Understanding Adolescent and Youth Sexual and Reproductive Health-seeking Behaviors in Ethiopia: Implications for Youth Friendly Service Programming

"Acknowledging the need for targeted health services for adolescents and youth, the Ethiopian Government has scaled-up and institutionalized youth friendly services (YFS) through intensive capacity building at all levels of the health system...."

This Population Council collaboration with USAID/Ethiopia and the Ethiopian Federal Ministry of Health (FMOH) is a study "aimed to generate evidence on current use and perspectives of YFS and to inform the FMOH in its future sexual and reproductive health (SRH) programming for young people. The study data came from a cross-sectional quantitative survey implemented between January and July of 2016, including 3,611 females and males aged 12–24 years living in rural and periurban areas of Amhara, Oromia, Tigray, SNNP, and Benishangul-Gumuz regions” in which 271 YFS sites were selected  including: health centres, hospitals, universities, and youth centres.

"The survey questions covered a range of topics including (but not limited to) respondent and household characteristics, use of basic health services, contraceptive use and sexual activity, awareness of YFS, and use of YFS. Bivariate analysis was conducted by sex, region, age, marital status, and school status." For comparison, one facility per region was also selected that did not receive any support or trainings in YFS. When possible, the comparison facilities were selected from within the same zone of the selected YFS site. 

Nineteen supervisors and 109 data collectors received training including: obtaining informed consent, review of the questions, and mock interviews. Male interviewers interview males, females interviewed females for the 3-4 week interview period. A bivariate analysis produced the following results:

• "[Y]oung people surveyed were satisfied overall with the health services they received, regardless of whether it was basic health services or YFS. Only a small proportion of youth had knowledge of YFS, and an even smaller proportion reported using YFS prior to the survey...."
• "[A]mong respondents who reported using contraception, many may have been using YFS without knowing it."
• "[R]espondents reported low levels of social autonomy and required permission to leave the house from either a parent or spouse. This may be a barrier for young people in accessing health services, and especially SRH services."

Implications from the study suggest that:

• Few female youth are sexually active before marriage, yet those who are young and married are not considered for YFS. "Programs need to find ways of reaching young married youth with SRH services."
• Parental supervision and involvement may limit mobility and decision-making of youth, including married youth. Future research is needed to understand parents, guardians, in-laws, teachers, religious leaders, etc.'s perspective of married youths' use of SRH service, with the goal of designing programmes to reduce these community gatekeepers' negative attitudes toward youth use of SRH services.
• Distance to services was found to be a factor, so "programs that aim at bringing health services to youth where they live could be explored. For example, programs may consider training health extension workers (HEWs) who already offer antenatal care, HIV testing, and family planning among other services, to provide SRH services to youth in their households."
• The high degree of satisfaction of those who accessed YFS, yet the low profile of the programmes, suggests that "programmers and policymakers need to consider how their resources and investments should be made moving forward." 

The report concludes that a more holistic approach could be taken to meet SRH needs of youth beyond YFS sites, and, at the same time, demand generation and changing of community norms toward more youth agency, as well as a focus on married youth, may increase the use of these services.