Barriers to adolescents’ access and utilisation of reproductive health services in a community in north-western Nigeria: A qualitative exploratory study in primary care

Abstract

Background There is a dearth of qualitative studies exploring in-depth barriers that adolescents face in accessing and utilising reproductive health services (RHS) in Nigerian primary healthcare centres. Aim This study explored the barriers hindering adolescents’ access to and utilisation of RHS in primary healthcare centres. Setting This study was conducted in three primary healthcare centres in Kaduna North Local government area, Nigeria. Methods This study used an exploratory descriptive qualitative design. Fourteen adolescents and three RHS providers were selected and interviewed. The data collection methods included individual in-depth interviews with adolescents and key informant interviews with service providers. Interviews were conducted between January 2017 and April 2017. Thematic content analysis was used to analyse the data. Results This study identified three thematic barriers to adolescent’s utilisation of RHS. These included individual, social and health system barriers. Individual factors included the following: inadequate knowledge about RHS and poor attitudes of adolescents towards RHS; social factors such as parental influence, community and religious norms, financial constraints and stigma; and health system factors such as poor attitudes of service providers and inconvenient health facility opening hours hindered adolescents from utilising RHS. Most prominent was the strong influence of the social factors that affected adolescents to the extent that they felt constrained to freely utilise RHS out of a sense of commitment to religious values. Conclusion The findings highlight the need for the development of programmes that would foster collective responsibility for supportive environments within communities and health facilities for positive adolescent RHS experiences.

Modern contraceptive use among unmarried girls aged 15–19 years in South Western Nigeria: results from a cross-sectional baseline survey for the Adolescent 360 (A360) impact evaluation

“…A study conducted in the Ashanti region of Ghana [ 26 ] also revealed that condoms (33.3%) were the most used form of contraceptive among sexually active female adolescents. We believe that the common use of condoms, a short-term method of contraception, may be because they are presumed to have no side effects and are more easily available and accessible from providers [ 38 ]. This may be particularly important in this population, where although 45% of sexually active girls used contraception, only 39% knew of a place they felt comfortable accessing it—this may limit them to seeking only the most accessible form of contraception.…”

Leveraging mobile health applications to improve sexual and reproductive health services in Nigeria: implications for practice and policy

“…The SRH coverage rates in Nigeria are typically low, especially in the rural (and hard-to-reach) areas and among adolescents [17,18]. Some of the identified barriers to accessing SRH services include inadequate knowledge about the services, inconvenient health facility opening hours, remoteness of facilities, financial constraints as well as community and religious norms [19]. Wider systemic issues also impact negatively on the SRH system in Nigeria.…”

Adolescents’ Sexual and Reproductive Healthcare-Seeking Behaviour and Service Utilisation in Plateau State, Nigeria

“…Health care facilities provide an important setting for adolescents to access accurate SRH preventive information, testing and treatment services. Unfortunately, adolescents’ utilisation of these facilities has remained low due to fear of being stigmatised, negative attitudes of health care providers and a lack of age-appropriate and adolescent-centred services [ 15 , 16 ]. For example, Odo et al [ 17 ] report that, for adolescents in Enugu State, SRH services were perceived as financially inaccessible and not adolescent-friendly.…”

“…For example, Odo et al [ 17 ] report that, for adolescents in Enugu State, SRH services were perceived as financially inaccessible and not adolescent-friendly. In many African countries, religion and social structures create certain norms around ASRH, which in turn create barriers for adolescents using these services [ 15 ]. Rather than seek health care in health facilities, some adolescents in Nigeria have reported seeking SRH care from unprofessional providers such as medicine vendors, traditional healers, and others self-medicate by purchasing drugs without prescription against the backdrop of antibiotic abuse and resistance [ 18 , 19 , 20 ].…”