The determinants of adolescents’ access and utilisation of sexual and reproductive health services in Nigeria : a mixed methods study

This thesis using sequential mixed-methods design underpinned by the Social Ecological Model (SEM), examines the determinants of adolescents’ access and utilisation of Sexual and Reproductive Health (SRH) Services in Nigeria. The quantitative strand of the study applied multilevel modelling to pooled data from the 2003-2013 Nigeria Demographic and Health Surveys (NDHS) comprising 18,255 unmarried adolescents aged 15-19 years, whereas the qualitative strand (8 FGDs and 16 in-depth interviews) informed by Foucault’s Theory of sexuality were analysed following an inductive thematic approach guided by Gioia’s analytical framework.Overall, the results showed that although most of the variations in SRH (contraceptive use and comprehensive knowledge of HIV) service use occur at the micro level, there were significant macro level effects on adolescent’s access to and use of services. The key predictors of SRH service use among adolescents were gender, age, ethnicity, education, employment, ever been tested for HIV, age of household head, educational years in state and region of residence. The qualitative findings supported and contextualised these results by revealing the individual level (limited knowledge of available services, fear of embarrassment), community level (Socio-cultural norms and values) facility level (service providers attitude, lack of confidentiality/privacy) and state level (lack of government commitment/funding) barriers to adolescents use of SRH services.This study aid the understanding of the application of SEM in advancing the field of adolescent SRH and re-contextualised Foucault’s theory of sexuality from a non-western perspective. It contributes significantly to key policy and global debates on the importance mainstreaming youth-friendly health services into the national health programmes. The findings highlight the urgent need for a multisectoral and multilevel approaches to meeting the changing needs, and addressing the contextual factors that influence adolescents’ use of services. Making the Primary Healthcare Centres youth friendly through service provider’s reorientation, ensuring confidential service delivery, and accelerating the nationwide implementation of quality school-based SRH education is a sure path to improving adolescent poor health outcomes in Nigeria