An assessment of factors determining access and utilization of reproductive health care services by adolescents in Nairobi City
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Adolescent sexual and reproductive health in Kenya is a relatively new and sensitive area mainly due to lack of formal structures to address of sex and sexuality. In an attempt to address the reproductive health challenges experienced by young people in Kenya, the Government, through the Ministry of Health Division of Reproductive Health in partnership with other stakeholders developed the Adolescent Reproductive Health and Development Policy (ARH&D) in the year 2003. It was not until July 2005 that the guidelines for the policy were finalized and disseminated. However, access and utilization of available reproductive health services by adolescents and the youth is determined by how the services are provided to them and how friendly the services are to them. This study examined the extent to which adolescent reproductive health services are appropriate, accessible and youth friendly, the patterns of utilization of reproductive health facilities of adolescents and identified barriers and challenges in provision of youth friendly services. In addition, the study explored ways of addressing the barriers and challenges to foster increased access and use of services among adolescents in Nairobi City. The study attempted to provide a theoretical understanding of factors affecting adolescents' access and use of reproductive health services. Using the Health Belief Model and Stanley Hall biological/problem-based view of adolescence, the study explored how individual factors like risk taking behaviour of adolescents and perceptions influence utilization of services. Through the Social Exclusion paradigm and the Transtheoritical Model, the study demonstrated how external factor determine access and utilization of health services by adolescent. The study used both quantitative and qualitative approaches to collect data. The study mainly utilized survey research and adapted a cross sectional design and a semi- structured questionnaire was used to interview 120 respondents. The study also used field research which key informants were interviewed by use of an interview guide. -The key informants were health providers and they included nurses and clinical officers. The quantitative data were analyzed using SPSS (Statistical Package for Social Sciences). The analysis done included univariate and bivariate. - IV The study conducted in Nairobi established privacy and confidentiality is a critical factor in determining the utilization of reproductive health services by the youth. Mixing of youth with the general population in provision of reproductive health deters the youth from seeking the services. The study also identified that the youth consider provision of recreational facilities as an important component in the constitution of a youth friendly service. Given the findings, it is clear that Reproductive Health services are accessible to the youth in Nairobi. However, there is need for gender and age consideration when planning for provision of reproductive health services. Given that these services are provided free of charge at the Nairobi city council health clinics, it is important to have a sustainability plan. There is need to ensure that health centre staff are sensitive to the needs of the youth by training them. Availability of recreational facilities should not be overlooked.