Barriers to adolescents' access and utilisation of reproductive health services in a community in north-western Nigeria: A qualitative exploratory study in primary care

Background: There is a dearth of qualitative studies exploring in-depth barriers that adolescents face in accessing and utilising reproductive health services (RHS) in Nigerian primary healthcare centres. Aim: This study explored the barriers hindering adolescents' access to and utilisation of RHS in primary healthcare centres. Setting: This study was conducted in three primary healthcare centres in Kaduna North Local government area, Nigeria. Methods: This study used an exploratory descriptive qualitative design. Fourteen adolescents and three RHS providers were selected and interviewed. The data collection methods included individual in-depth interviews with adolescents and key informant interviews with service providers. Interviews were conducted between January 2017 and April 2017. Thematic content analysis was used to analyse the data. Results: This study identified three thematic barriers to adolescent's utilisation of RHS. These included individual, social and health system barriers. Individual factors included the following: inadequate knowledge about RHS and poor attitudes of adolescents towards RHS; social factors such as parental influence, community and religious norms, financial constraints and stigma; and health system factors such as poor attitudes of service providers and inconvenient health facility opening hours hindered adolescents from utilising RHS. Most prominent was the strong influence of the social factors that affected adolescents to the extent that they felt constrained to freely utilise RHS out of a sense of commitment to religious values. Conclusion: The findings highlight the need for the development of programmes that would foster collective responsibility for supportive environments within communities and health facilities for positive adolescent RHS experiences.