How do South African policies address provision of contraception among adolescents?

BACKGROUND:  The South African government has pioneered several policy documents that emphasise the importance of sexual and reproductive health (SRH). AIM:  We examined how national policies address access and provision of contraception to adolescents in South Africa. SETTING:  South African national policies. METHODS:  We systematically searched various academic databases such as EbscoHost, Science Direct, Google Scholar, PubMed and Scopus, and other relevant sources to obtain 854 policy documents. Using a set of explicit inclusion criteria, we screened and selected 11 South African policies for analysis. Next, we analysed three international policies and frameworks to extract the key elements from them. Thereafter, we used these key elements to develop an analytical framework for conducting the analysis of the South African national policies. RESULTS:  We found that South Africa's SRH policies largely address the provision of contraception by following international guidelines. These policies recognise the value of providing contraception to adolescent girls. However, we also found gaps in some policies, which could impede how they are translated into practice. These include recognising that adolescent boys can play a role in contraception; adolescents have varying SRH needs and are a key stakeholder not only for policy development but also for monitoring and accountability. CONCLUSION:  With a specific focus on South Africa's contraception services in the public sector, these findings are relevant to policymakers, providers and users of contraceptives.Contribution: This review proposes recommendations that will assist with strengthening health policy development and thus improve primary health care services related to contraception for adolescents.

Provider perspectives on adolescent access to contraception in South Africa.

BACKGROUND:  Poor access to contraception influences adolescent health outcomes and may lead to sexual and reproductive health challenges. Unmet sexual and reproductive health should contribute to unplanned adolescent pregnancies, sexually transmitted infections, and other conditions. Therefore, it is crucial to enable adolescents to access appropriate contraceptive methods easily. AIM:  This study explored factors influencing adolescents' access to contraceptive methods from the perspective of primary healthcare providers in South Africa. SETTING:  This study was conducted in two health districts of the Western Cape province in South Africa: the City of Cape Town Metropolitan Municipality and the West Coast district. METHODS:  Using a qualitative research design, in-depth semi-structured interviews were conducted with 24 healthcare providers who work in primary healthcare clinics. Subsequently, the interviews were transcribed and verified for errors. Braun and Clarke's thematic analysis model guided the data analysis using ATLAS.ti software (version 22). The study adhered to the consolidated criteria for reporting qualitative studies checklist for qualitative research. RESULTS:  Four themes emerged through the data analysis: (1) personal influences, (2) community-level influences, (3) health system influences, and (4) policy-level influences. Representative quotations were used to illustrate the themes and sub-themes. CONCLUSION:  Adolescence is shaped by various influences that affect adolescents' ability to access contraception. These factors include their awareness of contraception, social environment, provider biases and school policies. Understanding these influences is crucial for addressing unintended pregnancies and promoting sexual and reproductive health among this age group.Contribution: This study highlights strategies that facilitate and hinder adolescents' access to contraception.

Age at sexual debut: a determinant of multiple partnership among South African youth.

Age at sexual debut is an important determinant of HIV infection. The paper investigates the effects of age at sexual debut on sexual behaviour among South African youth. Among 2 875 respondents who ever had sexual intercourse, 39% had early sexual debut (sexual debut at age 16 years and below). Males (44.6%) were significantly more likely than females (35.1%) to report early sexual debut (odds ratio (OR) = 1.45, p-value < 0.001). Multiple sexual partners are significantly more common among those that had early sexual debut (10.4% vs. 4.8%) than those who had late sexual debut, (OR = 2.29, p-value < 0.001). Those aged 15 to 19 years were 1.4 times more likely to report multiple partners compared to those aged 20 to 24 years. Delaying sexual debut is a strategy many national programmes are promoting. The results of this study provide additional arguments to support such initiatives and show the need to strengthen intervention targeting youth.

Media messaging: a synthesis of lessons from the literature to inform HIV prevention amongst young people.

Based on a review of literature, we provide a number of challenges and lessons to inform HIV-prevention media messaging initiatives for the youth. When designing initiatives, it is imperative that the unique needs of the youth are taken into account, although the youth should not be seen as a homogenous group. The evaluation of initiatives is also important and external evaluators and implementers should work together and draw on methodological pluralism to produce the most useful evaluations. For media initiatives to be successful, all stakeholders need to support the intervention. A key challenge is working with communities who may be divided over approaches to HIV prevention. Young people should not only be the 'target' of messaging initiatives but should play a central role in their design and implementation. Exposure to media messaging is not a proxy for behaviour change. Initiatives should be based on explicit theories of the complex relationship between messaging and behaviour change. It is important for media messaging to engage with how structures constrain sexual choices. Messaging is most successful when it uses a multi-media approach and when it is combined with interpersonal communication. This type of pedagogy is dialogical and allows for engagement with the youth, challenging the view of the youth as passive recipients of messages.