Distance, Disparity, and Duty: An Empirical Bioethical Analysis of Adolescent Sexual and Reproductive Health Access in Rural Uganda

ABSTRACT Disparities in adolescent sexual and reproductive health (SRH) access in rural Uganda are commonly attributed to geographic distance, resource scarcity, and service availability. These explanations, while important, remain ethically incomplete unless they also account for duty: the social and economic responsibilities that constrain adolescents’ capacity to prioritise health needs. Drawing on empirical findings from a study of 408 adolescents aged 13–19 years in the Bugweri and Iganga districts of eastern Uganda, this paper integrates Rawlsian distributive justice and the capability approach to examine how distance, disparity, and duty interact to undermine adolescent reproductive agency. Structural equation modelling shows that positive health‐seeking attitudes strongly predict anticipated future SRH utilisation; however, this relationship is attenuated among adolescents engaged in paid or subsistence work. Justice‐oriented SRH policy must recognise duty as a structural moral burden and design work‐sensitive interventions, such as mobile outreach and weekend clinics, that protect adolescents’ capability for reproductive agency.