Access to and use of sexual and reproductive health services among street children in Uganda: Does Migration matter?

Background While the nexus of migration and health outcomes is well acknowledged, the effect of rural-urban migration on uptake of sexual and reproductive health (SRH) services has received less attention. We assessed the effect of rural-rural urban migration on uptake of SRH services and whether there is a difference in uptake of SRH services among migrant and non-migrant street children. Methods Data were collected among 513 street children aged 12-24 years using face‐to‐face interviews. Participants were recruited by venue-based time-space sampling (VBTS). Using STATA 16.00, we performed multivariate binary logistic regression to identify correlates of SRH service uptake with migration status as the main predictor while controlling for confounding. In this study, migrants are defined as children who had moved to settle in the city for at least 24 months preceding the survey. Results Overall, two-thirds (66.82%) of children had moved to the city in the last 2 years, 20% in the last 3-5 years and 13.18% in 6 years or longer. Only 18.13% of the street children had ever used contraception/family planning, 45.89% had ever tested for HIV and knew their status while 34.70% had ever been screened for sexually transmitted infections. Multivariate analysis shows that migrant street children had reduced odds of using sexual and reproductive health services (HIV testing, use of contraception and screening for STIs) compared to the lifelong native street children (aOR=0.59, 95%CI 0.36- 0.97). Other factors associated with use of SRH services among street children include age (aOR=4.51; 95%CI 2.78-7.33), schooling status (aOR=0.34; 95%CI -1.830 0.15-0.76), knowledge of place of care (OR=3.37,95%CI 2.04-5.34) and access to SRH education information (aOR=2.7, 95%CI 1.67- 4.53). Conclusion Rural-urban migration is associated with low SRH service uptake. Access to and use of SRH services among migrant street children is low compared to non-migrant street children. Our findings point to the need for urban health systems to design effective interventions to improve equitable access to and use of quality SRH services among street children while taking into consideration their migration patterns.