Sexual and reproductive health services for young people in Kenya and Zambia : Providers attitudes and young peoples needs and experiences

Background: Unintended pregnancy, abortion and STI, including HIV are common sexual and reproductive health problems among young people in Kenya and Zambia. Yet, the reproductive health services are underutilised. Nurses and midwives are key providers in the promotion young peoples sexual and reproductive health in Kenya and Zambia. Aim: The overall aim was to describe and explore young peoples sexual and reproductive health needs and experiences and to describe health providers attitudes related to those needs as a basis for strengthening sexual and reproductive health services for young people in Kenya and Zambia. Methods: The studies were conducted between 2001 and 2005 in Kisumu and Nakuru, Kenya and Kitwe and Ndola, Zambia. Nurses and midwives (n= 707) attitudes were studied in a cross-sectional study using an attitudinal questionnaire (I). Self-generated questions were used to explore Zambian secondary school students (n= 716) needs regarding sexuality and reproduction (II). Young clients (n= 195) experiences of and preferences for sexual and reproductive health services were studied using exit interviews (III). A pilot intervention was conducted with one intervention group (28 health providers) and one control group (16 health providers). Reflective thinking methods were used to sensitise health providers in the intervention group in adolescent sexual and reproductive health matters. Health providers attitudes toward young peoples sexual and reproductive health issues were measured before and after the intervention at both the intervention and control clinics (IV). Results: Nurses and midwives disapproved of adolescent premarital sex, masturbation, contraceptive use and abortion, but were at the same time somewhat prepared to provide sexually active adolescents with contraceptives. Nurses and midwives who had received continuing education showed a tendency toward more youth-friendly attitudes (I). Young peoples sexual and reproductive health is vulnerable. This was reflected in the two emerging themes growing up in silence and being caught between norms and values and reality of life. The questions revealed that the young people have inadequate knowledge even about basic human reproduction and that they cry out for support and guidance regarding pregnancy, abortion and love. Boys and girls disapproved of sexual activity often based on religion but they also had difficulties in coping with emerging sexual feelings (II). Young clients experiences of the care provided were, in general, good. Preferences for service were related to respectful attitudes, being attended by a provider of the same sex, being asked questions and being examined during the consultation. There was also a wish for dedicated services for young people (Kenya) and staff trained in youth-friendliness. The open-ended question showed that some parents disapprove of reproductive health service for young people (III). Prior to the pilot intervention, disapproving attitudes among health staff were mainly related to abortion, masturbation and premarital sex in both the intervention and control group. At the second assessment, the intervention group tended to have more approving attitudes related to condom use and masturbation, whereas no major changes were seen in the control group. Health providers reported more youth-friendly attitudes toward boys sexuality compared to girls sexuality and this even increased after the intervention (IV). Conclusion: Culture, religion and gender influence attitudes around sexuality and make young people vulnerable to sexual and reproductive health risks. Training in adolescent sexual and reproductive health could be helpful for health providers to deal with adolescent sexuality. Young peoples own views as well as parents and the leadership in health authorities need to be considered for the strengthening of the sexual and reproductive health for young people.