Challenges to Youths Accessing Sexual and Reproductive Health Information and Services in Southern Africa: A Review of Qualitative Research in Seven Countries

The Soul City Institute for Health and Development Regional Programme, involving partner organisations in Lesotho, Malawi, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe, conducted qualitative formative audience research to explore knowledge, attitudes, and practices on sexual and reproductive health and rights (SRHR) issues among youth. Based on this research, this paper seeks to highlight challenges faced by youth in accessing sexual and reproductive health information and services in the 7 southern African countries and recommend possible ways to address the challenges. The findings were aimed at informing social and behaviour change communication interventions for the Soul City Regional Programme covering the 7 partner countries. 

Methods
From July to September 2011, partner organisations in the 7 southern African countries conducted a total of 86 focus group discussions (FGDs) with youth roughly equally distributed between boys and girls. Separate FGDs were conducted for boys and girls, except for 8 FGDs where boys and girls were mixed. Further, 18 FGDs with adults equally distributed between men and women but in mixed sex groups, as well as 22 indepth interviews equally distributed between men and women, were conducted. Each FGD comprised about 9 to 12 participants. Interviews were transcribed verbatim, and thematic data analysis was conducted. Each of the 7 partners produced a report. This paper is based on thematic meta analysis of the 7 country reports.

Findings and Discussion 
Youth, especially adolescents, are faced with challenges of (dis)orientation and discovery about sex and sexuality. This puts them at high risk of contracting sexually transmitted infections (STIs), including HIV, and unplanned and early pregnancies with negative consequences, such as dropping out of school and unsafe abortion. As much as youth acknowledged the need for correct information and services to minimise the risks, evidence across all 7 countries overwhelmingly shows that there are critical challenges faced by youth in accessing sexual and reproductive health information and services. The challenges are around unfriendly health services - both from health worker-client communication dynamics and unfavourable policies, poor parent child communication, and increased access to pornography via mobile phones - which encourages sex and unsafe sex. The evidence also suggests that adolescents opt to talk to their peers about issues of sex and sexuality, despite the fact that the information they get from their peers is sometimes misleading or inadequate.

From both prevention and human rights paradigms, youth access to credible sexual and reproductive health information and services has been touted as one way of minimising youth risk to teenage pregnancies and STIs. The evidence from the 7 southern African countries, however, reveals behavioural and structural gaps that need to be addressed if sexual and reproductive health information and services among youth are to be optimised.

Backed by the research findings in this paper and in line with the social and behaviour change theoretical framework, the paper offers recommendations which focus on: individuals, family, and community; supporting services; and the socio political environment. Thus, a holistic adoption of the recommendations is expected to minimise challenges faced by youth in accessing sexual and reproductive health information and services and improve the health status of the youth, at least in the countries under review. The recommendations are as follows:

1. There is a need for behavioural interventions to mitigate factors behind early and unsafe sex among youth. The interventions should aim at: increasing youth knowledge, skills, and self efficacy; shifting norms; and impacting on youth sexual behaviours.
2. There is need for interventions aimed at improving parental and youth communication on sexual and reproductive health issues affecting the youth.
3. Health systems and personnel need to be oriented to offer youth-friendly sexual and reproductive health services. For instance, there is need for youth-friendly hours of operation, affordable cost, confidentiality, empathy, and age- and gender-disparate (targeted) services. This recommendation reinforces similar recommendations made by other agencies that, however, seem to be ignored by health services in countries under review.
4. There is need to conduct research and advocate for ways of aligning national sexual and reproductive policies on youth with current youth sexual practices and envisaged youth sexual and reproductive health outcomes.