Factors influencing access and utilisation of preventive reproductive health services by adolescents in Kenya : a case study of Murang'a District
Sexual and reproductive health is part of physical and emotional well-being of all human beings. Adolescents globally have unique sexual and reproductive health needs and accompanying vulnerabilities. Many adolescents face sexual health risks of early sexual debut, sexually transmitted infections including HIV/AIDS, unplanned pregnancies and illegal abortions. These challenges threaten their health and survival. The 1994 International Conference on Population and Development stressed that adolescent sexual and reproductive health needs are basic human rights. It emphasised the need to offer sexual health services and information to adolescents and to address reproductive health challenges across the lifespan. For adolescents to effectively transit into adulthood, they need to be provided with factual, affordable, accessible, confidential, non-judgemental and friendly sexual health information and services. Despite this recognition, adolescent preventive reproductive health services (PRHS) and programmes remain largely inadequate in sub-Saharan Africa. In Kenya, efforts to provide reproductive health care services to adolescents have faced numerous challenges. These challenges include lack of mandatory health insurance, inadequate health facilities, and shortage of health care providers. The lack of decentralized health care delivery system in Kenya causes disparities in service provision, favouring urban as opposed to rural areas. The purpose of this study was to establish the factors that influence access and utilisation of preventive reproductive health services by the in-school adolescents in Kenya. This goal was achieved by carrying out a four months research in Murang'a District of Kenya. The study focused on five priority themes: (i) Understanding of sexual health concerns of adolescents, (ii) The availability of preventive reproductive health services for adolescents, (iii) The level of access and utilisation of preventive reproductive health services by adolescents, (iv) Existing reproductive health policies for adolescents and how they affected adolescents access and provision of services, and (v) Understanding of the challenges faced by adolescents in accessing and utilising the services. Data were collected by carrying out structured face-to-face interviews with 114 in-school adolescents, 25 health providers and 18 key informants. The study also used documents analysis and observation methods. Qualitative data were analysed using content analysis, whereas quantifiable data were coded and analysed using SPSS. This study has established that adolescents had unmet behavioural, psychosocial, emotional, maturation, developmental and gender-specific sexual and reproductive health needs and concerns. It has further established that Murang'a District did not have specific adolescent-friendly preventive reproductive health services. The level of access and utilisation of preventive reproductive health services by adolescents was low. This was due to the following factors: lack of adolescent-friendly services, inadequate school health services, and lack of adequate awareness among adolescents on available preventive reproductive health services. Other factors included lack of clear and effective policies to guide provision of preventive reproductive health services to adolescents, lack of adequate awareness among health providers and caregivers about existing adolescent reproductive health policies, restrictive eligibility criteria and rigid legal requirements for parental consent, judgmental attitude and professional bias among health providers.
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