Socio-ecological influences on sexual and reproductive health service use: Young adults and provider perspectives from Soshanguve, South Africa.
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Social norms strongly shape young adults’ use of sexual and reproductive health services. Conservative cultural and religious norms can make sexual health discussions taboo, while peer and masculinity norms may encourage sexual risk-taking, discourage condom use, and stigmatize care-seeking. Fear of being judged as promiscuous or immoral further reinforces secrecy and delayed care. The authors emphasize addressing these social environments through stronger family communication, positive peer influence, stigma reduction, and confidential, non-judgmental services.
Objectives Guided by the socio-ecological model, the study explored factors influencing young adults’ access to and use of sexual and reproductive health services in Soshanguve, South Africa, from the perspectives of young adults and service providers.
Methods This qualitative exploratory study conducted semi-structured interviews with 15 young adults aged 18–35 and five sexual and reproductive health service providers at three public clinics. Data were analyzed thematically using an abductive approach combining the socio-ecological model with inductively emerging themes. Social norms were explored through questions about family views of young adults’ sexual activity, peer perceptions of condom use, cultural norms, community perceptions, and social influences on service use.
Results Barriers operated across multiple levels. Limited knowledge and contraceptive misconceptions contributed to delayed care, while limited family communication increased reliance on peers. Peer norms sometimes encouraged unprotected sex and discouraged care-seeking. Community stigma, cultural expectations, religious beliefs about premarital sex, and fear of social judgement further discouraged service use. Provider judgement, privacy concerns, long waiting times, and restrictive clinic systems created additional barriers, while supportive relationships, respectful services, and community outreach facilitated access.
Conclusions Improving service use requires addressing more than service availability. Family silence, peer and gender norms, community stigma, individual beliefs, and health-system practices interact to sustain delayed and crisis-driven care. The authors recommend integrated, youth-centred approaches that counter harmful norms and stigma while strengthening family dialogue, confidentiality, non-judgemental care, male-inclusive programming, and community and school outreach.
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