formal (92%) sexual and reproductive health communication; 43% reported recent service use. In unadjusted analyses, parental and formal communication were positively associated with service use. In regression models, overall parental communication remained positively associated with service use (odds ratio, 1.6); parental abstinence-only communication, which was not significant in 2002, was associated with reduced odds of service use for the pooled sample (0.4) and in 2006-2008 (0.3). Formal communication was not associated with service use. Further research is needed to assess whether comprehensive sexual and reproductive health communication facilitates adolescents' health care utilization. Examination of how communication sources, quality and content are related to service use is needed to understand adolescents' sexual and reproductive health knowledge and needs.

In Ghana, several qualitative studies have explored users' perspectives on conventional sources of sexual and reproductive health (SRH) information and factors which influence provision of and access in rural settings. However, there is a dearth of qualitative studies on healthcare provider (HCP) perspectives on factors that deter access to conventional sources of SRH information among young people in rural Ghana and innovative ways for addressing barriers. This study explored perspectives on barriers to traditional sources of SRH information and services and innovative ways of using mHealth technologies for addressing provision and access challenges among young people in rural Ghana. This study used a qualitative approach using in-depth interviews. Semi-structured in-depth interviews were conducted with HCPs in rural areas in three regions of Ghana between May and August 2021. Participants were selected from rural communities using the convenience snowball sampling and were interviewed via Zoom. The interviews explored the experiences and perceptions of HCPs on conventional SRH information and services and young people's access to this information and services. The interviews were audio recorded and transcribed verbatim. Data were analysed thematically using NVivo software version 12, following the approach outlined by Braun and Clarke. Twenty HCPs were interviewed for this study. The participants identified different sources of SRH information and services used by rural young people. Peers or friends, health facilities, health providers, and community settings were reported as the main services and sources of SRH information. Participants reported several barriers and challenges to the provision of and access to SRH information to young people, including socio-cultural norms, religious beliefs, unfriendly health facility environments, negative health providers' attitudes, lack of privacy and confidentiality resulting in unfriendly youth SRH services, distance, and financial challenges due to costs of transportation which limits rural young people's access to, and use of, SRH services. All the participants indicated that in addressing provision and access barriers, the use of mobile phones could be beneficial. This study highlights several barriers and challenges that deter provision of, and access to, SRH information and services for young people in rural Ghana. The findings indicate the use of innovative mobile health (mHealth) technologies may be one solution to some of the barriers and challenges.

Young people with disabilities (YPWD) face numerous challenges in accessing sexual and reproductive health information (SRH) and services, including stigma and discrimination related to their disability. Consequently, many YPWD are reluctant to seek health care and have a high unmet need for SRH services. This study set out to explore the barriers to accessing Sexual and Reproductive health information and services among young people with disabilities in a Ugandan border context - known for high rates of early sexual initiation. The findings aimed to contribute insights that support the development of inclusive healthcare policies aligned with the SDG commitments to leave no one behind. We conducted a qualitative study among 12 male and female YPWD (aged between 10 and 24 years) with physical disabilities and 7 key Informants in Kyotera border district. Data were collected through In-Depth Interviews and Key Informant Interviews. Thematic analysis was conducted on transcripts. This study identified three key thematic barriers to young people with disabilities in accessing sexual and reproductive health information and services: individual, community, and health facility barriers. Individual barriers included Limited awareness about the availability of SRH information and services and low self-esteem. Community barriers were beliefs and practices, while health facility barriers reported by YPWD were communication challenges, shortages of commodities, and negative provider attitudes. The intricate challenges confronted by young people with disabilities in accessing sexual and reproductive healthcare in Kyotera underscore the urgent requirement for comprehensive interventions, spanning various levels, to dismantle these multifaceted barriers and establish a more inclusive and accessible SRH environment.

Young people, particularly adolescent girls and young women, represent a growing proportion of those living with HIV. Edutainment programmes have been widely used throughout the world to “educate” and “entertain” audiences and tackle serious social issues in bold and engaging ways. This paper examines the extent to which an edutainment programme, MTV-Shuga, was reported to influence young people’s engagement with sexual and reproductive health (SRH) information in rural KwaZulu-Natal, South Africa. In 2019 we conducted eight community-based screenings of MTV-Shuga episodes followed by 25 individual in-depth interviews and 13 focus group discussions with young people aged between 15 and 30. Interviews were audio recorded and transcribed verbatim. Data analysis was thematic and complemented by constant comparison and deviant case analysis techniques. In this rural and poor setting with a high burden of HIV, young people exhibited high levels of awareness of SRH and HIV but had constrained access to services, and limited ability to engage with parents or guardians on SRH matters. MTV Shuga provided an entertaining guide of ways to navigate the risks that they faced in a way that resonated with them. The findings highlight the importance of enabling young people in rural areas to watch MTV Shuga with peers in a safe space in which discussion of the content is facilitated. There is also value in encouraging parents to watch MTV Shuga as a means of enabling discussions between children and adults in their lives about SRH matters.