How to Enhance Effective Delivery of Quality Adolescent Sexual and Reproductive Health Services in Ghana Open Access

Adolescents constitute a significant segment (18%) of the population in Ghana, and their sexual and reproductive health (SRH) needs are crucial for their overall well-being; however, delivering quality SRH services to adolescents remains challenging in many countries. Pregnancy during adolescence is associated with a higher risk of health problems like anemia, sexually transmitted infections (STIs), unsafe abortion, postpartum hemorrhage, and mental health disorders (like depression).^[1] Pregnant adolescents also bear negative social consequences and often must leave school, reducing their employability and leading to long-term economic implications.^[1] Unmet needs for family planning, especially for birth spacing, are high among adolescents.^[2]

SRH services for adolescents, such as appropriate information, contraception, and treatment for STIs, are either not available or are provided in a way that makes adolescents feel unwelcome and embarrassed. Health services must be sensitive to adolescents’ needs and developmental attributes to attract them. The World Health Organization promotes “Adolescent-Friendly Health Services” to address these issues and to make it easier for adolescents to obtain the required services.^[3]

One of the key targets of Ghana’s Adolescent Health Service Policy and Strategy is to ensure that 90% of adolescents know SRH services and rights. This phenomenon has led to establishing adolescent-friendly health facilities to increase adolescent access to health information and services. Despite these efforts, access to health information and service utilization remains low among adolescents.^[4–6] Three approaches can be followed to enhance and ensure the effective delivery of quality adolescent SRH services:

1. Enhancing adolescents’ health literacy.

2. Making SRH services accessible, acceptable, and appropriate to adolescents.

3. Engaging in meaningful adolescent and community participation.

Reproductive health education (RHE) is central to the health and well-being of adolescents and young people. Unfortunately, the introduction and implementation of Ghana’s RHE Policy and Guidelines in 2019 faced several challenges (cultural and religious opposition, poor integration into school curriculum, limited community involvement, stigma and discrimination, and lack of political will and support), leading to its failure.^[6] Adolescents need to be able to protect themselves from unwanted pregnancy, HIV, and STIs to promote values of tolerance, mutual respect, and nonviolence in relationships, and to support a safe transition into adulthood. Yet, most adolescents lack the knowledge required to make those decisions responsibly, leaving them vulnerable to coercion, STIs, forced marriage, and unintended pregnancies.^[7,8]

SRH education should not be denied to adolescents. It should be made available and accessible for all. Enhancing adolescent health literacy involves strategies that ensure young people can effectively understand and use health information, including SRH information. Ghana must revisit introducing and implementing the RHE Policy and Guidelines. This should include education on SRH and rights in our educational curriculum and integrate comprehensive sexuality education (CSE) into all forms of training both in and out of school. It must be tailored to the specific context and needs of young people. Out-of-school programs or services, including community-based training and education, often aimed at adolescents most in need of information—such as married adolescent girls, homeless adolescents, migrants and refugees, adolescents in remote rural areas, and those living in conflict zones—should be provided in our communities. When implemented well, Ghana’s RHE Policy and Guidelines will have a positive impact on improving knowledge and self-esteem, changing attitudes, gender, and social norms, and building self-efficacy in adolescents. It will have a positive impact on safer sexual behaviors without hastening the sexual activity of adolescents. CSE will empower adolescents to make informed decisions about relationships and sexuality and navigate a world in which early and unintended pregnancies, HIV, and other STIs still pose serious risks to their health and well-being.^[9]

Adolescents face interrelated barriers that prevent them from accessing facility-based SRH services. These include individual barriers, such as feelings of shame and lack of awareness about the services available; socio-cultural barriers, such as social norms and stigma surrounding sexually active adolescents; and cultural barriers, which limit the ability of girls to access SRH services.^[4,6] Structural barriers include long distances to health facilities, inconvenient hours of operation, long waiting times, cost of services, and lack of privacy.^[6] Ghana must make a conscious effort to address these barriers to save adolescents from STIs; HIV/AIDS; adolescent pregnancy; unsafe abortion, which primarily results in adolescent death; harmful sexual reproductive health practices, such as female genital mutilation; child marriage; and sexual and gender-based violence.^[6]

Adolescent SRH services need to be designed and delivered in ways that ensure they are accessible, acceptable, and appropriate for adolescents. For SRH services to reach adolescents, SRH programs must take innovative approaches and consider cultural sensitivity and diversity. Ghana must ensure that services are provided confidentially and privately to encourage adolescents to seek care without fear of judgment or breach of privacy and train healthcare providers to adopt a nonjudgmental, respectful approach that makes adolescents feel safe and supported. Services should be in places that are easy for adolescents to reach and offer flexible hours that accommodate their schedules; ensure that services are free or affordable, as cost can be a significant barrier for adolescents; and provide comprehensive SRH education that covers a wide range of topics, including contraception, STI prevention, and healthy relationships. SRH education must inform adolescents about their rights and the importance of accessing health services and engage adolescents in designing, implementing, and evaluating SRH services to ensure that their needs and preferences are met. We must also implement systems for adolescents to provide feedback on services and make improvements based on their input.

Engaging adolescents and communities meaningfully requires thoughtful strategies to ensure their active involvement and empowerment. Ghana must ensure diverse representation from different backgrounds, including marginalized groups, when implementing policy documents to enhance the delivery of quality SRH services for adolescents.^[6,9] We must create spaces where adolescents feel safe and valued, encouraging equal participation. We need to involve adolescents and community members in all stages of decision-making processes, from planning to implementation and evaluation. Their insights and perspectives are needed to inform decisions and the outcomes of SRH service delivery.^[6,9]

For stakeholder engagement to be effective, open and honest communication is paramount. We must clearly explain their participation goals, processes, and expected outcomes. We must keep them updated on progress and decisions, develop long-term strategies for ongoing engagement rather than one-off consultations, and build structures that allow continuous involvement and feedback loops to adapt and improve initiatives over time. It is also important to recognize and value the contributions of adolescents and community members and provide feedback on how their input has influenced decisions and outcomes in SRH service delivery. Communities, if not engaged, may frequently become protective of cultural norms if they feel services do not align with their cultural norms and beliefs, thus preventing adolescents from accessing such services within the community.^[9,10]

There is a need to focus on and support adolescents’ SRH in Ghana. This means providing access to comprehensive SRH education; services to prevent, diagnose, and treat STIs; counseling on family planning; and much more. In addition, leveraging digital health technologies can provide confidential and accessible support to adolescents. Policymakers and stakeholders must prioritize adolescent SRH investments to ensure sustainable improvements in health outcomes. By addressing these challenges and implementing the proposed strategies, Ghana can make significant progress in improving the SRH of its adolescent population.