Abstract
Adolescent-friendly health programs have been in place in Nepal since 2008, yet uptake of the services for sexual and reproductive health remains suboptimal. For uptake of these services to improve, a rich understanding is needed of the factors impacting their acceptance and utilization from the perspectives of adolescents, health care staff, and key community informants. This study applied a qualitative research design involving six focus groups with 52 adolescents and in-depth interviews with 16 adolescents, 13 key informants, and 9 health care providers from six adolescent-friendly health facilities in Nepal. Thematic analysis was conducted for data analysis. The key themes identified as barriers include access issues due to travel, institutional health care barriers, perceived lack of privacy and confidentiality, and the unprofessional attitudes of staff towards the sexual health needs of adolescents. These themes are underpinned by gendered ideology and a moral framework around the sexual behavior of adolescents. Interview responses suggested that health care providers take a policing role in prescribing adolescents’ conformity to this moral framework in their delivery of reproductive health care and services. While physical access to health services may be problematic for some adolescents, this is not the priority issue. Attention needs to be given to increasing the capacity of health care providers to deliver services without imposing their own and socially sanctioned moral frameworks around adolescent sexual behavior. Such capacity building should include training that is experiential and emphasizes the importance of confidentiality and non-judgmental attitudes.
Highlights
Adolescence is a unique period of physical, psychological, emotional, and social maturation from childhood to adulthood [1,2,3]
A total of 68 adolescents participated in the study: 52 of them took part in six focus group discussions (FGDs); and 16 adolescents participated in in-depth interviews (IDIs)
Interviews and FGDs with adolescents, health care providers (HCPs), and key informants (KIs) clearly revealed that distance to the nearest health facility was one of the major barriers to utilizing Adolescent-friendly health services (AFHS)
Summary
Adolescence is a unique period of physical, psychological, emotional, and social maturation from childhood to adulthood [1,2,3]. It is estimated that 21 million girls aged 15–19 years and two million girls aged under years become pregnant each year; million of the girls aged 15–19 years and around 2.5 million who are under 16 years give birth in low and middle-income countries [7]. The majority of these adolescent pregnancies are the result of an unmet need for contraception [8]—about half (49%) of adolescent pregnancies are unintended [8]. Pregnancy and childbirth can result in pregnancyrelated complications, which have become the leading cause of death among adolescent females aged 15–19 years [9]
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