Determinants of Access to Sexual and Reproductive Health Services Among Female Adolescent Refugees in Nairobi City County

Abstract

This is a cross-sectional qualitative study on the determinants of access to sexual and reproductive health services among female adolescent refugees living in Nairobi City County. Specifically, the study set out to establish the socio-economic and facility based determinants of access to sexual and reproductive health services among female refugees aged between 10 and 19 years. This is because sexual and reproductive health (SRH) is a significant aspect of adolescents’ growth but remains difficult to access among adolescents who have been displaced by emergency and conflict situations and are not located in a specific camp or geographic area but are spread across urban areas. The disruption of family structures and adult role models that adolescents usually look to and the protective social norms, structures, and community groups through conflict and natural disasters makes access to SRH services particularly difficult for adolescents. Populations, who often end up living in displaced situations for a long time, in camps, rural or urban settings, face acute health challenges with women and adolescent girls, particularly, being vulnerable to being excluded, marginalized and exploited and at a higher risk of GBV. In Sub-Saharan Africa, efforts to attain quality sexual and reproductive health are constrained by inadequate access to and inequitable distribution of quality SRH services consequently contributing to poor utilization of SRHS among adolescents. The socio-economic determinants under study were: Parental support and control; Peer influence; Socio-cultural norms; Religious beliefs; Media and popular culture; Financial status. The facility-based determinants studied were: Availability, accessibility, acceptability and, equality. The study used the Social Exclusion Theory to explore how female refugee adolescents are excluded from accession SRH services due to their age and their migrant status as refugees. The study utilised in-depth interviews, focus group discussions and key informants. Purposive sampling was used to select the 30 participants of the in-depth interviews who were spread around different areas of Nairobi. The FGD participants were a subset of the participants of the in-depth interviews for two separate discussions. Four key informants were purposively sampled on the basis of their knowledge of adolescent refugee sexual and reproductive health matters. The results revealed a low access of SRH services among adolescent refugees. A majority of the study subjects accessed information from school, however this information was limited in scope and content. For most of the respondents, parents and guardians provided them with the initial information on SRH. However, this information was mostly limited to menstruation and menstruation hygiene. Though parents and guardians were the ones providing the initial source of information on SRH matters for most of them, the most preferred source of information were friends and social media. The adolescents shared that they were afraid or shy to bring up sexuality topics with their teachers and relied on the discretion of the teacher on what SRH topic they were to be taught. A total of 27% of the female adolescents had ever been to a medical facility to access SRH services. Most of those who had been to a medical facility were there for HIV testing and counselling and the rest to access services before and after child birth. Only 16% had access to information on contraceptives. The main barriers of access to SRH services were shyness and fear, cultural norms, imagined cost of access to SRH services and judgemental attitudes of service providers. Though most of study participants had never accessed SRH services from a health facility, they reported thinking that the services would be too expensive for them and thus did not attempt to visit any. The study recommends interventions to enhance the knowledge of SRH issues especially to the out-of-school adolescent refugees who would not be able to access the information from a school. There is also the need to broaden the SRH issues taught in school beyond abstinence to also include contraceptives and other STIs other than HIV. There is also the need to build the capacity of teachers, parents and guardians so that they might be able to speak freely about SRH matters.