Responding to adolescent sexual and reproductive health care needs: The complexities in plateau state Nigeria

Adolescents in Nigeria face significant sexual and reproductive health (SRH) challenges, yet services tailored to their needs remain limited, particularly within primary healthcare systems. This dissertation explored access to and use of adolescent sexual and reproductive health services (ASRHS) in Plateau State, Nigeria, with the aim of generating evidence to inform policy and programming. Five research questions guided the study: the nature of adolescents’ sexual behaviours and influencing factors; patterns of health-seeking behaviour; availability and accessibility of ASRHS in health facilities; preparedness of healthcare workers to deliver these services; and attitudes of healthcare workers towards adolescents and the drivers of their behaviour. A mixed-methods design was adopted, integrating quantitative and qualitative approaches. Data were collected from 428 adolescents across six local government areas (LGAs) through surveys, and 230 primary healthcare centres (PHCs) were assessed using a modified WHO quality standards tool. In addition, questionnaires and interviews were conducted with healthcare providers, and the COM-B model of behaviour change was applied to examine behavioural drivers. The findings reveal that adolescents are vulnerable to adverse SRH outcomes. Many reported early sexual debut, inconsistent condom use and multiple sexual partnerships, with girls disproportionately exposed to unintended pregnancies, unsafe abortions, and sexually transmitted infections (STIs). Health-seeking behaviour was generally poor. Adolescents showed reluctance to seek care at health facilities, preferring patent medicine vendors due to perceived affordability, confidentiality, and privacy. Socioeconomic and educational disparities influenced access, with older and more educated adolescents more likely to utilize formal health services. Assessment of PHCs showed that available services were not adolescent-friendly. Facilities lacked privacy, dedicated consultation spaces, appropriate medical equipment, and flexible opening hours, often operating during school hours when adolescents were unavailable. Contraceptives were rarely accessible, and services offered were primarily adult-oriented, such as antenatal care and HIV treatment, rather than tailored to adolescent needs. Healthcare workers demonstrated limited preparedness to deliver ASRHS. Many lacked training, skills, and awareness of national adolescent health policies. Few were able to provide core SRH services such as counselling, contraception, STI/HIV testing, or post-abortion care. Negative provider attitudes were also prominent, with frequent insistence on parental consent and failure to guarantee confidentiality, which discouraged adolescents from seeking care. Application of the COM-B model revealed that limited capacity, cultural and religious norms, and weak motivation constrained provider behaviour. Providers with prior training, younger staff, and male workers exhibited more favourable attitudes and were more likely to deliver adolescent SRH services. The study concludes that systemic gaps within the health system, combined with restrictive cultural and provider attitudes, create major barriers to adolescent SRH in Plateau State. These challenges, if unaddressed, will perpetuate high rates of adolescent pregnancies, unsafe abortions, maternal health complications, school dropouts, and the spread of HIV and other STIs. The long-term consequences include increased educational and economic marginalization of girls, greater social isolation, and poor mental health outcomes. To address these issues, the dissertation recommends: (1) strengthening PHCs to provide adolescent-friendly health services with privacy, confidentiality, and youth-responsive design; (2) capacity building for healthcare workers through training in adolescent health, comprehensive sexuality education, and respectful care; (3) dissemination and enforcement of national adolescent health policies across facilities; (4) advocacy to address cultural and religious barriers; and (5) integration of adolescent health into Nigeria’s universal health coverage and Sustainable Development Goals framework. Overall, the research underscores that adolescent SRH is a multidimensional issue requiring a holistic, rights-based, and inclusive approach. Improving access, quality, and acceptability of ASRHS in Nigeria is critical to reducing preventable SRH complications and ensuring the health, education, and well-being of future generations.