Disparities In Sexual and Reproductive Health Service Utilization and Associated Factors Among Agrarian and Pastoralist Adolescents In South Omo Zone, Ethiopia: A Community-Based Comparative Cross-Sectional Study

Abstract

Belay Wolde Esho and Nigist Katiwaso Wobo

Background: Nearly 1.2 billion people worldwide are adolescents aged between 10 and 19 years. In Ethiopia, pastoralists constitute approximately 12% of the total population. Studies on sexual and reproductive health service uptake in Ethiopia have been conducted, but they have not shown disparities in service utilization between agrarian and pastoralist settings. This study was necessary because the South Omo Zone is unique from other parts of Ethiopia and has not been addressed yet, as the cultural and lifestyle differences of adolescents living in the South Omo pastoralist and agrarian areas are significant.

Method: A community-based, comparative, cross-sectional study was conducted from May to June 2023. A multistage sampling technique was used, and 502 adolescents were randomly selected to participate in the study. Data was collected using a structured questionnaire with written consent. The data were entered into EPI Data version 4.6, and the analysis was performed using SPSS version 25. Bivariate and multivariate logistic regression analyses were conducted. Significance was considered at a P-value of <0.05 in the multivariate analysis.

Results: A total of 493 adolescents (247 from agrarian and 246 from pastoralist backgrounds) participated in the study, yielding a response rate of 98.2%. There were more females (61.9%) than males (38.1%). The overall utilization of SRH services was 27.4% (95% CI: 26.9, 27.8). There was a significant difference in SRH service utilization between agrarians (36%, 95% CI: 35.5, 36.5) and pastoralists (18.7%, 95% CI: 18.3, 19.1). The level of education (Uneducated adjusted odds ratio (AOR=0.187, 95% CI 0.065, 0.536), father/mother encouragement (AOR=2.817, 95% CI 1.120, 7.089), parent discussion (AOR=3.729, 95% CI 1.315, 10.574), and distance to SRH service (AOR=3.645, 95% CI 1.423, 9.337) were determinants of adolescent SRH service utilization. Fear of being seen by parents or others (20.9%) and lack of confidentiality (21.7%) were the most possible factors preventing adolescents from using SRH services in existing health institutions.

Conclusion: Overall, adolescent sexual and reproductive health service utilization in the study area was very low. Promoting father/mother encouragement and establishing sexual and reproductive health service centers at health institutions and school levels should be emphasized. The health sector and other stakeholders need to strengthen their efforts to establish sexual and reproductive health services near adolescents in places where they do not yet exist, in both agrarian and pastoralist areas.

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