Factors Influencing the Uptake of Sexual and Reproductive Health Services Among Adolescent Girls in Humanitarian Crises: A Case Study of Bor County, South Sudan

Authors

  • Areet A. A. Khang Kenya Methodist University
  • Lily J. A. Masinde Kenya Methodist University
  • Teresia M. Kyulu Kenya Methodist University

DOI:

https://doi.org/10.70619/vol5iss4pp1-16709

Keywords:

Sexual and Reproductive Health Uptake, Adolescents, Humanitarian Crisis, Sexually Transmitted Infections, Utilization

Abstract

Humanitarian crises in South Sudan, characterized by conflict, displacement, and disrupted health systems, severely limit adolescent girls' access to SRH services. The study employed a mixed-methods design. This study aimed to examine factors influencing the uptake of SRH services among adolescent girls aged 15-19 in Bor County, South Sudan. The target population included adolescent girls aged 15-19, with a sample size of 225 participants selected through purposive sampling. Data was collected via semi-structured questionnaires for quantitative insights and Key Informant Interviews (KIIs) for qualitative perspectives. Quantitative data were analyzed using descriptive statistics (means, standard deviations, and regression analysis) with SPSS Version 25.0, and results were presented in tables, pie charts, and graphs. Qualitative data were analyzed thematically using NVivo software to identify key patterns and themes. The study found that accessibility was the most significant barrier (Beta = 0.311, p = 0.021), with long distances to clinics, poor transportation, and lack of youth-friendly services limiting uptake. Awareness and knowledge (Beta = 0.219, p = 0.032) were constrained by inadequate school-based SRH education. Psychosocial factors (Beta = 0.201, p = 0.001), including stigma and trauma, significantly deterred service utilization. Socio-cultural and economic factors (Beta = 0.156, p = 0.002), such as cultural taboos and poverty, had a notable but lesser impact. This study enriches the literature by providing context-specific insights into SRH service uptake in humanitarian settings, emphasizing the unique challenges faced by adolescent girls in Bor County. It recommends youth-friendly mobile clinics, comprehensive sexuality education, and community-based stigma reduction programs to align with South Sudan’s adolescent health policies and global humanitarian SRH standards.

Author Biography

Areet A. A. Khang, Kenya Methodist University

Department of Public Health, Human Nutrition & Dietetics, School of Medicine and Health Sciences

References

Abdulai, M., Kenu, E., Ameme, D., Bandoh, D., Tabong, P., Lartey, A., ... & Nyarko, K. (2020). Demographic and socio-cultural factors influencing contraceptive uptake among women of reproductive age in Tamale Metropolis, Northern Region, Ghana. Ghana Medical Journal, 54(2), 64–72. https://doi.org/10.4314/gmj.v54i2.2

Adefalu, G.A., & Ayodele, K.O. (2019). Factors influencing access and utilization of reproductive health services among undergraduates in selected tertiary institutions in Ogun State, Nigeria. International Journal of Health Sciences, 7(2), 38–49.

Arnott, G., Otema, C., Obalim, G., Odallo, B., Nakubulwa, T., & Okello, S.B. (2022). Human rights-based accountability for sexual and reproductive health and rights in humanitarian settings: Findings from a pilot study in northern Uganda. PLOS Global Public Health, 2(8), e0000836.

Barot, S. (2017). In a state of crisis: meeting the sexual and reproductive health needs of women in humanitarian situations. Guttmacher policy review, 20, 24-30.

Bukuluki, P.M.W., Kisaakye, P., Wandiembe, S.P., Kiwujja, V., Kajungu, C., Mugwanya, W., ... & Kaikai, F. (2023). Utilization of sexual and reproductive health services among young people in refugee settings in Uganda. Frontiers in Reproductive Health, 5, 1077761. https://doi.org/10.3389/frph.2023.1077761

Chowdhury, R., & McKague, K. (2018). How culture shapes the sexual and reproductive health practices among adolescent girls in Eastern Equatoria, South Sudan. South Sudan Medical Journal, 11(3), 56–59.

Desrosiers, A., Betancourt, T., Kergoat, Y., Servilli, C., Say, L., & Kobeissi, L. (2020). A systematic review of sexual and reproductive health interventions for young people in humanitarian and lower-and middle-income country settings. BMC Public Health, 20, 1–21. https://doi.org/10.1186/s12889-020-08818-y

Espinoza, C., Samandari, G., & Andersen, K. (2020). Abortion knowledge, attitudes, and experiences among adolescent girls: a review of the literature. Sexual and Reproductive Health Matters, 28(1). https://doi.org/10.1080/26410397.2020.1744225

Fahme, S. A., Khater, B., Dagher, M., DeJong, J., & Abdulrahim, S. (2022). Developing a sexual and reproductive health educational intervention for adolescent Syrian refugee girls: Challenges and lessons learned. Frontiers in Reproductive Health, 4, 780157. https://doi.org/10.3389/frph.2022.780157

Fahme, S.A., Khater, B., Dagher, M., DeJong, J., & Abdulrahim, S. (2022). Developing a sexual and reproductive health educational intervention for adolescent Syrian refugee girls: Challenges and lessons learned. Frontiers in Reproductive Health, 4, 780157.

Fekene, D.B., Woldeyes, B.S., Erena, M.M., & Demisse, G.A. (2020). Knowledge, uptake of preconception care, and associated factors among reproductive age group women in West Shewa zone, Ethiopia, 2018. BMC Women’s Health, 20, 1–8. https://doi.org/10.1186/s12905-020-00990-1

Gayle, H., & Hammergren, J. (Eds.). (2017). Her Health, Her Lifetime, Our World: Unlocking the Potential of Adolescent Girls and Young Women. Rowman & Littlefield.

Habumuremyi, J., & Zenawi, Z. (2022). Psychosocial barriers to sexual and reproductive health service uptake among youth in Ethiopia: A qualitative study. Journal of Health Research, 36(4), 678–686.

Hadi, M. (2017). Historical development of the global political agenda around sexual and reproductive health and rights: a literature review. Sexual & Reproductive Healthcare, 12, 64-69.

Jennings, L., George, A.S., Jacobs, T., Blanchet, K., & Singh, N.S. (2019). A forgotten group during humanitarian crises: A systematic review of sexual and reproductive health interventions for young people, including adolescents, in humanitarian settings. Conflict and Health, 13, 1–16. https://doi.org/10.1186/s13031-019-0240-y

Jolem, M., & Imunu, S. (2023). Comprehensive Assessment of Adolescent and Youth Friendly Sexual Reproductive Health Services in South Sudan. DOI:10.21203/rs.3.rs-3641192/v1

Kane, S., Miedema, E., Dieleman, M., & Broerse, J. (2019). ‘You have a child who will call you “mama”’: understanding adolescent pregnancy in South Sudan. Global Health Action, 12(1), 1553282.

Kepon, A. (2022). Sexual and Reproductive Health of Internally Displaced Women and Children in Melanesia Review. https://openrepository.aut.ac.nz/items/0af8a874-1f85-4d98-b53d-09f1b9b4392a

Khan, M.N., Alam, M.B., Chowdhury, A.R., Kabir, M.A., & Khan, M.M.A. (2024). Availability and readiness of healthcare facilities and their effects on antenatal care services uptake in Bangladesh. BMC Health Services Research, 24(1), 431. https://doi.org/10.1186/s12913-024-10876-5

Kyilleh, J.M., Tabong, P. T.N., & Konlaan, B. B. (2018). Adolescents’ reproductive health knowledge, choices, and factors affecting reproductive health choices: A qualitative study in the West Gonja District in the Northern region, Ghana. BMC International Health and Human Rights, 18, 1–12. https://doi.org/10.1186/s12914-018-0147-5

Lobolia, A.W., M’mayi, C., & Kyulu, T. (2024). Level of awareness and utilization of sexual and reproductive health services among adolescents in secondary schools in Turkana South Sub-County, Turkana County, Kenya. International Journal of Professional Practice, 12(5), 12–21.

Mason, N.L. (2021). Tools for Empowerment: Improving Sexual Health Outcomes for Adolescent Girls (Doctoral dissertation, University of Saskatchewan). https://harvest.usask.ca/server/api/core/bitstreams/e1b9d39b-7207-458d-bbf8-311fa048d0a9/content

Meyer, K., Abimpaye, M., Harerimana, J.D.D., Williams, C., & Gallagher, M. C. (2022). Understanding the sexual and reproductive health experiences of refugee and host community adolescents and youth in Rwanda during COVID-19: Needs, barriers, and opportunities. Frontiers in Reproductive Health, 4, 799699. https://doi.org/10.3389/frph.2022.799699

Mochache, V., Wanje, G., Nyagah, L., Lakhani, A., El-Busaidy, H., Temmerman, M., & Gichangi, P. (2020). Religious, socio-cultural norms and gender stereotypes influence uptake and utilization of maternal health services among the Digo community in Kwale, Kenya: A qualitative study. Reproductive Health, 17, 1–10. https://doi.org/10.1186/s12978-020-00952-2

Munyuzangabo, M., Khalifa, D. S., Gaffey, M. F., Kamali, M., Siddiqui, F. J., Meteke, S., ... & Bhutta, Z. A. (2020). Delivery of sexual and reproductive health interventions in conflict settings: a systematic review. BMJ Global Health, 5(Suppl 1), e002206.

Musindo, O., Jafry, S., Nyamiobo, J., Becker, K. D., Gellatly, R., Maloy, C., ... & Kumar, M. (2023). Mental health and psychosocial interventions integrating sexual and reproductive rights and health, and HIV care and prevention for adolescents and young people (10–24 years) in sub-Saharan Africa: A systematic scoping review. EClinicalMedicine, 57, 101835. https://doi.org/10.1016/j.eclinm.2023.101835

Mutea, L., Ontiri, S., Kadiri, F., Michielesen, K., & Gichangi, P. (2020). Access to information and use of adolescent sexual reproductive health services: Qualitative exploration of barriers and facilitators in Kisumu and Kakamega, Kenya. PLoS ONE, 15(11), e0241985. https://doi.org/10.1371/journal.pone.0241985

Natalina, E.O. (2023). Poverty and adolescent pregnancy in Torit County, Eastern Equatoria State, South Sudan (Doctoral dissertation, Kampala International University, College of Humanities and Social Science). https://ir.kiu.ac.ug/items/cfd24e44-1d69-493a-83d4-3654c39ceb26

Ndayishimiye, P., Uwase, R., Kubwimana, I., Niyonzima, J.D.L.C., Dzekem Dine, R., Nyandwi, J.B., & Ntokamunda Kadima, J. (2020). Availability, accessibility, and quality of adolescent sexual and reproductive health (SRH) services in urban health facilities of Rwanda: A survey among social and healthcare providers. BMC Health Services Research, 20, 1–11. https://doi.org/10.1186/s12913-020-05388-1

Ooms, G. I., Kibira, D., Reed, T., Van Den Ham, H.A., Mantel-Teeuwisse, A. K., & Buckland-Merrett, G. (2020). Access to sexual and reproductive health commodities in East and Southern Africa: A cross-country comparison of availability, affordability and stock-outs in Kenya, Tanzania, Uganda and Zambia. BMC Public Health, 20, 1–14. https://doi.org/10.1186/s12889-020-09501-0

Owoko, S.O. (2023). Factors influencing contraceptive use among adolescent girls aged 14–19 years in Homa Bay County, Kenya [Doctoral dissertation, JKUAT-COHES].

Roth, C., Bukoye, F., Kunnuji, M., Schaub, E., Kanaahe, B., Atukunda, D., Esiet, A., & Izugbara, C. (2022). The sexual and reproductive health needs and challenges of adolescent girls and young women in humanitarian settings in Nigeria and Uganda. International Center for Research on Women, Washington, DC.

Soeiro, R. E., de Siqueira Guida, J. P., da-Costa-Santos, J., & Costa, M. L. (2023). Sexual and reproductive health (SRH) needs for forcibly displaced adolescent girls and young women (10–24 years old) in humanitarian settings: A mixed-methods systematic review. Reproductive Health, 20(1), 174. https://doi.org/10.1186/s12978-023-01704-8

Tazinya, R.M.A., El-Mowafi, I. M., Hajjar, J.M., & Yaya, S. (2023). Sexual and reproductive health and rights in humanitarian settings: a matter of life and death. Reproductive health, 20(1), 42.

UNFPA. (2020). State of the world population 2020: Against my will—Defying the practices that harm women and girls and undermine equality. United Nations Population Fund.

Van Heerden, A., Msweli, S., & van Rooyen, H. (2017). Psychosocial stressors and sexual health among young women in South Africa. Sexual and Reproductive Healthcare, 14, 37–43. https://doi.org/10.1016/j.srhc.2017.08.002

Wamoyi, J., Mshana, G., Mongi, A., Neke, N., Kapiga, S., & Changalucha, J. (2024). Psychosocial influences on adolescent sexual and reproductive health service uptake in rural Tanzania: A mixed-methods study. Global Public Health, 19(1), 1234567.

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Published

2025-12-16

How to Cite

Khang, A. A. A. ., Masinde, L. J. A. ., & Kyulu, T. M. . (2025). Factors Influencing the Uptake of Sexual and Reproductive Health Services Among Adolescent Girls in Humanitarian Crises: A Case Study of Bor County, South Sudan. Journal of Medicine, Nursing and Public Health, 5(4), 1–16. https://doi.org/10.70619/vol5iss4pp1-16709

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