Adolescent sexual and reproductive health needs and utilisation of health services in the Bono East Region, Ghana

BACKGROUND

Adolescents in Ghana are vulnerable to unequal power relations at the personal, community and structural levels which in turn limits their opportunities in access to critical sexual and reproductive health information and services. There is therefore high unmet need for sexual and reproductive health (SRH) information and services and the Bono East region typifies this situation, recording some of the poorest SRHR outcomes among adolescents. We, therefore, aimed to investigate the SRH needs (unmet), behaviors and utilization of SRH services among adolescents in the Bono East region.

METHODS

Using a maximum variation sampling approach, this qualitative study conducted in-depth interviews and focused group discussions with adolescent boys and girls, parents, community leaders, and healthcare providers.

RESULTS

Our findings are presented under two broad categories: major SRHR concerns of adolescents, and perspectives about that influences adolescents' utilization of SRHR services. Under the major SRHR need of adolescents, the following themes emerged: information and services on pregnancy prevention, menstrual hygiene management, availability of comprehensive abortion care services, and attitudes towards adolescent pregnancy. The perspectives about the factors that influence adolescent children were discussed at multiple levels: individual/personal. interpersonal and community/societal. At the individual level, limited understanding of adolescence/puberty, desire of adolescents to belong and misperceptions about contraceptives. At the interpersonal level, issues relating to technical capacity needs of service providers, disrespect exhibited by service providers, and parental failure were identified as influential factors. Then at the community/societal level, we identified structural constraints and compromised social safety concerns in accessing contraceptives and services.

CONCLUSION

In conclusion, the findings from this study offer valuable insights into the complex landscape of adolescent sexual and reproductive health in the Bono East region. The implications for policy and practice are manifold, ranging from comprehensive education to addressing menstrual hygiene, involving parents, training healthcare providers, and promoting respectful care.

Socio-Ecological Analysis of Barriers to Access and Utilization of Adolescent Sexual and Reproductive Health Services in Sub-Saharan Africa: A Qualitative Systematic Review

Background

In sub-Saharan African countries (SSA), despite the efforts to enable adolescents to access sexual and reproductive health (SRH) services, there are limited systematic review studies that comprehensively synthesize barriers to accessing services using a social-ecological model. Therefore, this review was conducted to fill this gap.

Methods

This study protocol was registered in the PROSPERO database (CRD42022259095). We followed PRISMA guideline to conduct this review. PubMed, Google Scholar, Embase and African Journal Online databases were used. Two authors individually screened articles. Only qualitative articles published in the English in last 10 years were included in this review.

Results

From the total of 4890 studies, 23 qualitative studies fulfilled the eligibility criteria. Those studies were from 11 SSA countries. This review finding revealed that inadequate information about the services, the incorrect perception about services, low self-esteem, fear of being noticed by family members, and financial constraints are barriers at the intrapersonal level. Unsupportive families and lack of open communication between adolescent-parent about sexuality issues were interpersonal barriers to access. Lack of provider competency, provider attitude, an unsupportive environment, physical inaccessibility of services, and shortage of medicine, and supplies were identified as institutional-level barriers. Moreover, community-level barriers like community stigma, social, religious, and gender norms within the society were identified as the main barriers to accessing services for adolescents.

Conclusion

This review finding reveals that the main barriers to access SRH services for adolescents living in SSA are misperception about services, low self-esteem to access services, financial constraints, unsupportive families, community stigma and social norms, unsupportive environments in health facilities, healthcare provider behavior, poor competency, being judgmental attitude, and breaking privacy and confidentiality. This study finding calls for new approach like a multi-pronged that works with service providers, with community, with families, and with adolescent to improve SRH services utilization of adolescent.

Online medical services utilization evaluated through the lens of socioecological theory and the information-motivation-behavioral skills model: evidence from China

Online medical services (OMS) have become increasingly advantageous, but there are still several barriers to utilization among patients. This study aims to explore the factors influencing OMS utilization (OMSU) for patients in micro-, meso-, and macrosystems based on socioecological theory (SET) and from the perspective of the information-motivation-behavioral skills (IMB) model. We selected 1065 participants through multistage stratified cluster random sampling in Jiangsu, China. In microsystems, information and behavioral skills were positively associated with intention (β = 0.84; β = 3.21) and actual utilization (OR = 1.69; OR = 1.69). Education level (β = 0.83) and personal motivation (β = 1.68) were positively related to intention. Chronic diseases (OR = 2.03) had a positive relationship with actual use. In mesosystems, recommendations from people around the patients (β = 1.14; OR = 1.99), provision of OMS in the nearest primary medical facility (β = 0.98; OR = 3.60), and provision of instructional information by medical institutions (β = 1.01; OR = 1.65) were related to OMSU. The average monthly household income (β = 0.54) was related to intention. Patients who had information about the OMSU experiences of people around them (OR = 1.73) correlated with actual utilization. In macrosystems, the social medical insurance type (OR = 0.66) was associated with OMSU. This study supports the applicability of the SET and IMB model to interpret patients' OMSU.

Barriers and enablers of contraceptive use among adolescent girls and women under 30 years of age in Cambodia: a qualitative study

OBJECTIVE

Unintended pregnancy and an unmet need for modern contraception remain high among adolescent girls and women in Cambodia. Qualitative descriptive research was conducted to explore the barriers to contraceptive use among young women in urban Cambodia.

METHODS

Semi-structured interviews were conducted among 30 adolescent girls and women aged 16-27 years, using purposive and snowball sampling strategies until data saturation was achieved. The audio-recorded interviews were transcribed verbatim and quality-checked. Inductive thematic data analysis was conducted. The results are presented using Bronfenbrenner's theoretical social ecological model.

RESULTS

The emerging major and minor themes indicate misconceptions about hormonal contraception as well as women's preference for using oral contraceptive pills for family planning after an unintended pregnancy. Women had low autonomy in choosing a contraceptive method, as their partners or husbands tended to prefer the withdrawal method. Young women faced cultural and supply chain barriers in accessing short- and long-acting reversible modern contraceptive methods at health centres.

CONCLUSION

Cambodian women aged 16-27 years are a vulnerable group who have low autonomy and sexual and reproductive health literacy and also face gender inequality.

Misconceptions and Unmet Need for Modern Contraception among Cambodian Females: A Mix Methods Study

(1) Background: Women using unreliable traditional contraception need to be included in the proportion of women having an ‘unmet need for modern contraception’ instead of the current classification which presumes they have a ‘met need’. (2) Methods: Mix methods research design comprising initial quantitative analyses utilizing data from the nationally representative 2014 Cambodian Demographic and Health Survey (CDHS) for 4823 Cambodian, sexually active females aged 15–29 years. Then a qualitative phase explored knowledge about the menstrual cycle and misconceptions about modern contraception with 30 females aged 15–29 years in urban Cambodia using semi-structured interviews, transcribed verbatim with quality checks. Purposive and snowball sampling strategies were used until data saturation was reached. Inductive thematic data analysis was conducted; (3) Results: Unmet need for modern contraception increased to 25.4% when traditional contraception users were included. The qualitative themes show women have a lack of information about the menstrual cycle and misconceptions about modern contraception which contributed to increased use of traditional contraception; (4) Conclusion: Major drivers of increased unmet need for modern contraception include lack of literacy, misconceptions and low autonomy to choose modern contraception. Cambodia needs to endorse a policy shift to implement targeted, countrywide sexual and reproductive health literacy and family planning services.

Factors influencing unmet need for contraception amongst adolescent girls and women in Cambodia

Background

Unmet need is the gap between women’s need and their practice of using contraception. Unmet need for contraception in female adolescents and women in Cambodia is a public health concern which may lead to unintended pregnancies or abortions that can contribute to maternal morbidity and mortality.

Methods

Bronfenbrenner’s Social Ecological Model was used as a theoretical framework to analyze data from the 2014 Cambodian Demographic and Health Survey to ascertain demographic and social factors potentially associated with unmet need for contraception. Bivariate and weighted multiple logistic regression analyses with adjusted odds ratios (AOR) were conducted for 4,823 Cambodian, sexually active females aged 15–29 years.

Results

The percentage of unmet need for contraception was 11.7%. At the individual level of the Social Ecological Model, there was an increased likelihood of unmet need in adolescent girls 15–19 years and women 20–24 years. Unmet need was decreased in currently employed women. At the microenvironment level, there was an increased likelihood of unmet need with the husband’s desire for more children and when the decision for a woman’s access to healthcare was made by someone else in the household. At the macroenvironment level, unmet need was decreased in women who could access a health facility near their residence to obtain medical care. There were no urban rural differences found in the Cambodian sample population.

Conclusion

Unmet need for contraception in Cambodian females adolescents and women is associated with younger age, unemployment and low personal autonomy for accessing healthcare but not with education or wealth status. There is a need to implement culturally appropriate reproductive and sexual health literacy programs to increase access to modern contraception and to raise women’s autonomy.