Search Results (61)

Introduction: Adolescents and young adults (AYAs), especially those from underserved communities, often face barriers to sexual and reproductive health (SRH). This pilot study evaluated the implementation of mobile health technologies to promote SRH care, including the integration of the Rapid Adolescent Prevention Screening^TM (RAAPS) and the Health-E You/Salud iTu^TM (Health-E You) app at a School-Based Health Center (SBHC) in Los Angeles using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Methods: This multi-method pilot study included the implementation of an integrated tool with two components, the RAAPS electronic health screening tool and the Health-E You app, which delivers tailored SRH education and contraceptive decision support to patients (who were sex-assigned as female at birth) and provides an electronic summary to clinicians to better prepare them for the visit with their patient. Quantitative data on tool usage were collected directly from the back-end data storage for the apps, and qualitative data were obtained through semi-structured interviews and in-clinic observations. Thematic analysis was conducted to identify implementation barriers and facilitators. Results: Between April 2024 and June 2024, 60 unique patients (14–19 years of age) had a healthcare visit. Of these, 35.00% used the integrated RAAPS/Health-E You app, and 88.33% completed the Health-E You app only. All five clinic staff were interviewed and expressed that they valued the tools for their educational impact, noting that they enhanced SRH discussions and helped uncover sensitive information that students might not disclose face-to-face. However, the tools affected clinic workflows and caused rooming delays due to the time-intensive setup process and lack of integration with the clinic’s primary electronic medical record system. In addition, they also reported that the time to complete the screener and app within the context of a 30-min appointment limited the time available for direct patient care. Additionally, staff reported that some students struggled with the two-step process and did not complete all components of the tool. Despite these challenges, clinic staff strongly supported renewing the RAAPS license and continued use of the Health-E You app, emphasizing the platform’s potential for improving SRH care and its educational value. Conclusions: The integrated RAAPS and Health-E You app platform demonstrated educational value and improved SRH care but faced operational and technical barriers in implementing the tool. These findings emphasize the potential of such tools to address SRH disparities among vulnerable AYAs while providing a framework for future implementations in SBHCs. Full article

Background: Adolescents in Ethiopia, particularly in rural areas, face significant barriers to accessing comprehensive sexual and reproductive health (SRH) services, resulting in poor health outcomes. The youth-friendly health services (YFHS) initiative addresses these challenges by training Health Extension Workers (HEWs) to deliver tailored, age-appropriate care at the primary care level. This study evaluates the cost-effectiveness of YFHS implementation in rural health posts in the Jimma Zone, Ethiopia. Methods: Using an ingredient-based costing approach, costs were analyzed across six health posts, three implementing YFHS and three offering routine services. Health outcomes were modeled using disability-adjusted life years (DALYs) averted, and incremental cost-effectiveness ratios (ICERs) were calculated. Results: Results showed that YFHS reached 9854 adolescents annually at a cost of USD 29,680, compared to 2012.5 adolescents and USD 7519 in control sites. The study showed the ICER of USD 25.50 per DALY averted. The intervention improved health outcomes, including a 27% increase in antenatal care uptake, a 34% rise in contraceptive use, and a 0.065% reduction in abortion-related mortality, averting 52.11 DALYs versus 26.42 in controls. Conclusions: The ICER was USD 25.50 per DALY averted, well below Ethiopia’s GDP per capita, making it highly cost-effective by WHO standards. Scaling YFHS through HEWs offers a transformative, cost-effective strategy to advance adolescent SRH equity and achieve universal health coverage in Ethiopia. Full article

The adolescent years are pivotal in reproductive and sexual development and maturation, yet the experience of migration can severely disrupt this period, inhibiting young immigrants’ knowledge, access, and engagement with sexual and reproductive health (SRH) services. Further, young immigrants and minority populations often face persistent intersectional barriers, including language difficulties, cultural stigma, and systemic exclusion, that result in adverse SRH outcomes. Recent advances in SRH care, particularly in digital health and community-based interventions, show promise in improving access to culturally appropriate SRH services and information. Co-designing SRH programs with families and young immigrants to adequately acknowledge the unique cultural norms and barriers in SRH is essential in ensuring a high outreach of interventions. Shifts in traditional health policies are needed to ensure that immigrant and minority adolescents are not overlooked and that SRH programs incorporate culturally relevant content that is easily and widely accessible. Despite positive shifts, several barriers remain: limited disaggregated data on diverse populations, inadequate policy attention, and the insufficient scalability and funding of promising interventions. Future research and promotional efforts must prioritise the co-creation of SRH interventions with stakeholders and affected communities, ensuring that services are sustainable, culturally appropriate, and accessible to all adolescents. Full article

New STI/HIV diagnoses disproportionately impact U.S. Black cisgender women at higher rates compared to other racial/ethnic U.S. cisgender women. Biomedical HIV prevention interventions, such as HIV Pre-Exposure Prophylaxis, have demonstrated lower uptake among Black women. Given the need to further develop prevention interventions that meet the sexual and reproductive health (SRH) needs of U.S. Black women, this study aimed to identify and characterize condom use behaviors, sexual communication efficacy, and SRH healthcare utilization among sexually experienced young Black women (YBW) aged 18–25 (N = 206). Participants completed a self-administered questionnaire assessing sexual and conception vulnerability, sexual/reproductive healthcare utilization, and sexual communication efficacy. Descriptive statistics and univariate analyses were conducted to identify correlations in sexual and reproductive behaviors. The results showed that 32% of YBW used a condom during their last sexual encounter. Five distinct trends in condom use were identified, three of which included condomless vaginal/oral sex. YBW reported high levels of sexual communication with sexual partners and consistent engagement in sexual/reproductive health care, including abortion care. Young Black women have diverse sexual/reproductive health needs and require culturally responsive patient-centered clinical practices aimed at reducing STI/HIV rates and unintended pregnancies. Future research could examine healthcare providers’ understanding of Black women’s SRH priorities and assess how this knowledge aligns with or diverges from established clinical guidelines and best practices. Such inquiries could illuminate potential gaps in provider education and clinical practice, ultimately informing the development of care models that are both evidence-based and responsive to the lived experiences of young Black women. Full article

Adolescence represents a vital transitional phase during which young people actively explore and engage with their sexual identity and expression. However, in Sub-Saharan African contexts, such as Ghana, prevailing socio-cultural norms can inhibit the recognition of young people as sexual beings, thereby restricting their ability to engage with their sexuality. It is essential to examine structural interventions, particularly sexual and reproductive health initiatives, to understand how they can better address the challenges within the Ghanaian context, where the conceptualization of young people’s sexuality remains problematic, because socio-cultural norms recognize only adults, and not young people, as sexual beings. This narrative review evaluates existing SRH policies in Ghana and analyzes evidence from schools, communities, and families to discern how young people’s sexuality is perceived. An overview of overarching policies shows a fragmented intersectoral approach, emphasizing an abstinence-based curriculum, while incorporating some elements of comprehensive sexuality education like condom use. Investigation into community, school, and home interventions reveals ambivalent attitudes toward young people’s sexuality, with a mix of acceptance and rejection of their sexuality, moral support for abstinence, and varying views on contraception. Further analysis using the sociology of childhood suggests that the incoherent framework for young people’s sexual and reproductive health, identified through this study’s reviews, is inadequate for a comprehensive understanding of young people’s sexuality. The existing sexual and reproductive health framework may not effectively challenge negative cultural norms and socio-cultural contexts that sustain the perception of young people as asexual beings. Therefore, implementing existing structural interventions within a comprehensive sexuality education framework is crucial to effectively tackle negative cultural norms and the contexts that marginalize young people’s sexuality. Full article

Latin American upper-middle-income countries (LAUMICs) face significant challenges in ensuring equitable access to sexual and reproductive health (SRH) for adolescents due to socioeconomic inequalities, migration, and historical violence. This systematic review examines the barriers and facilitators to sexual and reproductive health access for adolescent girls (≤19 years old) in vulnerable situations across Latin America. Using six databases, 391 articles were reviewed; 10 met the inclusion criteria, and 10 more were included through backward search, resulting in 20 analyzed studies. Structural barriers such as economic, regulatory, and institutional constraints were found to restrict SRH access, exacerbated by social stigma and negative narratives, especially in cases involving sexual violence and clandestine abortions. Facilitators included intersectoral collaboration, preventive education, and community networks, which improved access to and the quality of services for vulnerable populations. The findings emphasize the need for sustainable strategies that address structural inequalities and stigma while strengthening health systems, and intersectoral cooperation. Comprehensive, culturally tailored education and clear regulatory frameworks are essential to achieving equitable and sustainable SRH services. These insights offer practical guidance for public policy and program design in LAUMICs, particularly for addressing the needs of marginalized adolescent populations. Full article

Sub-Saharan African (SSA) women experience a high prevalence of HIV, sexually transmitted infections (STIs), and unintended pregnancies, necessitating effective, integrated prevention strategies. Multipurpose prevention technologies (MPTs) offer a promising approach to address these overlapping health concerns by providing single products that simultaneously prevent HIV, other STIs, and/or unintended pregnancies. Given the persistent sexual and reproductive health (SRH) challenges faced by women in SSA, in this opinion piece, we explore practical considerations for MPT adoption and scale-up within the region. With this opinion article, we discuss the data on MPT development and identify key factors for successful MPT implementation in SSA. We examine the current MPT pipeline, product features, regulatory challenges, and structural, individual, and community barriers that impact MPT acceptance and usage among SSA women. Successful MPT uptake hinges on designing discreet, user-controlled products and engaging end-users, healthcare providers, and communities in product development and promotion. Structural factors such as robust supply chains, regulatory clarity, and financial support are also essential. Addressing socio-cultural norms, especially partner consent, and strengthening demand creation through community-driven, culturally sensitive strategies are critical for scaling MPTs. In conclusion, MPTs represent a transformative opportunity to reduce the burden of HIV, STIs, and unintended pregnancies in SSA. Strategic, culturally attuned approaches are essential to ensure the acceptability and accessibility of MPTs. Expedited pathways for regulatory approval, collaborative partnerships, and community-centered demand creation will be vital to realize the full potential of MPTs in advancing women’s SRH in SSA. Full article

Every adolescent should have the right to make their own choices about their sexual and reproductive health (SRH). Achieving this goal can be challenging, especially in low- and middle-income countries (LMICs), where social norms and insufficient resources may limit access to information. Technology is increasingly being leveraged in LMICs to reach adolescents. We searched the literature to understand the landscape of digital SRH interventions in LMICs. The review addressed three questions: (1) What are the interventions and how effective are they? (2) What are adolescent preferences for information? And (3) What do the interventions cost? There is a wide variety in the populations addressed (e.g., adolescents with HIV, pregnant/post-partum adolescents) and the locations of the interventions, with the majority in sub-Saharan Africa. The types of interventions were evenly distributed between “push” approaches, where adolescents are sent information; “pull” approaches, where adolescents reach information from a website or app; and “two-way” approaches, which combine push and pull aspects. The most positive features identified were convenience and privacy. The major challenge is inadequate smartphone penetration in very low-income adolescents, especially girls. The evidence on the effectiveness of these interventions is mixed. Most studies show that SRH knowledge increases, but this does not necessarily lead to behavior change. Full article

Women from Syria and Iraq constitute two of the largest groups of humanitarian visa entrants to Australia in the past 10 years. Barriers to and enablers of preventive sexual and reproductive health (SRH) for these women are poorly understood. The aim of this study was to establish the preventive SRH care needs and experiences of women from refugee backgrounds from Syria and Iraq living in Australia. A qualitative study using semi-structured interviews was conducted with women from Syria and Iraq living in Melbourne, Australia. Caseworkers assisted with recruitment and volunteer interpreters with interviews. Between 1 December 2021 and 17 May 2022, interviews were conducted in English or in Arabic with a volunteer interpreter. Audio recordings of English dialogue were transcribed verbatim. Reflexive thematic analysis was used to analyse and report data. Eighteen women were interviewed. Six themes were identified: (1) Awareness and knowledge about preventive SRH, (2) Perceptions about the need for preventive SRH care seeking, (3) Self-care and lack of motivation to seek preventive SRH care, (4) Health information seeking, and (5) Barriers to and enablers of preventive SRH care. Complex factors were found to influence access to preventive SRH care. Enhancing educational initiatives, improving accessibility to reliable health information, and addressing structural and motivational barriers are important for fostering better preventive SRH outcomes. Full article

Many countries, including Sri Lanka, are taking steps to integrate sex education into their educational systems to combat child abuse. However, this effort is often met with skepticism in Asian nations, including Sri Lanka. This study takes a unique approach by applying the criteria of the health belief model to predict the quality of reproductive health (SRH) education in Sri Lanka, offering a fresh perspective on this issue. A positive philosophical framework and a deductive approach have been employed to provide justification for the underlying assumptions. A structured questionnaire was used as the survey methodology, which included questions about external cues to action, self-efficacy, perceived barriers, perceived susceptibility, and perceived severity. Data was collected from a total of 384 Sri Lankan non-state undergraduate students to test their perception of these factors and how they affect the perceived benefits of quality SRH education. The level of self-efficacy, perceived susceptibility, and perceived severity yielded a coefficient estimate that was statistically significant, thus influencing the perceived benefits of quality SRH education. These results, obtained through a multivariate regression analysis, underscore the importance of one’s role in implementing effective SRH education. Importantly, there is no evidence that external cues to action and perceived barriers predict the perceived benefits of quality SRH education. This underscores the gravity of the situation and the need for immediate action. The findings of this study have significant practical implications. They can be used to develop an effective SRH program that aims to prevent sexual abuse among adolescents. This study also demonstrates that the health belief model can serve as a useful conceptual framework for such intervention programs, providing tangible solutions to the issue of SRH education quality. Full article

Sexual and reproductive health (SRH) is essential for men’s health, but a large body of research has indicated that the underutilization of most SRH services by men is a persistent issue that needs to be addressed. Men’s reluctance to access sexual and reproductive health services is one of the factors that leads to high morbidity and mortality rates among men, although their diseases may have been prevented or cured. This study aimed to explore factors that influence the decision of men who resided in men’s hostels and who accessed urology clinics in KwaZulu-Natal to seek help for their sexual and reproductive health issues. An exploratory qualitative approach was adopted using focus group discussions. We interviewed seventy-two men of ages above 15 years. The data were analyzed thematically. The Biomedical Research Ethics Committee (BREC) of UKZN granted ethical clearance (BE 347/19). Of the 72 interviewed men, thirty-three men attended urology clinics in the selected hospitals, and thirty-nine men resided in the hostels around Durban in KZN. Seven themes (lack of awareness of SRH services; participants’ reluctance to access SRH services; influence of culture and religion; lack of financial resources; influence of relationship dynamics; perceived low risk of individual sexual behaviors; and healthcare factors that discourage men from accessing SRH services) emerged from the data that were identified as barriers to SRH service utilization by men, whilst three themes (healthcare enabling factors; access to general information on SRH services; and personal motivational factors) emerged as factors that encouraged the participants to access these services. The participants’ reluctance to access SRH services was attributed to the lack of awareness of available SRH services, the influence of culture and religion, lack of financial resources, relationship dynamics, the perceived low risk of sexual behaviors for individuals, and healthcare workers’ negative attitude towards men requiring SRH services. The availability of healthcare resources, the appointment of more male healthcare workers, and more positive attitudes among healthcare workers will encourage men to utilize SRH services. The exposure of various barriers to SRH service utilization by this investigation warrants urgent attention from the government to impart knowledge about this phenomenon to men. Full article

(1) Background: Migrant and refugee youth’s (MRY’s) sexual and reproductive health and rights (SRHRs) are a global health issue. MRY encounter adverse SRH experiences due to limited access to and knowledge of SRHRs services. Using a socioecological framework, this study examined the barriers affecting MRY’s SRHRs. (2) Methods: A cross-sectional study utilising a participatory action research design was used. A total of 87 MRY (ages 16–26, from 20 cultural groups within Greater Western Sydney, Australia) completed seventeen focus group discussions on their SRHRs experiences. The focus groups were co-facilitated by youth project liaisons to ensure their authenticity and validity. The data were analysed thematically and interpreted using socioecological theory. (3) Results: The findings identified socioecological barriers, a lack of awareness about and access to services, and sociocultural dissonance as leading to the under-implementation of SRHRs services. These barriers included cultural disconnects, language barriers, remote service locations, intergenerational cultural conflicts, and ineffective SRHRs services. The key themes identified included traditional and institutional stigma, lack of SRH education, reliance on social media for SRH information, and privacy concerns. (4) Conclusions: There is a limited consideration of MRY’s SRHRs and the impact of intergenerational discordance and stigma on MRY’s rights. The findings suggest the necessity for a collaborative SRHRs strategy and policy design that empowers MRY’s agency across multicultural contexts. Full article

Pregnancy termination, also referred to as abortion, is a contentious subject in many countries. Uganda’s culture requires young people to remain celibate; they therefore suffer from restricted access to any sexual and reproductive health information, products, and services, including contraceptives. Girls who are pregnant in Uganda are oppressed in various ways, including being expelled from school. Since abortion is illegal under Ugandan law, those abortions that take place are assumed to have a high risk of being unsafe. Most previous studies in the African context have thus focused on the phenomenon of unsafe abortion. Adolescent abortion is characterized by a rhetoric of pathology that frames girls as victims of deadly unsafe abortion practices. This paper aims to critique the view that pregnant adolescent girls are merely vulnerable victims who passively accept the denial of SRH services, including abortion. We analyzed the life histories of 14 girls in Uganda who had undergone pregnancy termination. Our findings showed that adolescent girls are not passive victims of the structural barriers to abortion. They use their agency to obtain knowledge, make decisions, successfully terminate pregnancy, and conceal the information as needed. It is therefore important for policymakers to acknowledge the agency of adolescent girls in regard to pregnancy termination and how this recognition could be of benefit in terms of devising appropriate supports for them. Full article

This paper assesses literature regarding the sexual and reproductive healthcare (SRH) needs of resettled refugee women who experienced gender-based violence (GBV) and trauma-informed care (TIC) principles utilized among SRH service providers. A systematic search identified relevant studies published between 2000 and 2021; no articles found reflected both SRH and TIC principles among refugee women. The search was therefore separated into two aims: to review the literature about SRH needs for refugee women in resettlement countries who experienced GBV (Aim 1) and to examine the use of TIC principles in SRH care among women who experienced GBV (Aim 2). Thematic analysis of the articles identified key themes. Twenty-six articles were included in the analysis across both aims (Aim 1 = 8, Aim 2 = 18). Aim 1 articles shared three factors shaping the SRH needs of resettled refugee women: the centrality of violence and trauma; structural barriers to SRH care; and actions, practices, and resources for service providers. Aim 2 articles illustrated seven key principles of TIC used in SRH service provision, such as empowerment; trauma-specific services and integrated care; connection; safety; collaboration; identity culture and context; and trustworthiness. Resettled refugee women’s experiences of violence necessitate trauma-informed SRH health care. While there is limited peer-reviewed literature regarding TIC-SRH care for refugee women, the findings regarding the SRH needs of refugee women and the findings regarding the implementation of TIC in SRH collectively frame recommendations for how SRH can be infused with TIC. An example from practice, in the form of the Refugee Women’s Health Clinic, is included as an exemplar of TIC SRH principles in action for the health of resettled refugee women who have survived gendered violence. Full article

While all modern contraceptive methods are available for free or at minimal cost in Nepal, contraceptive devices in Japan are mainly limited to condoms, requiring Nepalese migrant women to rely on their male partners for their use. Therefore, Nepalese migrants often seek contraceptive devices from Nepal or request friends or relatives to send them from their home country. This study aimed to identify the gaps and challenges associated with Nepalese migrants’ needs for sexual and reproductive health services (SRHSs), particularly contraceptives, before and after their migration to Japan. A mixed-methods study was adopted, an explanatory sequential design (ESD) combining quantitative and qualitative approaches, and data were collected from 186 Nepalese migrants (80 females and 106 males) through an online survey and from two focus-group discussions (FGDs) conducted among 24 participants (14 females and 10 males). This study highlighted the obstacles faced by Nepalese migrants in accessing contraceptive services, such as limited options, language barriers, and high costs. The study also revealed the importance of pre-departure training in Nepal and organizing post-arrival training in Japan to increase Nepalese migrants’ awareness of the SRHSs available in Japan, thereby helping to prevent SRH-related health problems, including unintended pregnancies and abortions, in Japan. Full article