Factors Influencing Access to Reproductive Health Information Services among Young Aged 15-24 in Garissa Municipality, Kenya

Abstract

Young people face severe threats to their health and general well being. They are vulnerable to sexual assault and prostitution, too-early pregnancy and childbearing, unsafe abortion, malnutrition, female genital cutting, infertility, anemia, and reproductive tract infections (RTIs) including STIs and HIV/AIDS (NCPD, 2006). Close to a half of women aged 15-19 in Kenya are sexually active and by age 20-24 years, almost all (90%) are sexually exposed, and that 84% of the women aged 15-19 are single girls, then a large proportion of never-married girls are in their sexually active period (KDHS,2003). This study was designed to look into demographic, economic, cultural, health factors and the knowledge, attitude and practices influencing the access to Sexual Reproductive Health (SRH) information services amongst the youth of Garissa. The qualitative and quantitative data were collected through structured face to face interviews, focus group discussions and key informant. Data was analyzed using SPSS (version 17). The data from the qualitative methods were analyzed by using the thematic framework analysis. Independent variables influencing the access to SRH information among the youth were determined using multiple logistic regressions. In conclusion the overall access to SRH information by the youth in Garissa Municipality was low and was mostly influenced by the economic factors, cultural, religious and societal norms that marginalize the youth and the overall lack of access and programs to address youth friendly SRH information. To address the challenges in the access to youth friendly reproductive health information in this setting it is our recommendation that improve the Clinical services to offer the youths with Contraceptive and STI prevention services, antenatal, perinatal, and postnatal care, STI diagnosis and treatment and lastly empower youths with RH and rights and HIV information and life skills education through community outreach programmes.

Full text

Research
Available Online at www.ijcrr.in
International Journal of Contemporary Research and Review
ISSN 0976 – 4852
https://doi.org/10.15520/ijcrr/2018/9/08/574
August, 2018|Volume 09|Issue 08|
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20537
Section: Medical Science
Factors Influencing Access to Reproductive Health Information Services
among Young Aged 15-24 in Garissa Municipality, Kenya
Fatuma I. Adan, Dr. M.N.Githae
Corresponding Author: Dr. M.N.Githae Received: 2018-07-10; Accepted 2018-08-09,
Executive Summary:
Young people face severe threats to their health and general well being. They are vulnerable to sexual
assault and prostitution, too-early pregnancy and childbearing, unsafe abortion, malnutrition, female genital
cutting, infertility, anemia, and reproductive tract infections (RTIs) including STIs and HIV/AIDS (NCPD,
2006). Close to a half of women aged 15-19 in Kenya are sexually active and by age 20-24 years, almost all
(90%) are sexually exposed, and that 84% of the women aged 15-19 are single girls, then a large proportion of
never-married girls are in their sexually active period (KDHS,2003).
This study was designed to look into demographic, economic, cultural, health factors and the knowledge,
attitude and practices influencing the access to Sexual Reproductive Health (SRH) information services
amongst the youth of Garissa. The qualitative and quantitative data were collected through structured face
to face interviews, focus group discussions and key informant. Data was analyzed using SPSS (version 17).
The data from the qualitative methods were analyzed by using the thematic framework analysis.
Independent variables influencing the access to SRH information among the youth were determined using
multiple logistic regressions.
Overall out of the 361 enrolled youths, majority 58.2% were males 51.8% were aged 16 to 20 years, 47.1%
were children to the household head including 22.4% who were themselves the household heads. Most
(64%) of these youths were single including 29.9% who were married (26.3% and 3.6% in a monogamous
and polygamous marriage respectively), almost all of the participants (95%) were Muslims and most 50.1%
of the youths belonged to either women, men or youth clubs in there locality.
Only about 35.7% of the youths stated or perceived that they had adequate up take of youth friendly
information and guidance on issues relating to sexual and Reproductive health verses 64.3% who lacked
these RH information.
Participants‘ location of origin was a key determinant on the level of access to RH information. Those from
the urban settings were more likely to access to these youth SRH information. Economic factors influencing
the access to RH information included; education levels and the willingness to seek the RH information.

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20538
Cultural norms preventing parents from freely discussing sexuality issues with their children because they
often consider the issue as a taboo and are also embarrassed by the subject, confined the youths in obtaining
these SRH information from their peer friends and from print and mass media. Among the health service
factors influencing access RH information on sexuality and reproductive health included; knowledge on
contraceptives, ability to readily discussed sexually related matters with parents, the number of sexual
partners, the approval of premarital sex and the age of debut for women. Overall their knowledge, attitude
and practices concerning RH information was as expected lower than that of bigger cities in Kenya.
In conclusion the overall access to SRH information by the youth in Garissa Municipality was low and was
mostly influenced by the economic factors, cultural, religious and societal norms that marginalize the youth
and the overall lack of access and programs to address youth friendly SRH information. To address the
challenges in the access to youth friendly reproductive health information in this setting it is our
recommendation that improve the Clinical services to offer the youths with Contraceptive and STI
prevention services, antenatal, perinatal, and postnatal care, STI diagnosis and treatment and lastly empower
youths with RH and rights and HIV information and life skills education through community outreach
programmes.
Introduction and Background Information:
General Introduction:
Reproductive health is ―a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity, in all matters relating to the Reproductive system and to its functions and
processes. Reproductive health information therefore implies that people are able to have a satisfying and
safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often
to do so .
RH Information is any kind of events that affects positively or negatively the state of reproductive health
system (Wikipedia accessed June 21 2011) Good reproductive health also means that men and women have
the information and means to protect themselves from harmful practices and sexually transmitted infections
(STIs) (ICPD 94) .
Reproductive health (RH) among the youth has gained increased attention among researchers, public health
experts and policy makers over the past decade. The 1994 International Conference on Population and
Development (ICPD) marked a paradigm shift by recognizing that youth have unique needs and
vulnerabilities. Many youth increasingly become sexually active before the age of 20 (WHO, 2003) and
many face difficulties in obtaining reproductive health care. They are also typically poorly informed about
how to protect themselves from pregnancies and sexually transmitted diseases (STDs).
Youth need a basic understanding of how their bodies work and the reproductive health concerns they face,
as can be provided through family life education. They need ways to develop stronger interpersonal skills
(for example, how to avoid unprotected sex). They should know about specific health services available to
them (treatment for sexually transmitted diseases, contraception and post abortion care) and how to obtain
commodities (condoms and other contraceptives, drugs for treatment and educational materials). They
should be aware that the choices they make today could help or harm them and those they love, perhaps with
lasting consequences (.Nancy E, FHI 2000)
Kenya‘s population is currently estimated at 38.7 according to the results from the last census (CIA World
Fact book, 2009). About half of the population is the youth. The social, economic, and cultural repercussions
of uninformed behavior by youth pose a serious threat to the country‘s growth and development. Unwanted
pregnancies, sexually transmitted diseases (STDs), abortions, and the related consequences of dropping out
of school, ill health, unemployment, and poverty burden all of society and jeopardize its future
stability(MOH, 2005; UNAIDS, 2006)

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20539
The Republic of Kenya highlighted these vulnerabilities and called for greater recognition of youth as a
special category with special needs. It emphasized the need to provide them with sexual and reproductive
health services and services and for adoption of integrated and comprehensive approaches to reproductive
health (RoK, 2004). Researchers have explored the need to provide youth-friendly sexual and reproductive
health services to curtail exposure to sexual health risks of unintended pregnancies, sexually transmitted
infections (STIs) including HIV/AIDS, and early sexual debut (McIntyre, 2002; Dehne and Riedner, 2005).
Despite the call by ICPD and Kenya‘s commitment to the Program of Action, youth in Kenya lack access to
sexual and reproductive health services. Also, despite evidence that youth face sexual health risks, the
perception of ‗healthy youth‘ persists. Youth globally access health services less frequently than expected
and are more likely to seek services after sexual exposure (Hocklonget al., 2003). Although youth both in
the developed and developing countries face challenges in accessing reproductive health services, there exist
regional differences with youth in developing countries facing greater challenges.
Although there is substantial literature about adolescent-friendly services, few studies have looked at the
factors determining the extent to which youth access and utilize existing services. Still, whereas ‗adolescent-
friendly services‘ and ‗youth- friendly clinics‘ are seemingly global concepts, and the norm in developed
countries and certain urban areas of developing countries, adolescent-friendly services are largely lacking in
developing countries. The marginalization of rural areas creates further challenges for youth wishing to
utilize preventive reproductive health services (PRHS). Attempts to provide youth with reproductive health
services have focused mainly in the urban areas leaving out the rural areas. However, even in the urban
areas, the services are offered alongside those of the adults and this makes them untailored to SRH needs of
young people.
Informing the youth about appropriate and acceptable behaviours and ways to protect them against
unwanted and unprotected sex has proved problematic in Kenya (RH Research agenda report for Kenya,
2008). Education programmes for in and out of school youth are lacking, there is controversy around
providing services to sexually active youth, and a pervasive concern that sexuality education and
contraceptive services leads to promiscuity (Frontiers in Reproductive Health, 2004).
Background Information of Garissa District:
Geographical Information:
Garissa District is one of the 11 districts that make up North Eastern Province and it covers an area of
432,599 Km2. The District borders Wajir District to the North, Tana River District to the South, Isiolo
District to the West and the Republic of Somalia to the East. Garissa District is divided into 4 divisions, 15
Locations and 27 Sub-locations. The district covers an area of 5,688.1 km2 and lies between latitude 10 25‘ N
and 00 45‘ S and longitude 390 45‘E and 380 45‘E.
Demographic Profile:
Garissa District has a higher proportion of young population; 23.4% who are children and 7.5% youth
(Republic of Kenya, 2002). In the District the age of marriage is between 15 and 17, and the median age at
first birth is 18 years, compared to 20 years nationally.
Economic Profile:
64% of the populations live below the poverty line. The causes of the extreme poverty is attributed to poor
infrastructure, poor access to education and health services, extreme draught, inadequate water and
sanitation and poor development of the agricultural sector ( GDP, 2008).

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20540
The community predominantly lead pastoral livelihood which is their economic mainstay. However a few
practice crop farming along the fertile banks of the Tana River using furrow and canal irrigation methods.
The area is hot and dry much of the year, receiving scarcity rainfall of 150-300mm annually. Temperatures
range between 250C- 380C.The hot months are between December and March with February being the
hottest.
Health Status:
The incidence of HIV/AIDS is estimated at 11% (KAIS, 2009) Garissa has the highest rates of pregnancy
and lowest rates of ante-natal clinic attendance. With limited access to health services, few women give
birth in health facilities. As a result, Garissa has high maternal and child mortality and poor health status,
compared to other major Kenyan towns with mother aged 15-24 being affected largely Young people in
Kenya especially Garissa District has limited knowledge of reproductive health, and faces many challenges
in their transition to adulthood. Chief among these challenges is the high prevalence of HIV/AIDS among
adults and its increasing incidence among rural youth (Frontiers in Reproductive Health, 2004).
The most prevalent diseases in the Division are Malaria, Diarrhea, Intestinal worms, ENT infections and
URTI, Typhoid fever, Malnutrition and skin diseases. HIV and AIDS prevalent rate is low at 2.7% as
compared to 6.7% at the national level (GDDP, 2008-2012).
Problem statement:
According to the KDHS 2009 only 17.4% of NEP have access to 3 sources of information once a week
compared to Nairobi of 75% , Central 43% and Nyanza 29% (KDHS,2009).
About half of the population is the youth. The social, economic, and cultural repercussions of uninformed
behavior by youth pose a serious threat to the country‘s growth and development. Unwanted pregnancies,
sexually transmitted diseases (STDs), abortions, and the related consequences of dropping out of school, ill
health, unemployment, and poverty burden all of society and jeopardize its future stability(MOH, 2005;
UNAIDS, 2006)
Negative attitudes of service providers and communities have been cited as important barrier to youth
access to reproductive health information services in Kenya and NEP in particular. These attitudes are
greatly influenced by religious and cultural backgrounds, professional training and orientation. Assessing the
feelings of service providers helps determine training needs and other staff, operational, and structural
(MOH 2005).
The health needs of youth as a group have been ignored by existing health services. The response of
societies to the reproductive health needs of adolescents is not based on information that helps them attain a
level of maturity required to make responsible decisions but on culture and religious stigma‖ Services that
are not accessible, acceptable and appropriate for adolescents. They are not that the right place at the right
price (free where necessary) and delivered in the right style to be acceptable to young people. They don‘t
meet the individual needs of young people who return when they need (FHI2006).
In Garissa, discussions on providing reproductive health services including information to young people
have always been sensitive. This is borne out of cultural and traditional orientation on matters related to
sexuality. Some sections of the community are concerned that providing such services may encourage
sexual activity among young people. Though research has shown that this is not true, program planners need
to be aware of this as they seek to mobilize the widest community support for youth services (MOH 2005).

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20541
While significant progress has been done in other part so the country in providing SRH information services
to the youth, little is ongoing in Garissa municipality therefore the need to explore what are the issues
affecting the access to SRH information services among the youth in Garissa is paramount.
Research Questions:
The overall research question for this study is what are the factors affecting access to RH information
amongst the youth in Garissa municipality
Specific objectives:
The main objective of this study is to determine the factors influencing the access to reproductive health
services among the youth in Garissa Municipality.
1. To determine the demographic characteristics affecting accessing to RHI services among the youth in
Garissa Municipality.
2. To establish the socio-cultural reasons affecting access to RHI services among the youth in Garissa
Municipality.
3. To assess the economic features affecting access to RHI services among the youth in Garissa
Municipality.
4. To assess the health service aspects affecting access to RHI services among the youth in Garissa
Municipality.
5. To establish the knowledge and attitude of the youth influencing access to RHI services among the
youth in Garissa Municipality.
Justification of the Study:
Although much information on youth RH in Kenya can be obtained from various studies done over the years,
these studies have tended to be institutional based, having been carried out in a subset of this category or those
already in the RH settings. Studying the youth in isolation from the community setting provides information
that is divorced from the context within which SRH activities take place. As ways and means of educating the
youth on issues pertaining to their sexuality and fertility are discussed and explored, an understanding of the
factors that draw the youth into accessing of RH services is crucial.
This study will therefore be very invaluable in opening avenues to assess reproduction health status of the
youth as well as providing findings to instigate and advocate for positive changes where applicable.
Literature Review:
Introduction:
Review of studies that had been carried out globally in relation to Reproductive Health Information services
was undertaken. The aim was to identify what had been done, any gaps and what could be replicated to
improve access to RHI services among the youth in Garissa district. The review focused on demographic
characteristics, economic features, cultural aspects, health service elements and knowledge and attitude
towards the RHI services.
Demographic Characteristics affecting access of RH information:
2.1.1 Age:
Reproductive health affects, and is affected by, the broader context of people's lives, including their age,
education, marital status, environment, and the traditional and legal structures within which they live.

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20542
Sexual and reproductive behaviours are governed by complex biological, cultural and psychosocial factors.
Therefore, the attainment of reproductive health is not limited to interventions by the health sector alone.
Nonetheless, most reproductive health problems cannot be significantly addressed in the absence of health
services and medical knowledge and skills (UNFPA, 2010).
In 2003, youth aged 10-24 years made up approximately 36% of Kenya‘s total population, and adolescents
ages 10-19 made up almost 26% of the population. Progress towards improved RH among youth in recent
years has been mixed in Kenya. Comparing the 1998 and 2003 Kenyan Demographic and Health Surveys
(DHS) reveals both positive and negative trends, though not all the differences are statistically significant.
On the positive side, the median age at first sex has risen from 16.7 years in 1998 to 17.8 in 2003, with
women living in rural areas having their first sex almost a year earlier than those living in urban areas.
Sex:
The status of girls and women in society is a crucial determinant of their reproductive health. Educational
opportunities for girls and women powerfully affect their status and the control they have over their own
lives and their health and fertility. The empowerment of women is therefore an essential element for health
(UNFPA, 2010).
Young women age 15-19 and rural women are least likely to be counseled, tested, and to receive their HIV
results. Nairobi has the highest percentage of women who were counseled about In 2008-2009 HIV during
antenatal care, offered a test, accepted it, and received the results (86 percent), while North Eastern province
has the least (11 percent). The survey results show that HIV counseling and testing during antenatal care
increases with the level of education.
Young women in North Eastern province reported the lowest use (2 percent) as either family planning North
Eastern province where Garissa is the provincial is has the lowest (16.7 %) levels of knowledge for all
methods of reducing the risk of contracting HIV/AIDS, compared to Nairobi 85.9% and Central province
(82.8%) tend to have the highest levels of knowledge (KDHS 2008). North Eastern province has the lowest
percentage of contraceptives used (0 percent).
Economic factors affecting access to RH information amongst the youth:
Household income:
Alderman and Lavy (1996) emphasized the need to look at the quality of health services. They noted that in
deciding whether to seek care and which provider to consult, households base their choice on many factors,
such as availability of drugs, doctors, hours, and clinical service, the adequacy of equipment and the
physical condition of health care facilities. Despite the widespread agreement on the value of providing
health services of adequate quality, the care available to youth in the developing world is far from
satisfactory. Counselling and access to sexual and reproductive health information and services for youth are
still inadequate or lacking and this can be quantified in an economic context. Also youth right to privacy,
confidentiality, respect and informed consent is often not considered (United Nations, 1999).
Access to health services has to do with quantity and procedure of health care services. Documented
operational factors that affect use of sexual and reproductive health services include the following: high cost
of care and services, inconvenient hours of operation, affordable transportation, travel time and opportunity
costs linked to it, perceived quality of care and provider behaviour (Hocklong et al. 2003). Operational
constraints also present challenges for service providers, even when there is willingness to provide care.
Neckermann (2002) observed that if public health facilities are not able to deliver basic health services to the
general population, it would be hard to make them youth-friendly.

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20543
Cultural factors affecting access to RH information:
Patriarchal gender constructions contribute to gender based violence amongst the youth. Although violence
has its roots in political and economic inequality, violence also stems from gender identification in terms of
masculinity and femininity: it is an expression of identity and the way in which identity is constructed and
reconstructed by society (Ulrike, 2003). A study based in South Africa showed that violence is strongly
influenced by community norms regarding the use of violence to resolve conflict, women‘s challenge of
traditional gender roles, and sexist attitudes among men (Jewkes, 2002). GBV has important implications for
RH and sexual behaviour. Studies have identified a strong link between GBV and HIV (Dunkle et al, 2004;
Garcia-Moreno and Watts, 2000) and other negative RH outcomes such as maternal mortality, poor outcome
of pregnancy and birth (Curry et al, 1998), gynecological morbidity (Schei and Bakketeig, 1989), nonuse of
contraceptives and unwanted pregnancies (Jewkes et al, 2001). GBV may contribute to HIV infection
directly through transmission of HIV during rape and indirectly through increasing vulnerability to risky
sexual behaviour. Women who live in abusive relationships are less likely to be able to negotiate in sexual
relationships or suggest condom use (Pulerwitz et al, 2000). Sexual abuse in childhood and intimate partner
violence in adulthood may lead to sexual risk taking (Dunkle et al, 2003; Pulerwitz et al, 2000), and partner
violence inhibits women from adopting self-protective practices such as condom use and access to voluntary
counseling and testing (VCT) for HIV (Gupta, 2000; Jewkes et al, 2003; Ulrike, 2003). In addition, male
perpetration of sexual violence is associated with lower condom use and with higher rates of STIs (Baker
and Acosta, 2002).
Historically, the ethnic Somalis that constitute the majority of Kenya‘s North Eastern Province (NEP) have
been largely isolated from other regions in Kenya, both culturally and geographically. One benefit of this
isolation was that their traditional Islamic practices, nomadic pastoral lifestyle, and remote location kept
them relatively untouched by the HIV epidemic and other reproductive health issues affecting the rest of the
country. But in recent years, new technology such as mobile phones, increasing road traffic between
provinces, shifting cultural practices and norms, and population changes are working together to change the
way all Kenyans interact, including the residents of NEP (Kenya Demographic and Health Survey 2003;
Kenya AIDS Indicator Survey, 2007). Currently there are no studies among the youth in Garissa District on
the effect of these rapid changes countrywide on the availability of reproductive health information and
knowledge and concomitant ACCESS of this information to protect themselves from reproductive health
risks
Health services factors affecting access to RH information:
Relationship between health workers and clients:
Among the factors which have been cited as reasons for under-utilisation of reproductive health services
include poor relationships between health care professionals and their clients, long waits, administrative red
tape, lack of emotional support and privacy, differences in language and culture between health
professionals and their clients, rude medical staff, and the often-expected ‗gift‘ for medical attention (Naré,
Katz and Tolley, 1997). While quoting Mensch (1993), Naré, Katz and Tolley observed that interpersonal
process is the vehicle by which health care is implemented and on which its success depends. Thus, the
relationship between the patient and provider should be characterized by privacy, confidentiality, informed
choice, concern, empathy, honesty, tact [and] sensitivity. Mensch further observed that the dimension of
health infrastructure cannot be ignored and that there is need to focus on such elements as equipment and
facilities, staff and training, supervision, record-keeping and supplies. However, according to Mensch, few

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20544
studies have looked at the infrastructure to determine the quality of care being provided, and that there are
few studies on the quality of care of fixed facilities.
Effective reproductive health care addresses problems from birth with appropriate and culturally sensitive
education and health care programmes (WHO, 2000b). For example, sexually active youth who lack
accurate knowledge about reproductive health, and lack access to reproductive health services, including
contraception, cannot protect themselves from pregnancy and STI/HIV (WHO, 2000b).
In relation to care, health has been defined as the extent to which an individual or group is able on the one
hand, to realize aspirations and satisfy needs, and on the other to change or cope with the environment.
Health is therefore seen as the resource for everyday life and not the object of living. Health is a positive
concept emphasizing social and personal resources, as well as physical capacities. The assumption that the
definition makes is that individuals or groups of people often know their health needs and therefore have to
negotiate or access means of satisfying them. This may however often not be the case particularly on issues
of sexual and reproductive health. Unless individuals know their needs, and are able to defme them within
the social and cultural settings, they are unlikely to address them.
Accessibility to reproductive health services is considered an essential component in fulfillment of
individuals‘ right to health in all its forms and at all levels. Accessibility to health facilities and health
services is determined by components such as non-discrimination, physical accessibility, affordability and
access to information (Hogerzeil, 2003). Theoretical models that describe access view it as a fit between
predisposing factors on one side, and enabling and health system factors on the other. Predisposing factors
include individual perceptions of an illness, population specific cultures, as well as social and
epidemiological factors. Enabling factors refer to the means available to individuals for using health
services. Health systems factors refer to resources, structures, institutions, procedures and regulations.
According to Klein et al. (2001), access to preventive health services could increase healthy habits and in
turn minimize behaviour risks that youth are exposed to. However, the potential for alleviating health
problems by targeting young people has been largely ignored (Goodbum and Ross, 2000). Regrettably, the
risky behaviour of youth tends to increase while their participation in health care tends to decrease (Cohen,
2002).
Knowledge and attitude of the youth, influencing access to RH services:
Knowledge on HIV and STIs:
According to Sebastian and Ishraq 2004, Positive changes in knowledge and attitudes relating to sexual and
reproductive health among young people include changes in attitudes about culturally rooted practices, such
as early marriage and female genital cutting.
Although general awareness about HIV/AIDS is widespread, i.e., greater than 97% among out of-school
youth, less than half of these young people are aware of HIV prevention methods and greater than 40% hold
myths and misconceptions about HIV transmission, according to the 2002 Kenya HIV/AIDS and STIs
Behavioral Surveillance Survey (BSS). Most Kenyans have heard of HIV/AIDS, but there is vast need for
greater behavior change, especially among youth who are ill-equipped to protect themselves against
unwanted and/or unprotected sex. Few youth seek HIV counseling and testing, and there are limited services
designed specifically for youth, particularly in rural areas (Frontiers in Reproductive Health, 2004; van Eijk
et al., 2008).

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20545
Education continues to be a critical factor in the HIV/AIDS epidemic, as the 2003 DHS demonstrated
increased accepting attitudes of HIV as level of education rose. Education is also a determinant of risky
behavior, particularly for young women. Females with some secondary education are less likely to undertake
risky sexual behavior, and among males, level of education positively impacts their use of condoms. Poverty
also plays a significant role, as 16% of young women ages 15-19 report receiving money, gifts, or favors for
sex. Furthermore, sexual coercion and violence play a serious role in the transmission of HIV among youth
in Kenya. A 2001 population-based survey in Nyeri done by the Population Council (that included a special
module on sexual coercion) showed that among sexually experienced respondents, 21% of females and 11%
of males had experienced sex under coercive conditions. For females, sexual coercion was associated with
having had multiple partners and a reproductive tract infection, and for males, it was associated with having
had a first sex partner who was five or more years older (Frontiers in Reproductive Health, 2004; van Eijk et
al., 2008).
According to the National AIDS Control Council (NACC) report 2002, an estimated 2.2 million Kenyans
are infected with HIV/AIDS; Adolescents are more vulnerable to HIV/AIDS infection. Young women in the
age groups 15-19 and 20-24 years are more than twice as likely to be HIV/AIDS infection. Young women in
the age groups 15-19 and 20-24 years are more than twice as likely to be infected as males in the same age
group. It is estimated that about 20 per cent of all reported AIDS patients are young people aged 15-24
years. Sexual contact accounts for 80-90 per cent of all infections, while the rest is due to exposure to
infected blood and mother-to-child transmission. Mother- to-child transmission is expected to increase
because of the high incidence of HIV among young women and will greatly affect infant and child mortality.
Kenya now has about 900,000 AIDS orphans, of whom about 78,000-aged 0-14 are infected with the virus.
This number of orphans is projected to reach 1.5 million by the year 2005. Increases in the mortality rates of
both children and young adults will have a substantial impact on life expectancy at birth. Sexually
transmitted infections, especially those that cause ulcerations to the genital area, significantly increase HIV
transmission rate - as much as 10 per cent. On the other hand, STIs are not easily detectable amongst
females, which become an intervention challenge.
Safe Motherhood:
Safe motherhood aims at assisting all women to go through pregnancy and childbirth with the desired
outcome of a live and healthy baby and mother. Current safe motherhood programmes include preventive
and health promoting activities encompassing family planning, antenatal care, safe delivery, postpartum care
and maternal nutrition. However, these services are not equitably accessible to female adolescent users in all
parts of the country. At the current estimate of 590/100,000 live births, Kenya's maternal mortality rate is
unacceptably high. Adolescents are more likely to suffer pregnancy related complications than older women
owing to their relative immaturity as well as preventable causes such as malnutrition, infectious diseases and
haemorrhage, malaria, and inadequate health care and supportive services, particularly in rural areas. A
significant contributor to maternal morbidity and mortality is unsafe abortion.
Reproductive Rights:
Reproductive rights, embracing certain basic human rights that are already recognized in Kenyan law and in
International human rights conventions and other consensus documents have emerged as a separate area of
concern requiring attention. These include the right of the youth to appropriate and relevant information and
services. Furthermore, those youth who are infected with HIV/AIDS have the right to receive health care

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20546
without being discriminated against because of their status. Denial of reproductive rights to young people
negatively affects their general well being.
Unsafe Abortion:
Unsafe abortion contributes significantly to maternal morbidity and mortality. The majority of women
seeking care for unsafe abortion complications are below 25 years of age. Effective advocacy and service
provision to reduce the need for unsafe abortion are not adequate. The promotion of knowledge and
adoption of appropriate attitudes towards abortion related issues will be enabled by this Policy. This includes
correct and adequate information where adolescents are found, as well as improved access to contraceptive
and post-abortion care Services.
Government facilitated policies on youth RH information services:
The 1997 Sessional Paper No. 4 on AIDS (RoK-MoH, 1997). The paper stipulated the need to target young
people with HIV/AIDS programmes. It recognized the need for strong political commitment in the
implementation of a multisectoral prevention and control strategy (RoK-MOH, 2001 a). It also highlighted
the government‘s role in co-ordinating HIV/AIDS prevention activities and programmes, especially
programmes that would delay the onset of sexual activity among young people. Further, the paper
emphasized the need to harmonize the age of consent, marriage and maturity to 18 years and to encourage
voluntary testing (RoK-MOH, 2001a). In response to the Sessional paper, the government embarked on
programmes aimed at awareness creation, education, condom distribution and STD management.
The “Condom Policy and Strategy” (RoK-MoH, 200 ib). The strategy aimed at enhancing access to
condoms by all sexually active Kenyans at affordable prices. It identified youth-friendly condom distribution
systems as key in increasing demand for and use of condoms. The government hoped to increase access to
information especially to the youth on HIV/AIDS, cultural and social development during the youth,
biological changes, and how to respond appropriately to these transitions without endangering their lives or
their reproductive health. The strategy emphasized development and adoption of appropriate behaviour, and
avoidance of exposure to risks of infection.
In 2001, the government developed the National Guidelines for Voluntary Counseling and Testing (RoK-
MoH, 2001c). The guidelines aimed at ensuring the provision of standardized and good-quality VCT
services. VCT counselors are trained using the national VCT curriculum. They are trained to administer and
read the same-day, the rapid HIV test. This allows test results to be shared before clients leave the facility.
Voluntary counseling and testing (VCT) is described as a powerful weapon against the spread of HIV/AIDS,
and a key entry point for needed medical, psychological, social, and legal interventions for HIV-positive
persons and their families. Interventions include treatment and prevention of opportunistic infections;
prevention of mother-to-child transmission of HIV; home-based care; orphan support; and post-test clubs
(USAID, 2003).
Recently in 2003, the government facilitated the development of “Adolescent Reproductive Health and
Development Policy” (RoK, 2003a). The policy was published in May 2003, and launched in October 2003
by the National Council for Population and Development (NCPD) of the Ministry of Planning and National
Development, jointly with the Division of Reproductive Health of the Ministry of Health. It recognized the
need to access information and services to youth. Despite efforts by the government, Kenya‘s youth have
been denied IEC and quality reproductive health services for years (Eschborn, 2002). This denial is
associated with high HIV prevalence among young people aged 15 — 24 years (Neckermann, 2002). Also,
despite the effectiveness of the VCT strategy, VCT services may only benefit youth aged 18 years.

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20547
Knowledge on RH services:
According to KDHS 2009 only 17.4% of the entire NEP are able to radio, television and newspaper once a
week compared to 75% in Nairobi, 43% Central and Nyanza29%
Informing adolescents about appropriate and acceptable behaviors, and ways to protect them against
unwanted and unprotected sex has proved problematic in Kenya. Parents, teachers, religious and community
leaders, and health care providers are all expected to educate adolescents about personal and physical
development, about relationships with each other, and about their roles in society, but their capacity to do so
in a comfortable, open and unbiased way is clearly lacking. Consequently, many adolescents rely on the
media and their friends and peer for sexual and reproductive health services, sources which are notoriously
poor at providing accurate and appropriate information (UNPIN, 2009).
Summary of literature review:
Theoretical statement:
What factors affect reproductive health behaviors of any population especially among the youths?
Demographic, economic, behavioral, social characteristics and availability, accessibility, affordability of
health services for youth may interact with each other and affect the access to RH services hence impact the
decision-making process of reproductive health behavior (St. James et al., 1993).
Operational Framework
Methodology and Materials:
This was a descriptive cross-sectional study designed to determine the factors that influence the access to
RH information services in Garissa Municipality. The methodology adopted in this research was pragmatic

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20548
approach where both quantitative and qualitative methods were applied in order to capture the key elements
of the research purpose and objectives. This was done through the use of pre-designed questionnaires,
focused group discussions and key informant interviews.
The study population was the youth of both sex aged between 15-24 years residing the district, cluster
sampling procedure was used, and the 5 villages in were included. Each village in the district acted as a
cluster. Structured questionnaires were then administered to collect data from 361 participants. Equal
proportion of youths from the predetermined population was randomly picked so as to give equal sample
size based on their population. These youths were then consented and enrolled in the study. Data was
collected using face to face interviews using semi-structured questionnaires and key informant interviews.
Results:
Demographic characteristics:
A total of 361 youths meeting the recruitment criteria were consented and enrolled in this study. There were
two location peaks Iftin (32.4%) and Township (30.2%) where majority of them were recruited from (2 =
89.845; df = 4; P = 0.0001) (Figure 1). In terms of sub-location or the village of origin, majority (30.2%)
were from Iskadek sub-location/village (2 = 15.321; df = 3; P = 0.002) (Figure 2).

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20549
Figure 1: Location of origin
Figure 2: Sub-Location of origin
Table 1 shows additional participants demographic information. Of the 361 enrolled youths, majority 58.2%
were males (2 = 10.737; df = 1; P = 0.0001), 51.8% were aged 16 to 20 years (2 = 250.645; df = 3; P =
0.0001), 47.1% were children to the household head including 22.4% who were themselves the household
heads (2 = 298.097; df = 5; P = 0.0001). Most (64%) of these youths were single including 29.9% who
were married (26.3% and 3.6% in a monogamous and polygamous marriage respectively), almost all of the
participants (95%) were Islam including 3% Christians (2 = 966.764; df = 3; P = 0.0001). lastly, most
(50.1%) were in various or belonged to either women, men or youth clubs in there locality (2 = 216.917; df
= 3; P = 0.0001)..

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20550
Table1:DemographicCharacteristics
Characteristics 2df P - value
Frequency Percent
Gender
Male 210 58.2
Female 148 41 10.737 1 0.001
Not Known 3 .8
Age group (years)
> 15 19 5.3
16 - 20 187 51.8
21 - 25 135 37.4 250.645 3 0.001
26 - 30 14 3.9
Not Known 6 1.7
Relationship to household
Head 81 22.4
Spouse 49 13.6
Child by birth 170 47.1 298.097 5 0.0001
child by relationship 28 7.8
Grand child 20 5.5
Others 10 2.8
Not Known 3 .8
Marital status
Married monogamy 95 26.3
Married polygamy 13 3.6
Single 231 64
Widow (er) 5 1.4 693.006 5 0.0001
Divorced 11 3
Underage 3 .8
Not Known 3 .8
Religion
None 2 .6
Islam 343 95
Catholic 8 2.2 966.764 3 0.0001
Protestant 3 .8
Not Known 5 1.4
Belongning Group
None 129 35.7
women/ men/ youth 181 50.1
Church 7 1.9 216.719 3 0.0001
Clubs 39 10.8
Not Known 5 1.4
2 - chi squar; df - degrees of freedom; P value - Level of sugnificance
Sample Size

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20551
Economic Characteristics:
Majority 68.4% of the participants had some form of the main source of income including (ranging from
21.3% livestock farming to 7.5% from remittance of one from). About 24.7% had no main source of income
with 6.9% not indicating on this issue (2 = 74.157; df = 6; P = 0.0001) (Figure 3).
Figure 3: Main source of income
Table 2 shows additional economic characteristics of the study participants. Majority (34.1%) had secondary
level education including 12.5% with tertiary level education with about 10.5% not having any form of
education (2 = 145.571; df = 5; P = 0.0001). In terms of housing, majority 65.9% of them occupied
permanent structure housing with about 15% occupying the Somali hut housing type (2 = 338.092; df = 3;
P = 0.0001). Majority 55.4% of them were able to pay for the reproductive health services with about 21.9%
of them being unable to pay for these services (2 = 209.196; df = 3; P = 0.0001). Lastly, most 58.4% of
them were willing to seek the youth friendly reproductive health services and only about 4.7% not willing to
seek these services (2 = 373.266; df = 4; P = 0.0001).

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20552
Table 2: Economic characteristics
Characteristics 2df P - value
Frequency Percent
Main source of income
None 89 24.7
Crop farming 38 10.5
Livestock farming 77 21.3 74.157 6 0.0001
Self employed 55 15.2
Salaried 50 13.9
Remittance 27 7.5
Not Known 25 6.9
Education Level
None 38 10.5
Primary 100 27.7
Secondary 123 34.1 145.571 5 0.0001
Tertiary 45 12.5
Duksi 27 7.5
Madrasa 24 6.6
Not Known 4 1.1
Housing types
Permanent 238 65.9
Semi permanent 46 12.7
Temporary materials 19 5.3 338.092 3 0.0001
Somali hut 54 15
Not Known 4 1.1
Ability to pay for RH services
Able 200 55.4
Not able 79 21.9 209.196 3 0.0001
Sometimes 64 17.7
Not Known 18 5
Willing to seek youth friendly
RH services
Able 211 58.4
Not able 65 18
Sometimes 55 15.2 373.266 4 0.0001
Not willing to seek 17 4.7
Not Known 13 3.6
2 - chi squar; df - degrees of freedom; P value - Level of sugnificance
Sample Size

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20553
Factors associated with uptake of youth friendly information service:
In this study to address the factors affecting the uptake and probably usage of this information the perceived
availability of adequate information and guidance on issues relating to sexual and reproductive health by the
youths was used as a measure to the level of uptake of the RH information services. This idea in this study
was captured in the following question ―in your opinion, do you think adolescents/youth have adequate
information and guidance on issues relating to sexual and Reproductive health?” A response YES was
taken to indicate adequate uptake and utilization of reproductive health services among the youth in Garissa
Municipality while a NO response indicated in adequate uptake of this information.
Based on this definition, there was very inadequate up take of youth friendly information and guidance on
issues relating to sexual and Reproductive health. Only a total of 129 of the 361 (35.7%) youths stated or
perceived that they had adequate up take of youth friendly information and guidance on issues relating to
sexual and Reproductive health verses 232/361 (64.3%) who lacked these RH information (2 = 29.388;
df = 1; P = 0.0001) as shown in figure 4.
Figure 4: Uptake of sexual and reproductive health information
Demographic factors associated with uptake of RH information service:
Table 3 shows the demographic factors associated with uptake of RH information on sexuality and
reproductive health. In bivariate analyses, participants who were recruited from Medina and Township
locations were more likely to utilize or take the RH information compared to those from Iskadek P = 0.008
(PR 3.01, 95% CI 1.33 to 6.76) and P = 0.008 (PR 2.91, 95% CI 1.32 to 6.37) respectively. On the other
hand participants from Iftin sub-location were less likely to take the RH information compared to those from
Sambul P = 0.007 (PR 0.36, 95% CI 0.17 to 0.76). Lastly those participants who were spouses to the head of
household were on the border line less likely to uptake the RH information P = 0.054 (PR 0.35, 95% CI 0.12
to 1.02).

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20554
Table 3A: Demographic factors associated with RH uptake:
Characteristics Sample Size Bivariate
Frequency Percent P - value
Location
Iftin 117 26 22.2 0.536
Iskadek 41 7 17.1 Referent
Medina 68 35 51.5 0.008
Sambul 26 7 19 0.394
Township 109 54 49 0.008
Sub-Location / village
Iftin 77 10 12.9 0.007
Sambul 67 24 35.8 Referent
Township 108 53 49.1 0.201
Iskadek 109 42 38.5 0.776
Gender
Male 210 83 39.5 0.157
Female 151 46 31 Referent
Age group (years)
> 15 19 15 78.9 0.47
16 - 20 187 65 34.7 0.538
21 - 25 135 42 31.1 0.427
26 - 30 14 4 28.7 0.464
Not Known 6 6 1.7 Referent
P value - level of significance
Uptake of RH Infromation

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20555
Table 3B: Demographic factors associated with RH uptake
Economic factors associated with uptake of RH information service:
Table 4 shows the economic factors associated with uptake of RH information on sexuality and reproductive
health. In bivariate analyses economic factors that were more likely to influence the uptake of the RH
information included; education those with primary education P = 0.036 (PR 3.5, 95% CI 1.08 to 11.35),
secondary level education P = 0.038 (PR 3.43, 95% CI 1.07 to 11.04) and those who attended Madrasa
education level P = 0.03 (PR 4.12, 95% CI 1.15 to 14.78) were more likely to uptake RH information than
Characteristics Sample Size Bivariate
Frequency Percent P - value
Relationship to household
Head 81 25 30.8 0.376
Spouse 49 8 16.3 0.054
Child by birth 170 78 45.8 0.989
child by relationship 28 8 28.6 0.375
Grand child 20 4 20.0 0.195
Others 13 6 46.2 Referent
Marital status
Married monogamy 95 28 29.5 0.975
Married polygamy 13 2 15.4 0.976
Single 231 91 39.4 0.974
Widow (er) 5 0 .0 0.974
Divorced 11 6 54.6 0.975
Underage 6 2 33.3 Referent
Religion
None 7 4 57.1 Referent
Islam 343 119 35 0.943
Christianity 11 6 54.6 0.28
Belongning Group
None 134 47 35.1 0.161
women/ men/ youth 181 69 38.1 0.097
Church 7 5 71.4 0.029
Clubs 39 8 20.5 Referent
P value - level of significance
Uptake of RH Infromation

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20556
those who did not attend any form of schooling. Lastly, participants who were willing to seek these RH
information P = 0.004 (PR 2.93, 95% CI 1.42 to 6.04) and those willing sometimes to seek these RH
information P = 0.001 (PR 4.75, 95% CI 1.84 to 12.36) were more likely to uptake the youth friendly RH
services than those who were not willing to seek these information. In multivariate analysis those
participants who sometimes were willing to seek RH information P = 0.011 (PR 5.36, 95% CI 1.47 to 19.64)
was the only factor which remained associated with uptake of RH information.
Table 4: Economic factors associated with RH uptake
Characteristics Sample Size Bivariate
Frequency Percent P - value
Main source of income
None 114 36 31.6 Referent
Crop farming 38 14 36.8 0.426
Livestock farming 77 39 50.7 0.3
Self employed 55 17 30.9 0.06
Salaried 50 17 34.0 0.487
Remittance 27 6 22.2 0.37
Education Level
None 42 16 38.1 Referent
Primary 100 39 39.0 0.036
Secondary 123 47 38.2 0.038
Tertiary 45 13 28.9 0.136
Duksi 27 3 11.1 0.05
Madrasa 24 11 45.8 0.03
Housing types
Permanent 238 76 31.7 0.684
Semi permanent 46 13 28.3 0.077
Temporary materials 23 13 56.5 Referent
Somali hut 54 27 50 0.091
Ability to pay for RH services
Able 217 92 42.4 0.304
Not able 79 23 29.1 0.963
Sometimes 64 14 21.9 0.631
Not Known 18 8 44.4 Referent
Willing to seek youth friendly
RH services
Able 211 90 42.7 0.004
Not willing to seek 82 22 27 0.001
Sometimes 55 8 14.5 Referent
P value - level of significance
Uptake of RH Infromation

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20557
Cultural factors associated with uptake of RH information service
Among the cultural issues highlighted included sources of RH information, most useful sources of
information and factors deterring acquisition of this RH information. The most (42.7%) stated sources of RH
information was from age mate and friend followed by 17.2% teachers and the least 0.8% from older
relatives (2 = 445.5; df = 8; P = 0.0001) (Figure 5).
Figure 5: Sources of sexual and reproductive health information
Majority 44.3% of the youths stated both mass and print media as the most useful sources of information on
issues relating to youth sexual and Reproductive health, others included 19.4% age mates and friend and the
least 0.8% older relatives years (2 = 227.146; df = 3; P = 0.0001) (Figure 6).
Figure 6: Sources of sexual and reproductive health information
Majority 37.4% of the youths could not identify the contributing factors to lack of information on issues
relating to youth sexual and Reproductive health. About 31.5% stated the inadequate feeling of parents to

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20558
handle issues related to sexuality and reproductive health information contributed to the youths lack of
information (2 = 227.146; df = 3; P = 0.0001) (Table 5).
Table 5 shows the cultural factors associated with uptake of RH information on sexuality and reproductive
health. Both in the bivariate and in multivariate analyses, none of the cultural factors were found to
influence the uptake of the RH information.
Table 5: Cultural factors associated with RH uptake
Characteristics Sample Size Bivariate
Frequency Percent P - value
Source of Information
Parents 40 13 32.5 0.816
Teachers 62 9 14.5 0.745
Age mates/ friends 154 72 46.7 0.624
Sexual partners/ lovers 21 10 47.6 0.621
Older relatives 3 2 66.7 0.446
Religious organisations 15 4 26.7 0.929
Mass and Print media 47 18 38.3 0.728
Community health workers 19 2 10 0.596
Most useful source of RH information
Mas and Print media 160 77 48.1 0.383
Parents 26 4 15.4 0.814
Teachers 22 5 22.7 0.907
Age mates/ friends 70 21 30 0.692
Sexual partners/ lovers 12 6 50 0.392
Older relatives 3 2 66.7 0.329
Religious organisations 20 10 50 0.382
Community health workers 31 0 0 1
Seminars 12 3 25 0.984
Don‘t Know 5 1 20 Referent
Contributing factors to lack of RH
Information
Parents feel inadequate in handling sexuality
related issues
114 1 0.88 0.998
The adolescent/youth resent any societal
prescriptiond for RH information
9 0 0 1
Parents assume the teachers are handlling these
issues
32 1 3.13 0.998
Parents reluctant and indifferent 13 1 7.69 0.997
Excessive media influence 10 0 0 1
Erosion of social norms, hence no guidance 19 0 0 1
Lack of facilities and appropriate personnel 8 0 0 1
Peer pressure 21 1 4.76 0.997
Don‘t Know 135 125 92.59 Referent
P value - level of significance
Uptake of RH Infromation

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20559
Health service factors influencing uptake of youth RH information:
Table 6 shows the health service factors associated with uptake of RH information on sexuality and
reproductive health. Among the health factors that influenced uptake of RH information included; the youth
thought contraceptives should be made accessible to sexually active youth (P = 0.001, those who had
reasons for not using contraceptives (P = 0.003), those who readily discussed sexually related matters with
parents (P = 0.014), the number of sexual partners (P = 0.004), the various reasons for first sexual
encounters (P = 0.025), the reaction of those told about the first sexual encounter (p = 0.016), the approval
of premarital sex (P = 0.003), and the age of debut for women (P = 0.007) influenced the decision by the
youths to seek, uptake or utilize the youth friendly RH and sexual information.
Table 6A: Health factors associated with RH uptake:
Characteristics Sample Size Bivariate
Frequency Percent P - value
Contraceptives made
accesible to sexually active
youth
Yes 198 86 43.4 0.001
No 162 43 26.5
Reasons for use of
contraceptive
Enable them continue their
education/ career
101 54 53.5
Protect them from premarital
pregnancies
53 29 54.7 0.442
Protect them from STI/HIV
infections
27 11 40.7
Avoid deaths through abortions 1 0 0
Don‘t Know 179 94 51.6
Reasons for not using
contraceptive
Enable them continue their
education/ career
54 9 16.7
Protect them from premarital
pregnancies
60 7 11.7 0.003
Health reasons 29 13 44.8
Future marriage prospects will
be affected
7 1 14.3
Don‘t Know 211 99 46.9
Discuss sexually related
matters with parents
Yes 28 16 57.1 0.014
No 333 113 34
Currently sexually active
Yes 198 80 36.7 0.679
No 163 49 34.5
P value - level of significance
Uptake of RH Infromation

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20560
Table 6B: Health factors associated with RH uptake
Characteristics Sample Size Bivariate
Frequency Percent P - value
Number of Sexual Partners
One 139 60 43.2
Two 37 5 13.5
More than two 13 4 30.8 0.004
Cannot remember 12 7 58.3
Don‘t Know 160 76 37.8
Age of sexual encounter
> 15 46 22 47.8
16 - 20 141 53 37.6
21 - 25 12 3 25 0.224
26 - 30 1 0 0
Not Known 161 51 31.7
Reasons for sexual encounters
Got married 93 27 29
Forced 7 6 85.7
Love for my partner 60 24 40 0.025
Curiosity 34 15 44.1
Desire to be like my friends 23 7 30.4
Don‘t Know 144 79 36.4
Told who on the first sexual
intercourse
Mother 11 5 45.5
Father 1 0 0
Brother/sister 16 4 25
Close relative 18 11 61.1 0.049
Religious leader 1 1 100
Close friend 100 41 41
Nobody 70 11 61.1
Not Applicable 144 56 38.9
Reaction of the person told
Approved 87 29 33.3
Disapproved 14 6 42.9
Did not care 10 4 40 0.016
Annoyed 12 10 83.3
Sympathetic and counselled me 27 14 51.9
Not Applicable 211 66 31.3
P value - level of significance
Uptake of RH Infromation

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20561
Table 6C: Health factors associated with RH uptake
Characteristics Sample Size Bivariate
Frequency Percent P - value
Number of Sexual Partners
One 139 60 43.2
Two 37 5 13.5
More than two 13 4 30.8 0.004
Cannot remember 12 7 58.3
Don‘t Know 160 76 37.8
Age of sexual encounter
> 15 46 22 47.8
16 - 20 141 53 37.6
21 - 25 12 3 25 0.224
26 - 30 1 0 0
Not Known 161 51 31.7
Reasons for sexual encounters
Got married 93 27 29
Forced 7 6 85.7
Love for my partner 60 24 40 0.025
Curiosity 34 15 44.1
Desire to be like my friends 23 7 30.4
Don‘t Know 144 79 36.4
Told who on the first sexual
intercourse
Mother 11 5 45.5
Father 1 0 0
Brother/sister 16 4 25
Close relative 18 11 61.1 0.049
Religious leader 1 1 100
Close friend 100 41 41
Nobody 70 11 61.1
Not Applicable 144 56 38.9
P value - level of significance
Uptake of RH Infromation

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Table 6D: Health factors associated with RH uptake
Characteristics Sample Size Bivariate
Frequency Percent P - value
Reaction of the person told
Approved 87 29 33.3
Disapproved 14 6 42.9
Did not care 10 4 40 0.016
Annoyed 12 10 83.3
Sympathetic and counselled me 27 14 51.9
Not Applicable 211 66 31.3
Approve premarital sex
Yes 54 13 24.1
No 273 99 36.3 0.003
Don't know 21 14 66.7
Not Applicable 13 3 23.1
Best sexual partner for youth
Age mate 278 104 37.4
Older person 20 4 20
Younger person 3 2 66.7 0.099
Don't know 30 12 40
None 24 4 16.7
Not Applicable 6 3 50
Age for women to get married
>15 114 28 24.6
16 - 20 193 80 41.5
21 - 25 35 11 31.4 0.007
26 - 30 5 1 20
>31 2 2 100
Not Applicable 12 7 58.3
Age for Men to get married
>15 13 3 23.1
16 - 20 166 62 37.3
21 - 25 109 41 37.6 0.679
26 - 30 48 13 27.1
>31 11 4 36.4
Not Applicable 14 4 36.4
P value - level of significance
Uptake of RH Infromation

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
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Knowledge, Attitude and Practices concerning RH information
The youths stated various methods of contraception majority 48% of whom stating the use of condoms with
only 2% aware of the injection method (2 = 23.12; df = 3; P = 0.0001) (Figure 7).
Figure 7: Pregnancy prevention methods
Majority 32.1% of these youths stated that mass media was the main source of information on the family
planning methods and 2.8% from religious leaders (2 = 244.915; df = 7; P = 0.0001) (Figure 8)
Figure 8: Sources of family planning information
For those who are sexually active, majority 45% were taking precaution to prevent pregnancy while equally
high 39.5% of the youths who were not taking precautions to prevent unwanted pregnancies (2 = 56.153;
df = 4; P = 0.0001) (Figure 9).

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
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DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20564
Figure 9: Taking precautions to prevent pregnancy
For those who are sexually active but were not taking pregnancy precaution measures, majority 43.8% were
on religious ground with other 13.2% fearing these contraceptives. There were about 2.1% of the youths
who feared their parents and hence could not use contraceptives (2 = 224.995; df = 7; P = 0.0001) (Figure
9).
Figure 10: Reasons for not using contraceptives
When asked the action to take in case of unwanted pregnancy for unmarried women, majority 36% stated
they would carry the pregnancy to term, 23.1% said they would seek an abortion (2 = 53.635; df = 5; P =
0.0001) (Figure 11).

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
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DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20565
Figure 11: Action to take during unwanted pregnancy
Only 8.9% of the youths had been infected with a sexually transmitted disease (2 = 234.078; df = 1; P =
0.0001) (Figure 12).
Figure 12: Previous STD infection
Almost all of the youths 97.7% stated having prior knowledge or heard about HIV/AIDS (2 = 317.734; df
= 1; P = 0.0001) (Figure 13).

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
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DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20566
Figure 13: Heard HIV/AIDS
The most 78.4% stated methods through which HIV/AIDS transmission occurs was through having
unprotected sexual relationship (2 = 1221.831; df = 6; P = 0.0001) (Figure 13).
Figure 14: Methods of HIV/AIDS transmission
Discussions:
Introduction:
It is widely acknowledged that the reproductive health of youth is one of the most important individual,
social and economic challenges that are facing sub-Saharan African countries. The risks related to sexual
activity and early childbearing jeopardize not only young people‘s physical and emotional health, but also
their economic and social well-being. The major reproductive health risks that young people face include
sexually transmitted diseases (STDs and HIV), sexual violence and coercion, and early (unintended)
pregnancy and childbearing (Kennedy et al., 2011). There are over 14 million births to adolescent women

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
International Journal of Contemporary Research and Review, Vol. 9, Issue. 08, Page no: MS 20537-20574
DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20567
aged 15-19 each year, 91 percent of these in low and middle-income countries (Population Division, 2008).
Six million adolescent pregnancies are unintended and occur in the context of low contraceptive prevalence
(Guttmacher Institute, 2010). Less than one third of currently married adolescent women in low and middle
income countries who want to avoid pregnancy are using a modern method of contraception, and more than
60 percent would like to avoid or delay pregnancy but are not able to do so (Singh et al., 2009). Less is
known about unmarried adolescents. Sexual activity outside of marriage is increasing, but less than half of
those who want to avoid pregnancy are using a modern method of contraception (Singh et al., 2009; United
Nations, 2002).
Adolescent pregnancy carries an increased risk of adverse health outcomes for young women and their
children. Globally, adolescents account for eleven percent of all births but contribute to 23 percent of the
burden of disease related to pregnancy and childbirth. Adolescents aged 10-14 years are five times more
likely to die as a result of pregnancy and childbirth than adult women, and maternal conditions are the
leading cause of death among women aged 15-19 (WHO, 2006; WHO, 2008; Patton et al., 2009).
Adolescents account for around 14 percent of unsafe abortions, an estimated 2.5 million every year (Shah,
2004). Babies of adolescent mothers have a 50-100 percent increased risk of mortality within the first month
of life and suffer higher rates of perinatal morbidity compared with infants born to adult women (WHO,
2004; WHO, 2008). By impacting on education, employment and economic opportunities, pregnancy during
adolescence can also have lasting socio-economic consequences which, in turn, contribute to poorer health
outcomes, gender inequity and poverty of adolescent mothers, their families and communities (Greene and
Merrick, 2005; Bearinger et al., 2007; UNFPA, 2007).
This leads us to consider the question of how we can promote young people‘s sexual and reproductive
health. In this chapter we will present the findings on the general SRH ill health amongst the youth, and the
factors influencing uptake of youth friendly services amongst the youth in Garissa.
Demographic characteristics of the respondent:
In this study location of origin was a key factor in determining the level of uptake of RH information.
Participants who were recruited from Medina and Township locations were more likely to utilize or take the
RH information compared to those from Iskadek (PR 3.01, 95% CI 1.33 to 6.76) and (PR 2.91, 95% CI 1.32
to 6.37) respectively. On the other hand participants from Iftin sub-location were less likely to take the RH
information compared to those from Sambul (PR 0.36, 95% CI 0.17 to 0.76). This finding mirrors the
common findings in the literature showing higher access and utilization of RH information in the urban
settings compared to the rural settings. Asiimwe, (2011) observed that In comparison to Kabale (rural)
district, Kyenjojo urban district scored highly at RH and ANC utilization with adolescents hailing from the
region 5.7 times more likely to seek ANC. Study by Nakiboneka and Maniple (2008) in Uganda found that
SRH is not a priority service in most health units studied, and that even where it is provided; the service is of
poor quality. Most health workers provide health education on for instant family planning and stop there.
There is poor record-keeping and follow up of the family planning clients. They further observed that most
health worker staff have not been trained in SRH counseling and provision. They do not feel confident
enough to assist clients especially the youth and some of them still think that any FP method is artificial and
thus forbidden by the RCC. Only a small minority of staff had referred clients who wanted artificial FP
methods to Government health units and clinics.
Some other studies among the youth have identified other independent demographic factors associated with
RH information uptake that we did not either measure or find to be significant in this study. Study by

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
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DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20568
Asiimwe, (2011) observed that gender was a significant factor in determining RH uptake, the study found
out that males were 0.5 times less likely to utilize RH information compared to females which they
attributed to the biological differences between the two genders that make it more compelling for females to
seek RH including antenatal care services because the burden of pregnancy targets them. Studies by (AYA,
2002; Asiimwe, 2011) on SRH, the SRH/ANC utilization improved with age. Those youth who were
married were 1.5 times more likely to seek RH information and go for ANC compared to unmarried in
Uganda (Asiimwe, 2011).
The literature reveals that male dominance and prevailing traditional Islamic and cultural restrictions on
youth and women in general are major factors affecting women‘s decision-making power in Pakistan. These
factors can be divided into two broad categories and male dominance, includes legal restrictions and
inequalities interpreted from the Quran (the holy book of Muslims), and traditional Shariah laws (laws based
on the Quran, Hadith, and Sunnah derived by Muslim jurists). These laws affect inheritance, marriage,
divorce, child custody, and women‘s ability to serve as legal witnesses (Hakim and Aziz, 1998).
Economic factors influencing access to RH information:
Economic factors that were more likely to influence the uptake of the RH information included; education
those with primary education (PR 3.5, 95% CI 1.08 to 11.35), secondary level education (PR 3.43, 95% CI
1.07 to 11.04) and those who attended Madrasa education level (PR 4.12, 95% CI 1.15 to 14.78) were more
likely to uptake RH information than those who did not attend any form of schooling. Asiimwe, (2011) also
observed that education was key to SRH information uptake. By education status, SRH utilization is
improved by higher education levels. The literature has suggested that education can improve maternity
services utilization by increasing youth‘s awareness, empowering them to take decisions on their own health
risks and increasing their ability to communicate with health professionals (Chakrabarti and Chaudhuri
2007).
Lastly, youths who were willing to seek these RH information (PR 2.93, 95% CI 1.42 to 6.04) and those
willing sometimes to seek these RH information (PR 4.75, 95% CI 1.84 to 12.36) were more likely to uptake
the youth friendly RH services than those who were not willing to seek these information. Poverty and
economic constraint is also the other major factor that influences the behavior of young people in most
cases. Participants expressed that young girls enter into sexual relationships with older, wealthy men often
referred as sugar daddies because of compelling reasons to earn money to cover their school related
expenses and material needs (ICOMP, 2009; AsnaAshari and Ahmadi, 2011).
Cultural factors influencing access to RH information:
Among the cultural issues highlighted included sources of RH information. The most (42.7%) stated sources
of RH information was from age mate and friend followed by teachers and the least 0.8% from older
relatives (P = 0.0001). Cultural norms and practices make women and girls to be marginalized, and not only
vulnerable in different ways to sexual and reproductive health problems, but the disparity also limits their
access to sexual and reproductive health services. The subordination makes women financially, materially,
and socially dependent on men and also to have limited power to negotiate relations including use of
condoms during sex (ICOMP, 2009).
Majority 44.3% of the youths stated both mass and print media as the most useful sources of information on
issues relating to youth sexual and Reproductive health, others included 19.4% age mates and friend and the
least 0.8% older relatives years (P = 0.0001). Which was reflected by the findings of ICOMP, (2009) that

Fatuma I. Adan et al. Factors Influencing Access to Reproductive Health Information Services Among
Young Aged 15-24 in Garissa Municipality, Kenya
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DOI: https://doi.org/10.15520/ijcrr/2018/9/08/574 Page | 20569
parents do not discuss sexuality issues with their children because they often consider the issue as a taboo
and are also embarrassed by the subject. Consequently, young people tend to value the opinions of their
friends and peers more highly. Youth who have more strong religion believes have more Youth who have
more strong religion believes have more positive attitude toward safe sex and reproductive health. Youth
who have more strong communications, have more positive attitude toward safe sex and reproductive health
(AsnaAshari and Ahmadi, 2011).
Health service factors influencing access to RH information:
Among the health service factors influencing uptake of RH information on sexuality and reproductive health
included; the youth who thought contraceptives should be made accessible to sexually active youth (P =
0.001), those who readily discussed sexually related matters with parents (P = 0.014), the number of sexual
partners (P = 0.004), the reaction of those told about the first sexual encounter (p = 0.016), the approval of
premarital sex (P = 0.003), and the age of debut for women (P = 0.007) influenced the decision by the
youths to seek, uptake or utilize the youth friendly RH and sexual information.
Admittedly, addressing the needs of young people goes well beyond the provision of comprehensive health
care. However, health care that is tailored towards an engendered linked response to other key services, and
aimed at attracting young people, can play a crucial role in promoting healthy sexual reproductive health
habits that will help young people attain healthy adulthood. Youth-friendly services are intended to promote
easy access to SRH information and promotion of health education and skills development (for safe sexual
behaviour). There is also a growing need to support engendered linked health services for, VCT for HIV,
promotion of condom use for dual protection, prevention and treatment of pregnancy, PMTCT, STIs, RH for
HIV and other male and female RH sexual disorders. This engendered linked response will foster a strong
supportive structure that will protect young people in their quest for knowledge, skills and good sexual
health (ICOMP, 2009).
Youth Knowledge and attitude influencing access to RH information:
The youths were knowledgeable of the various methods of contraception majority 48% of whom stating the
use of condoms with only 2% aware of the injection method (P = 0.0001). Majority 32.1% of these youths
stated that mass media was the main source of information on the family planning methods and 2.8% from
religious leaders (P = 0.001). For those who are sexually active, majority 45% were taking precaution to
prevent pregnancy while equally high 39.5% of the youths who were not taking precautions to prevent
unwanted pregnancies (P = 0.0001). For those who are sexually active but were not taking pregnancy
precaution measures, majority 43.8% were on religious ground with other 13.2% fearing these
contraceptives. There were about 2.1% of the youths who feared their parents and hence could not use
contraceptives (P = 0.0001).
When asked the action to take in case of unwanted pregnancy for unmarried women, majority 36% stated
they would carry the pregnancy to term, 23.1% said they would seek an abortion (P = 0.0001) . Only 8.9%
of the youths had been infected with a sexually transmitted disease (P = 0.0001). Almost all of the youths
97.7% stated having prior knowledge or heard about HIV/AIDS (P = 0.0001). The most 78.4% stated
methods through which HIV/AIDS transmission occurs was through having unprotected sexual relationship
(P = 0.0001).

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Young Aged 15-24 in Garissa Municipality, Kenya
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Conclusions and Recommendation:
Conclusions:
This study was designed to consider the question of how to promote young people‘s sexual and reproductive
health. The study established the key conclusions of the findings on the general SRH ill health amongst the
youth, and the factors influencing uptake of youth friendly services amongst the youth in Garissa.
1. Majority of the youths responders in the study were from urban locations. Majority of who were males
and were in the age bracket of 16 to 30.
2. The level of SRH information uptake was very low in this region; only a about 35.7% of the youths
stated or perceived that they had adequate up take of youth friendly information and guidance on issues
relating to sexual and Reproductive health verses 64.3% who lacked these RH information.
3. Participants‘ location of origin was a key determinant on the level of uptake on RH information. Those
from the urban settings being more likely to uptake these youth SRH information.
4. Economic factors that were more likely to influence the uptake of the RH information included;
education levels and the willingness to seek these RH information
5. Cultural norms preventing parents from freely discussing sexuality issues with their children because
they often consider the issue as a taboo and are also embarrassed by the subject. Confined the youths in
obtaining these SRH information from the peer friends and from print and mass media.
6. Among the health service factors influencing uptake of RH information on sexuality and reproductive
health included; knowledge on contraceptives, ability to readily discussed sexually related matters with
parents, the number of sexual partners, the approval of premarital sex and the age of debut for women.
7. Overall their knowledge, attitude and practices concerning RH information was as expected lower than
that of bigger cities in Kenya
Recommendations:
To address the challenges in the uptake of youth friendly reproductive health information services is to
customize or Islamize the youth services in agreement with the youth and community faith mosque approach
to adolescent health issues
1. Training of adult religious leaders and some parents as trainers and mentors of younger religious leaders
who in turn act as trainers and advocates of SRH information issues.
2. Joint secular and religious teams outreach programmes on SRH information services
3. Reprogramming youth peer education initiatives to be culturally acceptable by working within the
framework of the Somali culture in educating the youth
4. Working with adults in joints and business Centre‘s and giving ASRH issue and Islamic and Somali
face
5. Reducing the window period between post primary/secondary education to university/ colleague period
6. Working with G- youth to incorporated ASRH information on the youth initiative.

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7. Establish District joint G youth APHIA PLUS, PSI in partnership with the MOE and MOH to conduct
interactive programmes for selected in and out of school youth to provide RH information for the
youth
8. Establish youth friendly Centre in the PGH and train health care workers to YFHS.
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