Sexual and reproductive health knowledge, attitudes and service uptake barriers among Zambian in-school adolescents: a mixed methods study

ABSTRACT

The provision of comprehensive sexuality education (CSE) accords opportunities for scientifically accurate information about sexual and reproductive health (SRH). We used a mixed-methods study to characterise adolescent SRH knowledge, attitudes and service utilisation experiences in the context of CSE implementation in Zambia. In-school young people aged 12–24 years (N = 1,612) in the North-Western Province were randomly surveyed. A 29-item index was constructed to measure alignment of knowledge, attitudes and values (KAV) with the CSE curriculum. Logistic regression, stratifying by sexual debut status, modelled associations of past-year HIV counselling and testing and family planning service access, respectively, with CSE-KAV index scores. Focus group discussions further explored perceptions of and experiences accessing SRH services. Despite moderate SRH knowledge and acceptability of SRH services, fewer than half of sexually experienced young people reported accessing SRH services. Among sexually experienced youth, neither HIV testing nor family planning service utilisation in the previous year were associated with higher CSE-KAV index scores. Salient barriers to SRH service uptake included limited perceived benefits, unsupportive household and community environments, and negative interactions with health providers. To increase accessibility and uptake of youth SRH services, linking school-based CSE to SRH services is recommended.

KEYWORDS:

• Adolescents
• family planning
• HIV counselling and testing
• sexual and reproductive health
• comprehensive sexuality education

Acknowledgments

We thank Kondwani Kasonda for assistance with survey programming and data management; collaborators at the Ministries of Health and General Education for their support and oversight in study rollout and implementation; the research assistants (Priscilla Niamwiza, Rebbeca Lukavu, Chipango Kamobyi, Paul Muzungu, Kilaye Verady Vendricks, Sydney Hanzala, Caroline Choonga, Prudence Kangu, Elisa Mukabe, Elizabeth Kayeyi, Josephine Mbuyu and Gracious Muzata) who collected the data; the parent-teacher associations from the respective schools for their receptiveness towards and support of the study objectives; and the young people who participated in the study. Finally, we thank the teachers administering the CSE curriculum, who devote their time and livelihoods to forging a healthier Zambia.

Disclosure statement

The authors of this manuscript have no conflicts of interest to declare.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was funded by the United Nations Educational, Social and Cultural Organization (UNESCO) under contract [#450034506] and the United Nations Population Fund (UNFPA) under contract [GPS ID 74861].