Access to Sexual and Reproductive Health Information and Services for Young People in the Balkans

Team members: 
Françoise Wuillaume

This quantitative survey was coordinated by ICRH and commissioned by the International Planned Parenthood Federation (IPPF) European Network as part of the project “Youth, sexual health and HIV/AIDS in the Balkans”.

The general objective of the survey was to describe access of high-school students to Sexual and Reproductive Health (SRH) services in preparation for the establishment of youth clinics. The survey assessed sexual and health seeking behaviour related to contraception among urban high school students in Bosnia (Sarajevo), Former Yugoslavian Republic of Macedonia (Skopje), and Serbia and Montenegro (Belgrade and Podgorica). In addition, barriers to utilize Sexual and Reproductive Health (SRH) services were explored.

The cross-sectional survey was conducted in December 2004 using self-administered questionnaires. A clustered sample approach was adopted. Specifically, in each of the four capitals, two grammar high-schools, three technical high-schools and one medical high-school were selected at random from the list of public schools. Private schools were excluded because they were few in number and represented very specific population characteristics. Investigators randomly selected one class of grade 1 or grade 2, one class of grade 3 and one class of grade 4 in each of the selected high-schools. The questionnaire was translated by the local IPPF European Network partner organizations and an opt-out rather than an opt-in strategy was chosen to limit the risks of selection bias. At the outset, the purpose of the survey and the content of the anonymous questionnaire was explained by members of the IPPF partner organizations and the questionnaires were filled out in class. A common core questionnaire assessing the perceived access to condoms, contraceptive methods and STI/HIV care and two additional sections were administered: section A was to be filled out by students who had ever had sexual intercourse and section B by students who had not had sexual intercourse yet.

Main results were:
1) Sexual activity in Students’ population
Except in Montenegro where figures were lower, half of the boys and a quarter of the girls have already had sex when reaching grade 4 of studies. A difference between gender was demonstrated for the current sexual activity and the intention to start sexual activity within a
short period. Boys probably encountered sexual partners outside the high-school population. A partner seeking behaviour investigation could be helpful to define preventive messages in this population.

2) Access to general health services
Students rated high their health. Several arguments indicated that health was probably not a daily concern of this young population: a large proportion of them were ignorant about their vaccination status or their last visit to a doctor. The survey did not demonstrate an important problem of access to health services, but some limited populations could face particular problems.

3) Access to condoms
Students were satisfied with the market and considered there were enough places where to buy condoms. They expressed doubts about the quality of free condoms. A small group of students living outside the family house seemed to face financial problems to buy condoms. Condoms were by far the most frequently used contraception method. Students were more familiar with condoms and 50 % of them recognised lacking information on other contraception methods. Nevertheless, students were not always correctly informed about dual protection or good practice for condom use (30 % of boys found it more secure to wear two condoms at once).

4) Access to contraception
As mentioned, students recognised a low level of information about contraceptive methods (except condoms). The proportion of girls protected by pills at their first sexual intercourse, or later with partners, was low: 5 % or less at the first sexual intercourse, 11 % or less with current partners (for both genders). Fewer than 5 % of the students included in the four samples reported to have ever consulted a doctor or health facility for contraception. The survey collected several arguments documenting abortions were a problem among highschool students. Students were less satisfied with the market of contraception provision, without expressing a huge disagreement. For reproductive health matter, girls expressed preferences for private (for profit) health structures or youth clinics. The survey detected lack of knowledge in the different contraceptive methods including pills.

5) Access to HIV/STI services
Students rated high their level of knowledge about HIV but the survey identified misconceptions about curability of AIDS, susceptibility to HIV at first sexual intercourse, etc.. Some students declared they already needed HIV tests or suspected a STI without seeking treatment. Few reasons were related to the organisation of the health services. Subjective reasons like shame, fear that the parents or somebody else would know, fear of the diagnosis were reported. Some students have already been tested for HIV, but not always for reasons motivated by their sexual life.

Problems were identified in relation with the demand of services. The provision of services appeared sufficient but not ideal. Young persons should be guided in their reproductive health seeking behaviour. Youth organizations should focus on the awareness of young populations
regarding needs and protection. They should also make sure young persons are well oriented to the right services.

International Planned Parenthood Federation (IPPF) European Network
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