Exploring the factors impacting on access and acceptance of sexual and reproductive health services provided by adolescent-friendly health services in Nepal

Abstract

Adolescent-friendly health programs have been in place in Nepal since 2008, yet uptake of the services for sexual and reproductive health remains suboptimal. For uptake of these services to improve, a rich understanding is needed of the factors impacting their acceptance and utilization from the perspectives of adolescents, health care staff, and key community informants. This study applied a qualitative research design involving six focus groups with 52 adolescents and in-depth interviews with 16 adolescents, 13 key informants, and 9 health care providers from six adolescent-friendly health facilities in Nepal. Thematic analysis was conducted for data analysis. The key themes identified as barriers include access issues due to travel, institutional health care barriers, perceived lack of privacy and confidentiality, and the unprofessional attitudes of staff towards the sexual health needs of adolescents. These themes are underpinned by gendered ideology and a moral framework around the sexual behavior of adolescents. Interview responses suggested that health care providers take a policing role in prescribing adolescents’ conformity to this moral framework in their delivery of reproductive health care and services. While physical access to health services may be problematic for some adolescents, this is not the priority issue. Attention needs to be given to increasing the capacity of health care providers to deliver services without imposing their own and socially sanctioned moral frameworks around adolescent sexual behavior. Such capacity building should include training that is experiential and emphasizes the importance of confidentiality and non-judgmental attitudes.

Availability, Accessibility, and Quality of Adolescent Sexual and Reproductive Health (SRH) Services in Urban Health Facilities of Rwanda: A survey among social and healthcare providers

“…Some service providers suggested that it would be inappropriate for primary school adolescents to access SRH services irrespective of being between 10-19 years because they are not considered to be mature enough to make their own decisions regarding sexual health. These ndings are similar to what was found by other studies that adolescents less than 12 or 14 years old cannot access SRH services without the consent of their parents, or services were rejected to be provided by healthcare providers, especially when it comes to HIV related services [24,26].…”

“…These barriers play a role in affecting the general quality of services. The ndings are consistent with those from other low-and middle-income countries (LMICs) regarding the numerous barriers adolescents face while accessing SRH services [24,25]. This calls for policymakers, activists, and the community to formulate methodologies to ensure that the SRH services accessibility, availability, as well as the quality of services provided are considered while designing health services provision to ensure that the "no one left behind" principle is applied to achieve Sustainable Development Goal 3 [28].…”

What do Service Providers in Southern Ethiopia Think About Barriers to using Youth-Friendly Sexual and Reproductive Health Services for Adolescents?: Qualitative Study

“…Awkwardly, majority of providers in the study were mentioning the above challenges as limiting factors for utilization of the service. The ndings of this study were also congruent with studies done in Ethiopia [24], Ghana [25] and Nepal [26]. In addition, according to our ndings, adolescents wanted to be served by providers of older age and same sex.…”

“…Because, I see that adolescents are in uenced by peers not by theirs own decision." [Female, Age:[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Health Extension] Another participant witnessed disclosing secrecy of adolescents from his experience. "Healthcare providers have a problem of keeping secrets about adolescent and sexual issues.…”

Skilled birth attendance in Sierra Leone, Niger, and Mali: analysis of demographic and health surveys

“…The observed variation across the countries may be attributable to variation in societal acceptance of childbearing at teenage (15-19 years). Teens are likely to access the service of skilled personnel if they feel appreciated and welcomed by healthcare providers and the society in which they live [25]. Women who are advanced in age might be discouraged by the attitude of healthcare providers if they had a negative experience in the past, unlike those in the 15-19 age category who might be having first deliveries and, hence, fewer chances of negative delivery experience [26].…”