Abstract
Background
Adolescents in low- and middle-income countries face high rates of unintended pregnancy, sexually transmitted infections (STIs), and unmet sexual and reproductive health (SRH) needs. In Uganda, 24% of girls aged 15–19 years have begun childbearing, yet modern contraceptive prevalence among adolescents remains low (15%). These challenges are particularly severe in the Busoga region, where sociocultural norms, poverty, and limited health system capacity hinder access to adolescent-friendly SRH services. Despite national guidelines, utilization remains low. Few studies have triangulated perspectives from adolescents, health providers, and community/religious leaders. We explored stakeholder views to provide an integrated understanding of factors influencing adolescent SRH service utilization in Busoga, Uganda.
Methods
An exploratory qualitative study was conducted in Iganga and Bugweri districts. Four focus group discussions with 38 adolescents (13–19 years), stratified by sex, age group, and residence, and 12 key informant interviews with health providers and community leaders were conducted. Adolescents were recruited through peer networks, while key informants were purposively selected. Data were collected (November–December 2024), transcribed verbatim, and analyzed inductively using thematic analysis with NVivo 14. Ethical approval and informed consent/assent were obtained.
Results
Adolescents, health providers, and community stakeholders described SRH service utilization as shaped by adolescent motivation alongside persistent barriers. Adolescents showed strong preventive intent, but uptake was limited by misconceptions about contraception, fears of infertility, long distances, lack of privacy, negative provider attitudes, and commodity stock-outs. Providers and community leaders echoed concerns around misinformation, limited parental guidance, moral norms, and structural constraints. All stakeholders converged on the need for confidential, accessible, and peer- and community-based adolescent SRH services.
Conclusion
Adolescents in Busoga are motivated to use SRH services, but intersecting sociostructural and system barriers limit utilization. Strengthening adolescent-friendly services, improving provider responsiveness, addressing misinformation, and expanding community-based delivery are essential to enhance equitable access.