Exploring Sexual and Reproductive Health Needs and Associated Barriers of Homeless Young Adults in Urban Ghana: A Qualitative Study

Abstract

Background Homelessness has become a major global and public health challenge, especially in low- and middle-income countries. This phenomenon predisposes young adults to severe psychosocial and health challenges. Aim To explore the sexual and reproductive health needs and behaviours of homeless young adults and challenges in accessing these services. Methods A semi-structured interview guide was used for data collection from in-depth interviews, focus group discussions, and key informant interviews. Data were collected between 01 June and 31 July 2020 from 30 participants using in-depth interviews, two focus group discussions involving 12 participants, and one key informant interview. Thematic analysis was used to analyse transcripts from the interviews. Results The findings show that certain behavioural patterns associated with homelessness impact the lives of homeless young adults in their sexual and reproductive health (SRH) choices, beliefs, and perspectives. This group faces several challenges in accessing sexual and reproductive health services (SRHS) such as modern contraceptives and abortion care. The high cost, and undesirable and unfriendly attitude of service providers in health facilities pose as barriers to accessing SRHS by homeless young adults. Conclusion Sustainable and proactive measures must be put in place to address the identified barriers. Timely delivery of accurate information and educative materials, ensuring affordability, and setting up of accessible and friendly facilities could improve SRHS for this group. Social and Public Policy Implications This study may inform and support policy guideline development to address homelessness and SRH needs of young adults in urban Ghana.

The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review

“…A South African study of mobile voluntary counseling and testing (VCT) found higher accessibility in urban areas with most users able to walk to the mobile site [28]. Urbanization may result in the concentration of poverty [1,3], yet only 15 articles (13%) in the review capture the effects of poverty at the structural level on SRHR with most focusing more on individual behaviors and individual or household characteristics [6,18,[29][30][31][32][33][34][35][36][37][38][39][40]. Beyond individual income, urban slum environments function as "spatial poverty traps" in which multiple and reinforcing disadvantages are amplified at the neighborhood level, presenting unique challenges to SRHR, particularly among adolescents [14].…”

“…Although SRH services are offered in both public and private health facilities, FP service delivery channels are often different in urban areas and gaps exist in service coverage from the public sector [26,54]. Urban-dwelling women and adolescent girls generally prefer private over public facilities due to convenience and timeliness of services as well as more friendly environments and respectful providers, while other women may choose public facilities because they offer free service delivery [26,27,29,55]. Drug shops and pharmacies play an important role in the provision of contraceptives, filling gaps in public sector service coverage in urban areas, particularly for vulnerable and harder-to-reach populations such as young and unmarried women (and men), as they may feel more comfortable at these sites [56].…”

“…The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review of stigma, particularly among adolescents and FSWs [24,29,31,59]. For HIV testing and treatment programs, one study in urban Zambia found a higher preference for home-based models because they reported harsh treatment by clinic workers and long wait times at facilities [57].…”