Youth SRH services needs and challenges

Background: Young women often face social, economic, logistical, policy and health system barriers to access to sexual and reproductive health services, including safe abortion care.
Method: An OR project is launched in Jharkhand to assess the strategy of using youth leaders to link young women to SRH issues including safe abortion services. Using quasi-experimental longitudinal design a baseline household survey is conducted in July-August 2012 and interviewed 1381 young women (15-24 years) to assess the knowledge, attitude, and skills on SRH issues and barriers and forces of influence that lead to any particular behavior, decision, or service utilization.
Results: Even with high levels of literacy (66%-91%) and mass media exposures (65%-80%), the composite knowledge score on SRH (2.4 of 6), contraception (2.4 of 8), and abortion (0.5 of 8) related issues were significantly low. Multivariate analyses revealed age, education, family composition, living standard, and exposure to mass media as the influencing attributes of knowledge level. Around 4% of married young women reported experiencing induced abortion; one-third of them had no role in taking decision. 92% of them had approached private and illegal providers. Findings of this study had major policy implication for guiding the youth focused intervention strategy.

Understanding sexual and reproductive health of adolescents is of utmost importance and carries with it implications for improving individual health outcomes especially reduction in unintended pregnancies and STIs such as HIV/AIDS. Using data from poor urban youths in the slums Nairobi, we try in this paper to comprehensively look at the individual level factors that may influence contraceptive use and pregnancy outcomes among adolescents as they transition to adulthood, in a bid to understand the needs and challenges that they face. Preliminary results point to the fact that there is a diversity of experiences among adolescents with regards to knowledge, attitude and behavior. Age, education and marital status were often strongly associated with SRH experiences of adolescents, pointing to fact that targeted programs are needed to reach them with range of SRH info and services at different stages – before they initiate sex, as sexually active unmarried youth, or as married individuals and couples.

Few studies have evaluated whether youth-friendly health services improve young people’s experiences of using services, and none in South Africa have done so since the Department of Health took over management of the Youth Friendly Services program. This study investigated whether clinics providing Youth Friendly Services in Soweto, South Africa delivered a more positive experience to young people requesting advice on condom reliability or contraceptive methods than those not providing this program, using a simulated client method. 15 randomly selected primary healthcare clinics each received 3-4 simulated client visits. After each visit semi-structured debrief interviews were conducted with simulated clients. Multi-level linear regression was used to investigate associations between Youth Friendly Services provision and visit outcomes. Framework analysis of qualitative data was conducted. There was no evidence that clinics providing Youth Friendly Services delivered a more positive experience (difference in mean clinic visit score -0.18, 95% CI: -0.95, 0.60, p=0.656) than those not providing this program. More positive experiences were categorised by positive healthcare worker behaviour and less positive experiences by unnecessary protocols, negative attitudes to information seeking and lack of information or of privacy.

Adolescent pregnancies are most often the result of sexual risk taking. Adolescent birth rates in low and middle income countries lag behind those of higher income countries. The review’s objective was to present the best available evidence on facilitators and barriers to programs targeting a reduction in pregnancies among adolescents in low and middle income countries. Qualitative studies focused on interventions to persons aged 10 to 19 years residing in low and middle income countries of the world and factors that could influence those interventions were considered.
The review identified 8 perceived barriers and 3 perceived facilitators from 11 synthesized findings. Some perceived barriers were inadequate adult/parental support, negative perceptions about contraception, sex as a resource, lack of open sexual discourse, subordination of females to males and non-friendly institutions. Perceived facilitators were supportive institutions, families and parents, and adolescents’ determination not to be pregnant early in life.
A friendly approach to care, societal support and open discourse on sexual issues could facilitate a reduction of unintended pregnancies. Further research of myths against contraception use, cultural norms encouraging female subordination among others could guide pregnancy prevention programs.