Exploring Barriers to Accessing Adolescents Sexual and Reproductive Health Services in South Ethiopia Regional State: A Phenomenological Study Using Levesque’s Framework

Abstract

Introduction

Evidence suggests that adolescents face multiple barriers to accessing Sexual and Reproductive Health (SRH) services. However, there remains a notable gap in the literature regarding the nuanced interplay between supply-side and demand-side barriers. Therefore, this study aimed to examine barriers to accessing SRH services in the Gamo Zone of South Ethiopia Regional State.

Methods

A descriptive phenomenology study was conducted from September 04 to October 15, 2023. A total of seven Focus Group Discussions (FGDs), four with girls and three with boys, with a total of 75 adolescents, and ten Key informant interviews (KIIs)with healthcare providers participated in the study. A semi-structured interview guide was used to explore their lived experiences. All interviews and discussions were audio-recorded. To analyze and manage data framework analysis approach was applied using ATLAS Ti version 7 software.

Results

The major barriers preventing adolescents from accessing SRH services are related to the interplay between supply and demand-side barriers across all five domains of the Levesque framework. Despite the high need for access to health care, lack of SRH literacy, lack of outreach activities, and integration of SRH information in health facilities often hampered adolescents’ healthcare need. Additionally, fear of stigma from family and community, social norms, and lack of discussion of SRH issues hindered their ability to seek health care. Shortage of supplies and healthcare providers’ behaviors further hindering adolescents’ ability to access health care services. Furthermore, the limited involvement of adolescents in decision-making and the lack of effective coordination further complicate the appropriateness of services for adolescents.

Conclusion

The finding of this study reveals that adolescents face multifaceted barriers. Therefore, there is a need for high-impact complex interventions, program and policy that address both supply and demand side barriers needs to give due intention to improve access to SRH services for adolescents.

Keywords:

• adolescent
• sexual and reproductive health
• access
• barriers
• Southern Ethiopia
• levesque’s framework

Data Sharing Statement

All the data generated or analyzed during the study was included in this manuscript. However, the de-identified datasets used in the reported study are available upon reasonable request from the corresponding author.

Ethical Consideration

Ethical approval for this study was obtained from the Institutional Research Ethics Review Committee (IRRC) of Wolaita Sodo University on February 9, 2023 (project reference number: WSU-IRRC/004/2023). Before the fieldwork, necessary communications about the overall purpose of the study were made with the respective responsible bodies. A written permission letter was obtained from the Gamo Zone Health Department. Verbal consent from the village head/mayor is obtained before conducting community surveys. Written informed consent was obtained from all study participants after clearly describing the purpose of the study, benefits and risk of participation, being anonymity and the right to refuse at any stage of the interview. For participants under 18 years old, assent was obtained from study participants and written Informed consent was obtained from their parent and/or legal guardian. To ensure the publication of their anonymized responses, informed consent and assent were obtained from all study participants. Participation of the participants in the study was voluntary. There was an opportunity to ask questions about the study and the right to decline or cancel the interview. Privacy and confidentiality of information of the study participant was assured before obtaining data. With regard to confidentiality, respondents were given information that guaranteed them that the information they provided during the study would be used for the research purpose and would not be disclosed to anybody outside the research team. All methods were followed according to the Helsinki Declaration.

Acknowledgments

We would like to express our gratitude to Arba Minch University for its financial support. We would also like to thank Wolaita Sodo University for their approval of this doctoral thesis and the Zonal Health Department for their assistance in offering development and facilitating the logistics for data collection. We would also like to thank all study participants who agreed to participate in this study, as well as the data collectors and caregivers for their pleasant work. Finally, we thank Mrs. Bicha Oumer for her strong support and engagement during the data collection process and manuscript writing.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

This study was funded by Arba Minch University (Project Code: GOV/AMU/PhD/TH3/CMHS/PH/RCO/01/2015). However, the funder had no say in the study’s design, data collection, data analysis, manuscript preparation, and publication decision.