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Underutilization of sexual and reproductive health services among young people is associated with many adverse sexual and reproductive health-related outcomes and morbidity. Guided by the socioecological model, this study undertook a qualitative exploration of the barriers limiting young peoples' uptake of sexual and reproductive health services in Osun State, Nigeria. Fifty-eight young people (aged 15–24 years) from two universities and one community in Osun State were selected and involved in six focus group discussions. A thematic analysis was performed using NVivo software version 12. Intrapersonal, interpersonal, institutional, and community-level barriers were identified from the focus group discussions, aligning with the socioecological model framework. The study identified various interwoven barriers to the utilization of sexual and reproductive health information and services. The interrelatedness of the factors at different levels underscores the need to design and implement multifaceted policies and interventions aimed at improving young people's access to and utilization of sexual and reproductive health services. [ABSTRACT FROM AUTHOR]

Background: Ensuring uninterrupted access and utilisation of sexual and reproductive health (SRH) services remains crucial for preventing adverse SRH outcomes. However, the unprecedented emergence of the 2019 coronavirus disease (COVID-19) significantly disrupted most of these services in Africa. Thus, we systematically reviewed and examined barriers and facilitators to accessing and utilising SRH services during the COVID-19 pandemic in Africa. Methods: We systematically searched five databases for relevant articles published between January 2020 to December 2022, and the articles were screened following the JBI and PRISMA guidelines. Meta-synthesis of barriers and facilitators to accessing and utilising SRH services during the COVID-19 pandemic were reported, while a meta-analysis of the pooled prevalence of barriers to accessing and utilising SRH services during the COVID-19 pandemic in Africa was analysed using R. Results: The pooled prevalence of barriers to accessing and utilising SRH services during the COVID-19 pandemic in Africa was 26%. Seven themes were developed for the identified barriers (disruption of healthcare services, fear and misinformation, limited availability of resources, place & region of residence, healthcare staff attitude/manpower, limited access to transportation, and stigma and discrimination), whilst six themes were developed for the identified facilitators (support for vulnerable populations, socio-demographic characteristics, community outreach programs, policy adaptations, telemedicine and digital health, and change in choice of sexual and reproductive commodities). Conclusion: This study found that the COVID-19 pandemic significantly impacted SRH service access and utilisation in Africa. We recommend that future research consider a longitudinal examination of the pandemic on African SRH services. Trial registration: PROSPERO registration number: CRD42022373335. [ABSTRACT FROM AUTHOR]

Abstract Background The lack of adequate access to and use of sexual and reproductive health care by youth and adolescent, n low- and middle-income countries persists despite international accords on their rights, which exposes them to violence against children; early and unintended pregnancies; and sexually transmitted infections. This study examined functional sexual and reproductive health and right-based friendly services as perceived by exit male and female adolescents, caregivers, and health workers at the Tanzanian health services delivery points as they were the ones who would share their opinions to establish a diversified and representative reality about the matter based on sex. Methods This was a multicentric study among 205 randomly selected participants in eleven selected health facilities within the three regions of Tanzania including Dar es Salaam, Dodoma, and Kigoma regions using a one-time descriptive cross-sectional design with a quantitative research approach from 01 to 30 November 2022. Triangulation technique of data collection activities using structured questionnaires and observation checklist adopted from the Tanzanian Ministry of Health was used to collect data. IBM Statistical Package for Social Sciences version 26 data entry templates (Sa PSS – 26) were used to analyze data descriptively to establish frequencies and percentages. Results Results indicated that 205 participants were assessed in this study with a response rate of 100%. Exit adolescents (46%); health workers in dispensaries (60%), and community members (42%) were more likely to confirm the availability of functional SRH right-based adolescent and youth-friendly services at the health services delivery points. The SRH displays (50%); adolescent rights (6%) and confidentiality (5%) were the least reported functional SRH aspects by the study participants. It was noted that the 11 health services delivery points in their totality did not fully implement the National standards in providing the services to adolescents and youth of which standards III (54.0%) and VIII (46.1%) scored the lowest. Conclusion The results of this study have uncovered that there is disperities in the availability and accessibility of functional SRH right-based adolescent and youth-friendly services across the levels of health facilities; among adolescents and community members. Hospitals were more likely to confirm the availability of Functional Right Based Youth Friendly Services than at health centers and dispensaries with female adolescents, youth, and community members being disadvantaged. There is a need to address issues of differentials in equity to the accessibility of services among adolescents, youth, and community members by improving functional sexual and reproductive health and right-based friendly services provision infrastructures, health care workers capacity building, and mechanisms or approaches to increase adolescents’ access and uptake to SRHR services.

Background: The lack of adequate access to and use of sexual and reproductive health care by youth and adolescent, n low- and middle-income countries persists despite international accords on their rights, which exposes them to violence against children; early and unintended pregnancies; and sexually transmitted infections. This study examined functional sexual and reproductive health and right-based friendly services as perceived by exit male and female adolescents, caregivers, and health workers at the Tanzanian health services delivery points as they were the ones who would share their opinions to establish a diversified and representative reality about the matter based on sex. Methods: This was a multicentric study among 205 randomly selected participants in eleven selected health facilities within the three regions of Tanzania including Dar es Salaam, Dodoma, and Kigoma regions using a one-time descriptive cross-sectional design with a quantitative research approach from 01 to 30 November 2022. Triangulation technique of data collection activities using structured questionnaires and observation checklist adopted from the Tanzanian Ministry of Health was used to collect data. IBM Statistical Package for Social Sciences version 26 data entry templates (Sa PSS – 26) were used to analyze data descriptively to establish frequencies and percentages. Results: Results indicated that 205 participants were assessed in this study with a response rate of 100%. Exit adolescents (46%); health workers in dispensaries (60%), and community members (42%) were more likely to confirm the availability of functional SRH right-based adolescent and youth-friendly services at the health services delivery points. The SRH displays (50%); adolescent rights (6%) and confidentiality (5%) were the least reported functional SRH aspects by the study participants. It was noted that the 11 health services delivery points in their totality did not fully implement the National standards in providing the services to adolescents and youth of which standards III (54.0%) and VIII (46.1%) scored the lowest. Conclusion: The results of this study have uncovered that there is disperities in the availability and accessibility of functional SRH right-based adolescent and youth-friendly services across the levels of health facilities; among adolescents and community members. Hospitals were more likely to confirm the availability of Functional Right Based Youth Friendly Services than at health centers and dispensaries with female adolescents, youth, and community members being disadvantaged. There is a need to address issues of differentials in equity to the accessibility of services among adolescents, youth, and community members by improving functional sexual and reproductive health and right-based friendly services provision infrastructures, health care workers capacity building, and mechanisms or approaches to increase adolescents' access and uptake to SRHR services. [ABSTRACT FROM AUTHOR]

Background: Reproductive healthcare is essential for all people, including lesbian and bisexual women. However, lesbians and bisexual women are among society's most marginalised and excluded members. Objective: This study aimed to explore the challenges faced by lesbian and bisexual women in accessing Sexual and Reproductive Health (SRH) Services in Bulawayo, Zimbabwe. Design: An exploratory, descriptive qualitative study was conducted on two populations that included eight participants identified through the Voice of the Voiceless organisation in Bulawayo and 10 key informants and probed the challenges faced by lesbians and bisexual women when accessing SRH services. Methods: Data were gathered through 10 key informant interviews and 1 focus group discussion (FGD; with 8 participants). The interviews and FGDs were recorded, transcribed verbatim, coded and thematically analysed. Results: The themes that emerged included the uptake of SRH services among lesbians and bisexual women, the challenges faced by lesbians and bisexual women when accessing SRH services, and strategies to aid the uptake of SRH services by lesbians and bisexual women. The findings showed that the uptake of SRH services was generally low and was influenced by factors such as clinical settings. The challenges mentioned included stigma and the unavailability of specific lesbian and bisexual women's services. By contrast, the most frequent strategies included affirmative training for healthcare providers and improved clinical settings to become friendly and inclusive. Conclusion: There is an imperative for targeted SRH services that address the distinct needs of lesbians and bisexual women, in line with the 95-95-95 strategy and Sustainable Development Goals target 3.7. The observed low uptake of these services can be attributed to several systemic barriers, including inadequate training of health providers, negative attitudes and lack of inclusive policies. Enhancing the sensitivity of health facilities, strengthening links to sexual health education and implementing supportive legal frameworks are essential steps to improve SRH outcomes in this population. These findings elucidate critical gaps within the current healthcare system and present significant opportunities for policymakers to formulate evidence-based strategies to ensure equitable access to SRH services, thereby advancing public health objectives. Plain language summary: Access to sexual and reproductive health services by lesbians and bisexual women in Zimbabwe According to the United Nations, everyone should have access to healthcare related to sex and reproduction to improve their chances of fully protecting themselves from sexually transmitted infections, such as HIV and AIDS, and eliminate it by 2030. However, lesbian and bisexual women in Bulawayo often face challenges accessing services related to sexual health and reproduction. This study aimed to understand the difficulties faced by these women in accessing these services. Researchers interviewed experts, lesbians, and bisexual women to gain a better understanding of their difficulties. They discovered that many women rarely use these health services for two main reasons. First, some women fear judgment or discrimination by health care providers. Second, often no specific services are offered to address the needs of lesbian and bisexual women. To improve access to care, this study recommends that healthcare workers receive training to be more welcoming and to understand lesbian and bisexual women. Additionally, healthcare facilities should be designed to be inclusive and offer services that specifically cater to the sexual and reproductive health needs of this population. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Adolescents face unique challenges related to their sexual and reproductive health (SRH), with access to timely services being critical for positive outcomes. However, SRH service utilization among adolescents remains low. This study aimed to identify factors influencing SRH service use among adolescents in Gamo Zone, Ethiopia. Methods: A community-based cross-sectional study involved 1172 adolescents selected through stratified sampling. Structured face-to-face interviews were employed for data collection. Multilevel mixed logistic regression was fitted to identify factors and latent class analysis was conducted to understand population heterogeneity. Results: The findings of this study reveal that 198 (16.89%) adolescents (95% CI: 14.8%-19.2%) utilized SRH services within the past 12 months. Factors significantly associated with SRH service utilization included good knowledge about SRH rights (AOR = 4.65; 95% CI: 2.68, 8.07), belonging to one-parent families (AOR = 4.13; 95% CI: 2.39, 7.12), engaging in parental discussions regarding SRH issues (AOR = 3.17; 95% CI: 1.89, 5.29), high family support (AOR = 1.96; 95% CI: 1.09, 3.51), and enrolling in school (AOR = 0.19; 95% CI: 0.11, 0.33). Additionally, access to social media was associated with increased SRH service utilization among adolescents (AOR = 1.98; 95% CI: 1.25, 3.15). Latent class analysis identified four groups: rural school-enrolled adolescents living with parents, urban school-enrolled adolescents with both parents, urban disadvantaged female adolescents, and early adolescents with limited social media access. Conclusions: In conclusion, our study sheds light on the utilization of SRH services among adolescents, revealing that 16.89% of the participants accessed these services within the past year. Significant factors associated with SRH service utilization included good knowledge about SRH rights, belonging to one-parent families, engaging in parental discussions regarding SRH issues, high family support, and enrollment in school. Interestingly, access to social media was also linked to increased utilization of SRH services among adolescents. Furthermore, our latent class analysis identified four distinct classes of adolescents based on socio-demographic indicators, highlighting the heterogeneity within this population. These findings underscore the importance of tailored interventions and targeted approaches to address the diverse needs of adolescents in accessing and utilizing SRH services. [ABSTRACT FROM AUTHOR]

Objective. To describe care and information seeking, and the prevalence of use of sexual and reproductive health (SRH) services among sexually initiated adolescents aged 12-19 years. Materials and methods. We analyzed information from sexually initiated adolescents using the Encuesta Nacional de Salud y Nutrición 2023 (Ensanut 2023). We described the search for and use of SRH services according to sociodemographic characteristics. Results. One in three adolescents sought information or care; 94.6% of those who sought information or care received it. Females were more likely to use SRH services. Care was mainly provided at health days or health fairs (70%). The main reasons for seeking care were sexual orientation and contraceptive counseling. Conclusions. There is an urgent need to implement interinstitutional interventions that promote adolescents' access to health services, including strengthening knowledge of the wide range of services and spaces they can access. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enablers of the adoption of a school and community-embedded intervention that used community engagement, capacity building, partnerships and collaborations to deliver sexual and reproductive health services to adolescents. Methods The intervention was implemented between 2019 and 2021 in six local government areas in Ebonyi State. The results on adoption presented here were collected four months into the mid-phase of the project, targeting adolescents, parents, adult family members, healthcare providers, local authorities, and community members. Sixteen in-depth interviews were conducted with policymakers, 14 with health service providers and 18 Focus Group Discussions (FGDs) with parents, community leaders and adolescents who were part of the implementation process. The coding reliability approach, a type of thematic data analysis was used, that involves early theme development and the identification of evidence for the themes. Results The adoption of school and community-embedded reproductive health intervention was strong among stakeholders at the early stages of the implementation process. Multi-stakeholder involvement and its multi-component approach made the intervention appealing, thereby enabling its adoption. However, at the later stage, the adoption was constrained by beliefs and norms about sexual and reproductive health (SRH) and the non-incentivisation of stakeholders who acted as advocates at the community level. The sustainability of the intervention may be threatened by the non-incentivisation of stakeholders and the irregular supply of materials and tools to facilitate SRH advocacy at the community level. Conclusions The inclusive community-embedded reproductive health intervention was adopted by stakeholders because of the enablers which include timely stakeholder engagement. However, for it to be sustainable, implementers must address the non-incentivising of community-level advocates which serve as constraints.

Abstract Background The Family Guidance Association of Ethiopia (FGAE) operates as a non-governmental organization dedicated to offering family planning and reproductive health services to the Ethiopian population. The gap in the study regarding client satisfaction and contributing factors towards sexual and reproductive health services for youth at FGAE clinics highlights the need for a comprehensive investigation to fill this void. By conducting a mixed-method study, this research aims to provide a holistic understanding of the factors influencing client satisfaction in the delivery of sexual and reproductive health services to youth at FGAE clinics. The added value of this study lies in its potential to offer valuable insights and recommendations for improving service delivery systems and enhancing client satisfaction levels, ultimately contributing to the overall well-being and health outcomes of youth in North Ethiopia. Therefore study aimed to asses Client Satisfaction and Contributing Factors towards in sexual and reproductive health services delivery system among youth at Family Guidance Association of North Ethiopia (FGAE) Clinics, 2023. Method The study was conducted within the clinics of the Family Guidance Association of Ethiopia (FGAE), spanning Dessie, Kombolcha, and Woldia city administrations, involving a participant cohort of 416 clients. Facility-based concurrent type mixed method study design both quantitative and qualitative techniques were applied. Quantitative research employed a simple random sampling technique and conversely, the qualitative study utilized a heterogeneous type of purposive sampling strategy to recruit participants The collected data underwent a rigorous process of entry, cleaning, and coding using Epi-Data 4.6 software, followed by analysis in STATA V17. Descriptive statistics and binary logistic regression were employed to highlight the impact of independent variables on the dependent variable. A more comprehensive examination was provided through multivariable logistic regression. Crude and adjusted odds ratios, along with a 95% confidence interval, were computed, with significance set at a p-value ≤ 0.05. Result Nearly more than half of the clients 194 (47.8%) came to receive family planning services followed by maternal and child health 107 (26.4%). Sixty patients (14.8%) didn’t receive all the services they wanted or came for. Half of the participants 30 (50%) raised the unavailability of the service as a reason for not taking the service followed by not having enough time in the clinic 12 (20%). About 65.52% (60.74-70.00%) of the participants were satisfied with the Sexual and Reproductive Health services provided by the clinics of FGAE in northeast Ethiopia. Clients in the age group of 25–34 (AOR = 2.04; 95%CI: 1.11–3.72). Clients who had primary and secondary education (AOR = 2.49; 95%CI: 1.03–6.02) and (AOR = 3.05; 95%CI: 1.25–7.49) respectively. Clients who responded that physicians show respect (AOR = 5.59; 95%CI: 1.89–16.49). clients who received an explanation about the side effects of the utilized methods and follow-up dates (AOR = 4.59;95%CI:1.68–12.53) and (AOR = 2.89;95%CI:1.53–5.49) respectively. Conclusion The proportion of client satisfaction with Client Satisfaction in the Services delivery system at Family Guidance Association of Ethiopia (FGAE) Clinics was low as compared to the previous study. Age group 25–34 years, primary and secondary education, showing respect, explaining side-effects and follow-up visits were significant associated factors of client service satisfaction. Enhancing service delivery at Family Guidance Association of Ethiopia (FGAE) Clinics by targeting specific areas identified in the study. Strategies should focus on improving communication regarding side effects, ensuring respectful interactions, and prioritizing follow-up visits, particularly for clients aged 25–34 with primary and secondary education backgrounds.

Abstract Background COVID-19 pandemic widely disrupted health services provision, especially during the lockdown period, with females disproportionately affected. Very little is known about alternative healthcare sources used by women when access to conventional health services became challenging. This study examined the experiences of women and adolescent girls regarding access to sexual and reproductive health (SRH) services during the COVID-19 lockdown in Nigeria and their choices of alternative healthcare sources. Methods The study sites were two northern states, two southern states, and the Federal Capital Territory. Qualitative data were obtained through 10 focus group discussion sessions held with married adolescents, unmarried adolescents, and older women of reproductive age. The data were transcribed verbatim and analysed using a thematic approach and with the aid of Atlas ti software. Results Women reported that access to family planning services was the most affected SRH services during the COVID-19 lockdown. Several barriers to accessing SRH services during COVID-19 lockdown were reported, including restriction of vehicular movement, harassment by law enforcement officers, fear of contracting COVID-19 from health facilities, and fear of undergoing compulsory COVID-19 tests when seeking care in health facilities. In the face of constrained access to SRH services in public sector facilities during the COVID-19 lockdown, women sought care from several alternative sources, mostly locally available and informal services, including medicine vendors, traditional birth attendants, and neighbours with some health experience. Women also widely engaged in self-medication, using both orthodox drugs and non-orthodox preparations like herbs. The lockdown negatively impacted on women’s SRH, with increased incidence of sexual- and gender-based violence, unplanned pregnancy resulting from lack of access to contraceptives, and early marriage involving adolescents with unplanned pregnancies. Conclusion COVID-19 negatively impacted access to SRH services and forced women to utilise mostly informal service outlets and home remedies as alternatives to conventional health services. There is a need to ensure the continuity of essential SRH services during future lockdowns occasioned by disease outbreaks. Also, community systems strengthening that ensures effective community-based health services, empowered community resource persons, and health-literate populations are imperative for overcoming barriers to healthcare access during future lockdowns.

Abstract Background Sexual and reproductive health (SRH) is a right that should be guaranteed to every woman worldwide in order to have a healthy and safe sex life. In most Arab countries, including Egypt, there are different cultural, political, and religious factors that have contributed significantly to how society views and treats women’s bodies and sexuality. As a result, it is difficult to provide solid data and information to guide policymakers, policies, and to implement awareness and preventive programmes. This study sought to address this gap by looking at the intersectionality of women’s access to SRH services and information in Ismailia, Egypt. Methods The study utilised qualitative research methods. Semi-structured interviews were conducted with twelve married women and two key informant interviews with health professionals (a gynecologist and a pharmacist) in the study area. Results The study revealed that married women suffer from scarcity of understanding and knowledge of their SRH and lack of access to adequate SRH services and information. Married women’s experiences of accessing SRH services and information were influenced by intersecting factors located at the micro and macro levels. These intersected factors (e.g., power dynamics, socioeconomic factors, cultural norms, and religious misconception) shaped oppression and privilege structures which created unequal access to SRH information and services. Conclusion There is a need for building quality parental relationships for women before and after marriage in order to promote positive SRH attitudes and behavior. There is an urgent need to empower women before and after marriage with accurate, safe, and affordable SRH services and information that could have life-long benefits to protect them. There is a need to conduct educational programmes, and initiate media awareness campaigns, to equip women with information and knowledge about their SRH services and information.

Background: School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enablers of the adoption of a school and community-embedded intervention that used community engagement, capacity building, partnerships and collaborations to deliver sexual and reproductive health services to adolescents. Methods: The intervention was implemented between 2019 and 2021 in six local government areas in Ebonyi State. The results on adoption presented here were collected four months into the mid-phase of the project, targeting adolescents, parents, adult family members, healthcare providers, local authorities, and community members. Sixteen in-depth interviews were conducted with policymakers, 14 with health service providers and 18 Focus Group Discussions (FGDs) with parents, community leaders and adolescents who were part of the implementation process. The coding reliability approach, a type of thematic data analysis was used, that involves early theme development and the identification of evidence for the themes. Results: The adoption of school and community-embedded reproductive health intervention was strong among stakeholders at the early stages of the implementation process. Multi-stakeholder involvement and its multi-component approach made the intervention appealing, thereby enabling its adoption. However, at the later stage, the adoption was constrained by beliefs and norms about sexual and reproductive health (SRH) and the non-incentivisation of stakeholders who acted as advocates at the community level. The sustainability of the intervention may be threatened by the non-incentivisation of stakeholders and the irregular supply of materials and tools to facilitate SRH advocacy at the community level. Conclusions: The inclusive community-embedded reproductive health intervention was adopted by stakeholders because of the enablers which include timely stakeholder engagement. However, for it to be sustainable, implementers must address the non-incentivising of community-level advocates which serve as constraints. [ABSTRACT FROM AUTHOR]

Background COVID-19 pandemic widely disrupted health services provision, especially during the lockdown period, with females disproportionately affected. Very little is known about alternative healthcare sources used by women when access to conventional health services became challenging. This study examined the experiences of women and adolescent girls regarding access to sexual and reproductive health (SRH) services during the COVID-19 lockdown in Nigeria and their choices of alternative healthcare sources. Methods The study sites were two northern states, two southern states, and the Federal Capital Territory. Qualitative data were obtained through 10 focus group discussion sessions held with married adolescents, unmarried adolescents, and older women of reproductive age. The data were transcribed verbatim and analysed using a thematic approach and with the aid of Atlas ti software. Results Women reported that access to family planning services was the most affected SRH services during the COVID-19 lockdown. Several barriers to accessing SRH services during COVID-19 lockdown were reported, including restriction of vehicular movement, harassment by law enforcement officers, fear of contracting COVID-19 from health facilities, and fear of undergoing compulsory COVID-19 tests when seeking care in health facilities. In the face of constrained access to SRH services in public sector facilities during the COVID-19 lockdown, women sought care from several alternative sources, mostly locally available and informal services, including medicine vendors, traditional birth attendants, and neighbours with some health experience. Women also widely engaged in self-medication, using both orthodox drugs and non-orthodox preparations like herbs. The lockdown negatively impacted on women’s SRH, with increased incidence of sexual- and gender-based violence, unplanned pregnancy resulting from lack of access to contraceptives, and early marriage involving adolescents with unplanned pregnancies. Conclusion COVID-19 negatively impacted access to SRH services and forced women to utilise mostly informal service outlets and home remedies as alternatives to conventional health services. There is a need to ensure the continuity of essential SRH services during future lockdowns occasioned by disease outbreaks. Also, community systems strengthening that ensures effective community-based health services, empowered community resource persons, and health-literate populations are imperative for overcoming barriers to healthcare access during future lockdowns. [ABSTRACT FROM AUTHOR]

Background: The Family Guidance Association of Ethiopia (FGAE) operates as a non-governmental organization dedicated to offering family planning and reproductive health services to the Ethiopian population. The gap in the study regarding client satisfaction and contributing factors towards sexual and reproductive health services for youth at FGAE clinics highlights the need for a comprehensive investigation to fill this void. By conducting a mixed-method study, this research aims to provide a holistic understanding of the factors influencing client satisfaction in the delivery of sexual and reproductive health services to youth at FGAE clinics. The added value of this study lies in its potential to offer valuable insights and recommendations for improving service delivery systems and enhancing client satisfaction levels, ultimately contributing to the overall well-being and health outcomes of youth in North Ethiopia. Therefore study aimed to asses Client Satisfaction and Contributing Factors towards in sexual and reproductive health services delivery system among youth at Family Guidance Association of North Ethiopia (FGAE) Clinics, 2023. Method: The study was conducted within the clinics of the Family Guidance Association of Ethiopia (FGAE), spanning Dessie, Kombolcha, and Woldia city administrations, involving a participant cohort of 416 clients. Facility-based concurrent type mixed method study design both quantitative and qualitative techniques were applied. Quantitative research employed a simple random sampling technique and conversely, the qualitative study utilized a heterogeneous type of purposive sampling strategy to recruit participants The collected data underwent a rigorous process of entry, cleaning, and coding using Epi-Data 4.6 software, followed by analysis in STATA V17. Descriptive statistics and binary logistic regression were employed to highlight the impact of independent variables on the dependent variable. A more comprehensive examination was provided through multivariable logistic regression. Crude and adjusted odds ratios, along with a 95% confidence interval, were computed, with significance set at a p-value ≤ 0.05. Result: Nearly more than half of the clients 194 (47.8%) came to receive family planning services followed by maternal and child health 107 (26.4%). Sixty patients (14.8%) didn't receive all the services they wanted or came for. Half of the participants 30 (50%) raised the unavailability of the service as a reason for not taking the service followed by not having enough time in the clinic 12 (20%). About 65.52% (60.74-70.00%) of the participants were satisfied with the Sexual and Reproductive Health services provided by the clinics of FGAE in northeast Ethiopia. Clients in the age group of 25–34 (AOR = 2.04; 95%CI: 1.11–3.72). Clients who had primary and secondary education (AOR = 2.49; 95%CI: 1.03–6.02) and (AOR = 3.05; 95%CI: 1.25–7.49) respectively. Clients who responded that physicians show respect (AOR = 5.59; 95%CI: 1.89–16.49). clients who received an explanation about the side effects of the utilized methods and follow-up dates (AOR = 4.59;95%CI:1.68–12.53) and (AOR = 2.89;95%CI:1.53–5.49) respectively. Conclusion: The proportion of client satisfaction with Client Satisfaction in the Services delivery system at Family Guidance Association of Ethiopia (FGAE) Clinics was low as compared to the previous study. Age group 25–34 years, primary and secondary education, showing respect, explaining side-effects and follow-up visits were significant associated factors of client service satisfaction. Enhancing service delivery at Family Guidance Association of Ethiopia (FGAE) Clinics by targeting specific areas identified in the study. Strategies should focus on improving communication regarding side effects, ensuring respectful interactions, and prioritizing follow-up visits, particularly for clients aged 25–34 with primary and secondary education backgrounds. [ABSTRACT FROM AUTHOR]

Background: Sexual and reproductive health (SRH) is a right that should be guaranteed to every woman worldwide in order to have a healthy and safe sex life. In most Arab countries, including Egypt, there are different cultural, political, and religious factors that have contributed significantly to how society views and treats women's bodies and sexuality. As a result, it is difficult to provide solid data and information to guide policymakers, policies, and to implement awareness and preventive programmes. This study sought to address this gap by looking at the intersectionality of women's access to SRH services and information in Ismailia, Egypt. Methods: The study utilised qualitative research methods. Semi-structured interviews were conducted with twelve married women and two key informant interviews with health professionals (a gynecologist and a pharmacist) in the study area. Results: The study revealed that married women suffer from scarcity of understanding and knowledge of their SRH and lack of access to adequate SRH services and information. Married women's experiences of accessing SRH services and information were influenced by intersecting factors located at the micro and macro levels. These intersected factors (e.g., power dynamics, socioeconomic factors, cultural norms, and religious misconception) shaped oppression and privilege structures which created unequal access to SRH information and services. Conclusion: There is a need for building quality parental relationships for women before and after marriage in order to promote positive SRH attitudes and behavior. There is an urgent need to empower women before and after marriage with accurate, safe, and affordable SRH services and information that could have life-long benefits to protect them. There is a need to conduct educational programmes, and initiate media awareness campaigns, to equip women with information and knowledge about their SRH services and information. [ABSTRACT FROM AUTHOR]

IntroductionAdolescents face unique challenges related to their sexual and reproductive health (SRH), with access to timely services being critical for positive outcomes. However, SRH service utilization among adolescents remains low. This study aimed to identify factors influencing SRH service use among adolescents in Gamo Zone, Ethiopia.MethodsA community-based cross-sectional study involved 1172 adolescents selected through stratified sampling. Structured face-to-face interviews were employed for data collection. Multilevel mixed logistic regression was fitted to identify factors and latent class analysis was conducted to understand population heterogeneity.ResultsThe findings of this study reveal that 198 (16.89%) adolescents (95% CI: 14.8%-19.2%) utilized SRH services within the past 12 months. Factors significantly associated with SRH service utilization included good knowledge about SRH rights (AOR = 4.65; 95% CI: 2.68, 8.07), belonging to one-parent families (AOR = 4.13; 95% CI: 2.39, 7.12), engaging in parental discussions regarding SRH issues (AOR = 3.17; 95% CI: 1.89, 5.29), high family support (AOR = 1.96; 95% CI: 1.09, 3.51), and enrolling in school (AOR = 0.19; 95% CI: 0.11, 0.33). Additionally, access to social media was associated with increased SRH service utilization among adolescents (AOR = 1.98; 95% CI: 1.25, 3.15). Latent class analysis identified four groups: rural school-enrolled adolescents living with parents, urban school-enrolled adolescents with both parents, urban disadvantaged female adolescents, and early adolescents with limited social media access.ConclusionsIn conclusion, our study sheds light on the utilization of SRH services among adolescents, revealing that 16.89% of the participants accessed these services within the past year. Significant factors associated with SRH service utilization included good knowledge about SRH rights, belonging to one-parent families, engaging in parental discussions regarding SRH issues, high family support, and enrollment in school. Interestingly, access to social media was also linked to increased utilization of SRH services among adolescents. Furthermore, our latent class analysis identified four distinct classes of adolescents based on socio-demographic indicators, highlighting the heterogeneity within this population. These findings underscore the importance of tailored interventions and targeted approaches to address the diverse needs of adolescents in accessing and utilizing SRH services.

ObjectiveSexual health plays a vital role in healthy aging. However, little is known about the sexual attitudes of and the utilization of sexual and reproductive health services by older women in China. This article is based on a qualitative study of older Chinese women in suburban areas to examine their attitudes toward sexuality and their utilization of sexual and reproductive health services.MethodsFace-to-face semi-structured interviews were conducted with older women (ages 50 to 74) from suburbs of southern China. Participants were purposively sampled on a convenience basis and recruited when they were visiting community health facilities between June and December 2021. Inclusion criteria were older women aged 50 years and older who had sexual experience. A topic guide was used that focused on sexual activity, sexual attitudes, the utilization of sexual and reproductive health services, and the factors that influence these. Interviews were audio recorded and transcribed verbatim. We coded the data inductively and conducted a thematic analysis.ResultsTwenty-six Chinese women participated in the study. These older women had varying attitudes regarding sexual activity and its significance for older adults. The gender norms they held concerning sexual desire deemed that men had higher sexual desire than women. Most asymptomatic women did not actively seek sexual and reproductive health services. In most cases, women only sought professional services when they started to have sexual and reproductive health problems. Factors influencing the uptake of sexual and reproductive health services by older women were cost (affordability), availability, distance (accessibility), and conservative cultural norms towards sexuality.ConclusionThe attitudes of older women towards sexual activity are diverse. While some view sexual activity as common and essential for maintaining a sense of well-being in older age, others may hold different perspectives, considering it less significant. The utilization of sexual and reproductive health services by older Chinese women, except for when they were having a specific health issue, was low. Sexual health messages and services tailored for older women are needed.

Introduction: Dealing with intercultural communicative barriers in European countries' national health services is an increasing and necessary challenge to guarantee migrant women's right to health care. This integrative review describes the communication barriers and facilitators that migrant women encounter to access and use sexual and reproductive health (SRH) services in Europe. Methods: A literature search was performed to identify original studies in PubMed, CINAHL, PsycINFO, Web of Science, and Scopus, using keywords associated with migrant women and SRH services. This was supplemented by scanning the reference lists from relevant studies and similar reviews. Studies exploring the perspective of migrant women about communication barriers and facilitators to the access and use of SRH services were included, whereas those that solely explored health professional's experiences were excluded. Findings were organized into 4 themes: (1) verbal‐linguistic barriers, (2) nonverbal language barriers, (3) cultural barriers, and (4) communication facilitators. Results: Nineteen studies met the inclusion criteria. Results showed that when women had problems understanding or being understood by health professionals, they experienced feelings of anxiety, fear, insecurity, and discrimination that discouraged them from using SRH services. The most requested facilitators by women were health education, access to professional interpreters and translation of written information, and increasing the practitioners' cultural competence. Discussion: Communication barriers undermine migrant women's right to benefit from preventive SRH programs and to make informed decisions concerning their health. It is necessary to establish tailored plans in each health care center to improve intercultural communication that integrate facilitators proposed by women. Future research should provide solid evidence on the effectiveness of each facilitator implemented. [ABSTRACT FROM AUTHOR]

Programs such as the Friendly Clinic Initiative (NAFCI) accredited youth-friendly services (YFS) in South Africa have addressed issues such as HIV prevalence, sexual activity, and condom use, but they appear to have failed to significantly to reduce the incidence of pregnancy among learners who are still at school. This research sought to explore perceptions and experiences on the responsiveness of YFS in preventing unintended teenage pregnancy, from the viewpoints of teenage girls and boys in the township of Ekurhuleni (South Africa). This mixed-methods study included narratives with fifteen pregnant or teenage mothers, six focus groups, and a survey of 233 teenage boys and girls. Qualitative and quantitative data were assessed separately with thematic and descriptive analyses, respectively, and the outcomes were compared, combined, and discussed, where applicable. The findings of the study indicate that teenagers do not use the health services for prevention of unintended pregnancy and other consequences. They use the services only reactively and seem to perceive rather than experience barriers to attending any healthcare services. The study further highlights teenagers' aspirations of the services that will address their daily struggles and impact their reproductive health status. They suggest several possible non-conventional approaches that could be implemented to improve the provision of sexual and reproductive health. During the COVID-19 pandemic, there was some evidence to demonstrate that there is a place for non-conventional service provision for young people. This paper concludes that sexual reproductive health services be positioned as services that support the well-being of young people by looking at their health needs comprehensively. [ABSTRACT FROM AUTHOR]

Abstract Background This study explored the factors associated with the utilization of Youth-Friendly Sexual Reproductive Health (YFSRH) services among school-going Nigerian adolescents. Methods This cross-sectional study employed a mixed method involving school-going students attending five public secondary schools in Kogi State, Nigeria. Descriptive statistics were used to determine the patterns of utilisation of YFSRH services, whereas inferential statistics were performed to determine factors associated with utilization of YFSRH services. Qualitative data were analysed by thematic analyses of records using an inductive analysis. Results One in two secondary school-going students had used the YFSRH services. Most of the participants had poor awareness of YFSRH services and limited access to YFSRH services. While gender positively predicted the utilisation of YFSRH services among secondary school-going students (aOR = 5.7; 95% CI: 2.4–8.95, p = 0.001), we found that age (aOR = 0.94; 95% CI: 0.67–0.99, p =

Negussie Boti Sidamo,1,2 Amene Abebe Kerbo,1 Kassa Daka Gidebo,1 Yohannes Dibaba Wado3 1School of Public Health, College of Health and Medicine Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 2School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; 3African Populations and Health Research Center, Nairobi, KenyaCorrespondence: Negussie Boti Sidamo, Email Hanehalid@gmail.comBackground: In sub-Saharan African countries (SSA), despite the efforts to enable adolescents to access sexual and reproductive health (SRH) services, there are limited systematic review studies that comprehensively synthesize barriers to accessing services using a social-ecological model. Therefore, this review was conducted to fill this gap.Methods: This study protocol was registered in the PROSPERO database (CRD42022259095). We followed PRISMA guideline to conduct this review. PubMed, Google Scholar, Embase and African Journal Online databases were used. Two authors individually screened articles. Only qualitative articles published in the English in last 10 years were included in this review.Results: From the total of 4890 studies, 23 qualitative studies fulfilled the eligibility criteria. Those studies were from 11 SSA countries. This review finding revealed that inadequate information about the services, the incorrect perception about services, low self-esteem, fear of being noticed by family members, and financial constraints are barriers at the intrapersonal level. Unsupportive families and lack of open communication between adolescent-parent about sexuality issues were interpersonal barriers to access. Lack of provider competency, provider attitude, an unsupportive environment, physical inaccessibility of services, and shortage of medicine, and supplies were identified as institutional-level barriers. Moreover, community-level barriers like community stigma, social, religious, and gender norms within the society were identified as the main barriers to accessing services for adolescents.Conclusion: This review finding reveals that the main barriers to access SRH services for adolescents living in SSA are misperception about services, low self-esteem to access services, financial constraints, unsupportive families, community stigma and social norms, unsupportive environments in health facilities, healthcare provider behavior, poor competency, being judgmental attitude, and breaking privacy and confidentiality. This study finding calls for new approach like a multi-pronged that works with service providers, with community, with families, and with adolescent to improve SRH services utilization of adolescent.Keywords: adolescents, qualitative systematic review, sexual and reproductive health services, barriers, sub-Saharan Africa, socio-ecological model

AbstractPrevious studies have found high levels of unintended pregnancy among female sex workers (FSW), but less attention has been paid to their abortion practices and outcomes. This study is the first to investigate abortion-related mortality among FSW across eight countries: Angola, Brazil, Democratic Republic of Congo (DRC), India, Indonesia, Kenya, Nigeria, and South Africa. The Community Knowledge Approach (CKA) was used to survey a convenience sample of FSW (n = 1280). Participants reported on the deaths of peer FSW in their social networks during group meetings convened by non-governmental organisations (n = 165 groups, conducted across 24 cities in 2019). Details on any peer FSW deaths in the preceding five years were recorded. The circumstances of abortion-related deaths are reported here. Of the 1320 maternal deaths reported, 750 (56.8%) were due to unsafe abortion. The number of abortion-related deaths reported was highest in DRC (304 deaths reported by 270 participants), Kenya (188 deaths reported by 175 participants), and Nigeria (216 deaths reported by 312 participants). Among the abortion-related deaths, mean gestational age was 4.6 months and 75% occurred outside hospital. Unsafe abortion methods varied by country, but consumption of traditional or unknown medicines was most common (37.9% and 29.9%, respectively). The 750 abortion-related deaths led to 1207 children being left motherless. The CKA successfully recorded a stigmatised practice among a marginalised population, identifying very high levels of abortion-related mortality. Urgent action is now needed to deliver comprehensive sexual and reproductive healthcare to this vulnerable population, including contraception, safe abortion, and post-abortion care.

Abstract Background In Nigeria, vulnerability status may increase the risk for the violation of human rights while receiving health care. The present study determined the proportion and profile of people who reported rights violation while accessing HIV and sexual and reproductive health (SRH) services. Methods This was a cross sectional study with data collected between February and March 2021. The dependent variables were patients’ rights to autonomy: right to privacy and confidentiality of medical records; right to be treated with respect, regardless of gender, race, religion, ethnicity, allegations of crime, disability or economic circumstances; right to decline or consent to participation in medical research, experimental procedures or clinical trials; right to quality care in accordance to prevailing standards; and right to complain and express dissatisfaction regarding services received. The independent variables were sexual identity (heterosexual/straight, gay, lesbian, bisexual, queer), HIV status (positive, negative, do not know), living with disability (yes/no), and access point to HIV services (public or donor funded/private). Five multivariate regression models were developed to determine associations between the dependent and independent variable after adjusting for age, education level (no formal education, primary, secondary, tertiary), sex (male, female, intersex), marital status (single, married, separated/divorced, cohabiting) and gender identity (male, female, transgender). Results Complete data from 2119 study participants were analysed. Transgender individuals had significantly higher odds of experiencing violation of their rights to privacy and confidentiality of medical records (AOR:1.70), right to be treated with respect (AOR:1.71), right to complain and express dissatisfaction regarding services received (AOR:1.57) and right to decline consent to participate in medical research, experimental research, experimental procedures or clinical trials (AOR:1.81) compared to individuals who were males. Conclusion A high proportion of recipients of HIV and SRH services in Nigeria reported rights violations. Transgender individuals appear to have higher risk and those in spousal relationships have lower risk for rights violations. Studies are needed to learn how to improve rights-based HIV and SRH service delivery in Nigeria especially for transgender individuals.

Abstract Background Vulnerable adolescents are exposed to sexual and reproductive health harms. Ignoring the sexual and reproductive health of this group can have irreparable consequences. The present qualitative study aimed to explore the barriers to the access of vulnerable adolescent girls to sexual and reproductive health. Methods In this study, sixteen 14-19-year-old adolescent girls and twenty-two key informants were selected using purposive sampling method. Through in-depth semi-structured interviews, they expressed their experiences of barriers to sexual and reproductive health in vulnerable adolescent girls. The data were encoded using the conventional qualitative content analysis. Results Based on the results of the study, neglecting the reproductive and sexual health of vulnerable adolescent girls at different levels leads to serious challenges and obstacles in providing and maintaining it. Lack of a responsible family, the repulsive behaviors of the family and following risky behaviors of peers led to ignoring the sexual and reproductive health of adolescent girls. Unanswered sexual questions, defective life skills, unwanted pregnancy during adolescence, lack of awareness of unsafe sex, violating cultural norms and wounded psyche in vulnerable adolescent girls threaten their sexual and reproductive health. Ineffectiveness of key organizations in providing sexual and reproductive health services alongside lack of legal, political and social support in this area indicate that the sexual and reproductive health of these girls is not a priority for the society. Conclusion Numerous personal, family, social, legal and political barriers challenge the sexual and reproductive health of vulnerable adolescent girls. Developing a comprehensive and practical program beside legal and political support for this issue can provide the basis for the sexual and reproductive health of this group of adolescents in societies.

BackgroundLow-quality health care services are linked to a variety of health problems, which can have negative effects on adolescent and youth health. As a result, national data is crucial to providing high-quality healthcare to adolescents and youths in order to promote their health, wellness, and growth.ObjectiveTo examine the quality of young people's sexual and reproductive health care services and factors associated with service satisfaction in Ethiopia.MethodsThis review was carried out in accordance with the PRISMA guideline. We reviewed published data related to the quality of adolescent and youth-friendly sexual and reproductive health services (AYSRHS) in Ethiopia from January 02, 2002 to December 30, 2022. Relevant studies were identified through Google Scholar, PubMed, Cochrane Library, Science Direct, and HINARI. The extracted data was imported into STATA version 14.0 software for analysis. Heterogeneity among the reported prevalence of studies was checked using χ2 and I2 tests. The publication bias was examined by Egger's correlation and Begg's regression intercept tests at a 5% significance level.ResultsThe national pooled magnitude of structural, process, and output dimensions of quality of AYSRHS is 54.22% (95% CI: 33.21, 75.24%), 35.44% (95% CI: 24.95, 45.93%), and 57.01% (95% CI: 50.32, 63.7%), respectively. Being female (AOR: 1.61, 95% CI: 1.14–2.27), employed (AOR: 1.82, 95% CI: 1.06–3.14), waiting

Background: Men have poor access to sexual and reproductive health (SRH) services globally, particularly in low- and middle-income countries (LMICs). Nevertheless, in LMIC and high-income countries (HICs), low SRH utilisation happens on account of several factors, such as individual, health system-related, and sociocultural factors. Identifying and addressing men’s SRH service underutilisation remains essential to improving their sexual health and averting higher mortality and early morbidity associated with poor health seeking behaviour (HSB) among men. Aim: This narrative review identifies factors influencing whether men do or do not utilise SRH services in LMICs. Setting: We report on articles published in LMICs: Africa, Asia and South America. Method: In this narrative review, we searched for quantitative and qualitative articles published between 2004 and 2021 from international databases, including Google Scholar, ScienceDirect, EBSCOhost, Scopus, PubMed, Medline, and reference lists of retrieved published articles. Results: A total of 2219 articles were retrieved, from which 36 met the inclusion criteria. Factors contributing to poor uptake of SRH services by men included: a lack of access and availability of SRH services, poor health-seeking behaviour among men, and SRH facilities not being perceived as ‘male-friendly spaces’. Furthermore, our review reveals that decreased use of SRH services is attributed to factors such as a lack of focus on men’s SRH. Conclusion: The current underutilised state of SRH services calls for urgent implementation of evidence-based interventions. Identifying men’s SRH service inhibitors and enablers will assist programme managers and policymakers in designing SRH services tailored to their sexual health needs. Contribution: Despite numerous global interventions to motivate men, the findings provide insight into the underutilisation of SRH services. The study also reveals the inadequate comprehensive investigation of men’s SRH service utilisation, especially older men, to comprehend men’s problems fully. Further research needs to be conducted on SRH issues, including vasectomy, mental health, and chronic conditions related to sexual and reproductive health. The analysis can assist SRH policymakers and program managers in strengthening the policies to motivate men to engage better with SRH services.

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: We compared the use of sexual and reproductive health (SRH) services for Medicaid-enrolled women of reproductive age (WRA) living in Oregon by urban/rural status and examined the effect of the Affordable Care Act (ACA) Medicaid expansion on the use of SRH services for these women. Methods: We linked Oregon Medicaid enrollment files and claims for the years 2008–2016 to identify 392,111 WRA. Outcome measures included receipt of five key SRH services. The main independent variables were urban/rural status (urban, large rural cities, and small rural towns) and an indicator for the post-Medicaid expansion time period (2014–2016). We performed (conditional) fixed-effects logistic regression and multiple-group interrupted time-series analyses. Results: Women living in small rural towns were less likely than women living in urban areas to receive well-woman visits (odds ratio [OR] = 0.87; 95% confidence interval [95% CI] [0.80–0.94]), sexually transmitted infection (STI) screening (OR = 0.81; 95% CI [0.72–0.90]), and pap tests (OR = 0.91; 95% CI [0.84–0.99]). Women living in large rural cities were less likely than women living in urban areas to receive STI screening (OR = 0.91; 95% CI [0.84–0.98]). Following the implementation of ACA Medicaid expansion, the average number of all five SRH services increased for all women. With the exception of contraceptive services, the average number of SRH services examined increased more for urban women than for women living in small rural towns. Conclusions: Although Medicaid expansion contributed to increased use of SRH services for all WRA, the policy was unsuccessful in reducing disparities in access to SRH services for WRA living in rural areas compared with urban areas. [ABSTRACT FROM AUTHOR]

BACKGROUND:Over the last quarter century, there has been an emergence of evidence-based research directed toward the development, implementation, and assessment of youth-friendly health services (YFHS) to improve the delivery of sexual and reproductive health services for young people. Despite these research efforts, evidence supporting the effectiveness of YFHS is limited, which may be attributed to a lack of consensus on how to define and measure youth-friendliness to track progress and evaluate outcomes. The purpose of this systematic review is to assess how youth-friendly sexual and reproductive health services are measured worldwide. METHODS:We conducted a systematic review of studies measuring youth-friendly sexual and reproductive health services at health facilities published between January 2000 and June 2015 using PubMed, Web of Science, and POPLINE databases. Additional studies were identified by reviewing references of selected articles. Studies were screened to identify measurements and indicators that have been used to measure YFHS. RESULTS:Our review identified 20 studies from an initial search of more than 11,000 records, including six from high-income countries and 14 from low-and middle-income countries. The review identified 115 indicators used for measuring youth-friendly sexual and reproductive health services. Our review found a lack of consistency in the tools and indicators used to measure YFHS. The three most frequently assessed domains were accessibility, staff characteristics and competency, and confidentiality and privacy. The majority of the indicators were not specific to young people's needs and often reflected basic standards of care. CONCLUSIONS:This review shows the need for standardization and prioritization of indicators for the evaluation of YFHS. The results can be used to identify a core set of indicators that can be incorporated into a framework for assessing youth-friendly sexual and reproductive health services. There is a need to further distinguish between those variables that may have greatest impact on the use of services by young people, such as respect and privacy, those that impact the quality of services offered, and those that have limited relevance. Conducting more rigorous studies using a refined set of indicators is critical to measure and compare the impact and effectiveness of YFHS efforts.

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 crosssectional 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. [ABSTRACT FROM AUTHOR]

Transgender and non-binary (TNB) people are at increased risk of adverse sexual and reproductive health (SRH) outcomes compared to cisgender people. With this qualitative study, we investigated the experiences of TNB people with access to primary SRH care in the Netherlands. We conducted semi-structured, explorative interviews with fourteen TNB individuals. Data were analysed using thematic analysis. We identified three themes: 'navigating cisgender assumptions', 'depending on your healthcare provider' and 'access requires labour'. In primary SRH care, respondents felt that healthcare providers made incorrect assumptions about their care needs which required respondents to actively disclose their gender identity or medical history. However, some respondents felt disclosure also exposed them to clinical bias, or reduced them to a medical category 'transgender' that their healthcare providers perceived to require specialised knowledge. In this context, respondents felt the onus was on them to ensure their SRH care needs were met. Using the concept of trans erasure, we highlight how TNB people are put at risk of adverse SRH outcomes. Creating equitable care access requires not only that providers are educated on TNB health needs and their own cisnormativity, but also an ongoing, critical reflection on the use of gender- and sex-based categories in medicine. [ABSTRACT FROM AUTHOR]

Background: Men have poor access to sexual and reproductive health (SRH) services globally, particularly in low- and middle-income countries (LMICs). Nevertheless, in LMIC and high-income countries (HICs), low SRH utilisation happens on account of several factors, such as individual, health system-related, and sociocultural factors. Identifying and addressing men's SRH service underutilisation remains essential to improving their sexual health and averting higher mortality and early morbidity associated with poor health seeking behaviour (HSB) among men. Aim: This narrative review identifies factors influencing whether men do or do not utilise SRH services in LMICs. Setting: We report on articles published in LMICs: Africa, Asia and South America. Method: In this narrative review, we searched for quantitative and qualitative articles published between 2004 and 2021 from international databases, including Google Scholar, ScienceDirect, EBSCOhost, Scopus, PubMed, Medline, and reference lists of retrieved published articles. Results: A total of 2219 articles were retrieved, from which 36 met the inclusion criteria. Factors contributing to poor uptake of SRH services by men included: a lack of access and availability of SRH services, poor health-seeking behaviour among men, and SRH facilities not being perceived as 'male-friendly spaces'. Furthermore, our review reveals that decreased use of SRH services is attributed to factors such as a lack of focus on men's SRH. Conclusion: The current underutilised state of SRH services calls for urgent implementation of evidence-based interventions. Identifying men's SRH service inhibitors and enablers will assist programme managers and policymakers in designing SRH services tailored to their sexual health needs. Contribution: Despite numerous global interventions to motivate men, the findings provide insight into the underutilisation of SRH services. The study also reveals the inadequate comprehensive investigation of men's SRH service utilisation, especially older men, to comprehend men's problems fully. Further research needs to be conducted on SRH issues, including vasectomy, mental health, and chronic conditions related to sexual and reproductive health. The analysis can assist SRH policymakers and program managers in strengthening the policies to motivate men to engage better with SRH services. [ABSTRACT FROM AUTHOR]

Sexual and reproductive health services in Thailand have been provided in accordance with a national policy and strategic plan, but youths' sexual and reproductive health problems remain relatively high. A significant problem is youths' low access to appropriate services. This paper reports the first qualitative descriptive phase of participatory action research project, which aimed to develop a model for improving access to sexual and reproductive health services among youths. The study's purpose was to explore perceptions of youths regarding access to sexual and reproductive health services in northern Thailand. Qualitative data were collected from September 2019 to March 2020 through focus group discussions with 59 youths aged 15-24 years and in-depth interviews with four youths who had experienced an adolescent pregnancy. All participants were purposively recruited and volunteered. The data were recorded, transcribed verbatim, and analyzed using content analysis. Reflecting factors emerged from youths' needs and contexts toward access to sexual and reproductive health services. Five categories were classified: 1) inaccessibility to existing services, 2) unacceptability of available services, 3) unaware of access to effective information, 4) community's negative attitude toward youths accessing services, and 5) availability of other convenience services. These findings provide useful information for healthcare providers, particularly nurses and other stakeholders to better understand the perspectives of youths, enhance awareness of collaboration, and promote participation among youths in the development of intervention and strategies to improve access to sexual and reproductive health services. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sexual and reproductive health (SRH) is essential for men's health, but a large body of research has indicated that the underutilization of most SRH services by men is a persistent issue that needs to be addressed. Men's reluctance to access sexual and reproductive health services is one of the factors that leads to high morbidity and mortality rates among men, although their diseases may have been prevented or cured. This study aimed to explore factors that influence the decision of men who resided in men's hostels and who accessed urology clinics in KwaZulu-Natal to seek help for their sexual and reproductive health issues. An exploratory qualitative approach was adopted using focus group discussions. We interviewed seventy-two men of ages above 15 years. The data were analyzed thematically. The Biomedical Research Ethics Committee (BREC) of UKZN granted ethical clearance (BE 347/19). Of the 72 interviewed men, thirty-three men attended urology clinics in the selected hospitals, and thirty-nine men resided in the hostels around Durban in KZN. Seven themes (lack of awareness of SRH services; participants' reluctance to access SRH services; influence of culture and religion; lack of financial resources; influence of relationship dynamics; perceived low risk of individual sexual behaviors; and healthcare factors that discourage men from accessing SRH services) emerged from the data that were identified as barriers to SRH service utilization by men, whilst three themes (healthcare enabling factors; access to general information on SRH services; and personal motivational factors) emerged as factors that encouraged the participants to access these services. The participants' reluctance to access SRH services was attributed to the lack of awareness of available SRH services, the influence of culture and religion, lack of financial resources, relationship dynamics, the perceived low risk of sexual behaviors for individuals, and healthcare workers' negative attitude towards men requiring SRH services. The availability of healthcare resources, the appointment of more male healthcare workers, and more positive attitudes among healthcare workers will encourage men to utilize SRH services. The exposure of various barriers to SRH service utilization by this investigation warrants urgent attention from the government to impart knowledge about this phenomenon to men.

Nigussie Boti Sidamo,1– 3 Kassa Daka Gidebo,1 Yohannes Dibaba Wado,4 Amene Abebe,1 Mengistu Meskele1 1Department of Public Health, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 2Department of Reproductive Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; 3Department of Public Health, PHARMA College Wolaita Sodo Campus, Wolaita Sodo, Ethiopia; 4African Populations and Health Research Center, Nairobi, KenyaCorrespondence: Nigussie Boti Sidamo; Mengistu Meskele Email Hanehalid@gmail.com; mengistu77@gmail.comBackground: Healthcare providers play a critical role in the provision of sexual and reproductive health services for adolescents. In Ethiopia, due to different reasons, including healthcare providers associated reasons, most unmarried adolescents are not accessing the services. However, little is known about healthcare providers’ perception towards the provision of SRH services for unmarried adolescents. This study aimed to explore healthcare provider perception towards the provision of SRH services to unmarried adolescents in Gamo zone, Southern Ethiopia.Methods: A qualitative phenomenological research design was used in May 2021. Fifteen healthcare providers (HCPs) working in adolescent and youth sexual and reproductive health centers were involved in this study. A purposive sampling technique was used to select healthcare providers assuming they are “information-rich” regarding the phenomenon of interest. Inclusion of the study participants was continued until data saturation is reached. To analyze the data, we used inductive thematic analysis, method, and main themes, which captured the diverse views and feelings of the participants. To maintain the trustworthiness of the data, we used dependability, transferability, conformability, and credibility.Results: In this study, individual-level attributes such as healthcare provider’s personal belief, attitude, and motivation; community-level influences like socio-cultural norms, religious reasons, and lack of parental support; and health system setbacks like shortage of essential medical supplies and lack of training are identified as major obstacles in the provision of sexual and reproductive health services for unmarried adolescents.Conclusion: Provision of sexual and reproductive health services for unmarried adolescents is constrained by the interplay of factors acting at an individual level, community level, and health system level. The Ministry of Health (MOH), program planners and policymakers are recommended to give due attention to fulfill the necessary inputs, improving healthcare provider’s attitude and skill and engagement of religious and community leaders to create a safe and supportive environment for providing sexual and reproductive health services to unmarried adolescents.Keywords: healthcare provider, perception, sexual and reproductive health services, unmarried adolescents, Gamo Zone, Southern Ethiopia

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

Objective: To estimate the changes in infertility from 1995-2019 and determine the association of individual-level characteristics with fertility in the United States.Design: Cross-sectional study.Setting: Periodic data from 1995, 2002, 2006-2010, 2011-2013, 2013-2015, 2015-2017, and 2017-2019 cycles of the National Survey for Family Growth were used for this analysis. The National Survey for Family Growth comprises samples of the household-level population of women aged 15-44 years in the United States.Patient(s): Surveyed married and cohabiting women aged 15-44 years.Intervention(s): None.Main Outcome Measure(s): The primary outcomes were the rates of infertility across subgroups of married or cohabiting women. For secondary outcomes, we performed bivariable and multivariable logistic regression models using the pooled sample (N = 53,764) to determine the association of individual-level characteristics, including age, parity, pelvic inflammatory disease treatment, education, income, race or ethnicity, and receipt of sexual and reproductive health services, with the odds of 12-month infertility among married or cohabiting women.Result(s): The fluctuations in infertility over this period, with a low of 5.8% in 2006-2010 and a high of 8.1% in 2017-2019, were not found to be statistically significant. This trend was present across nearly all subgroups. The multivariable model showed that women who were older and nulliparous, had fewer years of education, had lower income, were non-Hispanic black, or were not receiving sexual and reproductive health services were more likely to be infertile.Conclusion(s): This study confirms that parity, age, race, and education level continue to have an association with infertility. Further, the results demonstrate that access to sexual and reproductive health services plays an important role in infertility. In contrast to previous studies, infertility in the United States is no longer on the decline, and Hispanic ethnicity did not have a significant relationship with infertility. Given the rise of sexually transmitted infections and the persistent lack of access to sexual and reproductive health services, particularly among already vulnerable groups, the connection between access to care and infertility is ripe for further investigation. [ABSTRACT FROM AUTHOR]

Plain language summary Antenatal care is the routine health care of pregnant women in order to diagnose pregnancy complications and to provide information about lifestyle, pregnancy and delivery. Maternal deaths among teenage mothers in South Africa is high and is largely due to conditions that can be prevented or managed by high quality antenatal care. Timely and routine antenatal care is therefore crucial for pregnant teenagers. The way in which pregnant teenagers are treated by health care workers at antenatal clinics influences their clinic attendance. This study reports on the experiences of pregnant teenagers with health care workers, when accessing antenatal care in Cape Town, South Africa. Nineteen pregnant girls aged 13–19 years were interviewed. Some positive experiences such as respectful and supportive treatment were reported. However, more negative experiences were reported, including victimization; discrimination against being pregnant at a young age; feeling disregarded and excluded; a lack of information about pregnancy, health and childbirth; being discouraged from attending the clinics; and mental health distress. In conclusion, many teenagers felt mistreated and discriminated against by the health care workers, which discouraged their clinic attendance. Maternal health care workers in South Africa need to receive support and regular training to provide youth friendly antenatal care to teenage girls.

Abstract Background Adolescent fertility is a main indicator of the Sustainable Developmental Goal (SGD) three. Although Sri Lanka is exemplary in maternal health, the utilization of Sexual and Reproductive Health services (SRH) by adolescents is less documented. We describe the hidden burden, associated biological and psychosocial factors and utilization patterns of pre-conceptional services among pregnant adolescents in rural Sri Lanka. Methods The study is based on the baseline assessment of the Rajarata Pregnancy Cohort (RaPCo) in Anuradhapura. Pregnant women newly registered from July to September 2019 were recruited to the study. The period of gestation was confirmed during the second follow-up visit (around 25–28 weeks of gestation) using ultra sound scan data. A history, clinical examination, anthropometric measurements, blood investigations were conducted. Mental health status was assessed using the Edinburgh Postpartum Depression Scale (EPDS). Results Baseline data on gestation was completed by 3,367 pregnant women. Of them, 254 (7.5%) were adolescent pregnancies. Among the primigravida mothers (n = 1037), 22.4% (n = 233) were adolescent pregnancies. Maternal and paternal low education level, being unmarried, and less time since marriage were statistically significant factors associated with adolescent pregnancies (p

Plain Language Summary Background Ethiopia is showing its enormous effort to improve the utilization of sexual and reproductive health services by adolescents and youths. But different factors are affecting it. This paper explains how many adolescents and youths are using sexual and reproductive health services and the factors affecting their utilization. Methods We interviewed 771 adolescents and youths aged 15 to 24 years in western Ethiopia. We asked them about the awareness and utilization of adolescents’ and youths’ sexual reproductive health services and the factors affecting their utilization. Results seven hundred seventy-one adolescents and youths were interviewed. Two hundred seventeen (28.1%) and 66 (8.6%) of them heard about and utilized adolescents' and youths' reproductive health services respectively. Those adolescents and youths who heard about sexual and reproductive health service practiced sexual intercourse and visited a health facility for other health services used sexual and reproductive health service more frequently. Conclusion Adolescents and youths who were using Sexual and reproductive health services were not many. Therefore, it better if the concerned bodies work on improving awareness and utilization of adolescents' and youths' sexual and reproductive health services.

Abstract Background While the nexus of migration and health outcomes is well acknowledged, the effect of rural–urban migration on the use of sexual and reproductive health (SRH) services has received less attention. We assessed the effect of rural–urban migration on the use of SRH services, while controlling for confounding, and whether there is a difference in the use of SRH services among migrant and non-migrant street children and young adults. Methods Data were collected from 513 street children and young adults aged 12–24 years, using venue-based time-space sampling (VBTS). We performed multivariate logistic regression analysis using Stata 16.0 to identify factors associated with SRH services use, with rural–urban migration status as the main predictor. Participants were further classified as new migrants (≤ 2 years of stay in city), established migrants (> 2 years of stay in city) or non-migrants (lifelong native street children) with no rural–urban migration history. Results Overall, 18.13% of the street children and young adults had used contraception/family planning, 58.67% had tested for human immunodeficiency virus (HIV) and knew their status and 34.70% had been screened for sexually transmitted infections (STIs). Non-migrants were 2.70 times more likely to use SRH services (HIV testing, STI screening and family planning) compared to the migrants (aOR = 2.70, 95% CI 1.23–5.97). Other factors associated with SRH services use among street children and young adults include age (aOR = 4.70, 95% CI 2.87–7.68), schooling status (aOR = 0.33, 95% CI 0.15–0.76), knowledge of place of care (aOR = 2.71, 95% CI 1.64–4.46) and access to SRH information (aOR = 3.23, 95% CI 2.00–5.24). Conclusions SRH services utilisation among migrant street children and young adults is low compared to their non-migrant counterparts and is independently associated with migration status, age, schooling status, knowledge of place of care and access to SRH information. Our findings call for the need to design and implement multi-dimensional interventions to increase the use of SRH services among street children and young adults, while taking into consideration their migration patterns.

Abstract Introduction Adolescent girls and young women (AGYW) remain disproportionately affected by HIV. In a rural area of South Africa with an annual incidence (2011–2015) of 5 and 7% per annum for 15–19 and 20–24-year olds respectively, oral pre-exposure prophylaxis (PrEP) could provide AGYW with a form of HIV prevention they can more easily control. Using quantitative and qualitative methods, we describe findings from a study conducted in 2017 that assessed knowledge of and attitudes toward PrEP to better understand community readiness for an AGYW PrEP rollout. Methods We used descriptive analysis of a quantitative demographic survey (n = 8,414 ages 15–86) to identify population awareness and early PrEP adopters. We also conducted semi-structured, in-depth interviews with a purposive sample of 52 potential PrEP gatekeepers (health care workers, community leaders) to assess their potential influence in an AGYW PrEP rollout and describe the current sexual health landscape. Interviews were recorded, transcribed, and iteratively coded to identify major themes. Results PrEP knowledge in the general population, measured through a demographic survey, was low (n = 125/8,414, 1.49% had heard of the drug). Medicalized delivery pathways created hostility to AGYW PrEP use. Key informants had higher levels of knowledge about PrEP and saw it as a needed intervention. Community norms around adolescent sexuality, which painted sexually active youth as irresponsible and disengaged from their own health, made many ambivalent towards a PrEP rollout to AGYW. Health care workers discussed ways to shame AGYW if they tried to access PrEP as they feared the drug would encourage promiscuity and “risky” behaviour. Others interviewed opposed provision on the basis of health care equity and feared PrEP would divert both drug and human resources from treatment programs. Conclusions The health system in this poor, high-HIV incidence area had multiple barriers to a PrEP rollout to AGYW. Norms around adolescent sexuality and gatekeeper concerns that PrEP could divert health resources from treatment to prevention could create barriers to PrEP roll-out in this setting. Alternate modes of delivery, particularly those which are youth-led and demedicalize PrEP, must be explored.

Abstract Background Adolescents are still getting pregnant and contracting Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STIs) in Rwanda as elsewhere. Quality and comprehensive SRH services and information for adolescents is valuable for adolescents’ wellbeing. This study aimed at understanding SRH services providers’ viewpoints on accessibility, availability, and quality of SRH services provided to adolescents in selected cities of Rwanda. Method The study was a descriptive cross-sectional survey conducted between May 2018 and May 2019 in six selected cities of Rwanda using a mixed-methods approach. A checklist was used to collect data from 159 conveniently selected SRH services providers. The survey tool was validated. SPSS version 20 was used to describe quantitative data and ATLAS TI version 5.2 was used to code and analyze the qualitative data thematically. Results Qualitatively, health care providers reported that the availability of adolescent SRHS are satisfactory with access to accurate SRH information, contraceptive methods, prevention and management of STIs and HIV services, and counselling. However, the accessibility of some services remains limited. According to respondents, some products such as female condoms are less in demand and often expire before they can be distributed. One nurse clarified that they render services at a low price if an adolescent has insurance medical coverture. Religious leaders and family members may hinder adolescents from health-seeking behavior by promoting abstinence and discouraging use of protective means. Quantitatively, we found that 94.3% of health facilities provide information to adolescents on SRH services that were available and 51.6% affirmed delivering services at a low cost. Only 57.2% of respondents mentioned that adolescents are involved in designing the feedback mechanisms at their facilities. Conclusion SRH services in Rwanda are available for the general population and are not specifically designed for adolescents. These SRH services seem to be fairly accessible to adolescents with insufficient quality as adolescents themselves do not get to be fully involved in service provision among other aspects of quality SRH as stated by the World Health Organization (WHO). Therefore, there is a need to improve the present quality of these services to meet adolescents’ needs in an urban setting.