This study seeks to understand the capacity of adolescent-friendly reproductive health services (AFRHS) in promoting sexual reproductive health (SRP) among adolescents in Bindura Urban of Zimbabwe. The data collection methods used allowed the researcher to get insight on adolescents' experience and the factors associated with their accessing SRH services from AFRHS, the meaning of AFRHS for adolescents, healthcare providers' attitudes towards adolescents seeking SRH services, and community perceptions and readiness to accept AFRHS. The findings showed that both socio-cultural and health facility factors influence utilisation of SRH services. Many of these factors stem from the moral framework encapsulated in socio-cultural norms and values related to the sexual health of adolescents and healthcare providers' poor value clarification. This study provides an empirical understanding of the reasons and factors associated with SRH service utilisation, which goes much deeper than program provision of AFRHS in Zimbabwe.
TopIntroduction
One of the major contributions made in response to the SRH care needs of adolescents came from the health sector with the Adolescent-Friendly Reproductive Health Services (AFRHS) initiative. The concept was introduced following the 1994 Cairo conference that prioritised the SRHS of adolescents and young people (UN, 1995). Since then, attempts have been made globally by the health sector to address young people’s SRH issues. The introduction of AFRHS into the current health delivery system is one example of healthcare improvements that were recommended, particularly for developing countries. The World Health Organization (WHO) defined AFRHS as an approach which brings together the qualities that young people demand, with the high standards that have to be achieved in the best public services” (McIntyre, 2002).
The concern about ASRH has grown following reports that sexual activity, early pregnancies and Sexually Transmitted Infections (STIs) including HIV infection rates are increasing at unprecedented rates among adolescents (UNICEF, 2007; Sandoy et al., 2007). The importance of facility-based AFRHS has long been recognised by health policy makers as manifested in an increasing number of countries. From its outset, AFRHS focused on improving the availability, accessibility and quality of SRH services because AFRHS were developed against the backdrop of inadequacies on the part of health systems to provide SRHS in an efficient, effective and equitable manner to young people (UNFPA, 2003). While most barriers to adolescents’ utilisation of SRHS have been attributed to quality of SRHS; a critical analysis of the barriers to ARHS promotion reveals that cultural norms that influence people’s behaviours and actions related to sexual and reproductive matters are also extremely important (Senderowitz, 1999). Furthermore, the current rapid social, political and economic transformations in Southern Africa appear to have a profound impact on the social norms affecting adolescents (Blum, 2007).
Overview of Adolescent Reproductive Health Rights in Zimbabwe
This section looks at the current legal and policy provisions on sexual and reproductive health services in Zimbabwe. Section 76 (1) of the Constitution of Zimbabwe (2013) states that:
Every citizen and permanent resident of Zimbabwe has the right to have access to basic health-care services, including reproductive health-care services.
The Public Health Act of 2018 is not particularly explicit, but its Section 35 has been read to provide that children – defined as persons under the age of 18 – require parental or adult consent to access medical health services. Section 52(2) of the Medicines and Allied Substances Control (General) Regulations, 1991, Statutory Instrument 150 of 1991 (made in terms of the Medicines and Allied Substances Control Act [Chapter 15:03] provides as follows:
No person shall sell any medicine to any person apparently under the age of 16 years;
(a) In the case of a household remedy or a medicine listed in Part I of the Twelfth Schedule, except upon production of a written order signed by the parent or guardian of the child known to such person;
(b) In the case of any other medicine not referred to in paragraph (a) except upon production and in terms of a prescription issued by a medical practitioner, dental practitioner or veterinary surgeon.
The limitation of access to ASRHS to persons above 16 years of age is often linked to the age of sexual consent, which in Zimbabwe is set at 16 by the Criminal Law (Codification and Reform Act). The notion is that a person under the age of 16 cannot legally have sexual intercourse and, therefore, can only access SRHS without a police report or adult company. This, however, disregards the fact that Zimbabwe does not penalise consensual sex between children aged 12 and 16.
Purpose of the Study
This study seeks to understand the capacity of AFRHS to promote SRH among adolescence in Bindura Urban of Zimbabwe
Research Objectives
- 1.
To identify the capacity of the ASRHS providers in meeting the SRHR needs of adolescents in Binndura urban of Zimbabwe
- 2.
To examine the impact of socio-cultural norms in influencing adolescent sexual behaviours.
- 3.
To identify the challenges being faced by ASRHS in meeting the needs of adolescents.