Background: Sexual activity during adolescence is common in Vanuatu, however many adolescents lack access to\nsexual and reproductive health (SRH) services and subsequently suffer a disproportionate burden of poor SRH.\nThere is limited peer-reviewed research describing adolescentsââ?¬â?¢ SRH service delivery preferences in Vanuatu to\ninform policy and programs. The aim of this qualitative study was to explore the barriers preventing adolescents\nfrom accessing SRH services in Vanuatu and the features of a youth-friendly health service as defined by\nadolescents.\nMethods: Sixty-six focus group discussions were conducted with 341 male and female adolescents aged\n15ââ?¬â??19 years in rural and urban communities. Additionally, 12 semi-structured interviews were undertaken with\npolicymakers and service providers. Data were analysed using thematic analysis.\nResults: Socio-cultural norms and taboos regarding adolescent sexual behaviour were the most significant factors\npreventing adolescents from accessing services. These contributed to adolescentsââ?¬â?¢ own fear and shame, judgmental\nattitudes of service providers, and disapproval from parents and community gate-keepers. Lack of confidentiality\nand privacy, costs, and adolescentsââ?¬â?¢ lack of SRH knowledge were also important barriers. Adolescents and service\nproviders identified opportunities to make existing services more youth-friendly. The most important feature of a\nyouth-friendly health service described by adolescents was a friendly service provider. Free or affordable services,\nreliable commodity supply, confidentiality and privacy were also key features. The need to address socio-cultural\nnorms and community knowledge and attitudes was also highlighted.\nConclusions: There are significant demand and supply-side barriers contributing to low utilisation of SRH services\nby adolescents in Vanuatu. However, there are many opportunities to make existing SRH services more youthfriendly,\nsuch as improving service provider training. Investment is also required in strategies that aim to create a\nmore supportive environment for adolescent SRH.
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