Views of Service Providers and Adolescents on Use of Sexual and Reproductive Health Services by Adolescents: A Systematic Review

This review examines the literature on adolescents' and providers' views on access and use of Sexual and Reproductive Health (SRH) information and services. The SRH services referred to in this study were predominantly family planning services, STI treatment including HIV testing and counselling services. The study design was a systematic review of empirical studies. Twenty-five databases were searched using a well-defined search strategy and Boolean operators. A total of 45 studies were included in the review, and the findings were reported thematically under four emerging themes. The review showed that adolescents and sexual health service providers had differing views on barriers and enablers to adolescent access to SRH services and often had contradictory views on key markers of youth-friendly services, service preferences, barriers and enablers of service use. While service providers perceived physical and financial barriers as fundamental, adolescents identified barriers emanating from providers' attitude as the key hindrance to their access and use of services. The review also revealed that the unprofessional attitudes of some service providers limit adolescents' access to SRH services. These findings serve as evidence to policy actors at all levels to consider attitudinal qualities of service providers when planning and designing sexual health services for adolescents

Trends in and predictors of pregnancy termination among 15–24 year-old women in Nigeria: a multi-level analysis of demographic and health surveys 2003–2018

Background: Three-quarters of pregnancy terminations in Africa are carried out in unsafe conditions. Unsafe abortion is the leading cause of maternal mortality among 15–24 year-old women in Sub-Saharan Africa. Greater understanding of the wider determinants of pregnancy termination in 15–24 year-olds could inform the design and development of interventions to mitigate the harm. Previous research has described the trends in and factors associated with termination of pregnancy for women of reproductive age in Nigeria. However, the wider determinants of pregnancy termination have not been ascertained, and data for all women have been aggregated which may obscure differences by age groups. Therefore, we examined the trends in and individual and contextual-level predictors of pregnancy termination among 15–24 year-old women in Nigeria. Methods: We analysed data from the 2003, 2008, 2013 and 2018 Nigerian Demographic and Health Surveys (NDHS) comprising 45,793 women aged 15–24 years. Trends in pregnancy termination across the four survey datasets were examined using bivariate analysis. Individual and contextual predictors of pregnancy termination were analysed using a three-level binary logistic regression analysis and are reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: Trends in pregnancy termination declined from 5.8% in 2003 to 4.2% in 2013 then reversed to 4.9% in 2018. The declining trend was greater for 15–24 year-old women with higher socioeconomic status. Around 17% of the total variation in pregnancy termination was attributable to community factors, and 7% to state-level factors. Of all contextual variables considered, only contraceptive prevalence (proxy for reproductive health service access by young women) at community level was significant. Living in communities with higher contraceptive prevalence increased odds of termination compared with communities with lower contraceptive prevalence (aOR = 4.2; 95% CI 2.7–6.6). At the individual-level, sexual activity before age 15 increased odds of termination (aOR = 2.3; 95% CI 1.9–2.8) compared with women who initiated sexual activity at age 18 years or older, and married women had increased odds compared with never married women (aOR = 3.0; 95% CI 2.5–3.7). Conclusion: Our findings highlight the importance of disaggregating data for women across the reproductive Life course, and indicates where tailored interventions could be targeted to address factors associated with pregnancy termination among young women in Nigeria

The effectiveness and characteristics of mHealth interventions to increase adolescent's use of Sexual and Reproductive Health services in Sub-Saharan Africa: A systematic review

Background mHealth innovations have been proposed as an effective solution to improving adolescent access to and use of Sexual and Reproductive Health (SRH) services; particularly in regions with deeply entrenched traditional social norms. However, research demonstrating the effectiveness and theoretical basis of the interventions is lacking. Aim Our aim was to describe mHealth intervention components, assesses their effectiveness, acceptability, and cost in improving adolescent's uptake of SRH services in Sub-Saharan Africa (SSA). Methods This paper is based on a systematic review. Twenty bibliographic databases and repositories including MEDLINE, EMBASE, and CINAHL, were searched using pre-defined search terms. Of the 10, 990 records screened, only 10 studies met the inclusion criteria. The mERA checklist was used to critically assess the transparency and completeness in reporting of mHealth intervention studies. The behaviour change components of mHealth interventions were coded using the taxonomy of Behaviour Change Techniques (BCTs). The protocol was registered in the 'International Prospective Register for Systematic Reviews' (PROSPERO-CRD42020179051). Results The results showed that mHealth interventions were effective and improved adolescent's uptake of SRH services across a wide range of services. The evidence was strongest for contraceptive use. Interventions with two-way interactive functions and more behaviour change techniques embedded in the interventions improved adolescent uptake of SRH services to greater extent. Findings suggest that mHealth interventions promoting prevention or treatment adherence for HIV for individuals at risk of or living with HIV are acceptable to adolescents, and are feasible to deliver in SSA. Limited data from two studies reported interventions were inexpensive, however, none of the studies evaluated cost-effectiveness. Conclusion There is a need to develop mHealth interventions tailored for adolescents which are theoretically informed and incorporate effective behaviour change techniques. Such interventions, if low cost, have the potential to be a cost-effective means to improve the sexual and reproductive health outcomes in SSA

Adolescents’ sexual and reproductive health education: perspectives from secondary school teachers in Northern Nigeria

Lack of sexual and reproductive health (SRH) education contributes to poor SRH outcomes for adolescents and young people in Sub-Saharan Africa. School-based comprehensive SRH education programmes in low- and middle-income countries aim to advance gender equality and human rights and reduce risky sexual behaviours in adolescents. However, the implementation of these programmes in Northern Nigeria is opposed by community and religious institutions because of mistrust of health interventions perceived as being framed on Western ideologies. This study explored perceptions of such programmes among secondary school staff in Northern Nigeria. We focused on knowledge and beliefs about comprehensive SRH education programmes, and views about barriers to delivery and ways to support their inclusion in schools. Sixteen semi-structured in-depth interviews were conducted with teachers and head teachers. Participants were aged 33–54 years and came from four public secondary schools in two states (Kano and Jigawa). Findings showed conflicting gender-based perspectives on the importance of comprehensive SRH education in schools. Barriers to delivery included lack of adequate skills and knowledge, beliefs/cultural norms and wider societal barriers. Involving traditional and religious leaders and schools in the design of tailored approaches could strengthen future delivery