Perceived Sexual and Reproductive Health Needs and Service Utilization among Higher Secondary School Students in Urban Nepal

Abstract

Introduction: Adolescent sexual and reproductive health (ASRH) is best addressed through the promotion of responsible, healthy behavior and the provision of age-appropriate services. This study aimed to assess Nepali adolescents’ perceived ASRH service needs and factors influencing their utilization of ASRH services. Methodology: This descriptive cross-sectional quantitative study was based on a structured, self-administered questionnaire of adolescents aged 15-19 (n = 338) in three government-run higher secondary schools in Bhaktapur, Nepal. Descriptive data was used to summarize socio demographics, sexual activity, and awareness and usage of SRH services. Chi-square and Fisher’s exact tests and binary logistical regression modeling were used to identify factors influencing ASRH service utilization. Results: ASRH service utilization was 9.2% among all respondents. Service utilization was lower among female (4.3%) than males (12.5%). Fifteen percent of students had ever felt a need to access ASRH services, a larger percentage than those who had accessed ASRH services (9.2%). Almost 37% intend to utilize ASRH services in the future. Students attending secondary schools that included ASRH in the school’s health services were 15 times more likely to utilize ASRH services(Adjusted OR: 14.85). The distance from health facility (Adjusted OR: 12.80) and being sexually active within 12 months (Adjusted OR: 10.31) were found to be associated with ASRH service utilization. Those who perceived barriers to services were more likely to utilize the services (Adjusted OR: 7.05).Lack of confidential services was the biggest barrier (71.4%),while friend and peer group influence (86.7%) was a major motivator to access ASRH services. Conclusion: ASRH service utilization among the adolescents is very low, with a gap between perceived needs and service utilization. Students who have accessed ASRH services are more likely to report that they perceived barriers, demonstrating that logistical difficulties may be considerable. Accessibility should be expanded.