Awareness, Accessibility and Preferences of Sexual and Reproductive Health Services Among Adolescent Girls Aged 15-24 Years on Management for Abortion Complications at the Kenyatta National Hospital

Abstract

Background: Adolescence is a period of transition from childhood to adulthood. It is typically regarded as 10-19 years of age however, as evidence shows that growth continues well into early 20’s, the definition used in this study was 10-24 years (as recommended by Centre for adolescent health) (39). It is a time of experimentation where young people encounter a myriad of problems including unintended pregnancies, unsafe abortions, HIV and other sexually transmitted infections. This exposes them to several short-term complications and long term complications which carry on into their early 20’s and can sometimes be lifelong. Despite the advancements in sexual and reproductive health service provision, the rate of unintended pregnancies, unsafe abortions and HIV acquisition is still high. This study aimed to determine the awareness, access and preferences of sexual reproductive health services among adolescent girls. Objective: To determine the level of awareness, accessibility, acceptability of sexual and reproductive health (SRH) services and preferences of SRH service delivery among adolescent girls managed for abortion complications at the Kenyatta National Hospital. Methodology: This was a cross sectional descriptive study using mixed methods. Qualitative and quantitative approaches were used to evaluate sexual and reproductive health (SRH) services among adolescent girls being managed for abortion complications at Kenyatta National Hospital using semi-structured interviewer administered questionnaire and two focus group discussions (6-8 girls each) respectively. Quantitative data was collected and entered in an excel sheet then analysed using SPSS® (Statistical Package for Social Sciences) version 21.0. Data from focus group discussions were tape-recorded, transcribed and thematic analysis performed. Results: Between July and November 2019, 90 adolescent girls managed for abortion complications were screened, and 100% enrolled in the study. Awareness of SRH services among adolescent girls was generally low (approximately 64%) except for VCT services (84%). VCT services were the most accessed SRH service (88.9%) and mainly at public health facilities (90%). Physical accessibility of public facilities was also highest (83%) with available SRHS found to be financially accessible to majority of adolescent girls (approximately 60%). Acceptability of the available SRH services was high (>90%) but quality of service indicators were generally low (42%). In the preference of type of service delivery, the participants mainly preferred integrated SRH services (54.4%) with 83% citing reduced trips to the health facility and opportunity to receive additional health services being the most common perceived advantages of integrated SRH services. 72% cited that the main disadvantage for this delivery model being that the health provider would be too busy. Conclusions: From the results of this study, it can be concluded that awareness of sexual and reproductive health services was generally low among adolescent girls managed for abortion complications in KNH. Perceived accessibility of SRH services was also generally low among this demographic. Acceptability of available SRH services was generally high however, quality of service indicators were generally low and participants cited that available services were just general and not adolescent/youth-focused. Integrated SRH services are more preferable among adolescent girls however this in the face of specialized adolescent SRH services being very few in our setting. Recommendations: Based on the study findings, there is need for innovative approaches to establish adolescent-focused SRH services and increase awareness of these services. There is need xi | P a g e

to take measures that improve the accessibility and awareness on accessibility of SRH services among young people. There is need to improve quality of SRH services among adolescents in order to increase acceptability of these services. There is need to introduce and educate adolescents and young people on options on the methods of service delivery in order to enhance choice and accessibility to SRH services. Key words: Adolescent, Sexual and Reproductive Health services, Abortion management .