Utilization Of Sexual And Reproductive Health Services Research Articles

IJCM_43A: Status of sexual and reproductive health services among youths from a rural area of Madhya Pradesh: A mixed-method approach

Background: Warranting adequate sexual and reproductive health (SRH) among the youth population in India is challenging. While the Government has undertaken several measures to improve SRH services, gaps exist in terms of availability of these services at the health centre. Objective: To assess utilization of SRH services and explore the associated factors among youth population in rural area of Central India. Methodology: An explanatory sequential mixed method study was conducted which included collection and analysis of quantitative data pertaining to the utilization of SRH services from 236 youth (aged 15-24 years) selected through multistage cluster sampling. This was followed by 29 in-depth interviews conducted among the various stakeholders. Quantitative data was entered using MS Excel and analyzed using R v-4.1.0. The notes and audio recordings from the interviews were transcribed manually and thematic analysis was done. Results: Out of 236 youths, only 90 (38.1%) had ever availed SRH services, of whom 85.5% had visited the SRH clinic in the past 12 months. The most common reason to visit a government health facility was cited as a pregnancy test while in the case of private health facility the reasons were STD treatment, pregnancy tests, and abortions. Except the request for contraceptive services and adequate response to questions by clients, the services provided by the facilities were reported to be inadequate. Further exploration summarized the barriers and facilitators of the health care services under the themes of training, logistics, ARSH clinic, adolescent health days, and community awareness. Conclusion: Among the various influences of SRH, the healthcare system is a fundamental aspect; which seems to address inadequately the varied needs of the rural youth. Future efforts must focus on community awareness and involvement of all stakeholders to uplift SRH services, so as to have positive impact on their sexual health.

Factors Associated with Utilization of Sexual and Reproductive Health Services among Married Adolescent Girls in Kano, Northern Nigeria.

Married adolescents face significant obstacles in making informed reproductive health decisions and accessing sexual and reproductive health (SRH) services. It is important to identify barriers hindering these adolescents from accessing SRH services. The aim of this study was to identify factors associated with the utilization of SRH services among married adolescent girls in northern Nigeria. We used a cross-sectional study design. The study population comprised of married female adolescents aged 14-19 years who were residents in the study areas for at least six months. The outcome measure was SRH service utilization, defined as the use of any of the conventional SRH services (ante/postnatal care, human immunodeficiency virus (HIV) testing and counseling, sexually transmitted infections (STI) treatment, family planning, and post-abortion care). Predictor variables included the sociodemographic, obstetric, and gynecological characteristics of the respondents. An adapted, pretested, interviewer-administered, and semi-structured questionnaire was employed for data collection. Multivariable logistic regression was used to explore the independent association between selected variables and utilization of SRH services. A total of 200 respondents were surveyed (100 each from an urban and a rural community in Kano, Nigeria), survey response rate: 94.5%. The age of respondents ranged from 14 to 19 years, with mean age (± standard deviation) of 18.5 (±1.1) years and 17.5 (±1.3) years for urban and rural respondents, respectively. All respondents were aware of the available SRH facilities and preferred public facilities (92.6% urban respondents and 67.0% rural respondents). Ever-use of SRH services was higher among urban than rural respondents (86% vs. 56%, respectively). Geographic proximity was a key factor for urban respondents (64.2%), while affordability was considered important by rural respondents (47.9%). Respondent's age and partner's occupation were independently associated with utilization of SRH services. Urban respondents whose husbands were businessmen were seven times more likely to use SRH services than those whose partners were civil servants (adjusted odds ratio [aOR] = 6.80, 95% confidence interval [CI]: 1.29-35.84, P = 0.02). Rural respondents 18 years of age and older were approximately six times more likely to utilize SRH services than those <18 years (aOR = 5.71, 95% CI: 1.56-12.78, P = 0.01). Awareness of available SRH services was high in the study population, and service utilization was influenced by the respondent's age and partner's occupation. Findings from this study can help inform the development of age-appropriate and accessible SRH services tailored to married adolescents in similar settings.

From Exploits to Remedy: Sexual Behaviour and Utilisation of Reproductive Health Services among In-School Adolescents in a South-Western Nigerian Town

Background: Adolescents are often involved in risky sexual behaviour. It has been reported that most male adolescents have multiple  sexual partners, and most female adolescents use condoms inconsistently. This study assessed sexual behaviour, information sources on  Sexual and Reproductive Health (SRH), knowledge of SRH, and utilization of RH services among senior secondary school students in Ile- Ife, Nigeria.&#x0D; Methods: A cross-sectional study was conducted on 424 students randomly selected from six public secondary schools in Ile-Ife. The  instrument was a pretested, self-administered questionnaire. The median score was used to categorise SRH knowledge into good and  poor. Respondents who did not use condoms consistently, or had multiple sexual partners, or engaged in transactional sex were  categorized as having engaged in risky sexual behaviour. Respondents who sought any RH service in a health facility were categorized as  having utilized SRH services. ChiSquare was used for associations between categorical variables, while binary logistic regression was used  to test for the predictors of utilization of SRH services.&#x0D; Results: Over a quarter (26.9%) of the respondents had experienced a sexual debut, with 52.6% doing so before 14 years. Teachers were  the most reported information source on pubertal changes (65.1%) and sexually transmitted infections (STIs) (71.7%). About 60.8% of  respondents had good knowledge of SRH; 55.3% of respondents had multiple sexual partners and 55.9% of respondents had utilized RH  services.&#x0D; Conclusion: A good proportion of the respondents had good SRH knowledge; however, the prevalence of risky sexual behaviour was  high. Adolescents need adequate SRH education and promotion. 

Assessing Barriers and Utilization of Sexual and Reproductive Health Services among Female Migrant Workers in Vietnam.

Young migrant women workers frequently experience disparities in accessing health services, including sexual and reproductive health (SRH) services, especially in urban settings. This study assesses the barriers and utilization of SRH services and explores factors associated with the utilization of these services among young female migrant workers working in the industrial zone (IZ) in Vietnam. A cross-sectional survey was conducted among 1061 young women migrant workers working in an IZ in Hanoi, Vietnam. Multivariable logistic regression analysis was used to identify factors associated with utilization of SRH services. Nearly 35% of the participants reported using SRH services at least once since working in the IZ. Additionally, around 78% of the participants reported using a contraceptive method during their last sexual encounter. The study also found that older participants (25-29 years old) were nearly two times more likely to use SRH services than younger participants (18-24 years old) (OR = 1.91, 95% CI: 1.19-3.06). Married participants had nearly six times higher odds of using SRH services compared to single participants (OR = 5.98, 95% CI: 3.71-9.63), and participants with higher incomes were more likely to use SRH services (OR = 1.02, 95% CI: 1.01-1.04). The most commonly reported barriers to access SRH services were inconvenient hours of service operation (26.2%), followed by long distance from the service location (9.2%) and high service cost (5.2%). This study found a low level of SRH service utilization and identified several barriers to accessing these services among the study participants. The study findings provide important evidence insights for policymakers and program managers to develop and implement policies that help reduce barriers and enhance the provision of SRH services tailored to the needs of IZ married and unmarried women migrant workers in the IZ in rapidly developing and urbanizing countries like Vietnam and other low- and middle-income countries with similar contexts.

Factors Associated with Utilization of Sexual and Reproductive Health Services among the Youth in Lira City West, Northern Uganda: A Cross-Sectional Study.

The youth in Uganda, as in much of sub-Saharan Africa, face numerous sexual and reproductive health (SRH) challenges, from human immunodeficiency virus HIV infection, and unsafe abortions to unwanted pregnancies. This study, therefore, assessed the utilization of sexual and reproductive health services and associated factors among the youth in Lira city west, northern Uganda. This was a cross-sectional study conducted in January 2023 among 386 young people (15-24 years) in Lira city west division, Lira city. Multistage cluster sampling technique was used to recruit our study participants. Data were collected using an interviewer-administered questionnaire. Data were analyzed using SPSS version 23, descriptive statistics, cross-tabulation, bivariate, and multivariate logistic regression analyses. All variables were set by p values less than 0.05 and reported adjusted odds ratio with its 95% confidence interval. The utilization of SRH services was 42.0% (162/386) among the study participants. Family planning, voluntary HIV counseling and testing (VCT), and general counseling services were the most utilized SRH services in the past 12 months. Young people who were aware of SRH services (AOR: 0.24; 95% CI: 0.08-0.74), were aware of a reproductive health facility (AOR, 4.24; 95% CI: 1.62-11.09), discussed SRH issues with peers/friends (AOR, 3.98; 95% CI: 1.53-10.33), had a sexual partner (AOR, 10.00; 95% CI: 4.05-24.69), had sexual intercourse (AOR, 4.59; 95% CI: 2.18-9.69), and had access to SRH services (AOR, 2.68; 95% CI: 1.12-6.40) were more likely to utilize SRH services compared to their counterparts. This study showed a low utilization of sexual and reproductive health services among youth in Lira city west, northern Uganda. Being aware of SRH services, awareness of reproductive health facilities, discussing SRH issues with peers, having sexual intercourse, having a sexual partner, and access to SRH services were independently associated with the utilization of SRH services. Therefore, there is a need to strengthen sustainable multisector approaches aimed at improving awareness and access to sexual and reproductive health services among the youth.

Factors influencing men's decisions to utilize sexual reproductive health services in KwaZulu Natal, South Africa.

Sexual and Reproductive Health (SRH) service utilization remains a global public health concern. The SRH problems account for major health challenges and disease burdens for men. This descriptive cross-sectional study of 421 men aims to identify factors influencing men's decisions to utilize SRH services. The interviewer-administered questionnaire obtained data from conveniently selected men who met the inclusion criteria. Frequencies and percentages were used to summarize variables associated with SRH services utilization. Univariable logistic regression was conducted before conducting a multivariable logistic regression. Of the 421 participants, 307 (72.9%) reported having utilized SRH services at least more than once. Although participants reported barriers to SRH service utilization, most men utilize services despite encountering challenges. The final multivariate logistic regression model revealed that age, education level, medical aid, and perceived good quality of services were significantly associated with SRHS utilization (p-value <0.05). Study findings indicate that older men (age 45 and above) were more likely to utilize SRH services than younger men (ages 15 to 44). Barriers to SRH service utilization must be eliminated so that men can easily use the services. Identifying factors influencing men to utilize SRH services will help policymakers and program managers address the poor utilization of SRH services by men.

Impacts of COVID-19 on reproductive health service provision, access, and utilization in Ethiopia: Results from a qualitative study with service users, providers, and stakeholders.

Ethiopia has made significant improvements to sexual and reproductive health (SRH) in recent decades, yet the COVID-19 pandemic brought new challenges to SRH service delivery. In the early months of the pandemic, health facility and health management information system data showed reductions in SRH service utilization, however more evidence is needed on ongoing SRH impacts to inform policy and program decision-making. Our study aimed to assess the impacts of COVID-19 on SRH service utilization and access from the perspective of providers, clients, and stakeholders in Addis Ababa and Amhara Regional State. We collected data from May through July 2021 via six focus group discussions with health service providers, 50 in-depth interviews with SRH service clients and 15 key informant interviews with policy and programmatic stakeholders. All audio recordings were transcribed and translated from Amharic into English. Data were coded and analyzed for content and themes using Excel and NVivo 10. We found that COVID-19 and associated public health mitigation measures had consequences on SRH prioritization, funding, and service delivery. Efforts to halt the spread of COVID-19, such as gathering and transportation restrictions, also reduced access to SRH services. Fear of infection, costly and inaccessible transportation, commodity stockouts, and limited service availability all impeded access to and use of SRH services. For some women, this meant losing timely access to contraception and subsequently facing unwanted pregnancies. Providers experienced increased workloads, anxiety, and stigma as possible sources of infection. Our findings offer useful learnings for program and policy stakeholders aiming to meet SRH needs during the pandemic, and during times of crisis more broadly.

Utilization of sexual and reproductive health services among young people in refugee settings in Uganda.

There is a considerable high level of unmet need for reproductive health services among refugees. Yet, there is limited research about the provision and utilization of sexual and reproductive health (SRH) services among young people in refugee settings. Drawing on a sample of 575 young refugees (15-24 years) from a cross-sectional survey, this study aims to fill this gap by identifying the factors associated with SRH utilization among young people living in refugee settings in Northern Uganda. The utilization of SRH services at the health facilities was significantly different between female and male young people after adjusting for all other variables (aOR = 2.46, 95% CI, 1.58, 3.84). Young people who were not living in a marital union (aOR = 0.38, 95% CI, 0.20, 0.71), or held inequitable gender norms about services (aOR = 0.28, 95% CI, 0.12, 0.66) had about a third of the odds of utilizing SRH services. Young women with comprehensive knowledge about contraception, modern contraceptives, and HIV and STI prevention, had more than twice the odds of utilizing SRH services (aOR = 2.23, 95% CI, 2.67, 6.90). There is need to integrate social norm measurements and social norm change strategies in strategies for promoting utilization of SRH services among refugees in low-income countries especially in Uganda.

Sexual and reproductive health service utilization among adolescent girls in Kenya: A cross-sectional analysis.

We examined the association between adolescents' sexual and reproductive health (SRH) service utilization in the past 12 months and structural, health facility, community, interpersonal, and individual level factors in Kenya. This cross-sectional analysis used baseline data collected in Homa Bay and Narok counties as part of the In Their Hands intervention evaluation from September to October 2018. In total, 1840 adolescent girls aged 15 to 19 years were recruited to complete a baseline survey. We used unadjusted and adjusted logistic regression to model factors associated with SRH utilization across the social-ecological framework levels. Overall, 36% of participants reported visiting a health facility for SRH services in the past 12 months. At the structural level being out-of-school (AOR: 2.12 95% CI: 1.60-2.82) and not needing to get permission to go (AOR: 1.37 95%CI: 1.04-1.82) were associated with SRH service utilization. At the interpersonal level, participants who reported being able to ask adults for help when they needed it were more likely to report using SRH services in the past 12 months (AOR: 1.98, 95% CI: 1.09-3.78). At the individual level, having knowledge about where to obtain family planning (AOR = 2.48 95% CI: 1.74-3.57) and receiving information on SRH services in the past year (AOR: 1.44 95% CI:1.15-1.80) were associated with SRH service utilization. Our findings demonstrate the need for interventions, policies, and practices to be implemented across structural, health facility, community, interpersonal, and individual levels to comprehensively support adolescent girls to access and use SRH services.

System-level factors influencing refugee women's access and utilization of sexual and reproductive health services: A qualitative study of providers' perspectives.

Refugee women have poor outcomes and low utilization of sexual and reproductive health (SRH) services, which may be driven by access to and quality of SRH services at their resettled destinations. While healthcare providers offer valuable insights into these topics, little research has explored United States (U.S.) providers' experiences. To fill this literature gap, we investigate U.S. providers' perspectives of healthcare system-related factors influencing refugee women's access and utilization of SRH services. Between July and December 2019, we conducted in-depth, semi-structured interviews with 17 providers serving refugee women in metropolitan Atlanta in the state of Georgia (United States). We used convenience and snowball sampling for recruitment. We inquired about system-related resources, facilitators, and barriers influencing SRH services access and utilization. Two coders analyzed the data using a qualitative thematic approach. We found that transportation availability was crucial to refugee women's SRH services access. Providers noted a tension between refugee women's preferred usage of informal interpretation assistance (e.g., family and friends) and healthcare providers' desire for more formal interpretation services. Providers reported a lack of funding and human resources to offer comprehensive SRH services as well as several challenges with using a referral system for women to get SRH care in other systems. Culturally and linguistically-concordant patient navigators were successful at helping refugee women navigate the healthcare system and addressing language barriers. We discussed implications for future research and practice to improve refugee women's SRH care access and utilization. In particular, our findings underscore multilevel constraints of clinics providing SRH care to refugee women and highlight the importance of transportation services and acceptable interpretation services. While understudied, the use of patient navigators holds potential for increasing refugee women's SRH care access and utilization. Patient navigation can both effectively address language-related challenges for refugee women and help them navigate the healthcare system for SRH. Future research should explore organizational and external factors that can facilitate or hinder the implementation of patient navigators for refugee women's SRH care.

Barriers to utilization of sexual and reproductive health services among young deaf persons in Ghana.

Despite significant progress made to improve access to sexual and reproductive health (SRH) services to the general populace in Ghana, information on the accessibility of such services to deaf persons is limited. This study investigated access to and utilization of SRH services among young female deaf persons in Ghana. Sixty deaf persons were interviewed from six metropolis/municipalities/districts in three regions of Ghana. The data were collected using focus group discussion and one-on-one interviews. The data were subjected to content analysis, leading to the identification of two broad themes. The study identified barriers at two levels: point of service delivery and barriers at the individual level. For instance, at the point of service delivery, they were claims that deaf women were victims of negative attitudes from health workers. The study concludes on the need for health policymakers to consider collaborating with the Ghana National Association of the Deaf in an effort towards designing inclusive SRH programmes.

Crush: A Randomized Trial to Evaluate the Impact of a Mobile Health App on Adolescent Sexual Health

PurposeMobile technology allows delivery of sexual and reproductive health (SRH) information directly to youth. We tested the efficacy of Crush, a mobile application aimed at improving sexual health by promoting the use of SRH services and contraception among female adolescents. MethodsWe recruited 1,210 women aged 14–18 years through social media advertising and randomized them into a Crush intervention group and a control group that received a wellness app. At 3 and 6 months post randomization, we compared changes from baseline in behaviors, attitudes, self-efficacy, perceived social norms, birth control knowledge, perceived control and use intentions, and SRH service utilization. Odds ratios were estimated with multivariable logistic regression and adjusted for baseline outcome, age, race/ethnicity, mother's education, and sexual experience. ResultsThere was no difference in accessing SRH services according to study group. Three months post baseline, Crush users had higher odds (p < .05) than control participants of reporting confidence in accessing SRH services (adjusted odds ratio [aOR] = 1.6, 95% confidence interval [CI]: 1.1–2.3) and of believing that it is a good thing to use birth control consistently (aOR = 2.3, 95% CI: 1.4–3.8). Six months after baseline, Crush users had higher odds than control participants of reporting they can control whether birth control is used every time they have sex (aOR = 1.8, 95% CI: 1.2–2.6) and perceiving they would get pregnant if they did not use birth control (aOR: 1.5, 95% CI: 1.1–2.2). Impacts on other behavioral constructs were also found. DiscussionCrush was associated with improvements in knowledge, attitudes, and self-efficacy related to key SRH behaviors and may be a strategy to deliver SRH education to adolescent women. Studies including larger numbers of sexually active adolescents are needed to demonstrate behavioral impacts.

Comparing access to sexual and reproductive health services among sexual minority youths and their peers: findings from a national survey in China

BackgroundLittle is known about the access to measures of sexual and reproductive health (SRH) services among sexual minority communities in China, where sexuality-related stigma and discrimination remains high. The aim of this study is to investigate access to measures of SRH services among Chinese sexual minority youths (SMY) aged 17 to 24 years old.MethodsThis cross-sectional study utilizes data on 54,580 youths from the 2019–2020 National College Student Survey on Sexual and Reproductive Health, conducted across 31 provinces in mainland China. Multivariable logistic regression modelling was utilized to assess the access to SRH services among Chinese youth with different self-reported sexual orientation.ResultsThe majority of respondents identified as heterosexual (77.6%). The remaining respondents identified as bisexual (9.0%), lesbian or gay (2.8%), others (3.02%), or unknown (7.51%). Gay men reported greater access to free contraceptives at health centers (OR 1.62, 95% CI: 1.32–1.99) and were more likely to have receive medical treatment for sexual and reproductive issues (OR 1.83, 95% CI: 1.26–2.63) compared to heterosexual men. Gay and bisexual men were also more likely to use condom at first sexual intercourse compared to heterosexual men (gay men: OR 1.38, 95% CI: 1.13–1.68; bisexual men: OR 1.33, 95% CI: 1.03–1.71). However, the associations were reversed among women (lesbians: OR 0.05, 95% CI: 0.03 to 0.08; bisexuals: 0.75, 95% CI: 0.65 to 0.86).ConclusionsAlthough SMY reported higher utilization of SRH services compared to their heterosexual counterparts, access to SRH services remains low among Chinese youths. Greater focus should be placed on improving access to SMY-friendly SRH services among Chinese youths.

Recommendations for removing access barriers to effective Sexual/Reproductive Health Services (SRHS) for young people in South East Nigeria: A systematic review

Young people’s Sexual and Reproductive Health (SRH) services in Nigeria are limited and there are issues of affordability and accessibility of these health services. Also, there are limited studies in Nigeria on the barriers to accessing and utilizing SRHS in the Nigerian healthcare sector. Furthermore, even when the services are provided they are not sensitive to the needs of young people. Hence, this study aims to assess the barriers to the availability and accessibility of sexual reproductive health services (SRHS) for young people living with sexually transmitted infections (STIs) in Abia State, Nigeria. Study Aim: To make recommendations for removing assess barriers to effective sexual and reproductive health services for young people living with STIs in southeast Nigeria. Methodology: A systematic review of 14 studies comprising 9 qualitative studies, 3 mixed methods, 1 quantitative and 1 cross-sectional study. The inclusion criteria were primary studies written in the English language which assessed barriers to SRH services while the exclusion criteria were the secondary studies and primary studies which did not access barriers to accessibility and availability of SRHS for young people. A total of 4, 705 participants from different African countries formed the sample size. Findings: Results showed that young people have little or no insight into STIs and their services. Moreover, they experienced different levels of barriers ranging from the negative and judgmental attitude of healthcare providers, stigma, cost, availability and accessibility of healthcare services as well as lack of integration of services and privacy and confidentiality. These are the major barriers that discourage young people from accessing SRH services. Also, experiences of fear and shame were reported as common barriers to utilizing care. Conclusion: Sensitizing the SRH needs of young people can enhance access to healthcare services. Therefore, there is a need to improve uptake and address the negative attitude of healthcare providers, as well as the issue of confidentiality, which will help to improve SRH service utilization among young people. Also, it is recommended that teaching health care professionals about these STI prevention centers will be the main solution to improve the preventive practice to reduce STI incidence in young people in Nigeria.

Sexual and reproductive health service utilization of young girls in rural Ethiopia: What are the roles of health extension workers? Community-based cross-sectional study

ObjectiveLittle is known about the extent to which Health Extension Programme (HEP) has played its role to increase service uptake among young girls. This study aims to estimate the status...

Determinant Factors of Sexual and Reproductive Health Service Utilization among In-School Adolescents with Disability in Jimma Zone, Southwest Ethiopia

Introduction Adolescents with disability are often presumed erroneously to be sexually inactive. Though they have the same need for sexual and reproductive health (SRH) services as nondisabled people, they are often overlooked by sexual and reproductive health programs, interventions, and studies. Objective To assess determinant factors of sexual and reproductive health service utilization among in-school adolescents with disability in Jimma zone, southwest Ethiopia. Method Institution-based cross-sectional study design was employed among in-school adolescents with disability in Jimma zone, Ethiopia, from September 21 to November 30, 2021. A total of 454 participants were included in the study by using the multistage sampling technique. Data were collected by using a structured questionnaire through face-to-face interviews. Data were entered into Epi-data version 4.2 and analyzed by using SPSS version 23. Bivariate and multivariable logistic regression analyses at a 95% confidence interval were performed, and a P value < 0.05 was considered statistically significant. Result 454 study participants were included in this study with a respondent rate of 97.4%. Only 38 (8.4%, 95% CI: 5.7-10.8%) of in-school adolescents utilized SRH information and education service. The majority (265, 49%) of adolescents with disability knew family planning as sexual and reproductive health services which were followed by voluntary counselling and testing for HIV/AIDS (116, 21.4%). Seventy-eight (17.2%, 95% CI: 13.7-20.5%) of in-school adolescents with disability visited nearby health facilities for VCT services. Male sex (AOR = 2.32, 95% CI: 1.18-4.57), favourable attitude (AOR = 3.11, 95% CI: 1.59-6.07), and history of sexual intercourse (AOR = 5.34, 95% CI: 2.05–13.92) were significantly associated with SRH service utilization. Conclusion The overall sexual and reproductive health service utilization of in-school adolescents with disability was low when compared with other studies. Physical impairment, male sex, ever had sexual intercourse, good knowledge, and favourable attitudes were determinant factors of SRH service utilization among in-school adolescents with disabilities. So, it is recommended that the Jimma zone administration, government, and NGOs should give attention to SRH services.

Availability and Readiness of Health Facilities to Deliver Sexual and Reproductive Health Services for Young People: A Case of the “Get Up Speak Out” Programme Implemented in Western Kenya

Young people have reported poor Sexual and Reproductive Health (SRH) indicators over the years including teenage pregnancy, unsafe abortion, neonatal mortality, and Sexually Transmitted Infections (STIs) including HIV/AIDs, among others. Further, study findings have shown barriers to young people’s access to and utilization of SRH services at health facilities include lack of confidentiality and privacy, stigma and discrimination, the unfriendly and negative attitude among service providers, long waiting time for services, and lack of information among young people on availability of SRH services at the health facilities. The limited access to SRH services among young people poses greater health risks to these groups such as a high risk of sexual and gender-based violence, a higher risk of unwanted pregnancies, and unsafe abortions. It is on this basis that the researchers conducted a study aimed at assessing the availability and readiness of Health Facilities to Deliver SRH Services for Young People in its implementation sites. A full-coverage survey across all 24 link health facilities of the Get Up Speak Out (GUSO) program implementation was conducted in May 2020 adopting an electronic approach in adherence to the MOH Covid-19 preventive guidelines. The study shows the alignment of health facilities’ activities with the Youth Friendly Services (YFS) guidelines, such as staff YFS training, YFS time allocation, and meaningful youth participation in governance and decision-making structures. However, the study has highlighted gaps such as inadequate display of SRH information; inadequate engagement and adoption of young people’s recommendations in health facilities’ governance structures for improved delivery, access, and uptake of SRH services by young people.

Accessibility and Utilization of Adolescent Sexual and Reproductive Health Services Among Undergraduate Students

Background: Young people's reproductive health services have been largely neglected in the past, leaving them vulnerable to reproductive health problems like Sexually Transmitted Infections (STIs), unintended pregnancy, unsafe abortion and other harmful practices. Although studies have been done on Adolescent Sexual and Reproductive Health, a persistence of reproductive health problems among undergraduates in Nigeria, especially in the Universities necessitated this study. Methods: The study utilized a descriptive cross-sectional design involving 357 students of randomly selected faculties in the university of Ibadan. A self-administered semi-structured questionnaire was used to assess the accessibility and utilization of Sexual and Reproductive Health Services (SRHSs) among the students. Statistical analysis of data was done using IBM-SPSS version 21.0 software, associations and differences were then tested using Pearson’s correlation test (with significance set at P≤ 0.05), while descriptive data were presented in frequency &amp; percentages. Results: The study found that 70.8% of the respondents have high access to SRHSs, while more than 67.3% underutilized those services. Attitudes of staff in the clinic, religion, cultural practices, longer waiting periods, and lack of privacy were all identified as factors that negatively affect the accessibility and utilization of SRHS. Gender (p=.012), and Accessibility (p=.000) were found to be significantly associated with Utilization of SRHSs. Conclusion: Despite high accessibility, most students still do not utilize available SRHSs. To ensure that young people have access to sexual and reproductive health care in all nursing practice sites, nurses need to gain the knowledge and hone the skills required to deliver evidence based counseling and services to adolescents.

Influence of education on sexual and reproductive health service utilization for persons with disabilities in nationwide Bangladesh: an explanatory sequential mixed-methods study

BackgroundPersons with disabilities comprise more than one billion people in the world, yet they are one of the most discriminated groups and face significant health disparities. Particularly in developing countries, which contain 80% of the entire population with disabilities, these individuals experience major barriers in accessing sexual and reproductive health (SRH) services. Education is an important factor that greatly affects individuals’ SRH service utilization. Hence, we sought to investigate the relationship between education and SRH service utilization for persons with disabilities in Bangladesh.MethodsUsing an explanatory sequential mixed-methods design, a total of 5000 persons with disabilities were surveyed for the quantitative component and 15 mini-ethnographic case studies were conducted with persons with disabilities for the qualitative component. Chi-squared tests and logistic regression analyses were performed on the survey data, while the qualitative interviews were coded and their SRH themes synthesized accordingly.ResultsOur quantitative findings show that education statistically significantly increases persons with disabilities’ SRH service utilization of antenatal care, delivery care, postnatal care, and family planning (P < 0.05). Interestingly, for persons with disabilities, primary education shows increased adjusted odds of family planning use but is likely not enough to increase antenatal care, delivery care, or postnatal care use; secondary or post-secondary education may be required to improve utilization of these latter services. Qualitative findings support the association between higher education levels and greater SRH service use. Persons with disabilities of lower educational attainment held misinformation and distrust in SRH services and experienced mistreatment by SRH healthcare providers, discouraging them from seeking future SRH services.ConclusionsWe report that higher formal education level is associated with greater SRH service use for persons with disabilities in Bangladesh. Formally educating persons with disabilities expands their SRH knowledge and familiarity with SRH services, as well as leads to more economic opportunities so they can afford SRH services. Increasing formal education levels for persons with disabilities, paired with integrating comprehensive sexuality education (CSE) in their schools, will likely help close the gap in SRH health disparities for this vulnerable population.

Socio-cultural context of adolescent sexuality and youth friendly service intervention in West Gojjam Zone, Northwest Ethiopia: a qualitative study

BackgroundRecognizing that adolescents face barriers in accessing services, may feel embarrassed, face stigma on sexual matters, or have concerns about judgmental providers, youth-friendly service (YFS) has been introduced to deliver health services that meet the sexual and reproductive health (SRH) needs of young people. Evidences on the role of YFS in addressing the socio-cultural norms influence unmarried adolescent SRH behaviour are limited. Therefore, this study explore whether the socio-cultural norms influencing adolescent SRH behaviour vary between youth friendly service program and non Program areas in West Gojjam Zone, North West Ethiopia.MethodsQualitative case study design was employed to explore the socio-cultural context of adolescent sexuality. Purposive sampling was used to identify study participants. Data were collected from 112 participants both from YFS program and non-program areas using semi-structured in-depth interviews, key informants, and focus group discussions guides. A total of 18 key informant interviews, twelve FGDs and four in-depth interviews were conducted. Participants were comprised from unmarried adolescents, parents, religious leaders, community elders, health professionals, teachers, and unmarried adolescents who experienced SRH problem. Thematic analysis was used to summarized the data.ResultsThe socio-cultural norms related to adolescent sexuality in both YFS program and non-program areas indicated that the community is intolerant to premarital sex, SRH service utilization (eg., contraceptive use) by unmarried adolescent; and discourage SRH communication with unmarried adolescents. According to the participants, premarital sex and SRH service use were not accepted by the community. Moreover, participants believed that, having communication on SRH issues with unmarried adolescents are equivalent to encouraging them to initiate sex, therefore, should not be practiced.ConclusionThe socio-cultural norms influencing adolescent sexual behaviour were more or less the same between settings. In both areas, the socio-cultural context discourages YFS intervention like SRH communication and service use. Also, the YFS program does not modify the socio-cultural norm affecting adolescent sexuality. Therefore, the YFS interventions strategies should give due emphasis to the socially accepted sexual norms like sexual abstinence.