Barriers to access and utilisation of sexual and reproductive health services among adolescents in Ethiopia: a sequential mixed-methods study

Abstract

Objective: To investigate and explore the barriers of access and utilisation of sexual and reproductive health (SRH) services among adolescents. Design: An explanatory sequential mixed-methods design was implemented with two phases. The questionnaire was created and used by five trained research assistants for the quantitative component of the study (phase I). In phase II, the qualitative component of the study included focus group discussions (FGDs) with adolescents. Setting: This study was conducted in rural areas of five secondary schools in Arsi zone, Ethiopia. Participants: In both phases, 15–19 years adolescents participated in the study. For the quantitative phase, a total of 800 randomly selected adolescents responded to the questionnaire, while 24 adolescents participated during FGDs until data saturation was reached. Primary and secondary outcome measures: For outcome variables, the respondents were asked if they used any SRH services in the past 12 months. It was recorded as 0=no and 1=yes. Results: Overall, SRH service utilisation was 208 (26.1%) among adolescents. Being aged 17–19 years adjusted OR, AOR 3.44, 95% CI 2.15 to 5.51). Grades 11 and 12 (AOR 2.70, 95% CI 1.22 to 2.32). Lack of income (AOR 0.0.43, 95% CI 0.31 to 0.61). Ever had sexual contact (AOR 3.04 CI 95% CI 2.15 to 4.29) and being knowledgeable on SRH service (AOR 1.47, 95% CI 1.05 to 2.05) were factors associated with outcome variable. The barriers hindering access and use of SRH services were found at the facility level, provider level, community level and personal level. Conclusion The research found a low level of SRH services access and utilisation among adolescents due to several factors. Interventions to design-specific policies and educational programmes are needed to promote healthy practices.