Provision Of Sexual Health Services Research Articles

57. Pilot Study: Impact of a Pediatric and Adolescent Gynecology Rotation on Confidence in Provision of Adolescent Sexual and Reproductive Health Services Among Pediatric Residents

57. Pilot Study: Impact of a Pediatric and Adolescent Gynecology Rotation on Confidence in Provision of Adolescent Sexual and Reproductive Health Services Among Pediatric Residents

Patients' and health care providers' perspectives of sexual and reproductive health services for people with disability: a scoping review protocol.

The objective of this review is to summarize the nature and focus of research that has been conducted into patients' and health care providers' perspectives of sexual and reproductive health access for people with disability. Article 25 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) requires people with disability to be provided with equitable access to sexual and reproductive health services. However, there are few scoping or systematic reviews examining the provision of inclusive sexual and reproductive health services to people with disability. Current and planned reviews are either not inclusive of a full range of disabilities or geographical regions, are limited to reproductive health, or focus exclusively on the perspectives of health professionals. Qualitative, quantitative, mixed method studies, and gray literature concerning sexual and reproductive health service access for people with disability will be included. The UNCRPD definition of disability will be adopted, together with a multidimensional conceptualization of "access." The review will be conducted in accordance with JBI methodology. A search strategy has been developed for MEDLINE, Embase, CINAHL, and gray literature. After de-duplication, results will be independently screened against the inclusion criteria by 2 reviewers. There will be no geographical limitations, but non-English-language publications will be excluded. Only literature published after the UNCRPD came into effect (May 3, 2008) will be included. Charting tools will be used for data extraction, and results will be presented in descriptive, diagrammatic, and tabular formats.

Disruptions of sexually transmitted and blood borne infections testing services during the COVID-19 pandemic: accounts of service providers in Ontario, Canada

BackgroundSince the onset of the COVID-19 pandemic in March 2020 in Canada, the availability of sexual health services including sexually transmitted and blood-borne infection (STBBI) testing has been negatively impacted in the province of Ontario due to their designation as “non-essential” health services. As a result, many individuals wanting to access sexual healthcare continued to have unmet sexual health needs throughout the pandemic. In response to this, sexual health service providers have adopted alternative models of testing, such as virtual interventions and self-sampling/testing. Our objective was to investigate service providers’ experiences of disruptions to STBBI testing during the COVID-19 pandemic in Ontario, Canada, and their acceptability of alternative testing services.MethodsBetween October 2020-February 2021, we conducted semi-structured virtual focus groups (3) and in-depth interviews (11) with a diverse group of sexual health service providers (n = 18) including frontline workers, public health workers, sexual health nurses, physicians, and sexual health educators across Ontario. As part of a larger community-based research study, data collection and analysis were led by three Peer Researchers and a Community Advisory Board was consulted throughout the research process. Transcripts were transcribed verbatim and analysed with NVivo software following grounded theory.ResultsService providers identified the reallocation of public health resources and staff toward COVID-19 management, and closures, reduced hours, and lower in-person capacities at sexual health clinics as the causes for a sharp decline in access to sexual health testing services. Virtual and self-sampling interventions for STBBI testing were adopted to increase service capacity while reducing risks of COVID-19 transmission. Participants suggested that alternative models of testing were more convenient, accessible, safe, comfortable, cost-effective, and less onerous compared to traditional clinic-based models, and that they helped fill the gaps in testing caused by the pandemic.ConclusionsAcceptability of virtual and self-sampling interventions for STBBI testing was high among service providers, and their lived experiences of implementing such services demonstrated their feasibility in the context of Ontario. There is a need to approach sexual health services as an essential part of healthcare and to sustain sexual health services that meet the needs of diverse individuals.

Jail Provision of Pregnancy and Sexual Health Services in Four Midwestern States.

Women incarcerated in local jails have pregnancy and sexual health needs, yet little information is available about what services are provided and how jail administrators prioritize this care. Our objective was to document jails' provision of pregnancy and sexual health services in four states in the Midwest. We invited all jail administrators (N=347) in Kansas, Missouri, Iowa, and Nebraska to participate in a web-based survey conducted from November 2017 to October 2018. We asked administrators which pregnancy and sexual health services they offered and to rate the importance of offering services. Results were analyzed using descriptive statistics and logistic regression. The survey response rate was 55% (192/347). Jails most often provided pregnancy testing (n=116 [60%]) and distribution of prenatal vitamins (n=85 [44%]). Sexually transmitted infection treatment was offered at 23% of jails (n=45). Larger, accredited jails located in urban areas and with high numbers of clinical providers on staff were more likely to provide sexual health services. Jails with privately contracted health care were more likely to provide pregnancy services compared with other entities providing medical care. The most prioritized sexual health service was sexually transmitted infection testing, with 39% of administrators believing it was important. Only 6% of administrators responded that contraception was important. Local jails in the Midwest do not meet the basic reproductive and sexual health needs of women. Provision of these services is not a priority for jail administrators. Appropriate partnerships could engage administrators and increase the availability of services to meet the needs of women in jail.

Factors Affecting the Providing of Sexual Health Services by Midwives: A Qualitative Research in Iran.

Sexual health is one of the most important aspects of health. In Iran, most services associated with reproductive and sexual health are provided by midwives at health centers. As different factors are effective in providing care services associated with sexual health, the present study aims to investigate the factors affecting the provision of sexual health services by midwives. In this qualitative content analysis study, data were collected by conducting in-depth interviews with 16 midwives, 7 key informants, and 6 stakeholders. Besides, the sampling method was purposeful, and data analysis was conducted using conventional content analysis and MAXQDA software. After analyzing the content of the qualitative data, two themes were extracted, which included facilitators of and barriers to providing sexual health services by midwives. By modifying educational curricula, providing in-service training, and adopting appropriate policies, barriers for providing accessible sexual health services by midwives can be reduced.

Perceived facilitators and barriers to the provision of sexual and reproductive health services in response to the Syrian refugee crisis in Lebanon.

The Syrian crisis has resulted in one of the worst humanitarian disasters in modern history. Inadequate access to and use of sexual and reproductive health services is a prevailing issue among adolescent girls and young refugee women in humanitarian settings. This article aimed to explore and describe the perceived extent of implementation of the different objectives and activities outlined within the minimum initial service package for reproductive health in crisis services in Lebanon, from the perspectives of a diverse set of stakeholders from leading organizations (public, private, primary health centers, nongovernmental organizations) that were directly engaged with the Syrian refugee crisis response. This study is a cross-sectional survey conducted using a standardized and validated questionnaire. Centers that provided sexual and reproductive health services to Syrian refugees in Lebanon were mapped. The study was based on a purposive sampling approach, retrieving 52 eligible organizations to cover most areas in the country. A total of 43 centers accepted to take part in the study. The head of the center was then asked to identify one person in their center who holds adequate knowledge of the explained objectives of the survey. Accordingly, the identified person was asked to fill out the survey. A considerable portion of the respondents had limited knowledge about the specific minimum initial service package objectives and related sexual and reproductive health services. The study found the presence of a leading reproductive health agency, the Lebanese MoPH, as an essential facilitating factor for sexual and reproductive health service provision in Lebanon and has helped in overseeing the overall sexual and reproductive health coordination response for Syrian refugees (76.74% of all respondents). The identified challenges impeding adequate sexual and reproductive health services provision for Syrian refugees included (1) insufficient supplies (46.51%); (2) insufficient funds (39.53%); and (3) shortage of staff (39.53%). The recommendations for improved sexual and reproductive health service provision include the need for (1) enforcing the lead minimum initial service package agency for adequate and effective coordination, reporting, and accountability and (2) increasing funding for training staff and healthcare workers, as well as improving the overall quality of services available with the inclusion of family planning services, purchasing the necessary commodities, supplies and equipment, and covering fees associated with the different sexual and reproductive health services.

Provision and uptake of sexual and reproductive health services during the COVID-19 pandemic: The case of Mali.

A qualitative study assessed the effects of the COVID-19 epidemic on Malian sexual and reproductive health services. Sexual and reproductive health (SRHR) providers in 25 purposively selected public health facilities in urban Bamako, rural Kita (western Mali) and Koutiala (southeast Mali) were interviewed. Disruptions within SRH supply, staffing, the prioritization of SRHR services, and patients' ability to seek, obtain and pay for services were reported across urban and rural settings at all levels of public health care, and by all cadres of SRHR providers. Most facilities in the study areas sustained some SRHR services at the height of the COVID-19 epidemic through innovative outreach and phone-based consultations. This study offers critical lessons for SRHR service provision during future waves of the pandemic or during periods of comparable emergency.

Healthcare workers' knowledge and perceptions on the prescripts of the criminal law (sexual offences and related matters) Amendment Act 5 of 2015 in East London, South Africa.

In 2015, South Africa amended the Criminal Law (Sexual Offences and Related Matters) Amendment Act 5 of 2015 to address several disparities surrounding the issue of consensual sex among minors. The amendment Act and its prescripts were met with mixed reactions from the stakeholders, healthcare workers and community. This affected its implementation as some supported the amendment while others opposed it based on their perceptions of the prescripts. The study was conducted in clinics in East London to explore the perception of healthcare workers (HCWs) regarding the prescripts of this Act and their implications to adolescent sexual and reproductive health services. The qualitative research approach and a combination of descriptive and exploratory research design were used to conduct the study. Data were collected through key-informant interviews, in-depth interviews and focus group discussions and analysed using thematic method. There were positive and negative perceptions that influenced the HCWs' attitudes and performance of their adolescent sexual and reproductive health duties towards minors. Those with positive perceptions regarded the Act as an enabler in the provision of adolescent sexual and reproductive health services that maintains adolescents' privacy and confidentiality as minors do not need parental consent to access these services. Those that had negative perceptions viewed the Act as taking away parental responsibilities, overloading health workers with parental duties and encouraging minors to be sexually active. The study recommended increased awareness about the Act to all members of society including minors, schools, parents and HCWs to ensure successful implementation of the Act.

An analysis on the roles and involvements of different stakeholders in the provision of adolescent sexual and reproductive health services in Southeast Nigeria

IntroductionSexual and reproductive health of young people involve a lot of stakeholders, traverse different sectors, and cut across all levels of government. For a clearer understanding of the activities of these stakeholders in adolescent sexual and reproductive health (ASRH) services, this paper was designed to explore the positions, attitudes and involvements of government/public institutions and non-governmental organizations (NGOs) in ASRH policy-making processes and implementations in Ebonyi State, Nigeria.MethodsThe evidence was generated from a cross-sectional qualitative study, with data collected through in-depth interviews and focus group discussions from 81 and 59 stakeholders in adolescent sexual and reproductive health, respectively. A mapping tool was used for the stakeholder analysis.ResultsThe State Ministry of Health (MOH) was identified as playing a major role in ASRH policy development and so was categorized as a ‘savior’. However, out of nine public institutions, four were categorized as ‘trip wire’ because they had non-supportive attitudes, weak powers and passive interests in ASRH policies and programs. All the NGOs were categorized as ‘friend’, because of their weak, but favorable disposition to ASRH policy-making processes. Regarding the implementation of ASRH programs, most public institutions were categorized as ‘savior’. Similarly, most of the institutions were classified as ‘trip wire’ at the local government level, in relation to ASRH policy development. Only, the offices of traditional rulers/village heads and local government administrative secretaries were regarded as ‘friend’, while the public schools were classified as an ‘acquaintance’. Concerning the implementation of ASRH programs at this level, public secondary schools, the offices of local government administrative secretaries and local government focal persons on ASRH were categorized as ‘savior’, while town union/ward development chairmen were considered ‘friend’. Few stakeholders, including, religious leaders were classified as ‘savior’ regarding engagement with local authorities on ASRH matters.ConclusionAlthough key stakeholders appear to play supportive roles in the implementation of ASRH programs in Ebonyi State, many of the relevant government and non-government institutions are not involved in the policy-making process. There is a need for more intentional and active involvement of relevant stakeholders in policy-making for better ownership and sustainability of ASRH interventions.

Non-Governmental Organisations and Health Service Delivery in The Gambia: A Case Study of The Hands-On-Care Clinic

This study mainly assessed the performance of the Hands-on-Care (HoC) Clinic, a Non-Governmental Organisation, in sexual and reproductive health service delivery in The Gambia and identified the challenges being faced by the organisation. Both primary and secondary data were used for this study. Primary data were collected using a questionnaire, in-depth interviews, and Participant Observation. The staff and patients of HoC Clinic and the two support societies were targeted for the study. The results of the study revealed that NGOs play vital roles in the delivery of health services. HoC Clinic has made and continues to make significant contributions to the sexual and reproductive health of The Gambia. The results also showed that it contributes individually and collectively in a participatory manner to improving the quality of life of all Gambians and non-Gambians alike. Based on the cumulative responses of staff, patients, and support societies and in consultation with relevant institutional documents, it could be observed that the institution continues to perform extremely well in the provision of sexual and reproductive health services to the people despite challenges in terms of human and material resources as alluded to by many respondents during the study. The performance of the institution was said to have been hindered by a poor commitment from the government, high reliance on donors, limited funding from other partners, and an unstable political environment, among others. The study concluded that NGOs play important roles in health service delivery, especially in developing countries where the government lacks the power to do all for its citizens. This makes them indispensable to the development of a country as they fill the gap the government is unable to fill.

Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women: conflicting perspectives in South Africa

BackgroundGlobally, an urgent need exists to expand access to HIV prevention among adolescent girls and young women (AGYW), but the need is particularly acute in sub-Saharan Africa. Oral pre-exposure prophylaxis (PrEP) offers an effective HIV prevention method. In many countries, however, accessing PrEP necessitates that AGYW visit their local health clinic, where they may face access challenges. Some countries have implemented youth-friendly services to reduce certain challenges in local health clinics, but barriers to access persist, including clinic stigma. However, evidence of clinic stigma toward AGYW, particularly with respect to PrEP service delivery, is still limited. This mixed methods study explores stigma toward AGYW seeking clinic services, in particular PrEP, from the perspective of both clinic staff (clinical and nonclinical) and AGYW who seek services at clinic sites in Tshwane province, South Africa.MethodsSix focus group discussions were conducted with AGYW (43 total participants) and four with clinic staff (42 total participants) and triangulated with survey data with AGYW (n = 449) and clinic staff (n = 130). Thematic analysis was applied to the qualitative data and descriptive statistics were conducted with the survey data.ResultsFour common themes emerged across the qualitative and quantitative data and with both AGYW and clinic staff, although with varying degrees of resonance between these two groups. These themes included (1) clinic manifestations of stigma toward AGYW, (2) concerns about providing PrEP services for AGYW, (3) healthcare providers’ identity as mothers, and (4) privacy and breaches of confidentiality. An additional theme identified mainly in the AGYW data pertained to stigma and access to healthcare.ConclusionEvidence is needed to inform strategies for addressing clinic stigma toward AGYW, with the goal of removing barriers to PrEP services for this group. While awareness has increased and progress has been achieved around the provision of comprehensive, youth-friendly sexual and reproductive health services, these programs need to be adapted for the specific concerns of young people seeking PrEP services. Our findings point to the four key areas noted above where programs seeking to address stigma toward AGYW in clinics can tailor their programming.

Improving the Well-Being of Adolescent Girls in Developing Countries

Abstract This paper conducts a large, narrative review of interventions that might plausibly (a) increase educational attainment, (b) delay childbearing, and/or (c) delay marriage for adolescent girls in low- and middle-income countries (LMICs). Using 108 interventions from 78 studies, predominantly in LMICs, the paper summarizes the performance of 15 categories of interventions in improving these outcomes. Transfer programs emerge as broadly effective in increasing educational attainment but their effects on delaying fertility and marriage remain mixed and dependent on context. Construction of schools in underserved areas and the provision of information on returns to schooling and academic performance also increase schooling. No category of interventions is found to be categorically effective in delaying pregnancies and reducing child marriages among adolescent girls. While targeted provision of sexual and reproductive health services, including vouchers and subsidies for family planning, and increasing job opportunities for women seem promising, more research is needed to evaluate the longer-term effects of such interventions. We propose that future studies should aim to measure short-term outcomes that can form good surrogates for long-term welfare gains and should collect detailed cost information.

A qualitative exploration of Ugandan mental health care workers’ perspectives and experiences on sexual and reproductive health of people living with mental illness in Uganda

BackgroundPeople with Mental Illness experience vast sexual and reproductive health challenges due to the affected mental health. Globally, prevalence of mental illness is on the rise with subsequent increase in the number of people with sexual and reproductive challenges warranting urgent public health intervention. However, information on the perceptions and experiences of mental health workers, the key health care providers for this population is generally lacking yet it’s essential for formulation of appropriate policies and public health interventions.AimTo explore Ugandan mental health care worker’s perspectives and experiences on the sexual and reproductive health of people living with mental illness in Uganda in order to generate recommendations to the ministry of health on how it can be improved.Materials and methodsQualitative study design was employed with utilization of phone call semi-structured in-depth interviews to collect data from 14 mental health workers from Uganda’s National mental referral hospital, Butabika. Purposive sampling and convenience recruitment was done and the collected data was analyzed using Thematic content analysis.ResultsFour themes were generated which included people with Mental illness having normal sexual needs, mental illness effect on sexuality and relationships, practices for safeguarding sexuality of people with mental illness and the barriers encountered in the provision of sexual and reproductive health services at a mental hospital.ConclusionPeople with mental illness experience a multitude of sexual and reproductive health challenges that need public health interventions. However, the integration of sexual and reproductive health services in a mental hospital are not yet successful making people with mental illness to remain with unaddressed health challenges. Policies should therefore be developed and implemented to ensure successful integration of sexual and reproductive health at all mental health service care provision points.

Married men’s sexual and reproductive health concerns and related health-seeking behavior in Bangladesh: A mixed methods study

BackgroundIn Bangladesh, men’s sexual and reproductive health (SRH) needs and related services are often neglected. Little is known of men’s SRH concerns, and of the phenomenal growth of the informal and private health actors in the provision of sexual health services to men in rural and urban areas of Bangladesh.MethodsUsing a mixed methods approach, a survey of 311 married men in three rural and urban sites was conducted in three different districts of Bangladesh and 60 in-depth interviews were conducted to understand their SRH concerns and choice of providers to seek treatment.ResultsThe research findings reveal that- men’s various SRH concerns are embedded in psychosocial and cultural concerns about their masculinity and expectations of themselves as sexual beings, with worries about performance, loss of semen and virility being dominant concerns. Sexually transmitted infections (STIs) were also mentioned as a concern but ranked much lower. Informal providers such as village doctors (rural medical practitioners and palli chikitsoks), drug store salespeople, homeopaths, traditional healers (Ojha/pir/fakir, kabiraj, totka) and street sellers of medicines are popular, accessible and dominate the supply chain.ConclusionThere is a need of appropriate interventions to address men’s anxieties and worries about their sexual abilities, well-being and choice of providers. This would go a long way to address and alleviate concerns, as well as identify and push men to seek formal care for asymptomatic STIs, and thereby reduce costs incurred and gender tensions in households.

HIV and adolescent girls and young women in sub‐Saharan Africa: A call for expedited action to reduce new infections

Adolescent girls and young women (AGYW) from sub-Saharan Africa (SSA), aged 15-24, remain at substantial risk of acquiring HIV. AGYW accounted for 63% of all new HIV infections in 2021. Reducing incident infections in AGYW and among the other key populations is key to eliminating HIV infections. Expedited prioritization and actions to reduce incident infections among AGYW from sub-Saharan Africa are therefore required to attain the UNAIDS 95-95-95 targets by 2030. In this article, we discuss the factors contributing to higher HIV infections among AGYW and strategies that can be used to reduce HIV infection among them. Several biological, socio-economic, religious, and cultural factors continue to put the AGYW at a disproportionately high risk of acquiring HIV. Many AGYW in SSA are economically marginalized and therefore are unable to negotiate condom use and monogamy. Patriarchal culture predominant in SSA also exacerbates AGYW's inferiority in sexual matters. To address these factors, a multi-pronged approach is required. Some of the strategies we recommend are passing stricter sentences for sexual offenders and abusers, economically empowering AGYW, increasing the provision of sexual and reproductive health and rights (SRHR) education and services to AGYW, increasing access to pre-exposure and post-exposure prophylaxis, treatment of HIV as prevention, and engaging and educating communities on SRHR matters.

The HIV epidemic and the COVID-19 pandemic: A double tragedy for sub-Saharan African women.

After four decades of the HIV epidemic, women from sub-Saharan Africa remain at a differentially high risk of acquisition. The Joint United Nations Programme on HIV and AIDS (UNAIDS) statistics show that the majority of HIV infections occur in this population and region. Evidence from previous humanitarian crises demonstrated adverse maternal consequences as a result of neglect for the provision of essential maternal, sexual and reproductive health services. The ongoing COVID-19 pandemic has had a similar effect, including an additional risk of HIV acquisition amongst women in sub-Saharan Africa. The COVID-19 pandemic has aggravated the risk of sub-Saharan Africa women to HIV infection because of a multitude of factors including child marriages, teenage pregnancies, dropping out of school, increase in incidence of sexual and gender-based violence and reduced access to preventive and treatment services for HIV and sexually transmitted infections. These include provision of care for rape and sexual and gender-based violence victims and provision of pre-exposure and postexposure prophylaxis for HIV and other STIs. Failure to urgently restore and maintain robust HIV prevention and treatment during the ongoing COVID-19 pandemic poses a risk of reversing the gains made over the years in reducing the incidence and morbidity from HIV amongst the population of sub-Saharan Africa women. There is need for an urgent and robust discourse to formulate effective interventions for protecting women and girls living in sub-Saharan Africa from an aggravated risk of HIV infection during the ongoing COVID-19 pandemic and other future humanitarian crises.

Reproductive health in Brazil and Europe: Commentary on an analytical parallel

Reproductive health in Brazil and Europe: Commentary on an analytical parallel

Online Sexual Health Information Seeking Patterns Differentiated by Social Location and Physical Location among Gay and Bisexual Men in Ontario, Canada

Objective This research aimed to understand the varying needs of diverse gay and bisexual men (GBM) in relation to online sexual health information-seeking dependent upon differing social sociodemographic variables and geographic location. Methods A total of 1802 GBM in Ontario participated in this study. Multivariable regressions were conducted to analyze differences in information-seeking based on ethnicity group, HIV status, recent sexual behavior and regionality (urban and rural location). Results There were significant differences in online sexual health information-seeking content based on these demographic variables. Conclusions Implications for sexual health outreach and service provision for diverse GBM are discussed as well.

The U.S. Global Gag Rule in Ethiopia: a foreign policy challenging domestic sexual and reproductive health and rights gains

BackgroundEthiopia’s government and civil society have driven crosscutting initiatives in the last 15 years to improve sexual and reproductive health outcomes, including passing a 2005 abortion law that facilitated reduced rates of maternal death due to unsafe abortion. However, both the government and nongovernmental organizations have relied on external funding for sexual and reproductive health and rights, particularly from the U.S. government, which has been Ethiopia’s largest global health donor. This article explores how the implementation and expansion of the 2017–2021 U.S. foreign policy “Protecting Life in Global Health Assistance,” also known as the Global Gag Rule—which attached itself to a nongovernmental organization’s funding—impacted sexual and reproductive health and rights, including safe abortion care, in Ethiopia.MethodsThis article is based on research conducted by PAI staff in Ethiopia in 2018 with follow-up in 2019. PAI held in-depth semistructured interviews with representatives of 30 organizations in Ethiopia’s capital, Addis Ababa. Among these groups were U.S.-based and non-U.S. nongovernmental organizations, including community-based organizations, non-U.S. government donors, and Ethiopian government officials.ResultsNongovernmental organizations have been essential to sexual and reproductive health service provision and advocacy in Ethiopia. Because of the sector’s reliance on U.S. global health assistance, these organizations; their activities; and, consequently, the wider health system were negatively impacted by the Global Gag Rule. Certain vulnerable groups, particularly adolescents and youth, have traditionally relied on the private sector for sexual and reproductive health services. PAI’s research demonstrates that U.S. policy disrupted activities and service delivery, threatened the closure of private clinics, stalled mobile outreach, and impacted safe abortion training of health personnel. Additionally, the Global Gag Rule dismantled partnerships, affected non-U.S. government donors’ investments, and caused confusion that limited activities permissible under the policy.ConclusionsThe Trump administration’s Global Gag Rule forced non-U.S. organizations to choose between providing comprehensive care or losing U.S. global health assistance, ultimately impacting populations in need of services. Ethiopia provides a clear example of how the Global Gag Rule can threaten a country’s domestic health agenda by targeting nongovernmental organizations that are vital to health service delivery and safe abortion care.

Exploring and Monitoring Privacy, Confidentiality, and Provider Bias in Sexual and Reproductive Health Service Provision to Young People: A Narrative Review.

Purpose: Poor privacy and confidentiality practices and provider bias are believed to compromise adolescent and young adult sexual and reproductive health service quality. The results of focus group discussions with global youth leaders and sexual and reproductive health implementing organizations indicated that poor privacy and confidentiality practices and provider bias serve as key barriers to care access for the youth. Methods: A narrative review was conducted to describe how poor privacy and confidentiality practices and provider bias impose barriers on young people seeking sexual and reproductive health services and to examine how point of service evaluations have assessed these factors. Results: 4544 peer-reviewed publications were screened, of which 95 met the inclusion criteria. To these articles, another 16 grey literature documents were included, resulting in a total of 111 documents included in the review. Conclusion: Poor privacy and confidentiality practices and provider bias represent significant barriers for young people seeking sexual and reproductive health services across diverse geographic and sociocultural contexts. The authors found that present evaluation methods do not appropriately account for the importance of these factors and that new performance improvement indicators are needed.