Adolescents face inter-related barriers that prevent them from accessing facility-based Reproductive Health (RH) services. These include:
Individual barriers, such as feelings of shame, fear or anxiety about issues related to sexuality and reproduction, lack of awareness about the services available, poor health, or advice-seeking behaviors and the perception that services will not be confidential;
Socio-cultural barriers, such as social norms which dictate the behavior and sexuality of both young men and women, stigma surrounding sexually active adolescents, cultural barriers which limit the ability of women, girls or certain sub-sets of the population from accessing health services, educational limitations, language differences, the attitudes of health care providers towards adolescents or their unwillingness to attend to their RH needs;
Restrictive Laws and Policies that influence Sexual and Reproductive Health Service delivery in countries.
Structural barriers, such as long distances to health facilities, lack of facilities for clients with disabilities, inconvenient hours of operation, long waiting times, charging fees for services and lack of privacy.
The barriers to accessing RH services by adolescents unfortunately are increased during a crisis situation, when health services and infrastructures such as communications and transportation are disrupted, when health services are overburdened by high patient loads, when insecurity leads to restrictions of movement, and when other activities, such as securing food and shelter, take priority over RH concerns.
We must make conscious effort to address these barriers to save adolescents from STIs, HIV/AIDS, and Adolescent pregnancy, Unsafe Abortion which mostly results in adolescent death, harmful sexual reproductive health practices such as FGM, Child marriage, Sexual and Gender-based violence, etc.
For SRH Services to reach adolescents, RH programs must take innovative approaches to make services acceptable, accessible and appropriate for adolescents, taking cultural sensitivity and diversity into consideration. Adolescents should be involved as much as possible in the design, implementation and monitoring of program activities, so that programs are more likely to respond to their RH needs and priorities and so that interventions are acceptable to them.
Introducing adolescent-friendly health services and involving adolescents in both the design and monitoring of these services will make facility-based RH services more accessible and acceptable to adolescents.
Community and parental acceptance and involvement in ASRH programs are crucial for the success and sustainability of the programs. Community members and parents, along with adolescents, should be involved from the earliest stages of program design and if possible, should contribute to program implementation.
Lastly, program managers, together with health providers, adolescents, and community members should consider alternative implementation strategies such as community interventions that will make it easier to reach adolescents with RH information and services.
Author: Augustine Kumah, PhD Student
Centre of Excellence in Reproductive Health Innovation (CERHI)
Department of Community Health, University of Benin
Benin City, Edo State, Nigeria.