Barriers and facilitators to sexual and reproductive health services among adolescents and young adults in Sidama region, Ethiopia: a qualitative study

BACKGROUND: Adolescents and young adults (AYAs) in Ethiopia face multiple challenges in accessing sexual and reproductive health (SRH) services. Understanding the barriers and facilitators to SRH service uptake is essential for designing tailored interventions. Therefore, this study aimed to explore barriers and facilitators to SRH service uptake from the perspectives of AYAs and stakeholders in southern Ethiopia. METHODS: We conducted a qualitative study in the Sidama region, Southern Ethiopia using focus group discussions (FGDs) with AYAs recruited from schools, communities, and a non-governmental organisation. A supplemental FGD was conducted with government officials, clinicians and SRH experts to capture stakeholder perspectives. The FGD was conducted in the national language (Amharic), which was then transcribed and translated into English for analysis. A thematic content analysis was used to present emerging themes in the FGDs. A ranking of barriers and facilitators was conducted to identify the most influential factors for SRH service uptake. NVivo 15 was used for data management and organisation for the thematic analysis. RESULTS: Nine FGDs were conducted with 56 AYAs and seven experts, with each FGD comprising 6-8 participants. We identified four major themes: 1) health system and policy environment, 2) service access and delivery, 3) user experience and outcomes, and 4) sociocultural and economic determinants. Participants ranked service quality, cost, and privacy higher in their influence on determining SRH service uptake. Stigma, religious beliefs, poverty, and urban migration were also identified as barriers to SRH service access among AYAs. CONCLUSIONS: SRH service uptake among AYAs was shaped by their interconnected health system and policy environment; service access and delivery; user experiences and outcomes, and sociocultural and economic determinants. Barriers and facilitators from service access and delivery theme such as service quality, privacy and health system factors such as cost emerged as the most influential drivers shaping service uptake. Policy and programme efforts should consider improving service quality, strengthening confidentiality, and reducing financial barriers. The findings may also inform future quantitative research examining AYAs' preferences for SRH service.