Adolescents' Views of and Preferences for Sexual and Reproductive Health Services in Burkina Faso, Ghana, Malawi and Uganda

Abstract

Adolescents' views of and preferences for sexual and reproductive health services highlight promising directions and persistent challenges in preventing pregnancy and HIV and treating sexually-transmitted infections (STIs) in this population. Results from nationally-representative surveys of 12-19 yearolds in Burkina Faso, Ghana, Malawi and Uganda in 2004 show that contraceptive and STI services and HIV testing are still under-utilized. A substantial proportion of sexually-active adolescents do not know of any source to obtain contraception or get STI treatment, and social-psychological reasons (e.g., embarrassment or fear) and financial cost remain common barriers to getting services. Adolescents' preferences are overwhelmingly for public clinics, with strongly positive perceptions of confidentiality, accessibility and cost. Some gender and country differences exist, yet overall females and males' views are similar. Results highlight the need to inform youth about sources, increase availability of government health facilities and improve youth's access to them, especially by reducing social barriers. Une grande proportion des adolescents qui sont sexuellement actifs ne connaissent pas les sources pour obtenir la contraception ou le traitement pour les IST; ensuite, des raisons socio-psychologiques (l'embarras et la peur) et le coût financier demeurent des obstacles à l'obtention des services. Les préférences des adolescents sont largement pour des cliniques publiques avec leur fortes perceptions positives de la confidentialité, de l'accessibilité et du coût. Il existe aussi certaines différences au niveau des genres et des pays, pourtant, en général, les opinions des mâles et des femelles sont similaires. Les résultats mettent l'accent sur la nécessité de renseigner la jeunesse sur les sources, d'augmenter la disponibilité des établissements de santé et d'améliorer l'accès de la jeunesse à ces établissements, surtout par la réduction des obstacles sociaux. (Rev Afr Santé Reprod 2007; 11[3]:99-110).

Seeking wider access to HIV testing for adolescents in sub-Saharan Africa

“…Other studies conducted across sub-Saharan Africa corroborate with the WHO study with respect to barriers to adolescent HTC (18,20,(22)(23)(24)(26)(27)(28)(29)(30)(31)(32). These studies identified major barriers as fear of a positive test, especially among those sexually active, and fear of stigma and discrimination, including being ostracized by friends and family.…”

“…All three documents strongly recommend revision of age of consent policies to increase independent access to HTC for adolescents. (17)(18)(19)(20), East (18,(21)(22)(23), and southern Africa (24)(25)(26). The proportion of adolescents willing to test differed within and between some countries with respect to factors including gender, geographical residence, socio-cultural norms, and HIV knowledge and risk perception of participants.…”

A strategic assessment of unsafe abortion in Malawi

“…12 Approximately a third of adolescents aged 15-19 years reported having a close friend who tried to end a pregnancy, as did a fifth of those aged 12-14. 5 Inadequate knowledge of sexual and reproductive health, 15 reluctance to access health services, 16 early marriage and sexual debut, 17 and low rates of contraceptive use make Malawian teens particularly vulnerable to sexual and reproductive health problems, including complications of unsafe abortion.…”

Scaling up male circumcision service provision: Results from a randomised evaluation in Malawi

“…In Malawi, the Yao and the Lomwe typically practise initiation ceremonies for adolescent boys that include circumcision, as well as rituals involving receiving instruction for future life as a man (Stannus and Davey 1913 (Munthali and Zulu 2007). It should be noted that approximately 80 per cent of youth in Malawi have had sex before the age of 18 years, suggesting that, in terms of using circumcision as an HIV-prevention strategy, earlier ages of circumcision might be more optimal (Biddlecom et al 2007). …”