Barriers and enablers to young people accessing sexual and reproductive health services in Pacific Island Countries and Territories: A scoping review

Abstract

Background The number of young people utilising sexual and reproductive health services in Pacific Island Countries and Territories remains poor despite the availability and the existence of the fundamental rights to access these services. Adolescents and youth need accurate information and timely access to contraceptives to prevent adverse consequences associated with unintended pregnancies, abortion, childbirth and untreated sexually transmitted infections. This scoping review identifies and analyses factors contributing to young people’s low access to sexual and reproductive health information and services in this region. Methods Guided by the PRISMA Scoping review guidelines, we searched three databases (Medline Ovid, Scopus and CINAHL Complete) for peer-reviewed articles published between 1st January 2000 and 31st August 2020 that reported on factors, including barriers and enablers, affecting access to sexual and reproductive health information and services by young people living in Pacific Island Countries and Territories. We assessed the quality of each study according to the study designs, methods of data collection, data analysis and ethical considerations. All information was sorted and organised using an Excel Spreadsheet. Text data from published articles were charted inductively using thematic analysis with no predetermined codes and themes. Findings Five hundred eighty-nine articles were screened, and only eight met the inclusion criteria outlined in this scoping review protocol. These eight articles reported studies conducted in four Pacific Island Countries and Territories: Cook Islands, Fiji, Papua New Guinea, and Vanuatu. Factors such as lack of accurate sexual and reproductive health knowledge and social stigma were the leading causes of young people’s limited access to sexual and reproductive health services. Cultural and religious beliefs also invoked stigmatising behaviours in some family and community members. Conclusion This scoping review revealed that social stigma and judgemental attitudes imposed by family and community members, including healthcare providers, hinder young unmarried individuals in Pacific Island Countries and Territories from accessing sexual and reproductive health information and contraceptives. Alternatively, a non-judgmental healthcare provider is perceived as an enabler in accessing sexual and reproductive health information and services. Moreover, given that only a few studies have actually focused on young people’s sexual and reproductive health needs in the region, more research is required to fully understand the health-seeking behaviours of young people in their specific contexts.

Barriers to sexual and reproductive health and rights of migrant and refugee youth: An exploratory socio-ecological qualitative analysis

“…MRY highlighted the potential culturally or socially instigated feelings of shame, guilt, and blame regarding SRHR, making it difficult to access necessary services or communicate these issues (Baigry et al, 2023; James et al, 2020). This was mirrored in the participants’ reflections, where societal judgement, internalised shame, and feelings of personal blame hindered their willingness to seek help.…”

“…Baigry et al’s (2023) recent findings identify social stigma, fear, and shame as barriers to accessing SRH services for young people in various countries, including Kenya, Nigeria, Malaysia, Nepal, and Iran – a similar demography represented in our study. Socio-cultural norms were also found to hinder youth’s access to contraceptives and STI treatments (Baigry et al, 2023). Similarly, the study by James et al (2020) highlights the association between stigma and healthcare utilisation, emphasising how stigma can lead to experiences of shame, guilt, and blame, ultimately deterring MRY from seeking adequate healthcare services (James et al, 2020).…”

Prevalence and predictors of HIV testing among young men in Papua New Guinea: a cross-sectional analysis of a nationally representative sample

“…Inadequate uptake of HIV testing among young people remains an obstacle toward universal access to treatment and care. Their engagement further remains a challenge within the cascade of HIV services as well as access to sexual and reproductive health [27,28]. While understanding the drivers of HIV among this population remains multifaceted, the incidence and prevalence of HIV have been widely explored among the general adult population [26,[29][30][31][32] and key populations [33][34][35].…”

“…Despite commendable efforts to increase the availability of HIV testing and treatment services in all provinces of PNG, the current HIV counselling and testing rate, particularly among young people, falls within the national HIV strategic guidelines [22]. Their engagement further remains a challenge within the cascade of HIV services as well as access to sexual and reproductive health [26,27]. While understanding the drivers of HIV among this population remains multifaceted, the incidence and prevalence of HIV have been widely explored among the general adult population [28][29][30][31][32] and key populations [33][34][35].…”

“…Although HIV testing services are widely available throughout PNG, the current testing rate among young people is suboptimal, especially among young men. Young men's engagement in HIV services and access to sexual and reproductive health remain challenging [27,28].…”