Provision of contraception to adolescents in primary healthcare clinics in South Africa: Perspectives of healthcare practitioners
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Abstract
Introduction: The provision of contraception to adolescents is a fundamental public health strategy for preventing adolescent pregnancies and realising universal access to sexual and reproductive health. In the South African context, and as informed by national and provincial policy guidelines, this strategy is delivered at primary healthcare clinics. In this study, we sought to explore the barriers and enablers of providing contraception to adolescents in primary healthcare clinics from the perspectives of healthcare practitioners.
Methods: We employed a qualitative research design. Using purposive sampling, we recruited senior managers and nurses involved in primary healthcare and sexual and reproductive health programmes in South Africa. We conducted semi-structured interviews with twenty-nine participants working in an urban or rural district. Subsequently, we transcribed the interviews, verifying for errors. Guided by Braun and Clarke’s model of thematic analysis, we grouped the data into four themes derived from the healthcare access frameworks. Each of the four themes has sub-themes describing both enablers and barriers to providing contraception to adolescents.
Results: The study revealed that practitioners’ knowledge of policy guidelines enabled them to provide contraception to adolescents effectively. However, the differences between what is stated in policy documents and practical limitations could impede the extent to which services reach adolescents. Other barriers to providing contraception to adolescents included language differences between healthcare practitioners and users, time constraints, and lack of privacy during consultations. Participants noted that appropriate nurse training and ensuring an accepting environment for adolescents facilitated the provision of contraception to this age group.
Conclusion: Our study offers valuable insights into the perspectives of primary healthcare practitioners about the barriers and enablers in providing contraception to adolescents. Our results indicate that policy development and future research should focus on strengthening the delivery of contraception services for adolescents.
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References
Every Woman Every Child. The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) [Internet]. Every Woman Every Child. New York; 2015. Available from: https://cdn.who.int/media/docs/default-source/mca-documents/global-strategy/ewec-globalstrategyreport-200915.pdf?sfvrsn=b42b6d22_2.
World Health Organization. Working for a brighter, healthier future - How WHO improves health and improves well-being for the world’s adolescents [Internet]. Geneva; 2021. Available from: https://www.who.int/publications/i/item/9789240041363.
United Nations Population Fund. Program of Action: Adopted at the International Conference on Population and Development, 5-13, Cairo, 1994 [Internet]. United Nations Population Fund. Cairo; 2004. Available from: https://www.unfpa.org/sites/default/files/event-pdf/PoA_en.pdf.
United Nations Population Fund. Universal Access to Reproductive Health. UNFPA: New York; 2016. Available from: https://www.unfpa.org/sites/default/files/pub-pdf/UNFPA_Reproductive _Paper_20160120_online.pdf.
Sully EA, Biddlecom A, Darroch JE, Riley T, Ashford LS, Lince-Deroche N, et al. Adding It Up: Investing in Sexual and Reproductive Health 2019 [Internet]. New York; 2020 Jul. Available from: https://www.guttmacher.org/report/adding-it-up-investing-in-sexual-reproductive-health-2019.
Todd N, Black A. Contraception for adolescents. J Clin Res Pediatr Endocrinol. 2020 Jan 1;12(1):28–40.
World Health Organization. Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to Support Country Implementation [Internet]. Geneva: World Health Organization; 2017. Available from: https://www.who.int/publications/i/item/9789240081765.
McClinton Appollis T, Jonas K, Beauclair R, Lombard C, Duby Z, Cheyip M, et al. Early sexual debut and the effects on well-being among South African adolescent girls and young women aged 15 to 24 years. Int J Sex Health. 2022;34(2):242–53. doi.org/10.1080/19317611.2021.1979162.
World Health Organization. WHO. 2022. Adolescent pregnancy: Fact Sheet. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy.
Gunawardena N, Fantaye AW, Yaya S. Predictors of pregnancy among young people in sub-Saharan Africa: A systematic review and narrative synthesis. BMJ Glob Health. 2019;4:e001499. doi.org/10.1136/bmjgh-2019-001499.
Chersich MF, Wabiri N, Risher K, Shisana O, Celentano D, Rehle T, et al. Contraception coverage and methods used among women in South Africa: A national household survey. S Afr Med J. 2017 Mar 29;107(4):307.
Chandra-Mouli V, Akwara E. Improving access to and use of contraception by adolescents: What progress has been made, what lessons have been learnt, and what are the implications for action? Best Pract Res Clin Obstet Gynaecol. 2020;66:107–18. doi.org/10.1016/j.bpobgyn.2020.04.003.
Every Woman Every Child. The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030). Geneve: WHO; 2016. Available from: http://www.everywomaneverychild.org/wp-content/uploads/2016/12/EWEC_Global_Strategy_EN_inside_LogoOK_web.pdf
South African National Department of Health. National Integrated Sexual and Reproductive Health and Rights Policy, Edition 1 [Internet]. Pretoria: Department of Health, South Africa; 2019. Available from: https://www.knowledgehub.org.za/elibrary/national-integrated-sexual-reproductive-health-and-right-policy-2020.
Hoopes AJ, Chandra-Mouli V, Steyn P, Shilubane T, Pleaner M. An analysis of adolescent content in South Africa’s contraception policy using a human rights framework. J Adolesc Health. 2015 Dec 1;57(6):617–23. doi.org/10.1016/j.jadohealth.2015.08.012.
James S, Pisa PT, Imrie J, Beery MP, Martin C, Skosana C, et al. Assessment of adolescent and youth friendly services in primary healthcare facilities in two provinces in South Africa. BMC Health Serv Res. 2018;18(1):1–10. doi.org/10.1186/s12913-018-3623-7.
South African National Department of Health. Standard Treatment Guidelines and Essential Medicines List for South Africa: Primary healthcare level [Internet]. Pretoria, South Africa: Department of Health, South Africa; 2020. Available from: https://test.knowledgehub.org.za/ elibrary/primary-healthcare-phc-standard-treatment-guidelines-and-essential-medicines-list-south.
South African National Department of Health. National Contraception Clinical Guidelines [Internet]. Pretoria: Department of Health, South Africa; 2019. Available from: https://www.knowledgehub.org.za/elibrary/national-contraception-clinical-guidelines-2019.
South African National Department of Health. National Adolescent and Youth Health Policy [Internet]. Pretoria: Department of Health, South Africa; 2017. p. 31. Available from: https://www.knowledgehub.org.za/elibrary/national-adolescent-and-youth-health-policy-2017.
Moult K, Müller A. Navigating conflicting laws in sexual and reproductive health service provision for teenagers. Curationis. 2016 Feb 25;39(1):1–7.
Western Cape Department of Health. Primary Care Guide for the Adult: Western Cape Edition [Internet]. Cape Town; 2020. Available from: https://knowledgetranslation.co.za/pack/wc-south-africa/
Abrahams GL, Thani XC, Kahn SB. South Africa public primary healthcare services and challenges: considerations during the Covid-19 pandemic. Administratio Publica. 2022;30(2):63–85.
Government of the Republic of South Africa. Nursing Act (No. 33 of 2005): Regulations regarding the scope of practice of nurses and midwives [Internet]. 2020 p. 5. Available from: https://www.gov.za/sites/default/files/gcis_document/202005/43305gon521_0.pdf.
Anders RL. Engaging nurses in health policy in the era of COVID-19. Nurs Forum (Auckl). 2021;56(1):89–94. doi.org/10.1111/nuf.12514.
Davids EL, Kredo T, Gerritsen AAM, Mathews C, Slingers N, Nyirenda M, et al. Adolescent girls and young women: Policy-to-implementation gaps for addressing sexual and reproductive health needs in South Africa. S Afr Med J. 2020;110(9):855–7. doi.org/10.7196/SAMJ.2020. v110i9.14785.
World Health Organization. Making health services adolescent friendly: Developing national quality standards for adolescent-friendly health services [Internet]. World Health Organization. Switzerland: World Health Organization; 2012. Available from: https://apps.who.int/iris/bitstream/handle/10665/75217/9789241503594_eng.pdf?sequence=1.
Kriel Y, Milford C, Cordero JP, Suleman F, Steyn PS, Smit JA. Quality of care in public sector family planning services in KwaZulu-Natal, South Africa: a qualitative evaluation from community and health care provider perspectives. BMC Health Serv Res. 2021;21(1):1–16. doi.org/10.1186/ s12913-021-07247-w.
Fataar K, Zweigenthal V, Harries J. Providers’ approaches to contraceptive provision in Cape Town. Front Glob Womens Health. 2022; Sep 14:3.
Jonas K, Roman N, Reddy P, Krumeich A, van den Borne B, Crutzen R. Nurses’ perceptions of adolescents accessing and utilizing sexual and reproductive healthcare services in Cape Town, South Africa: A qualitative study. Int J Nurs Stud. 2019 Sep;97:84–93.
Abrahams TL, Pather MK, Swartz S. Knowledge, beliefs and practices of nurses with long acting reversible contraception, Cape Town. Afr J Prim Health Care Fam Med. 2023;15(1):1–8. doi.org/ 10.4102/phcfm.v15i1.3571.
Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12(1):18.
Baroudi M. Beyond supply and demand: a new ecological framework for understanding the access of young migrants to sexual and reproductive health services in Sweden. Glob Health Action. 2023;16(1). doi.org/10.1080/16549716.2023.2251783.
Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: Striving to meet the trustworthiness criteria. Int J Qual Methods. 2017;16(1):1–13. doi.org/10.1177/ 1609406917733847.
Bradshaw C, Atkinson S, Doody O. Employing a Qualitative Description Approach in Health Care Research. Glob Qual Nurs Res. 2017 Jan 1;4:233339361774228.
Tolley, E.E., Ulin, P.R., Mack, N., Robinson, E.T., and Succop SM. Qualitative methods in public health: A field guide for applied research [Internet]. Second Edi. San Francisco: Jossey-Bass; 2016. Available from: http://lccn.loc.gov/2015042723
Babbie, E. and Mouton J. The practice of social research. Cape Town: Oxford University Press; 2010.
Western Cape Government. Health Annual Report, 2021/22 [Internet]. Vol. 191. 2022. Available from: https://www.westerncape.gov.za/assets/annual_report_2021-2022.pdf.
Western Cape Government. 2022 Socio-Economic Profile: City of Cape Town [Internet]. Cape Town; 2021. Available from: https://www.westerncape.gov.za/provincial-treasury/sites/ provincial-treasury.westerncape.gov.za/files/atoms/files/SEP-LG 2021-City of Cape Town.pdf.
Western Cape Government. 2022 Socio-Economic Profile West Coast District Municipality [Internet]. Cape Town; 2021. Available from: https://municipalities.co.za/overview/147/west-coast-district-municipality.
Creswell JW. Qualitative, Quantitative, and Mixed-Methods Approaches. Third Edit. Vol. 4, SAGE. Thousand Oaks: SAGE; 2009.
Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qual Res Psychol. 2021;18(3):328–52. doi.org/10.1080/14780887.2020.1769238.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health C. 2007;19(6):349–57. doi.org/10.1093/intqhc/mzm042.
Cornick R, Picken S, Wattrus C, Awotiwon A, Carkeek E, Hannington J, et al. The Practical Approach to Care Kit (PACK) guide: Developing a clinical decision support tool to simplify, standardise and strengthen primary healthcare delivery. BMJ Glob Health. 2018 Oct 1;3. doi.org/ 10.1136/bmjgh-2018-000962.
Hudson B, Hunter D, Peckham S. Policy failure and the policy-implementation gap: can policy support programs help? Policy Des Pract. 2019;2(1):1–14. doi.org/10.1080/ 25741292.2018.1540378.
Hajizadeh A, Zamanzadeh V, Kakemam E, Bahreini R, Khodayari-Zarnaq R. Factors influencing nurses participation in the health policy-making process: a systematic review. BMC Nurs. 2021;20(1):1–9. doi.org/10.1186/s12912-021-00648-6.
Wigle J, Paul S, Birn AE, Gladstone B, Braitstein P. Youth participation in sexual and reproductive health: policy, practice, and progress in Malawi. Int J Public Health. 2020 May 1;65(4):379–89. doi.org/10.1007/s00038-020-01357-8.
Agyei FB, Kaura DK. A systematic review of effective parent-adolescent sexual and reproductive health information communication in lower-and middle-income countries. Health SA Gesondheid (Online). 2023;28:1-9. doi.org/10.4102/hsag.v28i0.2435.
Zinke-Allmang A, Bhatia A, Gorur K, Hassan R, Shipow A, Ogolla C, et al. The role of partners, parents and friends in shaping young women’s reproductive choices in peri-urban Nairobi: a qualitative study. Reprod Health. 2023; 20(1):1–11. doi.org/10.1186/s12978-023-01581-4.
Magnusson BM, Crandall A, Evans K. Early sexual debut and risky sex in young adults: The role of low self-control. BMC Public Health. 2019 Nov 8;19(1). doi.org/10.1186/s12889-019-7734-9.
Bain LE, Amu H, Tarkang EE. Barriers and motivators of contraceptive use among young people in Sub-Saharan Africa: A systematic review of qualitative studies. PloS One. 2021 Jun 4;16(6):e0252745 51. doi.org/10.1371/journal.pone.0252745.
Ninsiima LR, Chiumia IK, Ndejjo R. Factors influencing access to and utilisation of youth-friendly sexual and reproductive health services in sub-Saharan Africa: a systematic review. Reprod Health. 2021;18(1):135. doi.org/10.1186/s12978-021-01183-y.
Al Shamsi H, Almutairi AG, Al Mashrafi S, Al Kalbani T. Implications of language barriers for healthcare: A systematic review. Oman Med J. 2020;35(2):1–7. doi.org/10.5001/omj.2020.40.
Ali PA, Watson R. Language barriers and their impact on provision of care to patients with limited English proficiency: Nurses’ perspectives. J Clin Nurs. 2018;27(5–6):e1152–60. doi.org/ 10.1111/jocn.14204.
Smith P, Marcus R, Bennie T, Nkala B, Nchabeleng M, Latka MH, et al. What do South African adolescents want in a sexual health service? Evidence from the South African studies on HIV in adolescents (SASHA) project. S Afr Med J. 2018;108(8):677–81. doi.org/10.7196/ SAMJ.2018.v108i8.13013.
Tessema GA, Gomersall JS, Mahmood MA, Laurence CO. Factors determining quality of care in family planning services in Africa: A systematic review of mixed evidence. PLoS One. 2016 Nov 3;11(11):e0165627. doi.org/10.1371/journal.pone.0165627.