Sexual and reproductive health and rights of “last mile” adolescents: a scoping review

Figures & data

Figure 1. Flow diagram of the scoping review process

Table 1. Characteristics of reviewed publications

Author(s), year	Study design	Study population
		Age	Gender	Country of origin/region	Rural/urban	Sampling strategy
Beguy et al., 2013^Citation24	Quantitative, Cross-sectional	15–19	Females	Kenya	Urban	Random
Beguy et al., 2014^Citation25	Quantitative, Longitudinal	15–22	Females	Kenya	Urban	Random
Blystad et al., 2020^Citation4	Qualitative, Cross-sectional	13–16	Females	Zambia	Rural	Purposive
Bobhate & Shrivastava, 2011^Citation26	Quantitative, Cross-sectional	10–19	Females	India	Urban	Purposive
Bukenya et al., 2020^Citation27	Quantitative, Cross-sectional	10–19	Males and females	Uganda	Mixed	Random
Cadena-Camargo et al., 2020^Citation28	Qualitative, Cross-sectional	18–35^a	Females	Colombia	Urban	Snowball
Carney et al., 2019^Citation29	Mixed-method, Cross-sectional	16–21	Females	South Africa	Urban	Purposive
Chhabra et al., 2018^Citation30	Mixed-method, Cross-sectional	13–18	Males and females	Kenya	Urban	Purposive
Chimbindi et al., 2018^Citation31	Quantitative, Cross-sectional and Longitudinal	15–24	Females	South Africa	Rural	Purposive
Culbreth et al., 2020^Citation32	Quantitative, Cross-sectional	12–18	Males and females	Uganda	Urban	Convenience
Embleton et al., 2015^Citation7	Qualitative, Cross-sectional	11–24	Males and females	Kenya	Urban	Purposive
Francis et al., 2018^Citation33	Quantitative, Cross-sectional	15–24	Males and females	South Africa	Rural	Random
Gabster et al., 2020^Citation34	Qualitative, Cross-sectional	14–19	Males and females	Panama	Rural	Purposive
Gebreyesus et al., 2019^Citation35	Quantitative, Cross-sectional	10–24	Males and females	Ethiopia	Rural	Random
Gupta et al., 2015^Citation36	Quantitative, Cross-sectional	10–19	Males and females	India	Mixed	Random
Hokororo et al., 2015^Citation37	Quantitative, Cross-sectional	14–20	Females	Tanzania	Mixed	Purposive
Ivanova et al., 2018^Citation8	Systematic review	10–24	Females	Uganda, Ethiopia, DR Congo, Somalia, Kenya, Nigeria, Djibouti, Rwanda and Sierra Leone	n/a	n/a
Ivanova et al., 2019^Citation9	Mixed-method, Cross-sectional	13–19	Females	Uganda	Rural	Convenience and purposive
Kaur, 2018^Citation38	Quantitative, Cross-sectional	15–19	Females	India	Urban	Not discussed
Kayode et al., 2020^Citation6	Quantitative, Longitudinal	16 and above ^b	Males, transgender women and other/unknown	Nigeria	Urban	Respondent driven
Kenny et al., 2019^Citation39	Qualitative, Cross-sectional	15–19	Females	Cambodia	Rural	Purposive
Khawcharoenporn et al., 2019^Citation40	Quantitative, Longitudinal	18–24	Males	Thailand	Urban	Purposive
Latham et al., 2012^Citation41	Qualitative, Cross-sectional	Not explicitly stated	Females	USA	Not explicitly stated	Purposive
Mark et al., 2017^Citation11	Mixed-method, Cross-sectional	Not explicitly stated	Males and females	23 sub-Saharan African countries	Mixed	Purposive and snowball
Mathur et al., 2020^Citation42	Quantitative, Cross-sectional	15–24	Females	Kenya, Malawi and Zambia	Mixed	Random
Mbalinda et al., 2015^Citation43	Quantitative, Cross-sectional	10–19	Males and females	Uganda	Not explicitly stated	Consecutive
McClair et al., 2017^Citation44	Quantitative, Cross-sectional	15–24	Males	Bangladesh	Urban	Random
Melesse et al., 2020^Citation45	Literature Review	15–24	Males and females	Sub-Saharan Africa	Mixed	n/a
Misunas et al., 2019^Citation46	Quantitative, Cross-sectional	20-49^b	Males	Bolivia, Central African Republic, Nepal, Lao People’s Democratic Republic, Honduras, Guyana, Guatemala, Cuba, Comoros, Madagascar, Mozambique, Thailand and Nicaragua	Mixed	Two-stage cluster
Mtasingwa, 2020^Citation5	Qualitative, Cross-sectional	17–24	Males and females	Tanzania	Peri-urban	Purposive and random
Mu et al., 2015^Citation47	Quantitative, Cross-sectional	12–20	Males and females	China	Rural	Purposive
Ngilangwa et al., 2016^Citation48	Mixed-method, Cross-sectional	10–24	Males and females	Tanzania	Not explicitly stated	Random, snowball and purposive
Nobelius et al., 2011^Citation49	Qualitative, Cross-sectional	13–19	Males and females	Uganda	Rural	Purposive
Nobelius et al., 2012^Citation50	Qualitative, Cross-sectional	13–19	Males and females	Uganda	Rural	Purposive
Parida, 2012^Citation51	Quantitative, Cross-sectional	12–19	Males and females	India	Rural	Random
Ramadhani et al., 2020^Citation52	Quantitative, Cross-sectional and longitudinal	16 and above^b	Males, transgender women and others	Nigeria	Urban	Respondent driven
Ramya et al., 2016^Citation53	Quantitative, Cross-sectional	15–19	Females	India	Urban	Random
Rees et al., 2012^Citation54	Quantitative, Cross-sectional	14–16	Females	India	Rural	Random
Reif et al., 2016^Citation55	Quantitative, Cross-sectional	10–24	Males and females	Haiti	Urban	Purposive
Reisner et al., 2019^Citation10	Mixed-method, Cross-sectional	16–24	Transgender women, transgender men and others	USA	Not explicitly stated	Purposive
Renzaho et al., 2017^Citation23	Quantitative, Cross-sectional	13–24	Males and females	Uganda	Urban	Random
Ricks et al., 2015^Citation56	Quantitative, Cross-sectional	15–23	Males	USA	Urban	Purposive
Robertson et al., 2011^Citation57	Quantitative, Longitudinal	12–18	Females	USA	Not explicitly stated	Random
Rose-clark et al., 2019^Citation58	Quantitative, Cross-sectional	10–19	Females	India	Rural	Purposive
Rosenberg et al., 2015^Citation59	Quantitative, Longitudinal	12–18	Females	South Africa	Rural	Purposive
Sambisa et al., 2010^Citation60	Quantitative, Cross-sectional	15–24	Males and females	Zimbabwe	Mixed	Two-stage cluster
Sharanya, 2014^Citation61	Quantitative, Cross-sectional	13–19	Females	India	Urban	Multi-stage cluster
Swahn et al., 2016^Citation62	Quantitative, Cross-sectional	12–18	Males and females	Uganda	Urban	Purposive
Tirado et al., 2020^Citation12	Scoping review	10–24	Males and females	Study settings included Australia, Kenya, Uganda, Ethiopia and Tanzania. Sample populations included refugees from Sudan, the Democratic Republic of Congo, Somalia, Burundi, Iraq and Bhutan.	n/a	n/a
Toska et al., 2020^Citation63	Quantitative, Cross-sectional	10–24	Females	South Africa	Mixed	Random and purposive
Tumwesigye et al., 2013^Citation64	Quantitative, Cross-sectional	15–24	Males and females	Uganda	Mixed	Multi-stage cluster
Wado et al., 2020^Citation65	Scoping review	10–19	Males and females	Sub-Saharan Africa	n/a	n/a
Wong et al., 2017^Citation66	Qualitative, Cross-sectional	11–19	Males and females	China	Rural	Purposive
Ziraba et al., 2018^Citation67	Quantitative, Cross-sectional	12–23	Females	Kenya	Urban	Random

^a At the time of this study, participants’ age varied from 18 to 35 years; however, their adolescent experiences were explored.

^b Age-disaggregated data for adolescents available.

Table 2. Intersecting factors of identity that could lead to SRHR vulnerabilities among adolescents in 50 reviewed publications

	Indigenous	2SLGBTQIA+	Out of school	Rurally located	Slum dwelling	Homeless	Incarcerated/previously incarcerated	HIV/AIDS infected	Physically disabled	Racial/ethnic minorities	Orphaned
Refugee			^Citation9, Citation35
Indigenous				^Citation34, Citation39
2SLGBTQIA+			^Citation7	^Citation5				^Citation6, Citation10, Citation40, Citation52
Out of school				^Citation4, Citation27–28, Citation36-37, Citation42, Citation46, Citation49–51, Citation54, Citation58-60, Citation64	^Citation23–26, Citation38, Citation53, Citation61, Citation67	^Citation44		^Citation29, Citation43, Citation47–48	^Citation48	^Citation60
Rurally located								^Citation11, Citation31, Citation33, Citation63, Citation66		^Citation60
Slum dwelling								^Citation32, Citation55, Citation62	^Citation23		^Citation30
Homeless
Incarcerated/ previously incarcerated										^Citation41, Citation56–57
HIV/AIDS infected											^Citation47
Physically disabled
Racial/ethnic minorities

Table 3. Region, methodology and thematic analysis of 54 reviewed publications

Category	Sub-category	Number of studies	References
Region	Sub-Saharan Africa	32	^Citation4–9, Citation11, Citation23-25, Citation27, Citation29-33, Citation35, Citation37, Citation42–43, Citation45, Citation48–50, Citation52, Citation59–60, Citation62–65, Citation67
	Asia	13	^Citation26, Citation36, Citation38–40, Citation44, Citation47, Citation51, Citation53–54, Citation58, Citation61, Citation66
	North America	6	^Citation10, Citation34, Citation41, Citation55–57
	South America	1	^Citation28
Methodology	Quantitative	34	^Citation6, Citation23–27, Citation31–33, Citation35–38, Citation40, Citation42–44, Citation46–47, Citation51–64, Citation67
	Qualitative	10	^Citation4–5, Citation7, Citation28, Citation34, Citation39, Citation41, Citation49–50, Citation66
	Mixed method	6	^Citation9–11, Citation29–30, Citation48
	Review	4	^Citation8, Citation12, Citation45, Citation65
Knowledge	Assessment of quality SRH knowledge	21	^Citation8–9, Citation12, Citation26, Citation30, Citation37–40, Citation42–43, Citation46–49, Citation51, Citation54, Citation58, Citation60–61, Citation65
	Source(s) of information	6	^Citation5, Citation8, Citation26, Citation35, Citation39, Citation58
Behaviour and practice		42	^Citation4–10, Citation12, Citation23–27, Citation30–35, Citation37–38, Citation40, Citation42–47, Citation49–50, Citation52–53, Citation55–57, Citation60–65, Citation67
Services	Access and/or utilisation	23	^Citation4–12, Citation23, Citation31, Citation34, Citation36, Citation43–44, Citation52–54, Citation58, Citation61, Citation63, Citation65–66
	Awareness about available services	3	^Citation23, Citation26, Citation36

Table 4. Linkages between findings of our scoping review and components of SRHR described in Panel 2 of the Guttmacher–Lancet Commission Report

Findings of our scoping review	Linkages with Panel 2 of the Guttmacher–Lancet Commission Report
Knowledge and awareness about: the types, symptoms, and curability of STIs and modes of transmission and preventive sexual practices menstruation abortion fertility and anatomy of the reproductive body condom use negotiation skills	The right to “receive comprehensive, evidence-based, sexuality education” The ability to “manage menstruation in a hygienic way, in privacy, and with dignity” The right to “make decisions concerning reproduction free of discrimination, coercion, and violence” The right to “receive accurate information about the reproductive system and the services needed to maintain reproductive health” The right to “engage in consensual sexual relations”; The right to have one’s “bodily integrity respected”
Behaviour and practices related to: Contraceptive use Menstrual hygiene management Early pregnancy Forced sexual intercourse	The ability to access “services for the prevention and management of sexually transmitted infections, including HIV/AIDS, and other diseases of the genitourinary system”; The ability to “access safe, effective, affordable, and acceptable methods of contraception” of one’s choice The ability to “manage menstruation in a hygienic way, in privacy, and with dignity” The right to “make decisions concerning reproduction free of discrimination, coercion, and violence” The right to choose one’s sexual partner; The right to “decide whether to be sexually active or not”; The right to “engage in consensual sexual relations”; The right to have one’s “bodily integrity respected”
Barriers in access to services: Judgmental and discriminatory attitudes of health service providers, lack of confidentiality at health facilities, feelings of shame and embarrassment among last mile adolescents Unaffordability and unavailability of services and commodities Restrictive laws and policies	Sexual rights include “the right of all persons, free of discrimination, coercion, and violence, to achieve the highest attainable standard of sexual health, including access to sexual and reproductive health services” The right of all people to access “services needed to maintain reproductive health”; The right to “access safe, effective, affordable, and acceptable methods of contraception” of one’s choice “The right of all persons, free of discrimination, coercion, and violence, to achieve the highest attainable standard of sexual health, including access to sexual and reproductive health services”; The right of all people to access “services needed to maintain reproductive health”

Table

Authors	Title
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Destil MNE, Steben M, Clermont M, et al	Factors influencing the sexual and reproductive health of the teenagers in rural areas in Haiti. Tropical Medicine and International Health. 2013;18(1):180.
Elimam BGM	Providing post abortion care in a humanitarian setting-an experience from Darfur, Sudan. International Journal of Gynecology and Obstetrics. 2018;143(SUPPL 3):114. DOI: 10.1002/ijgo.12583.
Fang LC, Ping NJ, Ping YY	Analysis of the sexual behavior and the influential factors of AIDS infection among out-of-school adolescent MSM in Chongqing. Acta Medicinae Universitatis Scientiae et Technologiae Huazhong. 2015;44(5):603-615.
Goyal RS	Whether educational poverty (Deprivation of schooling) affects the adolescent girls’ vulnerability to reproductive and sexual health concerns? Journal of Sexual Medicine. 2013;10(SUPPL. 2):172. DOI: 10.1111/jsm.12150
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