Effective Strategies to Provide Adolescent Sexual and Reproductive Health Services and to Increase Demand and Community Support

Abstract

Access to youth friendly health services is vital for ensuring sexual and reproductive health (SRH) and well-being of adolescents. This study is a descriptive review of the effectiveness of initiatives to improve adolescent access to and utilization of sexual and reproductive health services (SRHS) in low- and middle-income countries. We examined four SRHS intervention types: (1) facility based, (2) out-of-facility based, (3) interventions to reach marginalized or vulnerable populations, (4) interventions to generate demand and/or community acceptance. Outcomes assessed across the four questions included uptake of SRHS or sexual and reproductive health commodities and sexual and reproductive health biologic outcomes. There is limited evidence to support the effectiveness of initiatives that simply provide adolescent friendliness training for health workers. Data are most ample (10 initiatives demonstrating weak but positive effects and one randomized controlled trial demonstrating strong positive results on some outcome measures) for approaches that use a combination of health worker training, adolescent-friendly facility improvements, and broad information dissemination via the community, schools, and mass media. We found a paucity of evidence on out-of-facility-based strategies, except for those delivered through mixed-use youth centers that demonstrated that SRHS in these centers are neither well used nor effective at improving SRH outcomes. There was an absence of studies or evaluations examining outcomes among vulnerable or marginalized adolescents. Findings from 17 of 21 initiatives assessing demand-generation activities demonstrated at least some association with adolescent SRHS use. Of 15 studies on parental and other community gatekeepers' approval of SRHS for adolescents, which assessed SRHS/commodity uptake and/or biologic outcomes, 11 showed positive results. Packages of interventions that train health workers, improve facility adolescent friendliness, and endeavor to generate demand through multiple channels are ready for large-scale implementation. However, further evaluation of these initiatives is needed to clarify mechanisms and impact, especially of specific program components. Quality research is needed to determine effective means to deliver services outside the facilities, to reach marginalized or vulnerable adolescents, and to determine effective approaches to increase community acceptance of adolescent SRHS.

Challenges and strategies for sustaining youth-friendly health services — a qualitative study from the perspective of professionals at youth clinics in northern Sweden

“…This is not the case in many other countries where resource constraints and the controversies surrounding YFHSs might hinder the likelihood that policies and services for youth get prioritized. This finding underlines the importance of political and socio-cultural aspects in ensuring that health systems are responsive to youth [15, 42, 58]. …”

“…However, in smaller rural clinics the recruitment of health-care professionals is more difficult and candidates to choose from are not usually available [40, 41]. While high personal commitment might be key, it needs to be supported by an organizational structure that provides continuous training and that enables the time and freedom to put it into practice [15, 39, 42]. As stated in the results, ‘Working with the left hand’ does not ensure that the services provided are effective and might contribute to frustration and demotivation.…”

“…The other axes of inequity mentioned in this study — gender identity, sexual orientation, ethnic background and disability — deserve further exploration. Other studies have pointed out that the domain of equity is the one that is usually less developed when YFHSs are implemented [2, 42, 56]. …”

Identifying youth-friendly service practices associated with adolescents’ use of reproductive healthcare services in post-conflict Burundi: a cross-sectional study

“…The objectives of this research are (1) to examine the density of RHC service availability, (2) to assess spatial patterns of RHC facilities, and (3) to identify YFS practices associated with adolescents’ use of RHC services in post-conflict Burundi. In our study, of RHC services will be used interchangeably with FP/RH services and include “family-planning, counseling services; prenatal and postnatal care and delivery; abortion services and post-abortion care; treatment and prevention of reproductive tract and sexually transmitted diseases and infections including HIV; and information and counseling about human sexuality [14]. ”…”

The Tarunya Project’s efforts to improve the quality of adolescent reproductive and sexual health services in Jharkhand state, India: a post-hoc evaluation

“…The multifaceted approach that the Tarunya Project used to improve health worker and health facility performance is in line with evidence-based best practice (9). The application of such approaches has shown to increase the quality of health service provision in a number of countries.…”