Disparities in sexual and reproductive health services utilization among urban and rural adolescents in southern Ethiopia, 2020: a comparative cross-sectional study

Abstract

Background Although studies on the uptake of Adolescent sexual and reproductive health (ASRH) services in Ethiopia have been conducted they have failed to show the disparity in service uptake among rural and urban settings. Once the extent and determinants of ASRH service uptake in urban and rural contexts are known, it will be crucial to provide evidence-based information and recommendations for potential interventions to reduce the burden of disease and disability among adolescents. This study aimed at determining the level of SRH service utilization among urban and rural adolescents in the Guraghe zone, Southern Ethiopia. Methods A community-based comparative cross-sectional study was undertaken from November 1 –30, 2020. A multi-stage sampling technique was employed and a total of 1083 adolescents (361 from the urban and 722 from the rural areas) were selected randomly to take part in the study. Pre-tested, interviewer-administered, structured questionnaires were used to collect the data. The data were encoded and entered into Epi-Data version 3.1 and then exported to SPSS version 23 for analysis. χ2 test was computed to see a significant difference in SRH service utilization among urban and rural adolescents. In a bivariable logistic regression analysis, a variable with a p-value less than 0.25 has been selected for a multivariable logistic regression model. Variables with p-values less than 0.05 were declared statistically significant in multivariate logistic regression. Results A total of 1,075 adolescents (358 from urban and 717 from rural) took part in the study, yielding a response rate of 99.3%. The overall SRH service utilization among the whole adolescents was 39.5% (95%CI: 36.5, 42.4). There was a significant difference in SRH service utilization between urban 56.9% (95%CI: 51.8, 62.1) and rural 30.8% (95%CI: 27.4, 34.2) adolescents (χ2 = 68.3, p < 0.001). Residence[AOR = 2.62; 95%CI:1.63,3.41], availability of youth clubs [AOR = 4.73; 95%CI:3.43,6.53], taking part in peer education [AOR = 2.06; 95%CI:1.48,3.88], having parental discussion [AOR = 3.29; 95%CI:1.73,3.33], and being knowledgeable on SRH issues [AOR = 2.01; 95%CI: 1.45,3.03] were identified as a significant determinants of SRH service uptake. Having parental discussion, geographical accessibility, and knowledge on SRH were significant predictors of SRH service uptake among rural adolescents. Conclusion Overall, ASRH service utilization in the study area was low, despite urban adolescent service uptake becoming higher than rural adolescents. Since the majority of adolescents were enrolled in schools, schools should be an area of intervention to improve adolescents' knowledge of SRH services through mass media, community networks, and interpersonal/group communication. Furthermore, promoting parent-adolescent discussions, as well as peer-to-peer discussions at the family and school level, should be emphasized. Stakeholders in the education and health sectors need to strengthen their efforts to establish youth clubs in places where they do not yet exist, especially in rural schools.

Adolescents’ Contraceptive Uptake in Ethiopia: A Meta‐Analysis

“…Being of young age [ 22 , 26 ] and the income status of adolescents' families [ 24 ] were significantly associated with contraceptive utilization. Sociocultural-related factors are the most commonly stated determinants of adolescents' contraceptive uptake and are mentioned in five studies [ 12 , 21 – 24 ]. Discussion with the family/relatives and parents [ 12 , 21 ], parent disapproval and pressure from partners [ 22 ], and being married or having a partner [ 26 ] were reported as the most important determinants for adolescents' contraceptive uptake.…”

“…Healthcare service-related reasons that influence the uptake of contraceptives by adolescents were raised in four studies [ 21 , 22 , 24 , 25 ]. Availability of youth clubs and SRH services [ 21 , 22 ], inconvenient service hours for SRH, and lack of information about FP [ 24 , 25 ] were negatively associated with adolescents' contraceptive utilization. Having knowledge of contraceptive methods [ 23 ] and basic knowledge of SRH [ 21 ] and being informed about contraceptives through media [ 26 ] were knowledge-related determinants of adolescents' contraceptive uptake that were mentioned in three studies and found to be positively associated with adolescents' contraceptive utilization.…”

“…In this review, discussion with the family/relatives and parents [ 12 , 21 ], parent disapproval and pressure from partners [ 22 ], and being married or having a partner [ 26 ] were reported as the key factors influencing adolescents' contraceptive uptake. In Mali [ 36 ], Kenya [ 37 ], Ghana [ 11 ], and other low- and middle-income countries [ 31 ], the influences of social norms regarding sexual activity such as negative beliefs about contraceptive methods and feeling embarrassment at seeking contraceptive methods were reported as the major determinants of adolescents' contraceptive uptake.…”

“…Nevertheless, this achievement is still below the global FP target as adolescents, the largest segment of the population in Ethiopia, are left out of FP intervention programs and many adolescents' contraceptive needs are generally not taken into account [ 17 , 18 ]. Besides, the linkage between primary healthcare facilities and households has not been strong enough to deliver ideal contraceptive services for the majority of adolescents [ 19 – 21 ].…”

Enfermería en la salud sexual y reproductiva para jóvenes y adolescentes

“…Por un lado, el personal muestra un alto grado de satisfacción por la articulación con los jóvenes, quienes desde sus propias percepciones y experiencias contribuyeron al desarrollo de propuestas para abarcar la temática y de ese, modo facilitar la comunicación del tema dentro de la comunidad. De igual manera, como lo indica un estudio realizado en la zona rural de Etiopia, el fortalecimiento de sectores -especialmente educación y saludimpulsan esfuerzos para la articulación de la mejora en salud sexual y reproductiva de jóvenes y adolescentes (31).…”