The Economic Impact and Health Outcomes of Comprehensive Sexual and Reproductive Health Services for Adolescents in Ethiopia

ABSTRACT This study examines the economic impact and health outcomes of comprehensive sexual and reproductive health (SRH) services for Ethiopian adolescents using 2016-2021 Demographic and Health Survey data (N=5,109). Quantitative analysis revealed only 35.9% of adolescents accessed SRH services, with significant disparities by residence (urban 42.1% vs rural 32.8%), wealth (richest 51.3% vs poorest 18.2%), and education (secondary+ 45.6% vs no education 21.8%). Logistic regression identified SRH service use as the strongest protective factor (aOR=0.45, 55% risk reduction), followed by secondary education (aOR=0.61) and urban residence (aOR=0.76). Economic analysis demonstrated a 1:4.06 cost-benefit ratio, with every $1 invested yielding $4.06 in returns. Vulnerable groups faced disproportionate burdens: unintended pregnancy rates were nearly triple among the poorest (18.2%) versus richest (6.7%), while rural STI prevalence (11.2%) doubled urban rates (6.1%). The findings underscore three priority interventions: (1) expansion of mobile clinics and community-based distribution to reach rural adolescents, (2) integration of comprehensive SRH education with secondary school retention programs, and (3) implementation of poverty-sensitive initiatives like transportation subsidies and conditional cash transfers. These evidence-based strategies would address Ethiopia's SRH access inequities while capitalizing on the demonstrated economic returns of adolescent health investments. The study provides policymakers with actionable data to design targeted programs that reduce unintended pregnancies and STIs, ultimately contributing to Ethiopia's demographic dividend and sustainable development goals through improved adolescent health outcomes and productivity.