How the attitudes of trained healthcare workers affect the youth's ability to access sexual and reproductive services
Country level data have shown that investment in youth-friendly programmes has led to a significant improvement in the sexual and reproductive health outcomes for young people; however, not without challenges. Not enough young people are making use of these facilities, with attitudes of healthcare workers as a major barrier.
In 2005, the South African Children's Act lowered the age to access health services from 18 years old to 12 years old, allowing these children access to HIV testing, contraception and termination of pregnancy up to 12 weeks gestation without parental consent. These services are available to young people, but it is important to investigate whether these sexual and reproductive services are accessible to these women (Holt et al., 2012).
Although there are youth sexual and reproductive programmes in place such as The Youth Friendly Service (YES) programme in South Africa, a study by ISSUP (2013) found that health facilities providing the YES programme did not deliver more positive experiences than health facilities not doing so. Positive experiences occurred when healthcare workers were supportive, friendly, respectful, and when adolescents seeking information valued the services they received. On the other hand, negative experiences such as when healthcare workers expressed negative opinions about the adolescents seeking information, did not respect their privacy and gave inadequate information.
Previously, the perception was that providing health and sexual reproductive services to adolescents would promote promiscuity. This led to the stigma attached to youth sexuality. However, recently there has been an increased growth in the development and expansion of sexual and reproductive services to young people (Alli et al., 2012). Despite the growth of services in this domain, studies have revealed that the youth are avoiding these services, based on the negative interactions they experience with healthcare workers. Holt et al., (2012) refer to the dichotomy that previous research documented of healthcare workers' role as gatekeepers to young people accessing sexual and reproductive health services; while they are also blamed for stigmatisation and harsh treatment of youth seeking contraception.
Following are some of the challenges faced by adolescents receiving healthcare.
Challenges faced by adolescents seeking health services
Adolescents are usually very sensitive to rude, judgemental or overbearing attitudes and behaviours on the part of adults. According to AFY (n.d.), this can cause adolescents to leave the clinic before receiving care, failure to adhere to any treatment, and failure or refusal to follow-up care.
Lack of time in consultation
Clinic hours and waiting times are challenging for young people because the only available times they can attend are during lunch or after lectures if they are at university, college or school. Over lunch, the clinics may be closed or have less staff, which leads to longer waiting lines.
Following are some of the challenges healthcare workers face, which hinder them from being as empathetic and supportive as adolescents would expect.
Potential challenges facing healthcare workers
Common problems faced by healthcare workers include shortage of staff. This shortens the consultation time for each client, as there are often long waiting lines. Other problems are lack of infrastructure and stock outs resulting in overburdened healthcare workers. Personal variables such as healthcare worker bias, motivation and levels of preparedness contribute to undermine health service delivery to adolescents.
In South Africa, factors that influence the implementation of youth-friendly health services include the reduction of donor funding, the separate funding streams for sexual and reproductive health, policy restrictions related to funding and activities, and a lack of political conviction by donors and national governments to make youth-friendly health services a priority (Alli et al., 2012).
Alli et al. (2012) suggested that depending on the age and gender of the healthcare worker, adolescents were less likely to discuss sexual and reproductive issues for the fear of being disrespectful. Another study found that young unmarried pregnant women felt antagonised because of the perceived cultural immorality of being pregnant and unmarried (Wood & Jewkes cited in Holt et al., 2012).
Healthcare workers' mandate is to promote youth-friendly clinical services (AFY, n.d.). Three of their core values, founded in the ethical guidelines include
- Beneficence, which means that the healthcare worker would act in the best interests of their client and his/her welfare, and do no harm
- Justice, which refers to non-discrimination
- Respect for autonomy, which obligates health workers to obtain informed consent from clients and to respect confidentiality.
Although initial and annual refresher training of healthcare workers focus on provision of youth-friendly services, the ability to transfer the knowledge into practice lacks implementation. Moreover, as poor interpersonal relations have the potential to negatively affect service delivery, training for healthcare workers should tend to their interpersonal relations as much as on their technical capabilities.
Healthcare workers in the study by Holt et al., (2012) suggested that young women be better educated about the risk of pregnancy, infection, consequences of sex and protection methods. The social and economic factors influencing these young women play a huge role in their health-seeking behaviour, which may lead to less frequent clinic visits.
As a matter of importance, healthcare workers should not allow their own biases and opinions to affect the quality of their health service delivery. Training of healthcare workers on interpersonal relations for youth-friendly services is essential in overcoming the communication barrier when they interact with adolescents. Service delivery to adolescents on a more personal level can contribute to quality and comprehensive care.
- Advocates for Youth (AFY). (n.d.) Best practices for Youth Friendly Clinical Services [Online] (Accessed on 22 May 2014).
- Advocates for Youth (AFY). (n.d.) Youth reproductive and sexual healhth in Nigeria [Online] (Accessed on 22 May 2014).
- Alli, F., Maharaj, P., Vawda, M. Y. (2012) Interpersonal relations between health care workers and young clients: Barriers to accessing sexual and reproductive health care. Journal of Community Health.
- Holt, K., Lince, N., Hargey, A., Struthers, H., Nklala, B., McIntyre, J., Gray, G., Mnyani, C., Blanchard, K. (2012) Assessment of service availability and health care workers' opinions about young women's sexual and reproductive health in Soweto, South Africa. African Journal of Reproductive Health, 16 (2), pp. 283-294.
- ISSUP. (2013) Youth friendly services? Using simulated clients to evaluate sexual health services in urban South Africa [Online] (Accessed on 22 May 2014).
Author: By Jodilee Erasmus (B.Soc Sci)
Reviewed by: Hendra van Zyl (MPH), Jean Fourie (M.Phil) and Michelle Moorhouse (MBBCh, DA)
Date: June 2014
Erasmus, J. (2014) How the attitudes of trained healthcare workers affect the youth's ability to access sexual and reproductive services. Issue 14 no. 6, Health Profession (Open access).
2 June, 2014