Access and utilization of the youth-friendly sexual and reproductive health services in Nepal: What does literature show?

This study has attempted to assess the access and utilization of youth-friendly sexual and reproductive health services in Nepal. Different literature regarding youth-friendly sexual and reproductive health services has been reviewed using online databases. A total of 125 relevant articles were assessed for the study. The literature was categorized and analyzed with five key thematic areas: knowledge on SRH among youths, the prevalence of child marriage and teenage pregnancy, attitudes towards premarital sex, utilization of SRHs, and barriers to utilizing the SRHS. This study has found that youths do not always utilize SRHS. Various barriers exist for providing and using YFSRHs in Nepal. Nepal's adolescents and youths face problems of STIs, HIV/AIDS, early pregnancy and parenthood, difficulties accessing contraception, and safe abortion. The study has also found that many countries have single youth-friendly sexual and reproductive health policies and that utilization of SRHS is also high in those countries. Moreover, this review has also found that because of inadequate knowledge and information on SRHS, Nepalese youths are facing numerous reproductive health problems. Multiple factors contribute as barriers to utilizing the SRHS. Therefore, there is a need for a program to motivate youths to respect their right to access reproductive health information and service, ensure the availability of peer counselors in the health centers, and increase the awareness level of the community so that they can utilize the quality of SRHS.

Determinants of Contraceptives Uptake among Adolescents’ Girls Aged 14-19 Years in Homa Bay County

Introduction. Adolescents are individuals aged between 10-19 years. This phase is characterised by rapid growth, sexual maturation, and sexual exploration. These behaviours expose sexually active adolescent girls to a greater risk of unintended pregnancies, unsafe abortion, and sexually transmitted infections. This study aimed to assess the determinants of contraceptives uptake among adolescent girls in Homa Bay County in Kenya with specific objectives assessing the level of awareness, uptake as well as evaluating the factors affecting the sexual & reproductive health service provision to adolescent girls in the region. Result: A cross-sectional survey was done targeting 385 girls and 32 health facilities. The response rate was 100%, with the level of knowledge on contraceptives at 97.6%. The main sources of knowledge on contraceptives were from teachers in schools (30%), peers (17.2%) and media. 70% of the respondents were in a heterosexual relationship of which 58.6% preferred male condom use as their contraceptive method of choice, while the use of pills was the least at 0.6%. The majority (57.9%) of the girls did not practice safer sex exposing them to a higher risk of Sexually transmitted infections and unintended pregnancies. Discussions: The level of contraceptive uptake significantly varied from one sub-county to the other (p < 0.005), with the sub-counties in the Islands of Lake Victoria such as Suba sub-counties having up to 80% lesser chance of their girls using any form of contraceptives (OR = 0.2; CI: 0.2–0.8). Major barriers were the fear of side effects (51.8%) and self-stigmatisation (13.4 %). Health facilities were the main source of contraceptives (77.1%); however, the study noted a lack of youth-friendly services that would favour increased access. Further, there was a complete lack of knowledge on adolescent sexual and reproductive health policies and procedures among the girls (39.6%). Conclusion: Misinformation, cultural perception on the use of contraceptives among adolescents, and lack of youth-friendly services in health facilities are key drivers to the underutilisation of contraceptives by adolescent girls in Homabay county. Adolescents from the island stand a higher risk of non-utilisation of contraceptives compared to their mainland counterparts. Recommendations: There is a need for strengthened youth-friendly comprehensive sexual health education and services in all health facilities with more emphasis on risk reduction interventions and sensitisation of young girls on the available policies. Mechanisms should be availed, specifically to reach the “hard to reach” adolescent populations in the islands.

Photovoice as a research, advocacy, and harmonization tool for refugee and local youth in Turkey

Background Turkey has millions of refugee and local youth, who share common youth health problems. As part of the REACH Project, this study aimed to assess youth's access to health information, health care, and healthy environments, in addition to their perspectives on using digital health technologies. Methods We used photovoice, a community based participatory research approach, and worked with 4 mixed (refugee and local) youth groups between the ages of 15 to 24 in Istanbul. Each youth group met with the research team and a professional photographer before data collection. Young people then took photos of barriers and facilitators regarding their access to health information, health care, and digital health technologies, in addition to their health problems. This was followed by focus group-like discussions, where young people discussed the photos and their meanings for them. Content analysis was used for data analysis and findings were shared with stakeholders via photo exhibits, panels, and policy briefs for advocacy purposes. The study was funded by TaiwanICDF and Columbia University. Results Findings showed that youth had a wide range of physical, social and mental health problems coupled with problems in accessing health information and youth-friendly services. Problems with social determinants of health were more prominent for refugees. Although youth often used the internet to access information, their experiences with digital health technologies were very limited. Conclusions Our study findings indicated that despite legal rights to access health care for all youth, refugee youth faced more barriers in accessing information and services. On the other hand, refugee and local youth showed similarities regarding common youth health problems and access to youth-friendly services. The photovoice approach enabled active participation and created a shared environment for refugee and local youth to discuss their mutual problems and understand each other. Key messages Photography is a communication tool that acts as a bridge between participants, researchers, and decision makers. Photovoice, as a participatory approach, creates a learning environment for both participants and researchers.

Scaling Access to Contraception for Youth in Urban Slums: The Challenge Initiative's Systems-Based Multi-Pronged Strategy for Youth-Friendly Cities

Introduction: More than half of all adolescents globally live in Asia, with India having the largest adolescent population in the world at 253 million. In sub-Saharan Africa, adolescents make up the greatest proportion of the population, with 23% of the population aged 10–19. And these numbers are predicted to grow rapidly—particularly in urban areas as rural youth migrate to cities for economic opportunities. While adolescents and youth are subject to high sexual and reproductive health risks, few efforts have been documented for addressing these in urban settings, especially in poor settlements.Methods: The Challenge Initiative (TCI) is a demand-driven, family planning platform for sustainable scale and impact that lets city governments—in particular urban slums—lead implementation. It is currently active in 11 countries in Africa and Asia. In June 2018, TCI heightened its focus on adolescent and youth sexual and reproductive health (AYSRH) for youth living in urban slums. It now supports 39 city governments. TCI dedicates technical and program support to married (including first-time parents) and unmarried youth ages 15–24 years. Using an innovative coaching model and an online learning platform (TCI University), TCI supports city governments as they implement AYSRH interventions to accelerate the impact of TCI's model for rapid scale.Results: TCI has been assessing the performance of cities implementing its AYSRH approaches using its RAISE tool and has found considerable improvement over two rounds of assessments through TCI coaching and support for adaptation of its high-impact interventions between the first and second round.Conclusions: TCI's AYSRH approach scaled rapidly to 39 cities and multiple urban slums since 2018, using its evidence-based interventions and coaching model. In the context of universal health coverage, TCI has supported segmented demand generation and improved access to quality and affordable contraceptive as well as youth-friendly health services. It provides a menu of interventions for cities to implement for youth—including such approaches as public-private partnerships with pharmacies and quality assurance using quick checklists—along with an innovative coaching model. This approach has facilitated greater access to contraceptive methods of choice for youth.

Can We Build ‘Somewhere That You Want to Go’? Conducting Collaborative Mental Health Service Design with New Zealand’s Young People

Globally, young people are at high risk of mental health problems, but have poor engagement with services. Several international models have emerged seeking to address this gap by providing youth-specific care designed in collaboration with young people. In this study, 94 young people in New Zealand participated in collaborative workshops exploring their vision of an ideal mental health service. Participants were aged 16–25. Reflexive thematic analysis was used to identify seven themes. These describe the ideal mental health service for these young people as comfortable, accessible, welcoming, embedded in the community, holistic, adaptable, and youth-focused. In addition to describing how services might better serve the needs of youth, this article outlines a method for adapting international principles for youth-friendly care to the specific needs of a population of young people. This article provides supporting evidence that services should consider how to improve their engagement with youth through collaboration with local populations of young people.

Efficacy of a transdiagnostic ecological momentary intervention for improving self-esteem (SELFIE) in youth exposed to childhood adversity: study protocol for a multi-center randomized controlled trial

Background Targeting low self-esteem in youth exposed to childhood adversity is a promising strategy for preventing adult mental disorder, but psychological help remains difficult to access and accept for youth, calling for novel, youth-friendly approaches. Mobile Health (mHealth) and, most prominently, ecological momentary interventions (EMIs) provide a unique opportunity to deliver youth-friendly, personalized, real-time, guided self-help interventions. The aim of this study is to investigate the efficacy of a novel, accessible, transdiagnostic ecological momentary intervention for improving self-esteem (‘SELFIE’) in youth with prior exposure to childhood adversity. Methods/design In a parallel-group, assessor-blind, multi-center randomized controlled trial, individuals aged 12–26 years with prior exposure to childhood adversity and low self-esteem will be randomly allocated to SELFIE in addition to treatment as usual (TAU) as the experimental condition or the control condition of TAU only, which will include access to all standard health care. SELFIE is a digital guided self-help intervention administered through a smartphone-based app to allow for interactive, personalized, real-time and real-world transfer of intervention components in individuals’ daily lives, blended with three training sessions delivered by trained mental health professionals over a 6-week period. Outcomes will be assessed at baseline, post-intervention, and 6-month follow-up by blinded assessors. The primary outcome will be the level of self-esteem as measured with the Rosenberg Self-Esteem Scale (RSES). Discussion The current study is the first to establish the efficacy of an EMI focusing on improving self-esteem transdiagnostically in youth exposed to childhood adversity. If this trial provides evidence on the efficacy of SELFIE, it has significant potential to contribute to minimizing the deleterious impact of childhood adversity and, thereby, preventing the development of mental disorder later in life. Trial registration Netherlands Trial Register NL7129 (NTR7475). Registered on 9 November 2018

Widespread closure of HIV prevention and care services places youth at higher risk during the COVID-19 pandemic

Background Central to measuring the impact of the COVID-19 pandemic on HIV is understanding the role of loss of access to essential HIV prevention and care services created by clinic and community-based organization closures. In this paper, we use a comprehensive list of HIV prevention services in four corridors of the US heavily impacted by HIV, developed as part of a large RCT, to illustrate the potential impact of service closure on LGBTQ+ youth. Methods We identified and mapped LGBTQ+ friendly services offering at least one of the following HIV-related services: HIV testing; STI testing; PrEP/PEP; HIV treatment and care; and other HIV-related services in 109 counties across four major interstate corridors heavily affected by HIV US Census regions: Pacific (San Francisco, CA to San Diego, CA); South-Atlantic (Washington, DC to Atlanta, GA); East-North-Central (Chicago, IL to Detroit, MI); and East-South-Central (Memphis, TN to New Orleans, LA). Results There were a total of 831 LGBTQ+ youth-friendly HIV service providers across the 109 counties. There was a range of LGBTQ+ youth-friendly HIV-service provider availability across counties (range: 0–14.33 per 10,000 youth aged 13–24 (IQR: 2.13), median: 1.09); 9 (8.26%) analyzed counties did not have any LGBTQ+ youth-friendly HIV service providers. The Pearson correlation coefficient for the correlation between county HIV prevalence and LGBTQ+ youth-friendly HIV service provider density was 0.16 (p = 0.09), suggesting only a small, non-statistically significant linear relationship between a county’s available LGBTQ+ youth-friendly HIV service providers and their HIV burden. Conclusions As the COVID-19 pandemic continues, we must find novel, affordable ways to continue to provide sexual health, mental health and other support services to LGBTQ+ youth.