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Perceived barriers in accessing sexual and reproductive health services for youth in Lao People’s Democratic Republic


Autoři: Souksamone Thongmixay aff001;  Dirk Rombout Essink aff002;  Tim de Greeuw aff002;  Viengnakhone Vongxay aff001;  Vanphanom Sychareun aff001;  Jacqueline E. W. Broerse aff002
Působiště autorů: University of Health Sciences, Vientiane, Lao PDR aff001;  Vrije Universiteit Amsterdam, De Boelelaan, the Netherlands aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0218296

Souhrn

Background

Sexual activity during youth is common in Lao PDR. However, young people seldom utilize sexual and reproductive health services and subsequently suffer from poor sexual and reproductive health. The aim of this qualitative study was to explore the barriers perceived by youth that prevent their access to sexual and reproductive health services.

Methods

Twenty-nine semi-structured interviews were conducted with 22 participants aged 15–25 years, from urban and rural areas. A vignette was used during interviews with those who had no experience with sexual and reproductive health services. Additionally, seven semi-structured interviews were conducted with health providers from youth-friendly health clinics and from public sexual and reproductive health services. Data were analyzed using a thematic approach.

Results

The main barriers preventing young people from accessing sexual and reproductive health services were related to cognitive accessibility and psychosocial accessibility. The cognitive accessibility barriers were a lack of sexual knowledge and a lack of awareness of services. Perceived barriers in psychosocial accessibility were the feelings of shyness and shame caused by negative cultural attitudes to premarital sex, and the fear of parents finding out about visits to public sexual and reproductive health services, due to lack of confidentiality in the services and among health providers. In addition, the barriers of geographical accessibility, mainly insufficient availability of youth-friendly health clinics.

Conclusion

To improve access to services, a multi-component strategy is needed: promotion of youth-friendly health clinics; sexual education in schools; a formal referral system between schools and youth-friendly health clinics; and community support interventions. Prior to implementation, more research should be done on the applicability of these methods in the Laos context. Future research should try to determine the cost-effectiveness of youth-friendly health clinics integrated in a district hospital and stand-alone clinics, to provide insight into which form should be further developed.

Klíčová slova:

Pregnancy – Schools – Culture – Health education and awareness – Adolescents – Health services research – Female contraception – Lao people


Zdroje

1. Pachauri Saroj. Sexual and reproductive health services: Priority of South and East Asia. Indian J Community Med. 2011 Apr-Jun; 36(2): 83–84. doi: 10.4103/0970-0218.84116 21976789

2. Mokdad AH, Forouzanfar MH, Daoud F, Mokdad AA, Bcheraoui C El, Moradi-lakeh M, et al. Global burden of diseases, injuries, and risk factors for young people ‘ s health during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. 2016;6736(16):1–19.

3. Chandra-Mouli V, Svanemyr J, Amin A, Fogstad H, Say L, Girard F, et al. Twenty years after international conference on population and development: Where are we with adolescent sexual and reproductive health and rights? Journal of Adolescent Health 2015; 56(1), S1–S6, https://doi.org/10.1016/j.jadohealth.2014.09.015

4. Tylee A, Haller DM, Graham T, Churchill R & Sanci LA. Youth-friendly primary-care services: how are we doing and what more needs to be done? Lancet 2007; 369(9572), 1565–1573, doi: 10.1016/S0140-6736(07)60371-7 17482988

5. Lao Statistics Bureau and UNICEF. Lao Social Indicator Survey II 2017, Survey Findings Report. Vientiane, Lao PDR; 2018, https://www.unicef.org/eap/sites/unicef.org.eap/files/2018-06/Summary%20Survey%20Findings%20Report%20an%20statistical%20snapshots%20of%20Lao%20Social%20Indicator%20Survey%20II.pdf

6. Sychareun V, Phengsavanh A, Hansana V, Chaleunvong K, Kounnavong S, Sawhney M, et al. Predictors of premarital sexual activity among unmarried youth in Vientiane, Lao PDR: The role of parent-youth interactions and peer influence. Global Public Health 2013; 8(8), 958–975, doi: 10.1080/17441692.2013.830755 24066793

7. Lao People’s Revolutionary Youth Union, Lao PDR & United Nations Population Fund. Adolescent and Youth Situation Analysis Lao People ‘ s Democratic Republic “Investing in young people is investing in the future .” 2014, https://lao.unfpa.org/sites/default/files/pub-pdf/Final_Eng_AYSA%20Report.pdf

8. Vongxay V, Albers F, Thongmixay S, Thongsombath M, Broerse JEW, Sychareun V, et al. Sexual and reproductive health literacy of school adolescents in Lao PDR. PLoS ONE 2019; 14(1): e0209675. doi: 10.1371/journal.pone.0209675 30650100

9. Lim MSC, Zhang XD, Kennedy E, Li Y, Yang Y, Li L, et al. Sexual and Reproductive Health Knowledge, Contraception Uptake, and Factors Associated with Unmet Need for Modern Contraception among Adolescent Female Sex Workers in China. Plos One; 2015, 10(1), e0115435, doi: 10.1371/journal.pone.0115435 25625194

10. Thongmixay S, Schoneveld T, Vongxay V, Broerse JEW, Sychareun V, Essink D, et al. Quality of family planning services for reproductive age women in Lao PDR. Submitted for publication 2019. “Forthcoming”

11. Bankole A & Malarcher S. Removing Barriers to Adolescents’ Information Access Services to Contraceptive and Services. Population Council 2010; 41(2), 117–124, https://doi.org/10.1111/j.1728-4465.2010.00232.x

12. Denno DM, Hoopes AJ & Chandra-Mouli V. Effective strategies to provide adolescent sexual and reproductive health services and to increase demand and community support. Journal of Adolescent Health 2015; 56(1), S22–S41, https://doi.org/10.1016/j.jadohealth.2014.09.012

13. Svanemyr J, Amin A, Robles OJ & Greene ME. Creating an enabling environment for adolescent sexual and reproductive health: A framework and promising approaches. Journal of Adolescent Health 2015; 56(1), S7–S14, https://doi.org/10.1016/j.jadohealth.2014.09.011

14. Brittain AW, Williams JR, Zapata LB, Pazol K, Romero LM & Weik TS. Youth-Friendly Family Planning Services for Young People: A Systematic Review. American Journal of Preventive Medicine 2015; 49(2), S73–S84, https://doi.org/10.1016/j.amepre.2015.03.019

15. Bertrand JT, Hardee K, Magnani RJ & Angle MA. Access, Quality Of Care and Medical Barriers In Family Planning Programs. International Family Planning Perspectives 1995; 21(2), 64, https://doi.org/10.2307/2133525

16. Levesque JF, Harris MF & Russell G. Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health 2013; 12(1), 1, https://doi.org/10.1186/1475-9276-12-18

17. Hardee K, Kumar J, Newman K, Bakamjian L, Harris S, Rodríguez M, et al. Voluntary, human rights-based family planning: A conceptual framework. Studies in Family Planning 2014; 45(1), 1–18, doi: 10.1111/j.1728-4465.2014.00373.x 24615572

18. WHO. Global Standard for Quality Health-Care Services for Adolescent. Vol. 1, 2015

19. Charoenmukayananta S, Sriratanaban J, Hengpraprom S, Trarathep C. Factors influencing decisions of Laotian patients to use health care services in Thailand. 2015;8(5):665–71, https://doi.org/10.5372/1905-7415.0805.342

20. Ritchie J & Lewis J. Qualitative research practice. Choice Reviews Online 2013; 42(04), 42-2286–42–2286, http://doi.org/10.5860/choice.42-2286

21. Sychareun V, Vongxay V, Houaboun S, Thammavongsa V, Phommavongsa P, Chaleunvong K, et al. Determinants of adolescent pregnancy and access to reproductive and sexual health services for married and unmarried adolescents in rural Lao PDR: a qualitative study. BMC Pregnancy and Childbirth 2018; 18(219), https://doi.org/10.1186/s12884-018-1859-1

22. Barter CA & Renold E. The use of vignettes in qualitative research. Social Research Update 1999; 25

23. Fereday J & Muir-Cochrane E. Demonstrating Rigor Using Thematic Analysis: A Hybrid Approach of Inductive and Deductive Coding and Theme Development. International Journal of Qualitative Methods 2006; 5(1), 80–92, https://doi.org/10.1177/160940690600500107

24. Hoang A, Nguyen CQ & Duong CD. Youth experiences in accessing sexual healthcare services in Vietnam. Culture, Health and Sexuality 2018; 20(5), 545–559, doi: 10.1080/13691058.2017.1360945 28866956

25. Sychareun V, Thomsen S, Chaleunvong K & Faxelid E. Risk perceptions of STIs / HIV and sexual risk behaviours among sexually experienced adolescents in the Northern part of Lao PDR. BMC Public Health 2013; 13(1126), 1471–2458. https://doi.org/10.1186/1471-2458-13-1126

26. Maotwe T. Patterns of utilization of sexual and reproductive health services by secondary school-going adolescents in Gaborone. 2014, URI: http://hdl.handle.net/10413/11086

27. Bam K, Haseen F, Bc RK, Newman MS, Chaudhary AH. Perceived Sexual and Reproductive Health Needs and Service Utilization among Higher Secondary School Students in Urban Nepal. American Journal of Public Health Research 2015; 3(2), 36–45, https://doi.org/10.12691/AJPHR-3-2-1

28. Salam RA, Faqqah A, Sajjad N, Lassi ZS, Das JK, Kaufman M, et al. Improving Adolescent Sexual and Reproductive Health: A Systematic Review of Potential Interventions. Journal of Adolescent Health 2016; 59(2), S11–S28, https://doi.org/10.1016/j.jadohealth.2016.05.022

29. Sychareun V. Meeting the contraceptive needs of unmarried young people: Attitudes of formal and informal sector providers in Vientiane Municipality, Lao PDR. Reproductive Health Matters 2004; 12(23), 155–165, https://doi.org/10.1016/S0968-8080(04)23117-2 15242224

30. Agha S, Fareed A & Keating J. Clinical training alone is not sufficient for reducing barriers to IUD provision among private providers in Pakistan. Reprod Health 2011; 8(40), 1742–4755, https://doi.org/10.1186/1742-4755-8-40

31. Hubacher D, Olawo A, Manduku C & Kiarie J. Factors associated with uptake of subdermal contraceptive implants in a young Kenyan population. Contraception 2011; 84(4), 413–417, doi: 10.1016/j.contraception.2011.02.007 21920198

32. Nalwadda G, Mirembe F, Byamugisha J, Faxelid E. Persistent high fertility in Uganda: young people recount obstacles and enabling factors to use of contraceptives. 2010, doi: 10.1186/1471-2458-10-530

33. Kesterton AJ, Mello MC. Generating demand and community support for sexual and reproductive health services for young people: A review of the Literature and Programs. 2010;1–12, https://doi.org/10.1038/ijo.2010.151

34. Kennedy EC, Bulu S, Harris J, Humphreys D, Malverus J, Gray NJ. “Be kind to young people so they feel at home”: a qualitative study of adolescents ‘ and service providers ‘ perceptions of youth-friendly sexual and reproductive health services in Vanuatu. 2013, https://doi.org/10.1186/1472-6963-13-455

35. Mazur A, Brindis CD & Decker MJ. Assessing youth-friendly sexual and reproductive health services: A systematic review. BMC Health Services Research 2018; 18(1), 1–12. doi: 10.1186/s12913-017-2770-6

36. Lao PDR Ministry of Health. National Strategy and Action Plan for Intergrated Services on Reproductive, Maternal, Newborn and Child Health 2016–2025; retrieved 2016, http://www.laoshealth.org/assets/national-rmnch-strategy-2016-2025.pdf

37. Tangmunkongvorakul A, Banwell C, Carmichael G, Utomo ID, Seubsman SA, Kelly M, et al. Use and perceptions of sexual and reproductive health services among northern Thai adolescents. The Southeast Asian Journal of Tropical Medicine and Public Health 2012; 43(2), 479–500, http://www.ncbi.nlm.nih.gov/pubmed/23082599%5Cnhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC3732782 23082599

38. International Planned Parenthood Federation. Provide: Strengthening Youth Friendly Service. The International Youth Foundation. A framework for Integrating Reproductive Health and Family Planning into Youth Development Programs

39. Anna W, Jessica R, Lauren B, Susan, and Tasmeen S. Confidentiality in Family Planning Services for Young People: A Systematic Review. Am J Prev Med 2015; 49(2 0 1): S85–S92. doi: 10.1016/j.amepre.2015.04.001


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