Setting Regional Research Priorities for Sexual and Reproductive Health and Rights Services in Humanitarian Settings

Background: Despite increased recognition of the need for sexual and reproductive health and rights in humanitarian settings, evidence focusing on mainstreaming reproductive health services such as maternal, neonatal mortality, human immunodeficiency virus transmission and unsafe abortion still remains inadequate. The ability to understand the magnitude of the needs and highlight existing gaps is supported by improved data which is critical to informing effective policies, programming and funding decisions. The purpose of this report is to present the results of a research prioritization exercise on sexual and reproductive health and rights services in humanitarian settings for the WHO Africa region for the next three years. Methods: We adapted the Child Health and Nutrition Research Initiative method in three phases. Experts from the region participated in an online survey to identify key areas for research in sexual and reproductive health and rights. To identify potential areas for research, the experts ensured answerability, effectiveness, deliverability, equity and potential impact of the questions. The research areas they identified were reviewed by World Health Organization technical team from headquarters. In a meeting of 67 participants, the questions were subjected to further review and analysis. Using a modified for scoring criteria, the questions were scored and ranked to provide the top ten priority questions to address sexual and reproductive health and rights services in humanitarian settings. Results: A list of 21 priority research questions on sexual and reproductive health and rights services in humanitarian settings were scored and ranked. Top ten priorities research questions were identified. Those that scored highly by scoring 30 points out of the possible maximum of 30 include: “determining the prevalence and associated factors of unwanted pregnancies and abortions performed in emergency and humanitarian settings”, “evidence on gender-based violence in humanitarian situations and its associated factors” and “defining an optimal model for coordinating sexual and reproductive health and rights interventions and responses in crisis situations”. Conclusions: Top ten research priorities in sexual and reproductive health and rights services in humanitarian settings were identified. The priority research areas have the potential to identify the best areas for programming of services in humanitarian settings. It is our hope that the identified research areas will be prioritized to support programming of services in humanitarian settings based on scientific evidence.

Research Priorities for mHealth and Innovative Strategies in Sexual and Reproductive Health and Rights in the WHO Africa Region

Background: The use of mobile phones continues to rise rapidly in the provision of health related services. Many countries have adopted the use of mobiles to provide sexual and reproductive health and rights and especially among the adolescents where specific messages are tailored for various audiences with specific messages. The purpose of this paper is to present the results of a research priority setting exercise on mHealth and innovative strategies. Methods: We adapted Child Health and Nutrition Research Initiative methodology to identify and set research priorities on mHealth and innovative strategies that respond to sexual and reproductive health and rights services. General potential research questions were gathered online from multiple stakeholders in the region and sent for consolidation consolidated to technical experts in World Health Organization headquarters. The second phase involved a meeting with experts to review and thematically analyze the questions list of 33 questions producing a list of 22 research questions. The questions were scored against a six point criteria and ranked accordingly. Ten top priority research questions were identified. Results: Lists of 33 priority research questions for mHealth and innovative strategies were proposed for discussions by 67 stakeholders. The questions were reviewed, scored and ranked in a technical meeting by experts. The highest ranking questions at 87% include evaluation of mHealth for data management and sexual and reproductive health and rights decision making, assessment of innovative local financing techniques to support community based sexual reproductive health and rights and evaluation of the role of mobile technologies in referral and counter referral. Conclusions: Information and communication technology is developing drastically and has a great potential in improving health especially in sexual and reproductive health and rights service delivery. This potential must be demonstrated with more relevant and quality research on mHealth and innovative strategies priorities identified.

The WHO African Region: Research Priorities on Sexual and Reproductive Health and Rights

Background: Many policy makers deliberating on comprehensive sexual and reproductive health and rights services need reliable evidence to make choices that benefit women, adolescents, children and the wider society. While universal health coverage discourse provides an opportunity to expand access through evidence based interventions, many gaps exist. Research prioritization has proved to be very helpful in identifying relevant areas especially in constrained resource settings. The purpose of this paper is to present the results of the World Health Organization Africa Region research prioritization for sexual and reproductive health and rights. These priorities hope to guide the region for the next three years. Methods: We used the Child Health and Nutrition Research Initiative approach to identify priority questions among many potential areas for research prioritization on sexual and reproductive health and rights. The implementation process was organized in three phases. The first phase involved sending out an online survey to various experts with experience in sexual and reproductive health rights. These questions were received by a technical team from World Health Organization headquarters for review. 634 questions were identified for potential research and grouped into 12 themes. The second phase involved experts who reviewed the questions. The team merged questions with duplications, removed the questions that were out of scope and finally refined the wordings. In the final phase, experts worked in groups to score and rank top ten priority questions for each of the 12 thematic areas. Results: A list of 120 priority questions for sexual and reproductive health and rights were prioritized by 67 participants drawn from 16 organizations. Most of the priority research questions (45%) focused on the theme of gender-based violence, 35% prioritized services in sexual and reproductive health and rights in humanitarian settings while 15% prioritized preventing unsafe abortion. 5% of the participants prioritized cervical cancer prevalence, prevention and treatment as a thematic area out of the questions in the top 20 research priority questions. Conclusions: Key priority research questions in sexual and reproductive health and rights were identified around five themes. The priority list will be of significance to World Health Organization regional Office for Africa and her stakeholders for the next three years.

Quality Provision of Comprehensive Sexuality Education and Sexual and Reproductive Health in Resource Constrained Higher Education Institutions: A Case of Mukuba University

In an effort to ensure that Institutions of Higher Learning provide quality Comprehensive Sexuality Education (CSE) and Sexual and Reproductive Health (SRH) at the level of Universities and Colleges, indeveloping countries such as Zambia, some universities have engaged in offering programmes and services in CSE and SRH. However, the provision of such programmes has had some limitations in terms of resources to ensure quality delivery. As a result, there was a need to examine the provision of CSE and SRH in a resource constrained Mukuba University. The study has three research objectives: 1) to examine the CSE and SRH programmes and services that are available at Mukuba University;2) to determine the actual resources available for the University to ensure quality provision of CSE and SRH to students;3) to use views and opinions of students and academics to examine the extent to which the CSE and SRH are reflected as standards by UNESCO and universities and colleges. The study took a pragmatic philosophy stance and convergent parallel research design of mixed methods;the primary approach is qualitative which will be analysed using thematic analysis, while the quantitative approach was secondary and the data was analysed using descriptive statistics. The study envisaged some implications that include the rise in communicable diseases such as Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS), gender based violence, general lack of information on matters relating to CSE and SRH among students at Mukuba University. The policy implication is that policy makers will be able to formulate policies that address the needs and challenges of students in providing quality CSE and SRH programmes and services for a university that is constrained with resources. The study found that there was a need to contextualize the quality provision of CSE and SRH at an institutional level, for instance, Mukuba University has created an enabling environment for quality provision of CSE and SRH activities and programmes through training of the stakeholders. Further, it was found that in any successful programme, it is expected to meet certain challenges that might in some cases make it difficult to implement the programme as envisaged. In other words, this study has revealed that there are some drawbacks as well as lessons that Mukuba University could learn from other universities that offer CSE and SRH. The study provides a synergistic conceptual model that could be used in the implementation of CSE and SRH in colleges and universities for sustainability. It is hoped that this study has proved that even with limited resources a university can provide CSE and SHR programmes and services without depending on support from other external funders and cooperating partners.

Smart Approaches to Efficient Text Mining for Categorizing Sexual Reproductive Health Short Messages into Key Themes

To promote behavioral change among adolescents in Zambia, the National HIV/AIDS/STI/TB Council, in collaboration with UNICEF, developed the Zambia U-Report platform. This platform provides young people with improved access to information on various Sexual Reproductive Health topics through Short Messaging Service (SMS) messages. Over the years, the platform has accumulated millions of incoming and outgoing messages, which need to be categorized into key thematic areas for better tracking of sexual reproductive health knowledge gaps among young people. The current manual categorization process of these text messages is inefficient and time-consuming and this study aims to automate the process for improved analysis using text-mining techniques. Firstly, the study investigates the current text message categorization process and identifies a list of categories adopted by counselors over time which are then used to build and train a categorization model. Secondly, the study presents a proof of concept tool that automates the categorization of U-report messages into key thematic areas using the developed categorization model. Finally, it compares the performance and effectiveness of the developed proof of concept tool against the manual system. The study used a dataset comprising 206,625 text messages. The current process would take roughly 2.82 years to categorise this dataset whereas the trained SVM model would require only 6.4 minutes while achieving an accuracy of 70.4% demonstrating that the automated method is significantly faster, more scalable, and consistent when compared to the current manual categorization. These advantages make the SVM model a more efficient and effective tool for categorizing large unstructured text datasets. These results and the proof-of-concept tool developed demonstrate the potential for enhancing the efficiency and accuracy of message categorization on the Zambia U-report platform and other similar text messages-based platforms.

Evaluation of the Functionality of the Networking of Sexual and Reproductive Health Rights Services in the Event of Gender-Based Violence in the Commune of Kpomasse in 2022

Introduction: In developing countries, gender-based violence (GBV) is a real public health problem. In Benin, GBV affects the majority of women and girls (69%). Benin has implemented strategies and set up integrated centers for the management of violence in order to reduce cases of violence and ensure the holistic management of victims. The objective of our study was to assess the functionality of the network of sexual and reproductive health rights (SRHR) in case of GBV in the commune of Kpomasse in 2022. Method: This descriptive and evaluative study was conducted from March 21 to April 11, 2022. The sampling method used was non-probabilistic. Reasoned choice and convenience were the techniques used for the different targets of the study. The functionality of the SRHR service network was assessed first by calculating scores at the structure, process and outcome levels, and then by analysis using the human rights-based approach. Results: Out of the 34 GBV victims identified, only one had received a full response and 54% of the victims had no knowledge of SRHR. The lack of knowledge about health care facilities was 41% for victims and 80% for non-victims in the community who participated in the study. In the case of gender-based violence, the community preferred to settle out of court rather than report it. The functionality of the networking of sexual and reproductive health rights services in the event of the occurrence of gender-based violence in the commune of Kpomassè is insufficient. Lack of knowledge of the roles of rights holders (DD) and duty bearers (DO) explains the insufficient functionality of networking. Conclusion: Training of SRHR service agents and community sensitization are essential to improve the functionality of SRHR service networking in the commune of Kpomasse.

Sexual and reproductive health service needs of university/ college students： updates from a survey in Shanghai, China

Aim： To promote the provision of reproductive health services to young people by exploring the attitudes and perceptions of university students in Shanghai, China, toward reproductive health. Methods： From July 2004 to May 2006, 5 243 students from 14 universities in Shanghai took part in our survey. Topics covered the demands of reproductive health-care services, attitudes towards and experience with sex, exposure to pornographic material, and knowledge on sexual health and sexually transmitted infections （STIs）/AIDS. Results： Of the 5 067 students who provided valid answer sheets, 50.05% were female and 49.95% were male, 14.86% were medical students, and 85.14% had non-medical backgrounds. A total of 38.4% of respondents had received reproductive health education previously. The majority of students supported school-based reproductive health education, and also acquired information about sex predominantly from books, schoolmates, and the Internet. Premarital sexual behavior was opposed by 17.7% of survey participants, and 37.5% could identify all the three types of STIs listed in the questionnaire. Although 83.7% knew how HIV is transmitted, only 55.7% knew when to use a condom and 57.8% knew that the use of condoms could reduce the risk of HIV infection. Conclusion： The reproductive health service is lagging behind current attitudes and demands of university students. Although students＇ attitudes towards sexual matters are liberal, their knowledge about reproductive health and STIs/AIDS is still limited. It is therefore necessary to provide effective and confidential reproductive health services to young people.

KAP Survey of Turkish University Students on Sexuality,reproductive Health,Drug Addiction and Violence

Objective To investigate the attitudes, behaviours and reflections of the university students, on sexuality, reproductive health, violence, smoking, alcohol and drug use, and to find out their expectations from a youth health service. Methods A total of 5 300 students （1 880 girls, 3 420 boys）from various Jaculties of Kyrykkale University were enrolled into this cross-sectional study. Students completed the self-administered questionnaire as one of the researchers was present at the classroom. Research monitors five categories of priority health-risk behaviours among youth and young adults. Results Mean age of 3 420 male （64.5%） and 1 880female （35.5%） students were 20.3 years. Among all 4 380 （82,9%） students [1 350 girls （71.8%）, 3 030 boys （88.5%）] had some kinds of information about sexuality, however this dropped to 2 730 students （51.5%） within the context of adequacy. Friends were the major source （34%） for the first information on sexuality. Using a condom was the mostly heard method of contraception （46.9%） and interestingly 1.1% of the students had no knowledge on any of the protection methods. Among all 25.3% of the students （33.0% boys, 11.4% girls） had some kind of sexual intercourse, and within this group 58.8% experienced his/her first sexual relationship at 18 years of age and over; 53.9% were protected in all intercourses. Using a condom was the main way of protection for boys （63.7%） and pills were for the girls （73.9%）. None of the female students mentioned having an abortion but 8% had friends who had undergone abortion. Tobacco use was 35.1% among the group, and 8. 7% of the male and 3.6% of the female students were using drugs. Although 67. 4% students claimed they never witnessed violence between their parents, 43.2% witnessed violence among their siblings, 67.0% beween friends, 72.6% in the streets and 64.2% in the school. About 30.0% of the students reported having weight problems, and 14.7% admitted visiting a doctor for that problem. If there would be a service providedfor the adolescents in the university, 67% of the students would attend in case of a problem. Past experiences were important for us and we saw that among all 8% of the participants had some kind of sexual problem, within this group 50.7% felt uncomfortable during the visit and only 60.4% were satisfied with the care of the physician. Conclusion Our study results show the current situation of adolescents in Kyrykkale University and will be used to improve policies and programs to reduce priority healthrisk behaviours among youth of our and surrounding provinces and establish a youth friendly service in Kyrykkale University within this purposes.

Effectiveness of Peer-Led Intervention on KAP Related to Sexual Reproductive and Mental Health Issues among Adolescents in Low Resource Settings India: A Comparative Study among Participants and Non-Participants

Background: India being the country with largest adolescent population in the world, needs a special focus on the health services as the status of an adolescent determines the health status in his/her adulthood. Some of the major issues faced by the adolescents include: mental health problems, early pregnancy and childbirth, (HIV/STI) and other infectious diseases, violence, injuries and malnutrition. The present study aims to understand the effectiveness of peer-led intervention on knowledge, attitude and practices related to sexual reproductive and mental health issues in adolescents among participants and non-participants. The study was carried out to improve the health-seeking behaviour of adolescents on sexual reproductive and mental health issues in low resource setting across four states in India. Methods: The study adopted a cross-sectional survey which was conducted on 400 adolescents from each of the four districts namely Bangalore, Khagaria-Bihar, Khed-Pune and Sahinganj-Jharkhand. A comparative analysis was conducted between the participants and the non-participants of the intervention to understand the effectiveness of the intervention on the KAP related to sexual reproductive and mental health of adolescents. Results: The study shows that the participants from Karnataka and Maharashtra had better knowledge in emergency contraception, HIV awareness, use of contraceptives and consumption of IFA’s than the non-participants;both the participants and the non-participants showed a positive behaviour in help-seeking in case of psychological challenges. Conclusion: The peer-led approach was found to be an effective strategy for learning, sharing and monitoring adolescent sexual reproductive and mental health.

Availability, Range and Utilization of Sexual and Reproductive Health (SRH) Services for Adolescents at Kinondoni Municipality, Dar es Salaam—Tanzania

Background: It is estimated 1.2 billion of world’s population are adolescents aged 10 - 19 years;80% live in developing countries. Adolescents in developing countries especially Sub-Saharan Africa (SSA) face high burden of sexual and reproductive health problems. Sixteen million girls aged 15 to 19 years give birth every year of which 95% occur in low- and middle-income countries. Twenty five percent of unsafe abortions are in 15 - 19 years in Sub-Saharan Africa. Contraceptive use is low as approximately 10% of adolescents are current users. These problems can be averted if different ranges of Sexual and Reproductive Health Services for adolescent (SRHSA) are available and utilized by adolescents. In Tanzania, there is limited information addressing the availability, types and utilization pattern of sexual and reproductive health services by adolescents. This study investigates the availability, range and utilization of sexual and reproductive health services for adolescents (ASRHS) at Kinondoni Municipality, Tanzania. Method: A cross-sectional study was carried out in April to May 2013. A checklist was used to collect information on the availability and range of services offered at selected health facilities. In depth interviews conducted with in-charges of Reproductive and Child Health (RCH) clinics to explore barriers for provision of Sexual and Reproductive Health Services (SRHS) for adolescents. Adolescents were questioned using a questionnaire on utilization of SRHS and perceived barriers. Descriptive statistics were used to summarize quantitative data and content analysis for qualitative data. Results: On availability and range of adolescents’ sexual and reproductive health services, a total of 25 health facilities were surveyed. Forty four percent of the surveyed facilities did not have the adolescent sexual and reproductive health services (ASRHS). The Adolescents Sexual and Reproductive Health (ASRH) services offered differed greatly between facilities. On utilization of adolescents’ sexual and reproductive health services in total, 204 adolescents from the community were involved in this study. A third of adolescents reported to have ever used ASRH. The adolescents perceived barriers for underutilization of the services were fear of being seen at the clinics (23.3%), lack of money (18.3%), lack of privacy & confidentiality (14.2%) and unfriendly health care providers. Three barriers were perceived by health care providers in the provision of ASRHS: integration of SRHS, lack of training in relation to adolescents SRHS and attitudes of health care providers towards young people. Conclusion: About half of the health facilities did not have the SRH-services to adolescent (44%) and different ranges of services were not offered at the facilities as it was shown in the records. The results from this study show services were underutilized by adolescents. Training, attitudes of health care providers towards young people, & cost influenced ASRHS provision and utilization. Strategies to increase training in ASRHS for health providers including communication skills and scaling ASRH services to all primary care facilities may help to improve availability and access of services to adolescents.

Evaluation of adolescent/youth-friendly sexual and reproductive health services:A 7-year systematic review from January 2016 to April 2022

Adolescent/youth-friendly sexual and reproductive health services(SRHS)play a vital role in reducing morbidity and mortality associated with adolescent SRH.This review examined studies carried out on adolescent/youth-friendly SRHS with focus on availability,accessibility,utilization as well as perception of health care providers,and adolescents about the services.The study design was systematic review of empirical studies using a well-defined strategy.Online journal was searched comprehensively using Web of Science,Google Scholars databases,PubMed,Medline,and EMBASE.Other sources were identified through the scanning of references of selected sources.The articles selected were between 2016 and 2022 and had qualitative/quantitative and mixed methods.The articles that met the selection criteria were also screened using PRISMA-P guidelines and SPIDER framework for systematic review was further used for inclusion criteria based on the following concepts:sample,phenomenon of interest,design,evaluation and research type.A total number of 32 studies were included in the study and findings were reported based on the five emerging themes.The review showed that majority of the adolescents were not aware of adolescent/youth-friendly SRHS,some health care providers were not also in support of the services which accounted for low utilization of the services among adolescents.The review further showed poor accessibility and nonavailability of AYFSRHS as the only available SRHS were meant for married adults.Therefore,these findings serve as evidence for policy-makers at all the levels of healthcare delivery system to considered all the factors observed in this review and develop strategies that will make adolescent/youth-friendly SRHS available and accessible to adolescents.More so,other stakeholders,especially health care providers must improve their attitude toward provision of adolescent/youth-friendly SRHS.

Knowledge about Sexual and Reproductive Health Services and Practice of What Is Known among Ghanaian Youth, a Mixed Method Approach

Most young person will become sexually active before their 20th birthday having to battle with early and unplanned pregnancies, unsafe abortions, maternal deaths and injuries. This study examined young person’s sexual knowledge, attitudes and practices and their levels of utilization of sexual reproductive health. Our study progresses beyond current research of reporting only sexual behaviour among youth to have insight into sexual and reproductive health update drivers yielding new empirically robust results for the Ghanaian case for sexual and reproductive health service uptake. The descriptively cross sectional design was employed in sampling 170 youth (150 surveyed and 20 Interviewed) using the stratified sampling technique together with a purposive selection of one key informant. Test of significance and associations were performed with the Chisquare test. In all 45.2% (77/170) of youth (10 - 24) had had sexual experience in life time. In respect of in-school youth, 42% (63/150) had had sexual experience whiles 70% (14/20) out-of-school youth had had sexual intercourse in life time. A total of 28.8% (49/170) of all the youth had sexual intercourse in the last six months with only 40.1 (20/49) using condom for protection. Parental discussion of contraceptive methods (29.3%) and sexual and romantic relationship (28.0%) was the least sexual and reproductive health area discussed among in-school youth. Youth knowledge of the available sexual reproductive health service was statistically associated with reproductive health service utilization (X2 = 0.00, P ≤ 0.05). A concerted effort is required from government, NGO, Civil society organizations and religious bodies to help translate youth knowledge about sexual health into responsible sexual life and protective sex.

The Effects of Short Health Messages Intervention in Improving Knowledge and Attitude on Sexual and Reproductive Health among Late Adolescents at Colleges in Malaysia

Sexual and reproductive health problems among adolescents are increasing in trend. Inadequate knowledge of sexual and reproductive health is the main cause of problems in sexual and reproductive health. Short messages service (SMS) intervention has been implemented widely in health education and the outcomes are positive. Hence, this study was conducted to evaluate the effects of mobile phone messaging in improving sexual and reproductive health among late adolescents (age 18 - 19 years old). A quasi-experimental study was conducted in two Professional Vocasional Colleges in Malaysia. A total of 116 respondents in the intervention group and 130 respondents in the control group had completed the study. There was a series of 24 messages (SMS) sent to the respondents biweekly for 12 weeks. The adolescent girls (mean knowledge score 15.90, sd ± 3.321) in the intervention group had a significantly (P = 0.007) higher mean score in knowledge of sexual and reproductive health than boys (mean knowledge score 13.87, sd ± 4.003) at post intervention. The adolescent boys (mean knowledge scores 15.35, sd ± 4.748) in the control group had a significantly (P = 0.009) higher mean score for knowledge on HIV/AIDS than girls (mean scores 13.08, sd ± 4.325) at post intervention. In the intervention group, the number of respondents with good knowledge and good attitude on HIV/AIDS increased at 3 months post intervention. SMS intervention on knowledge of sexual and reproductive health for adolescents was accepted and effectively improved the knowledge scores and sustained even after 3 months post intervention. Therefore, the SMS intervention should be implemented as an intervention package to improve knowledge and reduce risk in developing sexual and health related problems among adolescents.

Sexual and reproductive health needs of adolescent girls from conservative and low-income families in Erzurum, Turkey

The objective of this survey was to determine the sexual and reproductive health needs of conservative and/or economically challenged adolescent girls. A total of 310 subjects (16.5 ± 2.2 years old), attending three private institutes teaching Islamic matter and the holy Quran and two private institutes teaching carpet-weaving in Erzurum, Turkey, were interviewed between November 2004 and February 2005. The ques-tionnaire covered knowledge on reproductive health and sexual matters to attain their feelings prior to their first menarche, their practices during menstruation, and their awareness of gynecological and sexually transmitted dis-eases as well as their attitudes toward and re-sponsiveness to domestic violence. Their re-sponses showed that these issues were con-sidered taboo and/or embarrassing to share. Also, a considerable percentage of the girls had no or limited knowledge on reproductive health and sexual matters and mismanaged gyneco-logical problems and domestic violence. More-over, those had knowledge revealed that their sources were non-scientific information from unprofessional individuals. In conclusion, the conservative and/or economically challenged adolescent girls who are not attending regular high schools need professional lectures on re-productive health and sexual matters.

Evaluation of Training Course Effects on Integrated Sexual and Reproductive Health Counseling

Objective To evaluate the training course effects on integrated sexual and reproductive health （SRH） counseling, so as to improve family planning providers＇ capacities of SRH counseling. Methods The SRH training course was conducted by using new curriculum and participatory training methods. The purpose was meeting the SRH needs of clients. Evaluations were done by pre- and post-training questionnaires to trainees. Results The average total scores of trainees were 54.9 before trained and 83.4 after trained respectively. As to trainees＇ self evaluation of the capacities, the capacity for comfortably discussing sexuality and related issues with clients increased from 9.9% to 90.7%, the capacity for helping clients to understand their sexual risk factors increased from 12.5% to 92.2%, the capacity for helping clients assessing their own needs for SRH services, information and emotional support increased from 16.0% to 87.8%, and the capacity for helping clients to develop negotiation and communication skills increased from 12.0% to 86. 0%. Conclusion The training course of integrated SRH counseling changed the traditional training types and services concept o f family planning service providers, and the trainees＇ capacities of implementing integrated SRH counseling also improved very much.

Caretaker’s Perceptions on Caretaker-Adolescent Communication on Sexual and Reproductive Health in Unguja-Zanzibar: Implication for Intervention

Caretaker-adolescent communication is an appealing source for influencing adolescents’ knowledge, attitudes and behavior, because caretakers are an accessible and often willing source of information for their children. With the realization of the importance of caretakers in influencing adolescent behaviours, it becomes interesting to explore their perceptions about caretaker-adolescent communication on Sexual and Reproductive Health (SRH). An exploratory qualitative research design was conducted in all six districts of Unguja-Zanzibar. Twelve focus group discussions (FGDs) with caretakers who were purposively selected were conducted. Thematic analysis guided the interpretation of the data. The main themes that were identified are perceived the risk of adolescents;style, time and content of communication;barriers to parent-child communication on SRH;and helping our children pass through adolescence safely. The findings show that participants have acknowledged the apparent risky sexual behaviors of their adolescents, and that information on SRH should be offered to children before they reach puberty. Participants had the opinion that communication on SRH should be in the form of warning, threat and unidirectional. Topics such as teenage pregnancy, STIs and HIV, and drug and alcohol were proposed to be openly discussed. However, topics on condom and contraceptives use faced strong opposition. Lack of favorable time, caretakers’ limited knowledge and skills, myth on SRH communication, and being uncomfortable were among the caretaker-adolescent communication barriers identified by caretakers. The findings suggest that participants are keen to help their adolescents to avoid SRH problems, most importantly they emphasised on the need to empower caretakers by equipping them with knowledge of SRH, good communication skills and religious knowledge. Communal parenting on the other hand has been identified as the major weapon in shaping adolescents’ behaviour. This information provides insight in designing family-based intervention aiming at increasing communication about SRH between caretakers and adolescents.

Caretaker-Adolescent Communication on Sexuality and Reproductive Health: My Perceptions Matter;A Qualitative Study on Adolescents’ Perspectives in Unguja-Zanzibar

This study was conducted to explore the perceptions of adolescents on caretaker-adolescent communication on sexuality. Using an Information-Motivation-Behavioural Skills model, this article highlights areas to emphasise when planning strategies to improve caretaker-adolescent communication on sexuality. Twelve focus group discussions were held with adolescents aged between 15 and 19 years, and data were analysed using content analysis. The participants found it important for caretakers to communicate with adolescents about sexuality to avoid sexual and related health risks. Caretakers were the most preferred communicators, by adolescents, on sexuality matters. It became apparent that information about the use of condoms was the most unpopular topic during the discussions, while information about the use of contraceptives seemed to be more interesting to the majority of the participants. From the adolescents’ point of view, the barriers to communication about sexuality on the caretakers’ side, include, the belief that such information might encourage promiscuity;some caretakers do not find it easy to discuss matters related to sexuality with their children;and others feel that some adolescents know more about sexuality than themselves. On the other hand, barriers on adolescents’ side include, “fear” of the caretakers, some of whom seem harsh, unfriendly, and sometimes unapproachable. Following the findings, it is being suggested that intervention strategies that would help to alleviate communication barriers would consequently facilitate caretaker-adolescent discussions about sexuality and reproductive health.

Socio-Cultural Barriers Influencing Utilization of Sexual and Reproductive Health (SRH) Information and Services among Adolescents and Youth 10 - 24 Years in Pastoral Communities in Kenya

Background: As in other developing countries, sexual and reproductive ill-health continues to mostly affect adolescents and youths. Samburu and Turkana counties in Kenya have some of the highest levels of total fertility rates (TFR) at 6.3 and 6.9 respectively placing them well above the national TFR of 3.9. Establishing factors that influence utilization of SRH services among adolescent and youth aged 10 - 24 years is critical in developing an effective program. Method: We used primary data from qualitative and purposeful study design. Data collection used Focus group discussions (FGD), In-depth interviews (IDIs) and Key informant interviews (IDIs). The target groups were adolescents and youth aged 10 - 24 years, health care providers, community health volunteers (CHVs), chemist assistants, parents of adolescents and youth, teachers, spiritual leaders and traditional activists. Findings and Conclusion: Socio-cultural factors were found to influence utilization of SRH services and information. Early marriage, being youth, male only decisions on sexuality matters and fear of family contribute to unprotected sex while myths and misconceptions on contraceptives affected utilization. The findings revealed that youth needs to know sources, how contraceptives work and how to use them. The findings suggest capacity building of health care providers, CHVs, teachers, parents and community leaders on adolescence, sexuality needs of adolescents and disadvantages of female genital mutilation (FGM) including early marriage.

Does Facility Based Sexual and Reproductive Health Services Meet the Needs of Young Persons? Views from Cross Section of Ghanaian Youth

The focus on facility based health setting to provide sexual and reproductive health to the youth has been tested in several settings and achieved varying results. This study examined whether facility based sexual and reproductive health services met the needs of Ghanaian youth. Adopting the descriptive cross sectional design, 170 youths between the ages of 10 and 24 were sampled. A three-stage stratified random sampling technique was adopted. The results of the study are presented using descriptive statistics. The study established that a total of 55.8% (95/170) of the youth had utilized at least one or more of a sexual and reproductive health service in life time. However, only 45.2% (43/95) of youth used or accessed sexual and reproductive health services from a facility based setting. Facility based sexual and reproductive health service provided specifically for the youth is very limited. This calls for the provision of out-of health facility services located within the communities and at strategic places while ensuring confidentiality to the youth. More rigorous research is recommended on a national scale to examine youth preference for the type of facility based and out-of-facility based sexual and reproductive health services to meet the needs of young people.