Increasing young people’s use of sexual and reproductive health services in government health facilities in rural Kenya.
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Social norms and provider attitudes can create important psychosocial barriers to young people’s use of sexual and reproductive health services. Fear of judgment, shaming, parental disapproval, and loss of confidentiality may particularly discourage younger adolescents and girls. The findings suggest these barriers can be reduced by fostering more supportive provider attitudes and building adolescents’ familiarity and trust with providers through school and community engagement.
Objectives The study evaluated whether making sexual and reproductive health services more convenient, private, confidential, and youth-friendly increased young people’s use of rural government health facilities in Western Kenya.
Methods A randomized cluster study assigned 13 government health facilities to a full intervention (five), partial intervention (four), or control (four). The evaluation compared baseline and endline facility registers and included nurse surveys, 1,923 youth client feedback cards, and focus groups with nurses and adolescents. Social norms-related measures assessed nurses’ attitudes and beliefs about family planning, adolescent sexuality, sexual norms, HIV, adolescent autonomy, parental permission, premarital sex, and stigmatizing beliefs about sexual behavior.
Intervention Details The After-Hours Adolescent Project extended clinic hours, recruited and trained recently graduated nurses in youth-friendly services and comprehensive sexuality education, improved privacy and supplies, and provided supervision. The full intervention additionally included nurse-led sexuality education in schools and communities; the partial intervention was clinic-based.
Results Youth sexual and reproductive health visits increased 87.3% across intervention facilities versus no change in controls, with increases of 96.8% in full and 77.2% in partial intervention facilities. Six of 12 nurse attitudes shifted significantly in a more youth-friendly direction. The full intervention also attracted significantly more female and younger clients.
Conclusions Combining convenient, confidential services with nonjudgmental providers and community-based sexuality education substantially increased service use, demonstrating the importance of addressing both structural and psychosocial barriers to adolescent care.
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