Youth reproductive health services in Bulawayo, Zimbabwe

Abstract

This study examines young people's access to reproductive healthcare services via an urban youth advisory centre in Bulawayo, Zimbabwe. The aim is to explain why teenagers do not always use existing health services. Data from exit questionnaires with users and focus groups with non-users are analysed to evaluate service accessibility. Analysis suggests that even where clinics are spatially accessible, barriers to access include temporal factors, lack of factual knowledge and stigmatisation. The paper concludes that spatial accessibility is not the only factor necessary to ensure equal access to health services. Recommendations are made towards tackling young people's unmet needs for reproductive healthcare services.

Introduction

Young people are the future everywhere. Globally, there are 1.04 billion young people aged 15–24 years, 87% of whom live in developing countries and form an estimated 18% of the global population (UNFPA, 2000a). Almost 50% of Zimbabwe's 11.3 million population is under 18 years (UNICEF, 2000). Youth¹ are increasingly being recognised as a marginalised social group, both in terms of their access to health care and their relative neglect by policy makers (Mann and Tarantola, 1996) and academics, including geographers (Matthews and Limb, 1999; Holloway and Valentine, 2000; Matthews and Tucker, 2000; Matthews et al., 1998). In particular, aspects of the health geographies of young people have been subjected to limited investigation, with few exceptions like Hayes’ work on the impact of childhood experiences on health through the life course (Hayes, 1999). Overcoming health inequalities, including those faced by young people, is an issue of global concern to geographers (Kearns, 1997), healthcare providers and others. Health geography needs to take into account young people as both potential and actual recipients (as well as informal providers) of health care.

This paper focuses on evaluating efforts to meet young people's reproductive health needs. Poor reproductive health including high rates of early pregnancy and STD infection among adolescents are matters of concern for parents, teachers, youth workers, medical practitioners, and young people themselves who may face early parenthood, morbidity, criminality and even mortality. Effective delivery of health services to youthful populations can reduce risky behaviour, ameliorate its negative impacts and ensure good reproductive health.²

This paper is rooted in the premise embraced by the World Health Organisation (2000) and UNFPA (2000b) that reproductive health is a basic human right. Reproductive health embraces not just an absence of disease or infirmity, but a state of complete physical, mental and social well-being in all matters related to the reproductive system, its functions and processes. Reproductive good health includes having a safe and satisfying sex life, the capability to have children and the freedom to decide if, when and how often to do so. Furthermore, women and men of all ages have the right to information and access to safe, effective, affordable and acceptable methods of fertility regulation of their choice. Women have the right to health care for safe pregnancy and childbirth. Reproductive health care contributes to good reproductive health and well-being by preventing and ameliorating problems of reproductive health.

While there are very commendable programmes for the under-5's and attention paid to maternity services for women, the reproductive health needs of young people are often neglected by healthcare professionals and policy makers alike. Where targeted services do exist they often suffer from adultist bias, being designed by adults with little consultation with young people. Participation by children and young people is slowly being recognised as essential for effective development strategies (Johnson et al., 1998).³

Youth reproductive health is a key issue within the varied health geography of Southern Africa, and elsewhere. This case study contributes to tackling health inequalities by exploring the factors contributing to low utilisation of reproductive health services by young people, thus providing useful policy-informing research in regard to healthcare access.