A strategy to enhance utilisation of adolescents' sexual and reproductive health services in South-East Ethiopia

Abstract

Adolescent sexual and reproductive health (SRH) remains a critical health challenge in low-resource settings, including Ethiopia. This study investigated service provision with respect to SRH for adolescents in south-east Ethiopia, focusing on barriers to access and strategies to enhance utilisation in the Arsi Zone. The findings informed the development of a strategy to enhance uptake of adolescent SRH services. A sequential explanatory mixed-methods design was employed in two phases: a quantitative phase comprising surveys with adolescents and a qualitative phase comprising focus group discussions with adolescents, key informant interviews with healthcare workers, teachers, and community leaders to explore perceptions and experiences of SRH services. The research team analysed quantitative data in Statistical Package for Social Sciences (SPSS) version 30 using descriptive and multivariate statistics, while qualitative data analysed thematically. Results showed that only 23.5% of adolescents accessed SRH services. Major barriers included lack of awareness (33.6%), financial constraints (28.9%), distance to facilities (18.3%), fear of parental reaction (17.7%), and religious or cultural taboos (13.2%). Factors that increase utilisation included discussion of SRH between adolescents and trusted adults (AOR=2.12) or did not feel fear when seeking care (AOR=2.07) were more likely to use services. Adolescents with SRH problems, such as STIs, were nearly five times more likely to seek services (AOR=4.88), while those who found service hours convenient were over three times more likely to use adolescent-friendly services (AFS) (AOR=3.19). Adolescents perceived SRH services as essential; however, they reported significant difficulties in accessing them. The need for comprehensive SRH education, open family discussions, and supportive community involvement emerged as a key. Socio-cultural barriers such as stigma and taboos were consistently reported as limiting service use. Trusted adults were identified as critical in reducing fear and encouraging utilisation. The findings informed the development of an alternative strategy which should improve adolescent sexual and reproductive health outcomes. Such a strategy should embrace target interventions that address key barriers to improve awareness, access, and acceptability of adolescent SRH services in Arsi Zone. The proposed strategy prioritises community participation, culturally sensitive education, expansion of AFS and multisectoral collaboration. Implementing this strategy has the potential to significantly improve SRH outcomes among adolescents in Arsi Zone.