Open Access Journal of Contraception (Jun 2023)
Socio-Ecological Analysis of Barriers to Access and Utilization of Adolescent Sexual and Reproductive Health Services in Sub-Saharan Africa: A Qualitative Systematic Review
Abstract
Negussie Boti Sidamo,1,2 Amene Abebe Kerbo,1 Kassa Daka Gidebo,1 Yohannes Dibaba Wado3 1School of Public Health, College of Health and Medicine Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 2School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; 3African Populations and Health Research Center, Nairobi, KenyaCorrespondence: Negussie Boti Sidamo, Email [email protected]: 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.Keywords: adolescents, qualitative systematic review, sexual and reproductive health services, barriers, sub-Saharan Africa, socio-ecological model
