Peer-reviewed article
Understanding barriers to young people's utilisation of sexual and reproductive health services in Asia-Pacific countries: a qualitative systematic review and thematic synthesis.
Riabroi W, Gregory B, Mackay D, Germeni E ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review synthesises qualitative research from 31 studies across 15 Asia-Pacific countries involving over 1,800 young people aged 10-24 years about their use of sexual and reproductive health services. The analysis identified six main barriers: navigating puberty, limited knowledge and beliefs about SRH, embarrassment and confidentiality concerns, low decision-making autonomy, traditional and religious beliefs, and social and gender norms. The researchers conclude that shame is a central emotion preventing young people from accessing these services and recommend shame-sensitive approaches in future interventions.
Key points
- Six main barriers to SRH service use identified: navigating puberty, knowledge gaps, embarrassment, low autonomy, traditional practices, and gender norms
- Shame emerged as the overarching analytical theme linking all barriers to service utilisation
- Study synthesised evidence from 31 qualitative studies across 15 Asia-Pacific countries with over 1,800 young people
- Significant inequalities in adolescent SRH knowledge and service use exist both within and between countries
- Interventions need to integrate shame-sensitive approaches and address social norms
Limitations
The review summarises qualitative findings and identifies barriers but does not evaluate the effectiveness of specific interventions to overcome these barriers. The synthesis focuses on young people's self-reported experiences and perceptions rather than objective measures of service access or health outcomes.
Abstract
Abstract Introduction Based on the United Nations' sustainable development goals, universal access to sexual and reproductive health (SRH) services should be attained by 2030. Yet, large inequalities in adolescent SRH knowledge and service use still exist both within and between countries. The goal of this study was to identify and synthesise published qualitative research on factors affecting young people's utilisation of SRH services in Asia-Pacific countries. Methods We systematically searched five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science) for qualitative studies reporting the experiences, attitudes and views of young people (aged 10-24 years) regarding the utilisation of SRH services in Asia-Pacific countries. We assessed the quality of identified studies using the Critical Appraisal Skills Programme qualitative checklist and employed a thematic synthesis approach for the data analysis. Results We included 31 articles that reported the experiences of over 1800 young people from 15 different countries. Thematic synthesis identified six descriptive themes that captured factors influencing SRH service utilisation: (1) navigating puberty; (2) knowledge and beliefs about SRH; (3) embarrassment and confidentiality concerns; (4) low decision-making autonomy; (5) traditional practices and religious beliefs; and (6) social and gender norms. Based on these, we developed an overarching analytical theme, 'trapped in a legacy of shame', which highlights the role of shame as a key emotion associated with young people's utilisation of SRH services. Conclusion Our findings point towards the necessity of integrating shame-sensitive approaches and a social norms perspective in interventions aiming to improve young people's SRH outcomes in Asia-Pacific countries. Prospero registration number CRD42023389653.