The prevalence of sexually transmitted infections (STIs), HIV, and unintended pregnancies, commonly known as teenage pregnancy, remains a significant public health challenge in sub-Saharan Africa, including Nigeria. This is largely attributed to unprotected sexual practices among adolescents. Studies conducted in Nigeria have consistently highlighted the widespread occurrence of sex without condoms and low contraceptive usage among sexually active adolescents. Even among those who report using condoms, many do so incorrectly or inconsistently, thereby increasing their susceptibility to sexual and reproductive health (SRH) issues.
The high incidence of unprotected sexual activity among adolescents, particularly those engaged in risky behaviors like multiple sexual partners, is linked to inadequate awareness of SRH risks such as STIs, HIV, and unintended pregnancy, as well as limited access to contraceptives among adolescents. Notably, the scarcity of adolescent-friendly SRH services and adolescents’ reluctance to seek care in health facilities are major factors contributing to low condom and contraceptive use.
Healthcare facilities play a crucial role in providing adolescents with accurate SRH information, testing, and treatment services. However, adolescents’ utilization of these facilities remains low due to concerns about stigma, negative attitudes from healthcare providers, and the absence of services tailored to their needs. For instance, research in Enugu State found that adolescents perceived SRH services as financially inaccessible and lacking in adolescent-friendly features.
Additionally, societal norms influenced by religion and social structures in many African countries create barriers for adolescents accessing SRH services. Rather than seeking care at healthcare facilities, some Nigerian adolescents resort to informal providers such as medicine vendors and traditional healers, while others self-medicate by purchasing drugs without prescriptions, contributing to issues like antibiotic abuse and resistance.
Promoting the proper utilization of sexual and reproductive health (SRH) care is considered a critical approach to tackling the SRH issues confronting adolescents. Nonetheless, there remain significant knowledge gaps concerning the factors that shape adolescents’ SRH-seeking behavior and their reluctance to seek care in healthcare settings.
This article delves into the SRH-seeking patterns of adolescents, examines the factors influencing their healthcare-seeking behavior, and assesses their inclination to seek SRH care at healthcare facilities in the future. The insights garnered from this article investigation can guide the development of interventions aimed at delivering tailored adolescent health services in Nigeria.
A study published in Healthcare in 2022 with the title “Adolescents’ Sexual and Reproductive Healthcare-Seeking Behavior and Service Utilization in Plateau State, Nigeria” explored the healthcare access patterns among youths in Plateau State, Nigeria. The participant inclusion proceeded in three phases: the first selection was from six LGAs via balloting from seventeen LGAs, the second was a random selection of eighteen wards (three from each LGA), and thirdly there was collaboration with organized youth groups to identify households with consenting adolescents aged 18 or 19 years.
The study used trained research assistants that were distributed and retrieved anonymously. The study also used self-completed questionnaires from these adolescents, ensuring completeness for analysis.
The study assessed socio-demographic characteristics including gender, age, marital status, schooling status, and highest educational qualification. Sexual activity was determined by current sexual engagement. Awareness of SRH issues, STIs, and HIV was assessed directly through questioning. Health-seeking behavior for SRH issues was queried regarding past facility visits, while willingness to seek SRH care at health facilities in the future was assessed. Reasons for non-utilization of health facilities for SRH issues were elicited through open-ended questions and categorized into themes.
The study findings revealed that over one-third of the adolescents surveyed were currently engaging in sexual activity, often without using any form of protection such as condoms. This aligns with previous studies among adolescents with similar demographics, which also highlighted a high prevalence of sexual activity and associated risks of unintended pregnancy, HIV, and STIs.
Despite the awareness of sexual and reproductive health (SRH) issues being relatively high, particularly for HIV compared to STIs, a significant proportion of participants (about three-quarters) had never sought information or services on SRH from healthcare facilities. Additionally, more than half expressed reluctance to seek SRH care at health facilities in the future. Similarly, other studies in Nigeria have reported adequate knowledge of SRH among adolescents, particularly regarding HIV, but this hasn’t translated into increased healthcare utilization. Instead, many adolescents in need of SRH services, such as condoms, contraceptives, and STI treatment, sought care from non-professional sources.
Reasons cited by adolescents for not utilizing or desiring to utilize healthcare services included concerns about privacy, negative attitudes from healthcare providers, affordability issues, and the lack of adolescent-friendly services in healthcare settings. Previous research has also highlighted the inadequacy of privacy and confidentiality in healthcare settings for adolescents, as well as the adult-centered nature of SRH services provided.
The reluctance of adolescents to seek care in health facilities is worrisome, as they could benefit from timely information and assistance regarding SRH issues. Our findings indicate that only about half of the adolescents surveyed would seek care in health facilities when needed, with some opting for self-medication or seeking care from unprofessional sources. However, SRH care requires specialized attention from trained providers, highlighting the importance of seeking care from qualified healthcare professionals.
Analysis of socio-demographic factors revealed that younger age, unmarried status, and being out of school were associated with lower likelihood of seeking SRH care in health facilities. However, being sexually active emerged as the sole significant factor associated with healthcare utilization. This suggests that adolescents who are more aware of their risk of SRH challenges are more likely to access healthcare services.
While adolescents with higher awareness of HIV expressed greater willingness to seek care at health facilities, it remains uncertain whether this will translate into actual utilization, given the aforementioned barriers.
Addressing the high rates of unintended pregnancy, STIs, and HIV among adolescents in Plateau State and Nigeria will require targeted interventions. Therefore, we recommend further research to explore healthcare providers’ perspectives on ASRH care provision. Insights from both clients and providers can inform decision-making for implementing interventions aimed at improving healthcare facility utilization for SRH in Nigeria.
Bottom Line
Concerning trends in youth reproductive health in Plateau State, Nigeria, including high rates of unprotected sexual activity and low healthcare facility utilization is an crucial issue. Despite awareness of sexual health issues, many adolescents do not seek care due to various barriers. Addressing these challenges requires targeted interventions and further research to improve healthcare access and services tailored to adolescent needs.
